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1.
Medicina UPB ; 40(2): 2-12, 13 oct. 2021. tab, Ilus
Article in Spanish | LILACS, COLNAL | ID: biblio-1342173

ABSTRACT

Objetivo: describir los datos sociodemográficos, las manifestaciones clínicas, los paraclínicos, el tratamiento y la recurrencia, en un grupo de pacientes con lesiones papilares. Metodología: estudio analítico de cohorte retrospectiva con fuentes secundarias de información, historias clínicas. Se incluyeron pacientes evaluados entre el 1º enero de 2016 y el 31 de diciembre de 2019. Se recopilaron datos demográficos, clínicos y paraclínicos, que fueron analizados con estadística descriptiva. Resultados: la prevalencia en la muestra fue de 4.7%; todos los casos fueron en mujeres, la media de edad fue 55,5 años; el motivo de consulta más frecuente fue alteración en la imagen de mama (n=79, 54.9%), el tamaño medio de la lesión fue 1,9 cm (rango 0,1-20). Se encontró discordancia entre el diagnóstico por biopsia cortante y el espécimen de patología en 70 (48.6%) casos, en estos se encontró infraestimación de lesiones con mayor riesgo en el 36,1% (n=52). Según la clasificación histológica, el tipo más frecuente de lesión fue el papiloma intraductal 34.7% (n=50), seguido por el carcinoma papilar en 11,8% (n=17). El tipo de cirugía más efectuado fue la cuadrantectomía, con un 68.7% (n=99). La media de seguimiento fue de 28.5 meses y se encontró recaída en siete casos (4.9%). Conclusión: las lesiones papilares comprenden un grupo heterogéneo, que incluye desde las benignas hasta aquellas con potencial maligno. Afectan a las mujeres en la quinta década de la vida, se presentan como una masa, pequeña, unilateral, sin predominio de lateralidad, de crecimiento lento. El tratamiento óptimo para las lesiones de riesgo y con atipias es la cirugía con márgenes negativos, el riesgo de recurrencia es clínicamente relevante.


Objective: to describe the sociodemographic data, the clinical and paraclinical ma-nifestations, the treatment and the recurrence, in a group of patients diagnosed with papillary lesions.Methodology:analytical study of a retrospective cohort with secondary sources of information from users' medical records in the period of January 1, 2016 to December 31, 2019. The demographic, clinical and paraclinical data collected were analyzed using descriptive statistics.Results:the prevalence in the sample was 4.7%; all cases were women, the mean age was 55.5 years; the most frequent reason for consultation was abnormal breast imaging examination (n=79, 54.9 %), the mean size was 1.9 cm (range 0,1-20). Disagreement was found between the diagnosis by sharp biopsy and the pathology specimen in 48.6% of cases (n=70); lesion underestimation with higher risk was found in 36.1% of them (n=52). According to the histological classification, the most frequent was intraductal papilloma in 34.7% (n=50), followed by papillary carcinoma in 11.8% (n=17). The type of surgery most performed was quadrantectomy, 68.7% (n=99). The mean follow-up was 28.5 months and relapse was found in 4.9% (n=7).Conclusion:papillary lesions comprise a heterogeneous group, with a spectrum that includes both benign lesions and those with malignant potential. The lesions affect women in their fifties. They become apparent as a small, unilateral mass, without a pre-dominance of laterality, and of slow growth. The optimal treatment in risk lesions and with atypia is surgery with negative margins. The risk of recurrence is clinically important.


Objetivo: descrever os dados sociodemográficos, manifestações clínicas e paraclínicas, tratamento e recorrência, em um grupo de pacientes com lesões papilares.Metodologia: estudo analítico de coorte retrospectivo com fontes secundárias de informação, prontuários. Foram incluídos os pacientes avaliados entre 1º de janeiro de 2016 e 31 de dezembro de 2019. Foram coletados dados demográficos, clínicos e paraclínicos, os quais foram analisados com estatística descritiva.Resultados: a prevalência na amostra foi de 4,7%; todos os casos eram em mulheres, a média de idade foi de 55,5 anos; o motivo de consulta mais frequente foi a alteração da imagem da mama (n = 79, 54,9%), o tamanho médio da lesão foi de 1,9 cm (variação de 0,1-20). Houve discordância entre o diagnóstico por biópsia cortante e o espécime anatomopatológico em 70 (48,6%) casos, nestes casos subestimação das lesões de maior risco em 36,1% (n = 52). De acordo com a classificação histológica, o tipo de lesão mais frequente foi o papiloma intraductal em 34,7% (n = 50), seguido do carcinoma papilífero em 11,8% (n = 17). O tipo de cirurgia mais realizada foi a quadrantectomia, com 68,7% (n = 99). O seguimento médio foi de 28,5 meses e recidiva foi encontrada em sete casos (4,9%).Conclusão: as lesões papilares constituem um grupo heterogêneo, que inclui desde as benignas até as com potencial maligno. Atingem mulheres na quinta década de vida, aparecem como uma massa, pequena, unilateral, sem predomínio da lateralidade, de crescimento lento. O tratamento ideal para lesões de risco e com atipia é a cirurgia com margens negativas, o risco de recorrência é clinicamente relevante.


