Ultrasound Guided Fine Needle Aspiration Cytology of Gallbladder Lesions Suspected to be Carcinoma Gallbladder: Experience of a Tertiary Care Hospital

Gallbladder carcinoma is the most common biliary tract malignancy in the world. Radiologicalinvestigations are helpful in diagnosing the gallbladder diseases especially carcinoma in most of thecases, but confirmation of diagnosis requires cytopathological correlation. We have undertaken astudy on 29 patients, who underwent ultrasound guided FNAC for evaluation of gallbladder lesionssuspected to be carcinoma gallbladder. 82.75% of patients had malignancy or suspicion of malignancyand 10.34% patients had abscesses, while in 6.9 % patients FNAC was inconclusive. Adenocarcinoma(NOS) was the most common diagnosis and was found in 62.6 % of patients. Poorly differentiatedcarcinoma, cytology suspicious of malignancy and abscesses were present in 7 % of patients each.Papillary carcinoma and squamous cell carcinoma were only seen in 3.44 % patients each. None ofthe patients in our study developed any minor or major complications during the procedure. A precisecytological examination is required not only to diagnose or rule out gallbladder malignancy, but alsofor prognostication of these carcinomas.

Caracterización clínica, patológica y epidemiológica de pacientes con carcinoma diferenciado de tiroides / Clinical, pathological and epidemiological characterization of patients with thyroid differentiated carcinoma

Introducción: El diagnóstico y tratamiento de pacientes con nódulo de tiroides son un desafío clínico, instrumental, imagenológico y patológico, y a pesar de que no representan un problema de salud en Cuba, afecta a un grupo importante de la población, fundamentalmente en edad laboral. Objetivo: Determinar las características clínicas, patológicas y epidemiológicas de pacientes con carcinoma bien diferenciado de tiroides. Métodos: Se realizó un estudio descriptivo y transversal de 30 pacientes con cáncer bien diferenciado de tiroides, operados en el Hospital Oncológico Conrado Benítez García de Santiago de Cuba, desde enero de 2014 hasta julio de 2017 y que recibieron tratamiento oncoespecífico, para lo cual se revisaron las historias clínicas y los informes de biopsia de cada uno. Resultados: En la serie predominaron las mujeres de 40-49 años de edad, los afectados de piel mestiza y negra, el aumento de volumen de la glándula, los nódulos hipoecogénicos, el tumor papilar, además de la infiltración capsular y la permeabilización vascular entre los factores pronósticos histológicos más comunes. Conclusiones: Existen elementos clínicos, epidemiológicos e imagenológicos para diagnosticar un presunto carcinoma bien diferenciado de tiroides.

Introduction: The diagnosis and treatment of patients with thyroid node are a clinical, instrumental, imagenological and pathological challenge, and although they does not represent a health problem in Cuba, they affect an important populational group, fundamentally in working periods. Objective: To determine the clinical, pathological and epidemiological characteristics of patients with well differentiated carcinoma of thyroid. Method: A descriptive and cross-sectional study of 30 patients with well differentiated cancer of thyroid, operated in Conrado Benítez García Oncological Hospital belonging to Santiago de Cuba was carried out from January, 2014 to July, 2017 and who received onchospecific treatment , for which the medical records and the biopsy reports were reviewed from each patient. Results: In the series the 40-49 year-old women , those patients affected of mestizo and black skin, the increase of the gland volume, the hypoechogenic nodules and the papillary tumor prevailed, besides the capsular infiltration and the vascular permeabilization among the most common histological prognosis factors. Conclusions: Clinical, epidemiological and imagenological elements exist to diagnose a presumed well differentiated carcinoma of thyroid.

