Distribución mutación BRAFsegún carac-terísticas epidemiológicas e histopatológicas en cáncer papilar de tiroides. Un estudio observacional de centro único / BRAFmutation distribution according to epidemiological and histopathological characteristics in papillary thyroid cancer patients. A single-center observational study

Introducción: El cáncer de tiroides se posiciona como una de las neoplasias más prevalentes en Ecuador, manifestándose típicamente en la cuarta década de vida, con una mayor inciden-cia en mujeres. El subtipo histológico predominante es el papilar (CPT), y diversos estudios han evidenciado que hasta un 80% de los casos de CPT presentan la mutación BRAF. Esta mutación se ha asociado con factores de pronóstico desfavorable, como la presencia de me-tástasis ganglionares, estadíos tumorales avanzados, extensión extratiroidea y característi-cas histológicas agresivas. Además, se ha observado una relación con una mayor tasa de recurrencia y una respuesta reducida al tratamiento con yodo. Ante este contexto, esta inves-tigación se propone analizar la distribución de la mutación BRAF según características epide-miológicas e histopatológicas en pacientes con diagnóstico de cáncer papilar de tiroides en Ecuador. Materiales y métodos: Este estudio se llevó a cabo de manera descriptiva y retrospectiva, abarcando a pacientes con diagnóstico de cáncer papilar de tiroides a quienes se les practicó el análisis genético para la detección de la mutación BRAF. La muestra incluyó 106 historias clínicas que cumplían con los criterios de selección establecidos Resultados: La evaluación de las historias clínicas reveló la presencia de la mutación BRAF en el 75% de los casos. Este porcentaje fue más elevado en mujeres, individuos mayores de 45 años y residentes en áreas urbanas. Respecto a la ocupación, la mayoría de los pacientes se dedicaba a labores de limpieza y no presentaban antecedentes personales de exposición a radiación ionizante ni antecedentes oncológicos familiares. El 84% se encontraba en la etapa clínica I, y en su mayoría, la neoplasia estaba localizada en el lóbulo tiroideo derecho.Conclusión:Este análisis subraya la imperiosa necesidad de identificar los factores de riesgo vinculados con la aparición del carcinoma papilar de tiroides en la población ecuatoriana. Los resultados indican una prevalencia significativa de la mutación BRAF, lo que subraya su rele-vancia comomarcador pronóstico en esta enfermedad. Estos hallazgos pueden contribuir a una mejor comprensión de la epidemiología y la patogenia del cáncer de tiroides, así como a la mejora de las estrategias de prevención y tratamiento en el ámbito local.

Introduction: Thyroid cancer is positioned as one of the most prevalent neoplasms in Ecuador, typically manifesting in the fourth decade of life, with a higher incidence in women. The pre-dominant histological subtype is papillary carcinoma (PTC), and various studies presentshown that up to 80% of PTC cases present the BRAF mutation. This mutation has been as-sociated with unfavorable prognostic factors, such as the presence of lymph node metasta-ses, advanced tumor stages, extrathyroidal extension, and aggressive histologicalfeatures. Additionally, a correlationhas been observed with a higher recurrence rate and a reduced re-sponse toiodine treatment. Given this context, this research aims to analyze the distribution of the BRAF mutation according to epidemiological and histopathological characteristics in patients diagnosed with papillary thyroid cancer in Ecuador. Materials and methods: This retrospective descriptive study involved the analysis of genetic data from 106 medical records of patients diagnosed with papillary thyroid cancer who under-went BRAF mutation detection. The sample was selected based on established criteria. Results: Evaluation of medical records revealed the presence of the BRAF mutation in 75% of cases. This percentage was higher in women, individuals over 45 years of age, and residents in urban areas. Regarding occupation, most patients were dedicated to cleaning work and had no personal history of exposure to ionizing radiation orafamily history of cancer.Additionally, 84% of the patients were in clinical stage I and the neoplasmswerelocated in the right thyroid lobe.Conclusion: This analysis highlights the urgent need to identify risk factors linked to the ap-pearance of papillary thyroid carcinoma in the Ecuadorian population. The results indicate a significant prevalence of the BRAF mutation, underlining its relevance as a prognostic marker in this disease. These findings may contribute to a better understanding of the epidemiology and pathogenesis of thyroid cancerleadingtoimprovementsinprevention and treatment strategies at the local level.