Subject(s)
Humans , Female , Pregnancy , Papilloma, Intraductal , Biopsy , Breast , Carcinoma, Papillary , Classification
2.
Rev. colomb. cir ; 36(2): 248-256, 20210000. tab
Article in Spanish | LILACS | ID: biblio-1223908

ABSTRACT

Introducción. Los microcarcinomas papilares de tiroides son tumores de hasta 10 mm en su diámetro mayor. Su tratamiento es sujeto de debate y se propone, desde seguimiento clínico, hasta intervención quirúrgica temprana. Este estudio buscó identificar factores de riesgo relacionados con compromiso ganglionar, que permitan una mejor selección de los pacientes en nuestro medio, en quienes se propone manejo quirúrgico inmediato o vigilancia activa, en consonancia con la clasificación del riesgo de progresión. Métodos. Estudio de cohorte analítica ambispectiva que incluyó pacientes con microcarcinoma papilar de tiroides llevados a tiroidectomía más vaciamiento central. Se caracterizó la población y se realizó un análisis de regresión logística multivariado para definir factores preoperatorios asociados al compromiso ganglionar. Adicionalmente, se evaluó de manera retrospectiva la eventual asignación a grupos de riesgo de progresión, según los criterios de Miyauchi, y su comportamiento respecto al estado nodal. Resultados. Se incluyeron 286 pacientes. El 48,9 % presentó compromiso ganglionar, y de estos, el 33,5 % presentó compromiso ganglionar significativo, que modificó su clasificación de riesgo de recaída. De estos últimos, el 59,5 % hubiesen sido manejados con vigilancia activa, según los criterios propuestos por Miyauchi. Se identificó que la edad menor de 55 años, los ganglios sospechosos en la ecografía y los nódulos mayores de 5 mm, se relacionan con compromiso ganglionar significativo. Discusión. El manejo quirúrgico inmediato parece ser una opción adecuada para pacientes con sospecha de compromiso ganglionar en ecografía preoperatoria, pacientes menores de 55 años y nódulos mayores de 5 mm. Es posible que los actuales criterios para definir vigilancia activa no seleccionen adecuadamente a los pacientes en nuestro medio.


Introduction. Papillary thyroid microcarcinomas are tumors up to 10 mm in greatest diameter. Its treatment is subject of debate, and it is proposed from clinical follow-up to early surgical intervention. The aim of the study was to identify risk factors related to lymph node involvement, which allow a better selection of patients in our setting, in whom immediate surgical management or active surveillance is proposed, in accordance with the classification of risk of progression.Methods. Ambispective analytic cohort study that included patients with papillary thyroid microcarcinoma who underwent thyroidectomy and central dissection. The population was characterized and a multivariate logistic regression analysis was performed to define preoperative factors associated with lymph node involvement. Additionally, eventual assignment to progression risk groups, according to the Miyauchi criteria, and their nodal state were evaluated.Results. 286 patients with papillary thyroid microcarcinoma were included. Among them, 48.9% had lymph node disease, and 33.5% had a significant lymph node disease that increased their relapse risk classification. Of the latter, 59.5% could have had a conservative treatment, under Miyauchi's criteria. For ages < 55 years old, suspect nodes in ultrasound and nodules > 5 mm were identified as related to significant lymph node involvement.Discussion. Immediate surgical management appears to be an appropriate option for patients with suspected lymph node involvement on preoperative ultrasound, patients younger than 55 years and nodules larger than 5 mm. It is possible that the current criteria for defining active surveillance do not adequately select patients in our setting.


Subject(s)
Humans , Thyroidectomy , Thyroid Neoplasms , Neck Dissection , Carcinoma, Papillary , Thyroid Cancer, Papillary , Lymphatic Metastasis
3.
Article in Chinese | WPRIM | ID: wpr-879266

ABSTRACT

In recent years, with the improvement of the sensitivity of examination equipment and the change of people's living environment and diet, the rate of thyroid cancer has risen rapidly, which has increased nearly five folds in 10 years. The pathogenesis, clinical manifestation, biological behavior, treatment and prognosis of thyroid carcinoma of different pathological types are obviously different. Papillary thyroid carcinoma (PTC) can develop at any age, which accounts for about 90% of thyroid cancer. It progresses slowly and has favourable prognosis, but lymph node metastasis appears easily. Whether PTC is accompanied by lymph node metastasis has an important impact on its prognosis and outcome. The Raf murine sarcoma viral oncogene homolog B(BRAF)gene mutation plays a crucial role in PTC lymph node metastasis. Having an in-depth understanding of the specific role and mechanism of BRAF gene mutation in PTC is expected to provide new ideas for diagnosis and treatment of PTC.


Subject(s)
Animals , Carcinoma, Papillary/genetics , Humans , Lymphatic Metastasis , Mice , Mutation , Oncogenes , Proto-Oncogene Proteins B-raf/genetics , Thyroid Cancer, Papillary/genetics , Thyroid Neoplasms/genetics
4.
Medicina (B.Aires) ; 80(5): 560-562, ago. 2020. graf
Article in Spanish | LILACS | ID: biblio-1287211

ABSTRACT

Resumen El cáncer diferenciado de tiroides generalmente se acompaña de una supervivencia a largo plazo. Sin embargo, en algunos casos pueden desarrollarse metástasis a distancia y, entre ellas, las localizaciones cerebrales son de mal pronóstico. El objetivo de esta presentación es comunicar el caso clínico de una mujer de 65 años que consultó por diplopía en la mirada vertical que había aparecido un mes antes. La resonancia magnética mostró una gran masa a nivel del cóndilo occipital. Se realizó el diagnóstico de tumor cerebral primario, por lo que fue operada dos veces con resección tumoral incompleta. El estudio histopatológico confirmó una lesión metastásica de carcinoma de tiroides. Se realizó una tiroidectomía total con resección de un cáncer papilar de la variante folicular. Luego, fue tratada con éxito con pequeñas cantidades repetitivas de yodo radiactivo para una dosis total acumulada de 325 mCi 131I, con una supervivencia a largo plazo.


Abstract Differentiated thyroid cancer is generally accompanied by a long term survival. However,in some cases distant metastases can develop and among them, brain localizations are of poor prognosis. The aim of this presentation is to communicate the clinical case of a 65 year-old woman who consulted for diplopia in vertical gaze which had appeared one month earlier. MRI showed a big mass at the level of the occipital condyle. Diagnosis of primary brain tumor was made so she was operated twice with incomplete tumor resection. The pathological study was confirmatory of a metastatic lesion of thyroid carcinoma. A total thyroidectomy with resection of a papillary cancer of the follicular variant was performed. Then, she was successfully treated with small repetitive radioiodine amounts for a total accumulated dose of 325 mCi 131I, with a long-term survival.


