768
THYROID CARCINOMA IN A PATIENT WITH A COEXISTING FUNCTIONAL ADENOMA ANDREW BLITZER, DDS, MD MAX L. SOM, MD NEW YORK, NEW YORK Fourteen case reports have been published in which "hot" nodules have been documented as carcinoma, with or without coexisting adenomas. The diagnosis of these lesions is difficult, since hot nodules usually represent benign disease. These carcinomas are not Iunctional, but represent coexistence of a functional area or a malignant degeneration. Hot nodule carcinomas should be suspected in high-risk patients. A euthyroid, 31-year-old woman who, as a teenager, had radiotherapy for acne is reported. She was followed up with yearly scans for a hot nodule in the right lower lobe of her thyroid. When she was 36, a node was discovered in the right side of her neck, and carcinoma was suspected. Surgical excision revealed a papillary-follicular carcinoma adjacent to an adenoma with metastases to regional lymph nodes.
INTRODUCTION
THYROID scanning has become an extremely helpful adjunctive procedure for the evaluation of thyroid nodules. It was in 1930 that Hamilton and Soley' reported a markedly decreased uptake of radioactive iodine (RAI) in thyroid cancers as compared with the surrounding tissues.
Submitted for publication Jan 17,1979. From the Department of Otolaryngology, College of Physicians and Surgeons, Columbia University, New York (Dr Blitzer), and the Mount Sinai School of Medicine, Division of Head and Neck Surgery, Beth Israel Medical Center, New York (Dr Sam). Presented as a Scientific Poster Presentation at the 1978 Annual Meeting of the American Academy of Otolaryngology, Las Vegas, Sept 10-13. Reprint requests to Department of Otolaryngology, College of Physicians and Surgeons, Columbia University, 630 W 168th St, New York, NY 10032 (Dr Blitzer).
Others later reported that many benign lesions showed an increased uptake of RAI as compared with the surrounding tissues. In 1949, Dobyns et al2 first classified thyroid nodules as "cold," "warm," and "hot" according to RAI uptake on scan. This gave clinicians a categoric tool for describing and studying thyroid disease. Using this information, Perlmutter and Slater.' in 1956, reviewed the scans of 140 solitary nodules (23 of 99 cold nodules were malignant, and 0 of 41 hot nodules were malignant) and concluded that a percentage of cold nodules represented malignancies, whereas hot nodules represented benign disease. This was further substantiated by Groesbeck- in 1959, when he analyzed 156 solitary thyroid nodules. He found malignancies in 14.5% of cold scans, 3.8% of warm scans, and 0% of hot scans. He believed, however, that these data were suggestive and not conclusive. He stated that, " . . . isotope function should be an adjunct to, not a substitute for, the critical evaluation of the clinical features of each case. If the patient's history, sex, age, and nodule consistency, for example, suggested the possibility of carcinoma, surgery for the diagnosis must be advised.:" About the same time, Molnar et als reported the first case of clinical hyperthyroidism with a hot nodule scan, which contained a focal area of sclerosing adenocarcinoma. Since this time, there have been, to the authors' knowledge, only 14 additional cases (including the present case) of a hot nodule scan with a histologic diagnosis of carcinoma (Table).
Otolaryngol Head Neck Surg 87:768-774 (Nov-Dec) 1979 Downloaded from oto.sagepub.com at UNIV CALIFORNIA SANTA BARBARA on June 9, 2016
REPORTED CASES OF HOT NODULE THYROID CARCINOMA IN THE ENGLISH LITERATURE
AUTHOR, YEAR
Downloaded from oto.sagepub.com at UNIV CALIFORNIA SANTA BARBARA on June 9, 2016
Molnar et al, 1958S
NO. Of CASES
AGE, SEX
1
28, M
THYROID FUNCTION
Hyperthyroid
LATERALITY
NO. OF CASES IN SERIES REVIEWED
PREVIOUS RADIOTHERAPY
NODES
MICROSCOPIC PATHOLOGY
Functional adenoma with 0.2-cm focus of • papillary carcinoma and 0.5-cm sclerosing adenocarcinoma
L
()
:> :-c ()
Z
0
Attie,l96Q11
0
r;;., -e ::J
Meadows, 1961'
0
148 cases with 16 hot nodules
2
103 cases with 15 hot nodules
Hyperthyroid
1
OQ
~
:> Papillary carcinoma within an adenoma
2.III
Q..
~
Becker et al, 1963'0
2
21, F 23, F
Euthyroid Euthyroid
Adenoma with embedded l-cm papillary carcinoma, adenoma with embedded papillary carcinoma
R R
III I"l
~
V'l
.,c
OQ
Q)
:':l
.
0m x Vl
:j
Z
C)
:> Grant et al, 1963'1
161 with 4 hot nodules
2
Papillary-follicular carcinoma
~
0 Z
m
0
~
Q)
...., ....,
:::;
:::I: ()
::t III
~
Dische, 1964"
1
Robinson et al, 196610
2
~
......
