Endocrine Malignancies
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Adrenocortical Cancer
Multiple Endocrine Neoplasia /Familial Thyroid Ca.
Pancreas Cancer
Parathyroid Cancer
Pheochromocytoma and Paraganglioma
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Thymoma and Thymic Carcinoma
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Medical Terminology for Cancer: The Endocrine System
Endocrinology / General Resources
Latest Research Publications

Endocrinology / General Resources (5 links)

Latest Research Publications

This list of publications is regularly updated (Source: PubMed).

Sokouti M, Montazeri V, Fakhrjou A, et al.
Thyroid cancer, clinical and hystopathological study on patients under 25 years in Tabriz, Iran (2000-2012).
Pak J Biol Sci. 2013; 16(24):2003-8 [PubMed] Related Publications
Thyroid cancer comprises a broad spectrum of diseases with variable prognoses. The aim of this study was to assess thyroid cancer in young population using the surveillance, epidemiology and end results database and whether radioactive fallout from the Chernobyl accident in 1986 influenced thyroid cancer incidence among children and adolescents in Tabriz, Iran. Patients aged 5-25 in Tabriz from April 2000 to April 2012 were studied. Using the surveillance and end results database, the study examined the overall incidence of thyroid cancer with variations based on tumor pathology, size and stage, as well as the current surgical therapy of thyroid carcinoma. This study demonstrated a positive correlation between thyroid carcinoma tumor size and stage of disease. Mortality rates were higher among men than women. Recurrence rates are also higher in men. Compared with women, men have greater likelihood ofloco regional lymph node involvement and more than twice the rate of distant metastases. Operative treatment for thyroid cancer also has shifted with Radical dissection+Total thyroidectomy replacing partial thyroidectomy as the most common surgical procedure. Our data indicate that the increasing incidence of thyroid cancer cannot be accounted for fully by an increased detection of small neoplasms. This study show the increasing in thyroid cancer incidence related to exposure to radiation from the Chernobyl accident.

Related: Thyroid Cancer

Liu Y, Sadowski SM, Weisbrod AB, et al.
Multimodal image driven patient specific tumor growth modeling.
Med Image Comput Comput Assist Interv. 2013; 16(Pt 3):283-90 [PubMed] Related Publications
Personalized tumor growth model using clinical imaging data is valuable in tumor staging and therapy planning. In this paper, we build a patient specific tumor growth model based on longitudinal dual phase CT and FDG-PET. We propose a reaction-advection-diffusion model integrating cancerous cell proliferation, infiltration, metabolic rate and extracellular matrix biomechanical response. We then develop a scheme to bridge our model with multimodal radiologic images through intracellular volume fraction (ICVF) and Standardized Uptake Value (SUV). The model was evaluated by comparing the predicted tumors with the observed tumors in terms of average surface distance (ASD), root mean square difference (RMSD) of the ICVF map, the average ICVF difference (AICVFD) of tumor surface and the tumor relative volume difference (RVD) on six patients with pathologically confirmed pancreatic neuroendocrine tumors. The ASD between the predicted tumor and the reference tumor was 2.5 +/- 0.7 mm, the RMSD was 4.3 +/- 0.6%, the AICVFD was 2.6 +/- 0.8%, and the RVD was 7.7 +/- 1.9%.

Related: Cancer of the Pancreas Pancreatic Cancer

Xing F, Su H, Yang L
An integrated framework for automatic Ki-67 scoring in pancreatic neuroendocrine tumor.
Med Image Comput Comput Assist Interv. 2013; 16(Pt 1):436-43 [PubMed] Related Publications
The Ki-67 labeling index is a valid and important biomarker to gauge neuroendocrine tumor cell progression. Automatic Ki-67 assessment is very challenging due to complex variations of cell characteristics. In this paper, we propose an integrated learning-based framework for accurate Ki-67 scoring in pancreatic neuroendocrine tumor. The main contributions of our method are: a novel and robust cell detection algorithm is designed to localize both tumor and non-tumor cells; a repulsive deformable model is applied to correct touching cell segmentation; a two stage learning-based scheme combining cellular features and regional structure information is proposed to differentiate tumor from non-tumor cells (such as lymphocytes); an integrated automatic framework is developed to accurately assess the Ki-67 labeling index. The proposed method has been extensively evaluated on 101 tissue microarray (TMA) whole discs, and the cell detection performance is comparable to manual annotations. The automatic Ki-67 score is very accurate compared with pathologists' estimation.

Related: Cancer of the Pancreas Pancreatic Cancer

Kapoor G, Salhan S, Sarda N, et al.
Phaeochromocytoma in pregnancy: safe vaginal delivery, is it possible?
J Indian Med Assoc. 2013; 111(4):266-7 [PubMed] Related Publications
Pheochromocytoma in pregnancy is rare (1 in 50,000 full term pregnancies). Recognition of the condition is central to improving outcome (maternal and foetal mortality is reduced from 58% and 56%, respectively to 2% and 11-15%, respectively). An antenatal patient in third trimester diagnosed as pheochromocytoma has been described. Diagnosis of pheochromocytoma was confirmed by urinary VMA levels and demonstration of right adrenal mass on ultrasound. A multidisciplinary approach was used and the patient received antihypertensives for 10 days. Vaginal delivery was conducted under epidural analgesia and the patient was kept under close surveillance. She delivered a healthy baby girl weighing 2.5 kg. The intrapartum and the postpartum period were uneventful. Adrenalectomy was done at 6 weeks postpartum. Using multidisciplinary approach and individualised management decreases both maternal and foetal morbidity and mortality. Selected multigravidae cases and those with previous history of short uncomplicated labour, may be considered for vaginal delivery under epidural analgesia and with back up facilities available to manage hypertensive crisis.

