P53, BCL-2 AND Ki-67 IN THE DIAGNOSIS OF INSULAR THYROID GLAND CANCER Case report with a review of literature

Autori:

Irena Novosel, Stela Bulimbašić, Vesna Ramljak, Božica Matković, Danijel Došen, Viktor Šeparović

Sažetak
Prikaz opisuje prvi slučaj insularnog karcinoma štitnjače zabilježen u hrvatskoj medicinskoj literaturi. Bolesnica u dobi od 71 godinu, primljena je u bolnicu zbog simptoma inspiratornog stridora. Kliničkim pregledom utvrdila se ekspanzivna tumorska masa. Ultrazvučno navođena citološka punkcija upućivala je na anaplastični karcinom te je učinjena totalna tireoidektomija. Patohistološka analiza H/E biopsija otkrila je tumorsku masu s karakterističnog inzularnog načina rasta monomorfnih tumorskih stanica. Imunohistokemijska analiza potvrdila je dijagnozu difuzno pozitivnom reakcijom na tireoglobulin, fokalno na ttf-1, te oskudno na citokeratin, dok su kalcitonin, FVIII, CD34 i LCA bili jasno negativni. p53 i bcl-2 bili su izraženi u 35,9% odnosno 85% tumorskih stanica. Proliferacijski indeks za Ki-67 iznosio je 4,19. Na temelju svog istraživanja preporučjemo paletu  imunohistokemijskih pretraga za diajgnozu insularnog karcinoma. Čak i kada je djelomično prisutan, insularni karcinom trabao bi  biti spomenut u patohistološkom izvješću zbog  prognostičkog značenja za bolesnika.
Summary

Summary. The report covers the first case of insular thyroid cancer recorded in Croatian medical literature. A 71-year old female patient presented to our hospital with symptoms of inspiratory stridor. Clinical examination disclosed an expansive tumor mass. US guided FNA indicated anaplastic cancer and total thyroidectomy was accordingly indicated. Patho- histological analysis of H/E biopsies disclosed a tumor mass with a characteristic insular growth pattern of monomorphic tumor cells. Immunohistochemical analysis confirmed diagnosis by a diffuse positive reaction to thyreoglobulin, focally to TTF-1, and scant to cytokeratin, while calcitonin, FVIII, CD34 and LCA were clearly negative. P53 and bcl-2 were expressed in 35.9% and 85% of tumor cells, respectively. The proliferation index for Ki-67 was 4.19. According to our survey we suggest a panel of immunohistochemistry for diagnosing insular cancer. Even if partly present, insular cancer should be mentioned in the pathohistological description because of its prognostic meaning.

Volumen: 9-10, 2006

Liječ Vjesn 2006;128:264-267

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