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Colorectal cancer is the third most common neoplasm and the second most lethal worldwide. The most common histological type is adenocarcinoma, characterized by its glandular pattern. Medullary colon carcinoma is a rare histological variant of colorectal cancer, characterized by a predominantly solid architecture, poorly di?erentiated or undifferentiated morphology, often associated with an anomalous immunophenotype and microsatellite instability. The present study reports a case in an academic service of general surgery of a 74-year-old patient who presented with a tumor of the ascending colon, histologically with an exuberant lymphocytic in?ltrate, suggestive of large cell lymphoma, but which was revealed by subsequent immunohistochemistry to be medullary carcinoma of the colon with microsatellite instability.
O câncer colorretal é a terceira neoplasia mais comum e a segunda mais letal no mundo. O adenocarcinoma é o tipo histológico mais comum, caracterizado pelo seu padrão glandular. O carcinoma medular do cólon é uma variante histológica rara do câncer colorretal, caracterizada por uma arquitetura predominantemente sólida, morfologia pouco diferenciada ou indiferenciada, frequentemente associada a um imunofenótipo anômalo e instabilidade de microssatélites. O presente estudo relata um caso em um serviço acadêmico de cirurgia geral de um paciente de 74 anos que apresentou tumor de cólon ascendente, histologicamente com infiltrado linfocitário exuberante, sugestivo de linfoma de grandes células, mas que foi revelado através de exame subsequente imunohistoquímico como carcinoma medular do cólon com instabilidade de microssatélites.
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Male , Aged , Carcinoma, Medullary , Colon, Ascending , Surgical Oncology , Colonic NeoplasmsABSTRACT
Objective To observe the influence of different acceleration factors(AF)on compressed sensing susceptibility weighted imaging(CS-SWI)for cerebral medullary veins of healthy people,and to screen the best AF.Methods Forty healthy volunteers were prospectively enrolled.Axial brain SWI images were obtained with CS technique under different AF(AF0,CS2,CS4,CS6,CS8 and CS10),and the phase value(PV)and standard deviation(SD)of bilateral septal vein(SV),internal cerebral vein(ICV),thalamus vein(TV),basal vein(BV)and dentate nucleus vein(DNV)were measured.Taken PV and SD of parietal white matter as controls,the signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of venous images were calculated.Then the original images were reconstructed with minimum intensity projection,and the subjective quality scoring of reconstructed images were performed using a 5-point scale.SNR,CNR,PV and quality score were compared among images under different AF,and the best AF,i.e.with the best performances for displaying and quantitatively analyzing cerebral medullary veins in healthy people was obtained.Results Compared with those acquired with AF0,SNR and CNR of all cerebral medullary veins acquired with CS6,CS8 and CS10 were significantly different(all adjusted P<0.05).Meanwhile,significant differences of PV in bilateral SV and right TV were found among CS6,CS8 and CS10,also in bilateral ICV,left TV and bilateral BV between CS8 and CS10(all adjusted P<0.05).Conclusion Excessive AF might decrease image quality of CS-SWI for cerebral medullary veins.CS4 was the best AF for displaying and quantitatively analyzing cerebral medullary veins in healthy people.
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Objective To assess the effect of ultrasonic thyroid artificial intelligence(AI)-assisted diagnostic system(AI-assisted diagnostic system)for diagnosing medullary thyroid carcinoma(MTC)compared with different physicians and taken papillary thyroid carcinoma(PTC)as the controls.Methods Totally 63 MTC,70 PTC and 62 benign thyroid nodules confirmed by pathology were enrolled.AI-assisted diagnostic system was utilized to analyze thyroid nodules and identify the likelihood of malignancy,and the probability value threshold was set at ≥0.40.All thyroid nodules were retrospectively reviewed and categorized by 3 physicians(1 senior physician,1 attending physician and 1 junior physician)according to Chinese thyroid imaging reporting and data system(C-TIRADS).The efficacy of AI-assisted diagnostic system and physicians for diagnosing MTC and PTC were evaluated.Results AI-assisted diagnostic system showed lower sensitivity,specificity,positive predictive value,negative predictive value,accuracy,and area under the curve(AUC)for diagnosing MTC and PTC compared with physicians.Significant differences of AUC were found between senior physician and AI-assisted diagnostic system,as well as between attending physician and AI-assisted diagnostic system for diagnosing MTC and PTC(all P<0.01),while no significant difference of AUC was between junior physicians and AI-assisted diagnostic system(both P>0.05).The sensitivity,specificity,positive predictive value,negative predictive value,accuracy and AUC for AI-assisted diagnostic system for diagnosing MTC were all lower than those for diagnosing PTC,but the AUC was not significantly different(P>0.05).Conclusion Ultrasonic thyroid AI-assisted diagnostic system had relatively high value for diagnosing MTC.
