Identification of unsuspected thyroid carcinoma using immunoperoxidase for thyroglobulin.

Two patients with poorly differentiated metastatic cancer were shown to have metastatic thyroid carcinoma. Each patient had poorly differentiated cancer and remaining thyroid tissue in the neck. The diagnosis was secured using the immunoperoxidase technique with an antibody against thyroglobulin. The proper evaluation of patients with carcinoma of unknown primary involves specific tissue identification using special techniques in pathology.

Comparative histologic study of 43 metastasizing and nonmetastasizing adrenocortical tumors.

A series of 43 adrenocortical tumors was analyzed using nine histologic features. Mitotic activity, especially with atypical forms, and venous invasion correlated best with metastasizing or recurring tumors; however, no single criterion was useful alone. The combination of the following nine criteria was most useful in distinguishing malignant from benign tumors: nuclear grade III or IV; mitotic rate greater than 5/50 high-power fields; atypical mitoses; clear cells comprising 25% or less of the tumor; a diffuse architecture; microscopic necrosis; and invasion of venous, sinusoidal, and capsular structures. None of the 24 tumors with two or less of these criteria metastasized or recurred, while all but one of the 19 tumors with four or more of these criteria either recurred or metastasized.

Metastatic prostatic carcinoma presenting as an oncocytic tumor.

We discuss a 63-year-old man who presented with a metastatic tumor in an inguinal lymph node. By light microscopy, the tumor cells were characterized by a finely granular eosinophilic cytoplasm. A diagnosis of metastatic oncocytic carcinoma was made based on the results of an ultrastructural examination, which showed the cytoplasm of the tumor cells to be filled with mitochondria. Results of immunocytochemical studies showed positive reactivity for prostatic acid phosphatase and prostate-specific antigen. A transurethral resection of the prostate showed an oncocytic adenocarcinoma of the prostate, apparently the first of its kind, which was demonstrated to be the site of origin of the inguinal lymph node metastasis.

Metastatic renal oncocytic neoplasm with benign histologic appearance.

We present a case of malignant renal oncocytoma which displayed a benign histologic appearance in the primary renal tumor and in metastases to the spine and liver. The case demonstrates the difficulty that may be encountered in distinguishing benign renal oncocytomas from malignant renal oncocytomas. Whereas, the accepted criteria will enable a distinction in the majority of instances, occasional instances may be encountered in which a benign histology does not provide an accurate reflection on the clinical course.

Utilization of luteinizing hormone-releasing hormone agonist in pulmonary leiomyomatosis.

A patient presenting a recurrent episode of pulmonary leiomyomatosis has been treated with the LH-RH agonist buserelin at a dosage of 200 micrograms tid SC for 7 days, then 500 micrograms SC daily for a total period of 6 months. Basal serum E2 was suppressed during treatment and varied between 62 and 180 pmol/ml (mean, 129.4 +/- 14.5). Pulmonary symptoms completely disappeared during treatment, but no objective regression of the pulmonary lesions was observed. Because of the uncertainty of response of benign metastasizing leiomyomas to castration and because of the reversibility of the medical treatment, LH-RH agonist may be preferred to surgical castration in this pathology.

Malignant growth hormone-secreting pituitary adenoma with hematogenous dural metastasis: case report.

A rare case of growth hormone-secreting pituitary adenoma with hematogenous metastasis to the dura mater of the cerebral convexity is presented. Immunohistological staining was essential to the diagnosis. The histological findings demonstrated that the metastasis was blood-borne. Extensive removal of the tumor and postoperative chemotherapy resulted in partial remission. The mechanism of metastasis, the histological findings, the treatment, and the prognosis are discussed.

Pediatric pituitary tumors.

This retrospective review of pediatric patients with pituitary tumors causing onset of symptoms by 17 years of age was done to define their pathological distribution, clinical presentation, treatment, and prognosis. Eighteen patients were evaluated and treated from 1979 to 1989. Five had Cushing's disease and 13 had prolactin-secreting tumors. The mean age at the onset of symptoms was 14.7 years, with a range of 7 to 17 years. The mean follow-up period was 4.6 years, and the series consisted of 15 girls and 3 boys. Four of the 5 patients with tumors secreting adrenocorticotropic hormone were girls. The five patients exhibited obesity, hypertension, and growth retardation. The mean age of this group of patients at diagnosis was 12.2 years, and all had intrasellar lesions removed by the transsphenoidal approach. Adenoma was documented in 4 cases by histopathology. There was complete resolution of the endocrinological and clinical abnormalities in each case. The group of patients with prolactinomas comprised 11 girls and 2 boys, and their mean age at diagnosis was 15.7 years. The girls exhibited either primary or secondary amenorrhea. Seven had macroadenomas and 4 had microadenomas. Nine of the 11 girls underwent transsphenoidal resection, and surgery failed in 6, based on hormonal or radiological data. The two boys had suprasellar tumor extension and required multiple surgical procedures plus radiation therapy for control of the tumor mass.

