Comparison of the clinicopathological characteristics between mixed medullary and papillary thyroid carcinoma and medullary thyroid carcinoma coexistent with papillary thyroid carcinoma / 中华普通外科杂志

Objective:To investigate the difference of clinicopathological characteristics between mixed medullary and papillary carcinoma of thyroid and medullary carcinoma coexistent with papillary carcinoma.Method:The clinicopathological data of 3 MMPTC cases and 9 MTC-PTC cases treated at Tianjin Medical University Cancer Institute & Hospital during the past ten years were retrospectively analyzed. The differences in clinical characteristics, pathological characteristics, immunohistochemistry results, treatment and prognosis of the two groups were compared.Results:In the MMPTC group, the median onset-age was 59 years old. 3 patients were all medullary carcinoma colliding with micropapillary carcinoma. The immunohistochemistry results showed that medullary carcinoma and papillary carcinoma showed their distinctive immunohistochemical characteristics. The lymph node metastasis rate was 66.7% (2/3). In MTC-PTC group, the median onset-age was 55; 8 out of 9 patients had an increased preoperative calcitonin level. Medullary carcinoma and papillary carcinoma showed their distinctive immunohistochemical characteristics. Four out of the 9 cases had lymph node metastasis.Conclusion:Compared with MTC-PTC, MMPTC is more common in middle-aged and elder patients, with higher lymph node metastasis rate. The pathogenesis of MTC-PTC is similar to papillary thyroid carcinoma, and the treatment should be individualized. The prognosis of these two groups of patients is fair.

Correlation between BRAF mutation and clinicopathological characteristics in pediatric papillary thyroid carcinoma / 中华实用儿科临床杂志

Objective:To investigate the BRAF(V600E)gene mutation of pediatric papillary thyroid carcinoma (PTC) and refine their clinicopathological correlates. Methods:Tumor tissue samples of pediatric PTCs (≤18 years old) were collected from tumor tissue bank of Tianjin Medical University Cancer Institute and Hospital from January 2012 to December 2016.The medical records of 22 patients with pediatric PTC were reviewed retrospectively.The frequencies of BRAF(V600E) mutation were evaluated and the correlation between BRAF(V600E) mutation and clinical characteristics were analyzed. Results:BRAF(V600E) mutations were present in 45.5% of cases (10 cases). BRAF(V600E) mutation in pediatric PTC was obviously lower than that in adults PTC(77.7%) ( χ2=11.250, P=0.001). BRAF(V600E) mutation in>12-year-old group (66.7%) was remarkably higher than that in ≤12-year-old group (20.0%) ( P<0.05). BRAF(V600E) mutation in female (69.2%) was greatly higher than that in male (11.1%) ( P<0.05). There was no significant correlation with BRAF(V600E) mutation and multiple tumor, tumor size, highly invasive subtype, extrathyroidal extension, lymph node metastasis and radiological history of infants (all P>0.05). The median follow-up time was 45 months.No patients died and BRAF(V600E) mutation was not associated with the increase of recurrence rate ( P>0.05). Conclusions:BRAF(V600E)gene mutation in pediatric PTC is lower than that in adults. BRAF(V600E) mutation does not portend a more aggressive clinical biological behavior in pediatric PTC.

Clinicopathological characteristics of differentiated thyroid carcinoma in 61 patients under 14 years old / 中华普通外科杂志

Objective To explore the clinico-pathological characteristics and treatment of thyroid carcinoma in patients under 14 years old.Method The clinical and pathological data of 61 children 14 years old or younger treated for differentiated thyroid carcinoma (DTC) from Jan 2005 to Dec 2014 were retrospectively analyzed.Results There were 26 males and 35 females with the sex ratio of 1 ∶ 1.35.All the 61 patients underwent surgery including lobectomy for ipsilateral foci in 11 cases and total or near total thyroidectomy for bilateral or multi-foci in 50 cases.5 patients had not lymph node metastasis.56 patients had central compartment metastasis and 47 patients had lateral cervical lymph node metastasis.9 patients had distant metastasis and the affected organ was lung.Pathology for all the 61 patients was thyroid papillary carcinoma,35 patients were of highly invasive subtype.The median follow-up time was 3 years and 6 months (30-116 months) with a total survival rate of 100％ while 4 patients suffered from recurrence.Conclusions For below 14 years old DTC patients,the prognosis is better than in adults.The rate of bilateral lesions or multiple foci in ipsilateral lobe and central compartment lymph node or lateral neck lymph node metastasis was higher than in adults.Furthermore,highly invasively pathological subtype is more common in younger patients.