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OBJECTIVE To investigate the diagnostic efficacy of serum calcitonin(Ctn)in medullary thyroid cancer(MTC),the correlation between preoperative serum Ctn and clinicopathological features,and the risk factors affecting the progression of MTC disease during follow-up.METHODS The clinical data of 50 patients admitted to the Hospital of Integrated Traditional Chinese and Western Medicine of Nanjing University of Chinese Medicine from 2011 to 2022 were systematically reviewed,the ROC curve calculated the diagnostic efficacy of Ctn and CEA levels on MTC,and the risk factors for lymph node metastasis in the central region of MTC were analyzed in univariate and multivariate,and the survival curve without disease progression was drawn to predict risk factors.RESULTS The ROC curve yields the preoperative cut-off value of Ctn was 23.81 pg/ml and the cut-off value of CEA was 3.035 ng/ml for the diagnosis of MTC.The age of disease,tumor diameter,and preoperative serum Ctn and CEA levels in MTC patients were higher than those in non-MTC patients.Ctn≥289.62 pg/ml was an independent risk factor for central lymph node metastasis in MTC.The survival curve showed that invasion of the capsule,central region metastasis,and TNM stage above T2 were risk factors for predicting disease progression(P<0.05).Patients with MTC who have disease progression have higher preoperative Ctn.CONCLUSION Serum Ctn has important clinical value in the differential diagnosis,preoperative evaluation and postoperative follow-up of MTC.
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Objective:The activation of astrocytes is an important process in the formation of chronic pain.This study aims to observe the activation of A1 reactive astrocytes in the medullary dorsal horn in the rat model of trigeminal neuralgia,and to explore the mechanism of central sensitization caused by A1 reactive astrocyte. Methods:The adult male rats were randomly divided into a sham group and a chronic constriction injury of infraorbital nerve(ION-CCI)group.The facial mechanical pain threshold and thermal withdrawal latency were measured before the operation and on the 1st,3rd,7th,10th,and 14th day after the operation.After pain behavior observation,the expression of glial fibrillary acidic protein(GFAP)in the medullary dorsal horn was observed by immunohistochemistry and immunofluorescence colocalization of GFAP,complement 3(C3)/S100A10,and 4',6-diamidino-2-phenylindole(DAPI)was analyzed.Primary astrocytes were cultured and randomly divided into a naive group and a DHK group.The DHK group was treated with 1 mmol/L of astrocyte activation inhibitor dihydrokainic acid(DHK).Fura-2/AM was used to stain the astrocytes and the calcium wave of the 2 groups under the stimulation of high potassium was recorded and compared.The expression of C3 was detected by Western blotting. Results:The facial mechanical pain threshold and thermal withdrawal latency of the ION-CCI group were significantly lower than those of the sham group(both P<0.05).There were a large number of GFAP positive astrocytes in the medullary dorsal horn of the ION-CCI group.The fluorescence intensity of GFAP in the ION-CCI group was higher than that in the sham group(P<0.05).GFAP and C3/S100A10 were co-expressed in astrocytes.Compared with the sham group,the fluorescence intensity of C3 and the protein expression of C3 in the ION-CCI group were increased(both P<0.05).The expression of C3 in ION-CCI group was significantly increased(P<0.05).Compared with the naive group,the C3 protein expression was significantly decreased in the DHK group(P<0.05).The intensity of calcium fluorescence was increased after high potassium stimulation in both groups.Furthermore,the peak and increase amplitude of calcium fluorescence in the naive group were much higher than those in the DHK group(both P<0.05). Conclusion:A1 reactive astrocytes in the medullary dorsal horn of trigeminal neuralgia model rats are increased significantly,which may participate in central sensitization of trigeminal neuralgia by impacting astrocyte calcium wave.
