Survival outcomes of adjuvant radiotherapy and chemotherapy in women with stage I serous papillary and clear cell carcinoma of the endometrium: a Korean multicenter study / 부인종양

OBJECTIVE: To compare the survival outcomes of adjuvant radiotherapy and chemotherapy in women with uterine-confined endometrial cancer with uterine papillary serous carcinoma (UPSC) or clear cell carcinoma (CCC). METHODS: Medical records of 80 women who underwent surgical staging for endometrial cancer were retrospectively reviewed. Stage I UPSC and CCC were pathologically confirmed after surgery. Survival outcomes were compared between the adjuvant radiotherapy and chemotherapy groups. RESULTS: Fifty-four (67.5%) and 26 (32.5%) women had UPSC and CCC, respectively. Adjuvant therapy was administered to 59/80 (73.8%) women (25 radiotherapy and 34 chemotherapy). High preoperative serum cancer antigen-125 level (25.1±20.2 vs. 11.5±6.5 IU/mL, p 0.999) and overall survival (77.5% vs. 87.8%, p=0.373) rates were similar between the groups. Neither radiotherapy (hazard ratio [HR]=1.810; 95% confidence interval [CI]=0.297–11.027; p=0.520) nor chemotherapy (HR=1.638; 95% CI=0.288–9.321; p=0.578) after surgery was independently associated with disease recurrence. CONCLUSION: Our findings showed similar survival outcomes for adjuvant radiotherapy and chemotherapy in stage I UPSC and CCC of the endometrium. Further large study with analysis stratified by MI or LVSI is required.

Is the ovarian preservation safe in young women with stages IB–IIA villoglandular adenocarcinoma of the uterine cervix? / 부인종양

OBJECTIVE: Because villoglandular adenocarcinoma (VGA) of the uterine cervix has favorable features and outcomes, patients receive less radical surgery and young women preserve their ovaries. We aimed to evaluate the clinicopathological features and outcomes of VGA and to see if the ovarian preservation is safe in young women with VGA. METHODS: We retrospectively reviewed medical records and identified patients with VGA, who had been treated and followed from January 2004 to December 2015. RESULTS: This study consisted of 17 patients with VGA, including 9 premenopausal women. International Federation of Gynecology and Obstetrics (FIGO) stage IB1 disease was found in 12 patients (70.6%), IA1 in 2, IA2 in 1, IB2 in 1, and IIA1 in 1. Of the 12 women diagnosed with stage IB1 disease, a young woman received only conization and she has not showed a recurrence. During a median follow-up of 58 months (range: 12–116), 4 patients, who had undergone radical surgery for stage IB1 disease, had a recurrence and one of them died due to disease progression. Among patients with stages IB–IIA disease, 2 premenopausal women did not receive simultaneous oophorectomy or chemoradiation therapy. Both of them had a recurrent tumor at adnexa. CONCLUSION: This study revealed favorable features and outcomes of VGA. However, the appropriate treatment for young women with early-stage VGA must be cautiously selected. Ovarian preservation might not be safe when young women with stages IB–IIA VGA undergo surgical procedures.

Diagnostic value of conventional ultrasound and contrast enhanced ultrasound in predicting extrathyroidal extension of papillary thyroid cancer / 中华超声影像学杂志

Objective To explore the diagnostic value of conventional ultrasound(US) and contrast enhanced ultrasound(CEUS) in predicting extrathyroidal extension of papillary thyroid cancer(PTC).Methods Eighty-five PTCs in 75 patients were selected for thyroid surgery underwent ultrasound and contrast-enhanced ultrasound.The degrees of contact between PTCs and capsule were observed by US and CEUS respectively(0,0-25％,25％-50％,≥50％),and the diagnostic efficiency in different degree of contact (＞0 ％,≥25 ％,≥50％) as preoperative diagnostic criteria were analyzed.The diagnostic efficiency between US and CEUS in predicting extrathyroidal extension of PTC were compared.Results Of the 85 PTCs,extrathyroidal extension was presented in 57 (67.06％) based on pathologic results.When the degree of contact (＞ 0 ％,＜ 25 ％,25 ％-50 ％,≥ 50 ％) was gradually increased,the incidence of extrathyroidal extension of the thyroid cancer was also gradually risen (P ＜0.001).Comparing the sensitivity,accuracy,odds ratio,and Az value of three groups(＞0％,≥25％,≥50％),it showed that the general diagnostic efficiency between two groups(＞0％,≥25％) was similar by US and CEUS.However,the sensitivity and accuracy of ＞0％ contact with the adjacent capsule were markedly higher than those of the other two groups(P ＜0.001).Selecting ＞0％ contact with the adjacent capsule as preoperative criteria,the Az value of CEUS was markedly higher than that of US (Z =2.208,P =0.027).Conclusions The preoperative imaging feature of more than 0％ contact with the adjacent capsule is more sensitive and accurate degree in predicting extrathyroidal extension of PTC.Compared with US,CEUS may serve as a better useful tool to predict extrathyroidal extension of PTC.