Positron emission tomography of pituitary macroadenomas: hormone production and effects of therapies.

Positron emission tomography with [18F]fluorodeoxyglucose (FDG) was carried out in 24 patients with pituitary macroadenomas (32 studies) to assess the glucose utilization of these tumors in vivo. The adenoma metabolic index, which is the ratio of FDG uptake of tumor to a whole brain slice, was calculated. Comparisons were made between tumor uptake of FDG and hormone secretion and response to therapies. In each positron emission tomography study, the macroadenoma could be easily identified visually as an area of increased FDG uptake near the region of the sella. FDG uptakes were highest for nonfunctional adenomas, and the prolactin, growth hormone, and thyroid-stimulating hormone-producing groups displayed similar levels of glucose metabolism. The adenoma metabolic index for all tumors averaged 1.3, ranging from 0.3 for a thyroid-stimulating hormone adenoma to 3.5 for a nonfunctional tumor. Tumors did not exhibit metabolic rates that could characterize the type of hormone produced. Recurrent macroadenomas displayed metabolism similar to tumors not operated on, whereas irradiated adenomas showed lower glucose uptake than nonirradiated tumors. Drug therapy with bromocriptine or the long-acting somatostatin analogue octreotide also decreased the glucose utilization of the tumor. There was no correlation between the amount of hormone produced and the adenoma metabolic index when a group of tumors was analyzed. Patients scanned more than once, however, demonstrated changes in hormone levels that changed or did not change in parallel with tumor metabolism. Thus, positron emission tomography offers the potential capability for predicting and defining the growth of pituitary adenomas. This may be of particular value when plasma hormone assays and conventional imaging techniques prove inadequate for monitoring patient response to therapy.

Nuclear DNA measurements in follicular thyroid adenomas.

The nuclear DNA content was measured retrospectively in histologically confirmed follicular adenomas in 20 patients, and prospectively in 25 patients. In the retrospective group two of the adenomas, and in the prospective group three of the adenomas were classified as atypical due to high cellularity and nuclear atypia, but with no sign of micro-invasive growth. In the group of patients studied retrospectively, the two patients with atypical adenoma had an aneuploid DNA pattern. One of these died 11 years after diagnosis with generalized disease. The other patient in this group with an aneuploid atypical adenoma is alive, as are all the remaining 18 patients with diploid adenomas. In the prospective group there were five aneuploid tumours. The atypical adenomas were aneuploid in two cases and polyploid in one case. No patient in the prospective group has shown any evidence of recurrence so far. Although DNA measurements are of value in distinguishing between low and high malignant potential in invasive tumors, the prognostic information if no invasion is found is uncertain. The importance of examining an adequate number of tissue blocks from the capsular region is emphasized.

Intracranial and intraspinal dissemination from a growth hormone-secreting pituitary tumor. Case report.

A 48-year-old woman developed multiple intracranial and intraspinal metastases from an invasive growth hormone-secreting pituitary adenoma after surgery and radiation therapy. This is the first reported case to show that the cells in the metastatic tumors and in the cerebrospinal fluid contained growth hormone.

Oncogene expression in follicular neoplasms of the thyroid.

Oncogene expression has been found to be a potential marker for aggressive biologic behavior in certain tumors. We studied 21 follicular adenomas and 20 follicular carcinomas by immunocytochemistry utilizing specific monoclonal antibodies against HER-2/neu and c-myc oncogenes. Survival data were obtained from our institution's tumor registry. No expression of the HER-2/neu oncogene was found in the specimens studied. Cytoplasmic staining for c-myc was observed in 3 of 21 adenomas (14%) and 9 of 20 (45%) carcinomas (p < 0.05). The incidence of local, regional, and distant metastases was not significantly different in c-myc (+) and c-myc (-) patients. The c-myc oncogene is expressed more often in malignant than in benign follicular neoplasms of the thyroid, but its expression does not appear to be a good prognostic indicator.

[The radioiodine-concentrating oncocytic thyroid carcinoma: a case report]. / Das radiojodspeichernde, onkozytäre Schilddrüsenkarzinom: Ein Fallbericht.