Related: Breast cancer in pregnancy

Mnif H, Chakroun A, Charfi S, et al.
Primary mucinous carcinoma of the thyroid gland: case report with review of the literature.
Pathologica. 2013; 105(4):128-31 [PubMed] Related Publications
Primary mucinous thyroid carcinoma (PMTC) are extremely rare lesions that are histologically indistinguishable from mucinous carcinoma of other sites. We describe the clinicopathological, histological and immunohistochemical features of this rare tumour with a review of the literature. We describe a case of thyroid tumour, in 56-year-old Tunisian man, composed of small nests and sheets of malignant epithelial cells associated with extensive extracellular mucin that entrapped the follicular parenchyma of thyroid. Thyroglobulin and thyroid-specific-transcription factor 1 (TTFl) were focally positive. Follow-up did not reveal another neoplasm at other sites. Based on these features, we classified this tumour as PMTC. Mucinous carcinoma of the thyroid gland can be a cause of pitfall in differential diagnosis. For correct diagnosis, complete clinical history, restricted histological criteria and immunohistochemical panel are necessary.

Related: Thyroid Cancer

Sokolov M, Toshev S, Todorov G, et al.
Per magna-ovarian metastases from primary locally advanced colorectal cancer--a review of the literature with a description of three clinical cases.
Khirurgiia (Sofiia). 2013; (3):39-47 [PubMed] Related Publications
Krukenberg tumor is defined as metastatic lesions of gastrointestinal cancers. Several specific immunohistochemical methods can identify the main focus of malignant neoplasm. Ovarian metastases from colorectal cancer are rarely seen phenomenon. The authors examine in detail the literature on this issue and describe three own clinical cases of metachronous ovarian meta lesions in women undergoing surgery for locally advanced colorectal cancer--two of these metastases are unilateral, while one--bilateral established in a short time interval despite the casuistic nature of the pathology. One of the patients died in the early postoperative period of co-morbid complications unrelated to the underlying disease, and the other two monitoring continues during the adjuvant. Krukenberg-metastases from colorectal cancer occur in the blood-vascular pattern in time without damage to the left or right ovary. Metachronous development and operative treatment of ovarian metastases is far better prognosis of the cases with and operated simultaneously established metastases in the ovaries.

Related: Colorectal (Bowel) Cancer

Schultz NA, Dehlendorff C, Jensen BV, et al.
MicroRNA biomarkers in whole blood for detection of pancreatic cancer.
JAMA. 2014 Jan 22-29; 311(4):392-404 [PubMed] Related Publications
IMPORTANCE: Biomarkers for the early diagnosis of patients with pancreatic cancer are needed to improve prognosis.
OBJECTIVES: To describe differences in microRNA expression in whole blood between patients with pancreatic cancer, chronic pancreatitis, and healthy participants and to identify panels of microRNAs for use in diagnosis of pancreatic cancer compared with the cancer antigen 19-9 (CA19-9).
DESIGN, SETTING, AND PARTICIPANTS: A case-control study that included 409 patients with pancreatic cancer and 25 with chronic pancreatitis who had been included prospectively in the Danish BIOPAC (Biomarkers in Patients with Pancreatic Cancer) study (July 2008-October 2012) plus 312 blood donors as healthy participants. The microRNA expressions in pretreatment whole blood RNA samples were collected and analyzed in 3 randomly determined subcohorts: discovery cohort (143 patients with pancreatic cancer, 18 patients with chronic pancreatitis, and 69 healthy participants), training cohort (180 patients with pancreatic cancer, 1 patient with chronic pancreatitis, and 199 healthy participants), and validation cohort (86 patients with pancreatic cancer, 7 patients with chronic pancreatitis, and 44 healthy participants); 754 microRNAs were screened in the discovery cohort and 38 microRNAs in the training cohort and 13 microRNAs in the validation cohort.
MAIN OUTCOMES AND MEASURES: Identification of microRNA panels (classifiers) for diagnosing pancreatic cancer.
RESULTS: The discovery cohort demonstrated that 38 microRNAs in whole blood were significantly dysregulated in patients with pancreatic cancer compared with controls. These microRNAs were tested in the training cohort and 2 diagnostic panels were constructed comprising 4 microRNAs in index I (miR-145, miR-150, miR-223, miR-636) and 10 in index II (miR-26b, miR-34a, miR-122, miR-126*, miR-145, miR-150, miR-223, miR-505, miR-636, miR-885.5p). The test characteristics for the training cohort were index I area under the curve (AUC) of 0.86 (95% CI, 0.82-0.90), sensitivity of 0.85 (95% CI, 0.79-0.90), and specificity of 0.64 (95% CI, 0.57-0.71); index II AUC of 0.93 (95% CI, 0.90-0.96), sensitivity of 0.85 (95% CI, 0.79-0.90), and specificity of 0.85 (95% CI, 0.80-0.85); and CA19-9 AUC of 0.90 (95% CI, 0.87-0.94), sensitivity of 0.86 (95% CI, 0.80-0.90), and specificity of 0.99 (95% CI, 0.96-1.00). Performances were strengthened in the validation cohort by combining panels and CA19-9 (index I AUC of 0.94 [95% CI, 0.90-0.98] and index II AUC of 0.93 [95% CI, 0.89-0.97]). Compared with CA19-9 alone, the AUC for the combination of index I and CA19-9 was significantly higher (P = .01). The performance of the panels in patients with stage IA-IIB pancreatic cancer was index I AUC of 0.80 (95% CI, 0.73-0.87); index I and CA19-9 AUC of 0.83 (95% CI, 0.76-0.90); index II AUC of 0.91 (95% CI, 0.87-0.94); and index II and CA19-9 AUC of 0.91 (95% CI, 0.86-0.95).
CONCLUSIONS AND RELEVANCE: This study identified 2 diagnostic panels based on microRNA expression in whole blood with the potential to distinguish patients with pancreatic cancer from healthy controls. Further research is necessary to understand whether these have clinical implications for early detection of pancreatic cancer and how much this information adds to serum CA19-9.