Subject(s)
Humans , Female , Aged , Brain Neoplasms/radiotherapy , Thyroid Neoplasms/radiotherapy , Iodine Radioisotopes/therapeutic use , Brain Neoplasms/diagnostic imaging , Carcinoma, Papillary/radiotherapy
5.
Int. braz. j. urol ; 46(1): 26-33, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1056358

ABSTRACT

ABSTRACT Purpose: Clear cell papillary (CCP) renal cell carcinoma (RCC) is a new subtype of RCC that was formally recognized by the International Society of Urological Pathology Vancouver Classification of Renal Neoplasia in 2013. Subsequently, CCP RCC was added to the 2016 World Health Organization Classification of Tumors of the Urinary System and Male Genital Organs. In this study, we retrospectively investigated the computed tomography (CT) findings of pathologically diagnosed CCP RCC. Materials and Methods: This study included 12 patients pathologically diagnosed with CCP RCC at our institution between 2015 and 2017. We reviewed the patient's CT data and analyzed the characteristics. Results: Nine solid masses and 3 cystic masses with a mean tumor size of 22.7±9.2mm were included. Solid masses exhibited slight hyper-density on unenhanced CT with a mean value of 34±6 Hounsfield units (HU), good enhancement in the corticomedullary phase with a mean of 195±34HU, and washout in the nephrogenic phase with a mean of 133±29HU. The walls of cystic masses enhanced gradually during the corticomedullary and nephrogenic phases. Solid and cystic masses were preoperatively diagnosed as clear cell RCC and cystic RCC, respectively. Conclusions: The CT imaging characteristics of CCP RCCs could be categorized into either the solid or cystic type. These masses were diagnosed radiologically as clear cell RCC and cystic RCC, respectively.


Subject(s)
Humans , Male , Female , Adult , Aged , Carcinoma, Papillary/diagnostic imaging , Carcinoma, Renal Cell/diagnostic imaging , Tomography, X-Ray Computed/methods , Kidney Neoplasms/diagnostic imaging , Immunohistochemistry , Carcinoma, Papillary/pathology , Carcinoma, Renal Cell/pathology , Retrospective Studies , Tumor Burden , Neoplasm Grading , Kidney Neoplasms , Kidney Neoplasms/pathology
6.
Rev. Col. Bras. Cir ; 47: e20202545, 2020.
Article in English | LILACS | ID: biblio-1136550

ABSTRACT

ABSTRACT Introduction: papillary thyroid carcinoma is a tumor with good prognosis. However, some patients treated present neck recurrence. Objective: to evaluate the risk factors for neck recurrence. Methods: a retrospective study enrolled 89 patients (68 women and 21 men) diagnosed with papillary carcinoma who underwent total thyroidectomy. In 21 patients, neck dissection was performed and 62 patients underwent radioiodinetherapy. Twelve patients relapsed with metastasis in this period with an average of 3.6 years. Results: out of 89 patients, 76.4% were female. Relapse occurred in nine (13.23%) women and three (14.28%) men. The average age of the patients was 44 years in the control group and in patients with relapsed. Eighteen patients (23.37%) in the control group and eight (64.28%) who relapsed had positive lymph nodes at initial diagnosis. The tumor size was significantly larger in the group of patients with cervical recurrence (3.3cm vs. 1.6cm - p=0.008, Student t test), whereas the presence of metastatic lymph nodes at the moment of the first operation was also significant (p=0.004 -Fisher exact test). The tumor size was an independent risk factor for recurrence at the multivariate anaylsis (OR=2.4, IC95%:1.3-4.6 - p=0,007, logistic regression). Conclusion: there is an increase in the risk of lymph node recurrence during the follow up of 2.4 folds for each increase of 1cm in the longer nodule diameter.


RESUMO Introdução: o carcinoma papilífero da tireoide é um tumor com bom prognóstico. Entretanto, alguns pacientes tratados evoluem com recidiva cervical. Objetivo: avaliar os fatores de risco para recidiva cervical. Métodos: um estudo retrospectivo arrolou 89 pacientes (68 mulheres e 21 homens) diagnosticados com carcinoma papilífero, submetidos à tireoidectomia total. Em 21 pacientes, realizou esvaziamento cervical e, em 62, radioiodoterapia. Doze pacientes apresentaram recorrência linfonodal no período, com media de 3,6 anos. Resultados: dos 89 pacientes, 76,4% eram mulheres. A falha ocorreu em nove mulheres (13,23%) e três homens (14,28%). A média etária tanto dos pacientes recidivados como do grupo-controle foi de 44 anos. Dezoito pacientes (23,37%) no grupo-controle e oito (64,28%) dentre os que recidivaram tinham linfonodos positivos ao diagnóstico inicial. O tamanho tumoral foi significativamente maior no grupo de pacientes que apresentaram recidiva cervical (3,3 cm vs. 1,6cm - p=0,008, teste t de Student), o mesmo foi observado para a presença de linfonodos metastáticos quando da primeira cirurgia (p=0,004 - teste exato de Fisher). À análise multivariada, o tamanho tumoral foi fator de risco independente de recidiva (OR=2,4, IC95%:1,3-4,6 - p=0,007, regressão logística. Conclusão: para cada aumento de 1cm no maior diâmetro da lesão, há um aumento de 2,4 vezes no risco de recidiva linfonodal ao longo do acompanhamento.


