Papillary thyroid carcinoma with heterotopic ossification is a special subtype with extensive progression.

An immunohistochemical study was conducted of 108 papillary carcinoma cases, including 48 cases with intratumoral heterotopic ossification (IHO). In 48 cases, papillary carcinoma with IHO was accompanied by nodular fibrosis. Cases of papillary carcinoma with IHO or nodular fibrosis showed higher incidences of lymph node metastasis, multifocal lesions, and extrathyroidal invasion than those without IHO and nodular fibrosis. A higher number of stromal myofibroblasts was observed in papillary carcinoma with IHO or nodular fibrosis than in that without fibrosis. Expression of both basic fibroblast growth factor (bFGF) and bone morphogenetic protein (BMP)-2 was the highest in papillary carcinoma with IHO. Papillary carcinoma with IHO showed higher vascular invasion and higher numbers of capillaries expressing nestin, which is associated with high expression of vascular endothelial growth factor (VEGF). Papillary carcinoma with IHO is a unique subtype with extensive progression including frequent lymph node metastasis, multifocality, and invasive behavior. Papillary carcinoma with IHO was correlated with expression of bFGF, BMP-2, and VEGF in the carcinoma cells, leading to neovascularization.

Congenital retroperitoneal vascular anomalies: impact on pelvic surgery.

PURPOSE: Congenital anomalies of the inferior vena cava (IVC) are not commonly recognized since they generally do not cause symptoms. METHODS: Preoperative cross-sectional imaging can identify anomalies of vascular structures that are highly relevant to the pelvic surgeon. The clinical impact of congenital vascular variations of IVC, especially on paraaortic lymphadenectomy, is investigated. RESULTS: In case the surgeon is unaware of these anomalies, impending differential diagnostic confusion (paraaortic adenopathy), intraoperative blood loss and the need for transfusion may occur. The development of IVC is a complex process concerning the formation of several anastomoses between three paired embryonic veins (posterior cardinal, subcardinal, supracardinal veins). In double IVC, the left IVC typically ends at the level of the left renal vein, in an anastomosis which crosses anterior to the aorta to join the normal right IVC. CONCLUSION: Anomalies of IVC are present in 0.4-3.5% of women. As different aberrations of IVC have important clinical implications, awareness of retroperitoneal abnormal vessels is crucial to avoid diagnostic pitfalls and intraoperative complications.

E-selectin and Sialyl Lewis X expression is associated with lymph node metastasis of invasive micropapillary carcinoma of the breast.

To investigate the possible roles of E-selectin and its ligand, Sialyl Lewis X, in lymph node metastasis of invasive micropapillary carcinoma of the breast, 100 cases of invasive micropapillary carcinoma and 97 cases of invasive ductal carcinoma were analyzed immunohistochemically for the expression of E-selectin and Sialyl Lewis X, along with CD34, to measure the microvessel density of invasive micropapillary carcinoma. We found that the number of E-selectin-positive vessels was greater in invasive micropapillary carcinoma than in invasive ductal carcinoma, and it was significantly correlated with the histological grade, the number of positive lymph nodes, and the microvessel density of invasive micropapillary carcinoma. The Sialyl Lewis X expression of invasive micropapillary carcinoma was higher than that of invasive ductal carcinoma, which was also associated with lymph node metastasis. In invasive micropapillary carcinoma, the Sialyl Lewis X expression was predominantly in the stroma-facing surface of the cell clusters and the adjacent stroma, while in invasive ductal carcinoma it was largely intracytoplasmic or intercellular. These findings suggested that E-selectin and Sialyl Lewis X might play an important role in lymph node metastasis in invasive micropapillary carcinoma. The expression pattern of Sialyl Lewis X in invasive micropapillary carcinoma suggested that the reversal of cell polarity of invasive micropapillary carcinoma might be as an important factor for the morphogenesis and possibly the pathogenesis, especially their higher rates of lymph node metastasis.

