Papillary thyroid carcinomas. Morphology and prognosis.

It is generally believed that the histological pattern of papillary thyroid carcinomas has no influence on the course of the disease. However, we were puzzled by the evidence differences in the clinical course of these tumours and decided to re-examine all microscopic specimens available at the Institute of Pathology of the University of Zürich. These had been obtained from 169 surgical cases operated on between 1962 and 1977. We classified the material according to precise morphological criteria and matched it with a number of clinical and catamnestic data in order to determine which parameters correspond best with the development of the disease. Although the fate of patients below 50 years of age is slightly more favourable than that of older subjects, age is by no means the most important factor. In fact, the prognosis correlates significantly better with the initial local extension of the primary tumour (occult, intrathyroid or extrathyroid). Furthermore, this parameter is closely related to the histological pattern of our various papillary carcinoma subtypes which we graded according to differentiation. All factors considered, the morphological pattern appears to offer a rewarding approach to the provision of an accurate prognosis.

Parathyroid response to EDTA in hypoparathyroidism and in tetany.

The parathyroid response to an EDTA infusion was measured in 11 patients with hypoparathyroidism and 22 patients with normocalcaemic tetany, and compared to that of normal controls and of 23 patients with primary hyperparathyroidism. Despite comparable basal PTH values, the patients with hypoparathyroidism and the normocalcaemic patients, with tetany following thyroid surgery, responded less than normals to EDTA, while normocalcaemic patients with tetany due to psychogenic hyperventilation responded more than normals. In hypoparathyroidism, mainly three types of results were observed: no response (total hypoparathyroidism), diminished or delayed response (partial hypoparathyroidism), and discrepant results using different antisera in cases of idiopathic hypoparathyroidism, suggesting the secretion of immunologically abnormal PTH. In tetany due to psychogenic hyperventilation, parathyroid hyperreactivity might be explained by repeated stimulation through respiratory alkalosis. Although the EDTA test rarely improved the diagnostic accuracy of basal PTH measurements in primary hyperparathyroidism, it was useful for differentiating between latent hypoparathyroidism and tetany due to psychogenic hyperventilation, both presenting with normal plasma calcium.

[Follicular carcinoma with sarcomatoid dedifferentiation or thyroid gland carcinosarcoma?]. / Carcinome folliculaire avec dédifférenciation sarcomatoïde ou carcinosarcome de la glande thyroïde?

Thyroid carcinoma may at times display unusual clinical and anatomo-pathologic behaviour. The case of a female patient associating goiter of long standing with a fulminating terminal course is presented. Since the patient was never treated, the evolution of her condition is thought to reflect the natural biologic behaviour of the disease process. Pathologic examination revealed the co-existence of both follicular and anaplastic carcinoma within the primary lesion. Moreover, metastases were either entirely follicular or poorly differentiated in structure, and occasionally even of striking sarcomatoid appearance. The possibility of carcinosarcoma was entertained but dismissed in view of the recent literature. Rather, the hypothesis of tumour dedifferentiation offers a more satisfactory explanation for the clinical course and pathologic findings.