• Korean Journal of Clinical Laboratory Science
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• v.45 no.1
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• pp.32-36
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• 2013

The thyroid is the organ that has the greatest risk of malignant tumors among the endocrine tumors. The papillary carcinoma occupies 80% of the entire thyroid tumors. Immunohistochemical staining of galectin-3 has usually been used in differentiating papillary carcinoma and follicular carcinoma. The p53 gene of the cell cycle is a tumor suppressor gene acting in on the control points. The cyclin D1 genes in the cell cycle, involved in the implementation of G1 and S phase, plays an important role in the progression of thyroid tumors. This research compares and analyzes correlation between papillary carcinoma, follicular carcinoma, p53, cyclin D1 and galectin-3 gene expression patterns. In a total of 30 cases from papillary carcinoma, 21 cases from p53 (70%), 27 cases in galectin-3 (90%), and 26 cases in cyclin D1 (86.7%) showed positive rate. The galectin-3 staining investigated, showed a significant difference between a papillary carcinoma and a follicular carcinoma. Follicular carcinoma from 15 cases, p53 in 13 cases (86.7%), galectin-3 in 5 cases (33.3%) and cyclin D1 in 12 cases (80%) showed a positive rate. The cyclin D1 in follicular carcinoma and staining between the p53 that had correlation was also investigated. In this study, as the examples of the expression of the 27 cases of galectin-3 (90%) in papillary carcinoma and 5 cases in follicular carcinoma (33.3%) indicate, it was concluded that there is a difference in the expression on both carcinoma. In addition, cyclin D1 and p53 has a positive rate in follicular carcinoma, when cyclin D1 in 12 cases (80%), there was a significant correlation that was investigated. Distinguishing between papillary carcinoma and follicular carcinoma can be identified by the expression of galectin-3. It is considered to get results that are more accurate in follicular carcinoma diagnosis depending on whether the cyclin D1 and p53 is expressed or not.

• The Korean Journal of Cytopathology
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• v.9 no.1
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• pp.63-68
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• 1998

Fine needle aspiration cytology of "cold" nodules of the thyroid has proved to be of great value in their preoperative diagnosis. Most types of thyroid tumors are readily recognizable from characteristic cellular patterns in the smears of needle aspirates. But follicular neoplasms present some problems because the cytomorphology of the adenomas frequently is same as in carcinoma. For differentiation of benign from malignant follicular neoplasms of the thyroid we tested the usefulness of two objective parameters - nuclear area and perimeter - by morphometry. This study was made on fine needle aspirates from 30 cases with cytologic diagnosis of follicular neoplasm of thyroid. The histologic classification was follicular adenoma in 22 cases and follicular carcinoma in 8 cases. As a reference group we used seven caes with nodular hyperplasia. The smears of aspirates were stained by Papanicolaou method. On each slide 200 randomly selected cells with intact nuclei were measured. The mean value of nuclear area are $25.32{\pm}5.50{\mu}m^2,\;34.08{\pm}7.50{\mu}m^2\;and\;39.97{\pm}6.63{\mu}m^2$ in nodular hyperplasia, follicular adenoma, and follicular carcinoma, respectively. The mean value of perimeter are $19.48{\pm}2.26{\mu}m,\;22.95{\pm}2.65{\mu}m\;and\;24.78{\pm}2.23{\mu}m$ in nodular hyperplasia, follicular adenoma and follicular carcinoma, respectively. The mean nuclear areas and perimeters of cells from follicular adenoma were significantly larger than those from nodular hyperplasia (p<0.05). The mean nuclear areas and perimeters of cells from follicular carcinoma were larger than those from follicular adenoma but the differences are not significant statistically(p>0.05). Therefore, morphometric assessment alone is inadequate to predict malignancy in thyroid aspirates.

• Korean Journal of Head & Neck Oncology
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• v.14 no.2
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• pp.191-198
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• 1998

Objectives: We performed an immunohistochemical study to examine the place of neovascularization in the tumorigenic process of follicular thyroid carcinoma and to determine whether tumor angiogenic activity in follicular carcinoma plays a role in tumor aggression. Materials & Methods: We studied 63 follicular thyroid carcinomas and compared with 22 follicular adenomas. The areas of capsular invasion, vascular invasion and cellular atypism of the tumor were confimed on H & E stains. The paraffin embedded tissues were stained by the use of monoclonal antibodies against Ag CD34. Microvesseles were counted in the area of highest vascular density at 200 times magnification. The microvessel densities(MVD) were analized in relation to histologic type and location of the tumors. Results: There were 59 minimal invasive types and 4 widely invasive types of carcinoma. In the histologic specimens of carcinomas, capsular invasion was identified in all the cases, vascular invasion in 46 and cellular atypism in 24. Mean values of the MVDs of the minimal invasive carcinomas, the widely invasive carcinomas and the adenomas were $263.8{\pm}69.2,\;256.l{\pm}49.3\;and\;241.5{\pm}159.4$, respectively and there was no significant difference between each group. In follicular carcinomas, there was a regional difference of the MVDs. The areas of tumor showing cellular atypism and adjacent to or penetrating the capsule, in which represents the tumorigenic process of carcinoma, had a higher rate of vascularization, than other areas of the tumor(p<0.05). However, these features were not noted in the follicular adenomas. Conclusion: Although there was no significant difference of the MVD between follicular carcinomas and adenomas, there was a regional difference of the MVD within the carcinomas and the values were significantly higher in the more malignant areas, as indicated by cellular atypism and capsular invasion. Therefore, tumor angiogenic activity measured by MVD may play a role in tumor aggression in follicular thyroid carcinoma.

