Carcinoma papilar difuso de tiroides: microcalcificaciones fuera del nódulo tiroideo / Diffuse Papillary Thyroid Carcinoma: Microcalcifications Outside the Thyroid Node

Resumen: Introducción: La incidencia de cáncer papilar de tiroides (PTC) ha aumentado de 1975 a 2015. Basados en criterios publicados, el ultrasonido (US) es muy efectivo para predecir el riesgo de malignidad. Todos estos criterios se enfocan en los nódulos tiroideos; sin embargo, 2% de los casos se pueden presentar como focos ecogénicos difusos sin un nódulo identificable. Caso: Mujer de 17 años con historia de 3 meses con una masa palpable en la región anterior derecha del cuello, sin otros síntomas. El US de cuello revela múltiples focos ecogénicos de distribución difusa en el parénquima tiroideo con un nódulo de 6 mm TI-RADS 5 en el lóbulo izquierdo y ganglio linfáticos con componentes sólidos y quísticos, pérdida del hilio graso y con puntos ecogénicos. Se le realizó tiroidectomía total con linfadenectomía bilateral. Discusión: Las microcalcificaciones son muy sugestivas de CPT. Los ecos puntiformes se correlacionan en patología con una forma de calcificación distrófica llamada cuerpos de Psammoma, los cuales se depositan en tejido no viable. La tiroiditis crónica también puede presentar calcificaciones distróficas. Por lo tanto, un parénquima tiroideo normal con presencia de microcalcificaciones, obliga a realizar una biopsia con aguja fina para descartar CPT. Estudios recientes sugieren que la lobectomía es una opción viable y debe ser la primera elección en CPT localizado (< 2 cm). Sin embargo, esto no se debe realizar en estos pacientes, ya que la presencia de microcalcificaciones difusas nos indica un tamaño del tumor mucho mayor y resultaría en un pronóstico desfavorable. Conclusión: Las microcalcificaciones difusas deben obligar al radiólogo a sospechar la variedad difusa del CPT como primera sospecha diagnóstica.

Abstract: Introduction: The incidence of thyroid papillary cancer (PTC) has increased from 1975 to 2015. Ultrasound is effective for predicting thyroid malignancy based on published criteria. All of these criteria focus on thyroid nodules but also 2% of the cases may appear as diffuse punctuate echogenic foci without an identifiable nodule. Case: A 17-year-old female with a 3-month history of a palpable mass on the right anterior side of the neck without any further symptoms. Neck ultrasound revealed multiple punctuate echogenic foci scattered along the thyroid parenchyma with a 6 mm nodule TI-RADS 5 on the left lobe, lymph nodes with cystic and solid components, loss of echogenic hilum and punctuate echogenic foci. The patient underwent a total thyroidectomy with bilateral lymphadenectomy. The pathology report revealed diffuse distribution of papillary cancer with a nodule on the left lobe and metastatic disease on the lymph nodes. Discussion: Microcalcifications are highly suggestive of PTC. Punctuate echogenic foci correlate in pathology with a form of dystrophic calcifications, called Psammoma bodies, which are deposited in nonviable tissue. Chronic thyroiditis may also present dystrophic calcifications. Thus, a normal thyroid parenchyma with microcalcifications should encourage the radiologist to perform a fine-needle aspiration biopsy (FNAB). Recent studies suggest that lobectomy is a viable option and should be pursued in the setting of localized PTC (<2 cm). A lobectomy should not be performed in patients with diffuse microcalcifications since it would result in an unfavorable outcome. Conclusions: Diffuse microcalcifications should immediately make the radiologist suspect diffuse PTC as a first diagnostic option.

Effect of AMPK pathway on apoptosis of human thyroid papillary cancer B-CPAP cells under low glucose and hypoxia conditions through CPT1c regulated by PPARα / 中国肿瘤生物治疗杂志

