Histopathological Evaluation of Solitary Nodules of Thyroid

Introduction: Solitary Thyroid nodules (STNs) can be ofboth non-neoplastic or neoplastic in nature and it is difficultto assess whether an STN is neoplastic or non-neoplasticby clinical examination alone. Imaging technique mayhelp in differentiating them preoperatively but histologicalexamination offers the final diagnosis. This study was aimedat studying the incidence rates of various types of STNs as itvaries from one geographical area to another.Material and methods: A total of 58 cases of STNsreceived over the period of 18 months were studied andhistopathological features were analysed.Results: In this study, non-neoplastic STNs were 32 (55.17%)and neoplastic were 26 (44.82%), the former being morecommon. There was a female preponderance in both nonneoplastic and neoplastic STNs with an incidence of 90.62%and 84.61% respectively. Mean age of presentation of STNswas 42.09 years. Non-neoplastic lesions of thyroid were; 18cases of colloid nodules, 10 cases of hyperplastic nodulargoitre, 04 cases of Hashimoto Thyroiditis and the neoplasticlesions were; 05 cases of follicular adenoma, 11 cases oftypical/conventional papillary carcinoma of thyroid (PTC),6 cases of papillary carcinoma thyroid variants, 01 case offollicular carcinoma 01 case of Undifferentiated carcinoma,01 case of Squamous cell carcinoma and 01 case of medullarycarcinoma.Conclusion: STNs are not so uncommon and comprise of agamut of both non-neoplastic and neoplastic lesions. Colloidnodule and PTC are the most common of non-neoplastic andneoplastic STNs respectively.

Management of Thyroid Carcinoma with Significant Mediastinal Involvement without Sternotomy

Papillary thyroid carcinoma usually presents as a palpable thyroid swelling, and presenting as cervical lymphadenopathy is uncommon. Metastasis to the cervical lymph nodes could have several primary sources. A 70 year old male presented with painless left cervical mass which was insidious in onset, gradually increasing in size since past one year. Physical examination revealed an oval left cervical mass, extending from anterior border of sternocledomastoid (SCM) muscle to the posterior triangle of neck at level III, IV and V. Plain and contrast enhanced Computed tomography (CT) of neck and thorax demonstrated an ill defined irregular intensely enhancing multi-lobulated lesion in the left supraclavicular region. Fine needle aspiration cytology (FNAC) was suggestive of either a metastatic lesion or a primary lesion. Level V lymph node biopsy suggested papillary carcinoma thyroid. The patient underwent total thyroidectomy with bilateral lymph node dissection with excision of mediastinal lymph nodes via cervical approach without sternotomy. Histopathological examination of the specimen confirmed Papillary Thyroid Carcinoma (conventional type) with secondaries to the neck. On discharge, the patient was given radioactive iodine therapy for two weeks, followed by lifelong oral thyroxine. No signs of recurrence were noted in the follow up visits. A combination of radiological and histopathological investigations can help to assess a cervical mass of thyroid origin. The transcervical approach is simpler and safer than the transsternal approach and avoids the morbidity of a sternal split.

Diagnostic utility of FNAC in thyroid lesions and their histological correlation – A case study

Fine needle aspiration of thyroid lesions forms the first diagnostic tool in the preoperative evaluation of thyroid lesions. Thyroid diseases are important as these are curable with medical as well as surgical treatment. Enlargement of thyroid called as goiter is the most common manifestation of thyroid diseases. FNAC forms an important role to determine the nature of thyroid lesion whether benign or malignant. It is simple, safe, accurate and cost effective method. This was a prospective and descriptive study done for the period of 2 years from January 2016 to December 2017 in the Department of Pathology at our tertiary care hospital. A total of 100 patients with thyroid lesions came for FNAC, out of which 50 cases were received for histopathological correlation. There were 39 cases of benign thyroid lesions out of which multinodular goiter were the commonest. Papillary carcinoma was the most common malignant lesion amongst 11 cases. Benign lesions presented in younger age group (20-40 years) whereas malignant lesions had bimodal presentation (20-40 years and 40-60 years). Hereby I have analyzed different types of thyroid lesions in different age groups based on cytological evaluation followed by its histopathological confirmation.

