Thyroid cancer in black thyroid glands: the effect of age and race.

BACKGROUND: Black thyroid pigmentation is a rare entity. The risk of malignancy is higher in black thyroid compared to non-black thyroid glands. We aimed to examine the effect of age and race on the risk of malignancy in black thyroid glands. METHODS: We identified a series of consecutive patients who underwent thyroidectomy at an academic institution between January 1998 and May 2013. Patient demographics, clinical characteristics, and histopathology data were reviewed. RESULTS: Among 925 patients who underwent thyroidectomy, 112 (12.1%) patients with black thyroid glands were identified. The incidence of thyroid cancer was 55.4% in black thyroid glands compared to 32.8% in non-black thyroid glands (p < 0.0001). The incidence of papillary thyroid cancer among the black and non-black thyroid glands was 34.8 and 20%, respectively (p < 0.001). The mean age (± SD) for patients with black thyroid glands and those with non-black thyroid was 54.3 ± 12.8 and 51.2 ± 15.7 years, respectively (p = 0.05). Black thyroid glands were also associated with a higher incidence of microcarcinomas (76 vs. 59%, p = 0.02). Among patients with black thyroid glands, Caucasians had a higher malignancy rate (63.4%) than African-Americans (37%; p = 0.03). CONCLUSION: The incidence of malignancy is higher in black thyroid compared to non-black thyroid glands, specifically in Caucasians.

Trocar Site Metastasis Following Robotic Oophorectomy for Ovarian Cancer: A Case Report and Review of the Literature.

While robotic surgery has seen much success in the treatment of gynecologic malignancies, the technical aspects of this approach raise concern for spreading tumor cells within the peritoneal cavity and to trocar sites. To date, robotic trocar site metastases have been identified following surgery for both endometrial and cervical cancer.

High circulating estrogens and selective expression of ERß in prostate tumors of Americans: implications for racial disparity of prostate cancer.

Although estrogen receptor beta (ERß) has been implicated in prostate cancer (PCa) progression, its potential role in health disparity of PCa remains elusive. The objective of this study was to examine serum estrogens and prostate tumor ERß expression and examine their correlation with clinical and pathological parameters in African American (AA) versus Caucasian American (CA) men. The circulating 17ß-estradiol (E2) was measured by enzyme immunoassay in blood procured from racially stratified normal subjects and PCa patients. Differential expression profile analysis of ERß was analyzed by quantitative immunohistochemistry using ethnicity-based tissue microarray encompassing 300 PCa tissue cores. In situ ERß expression was validated by quantitative reverse transcription-PCR in matched microdissected normal prostate epithelium and tumor cells and datasets extracted from independent cohorts. In comparison with normal age-matched subjects, circulating E2 levels were significantly elevated in all PCa patients. Further analysis demonstrates an increase in blood E2 levels in AA men in both normal and PCa in comparison with age- and stage-matched counterparts of CA decent. Histochemical score analysis reveals intense nuclear immunoreactivity for ERß in tumor cores of AA men than in CA men. Gene expression analysis in microdissected tumors corroborated the biracial differences in ERß expression. Gene expression analysis from independent cohort datasets revealed correlation between ERß expression and PCa progression. However, unlike in CA men, adjusted multivariate analysis showed that ERß expression correlates with age at diagnosis and low prostate-specific antigen recurrence-free survival in AA men. Taken together, our results suggest that E2-ERß axis may have potential clinical utility in PCa diagnosis and clinical outcome among AA men.

Robotic-assisted transaxillary parathyroidectomy of an atypical adenoma.

The advancement of minimally invasive surgical technologies over the past several years has led to improved surgical outcomes and greater patient satisfaction. Particularly for patients undergoing parathyroidectomies, endoscopic surgeries resulted in smaller surgical scars when compared with the open approach. Early endoscopic methods, however, were still restricted in their ability to provide adequate dexterity, two-dimensional views of the operative field; and while smaller than open surgeries, still left the presence of a small cervical scar. The limitations of endoscopic surgery led to application of the da Vinci S surgical robot system (Intuitive Surgical, Sunnyvale, CA, USA) and a novel transaxillary approach for parathyroidectomy. This surgical technique and approach is ideal for patients with primary hyperparathyroidism. This case report demonstrates that parathyroidectomy with en bloc thyroid lobectomy for atypical parathyroid adenomas using robotic- assisted transaxillary surgery is safe and feasible.