[Advances in the treatment of thyroid cancer in the era of molecularly targeted therapies]. / Les progrès dans le traitement des cancers de la thyroïde à l'ère des thérapies ciblées moléculaires.

During last decade, many progresses have been made in the understanding of thyroid cancer molecular biology. This knowledge led to the development of novel targeted therapy in iodine-resistant patients. However, the management of patients remains complex because of the broad spectrum of clinical presentation of thyroid cancers, differences in their natural histories and the lack of data about randomized trials. Angiogenesis inhibitors (sorafenib, motesanib, axitinib and vandetanib) have shown promising activity in differentiated thyroid cancer. Vandetanib, an inhibitor of RET and VEGFR tyrosine-kinases, is promising in medullary thyroid cancers. Preliminary results of these trials are discussed in this review.

[Expression of VEGF-C and angiogenesis, and lymphangiogenesis in papillary thyroid carcinoma].

OBJECTIVE: To investigate the relationship between the expression of vascular endothelial growth factor C (VEGF-C) and angiogenesis and lymphangiogenesis in papillary thyroid carcinoma (PTC). METHODS: Seventy-two PTC cases were divided into 3 groups according to the level of invasion: papillary microcarcinoma group (PMC group), intrathyroid carcinoma group (IPC group), and extrathyroid carcinoma group (EPC group). They were again divided into 2 groups according to lymph node metastasis: lymph node metastasis group and lymph node no-metastasis group. The expressions of VEGF-C, CD105 and vascular endothelial growth factor receptor-3 (VEGFR-3) were detected by SP method of immunohistochemical staining. The expression of VEGF-C was analyzed quantitatively by image analysis system, and the PI of VEGF-C (VEGF-C-PI), the number of MVD (microvessel density), and LVD (lymphaticvessel density) were obtained. RESULTS: The VEGF-C-PI of lymph node metastasis group (23.15 +/- 3.75) was higher than that of lymph node non-metastasis group (14.54 +/- 2.93) (P <0.01). MVD was 35.25 +/- 2.06 in the PMC group, 41.75 +/- 5.46 in the IPC group, and 52.58 +/- 4.16 in the EPC group, which showed the elevatory tendency with the increase of invasion (P < 00.5). LVD was 6.00 +/- 0.81 in the PMC group, 13.80 +/- 1.81 in the IPC group, and 19.17 +/- 2.96 in the EPC group, which again showed the elevatory tendency with the increase of invasion (P <0.05). The LVD of lymph node metastasis group (19.56 +/- 2.45) was significantly higher than that of lymph node non-metastasis group (12.48 +/- 2.84) (P < 0.05). VEGF-C was positively correlated with MVD and LVD (r = 0.743, 0.90, P <0.01). CONCLUSION: The expressions of VEGF-C and LVD are related to lymph node metastasis of PTC. MVD and LVD are related to the invasion of PTC. VEGF-C may play an important role in the angiogenesis and lymphangiogenesis.

[mRNA expression of IGF-IIand HGF in relation to microvascular density, tumor progression and prognosis of gastric carcinoma].

OBJECTIVE: To investigate whether correlation exists between mRNA expression of IGF-II and hepatocyte growth factor (HGF) and tumor progression and prognosis in gastric cancer. METHODS: In situ hybridization technique was used to examine mRNA expression of IGF-II and HGF, and immunohistochemical technique was used to examine protein expression of CD34 in 105 specimens of gastric carcinoma. RESULTS: In situ hybridization revealed that the positive rates of IGF-II mRNA and HGFmRNA were 49.5% and 57.1%, respectively. In stage T3-T4 cases, positive mRNA expression rates of IGF-II and HGF, the frequencies of vessel invasion, lymph node metastasis and distant metastasis were significantly higher than those in stage T1-T2 cases. The mean microvascular density (MVD) in stage T3-T4 tumors, vessel invasion, lymph node metastasis and distant metastasis were significantly more frequent than those in stage T1-T2 tumors. The mean MVD in tumors with positive IGF-II and HGF expressions was significantly higher than that in tumors without IGF-II and HGF expression. There were positive correlations between MVD and expression of IGF-II and HGF. The mean survival time and 5-year survival rate in cases with positive IGF-II and HGF expression and MVD value > or = 39.5 were significantly shorter those that in cases with negative IGF-II and HGF expression and MVD value < 39.5. CONCLUSION: IGF-II and HGF promote angiogenesis in gastric cancer, and take part in tumor invasion and metastasis. They can be used as prognostic markers of gastric cancer in clinical practice.