Clinicopathological analysis of thyroid nodules with preoperative recurrent laryngeal nerve palsy / 中国耳鼻咽喉头颈外科

OBJECTIVE To investigate the clinical significance of preoperative recurrent laryngeal nerve palsy (RLNP) for thyroid nodules with regard to the incidence of malignancy,recurrent laryngeal nerve involvement and histopathological character.METHODS Eighty patients with preoperative RLNP treated in Zhejiang Cancer Hospital between Jan 2007 to Dec 2014 were enrolled,their clinicopathological data were recorded and retrospectively analyzed.RESULTS Of 80 patients,16 patients had benign thyroid disease,while the other 64 had malignancies (80.0％).The preoperative RLNP incidence of benign and malignant lesions was 0.3％ and 0.9％ respectively.Poorly differentiated and anaplastic thyroid cancer had the higher incidence of preoperative RLNP comparing with other pathology types (25.93％,P＜0.05).The RLN did not preserved intraoperatively in 2 patients with benign lesions (2/16,12.5％) and in 42 patients with malignancy lesions (42/48,87.50％).All nerves were sacrificed in poorly differentiated and anaplastic thyroid cancer patients.The RLN could be isolated from 14 benign lesions and 6 malignancies,with or without adhesion,and the nerve function was recovered postoperatively.CONCLUSION The probability of preoperative RLNP is significantly higher in malignant lesions than benign lesions.Thyroid tumors with RLNP are strongly suggested of malignancy,with higher rate of intraoperative nerve sacrifice.The RLN should be preserved if it has not been invaded by the tumor,which offers a chance of functional recovery postoperatively.

Tiroidectomía axilar endoscópica video asistida 3D / 3-D video-assisted endoscopic axillary thyroidectomy

En la cirugía mínimamente invasiva del cuello poco se ha evolucionado considerando que usualmente se acompaña de disecciones extensas, dolorosas y prolongadas en tiempo operatorio. Este tipo de cirugía que denominamos como: "cirugía en mínimos espacios del cuello", es una línea de trabajo del grupo y a finales del 2015 se inició el programa de cirugía endoscópica de cuello. En junio del 2016 intervinimos una paciente joven con carcinoma papilar de tiroides, utilizando la Tiroidectomía Axilar Endoscópica Video Asistida (TAEVA) con equipo Endoeye Flex 3 D. Se observaron claras ventajas al usarlo, como alta resolución visual, buena profundidad de campo y versatilidad derivada de la flexibilidad de la cámara que evitó el intercambio de lentes rígidos de 0°,30° y70°, lo que acortó el tiempo operatorio. Hasta donde se tiene conocimiento es el primer caso de TAEVA 3 D publicado.

Little has evolved in minimally invasive neck surgery, considering that this is usually accompanied by extensive, painful, and prolonged operative time in dissections. This type of surgery is called "Minimum space surgery of the neck", and is a line of work of our group. For this reason, an endoscopic neck surgery program was started in 2015. A young patient with papillary thyroid carcinoma was intervened in June 2016 using Endoscopic Axillary Video assisted thyroidectomy (TAEVA) with equipment EndoEYE Flex 3 D. Clear advantages were observed including high visual resolution, good depth of field, versatility derived from the flexibility of the camera that avoided the exchange of inflexible 0°,30°, and 70° lenses, and shortening the operating time. To our knowledge, it is the first case of 3 D TAEVA published.

