title: Loss of estrogen receptor Beta expression in follicular thyroid carcinoma predicts poor outcome.
abstract: BACKGROUND
  Well-differentiated follicular thyroid carcinomas (FTCs) usually act indolently, while aggressively acting tumors are difficult to detect early enough. Estrogen receptors (ERs) have prognostic significance in many cancers. Thyroid diseases, including neoplasms, are associated with the female sex. The prognostic significance of ERs in FTCs has not been reported previously.
  
  
  METHODS
  We studied the role of ERα and ERβ in 83 cases of follicular thyroid adenoma (FTA) and 43 FTC cases, including seven cases of poorly differentiated FTC, obtained from the Department of Surgery, Helsinki University Central Hospital between 1990 and 2009. Patient follow-up was conducted until March 2011. Expression of ERα, ERβ, and MIB-1/Ki-67 was investigated by immunohistochemistry and correlated with clinicopathological characteristics, including survival.
  
  
  RESULTS
  Two major observations were apparent. First, ERβ expression was significantly higher in FTA than in FTC, and it was a stronger differential diagnostic marker than MIB-1/Ki-67. Second, low ERβ expression correlated with poor survival in FTC. All cancer-specific deaths due to FTC were among low ERβ-score patients.
  
  
  CONCLUSIONS
  ERβ is a differential marker for malignancy and could thus be used as a preoperative tool. FTC patients with a low ERβ score need more thorough follow-up and may benefit from more aggressive treatment.
authors.affiliation: Department of Pathology, Haartman Institute, University of Helsinki and HUSLAB, Helsinki, Finland.
authors.forename: Annukka
authors.initials: A
authors.lastname: Heikkilä
authors.forename: Jaana
authors.initials: J
authors.lastname: Hagström
authors.forename: Hanna
authors.initials: H
authors.lastname: Mäenpää
authors.forename: Johanna
authors.initials: J
authors.lastname: Louhimo
authors.forename: Päivi
authors.initials: P
authors.lastname: Siironen
authors.forename: Ilkka
authors.initials: I
authors.lastname: Heiskanen
authors.forename: Caj
authors.initials: C
authors.lastname: Haglund
authors.forename: Johanna
authors.initials: J
authors.lastname: Arola
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000235:genetics / Q000378:metabolism* / Q000473:pathology; D000236:Adenoma / Q000235:genetics / Q000378:metabolism / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000235:genetics / Q000378:metabolism; D047628:Estrogen Receptor alpha / Q000235:genetics / Q000378:metabolism; D047629:Estrogen Receptor beta / Q000235:genetics / Q000378:metabolism*; D005260:Female; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013961:Thyroid Gland / Q000378:metabolism* / Q000473:pathology; D013964:Thyroid Neoplasms / Q000235:genetics / Q000378:metabolism* / Q000473:pathology
chemical_list: D014408:Biomarkers, Tumor; D047628:Estrogen Receptor alpha; D047629:Estrogen Receptor beta