Subject(s)
Humans , Male , Female , Adult , Neck Dissection , Thyroidectomy , Thyroid Neoplasms/surgery , Carcinoma, Papillary/surgery , Thyroid Cancer, Papillary/surgery , Prognosis , Thyroid Neoplasms/pathology , Carcinoma, Papillary/pathology , Retrospective Studies , Thyroid Cancer, Papillary/pathology , Lymphatic Metastasis , Neoplasm Recurrence, Local
7.
Rev. chil. endocrinol. diabetes ; 13(3): 105-109, 2020. ilus
Article in Spanish | LILACS | ID: biblio-1117580

ABSTRACT

El carcinoma papilar de tiroides variante de células altas, descrito en 1976 por Hawk y Hazard, representa el 1% de los carcinomas diferenciados, siendo más agresivo e invasivo que la forma clásica y 80% de los casos se asocia con mutación B-RAF. Se presenta el caso de una mujer de 49 años con tumoración dolorosa en cara anterolateral de cuello, que tuvo un crecimiento rápido, disfonía y lateralización del cuello a izquierda. En la ecografía de tiroides se vio en el lóbulo derecho un voluminoso nódulo mixto, predominantemente sólido, hipoecogénico, con micro calcificaciones, sin separación del plano graso con los músculos infra hioideos. Se realizó punción con aguja fina que resultó Bethesda VI. En valoración pre quirúrgico se encontró la parálisis de cuerda vocal derecha. Se realizó tiroidectomía total con vaciamiento central y lateral derecho. El estudio anatomo-patológico reportó un carcinoma papilar de tiroides variante de células altas de 33 x 40 x 27 mm en lóbulo derecho que contacta con la tinta china, evade la cápsula y presenta invasión perineural. Ocho ganglios de 18 analizados fueron metastásicos en el compartimento VI. Posteriormente se realizó rastreo corporal total con una dosis mínima de I131 y luego se administró 150 mCi de I131. El carcinoma papilar de tiroides, variante de células altas puede presentarse inicialmente con el compromiso locorregional y su correcto diagnóstico tiene implicancia en el pronóstico y su manejo terapéutico. Debemos pensar en variantes agresivas cuando al inicio ya encontramos elementos sugestivos de extensión extratiroidea, como en este reporte.


High-cell variant papillary thyroid carcinoma, described in 1976 by Hawk and Hazard, represents 1% of differentiated carcinomas, being more aggressive and invasive than the classic form, and 80% of cases is associated with a B-RAF mutation. We present the case of a 49-year-old woman with a painful tumor on the anterolateral side of the neck, who had rapid growth, dysphonia and lateralization of the neck to the left. On thyroid ultrasound, a voluminous mixed node, predominantly solid, hypo echogenic, with micro calcifications, without separation of the fat plane with the infrahyoid muscles, was seen in the right lobe. Fine needle puncture was performed, resulting in Bethesda VI. In pre-surgical evaluation, right vocal cord paralysis was found. Total thyroidectomy was performed with central and right lateral emptying. The pathology study reported a 33 x 40 x 27 mm high cell variant papillary thyroid carcinoma in the right lobe that contacted with the Chinese ink, evaded the capsule and presented perineural invasion. Eight lymph nodes out of 18 analyzed were metastatic in compartment VI. Subsequently, a total body scan wasperformed with a minimum dose of I131 and then 150 mCi of I131 was administered. Papillary thyroid carcinoma, a high-cell variant, may initially present with loco regional involvement and its correct diagnosis has implications for prognosis and therapeutic management. We must think of aggressive variants when at the beginning we already found elements suggestive of extra thyroid extension, as in this report.


Subject(s)
Humans , Female , Middle Aged , Thyroid Neoplasms/surgery , Thyroid Neoplasms/diagnosis , Carcinoma, Papillary/surgery , Carcinoma, Papillary/diagnostic imaging , Thyroidectomy , Thyroid Neoplasms/pathology , Carcinoma, Papillary/pathology , Iodine Radioisotopes/administration & dosage
8.
Rev. chil. endocrinol. diabetes ; 13(1): 17-19, 2020.
Article in Spanish | LILACS | ID: biblio-1048802

ABSTRACT

INTRODUCCIÓN: Los quistes tiroglosos son las lesiones más comunes de la línea media cervical y se ha descrito el carcinoma papilar de tiroides en el 1%. Debido a su baja incidencia no existe un consenso acerca del tratamiento óptimo. Caso clínico: Paciente mujer de 34 años de edad consulta por aumento de volumen cervical doloroso y se evidencia nódulo doloroso en región cervical media. Ecografía de tiroides visualiza una lesión quística compleja. Se completa el estudio con tomografía computada del cuello con contraste que evidencia quiste del conducto tirogloso con compromiso inflamatorio-infeccioso, por lo que se decide cirugía. Biopsia evidencia cáncer papilar de 0.25 cm en quiste del conducto tirogloso, con bordes quirúrgicos negativos. Por bajo riesgo se decide control imagenológico estricto. DISCUSIÓN: Los quistes del conducto tirogloso comprenden las lesiones cervicales congénitas más frecuentes. Se presentan como masas indolentes y asintomáticas. El diagnóstico es confirmado mediante ecografía y la tomografía es utilizada para ampliar el estudio. La aparición de cáncer tiroideo en estos quistes es poco común, y generalmente son indistinguibles de las lesiones benignas en el preoperatorio. En relación al manejo del cáncer papilar en quiste del conducto tirogloso no existe un consenso de su tratamiento óptimo. Para los casos de bajo riesgo se sugiere control anual con TSH y ecografía tiroidea. Para aquellos pacientes de alto riesgo se sugiere tiroidectomía total y ablación de los restos tiroides con yodo radioactivo, con control anual con niveles de tiroglobulina. El pronóstico es excelente, con tasas de remisión que superan el 95%. CONCLUSIONES: Los carcinomas en quistes de conducto tirogloso son poco comunes y en la mayoría de los casos son lesiones diagnosticadas de manera incidental después de la resección quirúrgica. Para definir necesidad de tiroidectomía, debe realizarse estudio individualizado por un equipo multidisciplinario con amplia experiencia.


