HBME-l is an antimesothelial monoclonal antibody that recognizes an unknown antigen on microvilli of mesothelial cells. The antibody is only relatively specific for mesothelium and is used in the differential diagnosis of mesothelioma and adenocarcinoma within the context of an appropriate immuno-histochemical panel. HBME-l has also been reported to strongly and uniformly stain papillary and follicular carcinoma of the THYROID while benign disorders have been usually negative. We studied the immunoreactivity of HBME-l in 90 cases of benign and malignant THYROID lesions. We found strong positive staining in the majority of papillary carcinomas (28/31), in some of follicular carcinomas (4/6), and in a few follicular adenomas (2/17). Negative staining was found in oxyphilic cell adenoma (0/4), nodular goiter (0/13) and undifferentiated carcinoma. The results suggest that monoclonal antibody HBME-l is useful in differentiating papillary and follicular carcinoma of the THYROID from benign lesions, especially in more differentiated lesions. Strong and generalized immunoreactivity for HBME-l in a follicular lesion should raise the suspicion of malignancy, but negative staining specially in poorly differentiated lesion does not rule out malignancy.

On encountering an eyelid or orbital mass, apart from common skin lesions, the diagnosis requires systemic evaluation, radiological and eventually histological confirmation. The majority are uncommon conditions for ophthalmologists.1 The presenting signs in all soft tissue NEOPLASMs and carcinomas are rather similar with lid swelling and proptosis. In this edition Langerhans cell histiocytosis (LCH), granular cell tumor (GCT) and eyelid conjunctival amyloidosis have been reported. In all the diagnosis is based on confirmation of an adnexal mass and by imaging followed by a histopathological report along with systemic investigation.

Aim: THYROID scan with sestamibi is used for evaluation of THYROID nodules with the aim of increasing specificity before surgery. In this study we evaluated the role of Sestamibi THYROID scan in candidates for THYROID surgery.Methods and patients: During two years, 37 patients were studied with solitary THYROID nodules, referred for THYROID surgery due to malignant or suspicious FNAB results (66/7%), compressive effects or failure of medical therapy. THYROID scan was performed after IV injection of 15mCi of Tc-99m-MIBI in 4 phases (Angiography-First 10 minutes-15min and 2-3 hours after injection). THYROID MIBI uptake was scaled in 5 scores (0-4) with no uptake as score 0 and hot nodule as score 4. Patients underwent THYROID surgery and results of pathology are correlated with MIBI uptake. Results: From 37 patients (27female, 10 male, mean age=35.5 years+/- 13.6) 16 malignant and 21 benign nodules were detected. In another classification, we had 26 neoplastic and 11 non-neoplastic nodules. MIBI uptake score 3-4 was noted in 11 out of 16 malignant nodules and 13 out of 21 benign nodules (P=0.73). Sensitivity and specificity of high MIBI uptake (score 3-4)for diagnosis of malignancy was 68.7% and38% respectively. The values for sensitivity and specificity were 69.2% and 30.7% in diagnosis of NEOPLASM respectively. Washout index (considered as difference in uptake scores of late and early phases) was 0.45 in benign and 0.09 in malignant nodules (P=0.07). The values were 0.26 and 0.37 in neoplastic and non-neoplastic nodules respectively (P=0.65).Conclusion: THYROID MIBI scan has a low specificity for differentiating malignant from benign or neoplastic from non-neoplastic nodules in patients who are candidates for THYROID surgery according to clinical evaluation. Analysis of wash out index may increase specificity.

Background: Familial non-medullary THYROID cancer (NMTC) are supposed to be more aggressive and require more frequent treatment compared to non-familial THYROID cancer. Objectives: This matched case-control study aimed to compare the response to treatment between the matched case-control groups of familial and sporadic NMTC. Methods: This is a retrospective study in patients with familial NMTC (at least one other first-degree relative involved) who were treated with surgery, followed by radio-iodine therapy (RIT) without consideration of its familial origin. Response to treatment was compared between familial NMTC and age, sex, and TNM stage-matched non-familial NMTC (control group). Response to treatment was assessed one and two years after RIT, and time to excellent response was identified. Results: Out of 2, 944 NMTC patients, 81 (2. 75%) patients had familial NMTC. We compared 66 patients with familial NMTC and 66 sporadic NMTC patients. There was no significant difference in first thyroglobulin, initial and accumulative iodine dose, and additional treatments (additional surgery and radiotherapy) between patients and controls. Although no significant difference was noted in one and two years' responses to treatment between the case and control groups, familial NMTC patients required more time to achieve excellent response (26. 7-24. 9 versus 15. 9-9. 0 months, P = 0. 01). No significant difference was noted between familial NMTC patients with two or more than two involved relatives. Conclusions: Our study showed that if patients with familial NMTCs were treated in the same way as non-familial patients, the time to excellent response would be significantly longer, even when they have only one other involved relative.

Introduction: Several prognostic factors affect the outcome of THYROID carcinomas including tumor stage and distant metastases. Nm23 is a metastasis suppressor gene and has a crucial role in the control of metastatic potential of several carcinomas. The aim of our study is to evaluate expression of nm23 marker in benign and malignant THYROID NEOPLASMs using the immunohistochemistry method and to elucidate its relationship with tumor size, vascular or capsular invasion and lymph node involvement. Materials and methods: In a descriptive study, 200 paraffin blocks comprising of 38 benign and 162 malignant THYROID NEOPLASMs stained with nm23 marker were studied. Cytoplasmic staining in more than 10% of cells was considered as positive. The relationship between nm23 and tumor size, vascular or capsular invasion, lymph node involvement was analyzed using SPSS 11.5 software (p=0.05). Results: There was 40% positive incidence of nm23 in follicular adenoma, 87.5% in hurthle cell adenoma, 67.2% in papillary carcinoma, 66.7% in follicular carcinoma, and 64.7% in medullary carcinoma. In follicular adenoma, frequency of nm23 positive tumors was directly correlated to tumor size (p=0.04). There is no statistically significant correlation between nm23 and tumor size, vascular or capsular invasion or lymph node involvement in malignant THYROID NEOPLASMs. In papillary and medullary carcinoma, negative predictive value of nm23 for lymphnode involvement was over 80%. Also in follicular carcinoma, sensitivity and negative predictive value of nm23 for vascular invasion were approximately 90%. Discussion: Lack of significant correlation between nm23 and tumor invasiveness (and probably metastasis) factors, demonstrate that although nm23 is a potentially metastasis suppressor gene, whereas in many other tumors it may play a different role in THYROID NEOPLASMs, a role which necessitates further studies to be conducted.

Medullary THYROID carcinoma (MTC) is a rare tumor arising from parafollicular C-cells. The oncocytic variant of MTC is an extremely rare diagnosis, with less than 20 cases reported. Here we present the case of a 36-year-old male patient with complaints of neck swelling and dysphagia. On fine needle aspiration cytology (FNAC), a Hü rthle cell NEOPLASM was suggested. Finally with histopathology and immunohistochemistry (IHC), a diagnosis of MTC oncocytic variant was established. This tumor can be easily misdiagnosed for any THYROID Hü rthle cell lesions. An accurate diagnosis is important because MTC has different treatment protocols, and its oncocytic variant is expected to be associated with poorer patient survival. Thus, the oncocytic variant of MTC is a difficult diagnosis on FNAC. Histopathology and relevant IHC markers are necessary for a correct diagnosis.