Hypocalcemic Activity of Serum in Patients with Medullary Carcinoma of the Thyroid
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Abstract:
We have studied the hypocalcemic effect of serum from three patients with disseminated medullary carcinoma. Only one of three patients studied revealed significant hypocalcemic activity. The procedure we have described is simple to perform and, quite possibly, diagnostic when positive, but it is not sensitive enough to justify its use as a screening procedure in patients with suspected thyroid tumor. It might, however, be of interest and possible value in follow-up studies of patients with known medullary carcinoma, or in studies of the relatives of such patients. More sensitive methodology will be required for the consistent detection of this tumor and its hormonal by-products.Keywords:
Medullary carcinoma
To evaluate the mammographic features of medullary carcinoma, to determine the frequency of pathologic overdiagnosis of this neoplasm, and to assess whether mammography can distinguish true from atypical medullary carcinomas, since this distinction has important prognostic implications.Retrospective review revealed 25 patients with an initial pathologic diagnosis of medullary carcinoma. Histopathologic slides and mammograms were reviewed.After review of histopathologic slides, 14 (56%) lesions were classified as medullary carcinomas and 11 (44%) as atypical medullary carcinomas. At mammography, a circumscribed mass was present in four of the 14 (28%) medullary carcinomas and in one of the 11 (9%) atypical medullary carcinomas (P = .34), an indistinct mass was present in seven of the 14 (50%) medullary carcinomas and in five of the 11 (45%) atypical medullary carcinomas (P = .86), and an obscured mass was present in two of the 14 (14%) medullary carcinomas and in three of the 11 (27%) atypical medullary carcinomas (P = .62). Calcification, which was present in one of the 11 (9%) atypical medullary carcinomas, and s spiculated border, which was present in one of the 11 (9%) atypical medullary carcinomas, were not observed in medullary carcinomas (P = .44).At mammography, medullary carcinoma was usually an uncalcified mass with indistinct or circumscribed borders. Atypical medullary carcinoma may be misdiagnosed as medullary carcinoma. Mammography could not reliably help distinguish true medullary carcinomas from atypical medullary carcinomas.
Medullary carcinoma
Overdiagnosis
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Three medullary, eight atypical medullary and four non-medullary carcinomas of the breast were studied by transmission electron microscopy. Detailed comparison of a number of structural, cytoplasmic and nuclear features failed to confirm previous suggestions that medullary carcinoma cells have a distinctive ultrastructure. Electron microscopy is thus unlikely to be useful in the differential diagnosis of the tumours, nor does it suggest a basis for the good prognosis of medullary carcinoma.
Medullary carcinoma
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Objective To investigate the relationship between the sonographic and histologic appearances of breast medullary carcinoma, and to determine the value of sonography in the differentiation of typical and atypical breast medullary carcinoma. Methods We retrospectively reviewed ultrasonographic appearances of 19 cases of breast medullary carcinoma which were confirmed by pathology. Results Eight of 19 medullary carcinomas were classified as typical and 11 were atypical. On sonography,a smooth outline was visualized in 6 of the 8 typical medullary carcinomas but in none of 11 atypical carcinomas. A jagged margin was sonographically visualized in 10 of 11 atypical carcinomas, and a focal irregularity in the margin was visualized in 1 of the 11 atypical carcinomas. Four of the typical medullary carcinomas had posterior enhancement, and 8 of the atypical medullary carcinomas showed retrotumoral shadowing. The difference of tumor margin regularity between typical and atypical medullary carcinomas was statistically significant. Conclusions Treatment and prognosis of typical and atypical medullary carcinomas are different. Ultrasonography is useful in the differential diagnosis of typical and atypical medullary carcinomas.
Medullary carcinoma
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Objective To study the cause of different prognosis in typical medullary carcinoma and atypical medullary carcinoma. Methods The immunohistochemical staining method was used to evaluate the positivity of E cadherin,β catenin, in 30 cases of atypical medullary carcinoma and 18 cases of typical medullary carcinoma and 10 cases of normal breast. Results The positive rate and staining intensity of E cadherin and β catenin oncoprotein were significantly higher in typical medullary carcinoma than in atypical medullary carcinoma( P 0.01).Conclusion Expression of E cadherin and β catenin is one of the causes of similar morphology and different prognosis in medullary breast carcinoma.
Medullary carcinoma
Breast carcinoma
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Systematic screening of the families of a series of 39 patients with apparently sporadic medullary thyroid carcinoma detected seven new cases in four families. A negative family history in a patients presenting with medullary thyroid carcinoma is not reliable in excluding familial disease, and family screening should be considered for new patients with medullary thyroid carcinoma.