The clinicopathological features of follicular variant of papillary thyroid carcinoma / 中华普通外科杂志

Objective To analyze the clinical and pathological features of follicular variant of papillary thyroid carcinoma (FVPTC).Methods Clinical data of 131 FVPTC patients diagnosed and treated between January 2006 and June 2012 were retrospectively analyzed.Results Of the 131 FVPTC patients,the median age at diagnosis was 45 years and 74.0％ patients were female.Pathologically 29％ (38 patients) of the FVPTC patients were encapsulated,and 71％ (93 patients) were nonencapsulated.Compared with classical papillary thyroid carcinoma (CPTC),FVPTC patients were more likely to have lower ultrasound diagnostic accuracy rate,frozen section accuracy rate,tumor muhicentricity,tumor bilaterality,lymph node metastasis,lateral lymph node metastasis rate,N staging,TNM stage,ATA risk and higher M staging and concomitant chronic thyroiditis rate (all P ＜ 0.05).Moreover,there were significant differences between nonencapsulated and encapsulated follicular variant of papillary thyroid carcinoma in tumor size,TSH level,ultrasound diagnostic accuracy rate,extrathyroid invasion,T staging,lymph node metastasis,N staging,TNM staging,ATA risk and recurrence rate (all P ＜ 0.05).Conclusions Compared with CPTC,FVPTC have different clinical and biological features.It's necessary for different management strategies for different FVPTC patients.

Clinical and biological features of familial nonmedullary thyroid carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the clinical and biological features of familial nonmedullary thyroid carcinoma (FNMTC).</p><p><b>METHODS</b>Clinical data of 66 FNMTC cases of 32 pedigrees was retrospectively analyzed, compared with that of 182 control cases taken randomly from the patients with sporadic papillary thyroid carcinoma (SPTC), who were diagnosed and treated in Tianjin Cancer Hospital between January 2008 and November 2012. The features of FNMTC of the first and second generations were objectively analyzed. Some data quoted from the literature were also used for the analysis.</p><p><b>RESULTS</b>The median age at diagnosis of all the 66 FNMTC patients was 44 years, and 57 (86.4%) were females. Moreover, 71.2% (47 patients, 23 pedigrees) of the FNMTC patients exhibited a sibling relationship, and 28.8% (19 patients, 9 pedigrees) of the FNMTC patients exhibited a parent-offspring relationship, and 9 cases in the first generation and 10 cases in the second generation. There were significant differences between the FNMTC group and SPTC group in terms of tumor multicentricity, tumor bilaterality, lymph node metastasis, central lymph node metastasis, concomitant chronic thyroiditis and recurrence (P < 0.05). Compared with SPTC, sibling FNMTC presented a higher rate of central lymph node metastasis, while parent-offspring FNMTC showed frequent tumor bilaterality and a higher rate of recurrence (P < 0.05). Besides, patients in the second generation were diagnosed at an earlier age and had a higher male rate, the tumors were more frequently multifocal and bilateral, and had a higher rate of lymph node metastasis.</p><p><b>CONCLUSIONS</b>FNMTC may be more aggressive than SPTC and patients in the second generation may exhibit the "anticipation" phenomenon. It's necessary to make sufficient detailed interrogation and long-term follow-up of the patients and their family for providing individual recommendations for clinical management.</p>