Prognostic Value of Extranodal Extension in Thyroid Cancer: A Meta-Analysis

PURPOSE: Thyroid cancer is the most common endocrine cancer and its incidence has continuously increased in the last three decades all over the world. We aimed to evaluate the prognostic value of extranodal extension (ENE) of thyroid cancer. MATERIALS AND METHODS: We performed a systematic search of MEDLINE (from inception to June 2014) and EMBASE (from inception to June 2014) for English-language publication. The inclusion criteria were studies of thyroid cancer that reported the prognostic value of ENE in thyroid cancer. Reviews, abstracts, and editorial materials were excluded, and duplicate data were removed. Two authors performed the data extraction independently. RESULTS: 6 studies including 1830 patients were eligible for inclusion in the study. All patients included in the meta-analysis had papillary thyroid cancer (PTC). Recurrence-free survival was analyzed based on 3 studies. The pooled hazard ratio for recurrence was 2.01 [95% confidence interval (CI) 1.19–3.40, p=0.009]. Disease-specific survival was analyzed based on 3 studies with 973 patients. Patients of PTC with ENE showed 3.37-fold higher risk of death from the disease (95% CI 1.55–7.32, p=0.002). CONCLUSION: ENE should be considered to be a poor prognostic marker in thyroid cancer; such knowledge might improve the management of individual patients. This might facilitate the planning of appropriate ablation therapy and tailored patient follow-up from the beginning of treatment.

Actualización del manejo diagnóstico y terapéutico del paraganglioma / Update on diagnostic and therapeutic management of paraganglioma

El paraganglioma es un tumor neuroendocrino poco frecuente que puede desarrollarse en diversos sitios del organismo. Alrededor del 97 por ciento son benignos y se curan mediante la extirpación quirúrgica, y el restante 3 por ciento son malignos, y provocar metástasis a distancia. Alrededor del 75 por ciento son esporádicos y el restante 25 por ciento son hereditarios (y tienen una mayor probabilidad de ser múltiples y de desarrollo a una edad temprana). Pueden tener predisposición genética asociada a síndromes tumorales familiares, como la neoplasia endocrina múltiple tipo 2, el síndrome de Von Hippel-Lindau y la neurofibromatosis tipo 1, o mutaciones específicas relacionadas solamente con el desarrollo de paragangliomas. Comparado con la forma de aparición esporádica, la presentación familiar tiene tendencia a aparecer en edades más jóvenes, y a tener múltiple localización. Por la poca disponibilidad de recursos y lo costoso de las investigaciones utilizadas, son de difícil diagnóstico en nuestro medio, por lo cual no se excluye que exista un subregistro en el número de casos que se puedan presentar, razón por la que es importante siempre -ante la sospecha clínica- pensar en su probable confirmación diagnóstica y situación. Los estudios de imágenes y la medición de la producción no fisiológica de catecolaminas, pueden ayudar en el diagnóstico de esta entidad. Las principales modalidades de tratamiento son: la cirugía, la embolización y la radioterapia. Con el objetivo de actualizar y sugerir una guía de tratamiento se realizó la presente revisión(AU)

Paraganglioma is a rare neuroendocrine tumor that may occur in several parts of the body. Roughly 97 percent of these tumors are benign and can be excised through surgery whereas 3 percent of them are malignant and cause distant metastasis. Almost 75 percent are sporadic and the remaining 25 percent are hereditary (more likely to be multiple and developed at early ages). They may be genetically predisposed and associated to family tumor syndromes such as type 2 multiple endocrine neoplasia, Von Hippel-Lindau syndrome and type 1 neurofibromatosis or specific mutations related to development of paragangliomas. When compared to the sporadic occurrence, the family presentation tends to appear at younger ages, with multiple locations. Owing to the low resource availability and the high cost of research, these tumors are difficult to be diagnosed in our conditions, so there may be failures in registering the real number of cases; this is the reason why it is always important to think on possible diagnostic confirmation when clinical suspicion of paraganglioma arises. Imaging studies and measurement of the non-physiological production of catecholamines may help in the diagnosis of this disease. The main therapeutical modalities are surgery, embolization and radiotherapy. The present review was intended to update this topic and to submit a treatment guideline(AU)