Medullary carcinoma
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To determine the clinicopathological and molecular features of gastric medullary cancer.Clinicopathological review and microsatellite instability (MSI) analysis were carried out on 17 gastric medullary and 64 non-medullary cancers. In addition to characteristic histopathology, gastric medullary cancers had certain prominent features: (i) the average survival time was longer in medullary and low-grade non-medullary cancers than in high-grade (P = 0.004); (ii) serosal involvement was less common in medullary cancers (29.4%, 5/17) than in non-medullary cancers (9.4%, 6/64) (P < 0.05) while pushing borders were more common in medullary cancers (70.6%, 12/17 versus 17.2%, 11/64, P = 0); (iii) the presence of intraepithelial lymphocytes (IELs) in medullary and non-medullary cancers was 2380/10 high-power field (HPF) and 147/10 HPF (P = 0), respectively. Both peritumoural infiltrating lymphocytes (pTIL) and a Crohn's-like reaction were more common in medullary cancers than in non-medullary (pTIL 35.3%, 6/17 versus 3.1%, 2/64; a Crohn's-like reaction 70.6%, 12/17 versus 32.8%, 21/64; P < 0.05); (iv) medullary and high-grade non-medullary cancers were more associated with reduced ECD expression in comparison with low-grade cancers (P < 0.05); (v) higher MSI-H (Bat26+) rate was observed in medullary cancers (41.2%, 7/17) than in non-medullary (1.6%, 1/64) (P = 0).Gastric medullary cancer has distinct clinicopathological features and genetic alterations. Two subtypes of gastric medullary cancers, Bat26+ and Bat26-, might have prognostic implications, thus analysis of Bat26 may be of clinical value.
Medullary carcinoma
Microsatellite Instability
Intraepithelial lymphocyte
Histopathology
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Objective To evaluate mammography in distinguishing medullary carcinoma from fibroadenoma and in distinguishing true from atypical medullary carcinoma.Materials and Methods Mammographic findings of 27 medullary carcinomas and 34 fibroadenomas were retrospectively analyzed. The findings were compared with pathologic results.Results The most common finding was non-calcified mass for both medullary carcinoma (78%) and fibroadenoma (74%). Usually, the mass was of high-density for medullary carcinoma (19/25) and of iso-density for fibroadenoma (19/28), with significant difference between two tumors (P=0.001). Most medullary carcinomas showed an infiltrating or lobulated border (23/25), while most fibroadenomas had a clear border or could be demonstrated only on a certain direction exposure (25/28), with significant difference between two tumors (P0.001). Of 27 medullary carcinomas, 9 were atypical. No obvious difference in tumor's shape (P=0.670), margin (P=0.394) and density (P=0.637) existed between the true and the atypical medullary carcinomas. Conclusion Breast medullary carcinoma has certain mammographic features, which are well correlated with its pathology and based on which differentiation from fibroadenoma can be made. Pathologically, medullary carcinoma can be further divided into true type and atypical type. Nevertheless, it is almost impossible to make a correct differentiation of the two types on the mammogram.
Medullary carcinoma
Breast Fibroadenoma
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Objective:To investigate the dignosis and treatment of familial medullary thyroid carcinoma in order to provide basis for its early diagnosis and treatment.Methods: We summarized the clinical data of familial medullary thyroid carcinoma,and combined with literature to investigate its etiology,early diagnosis and treatment.Results:Familial medullary thyroid carcinoma is aeuchromosome obvious syndrome arosed by RET break.It is bilateral and many focus,and mostly is young blood;Reasonable operation can get satisfactory result in the treatment for familial medullary thyroid carcinoma.Conclutions:FMTC is a kind of hereditary diseases;there is satisfactory result when early diagnosis and reasonable operation are applied.Follow-up survey of family members should be performed in a long period of time.
Medullary carcinoma
Etiology
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Objective To investigate the clinical features and bilogical characteristics of the medullary carcinoma of the breast. Methods 27 cases of typical medullary carcinoma and 34 cases of atypical medullary carcinoma were analyzed. Results The results showed that the incidence of medullary carcinoma of breast was 6.6% of the total breast cancers, and the 3-,5- year survived rates were 96.29%,88.88% in the typical medullary carcinoma; 91.17%,79.41% in the atypical medullary carcinoma.Conclusion The common features of medullary carcinoma were fairly clear boundary mass.This suggest that medullary carcinoma should be made a definite diagnosis by needle and freeze biopsy.
Medullary carcinoma
Breast carcinoma
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OBJECTIVE:To summarize and analyze the experience and clinicopathological significance in application of fluorescence in situ hybridization(FISH)technique to diagnose HER-2gene amplification in uncommon medullary carcinoma of breast,and analyze the possible relationship between HER-2gene amplification and type of medullary carcinoma as typical medullary carcinoma and atypical medullary carcinoma.METHODS:Status of HER-2gene amplification was diagnosed by FISH technique and analyzed with other biomarkers and clincopathological data in 32cases of medullary carcinoma of breast.RESULTS:The positive rate for HER-2gene amplification was 37.5%(12/32),in which typical medullary carcinoma was 7.7%(1/13)and atypical medullary carcinoma was 57.9%(11/19),respectively.Amplification of HER-2gene was correlative positively with the type of medullary carcinoma(P=0.008),HER-2protein expression(P=0.000 1),tumor size(P=0.040),lymphatic metastasis(P=0.006),clinical stage(P=0.037)and p53(P=0.015),whereas not with age(P=0.438),ER(P=0.081)and PR(P=0.517).The type of medullary carcinoma of breast was correlative with HER-2protein(P=0.010),but not with age(P=0.426),tumor size(P=0.786),lymphatic metastasis(P=0.115),clinical stage(P=0.129),ER(P=0.116),PR(P=0.773)and P53(P=0.280).CONCLUSIONS:Amplification of HER-2gene may be involved in evolution and progress of breast medullary carcinoma.There is a significant difference in HER-2gene amplification between the typical type and the atypical type of medullary carcinoma of breast.Clinical application of FISH technique to diagnose the target of HER-2gene amplification may be helpful to direct molecular targeting therapy in breast atypical medullary carcinoma patients.
Medullary carcinoma
Breast carcinoma
Lymphovascular invasion
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