Pathology and cytologic features of thyroid neoplasms.

Most thyroid neoplasms arise from follicular cells and are well differentiated. Anaplastic and poorly differentiated carcinomas are rare and have a high mortality. Five percent of tumors are of C-cell origin, and 20% to 25% of these are hereditary. Thyroid lymphoma is rare and occurs in the setting of Hashimoto's thyroiditis. Fine needle aspiration biopsy is the best diagnostic tool to classify thyroid neoplasms.

Feasibility of endoscopic sentinel node biopsy in the porcine neck.

OBJECTIVE: To assess the feasibility of endoscopic sentinel node biopsy (SNB) using a tracer dye in a pig model. STUDY DESIGN AND SETTING: This was a prospective, nonrandomized experimental study in Yorkshire pigs. The posterolateral tongues of three animals were injected with a one-to-one solution of carbon dye to methylene blue dye. Endoscopic SNB was performed and stained lymph nodes identified and retrieved, followed by an open dissection to recover any remaining nodes. Specimens were analyzed by a pathologist for staining, size, and structural integrity. RESULTS: Six unilateral endoscopic SNBs were performed without complications. During endoscopic dissection, gross blue-staining of a sentinel node was noted in four of six dissections (66%). One of six sentinel nodes demonstrated histologic evidence of carbon staining. Structural integrity of all nodes was intact upon histological evaluation. CONCLUSION/SIGNIFICANCE: Endoscopic cervical SNB in pigs is feasible but has limitations based on lymph node size and reliability of tracer dyes. Further study is warranted to perfect tracer dyes and retrieval methods to improve this technique.

A third branchial pouch cyst presenting as a lateral neck mass in an adult.

Anomalies of the branchial apparatus occur with some frequency in the adult and pediatric populations. Branchial anomalies are most often derivatives of the first or second pouch. Branchial anomalies involving the third pouch may present as cysts, sinuses, fistulas, and ectopic glands. They are relatively rare, and they respond well to surgical removal. We report the case of a 53-year-old woman who was referred to us for evaluation of a persistent left upper neck mass. The patient had no history of a cervical mass as a child or young adult. The mass was excised uneventfully, and the final pathology revealed a normocellular parathyroid gland and thymic tissue.

Recurrent polymorphous low-grade adenocarcinoma manifesting as a sinonasal mass: a case report.

Polymorphous low-grade adenocarcinoma (PLGA) is a malignant neoplasm that tends to follow a benign clinical course. Recurrences are uncommon. We report a case of recurrent PLGA of the paranasal sinuses that manifested as a large mass that filled the entire nasal cavity and left maxillary sinus. To our knowledge, this is the first reported case of a recurrent PLGA of the paranasal sinuses.

Amyloidosis of the upper aerodigestive tract.

OBJECTIVES/HYPOTHESIS: To delineate the clinical and pathologic characteristics of upper aerodigestive tract amyloidosis with particular attention to laryngeal amyloidosis. STUDY DESIGN: Retrospective chart review of patients with amyloidosis of Thomas Jefferson University and its affiliated hospitals. MATERIAL AND METHODS: The charts of 16 patients with upper aerodigestive tract amyloidosis identified from the databases of the Thomas Jefferson University pathology department were reviewed and included in the study. RESULTS: Sixteen patients (9 male and 7 female, with an average age of 49.8 years) with upper aerodigestive tract amyloidosis were identified. The most common site of amyloid involvement was the larynx. Consequently, patients most commonly presented with hoarseness (14 of 16). All patients underwent surgical removal of the amyloid deposits. Fourteen patients had primary localized amyloidosis. Two experienced systemic involvement. Seven of the 16 patients developed recurrences requiring further treatment. CONCLUSIONS: Amyloidosis of the upper aerodigestive tract generally behaves as a benign, localized condition treatable by surgical resection. Regular follow-up with laryngoscopy is indicated for early diagnosis of recurrence, and multiple surgical procedures may be required to control symptoms.

Endometrial effects of lower doses of conjugated equine estrogens and medroxyprogesterone acetate: two-year substudy results.