INTRODUCTION: Thyroglossal cysts are the most common affection of the cervical midline. Papillary carcinoma has been described in 1% of this cysts. Due to its low incidence a consensus on the optimal treatment does not exist. Clinical case: A 34 year old female with no relevant past medical history, presented with a painful cervical mass of many weeks of appearance. The thyroid ecography showed a complex cystic lesion and the cervical computed tomography with contrast evidenced a cyst of the thyroglossal duct with inflammatory and infectious findings. Surgery with no incidents was performed. Biopsy reported a 0.25 cm papillary cancer in the thyroglossal duct cyst, with negativa surgical margins. Strict follow up with imaging studies was decided. DISCUSSION: the thyroglossal duct cyst are the most common congenital cervical affections. Classically, they present as indolente, asyntomatic masses on the cervical midline. The diagnosis is confirmed with ecography and computed tomography is used to extent evaluation. Thyroid cancer in thyroglossal duct cyst is uncommon and generally indistinguishable from benign lesions in the preoperative phase. A consensus regarding the optimal management of this patients does not exist. For low risk cases, an anual control with THS and thyroid ecography is suggested. For patients with high risk a Sistrunk with total thyroidectomy and radioactive ablation of thyroids remnants is recommend. Follow up with anual thyroglubin levels should be performed. The prognostic is excellent, with more than 95% remission rates. CONCLUSSIONS: Thyroglossal duct cyst carcinomas are rare. In most cases, diagnosis is made incidentally after surgical resection. To decide wheter thyroidectomy is necessary each case should be analyzed individually by a multidisciplinary team with vast experience.


Subject(s)
Humans , Female , Adult , Thyroglossal Cyst/diagnosis , Thyroid Neoplasms/diagnosis , Carcinoma, Papillary/diagnosis , Thyroglossal Cyst/surgery , Thyroglossal Cyst/pathology , Thyroidectomy , Thyroid Neoplasms/surgery , Thyroid Neoplasms/pathology , Carcinoma, Papillary/surgery , Carcinoma, Papillary/pathology
11.
Arch. endocrinol. metab. (Online) ; 63(5): 456-461, Sept.-Oct. 2019. tab
Article in English | LILACS | ID: biblio-1038498

ABSTRACT

ABSTRACT The indolent evolution of low-risk papillary thyroid microcarcinoma (mPTC) in adult patients and the consequences of thyroidectomy require a revision of the management traditionally recommended. Aiming to spare patients unnecessary procedures and therapies and to optimize the health system in Brazil, we suggest some measures. Fine-needle aspiration of nodules ≤ 1 cm without extrathyroidal extension on ultrasonography should be performed only in nodules classified as "very suspicious" (i.e., high suspicion according to ATA, high risk according to AACE, TI-RADS 5) and in selected cases [age < 40 years, nodule adjacent to the trachea or recurrent laryngeal nerve (RLN), multiple suspicious nodules, presence of hypercalcitoninemia or suspicious lymph nodes]. Active surveillance (AS) rather than immediate surgery should be considered in adult patients with low-risk mPTC. Lobectomy is the best option in patients with unifocal low-risk mPTC who are not candidates for AS because of age, proximity of the tumor to the trachea or RLN, or because they opted for surgery. The same applies to patients who started AS but had a subsequent surgical indication not due to a suspicion of tumor extension beyond the gland or multicentricity. Molecular tests are not necessary to choose between AS and surgery or, in the latter case, between lobectomy and total thyroidectomy. The presence of RAS or other RAS-like mutations or BRAFV600E or other BRAF V600E-like mutations should not modify the management cited above; however, the rare cases of mPTC exhibiting high-risk mutations, like in the TERT promoter or p53, are not candidates for AS.


Subject(s)
Humans , Thyroid Neoplasms/diagnostic imaging , Carcinoma, Papillary/diagnostic imaging , Thyroid Nodule/diagnostic imaging , Thyroidectomy , Thyroid Neoplasms/surgery , Carcinoma, Papillary/surgery , Thyroid Nodule/surgery , Biopsy, Fine-Needle , Expert Testimony
12.
Rev. chil. endocrinol. diabetes ; 12(3): 175-178, jul. 2019. ilus, tab
Article in Spanish | LILACS | ID: biblio-1006639

ABSTRACT

Los nódulos tiroideos suelen ser benignos en más del 95% de los casos y eutiroideos. La probabilidad de cáncer de tiroides en el hipertiroidismo es baja. Al enfrentarse a un nódulo tiroideo la importancia radica en excluir patología maligna, pero se debe mantener el orden en el algoritmo de estudio para evitar un diagnóstico incorrecto y caer en costos innecesarios. Se presenta el caso de una mujer de 23 años de edad con hipertiroidismo que en la ecografía aparece un nódulo tiroideo y adenopatía derecha, ambos con elementos sospechosos de malignidad, por lo que se pide punción de ambas estructuras, y se confirma el carcinoma papilar en el nódulo tiroideo, no así en la adenopatía. En el centellograma se observa un nódulo caliente que coincide con el nódulo maligno. Se realiza biopsia intraoperatoria de la adenopatía sospechosa y resulta ser una metástasis de carcinoma papilar. Se procedió a la tiroidectomía total con vaciamiento ganglionar central y lateral derecho. La anatomía patológica confirmó la presencia del carcinoma papilar clásico con metástasis de la adenopatía sospechosa. Posteriormente se administraron 130 mCi de radioyodo. Se debe considerar que los carcinomas pueden enmascararse ocasionalmente como nódulos «calientes¼ en el centellograma y en este caso, si bien en principio no estaría indicada la punción con aguja fina del nódulo dado que es hipercaptante en el centellograma, la ecografía demuestra elementos sospechosos contundentes de malignidad. En este caso el hilo conductor fue la ecografía y se rompió con el esquema clásico en la solicitud de estudios paraclínicos, obteniendo finalmente la confirmación diagnóstica de un cáncer y se realizó el tratamiento adecuado del mismo.


