Apport de l'échographie dans la prédiction de la malignité du nodule froid thyroidien

Objectifs: Analyser les éléments prédictifs échographiques permettant d'évoquer le caractère cytologique bénin ou malin des nodules thyroïdiens froids. Patients et Méthodes: Nous avons étudié 100 nodules froids chez des patients tout venants à la scintigraphie réalisée au technétium 99 m (99mTC) dans le service de biophysique et médecine nucléaire d'Abidjan. Les résultats de l'examen échographique de ces nodules froids ont été soumis au verdict diagnostique de la cytoponction thyroïdienne à l'aiguille fine.Résultats : La prédominance féminine a été de 90%. L'âge moyen était de 44±3 ans avec des extrêmes de 09 et 75 ans. La cytologie a donné 90% de lésions bénignes et 10% de lésions malignes avec la prédominances du carcinome papillaires. Les lésions bénignes étaient composés de:63 % de goitres colloïdes, 23% d'adénomes vésiculaires, 2% de thyroïdites, 2% de kystes thyroïdiens. Concernant la topographie, la taille, le nombre, les dimensions nodulaires et certains éléments propres à l'échographie telle l'échostructure, calcifications parenchymateuses, le seul élément discriminant est l'aspect des contours nodulaires. Autrement dit, lorsqu'un nodule froid thyroïdien présentait des contours irréguliers à l'échographie, il présageait à une malignité cytologique et le contraire à une cytologie bénigne.Conlusion : Le nodule froid comme les autres lésions thyroïdiennes est prédominant chez la femme. L'irrégularité des contours nodulaires semble liée à la malignité nodulaire thyroïdienne

Pattern of Second Primary Malignancies in Thyroid Cancer Patients

Many factors; including relatively young age of thyroid cancer diagnoses and improved survival; have led to increased concerns about the occurrence of second primary malignancies. This paper describes the pattern of occurrence of second primary malignancies in patients who were treated for malignant thyroid neoplasms in an Indian hospital. There were 21 affected patients of the approximately 4500 seen over 25 years. Most of the second primary cancers are solid tumors; and when nonthyroid cancers are the second tumors; ductal carcinoma of the female breast is the most common. Most of these tumors have very short detection intervals (including synchronous occurrences); suggesting that therapy with internal radiation was not contributory to the tumor development. When thyroid malignancies were the second primary cancers; they usually follow radiotherapy to the head and neck region for treatment of the first primary tumor and tend to be of aggressive histologic types than the common well differentiated thyroid carcinomas

Diagnostic d'orientation et traitement des cancers thyroidiens au Mali

Notre objectif a ete de rapporter les criteres de diagnostic d'orientation des cancers de la thyroide dans les conditions de la pratique en zone sahelienne. Ce travail s'etait base surl'analyse de dossiers de 29 personnes porteurs de cancer de la thyroide; vus dans le serice d'Oto-Rhino-Laryngologie (ORL) de l'hopital Gabriel Toure de Bamako au Mali; de janvier 2002 a decembre 2007. Trois symptomes ont constitue le motif de consultation : tumefaction cervicale dure (21 as) evoluant depuis plus de 10 ans; presence de signes de compression (dysphonie :5 cas; dyspnee :3; dysphasie : 1) et des adenopathies cervicales (6 cas). La confirmation histologique du diagnostic a ete faite par analyse du produit cytoponction ou d'une piece operatoire. Le traitement majeur a ete le geste chirurgical dont l'analyse de la piece operatoire a permis de connaitre le diagnostic positif. L'orientation diagnostique pre-therapeutique a montre ainsi sa place preponderante dans un contexte d'absence d'exonne extemporane

Thyroid Cancers in Nodular Goiters in Kano; Nigeria

Cancer is an occasional incidental finding in nodular goiter; but there has been no formal study on this disease in our locality. To determine the occurrence of histologically diagnosed malignancy in patients who presentwith nodular goiters. This is a 7- year (2000-2006) retrospective study of all histologically diagnosed malignancies within nodular goiters atAminuKanoTeachingHospital;Kano There were 160 multinodular goiters during the study period; out of which 24 (15.0) had histologically diagnosed cancer; and 1 out of the thirteen patients with solitary thyroid nodule (7.6) had carcinoma. The ages of the patients with carcinoma ranged from 16 to 65 years; with amean age of 38.8 years. Eighteen (72) were females; and 7(28) were males. Six out of the 25 cases of carcinoma were detected preoperatively by fine needle aspiration cytology. Well differentiated follicular carcinoma was the predominant histological type in 13(52) cases; followed by papillary in 10(40); medullary carcinoma in 1(4) and anaplastic carcinoma in 1(4) patient. One-seventh of nodular goiters in our center harbouredmalignancy; and follicular carcinomawas the prevalent histological type. This is consistent with the findings elsewhere in endemic goitrous regions. Ultrasound guided fine needle aspirationwould improve preoperative diagnosis and guide appropriate surgical management

Thyroid Cancers amongst Goiter Population in a Nigerian Tertiary Hospital:Surgical and Radiographic Perspective

