Myxofibrosarcoma of the thyroid gland

AbstractIntroductionMyxofibrosarcoma of the thyroid is exceptional: a Medline search found a single case report. We report a new case which raised diagnostic and therapeutic problems.ObservationWe report the case of a 74-year-old woman who presented with swelling of the left thyroid lobe and ipsilateral cervical lymphadenopathy. Total thyroidectomy with cervical lymph-node dissection was performed. Histological analysis diagnosed myxofibrosarcoma. Evolution was marked by rapid local recurrence, and chemotherapy based on doxorubicin and ifosfamide was introduced.Discussion/conclusionHead and neck myxofibrosarcoma is rare. MRI is essential and should always precede treatment. Diagnosis is histological. There is elevated risk of local recurrence after resection, accompanied by worsening tumor grade, whence the need for accurate diagnosis, appropriate treatment and regular MRI follow-up

Intracranial pressure and histology.

<p>Relative ventricle area (ventricle area / brain area) (A) in SAH animals with normal ICP (≤ 10 mmHg) or elevated ICP (> 10 mmHg). Representative micrographs of coronal Nissl stained brain sections in a SAH animal with normal ICP (B) and a SAH animal with ICP elevation (C). Mean is shown. ** p<0.01.</p

Correlation between behavior and intracranial pressure.

<p>Correlation analyses between the results of T-maze test at day 21 after surgery and intracranial pressure (ICP) in SHAM and SAH animals. Number of alterations (A) and mean latency to decision in seconds (B). Spearman’s rho and p-values are given.</p

Time course of intracranial pressure.

<p>Intracranial pressure (ICP) in mmHg at three different time points in SHAM or SAH animals. Repeated-measures two-way ANOVA showed a significantly different time course of ICP in SHAM or SAH animals (p<0.05). * p<0.05 for the post-hoc comparison of SHAM vs. SAH at day 21 (Bonferroni-corrected).</p

Neurobehavioral scores.

<p>Neurobehavioral scores 24 hours (A, B) and 21 days (C, D) after SHAM or SAH surgery respectively. Modified Garcia score (A), sum score of three consecutive trials of beam balance test (B), number of alterations in T-maze test (C) and mean latency to decision in seconds in T-maze test (D). Mean and SEM is shown. * p<0.05, ** p<0.01, *** p<0.001.</p

Matrix metalloproteinases (MMP) -3, -9, and their tissue inhibitors TIMP-1 and TIMP-3 in patients with Doppler sonographic cerebral vasospasm (dCVS) compared with patients without dCVS.

<p>MMP-9 (A) and MMP-3 (C) are significantly elevated in patients showing dCVS. * p<0.05, *** p<0.001.</p

Matrix metalloproteinases (MMP) -3, -9, and their tissue inhibitors TIMP-1 and TIMP-3 in patients with subarachnoid hemorrhage (SAH).

<p> MMP-9 (A) is significantly elevated in SAH patients compared to healthy controls (HC). By contrast MMP-3 (C) is significantly lower during the early phase after SAH, but increases later on. Serum levels of both tissue inhibitors (B, D) show a delayed rise in SAH patients. * p<0.05, ** p<0.01, *** p<0.001.</p

Baseline characteristics including demographic and laboratory data of the study population.

<p>dCVS: Doppler sonographic cerebral vasospasm, WFNS: World federation of neurosurgical societies, mRS: modified Rankin scale, EVD: external ventricular drainage,</p>*<p>Analysis of variance,</p>†<p>chi-square test.</p

Transmission electron microscopic micrographs of animals with CM (A-C) and an uninfected control animal (D).

<p>In animals with CM, ultrastructural changes indicating alterations of the endoplasmic reticulum (ER) were observed. In most neurons ribosomes and / or polyribosomes appeared conspicuously clustered (A-B, arrows). Some neurons even showed dilated ER (C, arrow-heads) and Golgi apparatus (A,C: g). Mitochondria (m) frequently showed altered cristae (B: asterisks). Control specimens from the same brain regions did not show signs of neuronal or oligodendroglial degeneration (D). Golgi apparatus are marked by g; mitochondria by m, nuclei by n. Bars in A, B, C, D correspond to 1 µm. Framed areas in A, B, D are shown at higher magnification in the respective inserts, where the bars correspond to 0.5 µm.</p

Representative Western blot (A) for Nogo-A (200 kDa) and alpha-tubulin (50 kDa) and densitometric analysis of western blot experiments (B) in mice with different stages of cerebral malaria (mild, CM1 n = 4; moderate, CM2 n = 9; severe CM3 n = 6), infected mice without neurological involvement (NCM n = 6) and uninfected control animals (CNT n = 5).

<p>A significant increase of densitometric measures for Nogo-A was observed in animals with CM compared to NCM and non-infected control animals. Comparing subgroups of animals with different clinical levels of severity CM2 and CM3 mice showed significantly higher Nogo-A levels compared to CNT mice. ***, p>0.001; **, p>0.01; *, p<0.05.</p