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Background. Several tumor factors are associated with papillary thyroid cancer. Most studies do not compare the expressions of these factors in the primary tumors and in their associated cervical metastasis. Methods. Paraffin sections of 20 patients with papillary carcinoma of the thyroid gland with lymph node metastasis were studied. The presence and distribution of insulin-like growth factor I (IGF-I) and proliferating cell nuclear antigen (PCNA) was analyzed, through immunohistochemical technique, in both primaries and lymph node metastasis. The results were correlated with clinical-pathologic data (sex, age, size of primary, multicentricity, thyroid capsule invasion, lymphatic and blood vessels invasion, development of distant metastasis, and associated thyroid diseases). Results. The qualitative analysis showed the reaction for IGF-I was present in more than 90% of the neoplastic cells in both primaries and lymph node metastasis. No correlation with the clinical-pathlogical features was observed. Regarding the PCNA, the mean percentage of nuclei stained showed no statistical difference between primaries and metastasis (p = 0.598). Except for age, clinicopathologic data had no influence on the mean percentage of nuclei stained. A correlation was verified between the percentage of cells stained by PCNA in primary tumors and the patients' age (p < 0.01). Conclusions. The expressions of these tumor factors are equally intense for both primary and metastatic tissue in papillary thyroid cancer. Despite the small size of the sample, the expressions of IGF-I and PCNA could not be associated to clinical-pathologic features, except for the age. As patients over 40 years old had higher expression of PCNA, this marker may have prognostic significance for patients with papillary thyroid cancer.

Insulin-like growth factor I and II (IGF-l and IGF-ll) have been implicated in the replication of normal thyroid follicular cells in vitro. This study evaluates the distribution and abundance of immunoreactive IGF-l by histochemical analysis in human thyroid tissue with different histopathologic characteristics. We used two types of highly specific and sensitive polyclonal rabbit anti-IGF-l antibodies and one monoclonal antibody (MAb) with the immunoperoxidase technique on sections of 25 glands harboring adenomatous goiter; 11 glands with follicular adenoma (FA); 45 glands with thyroid carcinoma of papillary, follicular, and undifferentiated types; and 18 glands with Graves' disease. Immunoreactive IGF-l was present in some thyroid follicular cells of all thyroid tissues examined. The percentage of cells staining positively varies among the different processes, being lowest in normal thyroid tissues and highest in all thyroid carcinomas. The cytoplasmic pattern of IGF-l immunoreactivity also varied among the different thyroid conditions. Furthermore, using nonradioactive in situ hybridization (ISH) we detected IGF-l mRNA in the thyroid cells of adenomatous goiter. The expression was higher in the histologically hyperplastic areas. These findings provide further support for an autocrine and/or paracrine role of IGF-l in the function and/or growth of normal thyroid follicular cells and suggest that IGF-l may play a role in the dysfunctional growth of thyroid follicular cells in adenomatous goiter, thyroid carcinoma, and Graves' hyperthyroidism.

Summary The authors have studied the presence and distribution of Insulin-Like-Growth-Factor-1 (IGF-1) in 5 autopsied normal and 20 surgically removed human pituitary adenomas, employing a peroxidase-anti-peroxidase method. IGF-1 could be demonstrated in all cases, with variation o f cells immunostaining from 60% in normal pituitary gland to 100% in corticotroph cell adenoma.

Six cases are reported of a previously undescribed unusual composite variant of lymphoplasmacytic lymphoma that is not readily classifiable by either the Rappaport or the Lukes and Collins classifications, or by the recently proposed Working Formulation. These cases are characterized by a partly nodular, partly diffuse proliferation of lymphoid cells surrounded by a separate, zonally distinct proliferation of large plasmacytoid cells. The latter cells are located in medullary and paracortical areas in lymph nodes and in the marginal zone of the white pulp and in the red pulp in the spleen. This distinct zonal characteristic was noted in the small bowel as well in one case. Five of our six patients were male, and their ages ranged from 46 to 68 years. Three had a monoclonal serum IgM and one had hyperglobulinemia that was not further characterized. Three had evidence of an altered immune state. In all cases, monoclonal IgM was demonstrated in involved tissues by an immunoperoxidase technique. These cases are unusual because of the unique topographic segregation of the varying types of tumor cells in all cases, and because of the association of paraproteinemia with nodular lymphoma in three. The resemblance of this tumor to the plasma cell variant of giant lymph node hyperplasia with which two cases were originally confused, and to lymph nodes in patients with autoimmune diseases, may be responsible for its lack of recognition. Cancer 53:1103-1108, 1984.