@#[Abstract] Objective: To investigate the mechanisms of carnitine palmitoyltransferase 1c (CPT1c) expression to affect the proliferation and apoptosis of human thyroid papillary cancer B-CPAP cells through the AMP-dependent/activated protein kinase (AMPK) pathway in the low glucose and hypoxic conditions. Methods: Firstly,humanthyroidpapillarycarcinomaB-CPAP cells were cultured under normal condition or low glucose and hypoxic condition respectively, followed with the treatment of AMPK inhibitor compound C. Western blotting was used to detect the expressions of AMPK, p-AMPK, peroxisome proliferator-activated receptor α (PPARα) and CPT1c; the proliferation and apoptosis were detected by CCK-8 and Flow cytometry, respectively. Then PPARα-siRNA was synthesized and transfected into B-CPAP cells to knock down PPARα, and then the cells were cultured under normal or low glucose and hypoxic condition respectively.Above indicators were also detected to verify the regulation of PPARα on CPT1c. Finally, the human luciferase reporter plasmid containing CPT1c gene promoter was constructed, and the effect of PPARα on the activity of CPT1c promoter luciferase activity was observed by immunofluorescence. Results: The expressions ofAMPK, p-AMPK, PPARα and CPT1c were significantly increased in B-CPAP cells under low glucose and hypoxia condition (P<0.05 or P<0.01), while cell proliferation and apoptosis rate did not change significantly (P>0.05). After the treatment of AMPK inhibitor compound C, the expressions of p-AMPK, PPARα and CPT1c in low glucose and hypoxia group were significantly decreased (P<0.05 or P<0.01), the inhibitory rate on cell proliferation and apoptosis rate were significantly increased (P<0.05). However, the change range was smaller than that in the normal culture + compound C group (P<0.05).After PPARα knockdown, the expressions ofAMPK, p-AMPK, PPARα and CPT1c in cancer cells cultured under normal conditions were significantly decreased (P<0.05 or P<0.01), and the inhibitory rate on cell proliferation and apoptosis rate were significantly increased (P<0.05). While under low glucose and hypoxia condition, the expression of CPT1c in cells after transfection was significantly decreased (P<0.05), and the inhibition rate on cell proliferation and the apoptosis rate were significantly increased (P<0.05); However, the change range was still lower than that of normal condition group after transfection (P<0.05).After PPARα overexpression, the ratio of fluorescence in the empty vector group was not significantly different from that of the blank group (P>0.05), and the ratio of fluorescence was significantly increased in PPARα over-expression group (P<0.05). Conclusions: AMPK can increase the expression of PPARα to promote the expression of CPT1c in thyroid cancer B-CPAP cells under low glucose and hypoxia conditions, thereby inhibiting cell apoptosis and maintaining cell proliferation ability.

A Case of Tracheal Defect Reconstruction Using Anterolateral Thigh Free Flap in Patients with Papillary Thyroid Carcinoma Invading Tracheal Cartilage / 대한이비인후과학회지

When a well-differentiated thyroid carcinoma invades the adjacent organ, the treatment of choice is en bloc surgical resection. After tracheal resection, the tracheal defect can be repaired in various ways. Depending on the invasion depth of the tumor or the defect circumference of the trachea, primary closure, reconstruction of surrounding muscles, or end-to-end anastomosis can be used. A 70-year-old man was diagnosed with papillary thyroid cancer with tracheal invasion. The patient was treated by total thyroidectomy with tracheal window resection of the invading trachea. The defect was reconstructed with an anterolateral thigh free flap. At 12 months after surgery, the patient leads a social life without any discomfort and has an acceptable voice. This case is reported along with associated techniques and reviews of related articles.

A study on inorganic elements in psammomas from ovarian & thyroid cancer.

Background & objectives: Concentric lamellar calcifications known as psammoma bodies (PB) are found in benign and malignant tumours. Whether or not the inorganic element concentrations in psammomas are similar to serous adenocarcinoma of the ovary and thyroid papillary cancer tissues has not yet been ascertained. We undertook this retrospective study to establish if there is any difference in the concentrations of inorganic ions found in psammomas in serous adenocarcinoma of the ovary, and those found in thyroid papillary cancer tissue. Methods: PB samples from patients with adenocarcinoma of the ovary (n = 10) and with thyroid papillary cancer (n = 10) were analyzed through inductively-coupled plasma spectroscopy (ICP). Results: There were no significant differences in the concentrations of inorganic elements in PB from thyroid papillary cancer than in those PB from ovarian cancer. Interpretation & conclusions: Differences in the concentrations of inorganic elements may be due to the variation in environmental pollution. Our study had limitation of small sample size. Our results suggest that some inorganic elements can participate in the origin of psammoma bodies.

A Case of Window Resection and Secondary Reconstruction of the Trachea Invaded by Papillary Thyroid Carcinoma / 대한이비인후과학회지

Generally, the treatment of well-differentiated thyroid cancer is not difficult, but it is so with invasive cancer which invades the airway such as the tracheal or cricoid cartilage. In case of circumferential invasion of the trachea, resection and end-to-end anastomosis is preferred. In the less-than-half involvement of the trachea, conservative management such as sternocleidomastoid periosteal flap, or fenestration and staged closure is feasible. But in more-than-half the involvement of the trachea, these managements are usually not preferred. Authors describe a case of tracheal fenestration and the closure of a tracheal defect, which are not usually found in such of cases. Some techniques and their advantages are presented with a review of related articles.