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Objective:To investigate the efficacy and prognosis of different surgical approaches in sporadic medullary thyroid carcinoma.Methods:A retrospective analysis was conducted on 101 patients with sporadic medullary thyroid carcinoma (MTC) who underwent surgical treatment at the Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University, from Feb. 2009 to Nov. 2023. The patients included 36 males and 75 females, with a male-to-female ratio of 1:2.1. The median age of the patients was 47 years old, with an age range of 21 to 72 years old. The study divided participants into two groups based on their surgical methods: an observation group (78 cases) and a control group (23 cases). The observation group received surgical methods in accordance with expert consensus, while the control group did not. The study compared the efficacy and prognosis of the two groups.Results:Statistical differences were found between the two groups in terms of stage II and III in TNM staging, intraoperative frozen pathological findings, number of lymph node resections in the central group, number of lymph node metastases in the central group, number of lymph node resections in the lateral cervical region, postoperative follow-up time, and five-year postoperative serum procalcitonin (Ctn) levels ( P<0.05) .Both groups of patients obtained a significant decrease in Ctn after surgical treatment. In the observation group, Ctn was at the remission level in 57 cases (73.1%), at the stable level in 13 cases (16.7%), and at the progression level in 8 cases (10.2%), while in the control group, Ctn was at the remission level in 20 cases (86.9%), at the progression level in 3 cases (13.1%), and there were no patients at the stable level after the operation.One patient (1.3 per cent) in the observation group had a recurrence after surgery; Two patients (8.7 per cent) in the control group had a recurrence. Conclusions:Standardised and thorough surgery can maximise the clearance of metastatic lymph nodes, effectively reduce the recurrence rate, achieve better efficacy, and improve the long-term prognosis of patients without increasing the risk of surgery and postoperative complications.
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ABSTRACT Objective: Although 18F-sodium fluoride (18F-NaF) uptake is frequently observed in extraosseous metastases of medullary thyroid carcinoma (MTC) with calcification, it can also occur in metastatic sites without visible calcium deposition, leading to the hypothesis that visually undetectable calcium accumulation may be responsible for this uptake. The aim of this study was to indirectly support this hypothesis by analyzing the correlation between the degree of 18F-NaF uptake and radiodensity in extraosseous MTC metastases, since calcium deposition can increase attenuation even when not visually detectable. Subjects and methods: Extraosseous metastatic lesions of 15 patients with MTC were evaluated using 18F-NaF positron-emission tomography (PET)/computed tomography (CT) and segmented by levels of standardized uptake value (SUV). The correlation between mean SUV and mean Hounsfield unit (HU) values was assessed for the entire group of segments and for two subgroups with different mean HU values. Results: Very high correlations were observed between mean SUV and mean HU values for both the entire group of segments and the subgroup with a mean HU value greater than 130 (p = 0.92 and p = 0.95, respectively; p < 0.01). High correlation (p = 0.71) was also observed in the subgroup with mean HU values ranging from 20 to 130 (p < 0.01). Conclusion: The findings of the present study suggest that there is an association between 18F-NaF uptake and calcium deposition in extraosseous metastases of MTC, supporting the hypothesis that visually undetectable calcium accumulation may be responsible for 18F-NaF uptake in regions without visible calcium deposition.
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Abstract Postoperative anemia is a complex clinical issue that requires attention due to its ramifications on the patient's recovery and prognosis. Originating from multiple determinants, such as intraoperative blood loss, hemolysis, nutritional deficiencies, systemic inflammation and impact on the bone marrow, postoperative anemia has varied and often challenging presentations. Patients undergoing major surgical procedures, in particular, are susceptible to developing anemia due to the considerable associated blood loss. Accurate diagnosis plays a crucial role in the approach, requiring meticulous hematological analysis, including hemoglobin, hematocrit and reticulocyte count, as well as an in-depth investigation of the underlying causes. An additional challenge arises in the form of the excessive practice of phlebotomy during hospitalization for clinical monitoring. Although it is essential to assess the progression of anemia, frequent removal of blood may contribute to iatrogenic anemia, further delaying recovery and possibly increasing susceptibility to infection.
