Document zdovEBzK7ygodJBxQDmBE43Rz

HFM - 003508 example, between 1960 and 1964 the Chi carcinoma, develops from the parafollic nese women (six percent of all women) ular cells. The biologic behavior of thy-;, incurred almost nine percent of all inci roid cancer is extremely variable, and any:'' dent cancers and 20 percent of incident system of histologic classification should.- thyroid cancers; the Japanese women (36 serve to ideittify important differences in: percent of all women) incurred 35 percent epidemiology, natural history, prognosis of all cancers and 32 percent of thyroid . and the rationale of therapy. At Memorial cancers. The proportional incidence would Hospital, we'have classified the epithelial suggest that the Chinese women in Hawaii tumors into papjllary,,occult sclerosing, may be at high risk for thyroid cancer. follicular, Hurthle cell, medullary, and The age-standardized morbidity ratio in spindle and giant cell. dicated a 43 percent excess of thyroid can The occult sclerosing carcinoma may cer in the Chinese women, but the 95 per cent confidence limits were not statistically significant for a Poisson distribution. be classified as a subtype of the papillary carcinoma; it is a small (commonly less than 1.5 cm. in diameter), unencapsulated Austin provided incidence data by race low grade carcinoma, showing marked, for the San Francisco-Oakland Standard desmoplasia. The Hurthle cell carcinoma Metropolitan Statistical Area (Figure 7.)17 represents a varietyof follicular carcinoma The age-adjusted rates were computed by the direct method using the 1950 popula tion of the continental United States as the standard. The incidence in the Chinese women was similar to that registered in white United States women, and exceeded the rates seen in Japanese and black women. and is composed of large cells with small hyperchromatic nuclei and relatively large amounts of pink cytoplasm. The resulting simplified taxonomy of thyroid carcino ma-papillary, follicular, medullary and anaplastic--is currently in common use. The percentage distribution by cell type will vary by age, sex, geographic The female:ma?e ratio of age-adjusted area, and source of pathologic material. incidence rates in the Hawaiian Chinese Surgical materials tend'to select the dif is 5.9 and, in the Hawaiian Chinese men, ferentiated carcinomas (i.e., papillary aqd the age-adjusted incidence is seven times follicular), whereas mortality studies tend that noted in the Singapore Chinese men. ' to select the anaplastic carcinomas (i.e., Fraumeni and Mason19 reported that thy spindle and giant cell).20 roid cancer mortality in the Chinese re siding in the United States during 19501969 was increased, particularly in males, when compared with the United States white and black populations. The geo graphic and racial patterns for thyroid cancer incidence and mortality should be studied carefully for differences in histopathology and natural history, and par ticularly among different generations of Chinese immigrants to the United States. It is possible that the complex of host and environmental factors that promote clini cal expression of disease are distinctive from those that initiate tumorigenesis. In the Third National Cancer Survey, papillary carcinoma was the most com-; mon form, accounting for 64 percent of all primary malignant tumors (Table III): This type of tumor has a peak incidence in the third and fourth decades, and qcctjjs three times more frequently in womCn than in men. The disease is distinctly less malignant in children and young adults. In our experience at Memorial Hospital, not more than 10 percent of these tumors may be classified as pure papillary carci nomas. The remainder of these tumors variously contain follicular, trabecular, Hurthle cell, epidermoid or spindle and Pathology giant cell features. The finding of foci of giant or spindle cell anaplastic carcinoma The majority of thyroid tumors arise from the epithelial elements of the gland. Most tumors originate from the follicular (aci interspersed throughout the papillary and, follicular structures is considered a poor prognostic sign.21 nar) cells, and at least one type, medullary The percentage relative frequency of AOUl 09 tin 70 iNCER JOURNAL FOR CLINICIANS Femelu United Statu Hawaii: Chinese. Hawaii: Filipino Hawaii: Hawaiian Hawaii: Japanese Hawaii: Caucasian Connecticut California, Alameda: White California, Aiamedja: Black 20.7* 14.3 10.1 6.5 5.4 3.0 1A 2.3 14.1t 18.7 16.0 7.8 9.2 3.7 6.5 1.9 Israel All Jews Jaws born in Africa or Asia Jews bom in Europe.or America Jaws born in Israel Non-Jews 4.2 8.3 4.6 6.7 4.0 6.4 2.0 6.1 2.0 1.8 Japan Okayama Prefecture Miyagi Prefecture 33 2.4 2.0 2.1 Now Zealand Maori European 5.5 2.3 2.6 2.Q . South Africa Natal: African . Natal: Indian : . Capa Province: White Cape Province: Bantu Cape Province: Non-white 3.3 3.0 3.6 2.7 1.1 Norway All Urban Rural Columbia, C8l) 2.4 2.6 2A ' 6.6 3.7 3.1 4.3 5.6 Canada, Quebec 2.6 2.7 Finland India, Bombay " 24 ; 1.5 2.9 1.8 Denmark 1.4 1.8 U.K., England and Walu (Liverpool Region) 1.3 1.2 Sources: *See referenca;13. tSea reference 14. Main 3.5* 4.5t 5.0 4.7 6.7 3.4 1.7 3.2 4.4 3.1 0.8 1.5 Z8 Z6 0.6 UB 1.8 4,2 1.6 2.4 2.0 4.2 0.3 4.8 1.2 1.9 1.1 0.8 0.6 0.4 Pi?: 0.9 1.0 0.2 1.0 1.2 ^. 0.0 0.8 .. 1.1 1-6 , 1.0 T;7 1.1 1-4 3.5 ' 2.7 :: 0.9 1.0 1.0 1,1 0.7 0.7 0.8 .0,8 0.6 Q.6 VOL. 28, NO. 2 MARCH/APRIL 1978 3001 O^fij