Regional Lymph Node Metastasis in Papillary Thyroid Cancer / 대한갑상선학회지

Papillary thyroid cancer is a common endocrine cancer and commonly presents with lymph node metastases. It has been generally accepted that lymphatic drainage occurs from the thyroid primarily to the central lymphatic compartment and secondarily to the lateral compartment nodes. Recently, improvements in the resolution of imaging studies and the availability of highly sensitive thyroglobulin assays have highlighted the importance of identifying disease in the pre-operative assessment and dealing effectively with metastatic regional disease in order to prevent recurrence. However, there are limitations to diagnosing central lymph node metastases. With unreliable imaging modalities, prophylactic central lymph node dissection should be performed on all patients with papillary thyroid cancer. In comparison with the central compartment, prophylactic lateral node dissection has little or no effect on improving the prognosis of patients with papillary thyroid cancer. Therefore, lateral node dissection is recommended only as a part of the therapeutic procedure. The extension of lateral neck dissection is recommended a comprehensive selective neck dissection of levels IIa, III, IV, and Vb. The rich lymphatic supply of the thyroid gland coupled with the propensity for nodal metastases in papillary thyroid cancer require the modern thyroid surgeon to be familiar with the indications for and techniques of regional lymph node dissection.

Solid pseudopapillary neoplasm of the pancreas: a case report with review of the diagnostic dilemmas and tumor behavior

Solid pseudopapillary neoplasm of the pancreas is a rare tumor of the pancreas often detected initially on imaging. Of uncertain histogenesis, it has a low-grade malignant potential with excellent post-surgical curative rates and rare metastasis. Despite advances in imaging, pseudocysts and other cystic neoplasms feature in the differential diagnosis. Pathological and/or cytological evaluation remains the gold standard in reaching a definitive diagnosis. On morphology alone, other primary pancreatic tumors and metastatic tumors pose a diagnostic challenge. Recent advances in immunohistochemical characterization have made the histopathologic diagnosis more specific and, in turn, shed light on the likely histogenesis of this rare tumor. We report a case of solid pseudopapillary neoplasm of the pancreas that was suspected on radiology and diagnosed intraoperatively on imprint cytology guiding definitive surgery. The diagnostic dilemmas are reviewed.

Metastatic lymph nodes from papillary cancer detected using 99Tc pertechnetate

This is a case report of a 51-year-old female diagnosed with papillary microcarcinoma of the thyroid gland after undergoing total thyroidectomy. A 99mTc pertechnetate thyroid scan was done before radioiodine ablation therapy. It showed cervical neck lymph nodes taking up the radiotracer. Another scan after ablation therapy showed the same nodes taking up the therapeutic iodine131. The paper discusses using 99mTc pertechnetate to detect thyroid cancer metastases.

Diagnostic value of antithyroglobulin antibodies in the detection of recurrent differentiated thyroid carcinoma: A meta-analysis

The aim of this study is to determine the diagnostic accuracy of antithyroglobulin antibodies in predicting recurrent differentiated thyroid carcinoma. We searched PubMed (1990-2010) and Google Scholar (1990-2010). Citation searches, manual searches and screening of references of f included studies were done. Diagnostic studies that utilized antithyroglobulin antibodies as a predictor of recurrent differentiated thyroid carcinoma. The authors searched citations that correlated with the criteria using a data collection form generated in Review Manager 5 (REVMAN 5). The methodological quality was then assessed using Quality Assessment of Studies of Diagnostic Accuracy (QUADAS). Hierarchical summary receiver operating characteristic (HSROC) mete-analytical tool was used to estimate summary receiver operating characteristic (ROC) curves. Eight studies with 2116 participants with 182 patients with recurrent differentiated thyroid carcinoma were included. Pooled sensitivity and specifically were 63% and 79% respectively. SROC shows an overall are under the curve (AUC) of 0.712. Antithyroglobulin antibody has ability to predict recurrent differentiated thyroid carcinoma.