Related: Cancer of the Pancreas Pancreatic Cancer

Wang H, Mu X, Zhou S, et al.
NEDD9 overexpression is associated with the progression of and an unfavorable prognosis in epithelial ovarian cancer.
Hum Pathol. 2014; 45(2):401-8 [PubMed] Related Publications
Neural precursor cell-expressed, developmentally down-regulated 9 (NEDD9), a scaffolding protein, has been identified as a prometastatic and poor prognostic gene in multiple malignant tumors. However, the potential role of the NEDD9 protein in epithelial ovarian cancer (EOC) remains unclear. In the present study, we investigated the expression of NEDD9 and the correlation between NEDD9 expression and prognosis in EOC. NEDD9 expression was detected in 129 archived EOC specimens by immunohistochemical staining and in 28 freshly frozen EOC specimens by Western blotting. The expression of NEDD9 was evaluated in ovarian cancer cell lines by Western blotting and immunofluorescence. The association between the expression of NEDD9 and prognosis was determined by survival analysis. Results suggested that NEDD9 was overexpressed in EOC specimens compared with noninvasive epithelial ovarian tumors and normal ovarian specimens. A high level of NEDD9 expression significantly correlated with advanced-stage tumors (International Federation of Gynecology and Obstetrics classes III-IV, P < .001), high-grade carcinoma (grades 2-3, P < .001), and suboptimal primary cytoreductive surgery (residual disease <1cm, P = .021). The expression level of NEDD9 varied in ovarian cancer cell lines. Multivariate analysis indicated that NEDD9 overexpression (P = .033), advanced stage (P < .001), and high-grade carcinoma (P = .01) were independent predictors of poor survival. In conclusion, NEDD9 is overexpressed and associated with an unfavorable prognosis in EOC. NEDD9 overexpression is an independent factor of poor prognosis and may serve as a potential biomarker in EOC.

Related: Ovarian Cancer

Lok T, Chen L, Lin F, Wang HL
Immunohistochemical distinction between intrahepatic cholangiocarcinoma and pancreatic ductal adenocarcinoma.
Hum Pathol. 2014; 45(2):394-400 [PubMed] Related Publications
Distinction between primary intrahepatic cholangiocarcinoma (ICC) and metastatic pancreatic ductal adenocarcinoma (PDA) on a liver biopsy is essentially impossible histologically but has important clinical implications. In this study, 41 ICCs and 60 PDAs were immunohistochemically evaluated for the expression of S100P, pVHL, IMP3, maspin, MUC5AC, and CK17 proteins. The results showed pVHL expression in 29 (71%) ICCs but in only 3 (5%) PDAs. S100P, MUC5AC, and CK17 were frequently expressed in PDAs, seen in 57 (95%), 40 (67%), and 36 (60%) cases, respectively. In contrast, only 11 (27%), 5 (12%), and 5 (12%) ICC cases expressed these proteins. IMP3 was expressed in 37 (90%) ICC and 54 (90%) PDA cases with equal frequency. All 60 (100%) PDA and 30 (73%) ICC cases showed positive maspin immunoreactivity. A S100P-/pVHL+/MUC5AC-/CK17- staining pattern was essentially indicative of ICC, whereas the S100P+/pVHL-/MUC5AC+/CK17+ and S100P+/pVHL-/MUC5AC-/CK17+ staining patterns were suggestive of PDA. These observations demonstrate that S100P, pVHL, MUC5AC, and CK17 are a useful immunohistochemical panel that may help distinguish primary ICC from metastatic PDA.

Related: Liver Cancer Cancer of the Pancreas Pancreatic Cancer

Reid MD, Saka B, Balci S, et al.
Molecular genetics of pancreatic neoplasms and their morphologic correlates: an update on recent advances and potential diagnostic applications.
Am J Clin Pathol. 2014; 141(2):168-80 [PubMed] Related Publications
OBJECTIVES: To summarize the most clinically and biologically relevant advances in molecular/genetic characteristics of various pancreatic neoplasms, with morphologic correlation.
METHODS: Whole-exome sequencing of numerous benign and malignant pancreatic tumors, along with the plethora of highly sensitive molecular studies now available for analyzing these tumors, provide mounting evidence to support the long-held belief that cancer is essentially a genetic disease. These genetic discoveries have not only helped to confirm the age-old, morphology-based classifications of pancreatic neoplasia but have shed new light on their mechanisms. Many of these molecular discoveries are currently being used in preoperative diagnosis.
RESULTS: Mutations in KRAS, P16/CDKN2A, TP53, and SMAD4/DPC4 are commonly seen in ductal neoplasia but not in nonductal tumors; ductal adenocarcinomas with SMAD4/DPC4 loss are associated with widespread metastasis and poor prognosis. GNAS and RNF43 mutations have been discovered in most intraductal pancreatic mucinous neoplasms, providing critical molecular fingerprints for their diagnosis. Mutation in DAXX/ATRX is only seen in pancreatic neuroendocrine tumors, making it a useful potential marker in distinguishing these tumors from mimics.
CONCLUSIONS: When combined with morphologic observations, molecular studies will increase our understanding of the pathogenesis and morphomolecular signatures associated with specific neoplasms and provide new horizons for precision medicine and targeted therapies.

