Skip to main content

Advertisement

SpringerLink
Log in

Probleme der differentialdiagnose follikulärer neoplasien der schilddrüse

Problems in the differential diagnosis of follicular neoplasies of the thyroid

  • Original investigations
  • Published:
Langenbecks Archiv für Chirurgie Aims and scope Submit manuscript

Summary

Fifteen resected follicular adenomas and 15 well-differentiated follicular carcinomas of the thyroid gland were analysed to determine whether a differential diagnosis of both “follicular neoplasms” can be performed by cytological criteria exclusively. 150–200 tumor cell nuclei (TCN) were studied per case for their TCN profile area, perimeter, density and for stereological estimates including the new parameter Vv, volume-weighted mean particle volume. Flow-cytometric analyses included measurement of the DNA index, the percentage of cells in S-phase and in G2/M phase. Follicular adenomas and follicular carcinomas did not show any significant differences in stereological estimates related to TCN size. Both groups included similar proportions of diploid and aneuploid neoplasms. Aneuploid follicular neoplasms showed a significantly greater area, perimeter and volume of TCN as compared to diploid tumors, regardless of their histological diagnosis. From our results a differential diagnosis of follicular neoplasms cannot be performed on the basis of cytological aspirates exclusively. Infiltration of capsula or vessels remain the only safe indicators of malignancy in the absence of metastases. The lack of cytological differences provides evidence that some follicular adenomas are preinvasive carcinomas, not yet showing infiltrative growth at the time of resection.

Zusammenfassung

Gut differenzierte follikuläre Neoplasien (FN) der Schilddrüse wurden unter der Frage analysiert, ob eine Differentialdiagnose ausschlielßlich anhand zytometrischer Kriterien möglich ist. Es wurden stereologische und flowzytometrische Tumorzellcharakteristika von 15 follikulären Karzinomen (FK) and 15 follikulären Adenomen (FA) untersucht mit den morphometrischen Primdrädaten Fldche, Umfang, Schnittsehnenldnge, numerische Dichte der Tumorzellkerne and der neue stereologische Schätzwert Vv. FK and FA unterschieden sich in keinem der untersuchten Tumorzellkernparameter. Diploide und aneuploide Tumoren kamen in beiden Gruppen gleichhdufig vor. Im Vergleich von diploiden mit aneuploiden FN zeigen aneuploide eine signifikante Vergrölßerung von Fläche, Umfang and Volumen der Tumorzellkerne. Unsere Ergebnisse schlielßen eine Differentialdiagnose der FN allein auf der Basis eines Aspirates aus. Die mangelnde zytologische Differenzierbarkeit zwischen beiden Typen der FN and der Nachweis malignomtypischer Stigmata bei den FA geben zu der Vermutung Anlaß, daß einige FA prdinvasive Karzinome sent könn-ten, die zum Zeitpunkt der Diagnose noch kein infiltratives Wachstum zeigen.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Literatur

  1. Arps H, Sablotny B, Dietel M, Niendorf A, Scbröder S (1988) DNA cytophotometry in malignant thyroid tumors — use of different evaluation schemes for prognostic statements. Virchows Arch [A] 413:319

    Google Scholar 

  2. Bay V (1989) Strategie und Radikalitätsprinzipien der chirurgischen Behandlung differenzierter Schildärüsenkarzinome. Aktuell Chir 24:53

    Google Scholar 

  3. Beck HP (1980) Evaluation of flow cytometric data of human tumors. Correction procedures for backround and cell aggregation. Cell Tissue Kinet 13:173

    Google Scholar 

  4. Böcker F (1984) Schilddruse. In: Remmele W (Hrsg) Pathologie 3. Springer, Berlin Heidelberg New York

    Google Scholar 

  5. Boon ME, Löwhagen T, Willems JS (1980) Planimetric studies of fine needle aspirates from follicular adenoma and follicular carcinoma of the thyroid. Acta Cytol 24:145