Significance of post-therapy whole body imaging with I-131 in well-differentiated thyroid cancer

Post-therapy whole body imaging with I-131 is not routinely done in the Philippines. This added cast of this procedure limits its diagnostic value for those patients who cannot afford it. This study was undertaken to evaluate the diagnostic relevance of I-131 whole body scan following therapeutic doses and its implication in further treatment and follow-up. This study included 61 patients treated in our institutions during a three-year period. Comparison of their-pre- and post-therapy who body scans was done. There were 10 males (16%) and 51 (84%) females with a mean age of 45 years + 15 (range, 17-77). Thirty three patients (54%) have corresponding pre-therapy serum thyroglobulin determination, which also guided the clinicians in the administration of appropriate therapeutic doses. The post-therapy studies were performed prior to hospital discharge . The mean interval between administration of therapy dose and imaging was 4 days (range, 2-10 days). About 34 patients (56% did not have any significant change between their pre- and post-therapy whole body scans. In 27 cases (44%), additional findings indicative of local and/or distant thyroid cancer metastasis were noted. Unsuspected cervical nodes were appreciated in 15(24%) of these cases. Seven (7) cases (11%) presented with increased metastatic deposits in the affected area. New areas of metastases were evident in 5 cases (8%). Our present data suggests that the incorporation of post-therapy whole body scans in the clinical evaluation of patients with well-differentiated thyroid cancer may help in the optimum therapeutic management and future follow-up of patients.

Retroperitoneal laparoscopic adrenalectomy for a large benign adrenal tumor: A case report

A 19-year old man presented with acute onset of intractable hypertension with associated dizziness and nausea. Abdominal computed tomography revealed a 7.0cm x 6.27cm x 6.0cm suprarenal mass on the right. The patient was diagnosed to have pheochromocytoma and successfully underwent retroperitoneal laparoscopic adrenalectomy.

Anesthetic experiences of myxoma removal surgery in two patients with Carney complex: A report of two cases / 대한마취과학회지

Carney complex is an autosomal dominant disorder that occurs due to a mutation in PRKAR1A, which encodes protein kinase A. The clinical features are multiple endocrine gland neoplasms, skin tumors, pigmented skin lesions, myxomas, and schwannomas. In Carney complex, the cardiac myxoma is a common co-morbidity. It occurs in multiples, during young age, regardless of gender and cardiac chamber and is known to recur frequently. Therefore there are high risks of adhesion and massive bleeding due to repeated surgeries. Such surgical risks account for over 50% of disease-specific mortality of Carney complex patients. Here, we present anesthetic experiences of myxoma removal surgery in two patients with Carney complex.

Tumor neuroendocrino de la mama: a propósito de un caso / Neuroendocrine tumor of the breast: a purpose of a case

Los tumores neuroendocrinos en la glándula mamaria, representan menos del 2 por ciento de las lesiones malignas que se presentan en la mama, un 30 por ciento pueden ser metastásicos, principalmente de tumores carcinoides intestinales. Se presenta el caso de una paciente femenina 64 años con el antecedente de carcinoma de mama izquierda pT1N1Mo Estadio II A, se le practicó en el año 2000 cirugía preservadora, recibió tratamiento sistémico y radioterapia, presentando recaída local, histológicamente y por inmuhistoquímica, como tumor neuroendocrino, en mayo de 2008 se le realiza mastectomía simple izquierda. Actualmente viva y sin enfermedad. Los tumores neuroendocrinos pueden presentarse en localizaciones extra intestinales. El diagnóstico debe realizarse por histología y confirmado con técnicas de inmunohistoquímica, son tumores de baja agresividad biológica, no se presentan síntomas sistémicos por liberación de hormonas como en otras localizaciones, y el tratamiento debe basarse en el estadio clínico de la enfermedad al momento del diagnóstico.

Neuroendocrines in the mammary gland tumors represent less than 2 percent of malignant injuries, which 30 percent can be source metastatic, mainly tumors intestinal carcinoid. The clinical of a female patient case 64 years old are presented with the antecedent of pT1N1Mo Stadium II A left breast carcinoma who was practiced in the year 2000 sparing surgery, received systemic therapy and radiotherapy, featuring local relapse, histological and inmuhistochemestry, as neuroendocrines, practicing it in May of 2008 mastectomy left, currently living and without disease tumor. Neuroendocrines tumors can occur in extra intestinal in lung, uterine and less common in the mammary gland neck locations. The diagnosis must be made by histology and confirmed with Immunohistochemistry techniques, are tumors of low biological aggression, not have systemic symptoms by release of hormones as in other locations, and treatment must be based on the clinical stage of the disease at the time of diagnosis.