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Anemia , Blood Transfusion , ErythropoietinABSTRACT
Purpose To explore the value of insulinoma associated protein 1(INSM1)in the pathological diagnosis and differential diagnosis of medullary thyroid carcinoma(MTC).Methods Twenty-eight cases of MTC were collected as the ex-perimental group and 25 cases of thyroid tumors(6 cases of transparent trabecular tumors,16 cases of poorly differentiated cancer,2 cases of spindle cell papillary carcinoma,and 1 case of thyroid paraganglioma)that needed to be differentiated from MTC in the same period were collected as the control group.The expression of INSM1 was detected using immunohistochemical EnVision method,and the sensitivity and specificity of INSM1 in MTC were analyzed,and compared with traditional MTC markers(Syn,CgA,CT,and CEA).Results The positive rate of IN-SM1 in the MTC group was96.4%(27/28),significantly high-er than the control group of 4.0%(1/25)(P<0.05).INSM1 had a sensitivity of 96.4%in MTC,significantly higher than CgA(71.4%)(P<0.05),and was positively expressed in CT negative MTC cases.The specificity of INSM1 in MTC was 96.0%,significantly higher than that of CEA(72.0%)(P<0.05).Conclusion INSM1 has high sensitivity and specificity in MTC,with a nuclear positive staining pattern,clear back-ground,and easy identification.It is superior to the traditional biomarkers and has high diagnostic value in MTC.
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Objective:To investigate the correlation of preoperative platelet distribution width (PDW) with clinical features and prognosis of patients with medullary thyroid carcinoma (MTC) .Methods:The clinical data of 160 MTC patients admitted to Zhejiang Cancer Hospital in Department of Head and Neck Surgery from Jun. 2007 to Sep. 2021 were retrospectively collected. There were 74 males and 86 females, aging 8-77 years (mean 48.73±13.76). The median was used to determine the cut-off value of PDW and divided into low PDW group and high PDW group. The correlation between preoperative PDW and clinicopathological features of MTC patients was analyzed by Chi-square test and Spearman correlation test. The relationship of preoperative PDW with overall survival (OS) and disease free survival (DFS) of patients were analyzed by Kaplan-meier and Log-rank test. Univariate and multivariate Cox regression analyses were used to analyze the risk factors for DFS in MTC patients.Results:The preoperative PDW level was closely correlated with the tumor size ( χ2=4.46, P=0.035), TNM stage ( χ2=5.02, P=0.025), bilateral lesions ( χ2=4.94, P=0.026) ,multiple lesions ( χ2=5.19, P=0.023), capsular invasion ( χ2=5.75, P=0.017), extrandular invasion ( χ2=4.27, P=0.039), and vascular tumor thrombus ( χ2=4.48, P=0.034) in MTC patients ( P<0.05). Spearman correlation test showed that preoperative PDW level was negatively correlated with clinical stage ( r=-0.166, P=0.036), lymph node metastasis ( r=-0.187, P=0.018), multiple lesions ( r=-0.176, P=0.026) and vascular tumor thrombus ( r=-0.220, P=0.005) in MTC patients ( P<0.05). Survival analysis showed that reduced PDW predicted worse DFS for MTC ( χ2=9.989, P=0.002). Multivariate Cox regression analysis showed that low PDW ( OR=0.847, 95% CI:0.724-0.992, P=0.040) and lymph node metastasis ( OR=4.913, 95% CI:2.415-9.995, P<0.001) were independent risk factors for DFS in MTC patients. Conclusion:Preoperative decreased PDW is a high risk factor for poor prognosis of MTC and can be used as an indicator to predict recurrence in MTC patients.