    Google Scholar 

  6. Boon ME, Löwhagen T, Lopes Cardozo P, Blonk DI, Kurven PJH, Baak JPA (1982) Computation of preoperative diagnosis propability of follicular adenoma and carcinoma on the thyroid on aspiration smears. Anal Quant Cytol 4:1

    Google Scholar 

  7. Droese M, Mentgen-Nothum V, Eins S, Klar R (1981) Morphometrische Dignitätsbeurteilung follikulärer Schilddrüsentumoren im Feinnadelpunktat. Verh Dtsch Ges Pathol 65:384

    Google Scholar 

  8. Feichter GE, Kühn W, Szernobilsky B, Müller A, Heep S, Abel U, Kaufmann M, Rummel HH, Kubli F, Goerttler K (1985) DNA flow cytometry of ovarian tumors with correlation to histopathology. Int J Gynecol Pathol 4:336

    Google Scholar 

  9. Georgii A (1977) Die epithelialen Tumoren der Schilddruse. Verb Dtsch Ges Pathol 61:191

    Google Scholar 

  10. Greenebaum E, Koss LG, Elequin, Silver CE (1985) The diagnostic value of flow-cytometric DNA-measurements in follicular tumours of the thyroid gland. Cancer 56:2011

    Google Scholar 

  11. Gundersen HJG, Jensen EB (1983) Particle sizes and their distribution estimated from line- and point-sampled intercepts. Including graphical folding. J Thorax 131:291

    Google Scholar 

  12. Gundersen HJG, Jensen EB (1985) Stereological estimation of the volume-weighted mean particle volume of arbitrary particles observed on random sections. J Microsc 138:127

    Google Scholar 

  13. Haag D (1980) Flow microfluorimetric desoxyribonucleid acid (DNA) analysis supplementing routine histopathologic diagnosis of biopsy specimens. Lab Invest 42:85

    Google Scholar 

  14. Haemmerli G (1970) Zytophotome trische und zytogenetische Untersuchungen an knotigen Veränderungen der menschlichen Schilddrüse. Schweiz Med Wochenschr 100:633

    Google Scholar 

  15. Hedinger C, Sobin LH (1974) Histological typing of thyroid tumors. World Health Organization, Geneva

    Google Scholar 

  16. Hedinger C (1988) Histological tumour typing of thyroid tumors, 2nd edn. Springer, Berlin Heidelberg New York Tokyo

    Google Scholar 

  17. Hedley DW, Friedlander ML, Raylor IW Rugg CA, Musgrove EA (1983) Method of analysis of cellular DNA content of paraffin embedded pathological material using flow-cytometry. J Histochem Cytochem 31:1333

    Google Scholar 

  18. Johannessen JV, Sobrinho-Simoes M, Lindmo T, Tangen KO (1983) The diagnostic value of flow cytometry DNA mesurements in selected disordes of the human thyroid. Am J Clin Pathol 79:166

    Google Scholar 

  19. Johannessen JV, Sobrinho-Simoes M (1983) Well-differentiated thyroid tumours. Problems in diagnosis and understanding. Pathol Annu 18:255

    Google Scholar 

  20. Johannessen JV, Sobrinho-Simoes M, Finseth I, Pilström L (1983) Ultrastructural morphometry of thyroid neoplasms. Am J Clin Pathol 79:166

    Google Scholar 

  21. Kriete A, Romen W, Schaffer R, Harms H, Haucke M, Gerlach B, Aus HM, ter Meulen V (1983) Computer analysis of chromatin arrangement and nuclear texture in follicular thyroid tumours. Histochemistry 78:227

    Google Scholar 

  22. Kriete A, Schaffer R, Harms H, Aus HM (1985) Computer-based cytophometric classification of thyroid tumors in imprints. J Cancer Res Clin Oncol 109:252

    Google Scholar 

  23. Lang W Georgii A, Atay Z (1977) Differentialdiagnose zwischen atypischem Adenom und follikulärem Karzinom der Schilddrüse. Verb Dtsch Ges Pathol 61:275