Thyroid nodules are usually benign in more than 95% of cases and euthyroid. The likelihood of thyroid cancer in hyperthyroidism is low. When dealing with a thyroid nodule the importance lies in excluding malignant pathology, but order must be maintained in the study algorithm to avoid an incorrect diagnosis and to fall into unnecessary costs. We present the case of a 23-year-old woman with hyperthyroidism who presented a thyroid nodule and right adenopathy on ultrasound, both with suspicious elements of malignancy, so puncture of both structures was requested, and papillary carcinoma was confirmed in the thyroid nodule, but not in adenopathy. In the scintigraphy a hot nodule is observed that coincides with the malignant nodule. Intraoperative biopsy of the suspected adenopathy is performed and it turns out to be a metastasis of papillary carcinoma. Total thyroidectomy was performed with central and right lateral lymph node dissection. The pathological anatomy confirmed the presence of classic papillary carcinoma with metastasis of the suspected adenopathy. Subsequently, 130 mCi of radioiodine was administered. It should be considered that carcinomas can occasionally be masked as «hot¼ nodules in the scintigraphy and in this case, although in principle the fine needle puncture of the nodule is not indicated given that it is hypercaptant in the scintigraphy, the ultrasound shows blunt suspicious elements of malignancy. In this case, the common thread was ultrasound and it was broken with the classic scheme in the request for paraclinical studies, finally obtaining the diagnostic confirmation of a cancer and the appropriate treatment was carried out.


Subject(s)
Humans , Female , Young Adult , Thyroid Neoplasms/diagnostic imaging , Carcinoma, Papillary/diagnostic imaging , Thyroid Nodule/diagnostic imaging , Thyroidectomy , Thyroid Neoplasms/surgery , Thyroid Neoplasms/pathology , Carcinoma, Papillary/surgery , Carcinoma, Papillary/pathology , Radionuclide Imaging , Ultrasonography , Thyroid Nodule/surgery , Thyroid Nodule/pathology , Sodium Pertechnetate Tc 99m , Hyperthyroidism
13.
Braz. j. otorhinolaryngol. (Impr.) ; 85(2): 237-243, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1001541

ABSTRACT

Abstract Introduction: For papillary thyroid microcarcinoma patients, the reported incidence of lymph node metastasis is as high as 40%, and these occur mainly in the central compartment of the neck. Because these metastases are difficult to detect using ultrasonography preoperatively, some authors advocate routine central neck dissection in papillary thyroid microcarcinoma patients at the time of initial thyroidectomy. Objective: To evaluate whether prophylactic central neck dissection can decrease the local recurrence rate of papillary thyroid microcarcinoma after thyroidectomy. Methods: The publicly available literature published from January 1990 to December 2017 concerning thyroidectomy plus prophylactic central neck dissection versus thyroidectomy for papillary thyroid microcarcinoma was retrieved by searching the national and international online databases. A meta-analysis was performed after the data extraction process. Results: Four studies were finally included with a total of 727 patients, of whom, 366 cases underwent thyroidectomy plus prophylactic central neck dissection and 361 cases received thyroidectomy only. As shown by the meta-analysis results, the recurrence rates in cases of thyroidectomy plus prophylactic central neck dissection were approximately 1.91% and were significantly lower than those with thyroidectomy only (OR = 0.24, 95% CI [0.10, 0.56], p = 0.0009). Conclusion: For patients with papillary thyroid microcarcinoma, thyroidectomy plus prophylactic central neck dissection is a safe and efficient procedure and it results in lower recurrence rate. Since the evidences are of low quality (non-randomized studies), further randomized trials are needed.


Resumo Introdução: A incidência relatada de metástases linfonodais chega a 40% em pacientes com microcarcinoma papilífero de tireoide e essas ocorrem principalmente no compartimento cervical central. Como essas metástases são difíceis de ser detectadas com o uso de ultrassonografia no pré-operatório, alguns autores defendem o esvaziamento cervical central de rotina em pacientes portadores de microcarcinoma papilífero de tireoide no momento da tireoidectomia inicial. Objetivo: Avaliar se o esvaziamento cervical central profilático pode diminuir a taxa de recorrência local de microcarcinoma papilífero de tireoide após a tireoidectomia. Método: A literatura disponível, publicada de janeiro de 1990 a dezembro de 2017, sobre tireoidectomia com esvaziamento cervical central profilático versus tireoidectomia somente para microcarcinoma papilífero de tireoide foi obtida através de busca nas bases de dados online nacionais e internacionais. A metanálise foi feita após o processo de extração de dados. Resultados: Quatro estudos foram finalmente incluídos na metanálise, com 727 pacientes, dos quais 366 foram submetidos à tireoidectomia com esvaziamento cervical central profilático e 361 só receberam tireoidectomia. Como mostrado pelos resultados da metanálise, as taxas de recorrência com tireoidectomia com esvaziamento cervical central profilático foram de 1,91% e foram significantemente menores do que aquelas em pacientes submetidos somente à tiroidectomia (OR = 0,24, IC95% [0,10-0,56], p = 0,0009). Conclusão: Para pacientes com microcarcinoma papilífero de tireoide, o esvaziamento cervical central profilático é um procedimento seguro e eficiente e resulta em menor taxa de recorrência. Como as evidências são de baixa qualidade (estudos não randomizados), mais estudos randomizados são necessários.