OBJECTIVE: To determine the endometrial safety of 2 years of treatment with lower doses of continuous combined conjugated equine estrogens (CEE) and medroxyprogesterone acetate (MPA). DESIGN: Randomized, double-blind, placebo-controlled, multicenter metabolic and osteoporosis substudy of the Women's Health, Osteoporosis, Progestin, Estrogen (Women's HOPE) study. SETTING: Nineteen study centers across the United States. PATIENT(S): Healthy, postmenopausal women (n = 822) with an intact uterus were recruited. INTERVENTION(S): Patients received CEE 0.625, CEE 0.625/MPA 2.5, CEE 0.45, CEE 0.45/MPA 2.5, CEE 0.45/MPA 1.5, CEE 0.3, CEE 0.3/MPA 1.5 (all doses mg/day), or placebo for 2 years. Endometrial biopsies were evaluated at baseline and years 0.5, 1, 1.5, and 2 using a centralized protocol. MAIN OUTCOME MEASURE(S): Efficacy of lower doses of CEE/MPA in reducing the incidence of endometrial hyperplasia rates associated with unopposed estrogen (E). RESULT(S): No cases of endometrial hyperplasia were seen in the four CEE/MPA groups. For the CEE-alone groups, a dose-related increase in incidence rates from 3.17% (CEE 0.3 mg) to 27.27% (CEE 0.625 mg) was seen at 2 years. The number of cases increased from year 1 to year 2. For the CEE-alone groups, the incidence rates and types of hyperplasia diagnosed varied among the pathologists. CONCLUSION(S): Two years of treatment with lower doses of CEE/MPA provided endometrial protection comparable to that seen with commonly prescribed doses. These regimens should be considered for postmenopausal women who are candidates for hormone therapy.

Nodal yield in neck dissection and the likelihood of metastases.

OBJECTIVES: The purpose of this study was to begin investigating the relationship between nodal yield in neck dissection and the likelihood of finding cervical metastases in T1 and T2 head and neck squamous cell carcinoma (HNSCC). No clinical implications are drawn from this preliminary work. STUDY DESIGN AND SETTING: This study was a retrospective analysis of 564 patients with T1 and T2 HNSCC of the oral cavity, oropharynx, or hypopharynx from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program registry. A multivariate analysis was performed to evaluate the relationship between nodal yield in neck dissection and the discovery of cervical metastases. Other independent factors included in the analysis were gender, age, race, and primary site of tumor. RESULTS: Compared with nodal yield < 13, cervical metastases were more likely to be found for nodal yield 21-28 (P < 0.001, odds ratio [OR] = 3.68), 29-40 (P = 0.021, OR = 1.98), and >40 (P < 0.001, OR = 3.52). Increased age, male sex, and oropharynx and hypopharynx primaries were also associated with a significantly increased likelihood of finding cervical metastases. CONCLUSION: In T1 and T2 cases of HNSCC, nodal yield >20, increased age, male sex, and primary site correspond with an increased likelihood of finding cervical metastases.

Metastatic cervical carcinoma with ectopic calcitonin production presenting as a thyroid mass.

OBJECTIVE: To describe a case of cervical carcinoma metastatic to the thyroid in association with ectopic production of calcitonin. METHODS: We present the medical history, clinical findings, and laboratory results in a 38-year-old woman with a neck mass, and we discuss the frequency of metastatic involvement of the thyroid. RESULTS: A 38-year-old woman was referred for evaluation of an enlarging neck mass. She had undergone radical hysterectomy and irradiation for invasive cervical carcinoma 1 year earlier. Laboratory investigation showed only mild anemia, high plasma bicarbonate concentration, increased alkaline phosphatase, and mild hypoalbuminemia. Computed tomography of the abdomen and pelvis disclosed multiple lesions in the liver. Fine-needle aspiration biopsy of the thyroid mass revealed a poorly differentiated carcinoma, which stained negative for thyroglobulin but positive for several neuroendocrine tumor markers. Measurement of serum calcitonin showed a dramatically increased level (5,000 pg/mL). The same histologic and immunochemical profile was found in a liver biopsy specimen and in the original cervical tumor. Metastatic neuroendocrine cervical carcinoma was diagnosed, and the patient died 6 months later despite four cycles of chemotherapy. CONCLUSION: To the best of our knowledge, this is the first case report of a neuroendocrine cervical carcinoma manifesting as a palpable thyroid mass, associated with ectopic production of calcitonin.

Evaluation of colposcopically directed cervical biopsies yielding a histologic diagnosis of CIN 1,2.

OBJECTIVE: To determine the prognostic value of the diagnostic category CIN 1,2. MATERIALS AND METHODS: Computerized pathology records of patients with CIN 1,2 at colposcopically directed biopsy followed by treatment with excision were examined, and we compared the diagnostic biopsy with the final tissue diagnosis. Two pathologists who were blinded to the final diagnosis reviewed the original biopsies independently. The ability of the referee pathologist to predict CIN 2 or 3 lesions and interobserver consistency are described. RESULTS: Sixty-nine cases of biopsies with CIN 1,2 were reviewed. Nineteen of these patients were lost to follow-up. Of the 46 cases with either an excisional biopsy or hysterectomy, 12 cases (26.1%) demonstrated CIN 2 or greater. Pathologist A and B correctly predicted the high-grade lesions in 66.7% and 58.3% of cases reviewed. Pathologist A and B agreed with each other in 33 of the 46 cases (71.1%). CONCLUSIONS: 1) CIN 1,2 on a colposcopic biopsy is associated with a high-grade lesion in 26.1% of the cases. 2) Experienced gynecologic pathologists can identify these high-grade lesions on review in only two thirds of the cases. 3) CIN 1,2 is a useful diagnostic category to prevent undertreatment.