Related: Cancer of the Pancreas Pancreatic Cancer

Havrilesky LJ, Gierisch JM, Moorman PG, et al.
Oral contraceptive use for the primary prevention of ovarian cancer.
Evid Rep Technol Assess (Full Rep). 2013; (212):1-514 [PubMed] Related Publications
OBJECTIVE: To estimate the overall balance of harms and benefits from the potential use of oral contraceptives (OCs) for the primary prevention of ovarian cancer
DATA SOURCES: We searched PubMed®, Embase®, the Cochrane Database of Systematic Reviews, and ClinicalTrials.gov for English-language studies published from January 1990 to June 2012 that evaluated the potential benefits (reduction in ovarian, colorectal, and endometrial cancers) and harms (increase in breast and cervical cancer, and vascular complications) of OC use.
REVIEW METHODS: Two investigators screened each abstract and full-text article for inclusion; the investigators abstracted data, and they performed quality ratings, applicability ratings, and evidence grading. Random-effects models were used to compute summary estimates of effects. A simulation model was used to estimate the effects of OC use on the overall balance of benefits and harms.
RESULTS: We reviewed 55 studies relevant to ovarian cancer outcomes, 66 relevant to other cancers, and 50 relevant to vascular events. Ovarian cancer incidence was significantly reduced in OC users (OR [odds ratio], 0.73; 95% CI [confidence interval], 0.66 to 0.81), with greater reductions seen with longer duration of use. Breast cancer incidence was slightly but significantly increased in OC users (OR, 1.08; 95% CI, 1.00 to 1.17), with a significant reduction in risk as time since last use increased. The risk of cervical cancer was significantly increased in women with persistent human papillomavirus infection who used OCs, but heterogeneity prevented a formal meta-analysis. Incidences of both colorectal cancer (OR, 0.86; 95% CI, 0.79 to 0.95) and endometrial cancer (OR, 0.57; 95% CI, 0.43 to 0.76) were significantly reduced by OC use. The risk of vascular events was increased in current OC users compared with nonusers, although the increase in myocardial infarction was not statistically significant. The overall strength of evidence for ovarian cancer prevention was moderate to low, primarily because of the lack of randomized trials and inconsistent reporting of important characteristics of use, such as duration. The simulation model predicted that the combined increase in risk of breast and cervical cancers and vascular events was likely to be equivalent to or greater than the decreased risk in ovarian cancer, although the harm/benefit ratio was much more favorable when protection against endometrial and colorectal cancers was added, resulting in net gains in life expectancy of approximately 1 month.
CONCLUSIONS: There is insufficient evidence to recommend for or against the use of OCs solely for the primary prevention of ovarian cancer. Although the net effects of the current patterns of OC use likely result in increased life expectancy when other noncontraceptive benefits are included, the harm/benefit ratio for ovarian cancer prevention alone is uncertain, particularly when the potential quality-of-life impact of breast cancer and vascular events are considered.

Related: Ovarian Cancer

Estrella JS, Li L, Rashid A, et al.
Solid pseudopapillary neoplasm of the pancreas: clinicopathologic and survival analyses of 64 cases from a single institution.
Am J Surg Pathol. 2014; 38(2):147-57 [PubMed] Related Publications
Although solid pseudopapillary neoplasms (SPNs) are considered tumors of low malignant potential, patients may present with aggressive disease (ie, liver metastasis/invasion into adjacent organs) and, rarely, die from disease. Although the clinicopathologic features associated with aggressive SPNs have been reported, important prognostic factors of survival remain unclear. We systematically reviewed 64 cases of SPN resected at our institution for tumor size, extent of invasion, margin status, presence of lymphovascular, muscular vessel, and perineural invasion, and lymph node and distant metastases. Clinicopathologic characteristics were correlated with the presence of metastasis/recurrence and disease-specific survival. Five (8%) patients presented with stage IV disease. During follow-up, 5 (13%) of 39 patients with stage I-II disease had recurrences. Patients with metastatic/recurrent SPNs had significantly larger tumor size (P<0.001) and more frequent tumor invasion into muscular vessels (P=0.02). In a median follow-up of 76 months, only 2 died of disease (1 who presented with extensive peritoneal tumor involvement who died 2.5 mo after surgery, and 1 unusual case who presented with multiple liver metastasis and peritoneal seeding who died 19 mo after surgery), and 5 were alive with disease. The 10-year disease-specific survival rate was 96%. Muscular vessel invasion (P=0.001), tumor (T) stage by European Neuroendocrine Tumors Society (ENETS) classification (P<0.001), ENETS stage grouping (P<0.001), and stage grouping by the American Joint Committee on Cancer (AJCC stage, P<0.001) were important predictors of disease-specific survival in patients with SPN. Our study highlights the importance of pathologic evaluation in risk assessment in patients with SPNs.

Related: Cancer of the Pancreas Pancreatic Cancer

Abbasi NZ, Zahur Z, Sheikh AS, et al.
Testicular choriocarcinoma: diagnosed on cervical lymph node biopsy.
J Pak Med Assoc. 2013; 63(12):1544-6 [PubMed] Related Publications
Choriocarcinoma is a very rare germinal testicular tumour and in literature its incidence has been reported to be 0.3% of all germinal testicular tumours. An important tumour marker is serum beta-hCG which not only helps in establishing diagnosis but also in assessing response to chemotherapy. In this study we present a case of testicular choriocarcinoma, who presented with abdominal pain, cough, generalized weakness and left sided cervical mass. Incisional biopsy of cervical mass was performed. Histopathology revealed metastatic choriocarcinoma. Serum beta-hCG levels were 1227 ng/mL. Patient received intravenous cycles of PEB (cisPlatin, Etoposide, Bleomycin) chemotherapy but he had progressive disease both radiologically and on tumour marker monitoring. He was planned for salvage chemotherapy but was lost to follow up there after. It is concluded that in males, choriocarcinoma carries a very dismal prognosis and a very poor response to chemotherapy and radiotherapy; surgery has no role in the management.

Related: Testicular Cancer

Rustgi AK
Familial pancreatic cancer: genetic advances.
Genes Dev. 2014; 28(1):1-7 [PubMed] Article available free on PMC after 01/07/2014 Related Publications
Beset by poor prognosis, pancreatic ductal adenocarcinoma is classified as familial or sporadic. This review elaborates on the known genetic syndromes that underlie familial pancreatic cancer, where there are opportunities for genetic counseling and testing as well as clinical monitoring of at-risk patients. Such subsets of familial pancreatic cancer involve germline cationic trypsinogen or PRSS1 mutations (hereditary pancreatitis), BRCA2 mutations (usually in association with hereditary breast-ovarian cancer syndrome), CDKN2 mutations (familial atypical mole and multiple melanoma), or DNA repair gene mutations (e.g., ATM and PALB2, apart from those in BRCA2). However, the vast majority of familial pancreatic cancer cases have yet to have their genetic underpinnings elucidated, waiting in part for the results of deep sequencing efforts.