Background: Goiters are commonly benign; but cases of malignancy can develop. Thyroid cancer is known to be commoner in whites than in blacks and in females than in males. Bone metastasis is a common occurrence and may be the initial manifestation in a small subset. We hope to determine the incidence and the cervical radiographic patterns of thyroid cancer amongst goiter population in Nigeria. Method: Surgical; histological and radiographic findings in patients with goiter who had thyroidectomy in our hospital from 1999 to 2006 were reviewed.Those with proven cancer were analyzed for sex; age and radiographic changes using SPSS 11.0 for windows. Results Thirteen (8.2) cases out of the 160 goiters were malignant and distant metastases were present in 1.3at presentation. The histological sub-types of malignant goiters were follicular (5.0); papillary (1.9) and poorly differentiated or anaplastic thyroid carcinoma (1.3). As much as 30of thyroid cancers demonstrated calcification on plain neck radiograph; which were commonly scattered or diffused. Conclusions: Carcinomatous goiters occurred in 9.3of the goiter population studied with predominance of follicular variant. Surgery remains the main stay but was inappropriate in about 1.2of population with goitre. Aside evidence of bony destruction; TC should be suspected in goiters with mixed (diffused or scattered) calcifications

Pathology of Common Diseases of the Thyroid Gland in Port Harcourt

Background: Thyroid diseases are rare in this environment but are more frequent in Western and Northern parts of Nigeria. These diseases present with neck swellings; pains and resulting in high morbidity and mortality rate as well as posing cosmetic problems. Aim: To study the frequency; age distribution and histological types of thyroid diseases. Design/ Setting: A ten-year (1994-2003) retrospective study in Port Harcourt; Nigeria. Methods: Histologic slides were reviewed to ascertain the type of diseases in all cases. The age; sex and clinical presentations were extracted from the histology consultation forms; surgical notes; day books; radiological reports and patient's case file. Results: Thyroid disease accounted for 0.9of biopsies received during the period under review. The lowest frequency occurred in the ages 0 - 10 and 61 -70 years; with one case (1.3) each. The highest occurred in the age group 31-40 years; which recorded 31 cases (38.8). The youngest was a 10 - year old male while the oldest was a 70-year-old female. Eight cases (10.0) occurred in males while 72 (90.0) occurred in females giving a female to male sex ratio of 9:1. Metabolic disease (colloid goitre) was the most common; occurring in 42 (52.0) cases. The least common was inflammatory diseases; 3 (3.8) cases. The most common clinical presentation was neck mass; 64 (80.0) cases. Conclusion: This study confirmed the rarity of thyroid diseases in the Port Harcourt environment and colloid goitre was the most frequent disease. The predominance of females needs an elaborate population based study

Histopathological Study of Thyroid Cancer in a Nigerian Tertiary Hospital

Background: Thyroid cancers are rare but are reported as the most common endocrine malignancies. There is a regional variation in the incidence. Aim: To evaluate the incidence and histological pattern of thyroid cancer with respect to age and sex. Methods: A 20-year (1986-2005) retrospective study of thyroid neoplasms at the University of Benin Teaching Hospital; Benin City. Nigeria. Results: A total of 46 malignant tumours were diagnosed constituting 8.6of all thyroid lesions and 1.3of the malignant tumours seen during the period of study. Thyroid cancer was more prevalent in females with a female to male ratio of 1.9:1. Papillary carcinoma (47.8) was the most common histological type of thyroid cancer; followed by follicular carcinoma (30.4); anaplastic carcinoma (13.0); and Medullary carcinoma (8.7); in order of frequency. While papillary carcinoma was the most common histological type of thyroid cancer in females; follicular carcinoma was the predominant form of thyroid cancer in males. Papillary carcinoma was most prevalent in the third decade of life while follicular carcinoma was more frequent after the fourth decade of life. Anaplastic carcinoma occurred in the 6th decade. Conclusion: There is need for an increased level of awareness of the disease and the provision of cancer registries

Place du prelevement ganglionnaire dans le traitement des cancers differencies de la thyroide n0 clinique