Endolymphatic sac tumor: staged endovascular-neurosurgical approach.

Endolymphatic sac tumors are rare, low-grade adenocarcinomas of the petrous bone. These tumors are highly vascularized and surgical removal is often challenging. We present a staged endovascular-neurosurgical approach consisting of stent-assisted angioplasty of the petrous carotid, selective endovascular embolization and surgical removal.

Endolymphatic sac tumour. A case report.

We present the case of a patient with an endolymphatic sac tumour (ELST). This rare tumour entity has only recently been defined and despite a well characterized clinical appearance misdiagnosis as jugular paraganglioma is frequent. A 68-year-old woman was admitted to our Neurosurgical Department with a mass lesion extending from the left temporal bone to the cerebello-pontine angle (CPA). Radiological features were high vascularization, contrast enhancement and destruction of the os petrosum. After preoperative angiographic embolization the tumour was removed in two surgical interventions, first via a lateral suboccipital approach and second by petrosectomy. The lesion proved to be a typical endolymphatic sac tumour by a synopsis of histological, radiological and clinical features. ELST should be taken into consideration in patients with mass lesions in the cerebellopontine angle destroying the petrous bone and resembling paraganglioma. Since slow growth rate and lack of metastases are particular features of ELST, complete resection of the tumour results in long survival times without adjuvant chemo- or radiotherapy.

[The effect of ectopic HCG on microvessel density in gastric carcinoma].

OBJECTIVES: To study the effect of ectopic HCG on microvessel density in gastric carcinoma using immunohistochemical staining with anti-beta-HCG polyclonal antibody and anti-factor VIII related antigen(FVIII RAg)antibody. METHODS: A total of 40 specimens resected from patients with gastric carcinoma was investigated by immunohistochemical staining with a anti-beta-HCG polyclonal antibody and a monoclonal antibody against FVIII RAg. The expression of beta-HCG and the microvessel density(the average number of microvessel in three areas of highest vascular density at 400 x magnification) in various regions of the histologic specimens were studied. RESULTS: Fifteen (37.5%) of the 40 gastric carcinomas was positive for beta-HCG protein in tumor tissue. beta-HCG protein was negative in the tumor-adjacent and in normal tissue. The mean microvessel density was 27.4 +/- 7.1 in the tumor, 11.9 +/- 5.4 in tumor-adjacent and 4.8 +/- 1.5 in normal tissues (P < 0.05-0.01). There was a close correlation with beta-HCG positivity and microvessel density (MVD). There was no correlation between the degree of tumor cell differentiation and beta-HCG expression, nor was a correlation between it and MVD. High expression level of beta-HCG and MVD was significantly associated with hematogenous metastases. CONCLUSION: Ectopic HCG expression may have angiogenic effect which, in turn, may facilitate hematogenous dissemination of gastric cancer.

[Bellini duct carcinoma of kidney with invasive growth pattern: a case report].

We report a case of Bellini duct carcinoma of the left kidney with invasive growth pattern. A 39-year-old man was admitted to our hospital with the chief complaint of gross hematuria. Ultrasonography showed left renal swelling but normal reniform configuration of the kidney was maintained. Computed tomography demonstrated a low density tumor infiltrating into the renal cortex and with tumor extension into the renal vein. Renal angiography revealed a hypovascular tumor. We suspected a left renal cell carcinoma with tumor extension into the left renal vein, and performed radical nephrectomy. Macroscopically, the resected kidney had a normal outer contour. The tumor with infiltrative growth pattern existed in renal medulla. Histopathologic examination revealed a papillary adenocarcinoma originated in Bellini duct (pT3bN2M0). The patient underwent systemic chemotherapy (M-VAC). This case showed invasive growth pattern, which were different from the usual renal cell carcinoma and Bellini duct carcinoma.