Plasmacytoma in the thyroid.

OBJECTIVE: The paper presents a case of plasmacytoma unexpectedly found in a goiter. PATIENT MATERIAL AND METHODS: The patient presented with compressive symptoms, including dyspnea and dysphagia and had no documented prior history of multiple myeloma. Physical examination revealed thyromegaly with no specific nodule. Computerized tomographic (CT) scan of the neck and chest showed diffuse homogenous enlargement of both the thyroid lobes extending into the mediastinum. Total thyroidectomy was done because of the compressive symptoms. RESULTS: Pathology revealed evidence of fibrosis surrounding small nodules of residual follicles with massive infiltration by plasma cells. The pathologic diagnosis was plasmacytoma. CONCLUSION: Plasmacytoma should be added to the list of causes of diffuse thyromegaly.

The Use of Smoothelin and Other Antibodies in the Diagnosis of Uterine and Soft Tissue Smooth Muscle Tumors.

Smoothelin is a cytoplasmic protein expressed in differentiated smooth muscle cells. Immunohistochemical evaluation of smoothelin has previously been reported in gastrointestinal (GI) smooth muscle tumors, but has yet to be studied in smooth muscle tumors of uterine and other soft tissue origin. DOG1 expression is reported to be specific for GI stromal tumors; however, variable expression has been reported in leiomyosarcomas (LMS) depending on site of origin. Overexpression of p16 is common in LMS of uterine and other sites of origin, but has not been correlated with tumor grade. This study explores the differential expression of these markers, as well as caldesmon, in LMS cases to assess diagnostic utility. Using tissue microarrays and cases from Tulane Medical Center and Medical College of Wisconsin, expression of smoothelin, DOG1, caldesmon, and p16 was evaluated by immunohistochemistry in 87 cases of LMS. The cases were subdivided by location of origin into uterine (N=31) and nonuterine (N=56) with 10 of the nonuterine of GI origin, as well as by grade into low grade (N=27) and intermediate and high grade (N=60). Differential expression among different grades and locations was evaluated. The same markers were evaluated in atypical leiomyoma cases (N=4) and 1 smooth muscle tumor of uncertain malignant potential case (N=1). Smoothelin expression was also assessed in 20 benign uterine leiomyomas. Weak DOG1 expression is rare but possible in extrauterine LMS. Expression of p16 is common in both uterine and extrauterine LMS, and more frequent in higher grades. Expression of smoothelin in this study differed depending on tumor type, grade, and site of origin. All leiomyomas and most atypical leiomyomas showed cytoplasmic positivity for smoothelin, whereas only 5% of LMS had cytoplasmic expression. The study suggests smoothelin may be downregulated in the cytoplasm of malignant smooth muscle tumor cells and may serve as a supportive aid in the distinction of LMS from benign smooth muscle tumors in cases where it is difficult by morphology alone.

Impact of Hurricane Katrina on medical student academic performance: the Tulane experience.

BACKGROUND: Hurricane Katrina forced the temporary closure of Tulane University School of Medicine requiring relocation to the Texas Medical Center in Houston, Texas. This required curricular restructuring, and resulted in faculty/student challenges. The effect of these stresses on student performance was studied. METHODS: A pre-Katrina and post-Katrina comparative analysis of all Tulane medical students' performance on standardized exams, internal examination and United States Medical Licensing Examination (USMLE) step exams was performed. A one-way analysis of variance was used to determine if mean examination scores differed from pre-Katrina to post-Katrina. RESULTS: Internal examination scores did not differ significantly. National standardized examination grades significantly decreased pre-Katrina to post-Katrina in Biochemistry, Pharmacology, Pathology, Medicine, Pediatrics and Psychiatry (P < 0.05). There was no statistical change in USMLE scores. CONCLUSIONS: Tulane students had a statistically significant decline in performance on many course and clerkship examinations, though overall performance on licensing examinations was unchanged. Many stresses may have affected students' ability to perform.

Management dilemma of thyroid nodules in patients with malignant struma ovarii.