Role of Ang-2, Tie-2 and VEGFR-2 in angiogenesis in colorectal carcinoma and their prognostic value / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the expression of angiotensin-2 (Ang-2), Tie-2 and vascular endothelial growth factor receptor-2 (VEGFR-2) in colorectal cancer and analyze their relationship with the occurrence, recurrence, metastasis, angiogenesis and prognosis of colorectal cancer.</p><p><b>METHODS</b>Immunohistochemistry with SP method was used to detect the expressions of Ang-2, Tie-2 and VEGFR-2 in 118 colorectal cancer, 40 adjacent normal tissue and 40 benign colorectal lesion specimens.</p><p><b>RESULTS</b>The positivity rates of Ang-2, Tie-2 and VEGFR-2 in colorectal cancer tissue were 74.58%, 69.49%, and 61.02%, respectively, significantly higher than those in the adjacent normal tissues (25.00%, 17.50%, and 17.50%, P<0.05) and benign colorectal lesion tissues (35.00%, 32.50%, and 32.50%, P<0.05). The rates of two or three coexpression were significantly higher than that of a single expression in the cancer tissues (61.02% vs 15.25%). The microvascular density (MVD) of colorectal cancer tissues was 31.43∓10.50, significantly higher than that of the adjacent normal tissues (10.61∓3.76) and benign colorectal lesions (16.89∓3.83) (P<0.05). The expressions of Ang-2, Tie-2, and VEGFR-2 were positively correlated with carcinoembryonic antigen (CEA) and MVD (P<0.05). The expression of Ang-2, but not Tie-2 and VEGFR-2, was positively correlated with CA199. Ang-2, Tie-2, and VEGFR-2 expressions showed significant differences between cases with tumor recurrence/metastasis and those without 5 years after radical mastectomy, and were all positively correlated with the 5-year survival rates (P<0.05).</p><p><b>CONCLUSION</b>Ang-2, Tie-2 and VEGFR-2 are involved in the development, invasion, metastasis, and prognosis of colorectal cancer, and play important roles in the angiogenesis of the tumors.</p>

The treatment and prognosis of anaplastic thyroid carcinoma / 中华普通外科杂志

ObjectiveTo investigate the clinical biocharacteristics,treatment,prognosis and the factors that influence prognosis of anaplastic thyroid carcinoma(ATC). MethodsThe clinical data of 108 ATC patients treated at our institution from January 1981 to April 2009 and follow-up results were retrospectively reviewed.ResultsThe median survival time of 108 patients was 6 months.The overall 1-year,2-year,5-year survival rate was 40.3％,30.9％ and 21.9％ respectively.Univariate analysis showed the factors influencing the prognosis of ATC patients were tumor size, distant metastases, stage,leukocytosis, radiotherapy, localresection, postoperativeradiotherapyandmultimodalitytherapy.Multivariate analysis indicated that tumor size,stage,leukocytosis and radiotherapy were independently associated with the prognosis.ConclusionsAnaplastic thyroid carcinoma is rare but highly aggressive malignancy with poor prognosis. ATC patients should receive multimodality therapy,especially local resection and postoperative radiotherapy.Even inoperable patients could benefit from radiotherapy.

Clinico-biological characteristics and prognosis of salivary duct carcinoma in 12 cases / 中华普通外科杂志

Objective To explore the clinico-biological characteristics, treatment and prognosis of salivary duct carcinoma. Methods This study included 12 cases of salivary duct carcinoma treated in our hospital. Clinical data were retrospectively analyzed for patients admitted between April 1995 and October 2006. The clinical characteristics, histological features, imaging, therapy methods and prognosis were analyzed. Results Of 12 salivary duct carcinoma, there were 10 males, 2 females. The age of onset ranged from 53 to 73 year old and the average was 56 year old. Physical examination revealed a firm and unboundary mass accompanied by nerve infiltrating symptom. The histological appearance was characterized by solid cell nests with ductal structures and central comedonecrosis. Extensive resection and radical neck dissection was performed in 11 patients, postoperation radiation done in 10 patients and chemotherapy in 3 patients. One year survival rate was 83. 33% , that of 3 years was 41. 67% , and of 5 years was 25. 00% , the median survival time was 36 months. Conclusion Salivary duct carcinoma is a rare malignant salivary tumor and most patients are men. Regional extensive resection and postoperative radiation or chemotherapy are the mainstay of therapy. Lymph node metastases in level Ⅰ ,Ⅱ , Ⅲ are a common finding in patients with SDC and the prognosis is poor.