Related: Melanoma Cancer of the Pancreas Pancreatic Cancer

Ahmed S, Ahmad M, Khan MA, et al.
The interobserver reproducibility of thyroid cytopathology using Bethesda Reporting System: analysis of 200 cases.
J Pak Med Assoc. 2013; 63(10):1252-5 [PubMed] Related Publications
OBJECTIVE: To determine interobserver reproducibility of thyroid cytopathology in cases of thyroid fine needle aspirates.
METHODS: The retrospective, descriptive study, was conducted at the Foundation University Medical College, Islamabad, using cases related to period between 2009 and 2011. A total of 200 cases of fine-needle aspirations were retrieved from the archives. Three histopathologists independently categorised them into 6 groups according to Bethesda reporting system guidelines without looking at previous reports. Kappa statistics were used for analysis of the results on SPSS 17.
RESULTS: Of the 200 patients, 194 (97%) were females and 6 (3%) were males. The overall mean age of patients was 46 +/- 20 years. Kappa value calculated for observer-1 and observer-2 was 0.735; for observer-1 and observer-3, 0.841; and for observer-2 and observer-3, 0.838, showing substantial interobserver agreement. Histopathological correlation was available, for 39 (19.5%). Of these cases, 5 (13%) were 'non-diagnostic, 20 (51%) 'benign, 2 (5%) 'atypia of undetermined significance/follicular lesion of undetermined significance, 6 (15%) 'follicular neoplasm, 1 (3%) 'suspicious for malignancy, and 5 (13%) 'malignant.
CONCLUSIONS: Good overall interoberver agreement was found, but discordance was seen when certain categories were analysed separately.

Kunstman JW, Korah R, Healy JM, et al.
Quantitative assessment of RASSF1A methylation as a putative molecular marker in papillary thyroid carcinoma.
Surgery. 2013; 154(6):1255-61; discussion 1261-2 [PubMed] Related Publications
BACKGROUND: Epigenetic alterations such as DNA methylation are widespread cancer, contributing to tumorigenesis and acting as markers for prognostication. Papillary thyroid cancer (PTC) demonstrates tumor-specific methylation of numerous genes, including RASSF1A. Although the function of RASSF1A in PTC tumorigenesis is still being defined, quantitative evaluation of RASSF1A methylation and its correlation with tumor characteristics has not been performed.
METHODS: Analysis of RASSF1A methylation was performed using quantitative polymerase chain reaction after methylation-dependent and -sensitive restriction enzyme digestion in PTC (n = 41) and normal (n = 18) thyroid tissue. Methylation was then evaluated for correlation with tumor size, stage, and multiple histopathologic characteristics.
RESULTS: RASSF1A promoter hypermethylation was observed in nearly all PTC cases versus normal thyroid tissue, with mean hypermethylation 4.2 times greater in PTC (P < .05). Hypermethylation was greater in multifocal than unifocal PTC (P < .05). Furthermore, tumor methylation was inversely correlated with extracapsular invasion (P < .05).
CONCLUSION: RASSF1A methylation differs in PTC compared with normal thyroid, is associated with multifocality, and is inversely correlated with extracapsular invasion. The ease of evaluating methylation status with minute amounts of DNA suggests a potential role for RASSF1A as a molecular marker for characterization of PTC histopathology.

Related: Thyroid Cancer RASSF1

Kruijff S, Aniss AM, Chen P, et al.
Decreasing the dose of radioiodine for remnant ablation does not increase structural recurrence rates in papillary thyroid carcinoma.
Surgery. 2013; 154(6):1337-44; discussion 1344-5 [PubMed] Related Publications
BACKGROUND: Our aim was to compare the rate of structural recurrence between patients who had lesser doses of radioactive iodine (RAI) and those who had traditional greater doses for remnant ablation after total thyroidectomy for papillary thyroid carcinoma (PTC).
METHODS: A retrospective cohort study of patients who had undergone thyroidectomy and RAI for PTC was undertaken. We divided the cohort into those who had < or =3 GBq (75 mCi) RAI (group A) and those who had >3 GBq (75 mCi) RAI (group B). The primary outcome measure was the rate of structural recurrence.
RESULTS: Of 1,171 patients with PTC from 1990 to 2012 who were followed for a mean of 60 months, 970 with T1–T3 tumors underwent RAI in addition to thyroidectomy. The mean first dose of RAI was 2.5 GBq (68 mCi) for group A (n = 153) and 4.7 GBq (127 mCi) for group B (n = 817; P < .001). The overall rate of recurrence was 8%. When corrected for T stage, the recurrence rates were not different for T1 tumors (2% group A versus 4% group B; P = .54) nor for T2 and T3 tumors (P = .36 and .55, respectively). On multivariate analysis, the dose of RAI was not an independent predictor for structural recurrence.
CONCLUSION: Decreasing the dose of RAI at initial ablation for patients with pT1–pT3 PTC does not seem to be associated with an increased risk of structural cancer recurrence.

Related: Thyroid Cancer

Zanocco K, Elaraj D, Sturgeon C
Routine prophylactic central neck dissection for low-risk papillary thyroid cancer: a cost-effectiveness analysis.
Surgery. 2013; 154(6):1148-55; discussion 1154-5 [PubMed] Related Publications
BACKGROUND: Routine prophylactic central neck dissection (pCND) after total thyroidectomy (TTX) for low-risk papillary thyroid cancer (PTC) offers the potential to decrease disease recurrence but may increase operative complications. We hypothesized that routine pCND is not cost-effective in low-risk PTC.
METHODS: A Markov transition-state model was constructed to compare TTX with and without pCND. Outcome probabilities, utilities, and costs were estimated on the basis of literature review. The threshold for cost-effectiveness was $100,000 per quality-adjusted life year. Sensitivity analysis was used to examine model uncertainty.
RESULTS: pCND cost $10,315 and produced an effectiveness of 23.785 quality-adjusted life years. This strategy was more costly and less effective than TTX without pCND and was therefore dominated. pCND became cost-effective when the probability of recurrence increased from 6% to 10.3%, cost of reoperation for recurrence increased from $8,900 to $26,120, or added probabilities of recurrent laryngeal nerve injury and hypoparathyroidism due to pCND were less than 0.20% and 0.18% during 2-way sensitivity analysis. Monte Carlo simulation showed that pCND was not cost-effective in 97.3% of iterations.
CONCLUSION: Routine pCND for low-risk PTC is not cost-effective unless the recurrence rate is greater than 10.3%. Application of pCND should be individualized based on risk of recurrence and added complications.