Subject(s)
Humans , Male , Female , Neck Dissection/methods , Thyroidectomy/methods , Thyroid Neoplasms/surgery , Carcinoma, Papillary/surgery , Prophylactic Surgical Procedures/methods , Neoplasm Recurrence, Local/prevention & control , Thyroid Neoplasms/pathology , Carcinoma, Papillary/pathology , Reproducibility of Results , Treatment Outcome
14.
Autops. Case Rep ; 9(2): e2018083, Abr.-Jun. 2019. ilus
Article in English | LILACS | ID: biblio-994679

ABSTRACT

Heterotopic ossification has been described in papillary thyroid carcinoma in association with high incidence of extrathyroidal invasion, multifocality, lymph node metastasis, and older age. Nevertheless, it has not been described as a specific subtype of papillary thyroid carcinoma, because of its rarity. We described the case of an 80-year-old female patient, with familial history of papillary thyroid carcinoma. In the annual screening examination, she was diagnosed with thyroid nodules. The patient was submitted to a thyroidectomy because the fine needle aspiration cytology was positive for malignancy according to the Bethesda classification. The surgical specimen analyses showed a multifocal papillary carcinoma with one major lesion in the left lobe measuring 0.9 cm, and two small lesions (0.4 cm and 0.2 cm) in the right lobe. Only the biggest lesion in the right lobe had the osteoid matrix with rare osteoclasts and fat metaplasia with progenitor cells. There was perineural invasion, but vascular invasion was not identified. The margins were free and there was no extrathyroidal extension. In the left lobe there was an oncocytic nodule and a lipomatous follicular nodule. In recent years there has been a significant increase in the diagnosis of thyroid cancer, mainly because of the finding of microcarcinomas as a result of many requests for cervical image exams. Future studies may define (i) whether papillary thyroid carcinoma with heterotopic ossification is a true histological variant; (ii) the causes of that alteration; and (iii) eventual follow-up implications.


Subject(s)
Humans , Female , Aged, 80 and over , Thyroid Neoplasms/complications , Ossification, Heterotopic/pathology , Carcinoma, Papillary/complications , Thyroid Nodule/complications
15.
Rev. otorrinolaringol. cir. cabeza cuello ; 79(1): 67-74, mar. 2019. tab, ilus
Article in Spanish | LILACS | ID: biblio-1004385

ABSTRACT

RESUMEN Introducción: Aunque el carcinoma papilar de tiroides (CPT) tiene una buena sobrevida, en el 30% de los casos recidivará a largo plazo. Se han descrito factores pronósticos como el tamaño, histopatología, procedimiento quirúrgico y administración de yodo radiactivo. Objetivo: Este trabajo pretende determinar factores de riesgo de recidiva a largo plazo. Material y método: Se realizó un estudio retrospectivo y observacional, se incluyeron a los pacientes sometidos a cirugía por CPT con seguimiento a 10 años, y se analizaron variables clínicas y bioquímicas relacionadas con la recidiva a largo plazo. Resultados: Se identificaron 91 pacientes con seguimiento de 10 años. No se encontró relación para recidiva con historia familiar oncológica, enfermedad tiroidea pre-via, pero sí con tabaquismo (p 0,040). Se encontraron a 27 (29%) con recidiva, en relación a lesiones >3 cm (p 0,05), y CPT multicéntrico (p 0,003). Conclusión: El tiempo de evolución prolongado favorece el crecimiento de las lesiones, y la diseminación de la enfermedad, así como la recidiva. El CPT es una enfermedad con capacidad metastásica a largo plazo, que requiere un seguimiento cercano y detección oportuna de pacientes susceptibles de recidiva. El tiempo entre el diagnóstico y la cirugía es un factor fundamental para el crecimiento de las lesiones y la propagación de la enfermedad, por lo que se debe reducir el tiempo de espera, evitando así las lesiones de mayor tamaño, diseminación de células tumorales y la recidiva con peor pronóstico para los pacientes.


ABSTRACT Introduction: The papillary thyroid cancer has good survival rate, however, 30% of the patients will have a recurrence. Prognostic factors have been described such as size, histopathology, surgical procedure and administration of radioactive iodine. Aim: To determine preventable risk factors for long-term recurrence. Material and method: This is a retrospective and observational study, patients undergoing surgery for CPT and 10 year follow up were included to analyze clinical and biochemical variables related to long-term recurrence. Results: Ninety-one patients with a 10-year follow-up were identified. No relationship was found for recurrence with oncological family history, previous thyroid disease, but smoking was a risk factor (p 0.040). We found 27 (29%) with relapse, in relation to lesions > 3 cm (p 0.05), and multicentric PTC (p 0.003). Conclusion: The long evolution time favors the growth of lesions, the spread of the disease, as well as the recurrence. The CPT is a disease with long-term metastatic capacity; it requires close monitoring and opportune detection of patients susceptible to recurrence. The time between diagnosis and surgery is a fundamental factor for the growth of the lesions and the spread of the disease, so the waiting time must be reduced, thus avoiding larger lesions, malignant cell dissemination and recurrence with worse prognosis for patients.


Subject(s)
Humans , Male , Female , Thyroid Neoplasms/pathology , Carcinoma, Papillary/pathology , Neoplasm Recurrence, Local/pathology , Neck Dissection , Thyroidectomy , Thyroid Neoplasms/surgery , Carcinoma, Papillary/surgery , Retrospective Studies , Risk Factors , Disease-Free Survival
16.
Article in Korean | WPRIM | ID: wpr-760145

ABSTRACT

The presence of lymph node metastasis of thyroid papillary carcinoma usually occurs in the internal jugular and paratracheal space on the side of the lesion. For this reason, metastasis to the retropharyngeal lymph nodes from papillary thyroid carcinoma is rare. We currently experienced two cases of retropharyngeal lymph node metastasis of thyroid papillary carcinoma. Both patients had a history of total thyroidectomy and ipsilateral neck dissection and had undergone retropharyngeal lymph node dissection via transoral approach after the diagnosis of retropharyngeal node metastasis. We suggest that the metastatic retropharyngeal lymph nodes can be successfully removed through transoral apparoach. The diagnosis of this rare lymph node metastasis requires sufficient imaging studies such as MRI, CT or PET-CT as well as appropriate history taking and physical examination.


