Anaplastic thyroid carcinoma (ATC) is one of the most lethal carcinoma with a poor prognosis; however, molecular mechanisms underlying the aggressiveness of ATC remain unclear. Our goal was to examine the expression of X-linked inhibitor of apoptosis protein (XIAP) in ATC, as well as its role in ATC tumorigenesis. This is a retrospective study of ATC patients from the Second Affiliated Hospital of Harbin Medical University during June 2003 to October 2013. The expression of XIAP in tumor specimens of ATC patients was examined by immunohistochemical staining. The roles of XIAP in proliferation, migration, invasion, and chemoresistance were investigated by shRNA mediated-knockdown of XIAP in human ATC cell lines. The effect of XIAP on tumorigenesis was evaluated using a xenograft tumor model with nude mice. XIAP expression was significantly higher in the invasive area of ATC samples, whereas XIAP expression was negative in either normal thyroid follicular epithelial cells or the differentiated papillary thyroid carcinoma. XIAP-depleted ATC cells showed a remarkable decrease in the proliferation, migration, and invasion compared with the scramble group. Knockdown of XIAP expression significantly enhanced the chemosensitivity of WRO and SW1736 cells to docetaxel or taxane. Moreover, knockdown of XIAP significantly suppressed ATC tumorigenesis in vivo. XIAP is highly expressed in ATC cells and tumors. XIAP play important roles in tumor behaviors and chemosensitivity of ATC cells. XIAP may function in ATC aggressiveness and may serve as a potential therapeutic target for ATC treatment.
Objective
To evaluate carbon nanoparticles suspension in protection and identification of parathyroid in total thyroidectomy for thyroid papillocarcinoma.
Methods
This retrospective analysis included the clinical and pathological data of 97 patients from January 2014 to December 2014, 52 cases injected carbon nanoparticles suspension (the test group). Serum calcium and parathyroid hormone(PTH) were measured preoperatively and on 1st, 3rd, 7th day and one month postoperatively.
Results
Incidental parathyroidectomy occurred in 1 case (1.9%, 1/52) in test group and in 7 cases (15.6%, 7/45) in control group(P<0.05). The mean numbers of parathyroid glands identified intraoperatively were 3.1±0.4/case and 2.6±0.3/case respectively(P<0.05). The occurrence of temporary PTH hypofunction was 19.2% (10/52) and 42.2%(19/45) respectively(P<0.05). Also, test group had a higher level of PTH on postoperative day 1, 3, 7 and one month (P<0.05).
Conclusions
Carbon nanoparticles suspension significantly improved the identification of parathyroid gland during thyroid cancer surgery and reduced the risk of incidental parathyroid ectomy in total thyroidectomy.
Key words:
Thyroidectomy; Hypoparathyroidism; Carbon nanoparticles suspension injection
We compared the clinical effects and prognosis of patients receiving lymph node dissection after surgical removal of the thyroid tissues and those not receiving it after the removal. A total of 80 patients diagnosed with differentiated thyroid carcinoma (DTC) by our hospital from March 2012 to March 2014 were successively included in the study. The cases were divided into the control group (n=36 cases) and observation group (n=44 cases), and the two groups underwent total or subtotal resection of the thyroid. In the control group, patients underwent preoperative high-frequency color ultrasonography, and the most suspicious lymph node was removed. In the observation group, patients underwent preoperative high-frequency color ultrasonography, and the surgeons cleared the lymph node of the widest range. Difference in clinical effects and prognosis of the two groups were compared. After nearly a year's follow-up observation, the tumor recurrence rate of the observation group was significantly lower than that of the control group and the survival rate of the observation group was significantly higher than that of the control group (P<0.05). The rate of surgery complications and comparative difference of the two patient groups had no statistical significance (P>0.05). When comparing the data of lymphatic metastasis tested by preoperative high-frequency color ultrasonography with intraoperative diagnosed figures, sensitivity was 97.4%, specificity 33.3%, positive predictive value 90.2% and the negative predictive value 66.7%. In conclusion, removal of the lymph node for DTC patients having undergone thyroid tissue excision with preoperative high-frequency color ultrasonography can be beneficial to improve the effects along with reduction in the recurrence rate.