El cáncer diferenciado de tiroides: experiencia clínica frente a un panorama cambiante / Differentiated thyroid cancer: clinical experience in a changing scenario

Antecedentes: el cáncer de tiroides es el cáncer endocrino más frecuente, ha aumentado significativamente su incidencia y se han producido importantes cambios en su tratamiento. Objetivos: analizar una población de pacientes con cáncer diferenciado de tiroides tratados en el Hospital Universitario Austral, evaluar sus resultados y discutir las nuevas tendencias en su manejo. Material y métodos: revisión retrospectiva de una serie de 344 pacientes operados entre mayo de 2001 y mayo de 2015; se realizaron 331 tiroidectomías totales y 13 lobectomías, con linfadenectomía central en el 82% y lateral en el 9 %, según hallazgos clínicos o ultrasonográficos. El 80% correspondieron al sexo femenino y el 95% fueron carcinomas papilares. De acuerdo con TNM, el 65 % fueron T1, 41% T1a (microcarcinomas) y, según ATA, el 87 % tenían bajo riesgo de recurrencia. El 34 % de los vaciamientos centrales y todos los laterales presentaron metástasis ganglionares, y solo el 1,8% presentó metástasis a distancia. El 73% de los pacientes recibieron I131 en dosis de 30 a 150 mCi (milicurios). Resultados: la supervivencia global fue del 99,2% con seguimiento promedio de 40,2 meses, con 0,8% de hipoparatiroidismo definitivo y 0,8% de parálisis recurrencial definitiva. Conclusiones: 1) casi el 80% de la población operada correspondía a estadios tempranos con bajo riesgo de recurrencia, 2) más del 40% correspondió a microcarcinomas, 3) los resultados obtenidos son similares a los comunicados por centros de alto volumen, 4) las conductas terapéuticas coincidieron con las recomendaciones de las guías en vigencia y con las nuevas tendencias en el manejo del cáncer diferenciado de tiroides.

Background: Thyroid cancer is the most common type of endocrine cancer with an incidence that is significantly increasing and with important treatment changes. Objectives: The aim of this study was to analyze a population of patients with differentiated thyroid cancer treated at the Hospital Universitario Austral, evaluate the outcomes and discuss the new trends in thyroid cancer management. Material and methods: A series of 344 patients undergoing thyroid surgery between May 2001 and May 2015 were retrospectively reviewed: 331 total thyroidectomies and 13 lobectomies. Central lymph node dissection was performed in 82% of the cases and lateral lymph node dissection in 9%, based on clinical and ultrasound findings. Most patients were women (80%) and 95% were papillary thyroid cancers. According to the TNM classification, 65% were T1, 41% T1a (microcarcinomas) and 87% corresponded to the ATA low risk of recurrence category. Lymph node metastases were present in 34% of the central neck lymph nodes and in all the lateral lymph nodes dissected, and only 1.8% presented distant metastasis. Radioactive iodine was used in 73% of the patients in doses between 30 and 150 mCi. Results: Overall survival was 99.2% with a mean follow-up of 40.2 months; 0.8% presented permanent hypoparathyroidism and 0.8% of the patients presented permanent recurrent laryngeal nerve palsy. Conclusions: 1) almost 80% of the patients undergoing surgery corresponded to early stages of the disease with low risk of recurrence; 2) more than 40% were microcarcinomas; 3) the results obtained are similar to those reported by high-volume centers; and 4) the review of this experience is similar to that reported by current practice guidelines, and the therapeutic approaches are in line with the recommendations of the current practice guidelines and with the new trends in the management of differentiated thyroid cancer.

Carcinoma diferenciado da tiroide / Differentiated thyroid carcinoma

O carcinoma diferenciado da tiroide (CDT) é a neoplasia endocrinológica mais comum. Nos Estados Unidos da América do Norte se estimam que 33.000 pessoas sejam acometidas pela doença. Nos últimos anos se tem observado um aumento progressivo no número de casos por ano em todo o mundo. O CDT tem usualmente uma sobrevida acima de 90% em dez anos, todavia, aproximadamente 20% dos pacientes podem cursar com recorrências locais e a distância, aumentando a mortalidade pelo tumor e reduzindo o tempo livre de doença. Por esses motivos a correta classificação dos indivíduos com CDT, torna-se imprescindível para oferecer o melhor e mais adequado tratamento.