Introduction of 7th AJCC TNM Staging for Hepatobiliary, Pancreatic Ampulla of Vater, Exocrine and Endocrine Cancers

The tumor node metastasis (TNM) system, which was developed by the American Joint Committee on Cancer (AJCC), is the most practical cancer staging system available. The AJCC TNM staging has been modified periodically in response to newly acquired clinical information and data on prognosis. The seventh edition of this system was published in late 2009 and the manual is effective for cancers diagnosed during or after 2010. There are 9 new classifications, 6 major modifications, elimination of cMX (metastasis cannot be assessed clinically), and there is an introduction to anatomical stages and prognostic groupings. But, compared to the 6th edition, there are no remarkable changes regarding ampulla of Vater and pancreatic cancer, except that neuroendocrine tumors of the pancreas now is staged as a carcinoma.

Imaging Findings in a Case of Mixed Acinar-Endocrine Carcinoma of the Pancreas

Mixed acinar-endocrine carcinoma (MAEC) of the pancreas is extremely uncommon. We report here a rare case of MAEC of the pancreas presenting as watery diarrhea. This is the first report in the English-language literature that describes the imaging findings of MAEC of the pancreas, including computed tomography (CT), magnetic resonance (MR) imaging, and MR cholangiopancreatography features.

Endocrinological cancers and the internet.

Endocrine cancers are some of the commonest forms of cancer getting mention as early as in old papyruses of Egypt. Our current knowledge about this cluster of cancer has grown immensely with improved survival rates. In the era of specialization and super specialization, we started peeking into these conditions more elaborately and beyond microscopically. The growing awareness demanded categorization of information into disease basics like molecular pathology of initiation and progression; advanced diagnostics; new therapeutic options; patient awareness and involvement in clinical trials. Recent advances in genomics and hereditary counseling have delineated pre-disease forecasting possibilities. With advanced diagnostics and therapeutic modalities, we saw an increase in cancer survivors demanding extra care and moral support. Throughout these developments, we went through a boost in global information communications, the main thrust being the Internet. Networking of computers globally generated a platform that created a ripple of knowledge far and wide. The purpose of this review is to investigate how the Internet is supporting the growth and development of the field of endocrine cancer, and present and future scope of the Internet as a tool for professionals involved in this area. The information furnished here were collected from cited references as well as all websites mentioned in the tables.

The usefulness of dual phase 99mTC sestamibi parathyroid scintigraphy in pre-operative localization of parathyroid adenomas

Pre-operative localization of abnormal parathyroid tissue helps in deciding whether surgery begins with a neck or mediastinal exploration. In this study we aimed to evaluate the usefulness of parathyroid scintigraphy in pre-operative localization of parathyroid adenomas and treatment. From February 2006 to October 2008, patients with signs and symptoms of hyperparathyroidism were recruited to join the study. The study group consisted of 3 males and 8 females. All subjects had a pre-operative parathyroid scintigraphy with Tc99m Sestamibi followed by parathyroidectomy. Ten patients had a positive scintigraphic finding which correlated to the actual location of the adenoma determined during the operation. Almost all patients (10 out of 11) underwent minimally invasive parathyroidectomy (MIP) while only one patient underwent bilateral neck dissection. The average incision length was 3.73 + 0.65 cm. Only one patient had an adverse event (transient hypocalcemia and bleeding necessitating a drain) which resolved later. The average hospital stay was 2.5 + 0.7 days. Parathyroid Tc99m-sestamibi scan is a reliable, non-invasive, and cost effective imaging modality in pre-operative localization of parathyroid adenomas for first time parathyroidectomy. This can help and guide surgeons to perform focused parathyroid surgery with minimal incision, successful localization, less complications, and shorter hospital stays.

¿Existen relaciones entre los factores ambientales rurales y la salud reproductiva en la Pampa Húmeda Argentina? / Is there any relationship between rural environmental factors and reproductive health in the Pampa Humeda in Argentina?