Objective: To investigate the difference of prognostic factors and recurrence rates between papillary thyroid microcarcinoma (PTMC) and lager papillary thyroid carcinoma (PTC) and analyze the clinical pathological characteristics of PTMC suitable for surgery. Methods: A retrospective analysis on the clinicopathological features, expression level of of v-raf murine sarcoma viral oncogene homolog B1 (BRAF) V600E gene mutation and pigment epithelium-derived factor (PEDF), and postoperative follow-up results of the 251 PTC patients who underwent surgical treatment from October 2011 to October 2013, including 169 cases with PTMC and 82 with lager PTC (Tumor diameter>1 cm). Results: The BRAF V600E mutation rates of PTMC and lager PTC patients are 65.1%(110/169)and 78.0% (64/82) respectively, and the difference is statistically significant (P<0.05). The prevalence of extrathyroidal invasion (7.1%) and lymph nodes metastasis (27.2%) of the patients with PTMC were significantly lower than those of the patients with larger PTC (15.9% and 46.3%, respectively)(P<0.01). The follow-up durations for PTMC and lager PTC were (45.6±3.6) months and (45.0±3.4) months, respectively (P>0.05). There was no statistic significance for the difference in age, gender, coexistent hashimoto's thyroiditis, PEDF expression, and recurrence rate between the patients with PTMC and with larger PTC (P>0.05). The recurrence rate of the patients who have the high risk factors of PTMC was 1.6%(2/122)and that of larger PTC was 4.9% (4/82). Conclusions: Extrathyroid invasion, lymph node metastases and BRAF V600E gene mutation are the high risk factors of recurrent PTMC. The same treatment strategy should be considered for PTMC with coexistent high risk factors as that for larger PTC. For PTMC with BRAF V600E gene mutation, earlier surgical treatment is suggested. PTMC patients with BRAF V600E gene mutation and high cell subtype are suggested to undergo total thyroidectomy for the first operation in order to reduce the potential risk of recurrence.目的： 探讨甲状腺微小乳头状癌(PTMC)与大甲状腺乳头状癌(PTC)在预后影响因素和疾病复发率间的差异，分析适合手术的PTMC患者临床病理特征。 方法： 回顾性分析2011年10月至2013年10月间收治的251例PTC患者的临床病理资料、鼠类肉瘤滤过性毒菌致癌同源体B1(BRAF)V600E基因突变和色素上皮衍生因子(PEDF)的表达情况，以及术后随访结果。251例PTC患者中，PTMC 169例，大PTC(肿瘤直径>1 cm) 82例。 结果： PTMC和大PTC患者的BRAF V600E突变率分别为65.1%(110/169)和78.0%(64/82)，差异有统计学意义(P<0.05)。PTMC患者的腺外侵袭率和淋巴结转移率分别为7.1%(12/169)和27.2%(46/169)，大PTC患者的腺外侵袭率和淋巴结转移率分别为15.9%(13/82)和46.3%(38/82)，差异有统计学意义(P<0.01)。PTMC和大PTC的随访时间分别为(45.6±3.6)个月和(45.0±3.4)个月(P>0.05)。PTMC和大PTC患者在性别、年龄、是否合并桥本氏甲状腺炎、PEDF表达和复发率间的差异无统计学意义(P>0.05)。合并高危因素PTMC患者的复发率为1.6%(2/122)，大PTC患者的复发率为4.9%(4/82)。 结论： 腺外侵及、淋巴结转移和BRAF V600E基因突变是PTMC复发的高危因素，合并高危因素的PTMC应考虑采取与大PTC相同的治疗策略。对于出现BRAF V600E基因突变的PTMC，更建议早期手术治疗。对于具有BRAF V600E基因突变的、高细胞亚型的PTMC患者，初次手术建议行全甲状腺切除，以降低潜在的复发风险。.