Nódulos de tireóide e câncer diferenciado de tireóide: consenso brasileiro / Thyroid nodules and differentiated thyroid cancer: brazilian consensus

Os nódulos tireoidianos constituem a principal manifestação clínica de uma série de doenças da tireóide com uma prevalência de aproximadamente 10 por cento na população adulta. O maior desafio é excluir o câncer da tireóide, que ocorre em 5 a 10 por cento dos casos. Os carcinomas diferenciados respondem por 90 por cento dos casos de todas as neoplasias malignas da tireóide. A maioria dos pacientes com carcinoma diferenciado apresenta, geralmente, um bom prognóstico quando tratada adequadamente, com índices de mortalidade similares à população geral. No entanto, alguns indivíduos apresentam doença agressiva, desafiando o conhecimento atual e ilustrando a complexidade do manejo dessa neoplasia. No presente trabalho, reunimos 8 membros do Departamento de Tireóide da Sociedade Brasileira de Endocrinologia & Metabologia, para elaborarmos, por consenso, as diretrizes brasileiras no manejo dos nódulos tireoidianos e do câncer diferenciado da tireóide. Os membros participantes representam diferentes Centros Universitários do Brasil, refletindo diferentes abordagens diagnósticas e terapêuticas. Inicialmente, cada participante ficou responsável pela redação de determinado tema a ser enviado ao Coordenador, que, após revisão editorial e elaboração da primeira versão do manuscrito, enviou ao grupo para sugestões e aperfeiçoamentos. Quando concluído, o manuscrito foi novamente enviado e revisado por todos. A elaboração dessas diretrizes foi baseada na experiência dos participantes e revisão pertinente da literatura.

Thyroid nodules are a common manifestation of thyroid diseases. It is estimated that ~10 percent of adults have palpable thyroid nodules with the frequency increasing throughout life. The major concern on nodule evaluation is the risk of malignancy (5-10 percent). Differentiated thyroid carcinoma accounts for 90 percent of all thyroid malignant neoplasias. Although most patients with cancer have a favorable outcome, some individuals present an aggressive form of the disease and poor prognostic despite recent advances in diagnosis and treatment. Here, a set of clinical guidelines for the evaluation and management of patients with thyroid nodules or differentiated thyroid cancer was developed through consensus by 8 member of the Department of Thyroid, Sociedade Brasileira de Endocrinologia e Metabologia. The participants are from different reference medical centers within Brazil, to reflect different practice patterns. Each committee participant was initially assigned to write a section of the document and to submit it to the chairperson, who revised and assembled the sections into a complete draft document, which was then circulated among all committee members for further revision. All committee members further revised and refined the document. The guidelines were developed based on the expert opinion of the committee participants, as well as on previously published information.

Insular (Poorly Differentiated) Carcinoma of Thyroid / 대한내분비외과학회지

Insular carcinoma of the thyroid is a rare thyroid malignancy, and this was named in 1984 by Carcangiu when he described its characteristic histology. Histologically, insular carcinoma is characterized by uniform cells arranged in distinct nests or an insular pattern that contain variable numbers of small follicles. Clinically and morphologically, it is considered to be in an intermediate position between well-differentiated carcinoma of the thyroid (papillary or follicular) and undifferentiated or anaplastic carcinoma of the thyroid. This thyroid malignancy is distinctive, aggressive and often lethal. However, most authors believe it to be an independent entity. The prognosis of this tumor is worse than that of classic differentiated thyroid carcinoma, and most authors advise aggressive therapy, which can achieve pro-longed survival in some cases. We describe here a patient (a 42 years-old woman) who was managed with completion thyroidectomy after unilateral lobectomy of the thyroid with confirmation of the permanent pathology as insular carcinoma. I-131 ablation (175 mCi) was performed on the remnant thyroid tissues after follow-up of I~131 whole-body scanning.