La relación entre factores ambientales y salud es un hecho reconocido. La influencia de ambientes rurales sobre la salud reproductiva ha sido fehacientemente probada en diferentes regiones del mundo, tanto en la fauna como en humanos. En América Latina pocas investigaciones han sido realizadas en este campo. El presente proyecto se establece sobre la base de la describir las relaciones entre salud reproductiva y factores ambientales en poblaciones rurales, caracterizada por aspectos ambientales particulares. Tres variables han sido evaluadas: relación de nacimientos masculinos/femeninos; incidencia de malformaciones uro-genitales masculinas (hipospadias y criptorquidias); e incidencia de cánceres hormono-dependientes. Se seleccionaron cinco comunidades rurales de la Pampa Húmeda de Argentina, comparándose los datos obtenidos con medias nacionales. Los datos bio-médicos y las fuentes ambientales de riesgo fueron relacionados entre sí a través de un sistema de geo-referenciación. La relación de nacimientos no mostró significación. Las malformaciones presentaron una muy significativa incidencia. Los cánceres hormono-dependientes presentaron incidencia mayores a las medias nacionales, particularmente en algunas de las comunidades estudiadas. Se concluye que existe una relación entre condiciones de salud reproductiva y factores ambientales en esta región.

The relationship between environmental factors and health is well known. Rural environmental influences on reproductive health have been properly proved, both in animals and humans. In Latin America, few studies have been conducted in this area. The current project is based on the description of relationships between reproductive health and environmental factors in rural populations, characterized by specific environmental characteristics. Three variables were evaluated: male-to-female birth ratio, male urogenital malformations (cryptorchidism and hypospadias), and endocrine-related cancer incidence. Five rural communities in the Pampa Humeda in Argentina were selected, and the data were compared to the national mean. Biomedical data and environmental risk factors were correlated through a geographic information system. The ratio of male to female births did not show any differences. Malformations showed very significant differences. Endocrine-related cancers showed higher incidence rates compared to the national mean, particularly in some communities. In conclusion, there is a relationship between environmental factors and reproductive health conditions in this region.

Comparison of Spleen Preserving Laparoscopic Distal Pancreatectomy with En Bloc Laparoscopic Distal Pancreatectomy

PURPOSE: The purpose of this study is to compare the clinical results of spleen preserving laparoscopic distal pancreatectomy (SPLDP) with en bloc laparoscopic distal pancreatectomy (LDP). METHODS: From March 2005 to August 2008, 52 cases of SPLDP and 84 LDPs were performed at our institution and we retrospectively compared these cases. The enrollment period were chronologically divided to four eras of 10.5 months each. RESULTS: The demographics, including the patients' age, gender and BMI, were not different between the two groups. The final pathologic diagnosis was diverse, and it included cystic tumor, SPT, IPMT, cancer, endocrine tumor, etc and there was no difference between the two groups. The tumor location, operative time, tumor size, perioperative transfusion requirement, the length of the hospital stay and the postoperative complications were not different between the two groups. The mean operative time was gradually shortened by eras (Era 1: 236.3 min, Era 2: 223.6 min, Era 3: 188.8 min, Era 4: 187.9 min) and the proportion of SPLDP was increased by eras from 1.9% to 9.6%, 42.3% and 46.2%, respectively. CONCLUSION: SPLDP might be technically more difficult than LDP, and especially in the initial learning stage of performing laparoscopic pancreatic surgery. After overcoming the learning curve, SPLDP can be performed safely and possibly within a shorter time. SPLDP should be tried whenever possible so that the patients get the maximal benefits of minimal invasive surgery and especially for resecting the more distal pancreatic lesions.

Localización de insulinoma pancreático con ultrasonografía laparoscópica / Location of insulinoma pancreatic with laparoscopic ultrasonography

Se presenta el caso de una paciente de 51 años con cuadro clínico de hipoglicemia por un probable insulinoma pancreático. Los exámenes de laboratorio confirmaron la sospecha de insulinoma, pero los estudios por imágenes no pudieron demostrar el tumor. Bajo estas circunstancias, la paciente tuvo abordaje laparoscópico y con la ayuda del ultrasonido intraoperatorio se localizó el tumor en el proceso uncinado del páncreas y, finalmente, se procedió a la enucleación laparoscópica.

The case of a 51-year-old woman with a clinical history of hipoglicemia causedby a presumed pancreatic insulinoma is reported. Laboratory tests pointed outfor a insulinoma, but imaginologic studies could not locate the tumor. Under this circumstances, the patient was laparoscopically approached. By means of the ultrasononography device the tumor was located at the uncinate process of the pancreas and, eventually treated by laparoscopic enucleation.