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  • 1
    ISSN: 1432-2307
    Keywords: Medullary thyroid carcinoma ; Calcitonin ; Amyloid fibrils
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Using 3 polyclonal antisera directed against synthetic human calcitonin, we investigated at the electron microscope level the intra-or-extracellular fibrillar/filamentous aggregates found in 4 amyloid-rich medullary thyroid carcinomas (MTC) and in a number of other endocrine polypeptide tumours with or without demonstrable amyloid deposition. The antisera were applied by the immunogold procedure on ultrathin sections of glutaraldehyde-fixed, usually osmium-postfixed, tissues. In MTC cases, a strong labelling was present over two types of aggregates: one composed of rigid, criss-crossing fibrils 7–10 nm in diameter, suggestive of amyloid, and the other consisting of loosely arranged fibrils, 4–7 nm in width, often wavy or poorly defined. In both cases, the labelling was closely associated with that part of the sectioned fibril exposed to the antiserum. Amorphous material was sometimes present adjacent to the latter aggregates, but did not bind the calcitonin antibodies. In contrast, no labelling occurred over the amyloid deposits found in two non-calcitonin-producing endocrine tumours of the pancreas, nor over the cytoskeletal filaments stored in various endocrine polypeptide tumours. The specific value of the labelling for calcitonin-like immunoreactivity was assessed by control tests, such as absorption of the antiserum by excess calcitonin and comparative use of normal serum and antisera directed against human IgG and P component. No immunoreactivity of the MTC amyloid fibrils was found using antibodies directed against katacalcin and human prealbumin. We conclude that in tumour tissues conventionally processed for electron microscopy, MTC amyloid fibrils of varying morphology can be selectively and specifically labelled for calcitonin-like immunoreactivity.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Twenty micro medullary thyroid carcinomas (MTCs) were found in histologic specimens of 19 patients in our department from 1990 to 1998. There were 14 women and 5 men, with a median age of 63 years. The indication for surgery was goiter in 12 patients and a solitary nodule in 7 patients (three differentiated cancers). Altogether, 18 patients had unifocal micro-MTCs with a median diameter of 3.6 mm. One patient had a bilateral MTC (3 and 5 mm, respectively). Surgical procedures consisted of 9 total thyroidectomies and 10 lobectomies or subtotal thyroidectomies. Of these 10 patients, 4 underwent reoperation (totalization). One was operated on 48 months after a positive pentagastrin test: There was no thyroid residual tumor but three lymph node micrometastases. Among the six patients in whom thyroid tissue was left, a 91-year-old woman died of unrelated cause and the five others remain disease-free without biologic abnormalities at follow-ups of 18 to 70 months. Considering the aggressiveness of MTCs, total thyroidectomy with central compartment dissection is theoretically indicated. However, among the nine total thyroidectomies and four secondary totalizations associated with at least central compartment dissection, no other thyroid lesion was observed and only one case of lymph node microinvasion was found. Because of the morbidity associated with reoperation and neck dissection, we propose that it is indicated only for microcarcinomas 〉 5 mm in diameter, in cases of an abnormal response to pentagastrin, or when it is difficult to ensure prolonged follow-up of the patient.
    Type of Medium: Electronic Resource
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