The expression and clinical significance of p53,C-myc and CerbB-2 in thyroid papillary carcinoma / 重庆医学

Objective To investigate the expression level and clinical significance of p53 ,C-myc and CerbB-2 in papillary thy-roid carcinoma patients .Methods The expression level of p53 ,C-myc and CerbB-2 were detected in 45 cases of papillary thyroid carcinoma tissue specimens and 45 cases of nodular goiter tissue specimens by using immunohistochemical staining .Their correla-tions with clinic pathological features in papillary thyroid carcinoma were analyzed further .Results The positive expression rates of p53 ,C-myc and CerbB-2 in the papillary thyroid carcinoma tissue specimens were significantly higher than that of the nodular goiter tissue specimens(all P< 0 .01) .The expression of C-myc and CerbB-2 significantly correlated with lymph node metastasis(P< 0 . 05) .The expression of CerbB-2 significantly correlated with tumor size ,local infiltration ,TNM stage ,differentiated degree and lymph node metastasis (all P< 0 .05) .p53 positive expression ,C-myc positive expression and CerbB-2 positive expression were the independent factors of cervical lymph node metastasis .Conclusion p53 ,C-myc and CerbB-2 were highly expressed in papillary thy-roid carcinoma and correlated with cervical lymph nody metastasis .The detection of p53 ,C-myc and CerbB-2 might be helpful for diagnosis of papillary thyroid carcinomas .

The Rare Primary Low Grade Papillary Adenocarcinoma of Nasopharynx: A Diagnostic Challenge and Management

Low Grade Papillary Nasopharyngeal Adenocarcinoma (LGPAC) is a very rare tumour of mucosal origin compared to a higher incidence of well differentiated keratinized/non-keratinized nasopharyngeal carcinoma. It is an epithelial tumour with glandular differentiation. Its papillary figure seen histologically, is also seen in metastatic papillary thyroid carcinoma. This has caused a significant challenge to the Pathologist to differentiate primary papillary nasopharyngeal adenocarcinoma and metastatic tumour. Thyroid Transcription Factor-1 (TTF-1) is also expressed in subsets of papillary nasopharyngeal adenocarcinoma, which is valuable as a diagnostic tool. LGPAC is a benign-like malignant neoplasm. An early diagnosis with a complete tumour removal via conventional excision or endoscopic approach has offered a good prognosis with low risk of recurrence.

Análise molecular do EXON 10 do gene receptor de TSH em pacientes com tumores da tireóide / Molecular analysis of EXON 10 of TSH receptor gene in patients with thyroid tumors

Introdução: O câncer da tireoide é a quinta neoplasia mais frequente entre as mulheres. A incidência dessa doença vem aumentando substancialmente nos últimos anos. Objetivos: O objetivo do estudo foi determinar a frequência do polimorfismo D727E no gene tshr e associar aos diferentes fenótipos clínicos de tumores de tireoide. Método: 48 pacientes portadores de tumores da tireoide foram operados em hospital de referência de Belém (Pará, Brasil). O grupo-controle foi composto de 131 indivíduos livres de doenças da tireóide. Resultados: Foram encontrados 26 pacientes com tumores malignos e 22 benignos. A frequência alélica do polimorfismo D727E foi de 17,7% em pacientes com tumor de tireoide e 8% no grupo-controle (p<0,03). O polimorfismo D727E mostrou-se em heterozigose em seis pacientes dos 23 com carcinoma papilar e em um com carcinoma folicular. Um paciente com carcinoma folicular e um com carcinoma indiferenciado não apresentaram o polimorfismo. Sete pacientes dos 15 com bócio colóide apresentaram D727E (seis em heterozigose e um em homozigose). Dois dos seis pacientes com adenoma folicular apresentaram o polimorfismo. Discussão: A análise da distribuição da idade de pacientes com câncer mostrou que houve diferença entre os pacientes com diagnóstico de câncer (48,7±14,7 anos) em relação a pacientes com doença benigna (37,8±11,7 anos). A idade de início dos sintomas, que melhor separa os grupos, foi 46 anos. As variáveis gênero feminino, antecedente familiar e idade >41 anos foram associadas à presença do polimorfismo D727E (p = 0,026), o que não foi observado nos pacientes que não apresentavam o polimorfismo. A ocorrência simultânea dos fatores: gênero feminino, antecedente familiar e idade > 46 anos foi relacionada com maior frequência em pacientes com patologia maligna da tireóide (p=0,0047). Conclusões: Estudos adicionais com um maior tamanho amostral são necessários para investigar com mais força estatística a relevância do polimorfismo D727E na gênese do câncer de tireoide e do bócio nodular coloide.