Related: Thyroid Cancer

Roberts OA, Oranye BC
Ovarian dysgerminoma in an adolescent: a case report.
Afr J Med Med Sci. 2013; 42(2):197-200 [PubMed] Related Publications
INTRODUCTION: Ovarian cancer is the second most frequent gynaecological cancer in Nigeria ranking next after carcinoma of the cervix. It has the highest case-fatality rate worldwide because of insidious onset, lack of effective screening methods and late presentation. This case of a sixteen-year old girl with a three-week history of abdominal pain which was later accompanied by abdominal swelling is a classic example of how dysgerminomas present.
METHOD: The presumptive diagnosis of an ovarian tumour was made after physical examination and this was later confirmed by ultrasound scan. Urgent laparotomy was carried out based on a suspicion of torsion of the pedicle of the cyst.
RESULT: At laparotomy, torsion of the pedicle with an intact capsule and imminent gangrene were found. The histology report revealed a malignant germ cell neoplasm (Dysgerminoma) with focal areas of necrosis without infiltration of the attached omentum.
CONCLUSION: She had conservative surgery (left oophorectomy) done. She, however, defaulted from further follow-up.

Related: Ovarian Cancer

Olusola-Bello MA, Agunloye AM, Adeyinka AO
Ultrasound prevalence and characteristics of incidental thyroid lesions in Nigerian adults.
Afr J Med Med Sci. 2013; 42(2):125-30 [PubMed] Related Publications
AIM/OBJECTIVE: Thyroid lesions are common and range from the incidental, asymptomatic, small solitary nodule to the large and partly intrathoracic masses. Thyroid lesions that are not palpable but identified by radiological imaging for unrelated symptoms are defined as incidentalomas of the thyroid gland.
OBJECTIVE: The aim of this study was to determine the ultrasound prevalence of thyroid incidentalomas and describe the ultrasound characteristics of such detected incidentalomas in Nigerian adults.
METHODS: This was a prospective study that examined 340 subjects over a period of 6 months. They were selected randomly from volunteers and patients presenting for ultrasound examination of other parts of the body. The subjects had their necks examined by palpation and ultrasound in the department of Radiology, University College Hospital, Ibadan, using a General Electric LogicP5 ultrasound machine with a 6-10 MHz linear transducer. Any incidentaloma detected was classified using the 'Thyroid Imaging Reporting and Data System' (TIRADS) classification.
RESULTS: Three hundred and forty (340) subjects comprising of 153 males and 187 females were examined. The ultrasound prevalence of thyroid incidentalomas was 22.4%. Thyroid incidentalomas were more common in females than males but this was not statistically significant. The prevalence of thyroid incidentaloma significantly increased with age up to the seventh decade. Majority of the lesions were solitary, homogenous and cystic.
CONCLUSION: The ultrasound prevalence of thyroid incidentalomas documented in the study area is high (22.4%) and they were commoner in women and older subjects. Majority of the lesions, 41 (53.95%) were classified as TIRADS 2 (benign lesions).

Hsu YW, Ho CY, Yen YS
Reconstructed bone chip detachment is a risk factor for sinusitis after transsphenoidal surgery.
Laryngoscope. 2014; 124(1):57-61 [PubMed] Related Publications
OBJECTIVES/HYPOTHESIS: Sphenoid sinusitis is a complication associated with endoscopic transsphenoidal pituitary surgery. Studies that address the relationship between methods of sellar defect reconstruction and postoperative sinusitis are rare. The purpose of this study was to investigate the incidence, the possible risk factors, and the causative pathogens of sphenoid sinusitis after endoscopic transsphenoidal pituitary surgery.
STUDY DESIGN: Prospective cohort study.
METHODS: We performed a prospective analysis of 182 patients with benign pituitary tumor who underwent endoscopic transsphenoidal pituitary surgery and sellar defect reconstruction with bone chip, from July 2008 through July 2011. All patients were followed up with nasal endoscopy for at least 6 weeks.
RESULTS: Fifty-seven (31.3%) patients developed postoperative sphenoid sinusitis. Comparing the sinusitis and nonsinusitis groups, we found that bone chip detachment was a significant risk factor for postoperative sinusitis, with a relative risk of 2.86 (64.1% vs. 22.4%). The most common pathogens present in cases of postoperative sinusitis were methicillin-sensitive Staphylococcus aureus, Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus.
CONCLUSIONS: Regular follow-up with nasal endoscopy can prevent delayed diagnosis of postoperative sphenoid sinusitis. Culture-directed antibiotics with aggressive endoscopic debridement are an effective treatment for these patients. An optimal reconstruction strategy should be further developed to reduce bone chip detachment and secondary sinusitis.

Related: Pituitary Tumors

Garla V, Kheetan R, Saleem T
Cushing's syndrome in pregnancy: a diagnostic conundrum.
W V Med J. 2013 Nov-Dec; 109(6):34-6 [PubMed] Related Publications
A 31 year old woman who was 16 weeks pregnant was admitted because of headache, blurred vision, excessive weight gain, and hirsutism. Laboratory tests showed low adrenocorticotropic hormone (ACTH) and elevated serum and urinary cortisol. Magnetic resonance imaging showed a left adrenal mass. Left adrenalectomy was done, and histopathology showed an adrenal adenoma. The patient had an uncomplicated delivery after 37 weeks of gestation. Cushing's syndrome is very rare in pregnancy. It may be difficult to diagnose because the clinical and laboratory signs of Cushing's syndrome may be similar to those of pregnancy.