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Objective:To investigate the clinical, imaging, etiological and prognostic features of patients with infarctions in different locations of the medulla oblongata.Methods:Patients with acute medullary infarction hospitalized at Tianjin Huanhu Hospital from July 2017 to July 2022 were included. The risk factors, clinical manifestation, stroke mechanism and 90-day prognosis of these patients were analyzed retrospectively.Results:Among the 256 patients enrolled, 150 (58.6%) had lateral medullary infarction (LMI), 106 (41.4%) had medial medullary infarction (MMI). The most frequent clinical manifestation of patients with LMI was dizziness (84.7%,127/150). And motor disorders (83.0%,88/106) was the most frequent clinical manifestation of patients with MMI. LMI lesions were mostly located in the middle (42.7%,64/150) and MMI lesions were mostly located in the upper (60.4%,64/106) medulla oblongata, with statistically significant difference (χ 2=47.53, P<0.001). Large artery atherosclerosis (LAA) was the main stroke mechanism in LMI and MMI [57.3%(86/150) vs 56.6%(60/106)]. Early neurological deterioration was more common in MMI (25.5%,27/106) and less common in LMI (7.3%,11/150), with statistically significant difference (χ 2=16.17, P<0.001). At discharge, more patients with MMI showed poor prognosis in short term [45.3% (48/106) vs 24.0% (36/150), with statistically significant difference (χ 2=12.76, P<0.001)] and even long term at 90-day follow-up [33.0% (35/106) vs 12.7% (19/150), also with statistically significant difference (χ 2=15.48, P<0.001)] than those with LMI. A total of 10 patients (4.0%, 10/256) developed respiratory failure during hospitalization, including 7 patients with LMI (4.7%, 7/150) and 3 patients with bilateral MMI (2.8%,3/106). Early neurological deterioration ( OR=3.38, 95% CI 1.25-9.10, P=0.016) and LAA (compared with small artery occlusion) ( OR=3.08, 95% CI 1.13-8.37, P=0.028) were independent risk factors for poor prognosis in MMI. Age ( OR=1.01, 95% CI 1.01-1.17, P=0.026) and early neurological deterioration ( OR=20.19, 95% CI=2.63-155.06, P=0.004) were independently correlated with poor outcome in LMI. Conclusions:LMI and MMI had similar etiology and significant differences in clinical manifestations, early neurological deterioration and prognosis. Further classification of medullary infarction was of great significance for diagnosis, treatment and prognosis evaluation.
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In patients with medullary thyroid carcinoma (MTC), calcitonin (Ctn) and carcinoembryonic antigen (CEA) were the most important serum biomarkers for diagnosis, evaluation and follow-up. Approximately 0.3% to 5.9% of the thyroid nodule population could present with elevated Ctn on screening, and a diagnosis of MTC can be basically confirmed when serum Ctn > 100 pg/ml.. Ctn and CEA levels could reflect tumor burden and help determine the extent and timing of surgery. When preoperative serum Ctn >200 pg/mL or CEA >30 ng/mL, nearly more than one-third of patients had lateral neck lymph node metastasis. Few patients developed distant metastasis when Ctn<500 pg/mL, however the proportion of distant metastasis could reach 75% when CEA>100 ng/mL. In inherited MTC patients, tumors with Ctn<30 pg/mL were usually localized in the gland without metastasis. The time to normalization of serum Ctn and CEA postoperatively was one month in most patients. According to the response to initial therapy, patients with undetectable Ctn and normal CEA had a low risk of relapse and death in the follow-up period. The risk of local recurrence, LNM and distant metastasis increased as Ctn levels rose. The Ctn/CEA doubling time could predict the disease prognosis, and when it was less than 0.5 years, most patients would die.
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Thyroid cancer is the most common malignant tumor of the endocrine system, and its incidence is increasing year by year showing younger trend. The pathological types of thyroid cancer are papillary carcinoma, follicular carcinoma, medullary carcinoma and undifferentiated carcinoma. Medullary thyroid carcinoma (MTC) and papillary thyroid carcinoma (PTC) are the two common types of thyroid cancer. Since MTC and PTC have different biological origins, invasiveness and prognosis. Therefore, the occurrence of both medullary carcinoma and papillary carcinoma is very rare and rarely reported in China and abroad and the treatment is challenging. In this paper, we review the pathogenesis, ancillary tests, diagnosis and treatment of this disease, with the aim of providing reference for clinical treatment of patients with medullary thyroid carcinoma complicated by papillary carcinoma.
