Thyroid carcinoma
	Helal et al., Clamart, France, performed FDG-PET studies in 11 consecutive patients with thyroid carcinoma (8 papillary, 2 follicular, 1 Hurthle cell). In all patients, who underwent total thyroidectomy and 131I therapeutic treatment, TG serum levels were above 35 ng/mL (off L-thyroxine) while 131I whole body scans after therapeutic dose were negative. FDG-PET was positive in 7/11 and negative in 4/11. In all 7 positive cases, diagnosis was confirmed histologically or by repeated ultrasound or magnetic resonance imaging. Localizations were cervical and mediastinal nodes in 5 cases and local recurrences in 2. (Comment: From these and other reports it seems more and more evident that FDG-PET is a useful technique in patients with suspect carcinoma with positive serum TG and negative whole body scans.) De Micco et al., Marseille, France, reported thyroperoxidase (TPO) immunocytostaining, using a monoclonal antibody against TPO, of fine needle aspirates (FNA) of thyroid nodules from 4419 patients of whom 1620 underwent surgical resection for suspicion of malignancy or other reasons (large size, physical or psychological discomfort). Results of TPO staining were considered suspect for malignancy if less than 80% of cells were positive. The results of immunostaining were compared with histological diagnosis. The sensitivity of TPO detection towards malignancy was 97.4% and the specificity of the method was 82%. The predictive value was reported to be 56.4% for a positive result and 99.2% for a negative result. The authors conclude that these values are even better than those of conventional cytology. (Comment: It is not known to what extent selection bias for surgery influenced the results. These results are however very interesting and should be confirmed by other laboratories.) Vlassopoulou et al., Athens, Greece, report outcome and prognostic factors in 245 patients with differentiated thyroid carcinoma (202 papillary and 34 folliculary), followed from 1965 till 1995 with a median follow-up period of 9.3 years. Seventy-four patients were female. During follow-up 9 cancer-related deaths occurred. No significant difference was present between the two histological types at 10 and 15 years. Disease-free survival was negatively affected by extent of disease at diagnosis, male sex, tumor size >4 cm, and age over 60 years. Fugazolla et al., Milan, Italy, describe a large family with familial medullary thyroid carcinoma (FMTC) consisting of three generations and a total of 46 members. In the first generation 2/7 (29%) members appeared to be affected. In the second generation these figures were 6/14 (43%) respectively. The third generation (25 members) is presently under clinical investigation, but 3/8 patients studied so far have an early presentation and aggressive behaviour of the tumor. Taken together, these findings are suggestive of the anticipation phenomenon (earlier presentation of disease at greater severity in successive generations). In all affected patients a mutation in exon 15 (codon 891) was present. Bauters et al., Lille and Toulouse, France, report a study of FMTC in a family with 5 affected members without pheochromocytoma or hyperparathyroidism. They found a new mutation i.e. in RET exon 8. (Comment: So far mutations have been reported in RET exon 10, 11, and 15. This information is important for screening purposes in families suspected for having FMTC.) Heshmati et al., Rochester MN, USA, report phenotypic presentation in 86 patients from 24 families with FMTC. Phenotypic representation was related to mutation subtypes in codon 634. Fourteen/twenty- four families had a cysteine to arginine mutation and 10 families other subtypes of mutations. C-cell disease, pheochromocytoma and hyperthyroidism were present in 100%, 65% and 31% of patients with cys. to arg. mutation and in 97, 37, 21% of patients with other mutations respectively. C-cell disease or hyperthyroidism was significantly higher in patients with the mentioned mutation as compared to those with other mutations. Mean age at diagnosis of C-cell disease, pheochromocytoma, and hyperthyroidism were similar in both groups. Ciampolillo et al., Bari and Milan, Italy, studied the expression of insulin-like growth factor 1 (IGF-1), both at the level of messenger RNA and of the protein in 50 adenomas and 53 differentiated carcinomas of the thyroid. An increased protein immunoreactivity was found in 62% adenomas and 72% of carcinomas as compared to normal thyroid tissue. IGF-1 mRNA was upregulated only in carcinomas. IGF-1 immunoreactivity positively correlated with tumor diameter and extensive capsular invasion but not with tumor type and stage. Klein et al., Nancy, France, studied expression of vascular endothelial growth factor (VEGF) at the level of the mRNA and of the protein in 17 cases of papillary cancer and 7 cases of follicular carcinoma. At both levels expression of VEGF was more intense in carcinomas than in normal thyroid tissue. Of interest is the fact that expression was also more intense in normal thyroid tissue in close contact with the tumor. (Comment: The previous and this study suggest that growth factors that normally stimulate thyroid growth may also play a role in malignant thyroid growth, although the results so far reported are too preliminar for definite conclusions.) Belfiore et al., Catania, Italy, studied the long term outcome of thyroid carcinoma in 21 patients with Graves' disease during a 12 year follow-up period. The results were compared to tumors of similar size occurring in 70 euthyroid controls, matched for sex and age. The frequency of clinically important (non-occult) thyroid carcinoma in the Graves' group was 4.7%. Distant metastases occurred in 5/21 (= 23.8%) versus 6/70 (= 8.6%) (p = 0.053). Graves' patients had less favourable cancer outcome, with more frequent recurrent and/or persistent disease or death (p = 0.0162) as compared to controls. Two patients died in the Graves' group and none in the control group. Circulating TSAbs were present in all but one patients of the Graves' group. The authors conclude that carcinomas occur at high frequency in Graves' patients and are more aggressive than those occurring in matched euthyroid controls. (Comment: in an editorial by Mazzaferri [J Clin Endocrinol Metab 70:826,1990] the association between Graves' disease and thyroid carcinoma is tentatively explained by the presence of long term stimulation by TSAbs. However, that the tumors are more aggressive than in euthyroid controls, has been contested [Hales at al. J Clin Endocrinol Metab 75:886,1992].)