Thyroid metastases from a breast cancer diagnosed by fine-needle aspiration biopsy. Case report and overview of the literature.

AIM: Intrathyroid metastases are uncommon in cytology practice. We report a case of metastatic lesion in the thyroid from breast carcinoma which was recognized in a fine-needle aspiration (FNA) biopsy and confirmed by immunohistopathology. In addition, we provide an overview of the literature describing similar cases. STUDY DESIGN: The patient was a 54-year old woman with a large, multinodular goiter and bilaterally enlarged lymph nodes in the supraclavicular areas. Fourteen years earlier she had undergone radical mastectomy followed by chemio- and radiotherapy due to a breast carcinoma. RESULTS: FNA of the thyroid nodules showed a metastatic breast carcinoma and was followed by total strumectomy and lymphadenectomy. Histological reassessment of the surgical thyroid specimens as well as the neck lymph nodes revealed multiple breast metastases. This was strongly confirmed by immunohistochemical examinations, which revealed a positive staining for: CKMNF 116, CK7, CEA as well as for ER, PgR and HER2, and a negative staining for: CK20, thyroglobulin, TTF1, calcitonin, and chromogranin. CONCLUSION: Every new aggregate in the thyroid in patients with even a long-term history of cancer should be considered as potentially metastatic until proved otherwise. FNA could be helpful in the diagnosis of thyroid metastatic lesion, but it should be confirmed by immunohistopathology.

Hot nodules in children and adolescents in western Poland from 1996 to 2000: clinical analysis of 31 patients.

In an iodine deficient area, a high incidence of hot thyroid nodules was observed in children after the introduction of iodine supplementation in 1997. Thirty-one children (28 girls, 3 boys) were identified with hot nodules between the years 1996-2000 (3 patients in 1996, 4 in 1997, 10 in 1998, 7 in 1999, and 7 in 2000). The incidence ratio of hot nodules in this study population increased significantly from 0.23 in 1996 to 0.80 in 1998. In 17 children, radionuclide uptake was confined exclusively to areas corresponding to the nodules. Cancer was detected in one child in post-operative histological examination. In the other 14 children, the predominant uptake was in nodules, but it was also registered within extranodular tissue. In the latter group, eight tumors were eventually diagnosed as cancer and six as benign tumors. The majority of tumors in the entire group was located in the right lobe (19/31) and was accompanied by reduced TSH levels (23/31), but only 14 of the 31 patients had signs of hyperthyroidism. The years 1996-2000, in which the increase in the incidence of "hot" nodules in children with nodular goiter was observed, correspond to a period of enforced salt iodinization. The existence of cancer within hot nodules is rare, ranging from 2-5% of all nodules. By contrast, the risk of cancer in hot nodules in the cohort of this study was significantly higher (9/31; 29.0%), especially in cases of hot nodules with a rudimentary radionuclide uptake in the extranodular area. We conclude that, in geographical regions affected with iodine deficiency, the therapeutic protocol for children with hot nodules should be based primarily on surgery rather than on radioiodine.

BRCA2 germline mutations in male breast cancer patients in the Polish population.

Breast cancer is a rare disease in men. Germ-line mutations in BRCA2 and androgen receptor (AR) genes are thought to be responsible for a proportion of male breast cancer cases. The present study was performed on a series of 37 consenting patients not selected for family history of breast/ovarian cancer. The entire coding region of the BRCA2 gene and two exons of the AR gene were analyzed for germ-line mutations to evaluate the association between BRCA2 and AR genes and male breast cancer in Poland. We identified four frameshift mutations (11%) in exons 10, 11, 17 and 18, two of them were novel: 6495del3insC and 8457insA. Three missense unclassified variants (8%) of the BRCA2 gene were also identified. The frequencies of missense alterations were examined in a set of 200 chromosomes. No alteration of the AR gene was found. We did not observe much difference in clinicopathological features between carriers and non-carriers of BRCA2 mutations. Five of 37 patients (14%) had a family history of breast cancer, in one first- or second-degree relative, among the latter was one mutation carrier. The results of this study suggest that germ-line BRCA2 mutations account for rather small proportion of male breast cancer in Poland.

Expression of interleukin-6, interleukin-6 receptor, and glycoprotein 130 correlates with good prognoses for patients with breast carcinoma.

BACKGROUND: Interleukin-6 (IL-6) is secreted by normal epithelial breast cells but not by oncogene-transformed cells. Interleukin-6 is able to inhibit growth of breast carcinoma cells in culture. Interleukin-6 exerts its activity via two receptor subunits, IL-6R and glycoprotein 130 (gp130). The expression of these receptor subunits in breast tumors has been studied, but there are no previous reports of their prognostic significance, to the authors' knowledge. METHODS: mRNA of IL-6, IL-6R, and gp130 was studied in 75 tumor samples obtained from breast carcinoma patients. Patients were followed for a maximum of 71 months (median follow-up, 61 months; 60 patients were followed for a minimum of 5 years or died during the observation period). Prognostic factors were analyzed in univariate and multivariate analysis. RESULTS: mRNA specific to IL-6, IL-6R, and gp130 was detected in 57%, 53%, and 71% of breast carcinoma tissues, respectively. Expression was strongly correlated with earlier stages of the disease. In univariate analysis, expression of IL-6 and its receptor subunits proved to be a positive prognostic factor for overall survival (OS) and disease free survival (DFS). IL-6R and gp130 expression were good independent prognostic factors for OS. The 5-year OS of all patients was 66%. The 5-year OS in IL-6, IL-6R, and gp130 positive groups was 95%, 94%, and 90%, respectively, whereas in negative groups it was 26%, 31%, and 9%, respectively. CONCLUSIONS: Expression of IL-6, IL-6R, and gp130 in breast carcinoma tissue is associated with earlier stages of the disease. In advanced stages, expression of IL-6 and its receptor subunits predicts better prognosis.

