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Introduction: Primary thyroid lymphoma is defined as a lymphoma involving only the thyroid gland, or thyroid gland with regional lymph nodes without contiguity or metastasis to other areas at the time of diagnosis. Hashimoto’s thyroiditis is a known risk factor for the disease. It responds well to chemotherapy but since it is a rare clinical entity, the diagnosis is often missed, thereby subjecting the patient to extensive surgery. Case report: A 69 years old male presented with rapidly progressive swelling in front of neck for 10 days associated with dysphagia, odynophagia and dyspnoea. He had right lobe thyromegaly with multiple cervical lymphadenopathy with ultrasonographic risk stratification of TIRADS 5. Diagnosis was clinched by core biopsy report on immunohistochemistry as Diffuse Large B Cell Non-Hodgkin’s Lymphoma. Positron emission tomography computerized scan revealed 18-fluorodeoxyglucose avid grossly enlarged thyroid lobes and isthmus with multiple bilateral cervical lymph nodes. Documenting the stage of disease as III E, he was managed with Chemo-immunotherapy consisting of RCVP regime with complete remission. Conclusion: Primary thyroid lymphoma with extra-thyroid involvement can be rapidly progressing and life threatening. However, timely investigation leads to correct diagnosis, appropriate curative medical management and can avoid unwarranted surgery.

Introduction: Primary thyroid lymphoma is defined as a lymphoma involving only the thyroid gland, or thyroid gland with regional lymph nodes without contiguity or metastasis to other areas at the time of diagnosis. Hashimoto’s thyroiditis is a known risk factor for the disease. It responds well to chemotherapy but since it is a rare clinical entity, the diagnosis is often missed, thereby subjecting the patient to extensive surgery. Case report: A 69 years old male presented with rapidly progressive swelling in front of neck for 10 days associated with dysphagia, odynophagia and dyspnoea. He had right lobe thyromegaly with multiple cervical lymphadenopathy with ultrasonographic risk stratification of TIRADS 5. Diagnosis was clinched by core biopsy report on immunohistochemistry as Diffuse Large B Cell Non-Hodgkin’s Lymphoma. Positron emission tomography computerized scan revealed 18-fluorodeoxyglucose avid grossly enlarged thyroid lobes and isthmus with multiple bilateral cervical lymph nodes. Documenting the stage of disease as III E, he was managed with Chemo-immunotherapy consisting of RCVP regime with complete remission. Conclusion: Primary thyroid lymphoma with extra-thyroid involvement can be rapidly progressing and life threatening. However, timely investigation leads to correct diagnosis, appropriate curative medical management and can avoid unwarranted surgery.

Anaplastic thyroid carcinoma is a rare entity (5-10% thyroid cancers) but it is one of the most lethal malignancies. It is usually diagnosed late and it is unresectable at that time. The definitive diagnosis is realized with a histological study. Regarding treatment, the combination of surgery, radiation therapy and chemotherapy is the one that obtains the best results. We reported a case of a 69-year-old female patient who underwent left hemithyroidectomy for a thyroid nodule initially with fine needle biopsy of follicular proliferation and with definitive pathology after excision of papillary thyroid carcinoma. Totalizing surgery was performed with a histological result of anaplastic thyroid carcinoma., El carcinoma anaplásico de tiroides es poco común (5-10% cánceres de tiroides) pero se trata de una de las neoplasias malignas más letales. Normalmente se diagnostica de forma tardía siendo en ese momento irresecable. El diagnóstico definitivo se realiza mediante estudio histológico. En cuanto al tratamiento, la combinación de cirugía, radioterapia y quimioterapia es la que obtiene mejores resultados. Se presenta el caso de una paciente mujer de 69 años intervenida de hemitiroidectomía izquierda por nódulo tiroideo inicialmente con PAAF de proliferación folicular y con anatomía patológica definitiva tras la exéresis de carcinoma papilar de tiroides. Se realiza cirugía totalizadora con resultado histológico de carcinoma anaplásico de tiroides.

Introduction and objective: PET/CT is a technique which oncological indications are now increasing, being thyroid cancer one of them. Method: narrative review. Comment: The present study is a review of well-known indications, as well as those fields in which more studies are needed to establish the utility of this technique in every kind of malignant thyroid pathology., Introducción y objetivo: La PET/TC es una técnica cuyas indicaciones en Oncología se encuentran en expansión y el cáncer de tiroides es una de ellas. Método: Revisión narrativa. Comentarios: En el presente artículo se revisan las indicaciones establecidas hasta la fecha, así como aquellos campos en los que son necesarias investigaciones adicionales que permitan establecer la utilidad de esta técnica en los distintos tipos de patología maligna tiroidea.

