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Organization. Statistical analysis The primary objective of this study was the estimation of true incidence of multifocal occult PTC in patients who underwent a total thyroidectomy for a solitary PTC lesion diagnosed by ultrasound. Occult PTC means the
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et al . 2005 ). This increase was mainly due to the increasing detection of occult medullary thyroid cancer no larger than 10 mm. In the presence of multinodular goiter, these occult cancers are barely amenable to conventional diagnostic strategies
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Department of Surgery, Department of Surgery, School of Public Health, Department of Pathology, Cancer Research Institute, The University of Hong Kong, Hong Kong SAR, China
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Department of Surgery, Department of Surgery, School of Public Health, Department of Pathology, Cancer Research Institute, The University of Hong Kong, Hong Kong SAR, China
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Department of Surgery, Department of Surgery, School of Public Health, Department of Pathology, Cancer Research Institute, The University of Hong Kong, Hong Kong SAR, China
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risks for temporary hypoparathyroidism and overall morbidity ( Lang et al . 2013 ). Therefore, identification of predictive factors for occult CNM is crucial to reduce unnecessary pCND ( Koo et al . 2009 , Hartl et al . 2012 , Zhang et al . 2012
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The current extension of the indications for adjuvant chemotherapy, which predisposes to early menopause, and the media coverage of the benefits of hormone replacement therapy (HRT) have led patients with a history of breast cancer to seek treatments for estrogen deprivation. In breast cancer survivors, most physicians avoid HRT because of concern regarding the potential promotion of growth of occult malignant cells by estrogens, due to the estrogen dependence of breast cancer. Soy phytoestrogens are being promoted as the 'natural alternative' to HRT and have been available without restrictions for several years as nutritional supplements. In this paper, data on the complex mammary effects of phytoestrogens in epidemiological studies, in in vitro studies, as well as in in vivo studies on animal carcinogenesis are reviewed. The potential benefits and risks of phytoestrogens are analyzed, and the prescription of phytoestrogens to postmenopausal women after breast cancer and the coprescription with the anti-estrogen tamoxifen are discussed. The absence of controlled trials and technical checking of extraction and titration in these preparations on 'free sale' raise a new problem in terms of public health and justify close reasoning and a cautious attitude of physicians, as well as straight information given to women, especially after breast cancer.
Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
Division of Bioinformatics, Walter and Eliza Hall Institute, Parkville, Victoria, Australia
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Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
Diagnostic Genomics, NICTA, Victoria Research Laboratory, The University of Melbourne, Parkville, Victoria, Australia
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Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
Department of Urology, Royal Melbourne Hospital, Parkville, Victoria, Australia
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Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
Department of Urology, Royal Melbourne Hospital, Parkville, Victoria, Australia
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Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
Department of Urology, Royal Melbourne Hospital, Parkville, Victoria, Australia
Department of Urology, Frankston Hospital, Frankston, Victoria, Australia
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Evidence suggests that altered adipose tissue homeostasis may be an important contributor to the development and/or progression of prostate cancer. In this study, we investigated the adipose transcriptional profiles of low- and high-risk disease to determine both prognostic potential and possible biological drivers of aggressive disease. RNA was extracted from periprostatic adipose tissue from patients categorised as having prostate cancer with either a low or high risk of progression based on tumour characteristics at prostatectomy and profiled by RNA sequencing. The expression of selected genes was then quantified by qRT-PCR in a cross-validation cohort. In the first phase, a total of 677 differentially transcribed genes were identified, from which a subset of 14 genes was shortlisted. In the second phase, a 3 gene (IGHA1, OLFM4, RERGL) signature was refined and evaluated using recursive feature selection and cross-validation, obtaining a promising discriminatory utility (area under curve 0.72) at predicting the presence of high-risk disease. Genes implicated in immune and/or inflammatory responses predominated. Periprostatic adipose tissue from patients with high-risk prostate cancer has a distinct transcriptional signature that may be useful for detecting its occult presence. Differential expression appears to be driven by a local immune/inflammatory reaction to more advanced tumours, than any specific adipose tissue-specific tumour-promoting mechanism. This signature is transferable into a clinically usable PCR-based assay, which in a cross-validation cohort shows diagnostic potential.
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The incidence of differentiated thyroid cancer (DTC) has increased in many places around the world over the past three decades, yet this has been associated with a significant decrease in DTC mortality rates in some countries. While the best 10-year DTC survival rates are about 90%, long-term relapse rates remain high, in the order of 20-40%, depending upon the patient's age and tumor stage at the time of initial treatment. About 80% of patients appear to be rendered disease-free by initial treatment, but the others have persistent tumor, sometimes found decades later. Optimal treatment for tumors that are likely to relapse or cause death is total thyroidectomy and ablation by iodine-131 ((131)I), followed by long-term levothyroxine suppression of thyrotropin (TSH). On the basis of regression modeling of 1510 patients without distant metastases at the time of initial treatment and including surgical and (131)I treatment, the likelihood of death from DTC is increased by several factors, including age >45 years, tumor size >1.0 cm, local tumor invasion or regional lymph-node metastases, follicular histology, and delay of treatment >12 months. Cancer mortality is favorably and independently affected by female sex, total or near-total thyroidectomy, (131)I treatment and levothyroxine suppression of TSH. Treatments with (131)I to ablate thyroid remnants and residual disease are independent prognostic variables favorably influencing distant tumor relapse and cancer death rates. Delay in treatment of persistent disease has a profound impact on outcome. Optimal long-term follow-up using serum thyroglobulin (Tg) measurements and diagnostic whole-body scans (DxWBS) require high concentrations of TSH, which until recently were possible to achieve only by withdrawing levothyroxine treatment, producing symptomatic hypothyroidism. New paradigms, however, provide alternative pathways to prepare patients for (131)I treatment and to optimize follow-up. Patients with undetectable or low Tg concentrations and persistent occult disease can now be identified within the first year after initial treatment by recombinant human (rh)TSH-stimulated serum Tg concentrations greater than 2 microg/l, without performing DxWBS. These new follow-up paradigms promptly identify patients with lung metastases that are not evident on routine imaging, but which respond to (131)I treatment. In addition, rhTSH can be given to prepare patients for (131)I remnant ablation or (131)I treatment for metastases, especially those who are unable to withstand hypothyroidism because of concurrent illness or advanced age, or whose hypothyroid TSH fails to increase.
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forgotten: the key role of the pathologist in the diagnosis and management of pheochromocytoma and paraganglioma and the identification of occult heritable cases. When a major strategy of risk management is based on early diagnosis and surveillance, imaging
Endocrinology Service, Peter MacCallum Cancer Centre, Melbourne, Australia
Department of Nuclear Medicine & Specialised PET Services, Royal Brisbane & Women’s Hospital, Brisbane, Australia
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Neuroendocrine Service, Peter MacCallum Cancer Centre, Melbourne, Australia
The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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localise or regionalise the occult insulinoma, or regionalise the most hyperfunctioning pancreatic tissue. A recent analysis ( Thompson et al. 2015 ) of 116 patients with biochemical evidence of hyperinsulinaemic hypoglycaemia and inconclusive imaging
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thyroid carcinoma: is extent of surgical resection important? Surgery 104 954 – 962 . Harach HR Franssila KO Wasenius VM 1985 Occult thyroid carcinoma of the thyroid. A ‘normal’ finding in Finland. A systematic autopsy study . Cancer 56
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F 2001b ErbB2 overexpression on occult metastatic cells in bone marrow predicts poor clinical outcome of stage I–III breast cancer patients. Cancer Research 61 1890 –1895. Braun S , Vogl FD, Naume B, Janni W