Subject(s)
Carcinoma, Papillary , Diagnosis , Follow-Up Studies , Humans , Lymph Node Excision , Lymph Nodes , Lymphatic Metastasis , Magnetic Resonance Imaging , Neck Dissection , Neck , Neoplasm Metastasis , Physical Examination , Thyroid Gland , Thyroid Neoplasms , Thyroidectomy
17.
Article in English | WPRIM | ID: wpr-786127

ABSTRACT

BACKGROUND: In the present multi-institutional study, the prevalence and clinicopathologic characteristics of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) were evaluated among Korean patients who underwent thyroidectomy for papillary thyroid carcinoma (PTC).METHODS: Data from 18,819 patients with PTC from eight university hospitals between January 2012 and February 2018 were retrospectively evaluated. Pathology reports of all PTCs and slides of potential NIFTP cases were reviewed. The strict criterion of no papillae was applied for the diagnosis of NIFTP. Due to assumptions regarding misclassification of NIFTP as non-PTC tumors, the lower boundary of NIFTP prevalence among PTCs was estimated. Mutational analysis for BRAF and three RAS isoforms was performed in 27 randomly selected NIFTP cases.RESULTS: The prevalence of NIFTP was 1.3% (238/18,819) of all PTCs when the same histologic criteria were applied for NIFTP regardless of the tumor size but decreased to 0.8% (152/18,819) when tumors ≥1 cm in size were included. The mean follow-up was 37.7 months and no patient with NIFTP had evidence of lymph node metastasis, distant metastasis, or disease recurrence during the follow-up period. A difference in prevalence of NIFTP before and after NIFTP introduction was not observed. BRAF(V600E) mutation was not found in NIFTP. The mutation rate for the three RAS genes was 55.6% (15/27).CONCLUSIONS: The low prevalence and indolent clinical outcome of NIFTP in Korea was confirmed using the largest number of cases to date. The introduction of NIFTP may have a small overall impact in Korean practice.


Subject(s)
Carcinoma, Papillary , Diagnosis , Follow-Up Studies , Genes, ras , Hospitals, University , Humans , Korea , Lymph Nodes , Mutation Rate , Neoplasm Metastasis , Pathology , Prevalence , Protein Isoforms , Recurrence , Retrospective Studies , Thyroid Gland , Thyroid Neoplasms , Thyroidectomy
18.
Article in Chinese | WPRIM | ID: wpr-813056

ABSTRACT

To investigate the experience and efficacy of endoscopic thyroidectomy for papillary thyroid microcarcinoma (PTMC) through total areola approach.
 Methods: A total of 117 PTMC patients, who were diagnosed pathologically in Minimally Invasive Surgical Center, Second Xiangya Hospital, Central South University from June 2016 to December 2017, were divided into a endoscopic surgery group (n=72) and an open surgery group (n=45). The number of dissected central lymph nodes, blood loss, amount of drainage, occurrence of postoperative complication and recurrence were collected and compared.
 Results: Compared with the open surgery group, the blood loss was less and the operative time was longer in the endoscopic surgery group (P0.05). The mean follow-up time was more than 20 months, and there was no recurrence in the 2 groups. 
 Conclusion: Endoscopic thyroidectomy with central compartment neck dissection through total areola approach is safe and feasible in patients with PTMC. It has many advantages, such as no scar on neck, less blood loss, shorter hospital stay and more acceptable to young patients.


Subject(s)
Carcinoma, Papillary , General Surgery , Endoscopy , Humans , Nipples , Thyroid Neoplasms , General Surgery , Thyroidectomy
19.
Article in Chinese | WPRIM | ID: wpr-773485

ABSTRACT

OBJECTIVE@#To explore the feasibility of radiomics for predicting lymph node metastasis in the central region of the neck in patients with thyroid papillary carcinoma (PTC).@*METHODS@#A total of 189 patients with PTC confirmed by thyroid fine needle aspiration biopsy were prospectively enrolled in this study. The cross-sectional and longitudinal ultrasound images and the images of both sections were analyzed for predicting central lymph node metastasis using a radiomics approach with pathological results as the gold standard.@*RESULTS@#In the 189 patients, the accuracy, sensitivity and specificity of preoperative thyroid ultrasonography for diagnosis of central lymph node metastasis was 69.39%, 64% and 73%, respectively. Based on the ultrasound images of the cross-sections, longitudinal sections and both sections, the accuracy, sensitivity and specificity of radiomics for predicting central lymph node metastasis was 66.06%/68.12%/77.69%, 53%/46%/40%, and 52%/53%/51%, respectively.@*CONCLUSIONS@#Radiomics with combined analysis of the ultrasound images on the cross-section and longitudinal section images achieves a higher accuracy for predicting central lymph node metastasis than analysis a single section, and its diagnostic accuracy is much higher than that of conventional ultrasound examination.


Subject(s)
Carcinoma, Papillary , Diagnostic Imaging , Pathology , Humans , Image Interpretation, Computer-Assisted , Lymph Nodes , Lymphatic Metastasis , Diagnostic Imaging , Neck , Prospective Studies , Thyroid Neoplasms , Diagnostic Imaging , Pathology , Ultrasonography
20.
Niger. j. surg. (Online) ; 25(1): 70-75, 2019. ilus
Article in English | AIM | ID: biblio-1267534

ABSTRACT

Background: Breast malignancies encompass various subtypes which differ in their clinical presentations, outcomes, and response to the treatment regimens. Thus, a proper histological diagnosis and a special mention of the rare histologic subtypes are required to formulate clear recommendations of their treatment protocols. Materials and Methods: This is a 1-year retrospective study highlighting the rarely encountered subtypes on the mastectomy specimens received. Results: We encountered only 11 rare cases out of the total 153 mastectomy specimens received. The rare subtypes were as follows mucinous cystadenocarcinoma (0.6%), mucinous carcinoma (0.6%), dermatofibrosarcoma protuberans (0.6%), Squamous cell carcinoma (0.6%), papillary carcinoma (2.6%), medullary carcinoma (0.6%), and malignant mesenchymal tumor (1.3%). Conclusion: Our data suggest that these variants are distinct clinicopathological entities with a unique hormonal receptor status. Scant information is available on the rare breast tumor subtypes


Subject(s)
Carcinoma, Medullary , Carcinoma, Papillary , Cystadenocarcinoma , Dermatofibrosarcoma , India
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