Eighty-four cases of spindle and giant cell carcinoma of the thyroid were reviewed. This is a swiftly growing, and rapidly fatal neoplasm that generally develops in the elderly. Treatment of this disease was generally unsuccessful with a 7.1% five-year survival rate and a mean survival period of 6.2 months from the time of tissue diagnosis. In the majority of cases, areas of well-differentiated thyroid carcinoma could be identified, supporting the concept that spindle and giant cell carcinoma results from the transformation of preexisting well-differentiated thyroid carcinoma. Because of the aggressive biologic activity of this neoplasm, we treat all cases as disseminated disease at the time of presentation. Our best therapeutic results have been obtained with a combination of surgery, irradiation, and chemotherapy; however, these results still leave much to be desired. Patients with only small foci of spindle and giant cell carcinoma, at the time of diagnosis, may have a better chance of prolonged survival.

Seven cases of functioning and two cases of nonfunctioning parathyroid carcinoma are presented together with a general discussion of this disease. Functioning parathyroid carcinoma may be associated with prolonged survival. The morbidity and mortality from this disease are generally related to the prolonged hypercalcemia that occurs. The hypercalcemia is best treated with excision of local recurrences; however, this surgery is most often palliative and seldom curative. The best operative results were obtained when the disease could be localized preoperatively. Neck and mediastinal exploration in the absence of physical or radiographic evidence of recurrence failed to affect serum calcium levels. Two patients with nonfunctioning parathyroid cancer did poorly compared with those with functioning parathyroid carcinoma. The few cases reported in the literature are also suggestive of a more aggressive disease. The failure of this tumor to produce parathyroid hormone may allow it to escape clinical attention until it has achieved an advanced state.

Two-hundred-seventeen women with primary breast carcinoma had an estrogen receptor determination tested by both the dextran-coated charcoal assay and sucrose density gradient. The results were correlated with the disease-free interval, survival, response to hormone therapy or chemotherapy, and site of recurrent disease. The disease-free interval (DFI) was significantly longer in premenopausal patients with estrogen receptor positive (ER+) determination compared with premenopausal patients with estrogen receptor negative (ER-) determinations, irrespective of nodal involvement (P less than 0.05). There was no difference between the postmenopausal patients. The survival of the ER+ patients was statistically longer than that of the ER- patients (P less than 0.05). Statistical significance remained when the patients were grouped according to menopausal status or nodal involvement (P less than 0.002 or less). Sixty-two patients were treated with hormonal therapy, either ablative or additive. Forty-eight percent of patients with ER+ responded compared with 6% of patients with ER- (P less than 0.0005). Seventy-nine patients received chemotherapy; 52% of the ER+ and 57% of the ER- patients responded (P less than 0.5). ER+ tumors had a predilection to metastasize in skin and bone, while ER- tumors metastasized more commonly to the viscera and brain.

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Hypokalemia is a potentially life-threatening biochemical abnormality in patients with hypercalcemia. We studied a large group of patients with hypercalcemia to determine the prevalence of hypokalemia. One hundred three patients with normal renal function and no history of taking potassium-depleting drugs comprise the substance of this study. Thirty three of 103 patients (32%) were hypokalemic. A higher prevalence (52.3%) was found in patients with hypercalcemia associated with malignant disease than in those with primary hyperparathyroidism (16.9%). In addition, the degree and frequency of hypokalemia were greatest at the higher serum calcium levels. The presence of hypokalemia must be considered when treating severe hypercalcemia; otherwise, vigorous use of diuretics may result in profound hypokalemia and tachyrhythmias.