Clinicopathologic Features of Poorly Differentiated (Insular) Carcinoma of Thyroid

PURPOSE: Well-differentiated carcinomas of the thyroid run an excellent clinical course. However 10~20% of thyroid carcinomas showed poor clinical outcomes. Insular carcinomas are an uncommon thyroglobulin-producing neoplasm, which show intermediate prognosis between well-differentiated carcinomas and undifferentiated anaplastic carcinomas, and their clinicopathologic features are poorly understood. Therefore, we aimed to investigate the clinicopathologic features and the prognosis of insular thyroid carcinomas. METHODS: We reviewed 10 patients who underwent an operation due to an insular thyroid carcinoma at Seoul National University Hospital between January 1990 and December 2001. Their clinicopathologic features and follow-up findings were retrospectively reviewed and compared. RESULTS: Four male and six female patients are reviewed, with a mean age of 54.8+/-6.4187, ranging from 37 to 69 years. Pathologically, eight of the tumors consisted of pure insular carcinoma and the others showed a papillary carcinoma as the major component and a minor insular component. The mean tumor size was 4.53 cm (4.53+/-1.4288 cm). An extrathyroidal extension was present in 7 cases and a vascular invasion in 6. Distant metastasis and local relapse of the regional lymph node were seen in 9 patients. Comparing the survivor and expired groups, all the male patients were in the expired group, and the mean tumor size was larger in the expired group (5.46 cm vs. 3.6 cm). But these differences were not statistically significant. CONCLUSION: Our study revealed that insular carcinomas have distinctive clinicopathologic features, and recognition of this histologic variant is important and significant for management of these unique tumors.

A clinicopathological analysis of 257 cases of differentiated thyroid carcinoma / 医学研究生学报

Objective: To analyze the clinicopathological characteristics of differentiated thyroid carcinoma. Methods: We retrospectively analyzed 257 cases of differentiated thyroid carcinoma between 1996 and 2005 according to the WHO classification,together with the follow-up data of some of the cases.Results: The 257 cases of differentiated thyroid carcinoma constituted 15.3% of the 1681 cases of thyroid lesion and 93.1% of the 276 cases of malignant thyroid tumor detected in the same period,including 241 cases of papillary carcinoma(14.3% of the thyroid lesions and 87.3% of the malignant thyroid tumors) and 16 cases of follicular carcinoma(1.0% of the thyroid lesions and 5.8% of the malignant thyroid tumors).The male to female ratio was about 1∶2.7.Histologically,the papillary structure was frequently noted admixed with the follicular pattern.Papillary carcinoma of the thyroid complicated by Hashimoto's thyroiditis,follicular adenoma and nodular goiter accounted for 16.2%,11.6% and 14.9%,respectively.A 1-10 y follow-up of 97 patients showed that all but one survived.Conclusion: Differentiated thyroid carcinoma is a fairly common malignant tumor,with papillary carcinoma as the commonest histological type and some complicated by other thyroid diseases.Its prognosis is relatively good despite the common occurrence of lymphoid and lung metastasis and local invasion.

Valor da dosagem da tireoglobulina no seguimento de pacientes com carcinoma diferenciado da tireóide submetidos à tireoidectomia parcial / Value of serum thyroglobulin measuremat in the follow-up of patients with differentiated carcinoma treated by partial thyroidectomy

OBJETIVO: Estudar o valor da dosagem da tireoglobulina (Tg) plasmática na detecção de recidivas, nos pacientes com carcinoma diferenciado da tireóide, submetidos à tireoidectomia parcial. MÉTODOS: São analisados, retrospectivamente, 48 pacientes portadores de carcinoma diferenciado e submetidos à tireoidectomia parcial que foram acompanhados no pós-operatório com dosagens de Tg plasmática. O exame foi realizado no paciente com TSH suprimido (< 0,6mU/cc) e o valor da Tg de 10ng/cc considerado como limite entre os casos com e sem suspeita de recidiva. O tempo médio de seguimento foi de 8,1 anos. RESULTADOS: Onze pacientes apresentaram Tg elevada (> 10ng/cc) e quatro eram portadores de doença benigna capaz de elevar a Tg como hipertireoidismo (dois casos) e doença de Hashimoto (dois casos). Estes quatro pacientes não foram considerados na análise estatística. Os sete restantes foram considerados suspeitos de recidiva tumoral que foi confirmada em seis (verdadeiro positivo) e não confirmada em um (falso positivo). Nos 37 pacientes com Tg baixa (< 10ng/cc) apenas um apresentou recidiva (verdadeiro negativo: 36 e falso negativo: 1). A análise estatística da capacidade da Tg em detectar recidivas mostrou: sensibilidade 85 por cento; especificidade 94 por cento; valor preditivo positivo 85 por cento; valor preditivo negativo 84 por cento e acurácia 95 por cento. CONCLUSÕES: Os resultados obtidos neste trabalho mostraram que a dosagem da Tg é de valor na detecção de possibilidade de recidivas no seguimento de pacientes operados por carcinoma diferenciado mesmo quando submetidos à cirurgia parcial.

