ABSTRACT
La coroides es el tejido ocular más comúnmente afectado por la enfermedad metastásica debido a su abundante vascularización y, en ocasiones, la primera manifestación (44-70% según las series) de cáncer de pulmón en hombres o de cáncer de mama en mujeres (3%). Síntomas oculares de inicio abrupto en pacientes jóvenes y signos al examen oftalmológico como engrosamiento de la pared posterior o lumpy-bumpy surface, entre otros, son orientativos. La uveítis anterior granulomatosa, la uveítis intermedia bilateral, la panuveitis bilateral o las lesiones granulomatosas a nivel coroideo o del nervio óptico se consideran indicativas de sarcoidosis en presencia de un cuadro radiológico compatible. Estas pueden preceder a los signos sistémicos en un 30% de los casos. Se presentan tres pacientes con signos y síntomas oftalmológicos que precedieron al diagnóstico de enfermedades sistémicas no infecciosas.
The choroid is the ocular tissue most commonly affected by metastatic disease due to its abundant vascularization and is sometimes the first manifestation (44-70% depending on the series) of lung cancer in men or breast cancer in women (3%). Abrupt-onset ocular symptoms in young patients and signs on ophthalmological examination such as thickening of the posterior wall, "lumpy-bumpy surface", among others, are indicative. Granulomatous anterior uveitis, bilateral intermediate uveitis, bilateral panuveitis or granulomatous lesions at the choroidal or optic nerve level are considered indicative of sarcoidosis in the presence of a compatible radiological picture. These may precede systemic signs in 30% of cases. We present 3 patients with ophthalmological signs and symptoms that preceded the diagnosis of non-infectious systemic diseases.
ABSTRACT
Objective:The clinicopathological features, diagnosis, and prognosis of follicular thyroid carcinoma (FTC) with distant me-tastasis as the first manifestation were evaluated in this study. Methods:A total of 129 FTC cases with clinical data were retrospective-ly analyzed in the Department of Pathology, Tianjin Medical University Cancer Institute and Hospital (January 2001 to January 2016). Survival analysis and conjoint analysis on FTC with clinical data, diagnosis, and morphological characteristics with distant metastasis as the first manifestation were performed. Results:Among the 129 FTC cases, 24 cases demonstrated distant metastasis as the first mani-festation (18.6%). Bone metastasis was the most common (13.2%). The presence of mass and pain at the metastatic sites were the usu-al clinical complaints. The morphological characteristics of FTC with distant metastasis can be classified into four subtypes:microfollicu-lar (10 cases), solid (4 cases), normofollicular (9 cases), and macrofollicular (1 case). Immunostaining tests on thyroglobulin and thyroid transcription factor-1 showed positive results in FTC with metastasis. Survival analysis showed that the five-year survival rates in the 24 cases were 87.1%. The prognosis of patients with solitary metastasis was better than that of patients with multiple metastasis (P=0.022). A higher survival rate was found in the normofollicular and macrofollicular subtypes than that detected in the microfollicular and solid subtypes (P=0.012). Conclusion:FTC is susceptible to distant metastasis. Some patients with FTC demonstrated distant me-tastasis as the first manifestation, and their diagnosis can be confirmed by pathological feature analysis and immunostaining. The prog-nostic significance is possibly related to the number of lesions of FTC with distant metastasis and histopathological subtypes.