• Korean Journal of Head & Neck Oncology
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• v.17 no.2
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• pp.139-147
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• 2001

Objectives: The most important differential point of follicular carcinoma from adenoma is capsular invasion or angioinvasion of follicular cells. Serial sections for examination of levels of tumor margins are necessary to watch the invasion. However, the interpretation of capsular invasion or angioinvasion is sometimes not feasible on the routine staining of tumor tissue. The aim of this study is to evaluate the clinical significance of expressions of $p27^{KIP1}$, MIB-1, bcl-2 and p53 in differential diagnosis of follicular adenoma and carcinoma. Materials and Methods: 16 cases of follicular carcinoma and 26 cases of follicular adenoma were entered on study of immunohistochemical stains for $p27^{KIP1}$, MIB-1, bcl-2 and p53. In carcinoma cases, correlation between the above markers, patient's age, tumor size, infiltration pattern and metastasis was studied. Results: $p27^{KIP1}$ labelling index (LI) of follicular carcinoma and adenoma was $4.89{\pm}6.92$ and $14.52{\pm}9.17$, respectively, but there was no significant difference between adenoma and carcinoma (p=0.2560). MIB-1 LI of carcinoma and adenoma was $4.11{\pm}3.89$ and $0.80{\pm}0.75$, respectively, and MIB-1 LI was significantly higher in carcinoma (p=0.0000). bcl-2 expression was seen in 2(12.5%) of 16 carcinoma cases and 130(50.0%) of 26 adenoma cases, and bcl-2 expression rate was higher in adenoma than in carcinoma(p=0.014). In one adenoma and one carcinoma case, p53 expression was noted. In follicular adenoma with atypia compared to adenoma without atypia, lower $p27^{KIP1}$ LI, higher MIB-1 LI and lower bcl-2 expression rate were seen. In follicular carcinoma, MIB-1 LI was significantly higher in invasive carcinoma(p=0.045) and was relatively increased in tumors larger than 3.0cm, showing angioinvasion and distant metastasis. But $p27^{KIP1}$ LI was higher in cases over 40 years old(p=0.008) and with conspicuous capsular invasion. There were no positive correlations between expressions of MIB-1, bcl-2 and p53. Conclusion: MIB-1 labelling index and bcl-2 expression could be helpful for differential diagnosis of follicular adenoma and carcinoma, but p53 showed very low expression rate and no significance in differential diagnosis. $p27^{KIP1}$ labelling index reveals decreasing tendency in carcinoma compared with adenoma, MIB-1 LI was considered as a poor prognostic marker in follicular carcinoma, but $p27^{KIP1}$ LI was higher in carcinoma cases over 40 years old with showing conspicuous capsular invasion. Further study for the significance of $p27^{KIP1}$ labelling index in follicular neoplasms is necessary to evaluate diagnostic value of follicular carcinoma.

• Journal of Korean Neurosurgical Society
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• v.45 no.3
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• pp.188-191
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• 2009

The presence of distant metastases from differentiated thyroid carcinoma decreases the 10-year survival rates of patients by 50%. This is a report of a 61-year-old female with follicular thyroid carcinoma who presented initially with low back pain. 2-deoxy-2-[18F] fluoro-D-glucose whole-body positron emission tomography/computed tomography (PET/CT) demonstrated a hypointensity lesion in the left thyroid gland with malignant uptake in L1 vertebra and magnetic resonance images revealed paravertebral and epidural extension of mass in L1 vertebra. After thyroidectomy, histopathological study showed a follicular carcinoma. We performed L1 total en bloc spondylectomy with expandable cage for long-term local control. The technical details of total en bloc spondylectomy in follicular carcinoma are described herein.

• Journal of Korean Neurosurgical Society
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• v.41 no.4
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• pp.269-271
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• 2007

Follicular thyroid carcinoma with metastasis rarely manifests as spinal cord compression without any previous symptoms of its malignancy. This report describes a 64-year-old man with follicular thyroid carcinoma who presented initially with left arm motor weakness. Magnetic resonance images demonstrated severe cervical cord compression by a mass with destruction of C4 vertebra. Corpectomy of C4 and anterior interbody fusion was carried out. Histopathological study revealed a metastatic follicular carcinoma of the thyroid. We present our case, especially focused of its possible pathophysiology, with review of pertinent literatures.