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Objective: To investigate the clinicopathological characteristics of superior mediastinal lymph node metastases (sMLNM) in medullary thyroid carcinoma (MTC). Methods: This retrospective analysis enrolled the patients who were treated for sMLNM of MTC in our hospital from May 2012 to January 2021. All patients were suspected of sMLNM due to preoperative imaging. According to the pathological results, the patients were divided into two groups named sMLNM group and the negative superior-mediastinal-lymph-node group. We collected and analyzed the clinical features, pathological features, pre- and post-operative calcitonin (Ctn), and carcinoembryonic antigen (CEA) levels of the two groups. Logistic regression analysis was used to analyze risk factors, and receiver operation characteristic (ROC) curves were drawn to determine the optimal cut-off values of preoperative Ctn and preoperative CEA for predicting sMLNM. Results: Among the 94 patients, 69 cases were in the sMLNM group and 25 cases were in the non-SMLNM group. Preoperative Ctn level (P=0.003), preoperative CEA level (P=0.010), distant metastasis (P=0.022), extracapsular lymph node invasion (P=0.013), the number of central lymph node metastases (P=0.002) were related to sMLNM, but the multivariate analysis did not find any independent risk factors. The optimal threshold for predicting sMLNM by pre-operative Ctn is 1500 pg/ml and AUC is 0.759 (95% CI: 0.646, 0.872). The sensitivity, specificity, positive predictive value, and negative predictive value of diagnosis are 61.2%, 77.3%, 89.1%, 39.5%, respectively. In patients who underwent mediastinal lymph node dissection through transsternal approach, the metastatic possibility of different levels from high to low were level 2R (82.3%, 28/34), level 2L (58.8%, 20/34), level 4R (58.8%, 20/34), level 3 (23.5%, 8/34), level 4L (11.8%, 4/34). Postoperative complications occurred in 41 cases (43.6%), and there was no perioperative death in all cases. 14.8% (12/81) of the patients achieved biochemical complete response (Ctn≤12 pg/ml) one month after surgery, 5 of these patients were in sMLNM group. Conclusions: For patients who have highly suspicious sMLNM through imaging, combining with preoperative Ctn diagnosis can improve the accuracy of diagnosis, especially for patients with preoperative Ctn over 1 500 pg/ml. The superior mediastinal lymph node dissection for the primary sternotomy should include at least the superior mediastinal levels 2-4 to avoid residual lesions. The strategy of surgery needs to be cautiously performed. Although the probability of biochemical cure in sMLNM cases is low, nearly 40% of patients can still benefit from the operation at the biochemical level.
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Humans , Carcinoembryonic Antigen , Lymphatic Metastasis/pathology , Retrospective Studies , Lymph Nodes/pathology , Thyroid Neoplasms/pathology , Carcinoma, Neuroendocrine/pathology , Lymph Node Excision/methodsABSTRACT
Objective: To investigate the feasibility and value of histogram analysis based on two-dimensional gray-scale ultrasonography in the differential diagnosis of medullary thyroid carcinoma (MTC) and thyroid adenoma (TA). Methods: The preoperative ultrasound images of 86 newly diagnosed MTC patients and 100 TA patients treated in the Cancer Hospital of Chinese Academy of Medical Sciences from January 2015 to October 2021 were collected. Histograms were performed based on the regions of interest (ROIs) delineated manually by two radiologists, thereafter, mean, variance, skewness, kurtosis, percentiles (1st, 10th, 50th, 90th, 99th) were generated. The histogram parameters between the MTC group and the TA group were compared, and the independent predictors were screened by multivariate logistic regression analysis. Receiver operating characteristic (ROC) analysis was used to compare the individual diagnostic efficacy and joint diagnostic efficacy of independent predictors. Results: Multivariate regression analysis showed that mean, skewness, kurtosis and 50th percentile were independent factors. The skewness and kurtosis in the MTC group were significantly higher than those in the TA group, and the mean and 50th percentile were significantly lower than those in the TA group. The area under the individual ROC curve of mean, skewness, kurtosis and 50th percentile is 0.654-0.778. The area under the combined ROC curve is 0.826. Conclusion: Histogram analysis based on two-dimensional gray-scale ultrasonography is a promising tool to distinguish MTC from TA, in which the joint diagnosis value of mean, skewness, kurtosis and 50th percentile is the highest.