Struma ovarii is a rare type of ovarian teratoma comprised of at least 50% thyroid tissue. While most are benign, 70% of malignant cases are diagnosed as papillary carcinoma. Management of patients with thyroid nodules following gynecologic surgery remains controversial and variable. Historically, the treatment of choice has been surgical removal to rule out ovarian carcinoma. Thyroid follow-up and further treatment options are guided by tumor characteristics. The patient in this case presented to the endocrine surgeon with multiple thyroid nodules, dysphagia and a history of struma ovarii that was surgically treated at an outside hospital. Fine needle aspiration demonstrated benign histology. However, due to compressive symptoms and uncertainty of other nodules, the patient underwent a total thyroidectomy. Due to limited published data and treatment guidelines regarding thyroid nodules in patients with a history of malignant struma ovarii, surgery was recommended to rule out papillary thyroid carcinoma and relieve the patient's dysphagia. More research focused on treatment and outcomes of struma ovarii patients with thyroid nodules is essential to establish treatment guidelines for these patients.

Dysregulation of miR-212 Promotes Castration Resistance through hnRNPH1-Mediated Regulation of AR and AR-V7: Implications for Racial Disparity of Prostate Cancer.

PURPOSE: The causes of disproportionate incidence and mortality of prostate cancer among African Americans (AA) remain elusive. The purpose of this study was to investigate the mechanistic role and assess clinical utility of the splicing factor heterogeneous nuclear ribonucleoprotein H1 (hnRNP H1) in prostate cancer progression among AA men. EXPERIMENTAL DESIGN: We employed an unbiased functional genomics approach coupled with suppressive subtractive hybridization (SSH) and custom cDNA microarrays to identify differentially expressed genes in microdissected tumors procured from age- and tumor grade-matched AA and Caucasian American (CA) men. Validation analysis was performed in independent cohorts and tissue microarrays. The underlying mechanisms of hnRNPH1 regulation and its impact on androgen receptor (AR) expression and tumor progression were explored. RESULTS: Aberrant coexpression of AR and hnRNPH1 and downregulation of miR-212 were detected in prostate tumors and correlate with disease progression in AA men compared with CA men. Ectopic expression of miR-212 mimics downregulated hnRNPH1 transcripts, which in turn reduced expression of AR and its splice variant AR-V7 (or AR3) in prostate cancer cells. hnRNPH1 physically interacts with AR and steroid receptor coactivator-3 (SRC-3) and primes activation of androgen-regulated genes in a ligand-dependent and independent manner. siRNA silencing of hnRNPH1 sensitized prostate cancer cells to bicalutamide and inhibited prostate tumorigenesis in vivo CONCLUSIONS: Our findings define novel roles for hnRNPH1 as a putative oncogene, splicing factor, and an auxiliary AR coregulator. Targeted disruption of the hnRNPH1-AR axis may have therapeutic implications to improve clinical outcomes in patients with advanced prostate cancer, especially among AA men.

Human, rhesus macaque, and feline sequences highly similar to mouse mammary tumor virus sequences.

Sequences highly similar (>95%) to the mouse mammary tumor virus (MMTV) env gene have been amplified from human DNA samples, including DNA samples from patients with breast cancer (BC) and persons who did not have BC. The sequences from human DNA were distinct from the MMTV sequences used as controls in these PCR reactions, indicating that these results are not simply due to contamination. In addition to both, mouse and human-related sequences were also amplified from some monkey and cat genomic DNA samples. These products were shown to be distinct from, but highly related to, the MMTV env gene, whereas, testing of other sources (lambda phage, snake, cockroach, sea urchin, chicken, or dog) demonstrated no specific amplification. A sequence 90% similar to the MMTV group antigen gene (gag) was amplified from cat DNA. These results indicate that DNA from vertebrate species other than rodents, including some but not all humans, monkeys, and cats, can contain sequences closely related to MMTV.

In vivo proteomic analysis of cytokine expression in laser capture-microdissected urothelial cells of obstructed ureteropelvic junction procured by laparoscopic dismembered pyeloplasty.