Objective To investigate the calcification of thyroid nodules detected by ultrasound and its relation with thyroid carcinoma.Methods Four thousand one hundred and eighty-six cases of thyroid disease were surgically treated during a period of five years.Retrospective analysis was made to compare preoperative color Doppler ultrasound and postoperative pathology.Results The incidence of calcification,non-microcalcification,and microcalcification were significantly higher in thyroid carcinoma than that in benign diseases(P＜0.05).For predicting thyroid cancer,microcalcification was more significant than non-microcalcification(P＜0.01).There was a significant difierence in the microcalcification between the different age groups(2.4%for patients of 45 and older,16.8%for patients younger than 45;P＜0.05):There was no difference in the calcification between male and female groups(P＞0.05);There was a significant difierence in malignant calcified nodules between difierent nodule groups(70.7%for patients of solitat'y.49.1%for patients of muhiple:P＜0.05).Conclusion Microcalcifications in the thyroid is related to thyroid cancer.especially to micro-papillary carcinoma.
Key words:
Thyroid nodule; Uhrasonography; Calcification; Thyroid neoplasms
We present a rare case of concurrent medullary thyroid cancer (MTC) and relapse of Graves' disease (GD).A 26-year-old Chinese female suffered from GD for 1 year.Physical examination demonstrated mildly diffuse goiter with a palpable 1.0 cm nodule in the right thyroid lobe and exophthalmos.Before hemithyroidectomy, calcitonin was elevated and thyroglobulin was normal.After surgery, histopathological fi ndings proved coexistence of MTC and GD.16 months later, GD relapsed and radioactive iodine 131 therapy was given.Meanwhile, postoperative monitoring showed well controlled calcitonin and carcinoembryonic antigen.Our lesson demonstrates although concomitant of MTC and GD is very rare, yet after hemithyroidectomy for the single nodular MTC lesion, remnant thyroid lobe could be the source of GD relapse very soon.More importantly, the relapse of GD and the following radioiodine therapy and radiation exposure could have been prevented if a better therapy plan of total thyroidectomy was adopted in the fi rst place, instead of hemithyroidectomy (Tab. 1, Fig. 2, Ref. 11).
To investigate the association of concomitant BRAFV600E mutation with central lymph node metastases in papillary thyroid carcinoma (PTC).The clinicopathological data of 126 PTC patients who underwent surgical treatment within a period of 2 years were retrospectively analyzed. The BRAF V600E gene mutation was detected by quantitative fluorescence PCR.The BRAF mutation rate was 69.0% (87/126). The univariate analysis showed that BRAF mutation status was significantly associated with central lymph node metastasis (P<0.05), while the gender, multiple lesions, tumor size, extra-thyroidal invasion, Hashimoto's thyroiditis and tumor stage were not significantly associated with the BRAF mutation (P>0.05 for all). The multivariate analysis showed that only central lymph node metastasis was significantly correlated with BRAF mutation (P<0.05). When the diameter of tumor was ≤10 mm, BRAF mutation was statistically not significantly correlated to central lymph node metastasis (P>0.05). When the diameter of tumor was >10 mm, the central lymph node metastasis rate was significantly higher in patients with positive BRAF mutation than that in patients with a negative BRAF mutation (P<0.05).The presence of BRAF mutation is an independent predictive factor for central lymph node metastasis. When PTC is with preoperative positive BRAF mutation, the cervical dissection should be routinely performed. The larger the tumor diameter is, the more important is the central lymph node dissection. There should be re-evaluated the necessity of preventative central lymph node dissection when the tumor diameter was ≤5 mm in patients with negative BRAF mutation.
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