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Humans , ROC Curve , Diagnosis, Differential , Retrospective Studies , Thyroid Neoplasms/diagnostic imaging , Ultrasonography , Diffusion Magnetic Resonance Imaging/methodsABSTRACT
Resumen ANTECEDENTES: El carcinoma medular de tiroides es un tumor maligno poco frecuente que se origina en las células parafoliculares tiroideas productoras de calcitonina. Si bien puede aparecer espontáneamente, la asociación familiar pocas veces es excepcional. Aunque la supervivencia en estadios iniciales es considerable, es frecuente la posibilidad de metástasis al momento del diagnóstico. CASO CLÍNICO: Paciente de 72 años, con un abultamiento en la región anterior del cuello y una adenopatía cervical izquierda de 15 días de evolución. La TAC, la ecografía y la biopsia reportaron: carcinoma bilateral de ovario poco diferenciado. Se procedió a la cirugía radical (histerectomía, doble anexectomía, linfadenectomía pélvica y para aórtica, omentectomía y apendicectomía) con la que se consiguió una citorreducción completa. En el estudio definitivo se encontraron metástasis de carcinoma medular de tiroides en ambos ovarios, miometrio y peritoneo. Enseguida se inició la quimioterapia con vandetanib. Después de 25 ciclos de tratamiento, la paciente continuó con el ácido zoledrónico y asintomática. Un mes después de finalizarlo comenzó con crisis comiciales que se trataron con quetiapina, con respuesta satisfactoria. Posteriormente, la paciente tuvo una celulitis facial que se trató con antibiótico y corticosteroide; tres semanas después falleció debido a insuficiencia multiorgánica. CONCLUSIONES: El carcinoma medular de tiroides es una rara localización de metástasis que aún requiere investigación que permita establecer protocolos de diagnóstico, tratamiento y estimación de la supervivencia.
Abstract BACKGROUND: Medullary thyroid carcinoma is a rare malignant tumor originating in the calcitonin-producing parafollicular thyroid cells. Although it can occur spontaneously, familial association is rarely exceptional. Although survival in early stages is considerable, the possibility of metastasis at the time of diagnosis is frequent. CLINICAL CASE: 72-year-old patient with a lump in the anterior neck region and left cervical adenopathy of 15 days of evolution. CT, ultrasound, and biopsy reported: bilateral poorly differentiated ovarian carcinoma. Radical surgery (hysterectomy, double adnexectomy, pelvic and para-aortic lymphadenectomy, omentectomy and appendectomy) was performed and complete cytoreduction was achieved. In the definitive study, metastases of medullary thyroid carcinoma were found in both ovaries, myometrium and peritoneum. Chemotherapy with vandetanib was then started. After 25 cycles of treatment, the patient continued with zoledronic acid and was asymptomatic. One month after the end of the treatment, she began to have comic crises that were treated with quetiapine, with satisfactory response. Subsequently, the patient had a facial cellulitis that was treated with antibiotics and corticosteroids; three weeks later she died due to multiorgan failure. CONCLUSIONS: Medullary thyroid carcinoma is a rare site of metastasis that still requires research to establish diagnostic and treatment protocols and to estimate survival.
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ABSTRACT Objective: The purpose of these guidelines is to provide specific recommendations for the surgical treatment of neck metastases in patients with papillary, follicular, and medullary thyroid carcinomas. Materials and methods: Recommendations were developed based on research of scientific articles (preferentially meta-analyses) and guidelines issued by international medical specialty societies. The American College of Physicians' Guideline Grading System was used to determine the levels of evidence and grades of recommendations. The following questions were answered: A) Is elective neck dissection indicated in the treatment of papillary, follicular, and medullary thyroid carcinoma? B) When should central, lateral, and modified radical neck dissection be performed? C) Could molecular tests guide the extent of the neck dissection? Results/conclusion: Recommendation 1: Elective central neck dissection is not indicated in patients with cN0 well-differentiated thyroid carcinoma or in those with noninvasive T1 and T2 tumors but may be considered in T3-T4 tumors or in the presence of metastases in the lateral neck compartments. Recommendation 2: Elective central neck dissection is recommended in medullary thyroid carcinoma. Recommendation 3: Selective neck dissection of levels II-V should be indicated to treat neck metastases in papillary thyroid cancer, an approach that decreases the risk of recurrence and mortality. Recommendation 4: Compartmental neck dissection is indicated in the treatment of lymph node recurrence after elective or therapeutic neck dissection; "berry node picking" is not recommended. Recommendation 5: There are currently no recommendations regarding the use of molecular tests in guiding the extent of neck dissection in thyroid cancer.
