Diagnosis and treatment of parathyroid carcinoma: 9 cases report and literature review / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the diagnosis and surgical treatment of parathyroid carcinoma.</p><p><b>METHODS</b>The clinical data of 9 cases of parathyroid carcinoma treated from January 1967 to December 2009 was analyzed retrospectively with the review of related Chinese literatures.</p><p><b>RESULTS</b>Parathyroid carcinoma accounted for 8.9% (8/90) of all patients with primary hyperparathyroidism in our hospital, and the other one case was transferred from another hospital. Of the patients, 8 cases were found with primary hyperparathyroidism. Primary surgery was carried out with small incision: 5 patients underwent en bloc resection, among which, 3 cases received central lymph node dissection; 2 patients received simple parathyroidectomy; one case underwent palliative tumor resection. The case from another hospital received subtotal thyroidectomy. Considering preoperative, intraoperative data and frozen sections pathology, all patients were diagnosed as parathyroid carcinoma. Nine patients were followed-up for 1 - 14 years, no recurrence occurred, and the patient received palliative resection died from carcinoma two years after the operation. In previous Chinese literatures and this group, there were total 146 patients reported as parathyroid carcinoma. Those patients were diagnosed through routine histopathology, accounted for 1.8% - 11.5% of patients with primary hyperparathyroidism.</p><p><b>CONCLUSIONS</b>The diagnosis of parathyroid carcinoma is established according to severe hypercalcemia, clinical features, subset B-ultrasound and Tc(99m)-sestamibi scanning, intraoperative finding of adherence to close structures and histopathology. The initial surgical procedure of choice is en bloc resection of the tumor by minimally invasive small incision, including adjacent structures and ipsilateral thyroidectomy. The prognosis is favorable after the operation.</p>

Endoscopic thyroidectomy through anterior chest and breast approach for papillary thyroid microcarcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the operative feasibility and safety of endoscopic thyroidectomy through anterior chest and breast approach for the treatment of the patients with papillary thyroid microcarcinoma (PTMC).</p><p><b>METHODS</b>Endoscopic thyroidectomy was attempted in 164 patients with thyroid diseases. For 28 cases, which were diagnosed as PTMC by frozen section intraoperatively, lobotomy plus central compartment dissection and contralateral subtotal lobotomy was achieved completely by endoscopic thyroidectomy. There were 27 females and 1 male, and their average age was 35.2 years old. Twelve and sixteen cases were diagnosed preoperatively as thyroid microcarcinomas and benign tumors, respectively.</p><p><b>RESULTS</b>The operation time of the 28 cases was (115 +/- 43) min. The maximum diameter of PTMC was 0.2 to 1.0 cm with a mean of 0.56 cm. 17.9% (5/28) of the PTMC patients had transient vocal cord palsy and restored after 1 to 2 months postoperatively. There were no complications such as subcutaneous emphysema and postoperative bleeding and postoperative hypocalcaemia. 46.4% (13/28) had node involvement of the central compartment. Postoperative ultrasonography and scintigraphy showed no evidence of recurrence or residual thyroid tissue in the thyroid bed where lobotomy was performed.</p><p><b>CONCLUSIONS</b>The endoscopic thyroidectomy through anterior chest and breast approach is a choice of the surgical treatment for selected cases of PTMC.</p>

Preoperative localization and minimally invasive management of primary hyperparathyroidism concomitant with thyroid disease / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

The coexistence of thyroid diseases with primary hyperparathyroidism (PHPT) can present a challenge in the clinical diagnosis and management for these patients. This study aims to determine the frequency of coexisting thyroid gland lesions in a consecutive series patients with PHPT, and to analyze the clinical features, diagnosis and treatment of these patients. Twenty-two cases of a total of 52 PHPT patients who had synchronous thyroid and parathyroid pathology were surgically managed in this study. Thirteen patients had ipsilateral thyroid nodules, and 9 patients had thyroid nodules in contralateral or bilateral side. Seven patients underwent direct parathyroidectomy and hemithyroidectomy via a mini-incision (about 3 cm), while other 15 procedures were converted to Kocher incision. Seventeen nodular goiter (32.7%), 2 thyroiditis (3.8%), 2 thyroid adenoma (3.8%) and 1 thyroid carcinoma (1.9%) coexisting with parathyroid adenoma were pathologically diagnosed. The sensitivity of preoperative ultrasonography (US) and methoxy-isobutyl-isonitrile (MIBI) scintigraphy for parathyroid lesions was 63.6% and 85.7%; and the overall positive predictive values for MIBI and US were 100% and 95.5% respectively. A high incidence of thyroid diseases that coexisted with PHPT in literatures was briefly reviewed. Our study illustrated the need for clinical awareness of concomitant PHPT and thyroid disease. A combination of US, computed tomography (CT) and MIBI scintigraphy would be recommended for preoperative localization of enlarged parathyroid adenoma and for evaluation of thyroid lesions. Synchronous treatment of associated thyroid abnormalities is desirable, and open minimally invasive surgical approach with additional resection of isolated ipsilateral thyroid nodules is possible in some of these patients.

Cloning of human vascular endothelial growth factor cDNA and its expression in COS-7 cells / 浙江大学学报·医学版

OBJECTIVE: To clone vascular endothelial growth factor (VEGF) cDNA gene, construct its eukaryotic expression vector and to express this recombinant plasmid in COS-7 cells. METHODS: Human VEGF165 cDNA was amplified by RT PCR from human ovarian carcinoma. After DNA sequenced, the VEGF165 cDNA was inserted into eukaryotic expression vector pcDNA3.1(-). The recombinant plasmid pcDNA3.1 VEGF165 containing VEGF165 cDNA was identified by enzyme digestion and transferred into COS-7 cells mediated by liposome. The transient expression of VEGF was detected by immunohistochemical staining. RESULTS: The cloned VEGF165 cDNA was confirmed by enzyme digestion and DNA sequence analysis. The immunohistochemical results showed that the VEGF165 protein was expression in COS-7 cells 72 h after gene transfer. CONCLUSION: VEGF165 cDNA gene successfully cloned and expressed in COS-7 cells.