Introduction: Cancer of the thyroid gland is the fifth most common malignancy among women. The disease’s incidence has been increasing over the years. Objectives: The aim of this study, was to determine the frequency of polymorphism D727E tshr gene and its association with different clinical phenotypes of thyroid cancer. Results: 48 patients with thyroid surgical diseases were operated in the city of Belém (Pará, Brazil). The control group was composed by 131 individuals free thyroid diseases. We observed 26 patients with thyroid malignant disease and 22 benign. The allele frequency of polymorphism D727E was 17.7% in patients with thyroid tumor and 8% in the control group (p <0.03). Among malignant thyroid tumors, D727E mutation was found in heterozygosis in 6 of the 23 patients with papillary thyroid carcinoma and in one of two patients with follicular carcinoma. Among the considered benign thyroid tumors: 7 out of 15 patients with nodular goiter colloid showed the mutation (6 heterozygous and 1 homozygous). Two of 6 patients with follicular adenoma showed polymorphism D727E. Discussion: The analysis of the age distribution of patients with thyroid cancer showed that there were differences between patients with cancer diagnosis (48.7 ± 14.7 years), compared to patients with benign disease (37.8 ± 11.7 years). The age of onset of the symptoms that best separates the groups was 46 years. The variables gender (female), family history and age > 41 years were associated with the presence of D727E polymorphism (p = 0.026), which was not observed in patients without this polymorphism. The simultaneous occurrence of gender (female), family history and age > 46 years was associated with increased frequency in patients with malignant thyroid pathology (p = 0.0047). Conclusions: Additional studies with a larger sample size are needed to investigate harder statistical relevance of polymorphism D727E in the genesis of thyroid cancer as well as nodular goiter.

Papillary Thyroid Carcinoma Presenting with Intraluminal Tracheal Mass Symptoms

Papillary thyroid carcinoma is a common thyroid malignancy reported world wide. It affects females more commonly in the 4th to 6th decades of life. The patients usually present with a painless anterior neck mass and occasionally with lymph node involvement. We report a case of an elderly male who presented with hoarseness and hemoptysis, which warranted bronchoscopy. Biopsy of the intraluminal tracheal mass revealed the diagnosis of papillary thyroid carcinoma. Computed tomography scan of the neck confirmed the presence of the primary lesion in the right thyroid lobe with invasion into the adjacent trachea and esophagus.

BRAFV600E gene mutation in papillary thyroid cancer / 国际肿瘤学杂志

The BRAFV600E mutation in papillary thyroid carcinoma is the most common genetic event,which is an invasive tumor clinical phenotype and a poor prognosis indicator.The BRAFV600E mutation detection has an important guiding significance for the differential diagnosis of malignant thyroid nodules on preoperative,guiding the surgical resection range of thyroid cancer,judging the patient(s) prognosis and guiding the subsequent treatment of postoperative.

Central compartment neck dissection for cN0 papillary thyroid carcinoma / 中国耳鼻咽喉头颈外科

OBJECTIVE To evaluate the value of central compartment neck dissection for cN0 papillary thyroid carcinoma.METHODS The clinical data of 46 cases with cN0 papillary thyroid carcinoma in our hospital from Jan.1999 to June 2004 were retrospectively studied.The level Ⅵ lymph nodes were removed during the operation.RESULTS In 46 cN0 cases,there were 11 cases(23.9 %) pathologically proved lymph nodes metastasis after operation.Four patients developed neck recurrence and underwent neck dissection.CONCLUSION It is necessary to probe the level Ⅵ lymph nodes during the operation for cN0 papillary thyroid carcinoma patients.

Papillary adenocarcinoma of the stomach with psammoma bodies: report of two cases

Calcification of gastric carcinoma is unusual and most of the reported cases were of the mucinous type. This report describes two cases of papillo-tubular adenocarcinoma of the stomach with psammomatous calcification confined only to the papillary portion. Calcification was so heavy that specimen X-ray was able to clearly delineate its distribution. Microscopically, the calcification was confined to the papillary carcinoma area and was not found in the area of the tubular adenocarcinoma. Polymorphic calcific bodies were found in the supportive stroma of papillae and extrapapillary spaces as concentrically laminated psammoma bodies. They were also found in tumor cells as minute corpuscles. The mechanism of neoplastic mineralization in these cases seemed different from ontogenic calcification of mucinous gastric carcinoma and we postulated the mechanism of psammomatous calcification which is referred as intracellular calcification.

Expression of C-MET in thyroid carcinoma detected by rapid immunohistochemical analysis and its clinical significance for predicting lymph node metastases / 中国普通外科杂志

Objective To investigate expression of C-MET in palliary thyroid carcinoma(PTC) detected by rapid immunohistochemical analysis and its clinical significance to predicting lymph node metastases.Methods The expression level of C-MET was examined by rapid immunohistochemical analysis with C-MET-EPOS antibody in 85 cases of PTC.Results The rate of cervical lymph node metastates in PTC with strong positive stain expression(95.0%,23/25) was significantly higher than in PTC with positive stain expression(13.4%,8/60)(P