The Effect of Atorvastatin and Simvastatin on NIS Expression of the TPC-1 Cell under the Therapeutic Blood Concentrations

BACKGROUND: Although so many experimental trials have been done to improve the redifferentiation and responsiveness of radioiodide therapy, they have not yet yielded any satisfactory results. As statins inhibit both farnesylation and geranylgeranylation, they have been reported to have an antineoplastic and redifferentiation effect in experimental and clinical studies. In this study, we investigated the relationship between statins and the alteration of the NIS expression and, TPC-1 cell apotosis to evaluate the possibility of using statins as adjuvant therapeutic agents for papillary thyroid cancer. METHODS: We used the TPC-1 cell lines for our experiments. Cell viabilities were measured by CCK-8. The degrees of apoptosis and, the expressions of NIS mRNA and NIS protein were measured by flow cytometry, semi quantitative RT-PCR and Western blot assay. RESULTS: Increased levels of NIS mRNA and NIS protein were observed under therapeutic blood concentrations (concentrations of simvastatin: 20, 50, 80 nM, concentrations of atorvastatin: 50, 80,110 nM), but the dose-response relationship was only manifested within simvastatin. The TPC-1 cells showed a concentration dependent decrease of viability and an increase of apoptosis not under therapeutic blood concentrations, but under excessively high concentrations (after treatment with 10-50 microM of atorvastatin and with 1-10 microM of simvastatin). CONCLUSION: The results of this study show that effective therapeutic blood concentrations of simvastatin and atorvastatin can give a favorable effect on the NIS expression under effective therapeutic blood concentrations. Therefore, we demonstrated the possibility that simvastatin and atorvastatin might have an important role as adjuvant therapeutic agents to improve the responsiveness of radioiodide therapy for papillary thyroid cancer. Further studies are needed to clarify this issue.

A Case of Recurrent Posterior Scleritis With Hyperthyroidism in Both Eyes

PURPOSE: Posterior scleritis is known to be a rare disease. The authors of the present study herein report a case of posterior scleritis, which occurred in a patient's eye, accompanied by hyperthyroidism and recurring in the other eye one year later. CASE SUMMARY: A 39-year-old female patient visited the hospital for ocular pain in the left eye and a headache. The patient was diagnosed with posterior scleritis through fundus examination, ultrasonography, CT and MRI, and an effective outcome of treatment was obtained by oral administration of methylprednisolone. Four months after discharge, the patient received left subtotal thyroidectomy for thyroid papillary cancer. Seven months after surgery she visited again, due to ocular pain that started 1 week earlier in the left eye, as well as a headache, and was diagnosed with posterior scleritis upon fundus examination, ultrasonography and MRI. Methylprednisolone was administered orally and an effective treatment result was obtained. After discharge, the patient was followed up for 5 months and did not show any signs of recurrence. CONCLUSIONS: When a hyperthyroidism patient has ocular pain or a headache, the possibility of posterior scleritis accompaniment should be considered, as well as the possibility that posterior scleritis, which already occurred in one eye, may recur in the other eye.

A Case of Locally Invasive Thyroid Papillary Cancer Diagnosed by Esophagoscopy / 대한소화기내시경학회지

Papillary carcinoma is the most common malignant tumor of the thyroid gland, and it only infrequently invades the upper aerodigestive tract. When such invasion does occur, it is a source of significant morbidity as well as mortality. Although most thyroid tumors first clinically manifest as a neck mass, there have been few reports of patients whose initial compliant was a disturbance of the aerodigestive tract. The patient in our present study had no significant past medical history, and esophagoscopy and biopsy revealed papillary adenocarcinoma. We report here on a case of thyroid papillary carcinoma that was diagnosed by esophagoscopic biopsy.

Management of Thyroid Papillary Carcinoma Invading the Recurrent Laryngeal Nerve / 대한내분비외과학회지

PURPOSE: Invasion of the recurrent laryngeal nerve (RLN) by papillary carcinoma of the thyroid gland is rather infrequent. Tumor excision for this patients with invasion of the RLN has been categorized into two groups on the basis of completeness: (1) Resection of the RLN was required for complete excision, and (2) isolation of the RLN from thyroid cancer was mainly performed by sharp dissection to leave as little tumor as possible. Reconstruction of the nerve after complete tumor resection can be added as a supplementary procedure. This study was designed to analyze the clinical characteristics and surgical treatment of thyroid cancer invading the RLN. METHODS: At the Department of Endocrine Surgery of our hospital, 1,426 patients were diagnosed and operated on for papillary thyroid cancer during 36 months, from December 2004 to December 2006. Among them, 49 patients who revealed invasion of the recurrent laryngeal nerve were retrospectively evaluated for their age, gender, preoperative hoarseness and the operative method, change of their postoperative symptoms, radioiodine ablation, the laryngoscopic findings, recurrence and the prognosis. RESULTS: Of the 49 patients, 10 patients had preoperative hoarseness and 13 patients were treated by complete resection. We tried reconstruction of the recurrent laryngeal nerve with using the hypoglossi-recurrent nerve in one case, and with direct end-to-end anastomosis in two cases. The rest of the 36 patients were treated by shaving resection of thyroid and leaving the RLN intact. CONCLUSION: When a surgeon finds papillary carcinoma infiltrating a recurrent laryngeal nerve, regardless of the preoperative symptoms, preservation of the RLN and removal of as much tumor as possible will offer a good result.