Related: Adrenocortical Cancer Adrenocortical Carcinoma - Molecular Biology Breast cancer in pregnancy

Hobbs HA, Bahl M, Nelson RC, et al.
Journal Club: incidental thyroid nodules detected at imaging: can diagnostic workup be reduced by use of the Society of Radiologists in Ultrasound recommendations and the three-tiered system?
AJR Am J Roentgenol. 2014; 202(1):18-24 [PubMed] Related Publications
OBJECTIVE: The purpose of this study was to determine the number of thyroid nodule workups that could be eliminated and the number of malignant tumors that would be missed if the Society of Radiologists in Ultrasound (SRU) recommendations and the three-tiered system were applied to incidental thyroid nodules (ITN) detected at imaging.
MATERIALS AND METHODS: This retrospective study included ITN in 390 consecutively registered patients who underwent ultrasound-guided fine-needle aspiration of one or more thyroid nodules from July 2010 to June 2011. Images were reviewed, and nodules were categorized according to two workup criteria: ITN seen on ultrasound images were categorized according to SRU recommendations, and those seen on CT, MR, or PET/CT images were classified according to the three-tiered risk-categorization system.
RESULTS: In this study 114 of 390 (29%) patients had nodules first detected incidentally during imaging studies, and 107 patients met the inclusion criteria. These patients had 47 ITN seen at ultrasound and 60 ITN seen at either CT, MRI, or PET/CT. If the SRU recommendations had been applied, 14 of 47 (30%) patients with ITN on ultrasound images would not have received fine-needle aspiration and one of four cases of cancer would have been missed. The missed malignant tumor was a 14-mm localized papillary carcinoma. If the three-tiered system had been applied, 21 of 60 (35%) patients with ITN on CT, MR, or PET/CT images would not have received fine-needle aspiration, but none of the three malignancies would have been missed. Overall, 35 of 107 (33%) of patients with ITN did not meet the SRU recommendations or the three-tiered criteria.
CONCLUSION: Use of the SRU recommendations and three-tiered system can reduce the workup of ITN by one third compared with current practice without specific guidelines. One case of localized papillary carcinoma was missed when the SRU recommendations were used.

Related: Thyroid Cancer

Scarpa MG, Norbedo S, Murru F, et al.
Abdominal asymmetry in a 17 year old girl.
Pediatr Med Chir. 2012 Nov-Dec; 34(6):297-8 [PubMed] Related Publications
The pseudopapillary pancreatic solid tumor (TPSP) is a rare malignancy typical of young adult women (only 12 pediatric cases from 2000 to 2009), it can recur and metastasize. The prognosis is usually good after radical surgical removal. We emphasize the importance of TPSP in differential diagnosis of retrogastric, peripancreatic masses especially in puberal females. We describe the case of an adolescent girl with an abdominal mass revealed as a rare pancreatic neoplasia.

Related: Cancer of the Pancreas Pancreatic Cancer

Torelli T, Lughezzani G, Catanzaro M, et al.
Prostatic metastases from testicular nonseminomatous germ cell cancer: two case reports and a review of the literature.
Tumori. 2013 Sep-Oct; 99(5):e203-7 [PubMed] Related Publications
BACKGROUND: Prostatic metastases from testicular germ cell tumors (TGCTs) are extremely uncommon. To the best of our knowledge, only five cases of prostatic metastases from seminoma have been reported in the literature. Conversely, no cases of metastases to the prostate from nonseminomatous germ cell tumors (NSGCT) have been previously reported.
CASE PRESENTATION: We present two patients who developed prostatic metastases 5 and 21 years after the initial diagnosis. The first case concerned a 28-year-old Caucasian man who underwent a right orchiectomy and right retroperitoneal lymph node dissection (RPLND) for a stage I NSGCT in 1999 and five years later was diagnosed with prostatic metastases. The second case concerned a 30-year-old man treated with a right orchiectomy and right RPLND for stage I NSGCT in 1985 who was diagnosed with prostatic metastases in 2006, 21 years after primary surgery. We reviewed the available literature on the topic.
CONCLUSION: Prostatic metastases from TCGTs are highly unusual. Lower urinary tract symptoms in patients treated for previous testicular cancer require immediate clinical attention. However, because of their extreme rarity, specific clinical investigations to screen for possible prostatic involvement from TGCT should not be recommended.

Related: Bleomycin Cisplatin Cyclophosphamide Etoposide Ifosfamide Testicular Cancer

Virzì S, Iusco D, Baratti D, et al.
Pilot study of adjuvant hyperthermic intraperitoneal chemotherapy in patients with colorectal cancer at high risk for the development of peritoneal metastases.
Tumori. 2013 Sep-Oct; 99(5):589-95 [PubMed] Related Publications
AIMS AND BACKGROUND: The prognosis of peritoneal metastases from colorectal cancer has recently improved with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Although outcomes are further improved when early stage peritoneal metastases are treated, adjuvant hyperthermic intraperitoneal chemotherapy has never been thoroughly addressed. This prospective pilot study assessed feasibility, safety and efficacy of hyperthermic intraperitoneal chemotherapy combined with primary curative surgery in colorectal cancer at high risk for peritoneal metastases.
METHODS: Twelve patients were prospectively selected according to predetermined risk factors for the development of peritoneal metastases. Patients underwent conventional colon surgery, closed-abdomen mitomycin-C plus cisplatin-based hyperthermic intraperitoneal chemotherapy, and cytoreductive surgical procedures, as needed.
RESULTS: Preoperative tumor-related risk factors were confirmed by intraoperative findings and pathological examination in all patients: minimal synchronous peritoneal metastases (n = 2), synchronous ovarian metastases (n = 1), positive peritoneal washing cytology (n = 2), primary tumor directly invading other organs (n = 6), or penetrating visceral peritoneum (n = 1). Major morbidity occurred in 2 patients and operative death in none. Median follow-up was 49 months (range, 22-72). Peritoneal metastases occurred in 1 patient and distant metastases in 2. Five-year overall survival was 83.3%.
CONCLUSIONS: Preoperative/early intraoperative assessment can reliably identify colorectal cancer patients at high risk for peritoneal metastases. Adjuvant hyperthermic intraperitoneal chemotherapy is well tolerated and safe. These preliminary results would support the design of future phase-III trials of adjuvant hyperthermic intraperitoneal chemotherapy.

