The cytomorphologic features in fine-needle aspiration (FNA) The thyroid gland is believed to have two distinct primordia: the thyreoglossal duct, which gives rise to the follicular epithelium, and the branchial pouches, which yield cells that differentiate into parafollicular cells (C-cells). Upon neoplastic transformation, the follicular cells generate follicular adenomas and follicular or papillary carcinomas, while Ccells are considered to be the progenitors of medullary carcinomas.Medullary carcinoma of the thyroid (MCT) was first described by Horn, 1 but he failed to separate it from undifferentiated thyroid carcinoma. In 1959, Hazard et al. 2 adapted the term "medullary carcinoma" and recognized the characteristic amyloid stroma. In 1966, Williams 3 and Williams et al. 4 identified the neuroendocrine nature of the tumor by describing its origin in the parafollicular cells and defined the tumor as a neoplasm which is capable of producing calcitonin and which may contain argyrophil tumor cells having intracytoplasmic secretory granules of endocrine type. Besides calcitonin, this tumor may also elaborate other substances, including peptide hormones such as adreno-corticotropic hormone (ACTH) 5 and somatostatin. 6,7 With respect to genetic associations, perhaps 80 -90% of these neoplasms occur sporadically, usually in adults, but 10 -15% are encountered in children and teenagers in welldefined genetic syndromes, all transmitted by autosomal dominant patterns of inheritance. 8 Preoperative recognition of MCT by fine-needle aspiration biopsy (FNAB) enables the surgeon to investigate the patient for a possible multiple endocrine neoplasia syndrome (MEN type II) that might include pheochromocytoma, and to plan the initial surgery with radical neck dissection, if necessary. 2 This study presents the diagnostic results by FNA and the cytomorphological features of 91 histologically verified MCT. Fourteen cases of thyroid tumors were cytologically diagnosed as MCT, but histologic examination yielded discrepant results. These cases are illustrated to discuss the differential diagnosis of MCT and its potential pitfalls. Materials and MethodsWe reviewed the aspirates from 128 patients who were registered in the files of the Department of Cytopathology of the University of Göttingen under the category "medullary carcinoma of the thyroid," between the years 1977-1999. These patients were divided into three groups. The first group was composed of 91 patients with histologically verified MCT. The second group included 14 patients with cytologically diagnosed or suspected MCT but discrepant histologic diagnosis (Table II). For the remaining 23 patients, we had no subsequent histologic examination.A detailed morphological analysis of the 91 histologically verified MCT was done by two cytopathologists. The FNAs were performed with 22-gauge needles, and the air-dried smears were routinely stained by the May-Grünwald-Giemsa (MGG) method.Thirty-seven out of 91 patients with histologically confirmed MCT were males, and 54 were f...
Extra-abdominal desmoid tumours are slow-growing, histologically benign tumours of fibroblastic origin with variable biologic behaviour. They are locally aggressive and invasive to surrounding anatomic structures. Magnetic resonance imaging is the modality of choice for the diagnosis and the evaluation of the tumours. Current management of desmoids involves a multidisciplinary approach. Wide margin surgical resection remains the main treatment modality for local control of the tumour. Amputation should not be the initial treatment, and function-preserving procedures should be the primary treatment goal. Adjuvant radiation therapy is recommended both for primary and recurrent lesions. Chemotherapy may be used for recurrent or unresectable disease. Overall local recurrence rates vary and depend on patient's age, tumour location and margins at resection.
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