42, F
Hyperthyroid
R
506 with 11 hot nodules
Follicular-alveolar cell carcinoma (without adenoma)
148 with 31 hot scans
Papillary carcinoma
z
:>
0
THYROID CARCINOMA IN A PATIENT WITH A COEXISTING FUNCTIONAL ADENOMA ANDREW BLITZER, DDS, MD MAX L. SOM, MD NEW YORK, NEW YORK Fourteen case reports have been published in which "hot" nodules have been documented as carcinoma, with or without coexisting adenomas. The diagnosis of these lesions is difficult, since hot nodules usually represent benign disease. These carcinomas are not Iunctional, but represent coexistence of a functional area or a malignant degeneration. Hot nodule carcinomas should be suspected in high-risk patients. A euthyroid, 31-year-old woman who, as a teenager, had radiotherapy for acne is reported. She was followed up with yearly scans for a hot nodule in the right lower lobe of her thyroid. When she was 36, a node was discovered in the right side of her neck, and carcinoma was suspected. Surgical excision revealed a papillary-follicular carcinoma adjacent to an adenoma with metastases to regional lymph nodes.
INTRODUCTION
THYROID scanning has become an extremely helpful adjunctive procedure for the evaluation of thyroid nodules. It was in 1930 that Hamilton and Soley' reported a markedly decreased uptake of radioactive iodine (RAI) in thyroid cancers as compared with the surrounding tissues.
Submitted for publication Jan 17,1979. From the Department of Otolaryngology, College of Physicians and Surgeons, Columbia University, New York (Dr Blitzer), and the Mount Sinai School of Medicine, Division of Head and Neck Surgery, Beth Israel Medical Center, New York (Dr Sam). Presented as a Scientific Poster Presentation at the 1978 Annual Meeting of the American Academy of Otolaryngology, Las Vegas, Sept 10-13. Reprint requests to Department of Otolaryngology, College of Physicians and Surgeons, Columbia University, 630 W 168th St, New York, NY 10032 (Dr Blitzer).
Others later reported that many benign lesions showed an increased uptake of RAI as compared with the surrounding tissues. In 1949, Dobyns et al2 first classified thyroid nodules as "cold," "warm," and "hot" according to RAI uptake on scan. This gave clinicians a categoric tool for describing and studying thyroid disease. Using this information, Perlmutter and Slater.' in 1956, reviewed the scans of 140 solitary nodules (23 of 99 cold nodules were malignant, and 0 of 41 hot nodules were malignant) and concluded that a percentage of cold nodules represented malignancies, whereas hot nodules represented benign disease. This was further substantiated by Groesbeck- in 1959, when he analyzed 156 solitary thyroid nodules. He found malignancies in 14.5% of cold scans, 3.8% of warm scans, and 0% of hot scans. He believed, however, that these data were suggestive and not conclusive. He stated that, " . . . isotope function should be an adjunct to, not a substitute for, the critical evaluation of the clinical features of each case. If the patient's history, sex, age, and nodule consistency, for example, suggested the possibility of carcinoma, surgery for the diagnosis must be advised.:" About the same time, Molnar et als reported the first case of clinical hyperthyroidism with a hot nodule scan, which contained a focal area of sclerosing adenocarcinoma. Since this time, there have been, to the authors' knowledge, only 14 additional cases (including the present case) of a hot nodule scan with a histologic diagnosis of carcinoma (Table).
Otolaryngol Head Neck Surg 87:768-774 (Nov-Dec) 1979 Downloaded from oto.sagepub.com at UNIV CALIFORNIA SANTA BARBARA on June 9, 2016
REPORTED CASES OF HOT NODULE THYROID CARCINOMA IN THE ENGLISH LITERATURE
AUTHOR, YEAR
Downloaded from oto.sagepub.com at UNIV CALIFORNIA SANTA BARBARA on June 9, 2016
Molnar et al, 1958S
NO. Of CASES
AGE, SEX
1
28, M
THYROID FUNCTION
Hyperthyroid
LATERALITY
NO. OF CASES IN SERIES REVIEWED
PREVIOUS RADIOTHERAPY
NODES
MICROSCOPIC PATHOLOGY
Functional adenoma with 0.2-cm focus of • papillary carcinoma and 0.5-cm sclerosing adenocarcinoma
L
()
:> :-c ()
Z
0
Attie,l96Q11
0
r;;., -e ::J
Meadows, 1961'
0
148 cases with 16 hot nodules
2
103 cases with 15 hot nodules
Hyperthyroid
1
OQ
~
:> Papillary carcinoma within an adenoma
2.III
Q..
~
Becker et al, 1963'0
2
21, F 23, F
Euthyroid Euthyroid
Adenoma with embedded l-cm papillary carcinoma, adenoma with embedded papillary carcinoma
R R
III I"l
~
V'l
.,c
OQ
Q)
:':l
.
0m x Vl
:j
Z
C)
:> Grant et al, 1963'1
161 with 4 hot nodules
2
Papillary-follicular carcinoma
~
0 Z
m
0
~
Q)
...., ....,
:::;
:::I: ()
::t III
~
Dische, 1964"
1
Robinson et al, 196610
2
~
......
42, F
Hyperthyroid
R
506 with 11 hot nodules
Follicular-alveolar cell carcinoma (without adenoma)
148 with 31 hot scans
Papillary carcinoma
z
:>
0