Clinical Significances of the Unintentional Parathyroidectomy during Operation for Thyroid Carcinoma / 대한내분비외과학회지

PURPOSE: Many surgeons intend to preserve all of the parathyroids during a thyroid operation; however, they have had the unpleasant experience of achieving unintentional parathyroidectomy. We studied the risk factors for unin-tentional parathyroidectomy and whether these unintentional parathyroidectomies caused symptomatic hypocalcemia. METHODS: We conducted a retrospective review of the medical records and pathologic reports of 95 papillary carcinoma patients who underwent operations between January 1994 and December 2003. We statistically analyzed the correlation between unintentional parathyroidectomy and the risk factors such as tumor size, capsular invasion, including extra-thyroidal extension, and the operation method. RESULTS: Of the total 95 procedures, 14 (14.7%) produced patho-logy reports stating that incidental parathyroid tissue was identified within the thyroidectomy specimen. The majority of the 14 reported cases contained only a single focus of inci-dental parathyroid tissue; however, one of these thyroidectomy specimens contained two foci of parathyroid tissue. The factors such as tumor size, capsular invasion and extensive surgery were not correlated with the prevalence of unintentional parathyroidectomy. There was no association of unintentional parathyroidectomy with postoperative hypocalcemia (P=.449). CONCLUSION: Unintentional parathyroidectomy is not associated with symptomatic postoperative hypocalcemia. The factors such as tumor size, capsular invasion or extensive surgery are not risk factors for unintentional parathyroidectomy.

Direct Invasion of Thyroid Papillary Carcinoma to Esophagus Presenting as an Intraluminal Polypoid Mass Which Causes Hematemesis / 대한소화기내시경학회지

We report an unusual case of metastatic thyroid papillary carcinoma directly invades the esophagus presenting as an intraluminal polypoid mass which causes hematemesis. The patient had a past medical history of thyroid nodule. Physical examination was unremarkable except the palpable thyroid mass. Esophagoscopy and esophagography revealed an intraluminal polypoid mass to the left of the cervical esophagus. Chest computed tomography showed round, homogenous, well-enhancing mass and calcifying thyroid nodule is found in front of the mass. Thyroid lobectomy and partial esophageal resection was performed. Microscopic finding showed typical features of thyroid papillary carcinoma. Metastatic thyroid papillary carcinoma should be included in the differential diagnosis of an intraluminal polypoid esophageal mass, particularly if the patient has a known thyroid tumor.

Diffuse pulmonary nodular lesions persisting for 5 years / 결핵

Diffuse pulmonary nodular lesions have many causes. When they are caused by infection, the likely organisms are M. tuberculosis and various fungi. Silicosis, eosinophilic granuloma and pulmonary metastasis should be considered for differential diagnosis. Differential diagnosis needs detailed clinical history, physical examination and various laboratory tests. A case of persistent diffuse pulmonary nodular lesions which had persisted 5 years is reported. The patient was a 25 years old man with minimal pulmonary symptoms. Detailed past history and physical examination suggested thyroid tumor. Chest radiography showed numerous evenly sized well-defined nodules scattered in entire lung fields. Previous chest X-rays showed similar nodular lesions, which had lasted for 5 years. The number of nodules was slightly increased. Neck CT showed heterogenous mass in left lobe of thyroid gland and multiple lymphadenopathies along both internal jugular chains. Total thyroidectomy was performed. A case of lung metastasis which progressed slowly in papillary thyroid cancer is reported.

A Case of Thyroid Papillary Cancer Derived from Diffuse Goiter in a Patients with Acromegaly / 대한내분비학회지

Patients with acromegaly have a reduced life expectancy rnainly due to cardiovascular, respiratory or cerebrovascular diseas-. Malignancy also seems to occur with greater than the expected incidence. In particular, the published retrospective or prospective studies have suggested a strong association of colonic neoplasia with acromegaly. But, there were a few reports of thyroid cancer in acrornegaly. We report a case of thyroid papillary cancer derived from diffuse goiter in acromegaly, sugge- sting the possible carcinogenic role of growth hormone.