Undifferentiated pancreatic carcinoma, also called anaplastic pancreatic carcinoma or giant cells pancreatic carcinoma, is an uncommon and aggressive variety of ductal adenocarcinoma. Three types of undifferentiated carcinoma of the pancreas are known: Osteclastic-like giant cells tumor, pleomorphic giant cells tumor, and mixed giant cells tumor. Osteoclast-like giant cells tumor is characterized by the presence of large histocytic elements with many small nuclei showing no atypia. Pleomorphic giant cells tumor is characterized by the presence of bizarre mono- or multinucleated giant cells with atypical mitoses. The mixed giant cells tumor shows the simultaneous presence of both histological histotypes. The histogenesis of giant cells is controversial. Currently osteoclast-like giant cells are considered reactive elements deriving from a histiocytic lineage. Pleomorphic giant cells tumor originates from ductal epithelium with subsequent sarcomatous transformation. The various hystotypes show different behavior in terms of survival. Pleomorphic giant cells tumor is characterized by a worse prognosis than ductal adenocarcinoma while osteoclast-like giant cells tumor can be associated with longer survival time. The mixed giant cells tumor presents an intermediate prognosis. In conclusion, in case of undifferentiated pancreatic carcinoma, an accurate histopathological diagnosis can predict different behavioral pathways in terms of tumor progression and prognostic profile.

Certain carcinomas of the thyroid gland behave aggressively resulting in increased patient morbidity and poor patient prognosis. The diagnosis of these aggressive thyroid cancer subtypes is sometimes challenging and subject to increased interobserver variability. This review deals with the cytological features of such tumors including aggressive variants of papillary thyroid carcinoma, poorly differentiated thyroid carcinoma, and anaplastic thyroid carcinoma. These malignancies fall into 2 groups based on their cytomorphology: those that exhibit distinct microscopic features (eg, nuclear findings typical of classical papillary thyroid carcinoma or marked anaplasia) and those that present with more subtle cytologic features (eg, nuclear pseudostratification, “soap bubble” nuclei, supranuclear or subnuclear cytoplasmic vacuoles, rosette-like structures, hobnail cells). We review the literature regarding these aggressive thyroid cancers and highlight important phenotypic characteristics that can be useful for their diagnosis based on fine needle aspiration.

Progresija malignih tumora štitaste žlezde od dobro diferenciranih (papilarni karcinom) u nediferencirane, agresivne forme (anaplastični karcinom) praćena je različitim promenama na molekularnom nivou, koje omogućavaju malignoj ćeliji kontinuiranu aberantnu stimulaciju rasta i izbegavanje apoptotske smrti, što uz neoangiogenezu (formiranje novih krvnih i limfnih sudova) predstavlja preduslove tumorskog rasta i širenja. Predmet ovog rada je izučavanje molekularnih promena koje prate dediferencijaciju papilarnog u anaplastični karcinom štitaste žlezde, tj. ispitivanje promena ekspresionih profila apoptotskih molekula (Bcl-2, Bax, survivin) i limfangiogenog faktora (VEGF-C) u korelaciji sa kliničkim parametrima tokom progresije maligniteta tumora štitaste žlezde. Imunohistohemijskom analizom ekspresionih profila članova Bcl-2 familije konstatovano je da tokom progresije dolazi do smanjenja ekspresije Bcl-2 (antiapoptotski molekul), ali da je in situ apoptotska smrt detektovana TUNEL metodom na niskom nivou, uprkos visokih ekspresionih nivoa Bax (pro-apoptotskog) molekula. U isto vreme sa smanjenjem ekspresije Bcl-2 tokom progresije maligniteta dolazi do postepenog povećanja drugog antiapoptotskog molekula, survivina, koji je operativan nizvodno od Bax-a. Visoka ekspresija survivina je bila u korelaciji sa sniženim stepenom in situ detektovane apoptotske smrti, što sugeriše da survivin, a ne odnos Bcl-2/Bax ima ulogu u inhibiciji finalizacije programirane ćelijske smrti. Poređenjem imunohistohemijske ekspresije survivina sa kliničko-patološkim parametrima pacijenata utvrđena je značajna korelacija između visoke ekspresije survivina i prisustva metastaza u limfnim čvorovima. Ekspresioni profili VEGF-C proteina (angiogeni faktor koji promoviše formiranje tumorske vaskulature, a time i rast i širenje tumora) pokazali su porast tokom tumorske progresije i značajnu korelaciju sa prisustvom limfnih metastaza, ekstratiroidnom invazijom i uznapredovalim stadijumom tumorske bole, Progression of malignancy of thyroid gland tumors from well differentiated (papillary carcinoma) to undifferentiated, aggressive form (anaplastic carcinoma) is accompanied by molecular changes. These enable continuous stimulation of aberrant growth and escape from apoptotic death, together with neoangenesis (formation of new blood and lymphatic vessels) which are prerequisites for tumor growth and spread. The objective of this work was examination of some molecular changes accompaning dedifferentiation of papillary to anaplastic carcinoma of the thyroid gland, i.e. an investigation of alterations in expression profiles associated with apoptosis (Bcl-2, Bax, survivin) and lympfhangiogenic factor, VEGF-C, in correlation with clinicopathological parameters during the progression of malignancy of thyroid gland tumors. Immunohistochemical analysis of expression profiles of Bcl-2 family members revealed decrease of Bcl-2 expression (anti-apoptotic molecule) during this progression, but a low level of in situ apoptotic cell death detected by the TUNEL method, despite high levels of Bax (pro-apoptotic molecule). The decrease of Bcl-2 expression was followed by increase of another anti-apoptotic molecule, survivin, which acts downstream from Bax. High survivin expression was found to correlate with the lower rate of in situ apoptotic cell death, suggesting that survivin, but not the Bcl-2/Bax ratio, has a role in finalization of programmed cell death. By comparing survivin immunohistochemical expression with clinico-pathological parameters of patients we found a significant positive correlation between high survivin expression and the presence of lymph node metastases. Expression profiles of VEGF-C protein (an angiogenic factor which promotes the formation of tumor vasculature, and thereby tumor growth and spread) revealed increased levels during tumor progression and a significant correlation with the presence of lymph node metastases, extrathyroid invasion and advanced sta