Related: Cisplatin Colorectal (Bowel) Cancer Mitomycin

Al-Hawary MM, Francis IR, Chari ST, et al.
Pancreatic ductal adenocarcinoma radiology reporting template: consensus statement of the society of abdominal radiology and the american pancreatic association.
Gastroenterology. 2014; 146(1):291-304.e1 [PubMed] Related Publications
Pancreatic ductal adenocarcinoma is an aggressive malignancy with a high mortality rate. Proper determination of the extent of disease on imaging studies at the time of staging is one of the most important steps in optimal patient management. Given the variability in expertise and definition of disease extent among different practitioners as well as frequent lack of complete reporting of pertinent imaging findings at radiologic examinations, adoption of a standardized template for radiology reporting, using universally accepted and agreed on terminology for solid pancreatic neoplasms, is needed. A consensus statement describing a standardized reporting template authored by a multi-institutional group of experts in pancreatic ductal adenocarcinoma that included radiologists, gastroenterologists, and hepatopancreatobiliary surgeons was developed under the joint sponsorship of the Society of Abdominal Radiologists and the American Pancreatic Association. Adoption of this standardized imaging reporting template should improve the decision-making process for the management of patients with pancreatic ductal adenocarcinoma by providing a complete, pertinent, and accurate reporting of disease staging to optimize treatment recommendations that can be offered to the patient. Standardization can also help to facilitate research and clinical trial design by using appropriate and consistent staging by means of resectability status, thus allowing for comparison of results among different institutions.

Related: Cancer of the Pancreas Pancreatic Cancer

Al-Hawary MM, Francis IR, Chari ST, et al.
Pancreatic ductal adenocarcinoma radiology reporting template: consensus statement of the Society of Abdominal Radiology and the American Pancreatic Association.
Radiology. 2014; 270(1):248-60 [PubMed] Related Publications
Pancreatic ductal adenocarcinoma is an aggressive malignancy with a high mortality rate. Proper determination of the extent of disease on imaging studies at the time of staging is one of the most important steps in optimal patient management. Given the variability in expertise and definition of disease extent among different practitioners as well as frequent lack of complete reporting of pertinent imaging findings at radiologic examinations, adoption of a standardized template for radiology reporting, using universally accepted and agreed on terminology for solid pancreatic neoplasms, is needed. A consensus statement describing a standardized reporting template authored by a multi-institutional group of experts in pancreatic ductal adenocarcinoma that included radiologists, gastroenterologists, and hepatopancreatobiliary surgeons was developed under the joint sponsorship of the Society of Abdominal Radiologists and the American Pancreatic Association. Adoption of this standardized imaging reporting template should improve the decision-making process for the management of patients with pancreatic ductal adenocarcinoma by providing a complete, pertinent, and accurate reporting of disease staging to optimize treatment recommendations that can be offered to the patient. Standardization can also help to facilitate research and clinical trial design by using appropriate and consistent staging by means of resectability status, thus allowing for comparison of results among different institutions.

Related: Cancer of the Pancreas Pancreatic Cancer USA

Hoang JK, Sung WK, Bahl M, Phillips CD
How to perform parathyroid 4D CT: tips and traps for technique and interpretation.
Radiology. 2014; 270(1):15-24 [PubMed] Related Publications
Parathyroid four-dimensional (4D) computed tomography (CT) is an imaging technique for preoperative localization of parathyroid adenomas that involves multidetector CT image acquisition during two or more contrast enhancement phases. Four-dimensional CT offers an alternative or additional tool in the evaluation of primary hyperparathyroidism. The purpose of this article is to describe the 4D CT technique and provide a practical guide to the radiologist for imaging interpretation. The article will discuss the rationale for imaging, approach to interpretation, imaging findings, and pitfalls.

Related: Parathyroid Cancer

Zhang Z, Zhou B, Wu Y, et al.
Prognostic value of IL-27 polymorphisms and the susceptibility to epithelial ovarian cancer in a Chinese population.
Immunogenetics. 2014; 66(2):85-92 [PubMed] Related Publications
This study investigated the association between IL-27 gene polymorphisms and susceptibility to epithelial ovarian cancer in a Chinese population and discusses the risk factors associated with survival time. We collected data on 229 patients diagnosed with epithelial ovarian cancer, from 15 to 77 years of age with a long clinical follow-up period. Polymerase chain reaction-restriction fragment length polymorphism was performed to determine the genotype of IL-27 gene polymorphisms. Ovarian cancer-specific survival (OCSS) according to genotype of IL-27 gene polymorphisms was explored by Kaplan-Meier analysis and Cox proportional hazards modeling. Significant differences for genotype frequencies of both SNP sites were found between cases and controls. Both allele G frequencies were significantly greater among the cases (rs153109: 0.404 vs. 0.303, P = 0.001, odds ratio [OR] = 1.333, 95% confidence interval [CI] = 1.133-1.567; rs17855750: 0.146 vs. 0.083, P = 0.001, OR = 1.766, 95% CI = 1.258-2.481). Haplotype analysis showed haplotypes AG, GT and GG were associated with increased ovarian cancer susceptibility while AT was a protective haplotype. Advanced FIGO stage (stages III + IV) and non-optimal cytoreductive surgery (residual tumor ≥1 cm) were poor prognostic factors in the univariate analysis (P = 0.003, P = 0.049). However, FIGO stage was found to be the only independent significant prognostic factor by Cox proportional hazards analysis (P = 0.042). IL-27p28 mRNA expression was significantly decreased in ovarian cancer patients (P < 0.0001), while no significant relationship was found between IL-27p28 mRNA expression and polymorphism of rs153109 and rs17855750 (P = 0.193 and P = 0.146, respectively). Our study suggests that IL-27 gene polymorphisms may be involved in the susceptibility to epithelial ovarian cancer, but not in survival in a clinic-based Chinese population. Haplotype analysis of these two SNPs seems to be an important mark to predict the disease susceptibility. Advanced FIGO stage, as the only significant, independent risk factor, predicts poor clinical outcomes for patients diagnosed with epithelial ovarian cancer. The decreased expression of IL-27p28 mRNA in ovarian cancer might indicate the antitumor activities of this novel cytokine.

Related: Ovarian Cancer

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