Thyroid surgery performed on an overnight basis: a 17 years of experience

Objective This study aimed to evaluate the results of thyroid surgeries with hospitalization periods shorter than 18 hours performed in a surgical endocrinology service, correlating these results with type of procedure, the definitive diagnosis and complications associated with the procedure.Subjects and methods The procedures performed, complications associated, hospitalization period, and relationships among these variables were assessed in consecutive patients subjected to different types of thyroid surgeries from January 1997 to March 2014 by the same group of surgeons. Data were analyzed by frequency, and the associations between the hospitalization period and other variables were analyzed using the Pearson chi-square test and Fisher’s exact test, using a multiple comparisons test with Bonferroni correction.Results Among the 3,411 surgeries performed, 799 of them were malignant neoplasia, 2,505 were benign tumors and 107 were Graves’ disease. The following procedures were performed: total thyroidectomy (1597 patients); total thyroidectomy with neck exploration (369 patients); lobectomy plus isthmectomy (1084 patients); total thyroidectomy complementation (145 patients); total thyroidectomy with neck dissection (84 patients); modified radical total thyroidectomy (13 patients); nodulectomy (11 patients); unresectable (9 patients); central neck dissection (48 patients); lateral neck dissection (38 patients); and others (13 patients). The following surgical complications, characteristic of the procedure: hemorrhage in 41 (1.2%) patients, hypoparathyroidism in 10 (0.3%) patients and recurrent laryngeal nerve (RLN) injury in 23 (0.7%) patients. Hospitalization shorter than 18 hours was observed in 97% of patients.Conclusion Thyroid surgery can be safely performed in virtually all patients on an overnight basis in specialized services.

Primary osteosarcoma of the thyroid gland: report of a rare neoplasm / Osteossarcoma primário da glândula tireoide: relato de uma neoplasia rara

Primary mesenchymal tumors of the thyroid gland are extremely rare. The authors report a case of primary thyroid osteosarcoma in a male patient presenting a tumoral mass in the neck. CT scan demonstrated a large tumor in the right thyroid lobe with areas of calcification. The surgical specimen consisted of a hard brown-gray tumor, measuring 13 × 11 × 7.5 cm. Microscopy revealed a high-grade malignant neoplasm composed of polygonal cells of intermediate size, chondroid pattern in some areas and osteoid formation. The process was immunonegative for AE1/AE3, glial fibrillary acidic protein (GFAP), epithelial membrane antigen (EMA), p53 and thyroid transcription factor-1 (TTF-1), and immunopositive for CD99 and S100. Thus the diagnosis of primary osteosarcoma of the thyroid gland was established.

Tumores mesenquimais da glândula tireoide são extremamente raros. Os autores relatam um caso de osteossarcoma primário de tireoide em um paciente masculino que apresentou massa tumoral na região cervical. A tomografia computadorizada demonstrou um grande tumor no lobo tireoideano direito, com zonas de calcificação. A peça cirúrgica consistia de um tumor marrom-acinzentado e firme, medindo 13 × 11 × 7,5 cm. À microscopia, foi encontrada neoplasia maligna de alto grau composta por células poligonais de tamanho intermédio, com um padrão condroide em algumas áreas e formação de osteoide. O processo revelou imunoexpressão negativa para AE1/AE3, proteína glial fibrilar ácida (GFAP), antígeno da membrana epitelial (EMA), p53 e fator de transcrição da tireoide (TTF-1) e imunopositividade para CD99 e S100. O diagnóstico de osteossarcoma primário da glândula tireoide foi, então, estabelecido.

Plasmocitoma da glândula tireoide: relato de caso de uma rara neoplasia / Primary plasmacytoma of the thyroid gland: a case report of a rare neoplasia

Extramedullary plasmacytoma comprises 3%-5% of all plasma cell neoplasms, and approximately 80% of the cases occur in the upper respiratory tract. Primary thyroid plasmacytomas (PTP) are rare tumors. The authors report a case of PTP in a male patient with dyspnea and dysphagia. Physical examination and computerized tomography (CT) scan revealed a solid tumor affecting the thyroid gland, measuring 12 cm in its greatest dimension. Surgical biopsy was performed. Microscopy revealed a hypercellular malignant neoplasm composed of round plasmacytoid cells arranged in solid nests, which showed a positive immunoexpression for CD138, epithelial membrane antigen (AME), kappa light chains and multiple myeloma oncogene 1 (MUM1). The diagnosis of PTP was accordingly established.