A patient with radioiodine-positive metastases to bone and lung of an oncocytic thyroid cancer is reported. A left-sided thyroidectomy had been performed nine years earlier. Histologically it had been a large capsular Huerthle-cell adenoma with regressive changes without signs of malignancy. During a recent operation for a disc prolapse in the lumbar spine a metastasis of an oncocytic thyroid cancer was found. A radioiodine scan showed high accumulation of 131I in the thyroid region, the lung and the lumbar spine. The rare finding of radioiodine uptake in oncocytic cancer is discussed.

Metastasis to pituitary adenoma.

Neoplasm to neoplasm metastasis is a medical curiosity. We report two cases of adenocarcinoma metastatic to pituitary adenoma. In both, abrupt progression of symptoms referable to the sellar region was noted and followed by the death of the patient.

Breast carcinoma metastatic to a solitary adenomatous polyp in the colon.

A 70-year-old woman with known metastatic breast cancer was found at autopsy to have widely disseminated, poorly differentiated adenocarcinoma. An incidental adenomatous polyp of the colon also contained metastatic breast carcinoma. This is the first report, to our knowledge, of a metastasis to an adenomatous polyp of the colon.

Subarachnoid dissemination of a pituitary adenoma.

The authors present an unusual case of a pituitary adenoma that developed into intracranial and intraspinal dissemination following intracranial surgery with adjunctive radiation, and review metastasis of pituitary adenomas in the central nervous system briefly in light of other reported cases.

Metastatic carcinoma to pituitary adenoma. Report of two cases.

The authors present two patients with symptomatic carcinomas which have metastasized to pituitary adenomas. Despite the advanced age of these patients, the preoperative clinical and radiologic evaluations were consistent with pituitary adenoma. There was no previous history of malignancy in either patient, and the symptomatic pituitary metastases were responsible for the initial presentations. A review of the literature is presented with emphasis on the incidence and possible factors responsible for tumors metastasizing to distant neoplasms.

Outcome of follow-up programs in patients previously resected for colorectal cancer.

The survival of a group of 115 patients (group A) who entered a follow-up program after apparently "curative" surgery for colorectal cancer was compared with that of 62 similar patients (group B) who did not join such a program. No significant difference was found. Clinical benefits to single patients in group A, in terms of anticipated diagnosis and effective treatment of recurrences and of metachronous neoplasias, appeared to be, if any, extremely limited. In light of the high costs of intensive follow-up programs, it is concluded that their use can be justified only within controlled perspective trials aimed to evaluate their usefulness.

Surgical treatment of cervical spine tumors.

Of 40 patients with cervical spine tumor treated from 1980 to 1990, 24 had a primary tumor and 16 a metastatic tumor. Thirty-four patients were operated on through anterior and 5 through posterior approach. Preoperative neck pain was relieved and muscular strength of shoulder and arm increased after operation. Total excision methylmethacrylate or metal prosthesis replacement was used. Total excision of the lesion was emphasized for preventing the recurrence of the tumor. Indications and aims of the operation are discussed.

Multiple intracranial metastases following malignant evolution in recurrent pleomorphic adenoma of the lacrimal gland--case report.

A 54-year-old female presented with multiple intracranial metastases following malignant transformation in the third recurrence of pleomorphic adenoma of the left lacrimal gland, 25 years after the first surgical treatment. The preoperative computed tomography and magnetic resonance imaging demonstrated direct invasion of the orbital tumor into subdural and epidural spaces in the ipsilateral frontotemporal region and also an intracerebral metastasis in the ipsilateral parietal lobe. Histological examination of the surgical specimen revealed features of poorly differentiated adenocarcinoma, suggesting carcinomatous changes. The relevant literature is reviewed.

Diagnosis and treatment of cortical tumours of the suprarenal gland.

The authors report on their own groups of benign (20 patients) and malignant (14 patients) cortical tumours of the suprarenal gland. In both kinds of tumour the occurrence is higher in females. Adenoma occurred more often in the left adrenal gland and cancer in the right one. Some tumours manifested themselves by an increased production of suprarenal hormones, others were hormonally inactive and did not become manifest until the later stage of development. In the therapy of adenomas the classical lumbar approach through the 11th intercostal space is adequate, in the case of cancer and extended lumbotomy laparotomy or thoracotomy is necessary. The need of participation of other specialists in the treatment (endocrinologist, radiologist, oncologist, anaesthesiologist) is emphasized.