[Usefulness of three-dimensional CT angiography for cervical tumor].

In this study, the usefulness of three-dimensional angiographic imagings from helical scanning computed tomography (CT) enhanced by contrast media were evaluated based on results from three patients with a cervical mass, e.g. thyroid cancer and carotid body tumor. Three-dimensional CT (3D-CT) angiographic imagings in these cases clearly demonstrated secondary dislocation or distortion of the major cervical vessels caused by the tumor or metastatic lymph nodes. It was remarkable that in the highly vascularized tumor in case 3, all features of the tumor were delineated by 3D-CT angiography. Our results indicate that 3D-CT angiographic imagings are especially useful for preoperative evaluation of the relationship of the cervical mass to major cervical vessels as well as in the observation of tumors rich in vasculature.

[Selective thyroid angiography: techniques, diagnosis and indications].

In the clinical research on angiographic diagnosis of thyroid tumor over twenty years, techniques, diagnostic points and limitations in angiogram were studied, and its indications and significance were reviewed. 1) As about 80% of the feeding artery for thyroid tumor was the superior thyroid artery, superior and inferior thyroid angiography via the femoral artery can be a basic method for angiographic diagnosis. 2) The success rate of insertion into superior and inferior thyroid artery depended on age, vascular anatomy, the shape of catheter, technique and procedure. The success rate was improved from 57.3% to 86.9% by reconsideration and devices. 3) The diagnostic points in thyroid angiographic findings are the morphological character of tumor vessel, the margin of tumor stain and the condition of its density. By checking these three points, the correct diagnostic rate of 94.7% was obtained in the differential diagnosis of malignant and benign. 4) Microangiogram and pathological findings of resected specimen were compared. The results suggest that the variety of width and distribution of vascular space in tumor and secondary degeneration prevent accurate diagnosis. 5) Today, noninvasive diagnostic methods for thyroid tumor have been advanced, therefore eight new indications of selective thyroid angiography for extraglandal change are proposed.

Transcatheter embolisation to control severe bleeding in fungating breast cancer.

Severe and recurrent haemorrhage from ulcerating breast or skin lesions was controlled in seven of nine women with breast cancer. Arterial catheterisation and embolisation with a variety of materials (gelfoam, polyvinyl alcohol, steel coils, 50% dextrose) was used. Local anaesthesia only was needed, allowing very ill patients to be treated. This approach is the treatment of choice for severe haemorrhage in breast cancer.

Renal papillary adenocarcinoma.

Papillary adenocarcinoma of the kidney is an uncommon variant of renal tubular carcinoma, which on radiographic and ultrasonographic evaluation presents characteristically as a predominantly solid hypovascular or avascular mass. Surgery is required to distinguish this lesion from other solid renal lesions, which differs from the more common form of renal tubular carcinoma in several important respects.

Angiographic features in tubular-papillary adenocarcinoma of the kidney.

Angiography and nephrotomography are essential in evaluation of avascular or hypovascular space occupying lesions of the kidney. Ultrasound adds another dimension in differentiating solid from cystic masses. Two cases of tubular-papillary adenocarcinoma were reported. Their angiographic findings consisted of a few neovascularities. Nephrotomography and ultrasonography in the second case showed a solid mass.

Clinical comparison between vascular and avascular renal cell carcinoma.

Of 72 patients with renal cell carcinoma 19 were found to have an angiographic avascular neoplasm. These avascular tumors have a lower incidence of vein and capsule invasion than vascular tumors. Among these avascular cancers papillary adenocarcinoma was the predominant histologic pattern. Patients with papillary tumors seem to have a lower clinical stage and increased survival rate than patients with non-papillary tumors.