Background: Primary cutaneous CD30+ lymphoproliferative disorders include lymphomatoid papulosis (LyP) and primary cutaneous CD30+ anaplastic large T-cell lymphoma (ALCL). Because of overlapping histological features, it is impossible to distinguish ALCL from LyP on histological grounds. MUM1 (Multiple Myeloma oncogene 1) is expressed in systemic ALCL and classical Hodgkin lymphoma. MUM1 expression has not been studied in detail in CD30+ lymphoproliferative disorders. Objectives: To examine the expression of MUM1 in CD30+ lymphoproliferative disorders and to assess its value as a diagnostic marker. Methods: Thirty-one formalin-fixed paraffin-embedded specimens of LyP (n = 15), primary cutaneous ALCL (n = 10), secondary cutaneous infiltrates of systemic ALCL (n = 4) and secondary cutaneous Hodgkin lymphoma (n = 2) were analysed by immunohistochemistry with a monoclonal antibody against MUM1. Results Results: Positive staining for MUM1 was observed in 13 cases of LyP (87%), two cases of primary cutaneous ALCL (20%), four cases of secondary cutaneous ALCL (100%) and two cases of secondary cutaneous Hodgkin lymphoma (100%). In 11 of 13 LyP cases (85%), MUM1 was displayed by the majority, i.e. 50-90%, of the tumour cells. In contrast to LyP and secondary cutaneous ALCL, only two cases of primary cutaneous ALCL (20%) harboured MUM1-positive tumour cells. There was a statistically significant difference in the expression of MUM1 between LyP and primary cutaneous ALCL (P = 0.002) and between primary cutaneous ALCL and secondary cutaneous ALCL (P = 0.015). Conclusions: MUM1 expression is a valuable tool for the distinction of LyP and ALCL and thus represents a novel adjunctive diagnostic marker in CD30+ lymphoproliferative disorders. © 2008 The Authors.

Extrapulmonary small cell and small cell neuroendocrine tumors of unknown primary site are, in general, aggressive neoplasms with a short median survival. Like small cell lung cancer (SCLC), they often are responsive to chemotherapy and radiotherapy. Small cell lung cancer and well differentiated neuroendocrine carcinomas of the gastrointestinal tract and pancreas tend to express somatostatin receptors. These tumors may be localized in patients by scintigraphic imaging using radiolabeled somatostatin analogues. A patient with an anaplastic neuroendocrine small cell tumor arising on a background of multiple endocrine neoplasia type 1 syndrome is reported. The patient had a known large pancreatic gastrinoma and previously treated parathyroid adenopathy. At presentation, there was small cell cancer throughout the liver and skeleton. Imaging with a radiolabeled somatostatin analogue, 111In- pentetreotide (Mallinckrodt Medical B. V., Petten, Holland), revealed all sites of disease detected by routine biochemical and radiologic methods. After six cycles of chemotherapy with doxorubicin, cyclophosphamide, and etoposide, there was almost complete clearance of the metastatic disease. 111In-pentetreotide scintigraphy revealed uptake consistent with small areas of residual disease in the liver, the abdomen (in mesenteric lymph nodes), and posterior thorax (in a rib). The primary gastrinoma present before the onset of the anaplastic small cell cancer showed no evidence of response to the treatment. The patient remained well for 1 year and then relapsed with brain, lung, liver, and skeletal metastases. Despite an initial response to salvage radiotherapy and chemotherapy with carboplatin and dacarbazine, the patient died 6 months later.