BACKGROUND: Serum thyroglobulin determination has been reported to be a sensitive indicator of recurrent differentiated thyroid carcinoma. The purpose of this study is to determine the accuracy of serum thyroglobulin levels in predicting tumor recurrency after parcial thyroidectomy. METHODS: Forty eight patients with differentiated thyroid carcinoma were followed with serum thyroglobulin measurement after parcial thyroidectomy. Patiens recived hormonal suppressive therapy to maintain plasma TSH level below 0,6 mU/cc. Mean follow-up was 8,1 years. Serum thyroglobulin level above 10ng/cc was considered suspect of tumor recurrency. RESULTS: Eleven patients showed serum thyroglobulin level above 10 ng/cc. In four of them, elevations were considered spurious (hiparthyroidisme - 2 cases, and Hashimoto disease - 2 cases) and were excluded from statistical analysis. In the other 7, tumor recurrence was demonstrated in 6 (true positive: 6; false positive: 1). In 37 patients with low thyroglobulin level, only 1 had recurrence (true negative: 36; false negative: 1). Statistical analysis show sensibility 85 percent, specificity 94 percent, positive predictive value 85 percent, negative predictive value 84 percent and accuracy 95 percent. CONCLUSIONS: Serum thyroglobulin determination is an useful test to identify patients with persistent or recurrent differenctiated cancer, inicially submited to parcial thyroidectomy.

Aspiration Cytology of Insular Carcinoma of Thyroid: A Case Report / 대한세포병리학회지

Fine needle aspiration cytologic features of a case of insular carcinoma of the thyroid in a 23-year-old woman who presented a palpable neck mass is described. The aspirate showed cellular smear arranged in trabeculae, solid or loose clusters, and microfollicles in necrotic background. The tumor cells had uniform, small round, hyperchromatic nuclei. The chromatin was finely granular, and nuclear membrane was smooth. Nucleoli were not discernible. Nuclear pleomorphism was minimal. The cytoplasm was usually scanty, pale, poorly outlined, and almostly amphophilic. Sometimes paranuclear cytoplasmic vacuoles were noted. Final diagnosis was confirmed by total thyroidectomy as insular carcinoma.

Poorly Differentiated Carcinoma of the Thyroid Retrospective Clinical and mMrphologic Evaluation

Five thyroid carcinomas showing clinically aggressive biologic behavior were retrospectively reviewed to evaluate the possible presence of morphologic differences from conventional thyroid carcinomas. They were originally diagnosed as follicular carcinomas, medullary carcinoma, papillary carcinoma, and mixed papillary and medullary carcinoma. There were three males and two females. The age at the time of initial diagnosis ranged from 36 years to 67 years (mean 56 years). The size of the tumor varied from 4.5cm to 10cm (mean diameter 7cm). One patient died of brain metastasis four years after the initial therapy and the other four patients are still alive with local recurrences and/or metastases to bone, spinal cord, lung, and buttock. Histologically these lesions are categorized into two different groups: insular variant and columnar cell variant. Insular variant was characterized by well-defined nests (insulae) that are composed of small, uniform cells, frequent tumor necrosis, and hyalinization of the stroma. Columnar cell variant was characterized by tall columnar cells with marked nuclear statification. All five cases stained positively for thyroglobulin and negatively for calcitonin. With the above clinical and histopathological findings, we interpreted these lesions as a poorly differentiated carcinoma, biologically in an intermediate position between well differentiated and anaplastic carcinomas. The rapid and often fatal outcome associated with these variants of poorly differentiated carcinoma warrants aggressive treatment at the time of diagnosis.