Carcinoma papilar de tiroides y pancreatitis autoinmune: a propósito de un caso / Thyroid Papillary Carcinoma and Autoimmune Pancreatitis: A case study

El objetivo de este caso es resaltar la utilidad del ultrasonido endoscópico en pacientes con trastornos gastrointestinales. Este caso es interesante en vista que involucra dos patologías que no tienen relación entre si y que se diagnosticaron por ultrasonido endoscópico en una misma paciente, hablamos de la pancreatitis inmunológica y del carcinoma papilar de tiroides. El carcinoma papilar de tiroides se presenta en el 80 % de los casos de pacientes con neoplasia endocrina afectando a mujeres blancas, con una sobrevida mayor al 90 % si se diagnostica en estadios tempranos. En los últimos años se han descrito, cada vez con mayor frecuencia, enfermedades inflamatorias pancreáticas provocadas por mecanismos inmunológicos, que responden a tratamiento con esteroides. La disponibilidad de herramientas diagnósticas basadas en la imagen, la histología y la serología establecidas en los últimos años sirvió para determinar con exactitud la etiología de estas enfermedades.Se presenta el caso de femenina de 48 años, diabética tipo II, en tratamiento regular, cuyo motivo de consulta fue dolor abdominal difuso, gases y distensión abdominal. Se le realizó ecoendoscopia superior que concluyó lesión neoproliferativa de la cola del páncreas y aumento de volumen del lóbulo tiroideo derecho. La punción aspiración por ecoendoscopia de lesión en cola de páncreas reportó células acinares dispersas y dispuestas en grupos entremezclados con exudado inflamatorio mixto a predominio de linfocitos típicos y reactivos, histiocitos, compatibles con pancreatitis autoinmune y la punción aspiración de tiroides reportó células foliculares dispuestas en placas y papilas con atipias nucleares, abundante citoplasma denso, agrandamiento nuclear con anisonucleosis moderada, aclaramiento cromatínico con micro nucléolos, numerosas hendiduras y pseudoinclusiones nucleares concluyendo carcinoma papilar. También se le realizó determinación de IgG4 que resultó positiva...

The objective of this work is the importance of using endoscopic ultrasound in patients with gastrointestinal disorders; this case is interesting given that it involves two unrelated pathologies, which were diagnosed by endoscopic ultrasound in a same patient. We talk about the immunological Pancreatitis and Papillary Carcinoma of Thyroid. The Papillary Carcinoma of Thyroid is the Endocrine Neoplasm that occurs in 80 % cases, affecting white women, with one survival rate greater than 90 %, if diagnosed in early stages. In recent years more and more frequently pancreatic inflammatory diseases caused by immunological mechanisms, which respond to treatment with steroids have been described. The availability of diagnostic tools based on the image, the histology and serology, established in recent years, served to determine accurately the etiology of these diseases. The case of female 48 years, diabetic type II, under regular treatment, whose reason for consultation was: the presence of diffuse abdominal pain, gas, as well as positive abdominal distension. The patient underwent upper digestive ecoendoscopy. It concludes: pancreas´s tail neoproliferative lesion, as well as, and increase in volume of the right thyroid lobe, etiology to be clarify. FNA of the lesion of the tail of the pancreas reported acinar, scattered cells, arranged in groups intermingled with mixed inflammatory exudate, with predominance of typical and reactive lymphocytes, histiocytes, consistent with Immunological Pancreatitis. FNA of thyroid reported groups of follicular cells arranged in plates and papillae with nuclear atypias, abundant dense cytoplasm, and nuclear enlargement with moderate anisonucleosis, chromatinic, with micronucleus, numerous cracks and nuclear pseudo inclusions, which concludes Thyroid Papillary Carcinoma. Also it was done Ig4, proving positive. The patient underwent surgery of the thyroid, currently responding well to medical treatment.

Transformación anaplásica tardía de bocio multinodular / Late anaplastic transformation Of multinodular goitre