O plasmocitoma extramedular constitui 3%-5% de todas as neoplasias de plasmócitos e aproximadamente 80% dos casos ocorrem no trato respiratório superior. Plasmocitomas primários da tireoide (TPP) são tumores raros. Os autores relatam um caso de TPP em um paciente masculino referindo dispneia e disfagia. O exame físico e a tomografia computadorizada revelaram tumor sólido comprometendo a glândula tireoide, medindo 12 cm na maior dimensão, o qual foi submetido à biópsia cirúrgica. À microscopia, foi identificada neoplasia maligna hipercelular constituída por células redondas/plasmocitoides dispostas em ninhos sólidos, as quais exibiam imunoexpressão positiva para CD138, antígeno da membrana epitelial (AME), cadeias leves kappa e oncogene mieloma múltiplo 1 (MUM1). O diagnóstico de TPP foi, então, estabelecido.

A relação entre o tamanho tumoral e fatores prognósticos em 241 casos de carcinoma papilar da tireóide / The relation between tumoral size and prognostic factors in241 cases of thyroid papillary carcinoma

Introdução: O carcinoma papilar é a neoplasia mais frequente da tireoide. Em geral, corresponde a lesões indolentes, com excelente prognóstico em longo prazo. Os fatores prognósticos associados ao carcinoma papilar incluem idade, invasão neoplásica extratireoidiana e presença de metástases à distância. Os autores avaliam 241 casos de carcinoma papilífero da tireoide com o objetivo de estimar a relação entre o tamanho tumoral e fatores prognósticos nesta neoplasia. Métodos: No presente estudo, foram analisadas as seguintes variáveis: idade, sexo, topografia, tamanho tumoral, grau de diferenciação, variante histológica, multicentricidade, margens cirúrgicas, invasão angiolinfática, capsular e extratireoidiana, estadiamento e presença de metástases nodais. Foi utilizado o teste de Mann-Whitney para verificar a associação entre o tamanho tumoral e as variáveis. Resultados: A idade média correspondeu a 53,22 anos, sendo encontrados 211 casos no sexo feminino (87,6%). O tamanho tumoral esteve associado a idade (p<0,001), sexo (p<0,001), invasão capsular (p<0,01), extensão neoplásica extratireoidiana (p<0,001), invasão neoplásica angiolinfática (p<0,02) e presença de metástases em linfonodos regionais (p<0,001), não existindo relação com grau e variante histológica (p>0,05). A presença concomitante de tireoidite de Hashimoto e hiperplasia nodular exibiu associação significante (p<0,001). Conclusão: No carcinoma papilífero, o tamanho tumoral representa um dos principais fatores morfológicos relacionados à invasão neoplásica capsular e angiolinfática, extensão extratireoidiana e metástases em linfonodos.

Introduction: Papillary carcinoma is the most common cancer of the thyroid gland. In general the lesions are indolent with an excellent long-term prognosis. The prognostic factors associated with papillary carcinoma include age, extra-thyroid neoplastic invasion, and presence of distant metastases. Here the authors studied 241 cases of papillary thyroid carcinoma in order to estimate the relationship between tumor size and prognostic factors in this malignancy. Methods: The following variables were considered in this study: age; sex; topography; tumor size; differentiation grade; histological variant; multicentricity; surgical margins; angiolymphatic, capsular and extra-thyroid invasion; taging; and nodal metastasis. The Mann-Whitney test was used to determine the association between tumor size and the variables. Results: The mean age was 53.22 years, and 211 cases occurred in females (87.6%). Tumor size was associated with age (p <0.001), gender (p <0.001), capsular invasion (p <0.01), extra-thyroid neoplastic extension (p <0.001), angiolymphatic neoplastic invasion (p <0.02), and presence of regional lymph node metastases (p <0.001), with no relationship to grade and histological variant (p> 0.05). The concomitant presence of Hashimoto’s thyroiditis and nodular hyperplasia were significantly associated (p <0.001). Conclusion: In papillary carcinoma, tumor size represents one of the main morphological factors related to capsular and angiolymphatic invasion, extra-thyroid extension, and lymph nodes metástases.

Peliose hepática associada a contraceptivos orais: relato de um caso e revisäo da literatura / Peliosis hepatis associated with oral contraceptives: report of a case and review of the literature

Peliose hepática é um distúrbio raro, caracterizado pela existência de múltiplas cavidades cheias de sangue, distribuídas irregularmente pelo parênquima hepático. Os autores relatam sua experiência no diagnóstico e tratamento de uma mulher de 30 anos portadora da referida patologia, na qual o único fator etiológico identificado foi o uso crônico de anticoncepcionais orais. É realizada revisäo da literatura