• The Korean Journal of Cytopathology
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• v.7 no.2
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• pp.134-137
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• 1996

Monoclonal antibody(TCM-9) against human thyroid cancers have been studied by screening with human thyroid cancers, normal and benign thyroid tissue, and normal human serum protein. A monoclonal antibody(TCM-9) that is known to have strong specificity for human thyroid cancer but not for Graves' disease, adenoma or normal thyroid does not bind to native or mature human thyroglobulin(Tg). We used to TCM-9 antibody by immunohistochemical staining on 5 follicular cancer, 2 follicular adenoma, 1 follicular neoplasm with suspicious invasion, 2 papillary cancer to ascertain being of help in differentiation between follicular carcinoma and adenoma. Reactivity of TCM-9 was observed in follicular carcinoma and papillary carcinoma but not observed in follicular adenoma. Thus TCM-9 is a novel monoclonal antibody against the thyroid cancer.

• The Korean Journal of Cytopathology
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• v.9 no.2
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• pp.169-180
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• 1998

Fine needle aspiration cytology(FNAC) has been used effectively as the initial modality in evaluating various thyroid lesions. We correlated cytologic and histopathologic features to investigate the diagnostic pitfalls of FNAC of the thyroid. A total of 1,593 FNACs of the thyroid were diagnosed at the Department of Pathology, Hanyang University Hospital, from January 1993 to December 1997 There were 963 cytologically benign cases(60.5%), 97 suspicious cases(6.1%), and 75 malignant cases(4.71%). The remaining 458 cases(28.8%) were unsatisfactory. Subsequent surgical resection was done in 192 cases. Seventy-two cases(37.5%) were cytologically diagnosed as benign, 45 cases(23.4%) suspicious, 56 cases(29.2%) malignant, and 19 cases(9.9%) unsatisfactory. Histopathologically, 101 cases were benign(11 thyroidites, 52 adenomatous hyperplasias, 34 follicular adenomas, and four Hurthle cell adenomas), and 91 cases malignant(72 papillary carcinomas, 16 follicular carcinomas, one medullary carcinoma, one anaplastic carcinoma, and one granular cell tumor). After excluding 19 unsatisfactory cases, 63 were misdiagnosed. They included 17 benign(three thyroidites and 14 adenomatous hyperplasias), 27 suspicious(10 follicular adenomas, four Hurthle cell adenomas, and seven follicular carcinomas), and 19 malignant(16 papillary carcinoma, one medullary carcinoma, one anaplastic carcinoma. and one granular cell tumor) lesions. The accuracy rates in the benign, suspicious, and malignant categories were 54.9%, 49.8%, & 92.8%, respectively. The cytological pitfalls were as follows: (1) background, (2) crowded follicular cell clusters indistinguishable between follicular neoplasia and adenomatous hyperplasia, (3) papillary structure, irregular nuclear membrane and pleomorphism mimicking those of papillary carcinoma, (4) indistinct eosinophilia in follicular epithelial cells, (5) unusual cellular components not commonly seen in FNACS of the thyroid.

• The Korean Journal of Cytopathology
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• v.7 no.1
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• pp.23-30
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• 1996

Chromatin texture, which partly reflects nuclear organization, is evolving as an important parameter indicating cell activation or transformation. In this study, chromatin pattern was evaluated by image analysis of the electron micrographs of follicular and papillary carcinoma cells of the thyroid gland and tested for discrimination of the two neoplasms. Digital grey images were converted from the electron micrographs, nuclear images, excluding nucleolus and intranuclear cytoplasmic inclusions, were obtained by segmentation; grey levels were standardized; and grey level histograms were generated. The histograms in follicular carcinoma showed Gaussian or near-Gaussian distribution and had a single peak, whereas those in papillary carcinoma had two peaks(bimodal), one at the black zone and the other at the white zone. In papillary carcinoma, the peak in the black zone represented an increased amount of heterochromatin particles and that at the white zone represented decreased electron density of euchromatin or nuclear matrix. These results indicate that the nuclei of follicular and papillary carcinoma cells differ in their chromatin pattern and the difference may be due to decondensed chromatin and/or matrix substances.

• The Korean Journal of Cytopathology
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• v.19 no.2
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• pp.152-159
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• 2008

Fine-needle aspiration cytology (FNAC) cannot differentiate follicular adenoma from follicular carcinoma since this distinction can only be based on the presence of capsular or vascular invasion, and this can￢not be detected on a cytologic smear. The goal of this study was to define the diagnostic cytologic findings of follicular neoplasm and the possibility of diagnosing follicular neoplasm by performing FNAC. The cases of histologically diagnosed follicular adenoma and follicular carcinoma on the thyroidectomy specimens were retrieved. Among them, the cases with preoperative FNAC that was done within 3 months of the operation were finally selected. Then we reviewed the FNAC and histologic slides of 19 cases: 9 follicular adenomas and 10 follicular carcinomas. Our results suggest that for cases of follicular neoplasm, the aspirates show high or abundant cellularity, frequent follicle formation and occasional cellular atypism of the follicular cells. However, the atypism is more pronounced and more frequently noticed in the cases of follicular carcinoma, which reveals more higher anisocytosis (7/10, 70%), nuclear pleomorphism (9/10, 90%), coarse clumping of chromatin (8/10, 80%) and cellular overlapping (8/10, 80%).