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Small intestinal medullary carcinoma (MC) is a newly recognized subclass of small intestinal carcinomas and is an exceptional entity for this site. A search of the literature for similar cases arising in the small intestine revealed only six previously reported cases. Here we present a case of MC arising in the jejunum of a 65-year-old male. The patient presented to the emergency with features of perforation peritonitis with liver metastasis and no known predisposing factors like inflammatory bowel disease and celiac disease. Studies conducted on this tumor's colonic counterpart have shown microsatellite instability (MSI) and B-type Raf kinase (BRAF) mutations; however, few exceptions are known. Also, this subtype of carcinoma is known to have a better prognosis than its other histological subtypes.
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O Tronco encefálico (TE) é uma estrutura singular do sistema nervoso central, pois nele passam tratos sensoriais ascendentes da medula espinal, tratos sensoriais da cabeça e do pescoço, os tratos descendentes motores originados no prosencéfalo (divisão mais rostral do encéfalo), e as vias ligadas aos centros de movimento dos olhos. Contém ainda os núcleos dos nervos cranianos e está envolvido na regulação do nível de consciência através de projeções ao prosencéfalo oriundas da formação reticular. Todas essas estruturas coexistem em um espaço muito exíguo, o que faz com que o TE seja um local muito sensível às alterações patológicas, sendo que os pacientes apresentam muitos sinais neurológicos mesmo com lesões muito pequenas nesse local. Compreender a anatomia interna do TE é essencial para o diagnóstico neurológico e a prática da medicina clínica. Outros profissionais da saúde também se beneficiam desse conhecimento para melhor manejo dos seus pacientes neurológicos. Essa revisão apresenta detalhes da anatomia macroscópica e microscópica do bulbo, bem como seus correlatos clínicos frente às lesões mais comuns dessa divisão particular do TE, conhecidas como síndromes bulbares.
The brainstem is a unique structure in the central nervous system, since it gives way to ascending sensory tracts from the spinal cord, sensory tracts from the head and neck, motor descending tracts originating from the forebrain, and the pathways connected to the eye movement centers. It also contains the cranial nerve nuclei and is involved in the regulation of consciousness levels through projections to the forebrain originating in the reticular formation. All these structures coexist in a very small space, which makes the brainstem very sensitive to pathological changes, with patients presenting several neurological symptoms even with very small brainstem lesions. Understanding the internal anatomy of the brainstem is essential for neurological diagnosis and the practice of clinical medicine. Other health professionals also benefit from this knowledge to better manage their neurological patients. This review presents detailed information on the macroscopic and microscopic anatomy of the medulla, as well as its clinical correlates in the face of the most common lesions of this particular division of the brainstem, known as medullary syndromes.
Subject(s)
Humans , Lateral Medullary Syndrome/diagnosis , Medulla Oblongata/anatomy & histology , Pyramidal Tracts/anatomy & histology , Reticular Formation/anatomy & histology , Trigeminal Nucleus, Spinal/anatomy & histology , Area Postrema/anatomy & histology , Cerebral Peduncle/anatomy & histologyABSTRACT
Medullary thyroid carcinoma is a rare malignancy. We report a case of Medullary thyroid carcinoma in a 56-year-old male patient. Patient presented with lower limb paresis and severe hypokalemia. Cushing’s syndrome is a rare complication of Medullary thyroid carcinoma [MTC] and is due to ectopic Adrenocorticotropic [ACTH] secretion by tumor cells. Cushing’s syndrome presents a challenging diagnostic and management issue in patients with MTC. Entire clinical history, laboratory investigations, microscopic pictures are discussed in detail.