Objectif : Demontrer l'interet du prelevement ganglionnaire sus-claviculaire et jugulaire inferieur dans la prise en charge des cancers differenties de la thyroide (CDT) N0 clinique. Materiel et methodes : Nous rapportons une etude retrospective a propos de 170 patients colliges sur 12 ans 2005). Tous les patients ont eu une thyroidectomie totale en 1 ou 2 temps. Le curage mediastino-recurrentiel a ete pratique soit systematiquement soit en cas de decouverte d'adenopathies en peroperatoire. Le curage lateral a ete realise soit de principe soit apres un prelevement ganglionnaire sus-claviculaire et jugulaire inferieur positif a l'examen extemporane. Des doses ablatives d'iode radioactif ont ete administrees en cas d'elevation du taux de la thyroglobuline ou d'une fixation d'iode lors du balayage cervico-thoracique. Resultats : L'examen anatomopathologique trouvait un carcinome papillaire (74;1); vesiculaire (16;5) ou papillaire a composante vesiculaire (9;4). Trente patients ont eu un curage fonctionnel systematique uni ou bilateral; une metastase ganglionnaire a ete notee chez 9 d'entre eux. Cent quarante patients ont eu un prelevement ganglionnaire uni ou bilateral; un curage fonctionnel a ete pratique chez 6 d'entre eux devant un examen extemporane positif. Les taux de remission; de recidive et de metastases etaient respectivement de 83;3; 6;7et 10dans le premier groupe; et de 89;3; 4;3et 6;4dans le deuxieme groupe. Par ailleurs; un deces a ete observe chez deux patients du deuxieme groupe (1;4) . Aucune difference statistiquement significative n'a ete retrouvee entre les differents taux. Conclusion : Les resultats de notre serie mettent en evidence l'interet du prelevement sus-claviculaire et jugulaire inferieur permettant d'eviter le curage fonctionnel systematique

Les tumeurs oncocytaires de la thyroide : a propos de 25 cas

But : Les tumeurs a cellules oncocytaires de la thyroide (TOT) ont donne jusqu'a ces dernieres annees de nombreuses controverses; du fait des difficultes a differencier les tumeurs benignes des tumeurs malignes; entrainant des attitudes therapeutiques divergentes. L'objectif de cette etude est de voir a travers une revue de litterature les aspects cliniques et pathologiques particuliers aux tumeurs oncocytaires de la thyroide et d'essayer de reunir les elements cliniques et anatomopathologiques pouvant predire l'aspect malin de ces tumeurs. Methodes : Il s'agit d'une etude retrospective menee sur une periode de 19 ans etalee de janvier 1988 a decembre 2006; pendant laquelle nous avons collige 25 cas de tumeurs oncocytaires de la thyroide. La circonstance de decouverte etait un nodule thyroidien pour tous les patients. Resultats : Notre travail repose sur une serie de 25 tumeurs oncocytaires de la thyroide; dont 3 cancers oncocytaires (12). Ces tumeurs representent 1;2 des tumeurs thyroidiennes operees durant la meme periode. L'age moyen des patients ayant eu un carcinome oncocytaire etait de 65 ans; la taille moyenne de ces carcinomes etait de 4 cm. Le traitement a consiste en une loboisthmec- tomie pour les adenomes et en une thyroidectomie totale associee a un curage ganglionnaire cervical suivi d'une iratherapie pour les carcinomes. Une seule patiente ayant presente un carcinome oncocytaire a developpe une metastase a distance. L'evolution etait favorable chez tous les autres patients avec recul variable de 9 mois a 22 ans avec une moyenne de 5 ans. Conclusion : Les tumeurs oncocytaires de la thyroide sont reconnues a la lumiere des travaux recents comme une entite anatomo-clinique particuliere; se differenciant des tumeurs vesiculaires (auxquelles elles ont ete longtemps assimilees) par une evolution plus pejorative et par une insensibilite a l'iode radioactif avec une frequence accrue de metastases pour les carcinomes

Report of six cases of metastatic jaw tumours in Nigerians

Background: Metastatic tumours make up approximately one per cent of all oral malignancies. Such tumours may present in the jawbones and oral soft tissues. The commonest oral site is the mandible. Nigerian reports of metastatic tumours to the jaws are very rare. Method: This is a retrospective study of six cases of metastatic tumours to the jaws seen at the Maxillofacial Unit, Ahmadu Bello University Hospital, Kaduna from 1979-1998,representing 1% of all histologically confirmed malignant jaw tumours in the hospital. Results: Unlike in other reports, most (three of our six cases) originated from the thyroid gland while the rest were from the breast, uterus and the nasopharynx. More of our lesions occurred in the mandible (4) than the maxilla (2) and almost all patients presented with oral complaints oblivious of the primary malignancy. These complaints resemble those from odontogenic infections and benign neoplasms. The most common histological type of metastatic tumours in this study was the adenocarcinoma (50%). Conclusion: In view of the similarity in presentation of metastatic lesions to the jaws and other odontogenic tumours and even infections, a high index of clinical suspicion is advocated to ensure early, multidisciplinary care of patients

Aspects echographiques de la pathologie hypertrophique du corps thyroide a l'Hopital Militaire de Yaounde

Les auteurs procedent a une etude retrospective de 36 patients; porteurs d'une hypertrophie de la thyroide; sur un bilan clinique; echographique; hormonal; chirurgical et anatomo-pathologique. Ils notent comme beaucoup d'auteurs une absence de specificite entre les aspects cliniques echographiques et histologiques. Ils preconisent un examen echographique systematique pour le bilan d'une masse thyroidienne; car dans un contexte comme celui du Cameroun sans examen scintigraphique; l'echographie bien que non specifique est plus sensible que l'examen clinique; elle permet un bon bilan diagnostique; revelant des criteres de presomption de benignite ou de malignite. Associee a la cytoponction echo-guidee; elle ameliore la precision diagnostique; permettant un traitement plus efficace