Micropapillary carcinoma or a micropapillary carcinoma component has been reported in the ovary, breast, and urinary bladder and is generally thought to have prognostic significance. However, little has been written on micropapillary differentiation in lung carcinoma. We studied 35 cases of primary lung adenocarcinoma with a micropapillary component seen at the M.D. Anderson Cancer Center. The micropapillary component in these tumors ranged from focal to prominent and was seen at both primary and metastatic sites. This component was not associated with any particular histologic subtype of lung adenocarcinoma. Of the 15 cases with available material, 14 (93%) stained positive for cytokeratin 7, whereas only two of the 15 cases (13%) stained positive for cytokeratin 20. Thyroid transcription factor-1 immunostaining of tumor nuclei was seen in 12 of the 15 cases (80%). Immunostaining was seen in areas both with and without micropapillary differentiation. Thirty-three of 35 patients (94%) developed metastases, which occurred most commonly in the lymph nodes (n = 26), and also in the lung (n = 17), brain (n = 9 cases), bone (n = 9 cases), and other sites. Most metastases had a prominent micropapillary component, irrespective of the extent of the micropapillary carcinoma component in the primary lung tumor. Adequate clinical follow-up information was available for 29 patients. The mean follow-up was 25 months. At their last follow-up, 16 of 29 patients (55%) were still alive with disease, 5 (17%) were dead of disease, and 8 (28%) were alive with no evidence of disease. We believe that a micropapillary component occurring in lung adenocarcinoma should be reported, as this component may be more likely to metastasize. The presence of this component should alert the clinician to search more carefully for metastases and have a closer follow-up on these patients. It is also important to recognize this component in evaluating a metastasis from an unknown primary site, as it should alert the pathologist to a possible primary in the lung in addition to breast, urinary bladder, and ovary.
Management of nonneoplastic thyroid nodules (TN) diagnosed by fine-needle aspiration (FNA) is controversial. While clinical follow-up with repeat FNA for enlarging TN is recommended in some studies, others recommend repeat FNA in follow-up of all benign TN after several months or years, in order to identify possible misdiagnosed malignant lesions. This study was done to determine the usefulness of repeat FNA in patients with benign nodular thyroid disease. We studied 94 fine-needle reaspirations performed on 43 females and 2 males 48.2 +/- 17 years of age with benign nodular thyroid nodular disease. Four patients had 3 consecutive FNAs and 41 patients had 2 consecutive FNAs. All FNAs were carried out by the same endocrinologist in the same thyroid area or by cytopathologists. The average time elapsed between the two consecutive FNAs was 18.3 +/- 11.2 (range, 4-48) months. Of the 45 patients, 23 presented with increase in size of the nodule and the remaining 22 patients did not have any change in size at the time of repeat FNA. Identical cytologic diagnoses were rendered in 39 of the 45 patients who underwent 2 or 3 consecutive FNA. Repeat FNA did not result in detection of any malignant neoplasms. Thyroid resection in 7 patients with increased nodule size and pressure symptoms confirmed the cytologic impressions of benign thyroid nodular disease. Our results show that the routine performance of repeated FNA cytology in the follow-up of patients with benign nodular thyroid disease with or without any clinical changes is of limited usefulness. Clinical factors rather than repeat FNA may hold precedence in surgical management of patients with benign nodular thyroid disease.
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