Introducción: el Cáncer tiroideo se caracteriza por su baja incidencia, comportamiento maligno infrecuente y baja mortalidad. La mayoría de ellos procede de bocios multinodulares de larga duración por lo que es muy importante tener en cuenta factores que constituyen riesgos potenciales como: tiempo de establecimiento de la enfermedad, tamaño, así como las características particulares personales y la evolución de la entidad en cada caso. Si tenemos en cuenta el gran avance tecnológico que constituye la Biopsia Aspirativa con Aguja Fina (BAAF), que nos permite no solamente evitar su transformación neoplásica maligna, sino que también podemos prolongar la vida con la calidad que humanamente se requiere que es en definitiva la meta principal de la Salud Pública Cubana. Objetivo: destacar la importancia del adecuado seguimiento evolutivo del Bocio multinodular como elemento significativo en la prevención de su transformación maligna. Presentación del caso: Paciente femenina de 80 años de edad con aumento de volumen de la región anterior del cuello y antecedentes patológicos personales de Bocio Multinodular (BMN) con tratamiento inconstante e irregular de años de evolución, quien no solamente pudo haber mejorado la calidad de su vida sino que no la hubiera truncado, considerando las condiciones atenuantes en la forma de presentación que tuvo su caso. Al examen físico: Aumento de la región anterior del cuello, palpándose masa de superficie irregular, consistencia firme, dolorosa, de aproximadamente 6x5 cm que había aumentado considerablemente en los últimos meses sin fecha precisada. La paciente fue ingresada por el gran agobio respiratorio y la toma del estado general, pudiéndose realizar únicamente la Biopsia Aspirativa con Aguja Fina (BAAF). Desde su ingreso presenta evolución tórpida con incremento del compromiso respiratorio requiriendo la práctica de la traqueotomía que sólo ayuda como medida de soporte al estadio terminal de esta enfermedad neoplásica maligna. (Carcinoma Anaplásico del Tiroides). A pesar de ello la paciente fallece y los familiares autorizan la necropsia. Conclusiones: los BMN deben tener seguimiento evolutivo que permita precisar una tiroidectomía a tiempo como prevención en enfermedades benignas del Tiroides, por los cambios malignos que pueden producirse cuando la glándula es irradiada. La tiroidectomía a tiempo permite evitar no solamente la transformación maligna que puede producirse, sino también previene las metástasis que ocurren en los Carcinoma Anaplásicos.

Introduction: the thyroid carcinoma is characterized by low incidence, low malignant behaviour as well as low mortality. The most of they are developed from multinodular goitres of long duration so is important to be into account the risk factors such as: time of the establishment of the disease, size and the particular and personal characterists and the evolution of the each case. If we take into account the great technological advance of the BAAF from its performance in the past century to be united to the National Health System of our country ,we have to say that the multinodular goitres in any group of age are easily manageable and accessible which may us to avoid the malignant transformation besides we can do that the life continues with the quality humanely requested . Finally, this is the first goal of the Cuban Public Health. Objective: to highlight the importance of an appropriate follow-up of multinodular goitre as a significant element in the prevention of its multinodular malignant transformation. Case presentation: an 80 year- old, female patient presents an increase of the volumen of the anterior section of the neck, with pathologic antecedents of a multinodular goitre which the evolution has been characterized by an irregular and non systematic treatment along of years .She could have better quality of life as well as to avoid to death taking into account the wild conditions of that disease was presented herself. Physical examination: It has been observed an increase of the anterior area of the neck. On palpation ,it was felt a mass of irregular surface , painful and of a hard consistency with 6x5cms. approximately that had increased notably in the course of the last months . On the admission, the patient presented a serious respiratory process and poor general status so we only achieved a Fine Needle Aspirative Biopsy (FAAB).She continuos with reapiratory compromised so a surgical racheotomy was ejecuted that only help her as a way of supporting in the patient terminal stage in this malignant disease (Anaplastic Carcinoma of Thyroid). Despite the recommended procedure the patient died. The family accepted the autopsy. Conclusions: the multinodular goitres have to exam periodically in order to just may to do the tiroidectomy as the preventive measure in benign diseases of thyroid and avoid the malignant changes that could occurred when the gland is irradiated.The tiroidectomy ejecuted at just time avoid the malignant transformation as well as the metastasis in Anaplastic Carcinoma Thyroid.

Neurofibroma de tireóide em uma paciente com neurofibromatose tipo 1 / Neurofibroma of thyroid in a patient with neurofibromatosis type 1

A neurofibromatose tipo 1 (NF1), também conhecida como doença de von Recklinghausen, é uma doença autossômica dominante com alto grau de variabilidade da expressão clínica, comumente envolvida na formação de tumorações na maioria das vezes de origem benigna, localizadas principalmente na região da cabeça e do pescoço, sendo a tireóide acometida raramente. Porém existe na literatura a associação com carcinoma medular da tireóide (CMT), necessitando sempre sua exclusão. Relatamos o caso de uma paciente com NF1, com um nódulo de tireóide não-funcionante e sintomas obstrutivos. Foi realizada ressecção cirúrgica da lesão, com achados histopatológicos compatíveis com neurofibroma em tecido tireoidiano. A importância desse caso deve-se não só à raridade dessa apresentação da NF1, mas também à possibilidade de associação desta com CMT, tumor agressivo com possibilidade de cura pela ressecção cirúrgica.