[Thyroid cancer in autonomous "hot nodule"]. / Rak tarczycy w autonomicznym "guzku goracym"

17-year-old girl with thyroid tumor of the right lobe is described in this paper. Based on clinical picture and diagnostic criteria the follicular adenoma was suspected pre-operatively as the most likely final diagnosis. Post-operative histopathological evaluation proved the presence of the oxyphilic type of follicular thyroid cancer within the follicular adenoma. The authors analyze the possibilities of the pre-operative discovery of the discussed cancer.

Lectin staining of renal tubules in normal kidney.

Lectins are glycoproteins able to bind carbohydrate structures specifically. In this study we applied six different lectins on normal renal tissue to investigate their specificity for different segments of the renal tubular system. The following lectins were used: jacalin, peanut agglutinin (PNA), wheat germ agglutinin (WGA), phytohemagglutinin E (PHA-E), concanavalin A (Con A), and Dolichos biflorus agglutinin (DBA). Particular attention was paid to jacalin lectin as its staining properties respecting the renal tubular system were not known. We showed that jacalin lectin strongly stains the luminal border of distal tubules, as well as single cells of the collecting tubules. As regards the other five lectins, PNA stained distal tubules, WGA the whole nephron, PHA-E proximal tubules, and Con A and DBA a few cells of the loop of Henle.

Lectin staining of renal cell tumours with special emphasis on oncocytomas.

There are conflicting results respecting the segmental tubular origin of renal oncocytomas, a type of tumour said to be highly differentiated and benign, though metastases have been described. The aim of this study was, by applying different lectins on renal cell carcinomas (n = 50) and oncocytomas (n = 12), to search for patterns which could indicate a specific segmental origin of oncocytomas and perhaps elucidate the differentiation of this tumour. The following lectins were applied: jacalin, peanut agglutinin (PNA), wheat germ agglutinin (WGA), phytohemagglutinin E (PHA-E), concanavalin A (Con A), and Dolichos biflorus agglutinin (DBA). The results show that oncocytomas are positive when jacalin, a Lectin that stains distal tubules and collecting tubules, is used, supporting the view that the tumour derives from distal or collecting tubules. The staining of the oncocytomas is generally polarized as in normal kidney tubules underlining that the tumour is highly differentiated. Two oncocytomas with aggressive behaviour showed areas with a diffuse pattern suggesting lower differentiation.

Morphological aspects of the aortofemoral graft thrombosis.

Sixty seven patients underwent aorto-femoral double velour grafting for aortoiliac occlusive disease and 38 patients were treated for recurrent lower limb ischemia following aortofemoral grafting. Apart from various clinical examinations the patients underwent angiography as well as the morphological investigation of specimens obtained from abdominal aortae, common femoral arteries and from grafts implanted into the aorto-femoral section. The examinations showed that diffuse intimal thickening may, in the course of atherosclerosis, convert itself into uncomplicated fibrous and further into complicated plaques impairing mainly graft outflow. The drawbacks of grafts are: 1) persistens of fibrin deposits on the luminal surface of the prosthesis which may contribute to thrombosis development, 2) appearance of foci or bands of hyalinized connective tissue causing the stiffening of the graft, 3) development of lesions resembling atheromatous changes at the anastomotic areas and, 4) anastomotic hyperplasia which may contribute to stenosis at the femoral implantation site.

Morphological changes in femoropopliteal venous grafts.

Morphological examination of specimens obtained from 82 venous grafts implanted into the femoropopliteal section were done. Intimal oedema, necrosis of single smooth muscle cells and partial exfoliation of the endothelium with as occurrence of parietal thrombi may lead to early graft impatency. The late cause of stenosed inner diameter below 4 mm in the venous graft was in 14,6% the hyperplasia of the smooth muscle cells and collagen and elastin fibres in the intima, whereas in 4,9% the changes were defined as graft atherosclerosis.

[Diagnostic value of fine needle aspiration biopsy in liver and pancreas diagnosis with computer tomography control]. / Diagnostischer Wert der Feinnadelaspirationsbiopsie in der Leber- und Pankreasdiagnostik unter Computertomographiekontrolle.

The aspiration biopsy with thin-needles controlled by computer tomography permits an aimed, safety and nearly not dangerous investigation of patients with liver and pancreas diseases. The cytologic examination allows the differentiation of neoplastic tumors from other processes.