BACKGROUND AND PURPOSE: Ureteropelvic junction obstruction (UPJO) is defined as an impediment to urinary flow from the renal pelvis into the ureter. The exact cause remains an enigma despite investigations along embryologic, anatomic, and histologic lines. Our goal was to investigate in vivo the expression profile of cytokines in hyperplastic urothelial cells as a means of determining the source of UPJO. MATERIALS AND METHODS: Cellular proteomes of matched normal and hyperplastic urothelial cells were analyzed by laser capture microdissection (LCM) and tissue microdissection and human cytokine proteomic chips. All specimens (N = 9) were surgically obtained from patients undergoing laparoscopic dismembered pyeloplasty and were immediately embedded in O.C.T. solution and flash-frozen in liquid nitrogen. Tissue sections (6 microm) were mounted on uncoated glass slides using a cryostat, fixed in 70% ethanol, stained with hematoxylin and eosin, and sequentially dehydrated in ethanol and xylene. Typically, paired samples of normal and hyperplastic urothelial cells were procured on separate caps from serial sections of each specimen by the Arcturus PixCell II LCM system using 3000 laser pulses and a spot diameter of 30 microm. Total proteins were harvested and quantitated. Differential expression profile analysis of 43 cytokines in normal and hyperplastic cells were performed using human protein chips. Briefly, the membranes were initially probed with protein (150 ng) from normal or hyperplastic cells and sequentially reacted with a cocktail of biotinylated cytokine antibodies and horseradish peroxidase-conjugated streptavidin. The membranes were developed using enhanced chemiluminescence and analyzed by densitometry. RESULTS: Comparative densitometric analysis revealed twofold to fourfold upregulation of growth-related oncogene alpha (GRO-alpha), interleukin (IL)-1alpha, interferon (INF)-gamma, IL-8, tumor necrosis factor (TNF)-alpha, RANTES, and macrophage inflammatory protein-1beta (MIP-1beta) and twofold to fourfold downregulation of transforming growth factor (TGF)-beta and IL-10 in hyperplastic urothelial cells compared with paired control cells. CONCLUSIONS: We here report the efficient application of LCM and proteomic array chips for expression profile analysis of cytokines in vivo. Because the etiology and pathogenesis of UPJO are still fragmentary, the marked heterogeneity of the observed cytokine alterations reported here may be of significance. Further studies are required to elucidate the functional significance of the differentially expressed cytokines in the pathogenesis of the disease.

Periprostatic subendothelial intravascular granulomatosis: a mimic of high-grade intravascular prostatic adenocarcinoma.

A rare case of intravascular granulomatous inflammation mimicking intravascular prostatic adenocarcinoma is reported. To the author's knowledge, there have been no previous reports of prostatic or periprostatic intravascular granulomatous inflammation. A 67-year-old man presented with elevated serum prostate specific antigen (PSA) and was found to have a high-grade adenocarcinoma of the prostate. A radical prostatectomy revealed intravascular subendothelial granulomatous inflammation mimicking vascular invasion of a high-grade adenocarcinoma found elsewhere in the prostate. Immunoperoxidase stains confirmed that the subendothelial infiltrate was composed of histiocytes and not tumor cells. Periprostatic subendothelial intravascular granulomatosis is a rare event, which may mimic vascular involvement of high-grade prostatic adenocarcinoma and may result from a previous needle biopsy of the prostate. Possible mechanisms for this finding are discussed. It is important to distinguish this process from high-grade prostatic adenocarcinoma involving blood vessels for obvious clinical reasons.

Clostridial enteritis necroticans versus secondary clostridial infection superimposed upon ischemic bowel disease.

Clostridial enteritis necroticans, or pig-bel, as seen in Papua New Guinea, is a necrotizing, segmental gangrene of the small intestine occurring in members of a malnourished population, who become ill after consuming large quantities of pork contaminated with Type C. Clostridium perfringens. We report a case of possible Clostridial enteritis necroticans with concomitant ischemic intestinal disease secondary to superior mesenteric arterial thrombosis occurring in a 53-year-old woman with a long history of diabetes mellitus, hypertension, and peripheral vascular disease. The differential diagnosis and the pathogenesis of C. perfringens enteritis necroticans are discussed.

Papillary thyroid carcinoma in black thyroids.