The neurofibromatosis type 1 (NF1), also known as von Recklinghausen’s disease, is an autosomal dominant disorder, with high degree of variability of clinical expression, usually involved with formation of tumors, with benign origin in the majority of cases mainly localized in the region of the head and neck and rarely incident in the thyroid area. However, the association with medullary carcinoma of the thyroid (MCT) exists in literature and needs to be excluded. We report a case of a patient with NF1, nonfunctional thyroid nodule and obstructive symptoms. Surgical resection of lesion was performed, with histopathologic findings compatible with neurofibroma in thyroid tissue. This case is relevant not only because of the rarity of the presentation of NF1, but also due to the likely association with MCT, an aggressive tumor that can be cured by surgery.

A Case of Papillary Carcinoma of Thyroid Gland Arising from Ovarian Mature Cystic Teratoma / 대한산부인과학회잡지

Malignant transformation is a rare complication in a mature cystic teratoma of the ovary, usually being reported less than 2% of cases. The most common malignant tumor arising from a mature cystic teratoma of the ovary is a squamous cell carcinoma. However, adenocarcinoma is reported extremely rare, in most cases it was impossible to tell the source of the malignancy. We experienced a case of papillary carcinoma of thyroid glands arising from mature cystic teratoma of the ovary and report this case with a brief review of literature.

Two Cases with Squamous Cell Carcinoma of the Thyroid Gland / 대한내분비학회지

Primary squamous cell carcinoma of the thyroid is rare, presenting much less than one percent of all primary thyroid malignancies. Most cases have been reported in elderly patients with a history of goiter. It is necessary to differentiate between primary squamous cell carcinoma and secondary involvement from other sites. Secondary involvement of the thyroid may be more amenable to palliation or cure. The treatment of choice in primary squamous cell carcinoma is radical surgery in resectable cases, but the squamous cell carcinoma behaves aggressively and carries a uniformly poor prognosis regardless of the treatment. We had an experience of a primary squamous cell carcinoma of the thyroid in two elderly patients. These patients presented a typical feature of a primary squamous cell carcinoma of the thyroid, which has been rarely reported in Korea.

Concurrent Medullay and Papillary Carcinoma of the Thyroid / 대한내분비학회지

The origins of medullary carcinoma and papillary carcinoma of thyroid are embryologically different. We report a case of simultaneous occurrence of medullary carcinoma and papillary carcinoma of the thyroid in the same thyroid gland. In this case, the occurrence of the two tumors may be a coincidence, does not have embryological or genetical significance.

Analysis of Prognostic Factors Determining the Recurrences in Patients with Papillary Thyroid Cancer After Surgical Treatment / 대한내분비학회지

BACKGROUND: It is important to recognize the independent prognostic factors of papillary carcinoma of thyroid in therapeutic and follow up planning. However, its good prognosis and its low prevalence make it difficult to analyze prognostic factors determining patients survival in a relatively short period of time. We retrospectively investigated the independent prognostic factors for determining disease recurrence after surgery which, in adults, are known to be closely related to the prognosis of cancer. METHOD: We retrospectively reviewed the clinical records of 456 patients (male 70, female 381, unknown 5, mean age of 43.9+-12.9 years) who had visited the thyroid clinic in Seoul National University Hospital and analyzed the data with statistical software program. RESULTS: 1) At initial visit, chief complaint of the patients was abnormal neck mass in 90 percent. 2) In preoperative thyroid scan study, 82% showed cold area and 16% showed diffuse enlargement. 3) Of the 50 recurrent cases after surgery (11.5% of the total cases), 39 cases (78%) had recurred disease in neck area and 11 cases (22%) had recurrences at distant sites. (Lung 9 cases, Brain I case, Mediastinum 1case) 4) Statistically significant risk factors for recurrence after surgery were male sex, size of tumor (above 4.5cm in this study), extrathyroidal invasion of cancer, involvement of resection margin and no remnant ablation of thyroid tissue using radioiodine. CONCLUSION: Through retrospective study, we presented some clinical characteristics of papillary thyroid cancer in Korea and independent risk factors of cancer recurrences after surgery.