    Google Scholar 

  24. Luck JB, Mumaw VR, Frable WJ (1983) Fine needle aspiration biopsy of the thyroid. Differential diagnosis by videoplan image analysis. Acta Cytol 26:793

    Google Scholar 

  25. Mikuz G, Hofstädter F, Schwarzlmüller B (1977) Feulgenzytophotometrische Untersuchungen an „falsch” und „richtig positiven” zytologischen Präparaten von Feinnadel-Schilddrüsenpunktaten. Verb Dtsch Ges Pathol 61:290

    Google Scholar 

  26. Möller P, Gross C, Feichter G, Mattfeldt T, Kaufmann M (1985) Vergleich von Bindungsmustern etablierter und neuer monoklonaler Antikörper, von Antiseren und Lektinen mit impulscytophotometrischen und morphometrischen Parametern und dem Hormonrezeptorstatus am Mammacarcinom. Verh Dtsch Ges Pathol 69:405

    Google Scholar 

  27. Nielsen K, Colstrup H, Nilsson T, Gundersen HJG (1986) Stereological estimates of nuclear volume correlated with histopathological grading and prognosis of bladder tumor. Virchows Arch [B] 52:41

    Google Scholar 

  28. Nielsen K, Jorgensen PE, Besild GH, Bruun E, Weiss N, Gundersen HJG (1987) Stereological estimates of unclear volume correlated with clinical stage and progression of prostatic cancer. Application of a Stereological method in diagnostic quantitative pathology. Acta Stereol 6 [Suppl III]: 59

    Google Scholar 

  29. Rabenhorst G (1974) The diagnostic value of the DNA content of fine needle biopsies of the thyroid gland. Virchows Arch [B] 16:379

    Google Scholar 

  30. Schröder S, Dralle H, Rehpenning W, Böcker W (1987) Morphologie und Prognose des folliculären Schilddrüsencarcinoms. Eine klinisch-pathologische und DNS-cytometrische Untersuchung an 95 Tumoren. Langenbecks Arch Chir 370:3

    Google Scholar 

  31. Schuh D, Steidl R, Voß K (1980) Unterscheidung von follikulären Adenomen und Karzinomen in der Schilddrüsenfein-nadelbiopsie durch computergestiitzte zytomorphometrische Untersuchungen. Zentralbl Allg Pathol 124:557

    Google Scholar 

  32. Schuh D, Steidl R, Mende T, Schneider H, Reske W (1984) Ergebnisse der automatischen Mikroskopbildanalyse von Schilddrüsenfeinnadelbiopsien. Zentralbl Allg Pathol 129:35

    Google Scholar 

  33. Sprenger E, Löwhagen T, Vogt-Schaden M (1977) Differential diagnosis between follicular adenoma and follicular carcinoma of the thyroid by nuclear DNA determination. Acta Cytol 21:528

    Google Scholar 

  34. Tschahargane C, Goerttler K; Ehemann V, Haag D (1978) Application of flow-through DNA measurements in thyroid diseases. Pulse Cytophotometry 3:527

    Google Scholar 

  35. Weibel ER (1979) Stereological methods. I. Practical methods for biological morphometry. Academic Press, London

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Chirurgische Klinik, Kirschnerstraße 1, D-6900, Heidelberg

    G. Schürmann & H. J. Buhr

  2. Pathologisches Institut der Universität Heidelberg, Im Neuenheimer Feld, D-6900, Heidelberg

    T. Mattfeldt & G. Feichter

Authors
  1. G. Schürmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Mattfeldt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. Feichter
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. J. Buhr
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schürmann, G., Mattfeldt, T., Feichter, G. et al. Probleme der differentialdiagnose follikulärer neoplasien der schilddrüse. Langenbecks Arch Chiv 375, 95–101 (1990). https://doi.org/10.1007/BF00713393

Download citation

  • Received:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00713393

Key words

Search

Navigation