BACKGROUND: Black thyroid is a rare condition. It has been considered to be pathognomonic of chronic minocycline ingestion for more than 30 years, although it can also occur in patients with hemochromatosis, ochronosis, mucoviscidosis, and hemorrhage. A possible association of black thyroid with thyroid cancer has been considered, but no direct causal relationship has been established. Hence, the purpose of this article was to identify the malignant potential of such glands. METHODS: A retrospective medical chart review was performed on 433 patients who underwent thyroid surgery at Tulane University Medical Center from 2001 to 2008. Patients were grouped based on pathology: (1) benign, (2) papillary carcinoma, and (3) non-papillary thyroid carcinoma. RESULTS: At surgery, 63 patients (15%) with black thyroid gland were found to have thyroid nodules. Among these nodules, 22 (35%) were benign, 21 (33%) contained papillary thyroid cancer, and 20 (32%) had a non-papillary thyroid malignancy. Nodules in black thyroids were associated with higher risk of malignancy than nodules in non-black thyroids (p = .0001). Further analysis of the papillary thyroid carcinoma group showed no statistical difference in regard to tumor size or evidence of multifocality of disease. CONCLUSION: The finding of a black thyroid gland is unusual and disconcerting. To our knowledge, this is the first study aimed at documenting the malignant potential of black thyroid glands. This report documents that the risk of malignancy is higher in black thyroid compared to non-black thyroid glands. Furthermore, among those with papillary thyroid cancer, the presence of the pigment did not correlate with malignancy, multifocality, or tumor size.

Primary peripheral nerve sheath tumors of the thyroid gland.

BACKGROUND: Primary peripheral nerve sheath tumors (PNSTs) of the thyroid gland are exceptionally rare tumors that usually present as asymptomatic neck nodules in adults. This article presents a literature review of these tumors. SUMMARY: PNSTs of the thyroid can be classified into benign and malignant. Only three cases of malignant PNSTs have been reported. Benign PNSTs of the thyroid include neurofibromas and schwannomas. Only two cases of isolated neurofibroma of the thyroid have been reported. Schwannomas are typically benign, slow-growing tumors that originate from neuronal schwann cells, with a clinical picture depending on the anatomic size and site. Pathologically, schwannomas are classified into Antoni A and Antoni B. Only 17 cases of schwannomas of the thyroid exist in literature to date. CONCLUSIONS: Schwannomas of the thyroid gland are extremely rare and usually asymptomatic. Complete surgical resection is mandatory for care.

Black thyroid associated with thyroid carcinoma.

Objective. Black thyroid is a rare pigmented change seen almost exclusively in patients upon minocycline ingestion, and the process has previously been thought to be generally benign. There have been 61 reported cases of black thyroid. We are aware of 13 cases previously reported in association with thyroid carcinoma. This paper reports six patients with black thyroid pigmentation in association with thyroid carcinoma. Design. The medical records of six patients who were diagnosed with black thyroid syndrome, all of whom underwent thyroid surgery, were reviewed. Data on age, gender, race, preoperative fine needle aspiration biopsy (FNA), thyroid function levels, and pathology reports were collected. Main Outcome. The mean age was 60 years. There were 5 females, 4 of whom were African American. All patients were clinically and biochemically euthyroid. Black pigmentation was not diagnosed in preoperative FNA, and only one patient had a preoperative diagnosis of papillary thyroid carcinoma. The other patients underwent surgery and were found to have black pigmentation of the thyroid associated with carcinoma. Conclusions. FNA does not diagnose black thyroid, which is associated with thyroid carcinoma. Thyroid glands with black pigmentation deserve thorough pathologic examination, including several sections of each specimen.

Splenic papillary angioendothelioma in a 6-year-old girl.

Papillary angioendothelioma is a rare, low-grade neoplasm of lymphatic channels that usually presents intradermally. We report the case of a 6-year-old girl with isolated splenomegaly and symptoms of early satiety and weight loss, whom was found to have a splenic papillary angioendothelioma. Preoperative abdominal computed tomography scan showed an irregular, heterogeneous mass; a tagged red cell scan ruled out a hemangioma, whereas a positron emission tomography scan showed mildly increased uptake. Subsequent surgery and pathologic assessment revealed a papillary angioendothelioma (Dabska tumor) within lymphatic spaces. The child has no evidence of recurrence or metastases 1 year postoperatively.

Testicular presentation of sarcoidosis and organ preservation: case report and review of management strategies.

We report the case of a 24-year-old Cuban-American man initially presenting with a 1-year history of bilateral testicular pain, subsequently diagnosed as sarcoidosis. The diagnosis was histologically confirmed intraoperatively with excisional biopsy of the right tunica. Genitourinary complaints are a rare initial presentation of this disease. Although therapeutic approaches have varied in published reports, no definitive protocol for treatment has been established. We suggest confirmation of the diagnosis, followed by symptomatic treatment, reserving orchiectomy and steroid therapy for severe, refractory, or disseminated cases.