Multifocal papillary thyroid carcinoma / 中华普通外科杂志

Objective To investigate the biological characteristics and management of multifocal papillary thyroid carcinoma. Methods Clinical data of 86 patients who underwent thyroidectomy and were pathologically diagnosed as progressive multifocal papillary thyroid carcinoma from 1995 to 1997 in Tianjin Cancer Hospital were retrospectively analyzed. Results There were 86 cases of multifocal papillary thyroid carcinoma, accounting for 23.4% of all papillary thyroid carcinoma of the same period. In the 86 cases of multifocal papillary thyroid carcinoma, there was unilateral in 12 cases and bilateral in 74 cases; cervical lymph node metastasis in 51 cases ( 59. 3% ); combined microcarcinoma of 46 cases ( 53.5% );Hashimoto's thyroiditis was concomitant in 23 cases (26.7%); local invasion was found in 19 cases (22. 1% ); distant metastasis occurred in 1 case ( 1.2% ); 10-year survival rate was 95.3%. American Joint Committee on Cancer ( AJCC ) stage was associated with prognosis significantly ( x2 = 63. 395, P =0.000). Conclusions Multifocal papillary thyroid carcinoma often occurs bilaterally, concomitant microcarcinoma and Hashimoto's thyroiditis is common with a comparatively favorable prognosis. AJCC stage is still the best prognostic factor.

Diagnosis and clinical staging of thyroid carcinoma by ultrasound / 中华普通外科杂志

Objective To analyze and compare the ultrasound characteristics in different pathologic classifications of thyroid carcinoma.The ultrasound characteristics of thyroid carcinoma were investigated in order to determine the clinical diagnosis and clinical stasing of thyroid carcinoma.Methods In this study,407 cases of thyroid carcinoma were enlisted for ultrasonic typing of thyroid carcinoma according to the ultrasound features.The resuh was used for clinical staging of thyroid carcinoma. Results Combined ultrasound mediated clinical stage has a higher accuracy rate and specificity,its accuracy rate of T stage is 93.9%,for No stage is 86.1%,for N1a stage is 80%,for Nlb stage is 74.9%.Preoporative US detected 51.5% occult metastatic LN.Conclusion Ultrasound has a very important effectiveness for the evaluation.staging,location of thyroid carcinoma and cervical lymph node metastasis.

In situ parathyroid gland blood supply preservation and parathyroid autotrausplantation during total or near total thyroidectomy / 中华普通外科杂志

Objective To introduce the processes of vascularized parathyroid gland reservation and parathyroid autotransplantation applied in thyroidectomy. Methods In 46 cases who underwent total/near total thyroidectomy, in situ vascularized parathyroid gland reservation was performed in 24 cases,isolated parathyroid autotransplantation was performed in 5 cases, in situ vascularized parathyroid gland reservation of 1～2 parathyroid glands combined with immediately transplantation of the remaining isolated parathyroid glands were performed in 17 cases. Results Five cases suffered from transient hypocalcaemia, including 2 cases of vascularized parathyroid gland reservation and 3 cases of vascularized parathyroid gland reservation in 1～2 parathyroid glands combined with immediately transplantation of other parathyroid glands. Two cases who received parathyroid autotransplantation suffered from hypocalcaemia and received conservative treatment with activated vitamin D3 and caleium for 4 weeks or 8 weeks. Permanent hypoparathyroidism occurred in 1 case of 46 cases which undergone the total/near total thyroidectomy(2.2%). Conclusion Application of vascularized parathyroid gland reservation and parathyroid autotransplantation in total/near total thyroidectomy could reduce the incidence rate of post-operative hypoparathyroidism.

Cervical plexus reinnervation for recurrent laryngeal nerve injuries / 中华普通外科杂志

Objective To explore the clinical therapeutic effects of Ⅰ-stage or delayed Ⅰ-stage cervical plexus reinnervation for recurrent laryngeal nerve(RLN)injuries. Methods During the process of neck dissection of papillary thyroid carcinoma,18 cases with recurrent laryngeal nerve deficit underwent cervical plexus reinnervation on Ⅰ-stage or delayed Ⅰ-stage RLN prosthosis basis.Therapeutic effects were evaluated by fibrolaryngoscope and voice evaluation preoperatively and postoperatively. Results All the cases were followed-up for 3 months to 2 years(average 8 months).Abductory motion of the vocal cords of 16 patients totally or partly restored,and not improved in 2 patients,with the recovery rate of abductory motion of the paralyzed vocal cords of 88.9%(16/18).Patient's phonation was restored totally or partially in 16 cases and the hoarseness was ameliorated significantly. Conclusions Cervical plexus-RLN reinnervation should be considered as a suitable treatment for unilateral vocal cord paralysis.One stage or delayed one stage cervical plexus reinnervation for recurrent laryngeal nerve injury is convenient and easy to perform.Postoperatively the abductory motion of vocal cord could be restored by this reinnervation satisfactorily.