ABSTRACT
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.
Subject(s)
Humans , Male , Adult , Thyroidectomy , Endoscopes , Thyroid Cancer, Papillary , Robotics , Thyroid Neoplasms , Adenocarcinoma, Papillary , LaparoscopyABSTRACT
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 diseases 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.
ABSTRACT
Paciente masculino mestizo de 39 años de edad, fumador con antecedentes de buena salud que acude a consulta externa refiriendo hematuria y dificultad para orinar. Se le realiza tacto rectal y se le detecta tumoración que hacía protusión en el saco de Douglas y de la cual se tomó biopsia para estudio histológico. Se llega al siguiente diagnóstico: C arcinoma papilar sin poder precisar origen exacto y que el diagnóstico concluyente quedaba sujeto a pruebas de inmunohistoquímica. Estas pruebas fueron realizadas y el diagnóstico diferencial quedó concluido como Adenocarcinoma papilar de vejiga urinaria . Nos entusiamó la controversia diagnóstica desde el punto de vista morfológico que se establece en esta entidad, la utilidad de las pruebas inumohistoquìmicas en su corroboración, así como la precisión del origen vesical o uracal.
A 39 years old male, black patient who smokes and previous history of health appears in the out patients department complaining of blood in the urine, difficulties in the miction. A rectal exam is performed and we detect a tumor protruding in the Douglas sac out of which we obtained a biopsy for morphologic studies. Diagnosis: Papillary adenocarcinoma of the bladder, the rest of the diagnosis remains in the inmunehistollogical exam of the sample. We were enthusiastic about the morphological controversy of this entity and the utility of the inmunehystochemical tests in its corroboration, therefore its prognostic factors.
Subject(s)
Humans , Male , Adult , Biopsy , Urinary Bladder Neoplasms/pathology , Douglas' PouchABSTRACT
Se reporta una paciente con diagnóstico histopatológico de Adenocarcinoma papilar infiltrante de la trompa de Falopio moderadamente diferenciado, que invade hasta la capa muscular, sin rebasar a ésta, con metástasis a un ganglio del epiplón y no invade endometrío. Operada en la clínica de Onco-Ginecología y Patología cervical del Departamento de Gineco-obstetricia Hospital Obrero No 2 de la Caja Nacional de Seguro, constituyendo el único caso conocido en nuestro Hospital. Se completa el tratamiento remitiendo al Servicio de Oncología.
Its report a patient with a diagnosis of papillary adenocarcinoma of the fallopian tubes moderately differentiated, than invades until the muscle layer, without exceeding this layer, metastasis to the ganglyon of epiplon and does not invades endometrial layer. Operated at the Onco-gynecology and cervix pathology clinic of the Department of Gynecology - obstetrics of the Hospital worker at the CNS, been the only one case Knowed in our hospital. The treatment its completed sent the patient to the oncology service.