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1.
Arch. endocrinol. metab. (Online) ; 66(1): 50-57, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1364302

ABSTRACT

ABSTRACT Objective: A primary medical relevance of thyroid nodules consists of excluding thyroid cancer, present in approximately 5% of all thyroid nodules. Fine-needle aspiration biopsy (FNAB) has a paramount role in distinguishing benign from malignant thyroid nodules due to its availability and diagnostic performance. Nevertheless, intraoperative frozen section (iFS) is still advocated as a valuable tool for surgery planning, especially for indeterminate nodules. Subjects and methods: To compare the FNAB and iFS performances in thyroid cancer diagnosis among nodules in Bethesda Categories (BC) I to VI. The performance of FNAB and iFS tests were calculated using final histopathology results as the gold standard. Results: In total, 316 patients were included in the analysis. Both FNAB and iFS data were available for 272 patients (86.1%). The overall malignancy rate was 30.4%% (n = 96). The FNAB sensitivity, specificity, and accuracy for benign (BC II) and malignant (BC V and VI) were 89.5%, 97.1%, and 94.1%, respectively. For all nodules evaluated, the iFS sensitivity, specificity, and accuracy were 80.9%, 100%, and 94.9%, respectively. For indeterminate nodules and follicular lesions (BC III and IV), the iFS sensitivity, specificity, and accuracy were 25%, 100%, and 88.7%, respectively. For BC I nodules, iFS had 95.2% of accuracy. Conclusion: Our results do not support routine iFS for indeterminate nodules or follicular neoplasms (BC III and IV) due to its low sensitivity. In these categories, iFS is not sufficiently accurate to guide the intraoperative management of thyroidectomies. iFS for BC I nodules could be an option and should be specifically investigated


Subject(s)
Humans , Thyroid Neoplasms/surgery , Thyroid Neoplasms/diagnosis , Thyroid Neoplasms/pathology , Thyroid Nodule/surgery , Thyroid Nodule/diagnosis , Thyroid Nodule/pathology , Retrospective Studies , Sensitivity and Specificity , Biopsy, Fine-Needle/methods , Frozen Sections/methods
2.
Rev. chil. endocrinol. diabetes ; 15(1): 19-22, 2022. ilus
Article in Spanish | LILACS | ID: biblio-1359334

ABSTRACT

El cáncer papilar constituye aproximadamente el 80% de todos los casos de cáncer de tiroides y el 85% de los tumores diferenciados. La variante de células altas representa el 1,3 al 12% del cáncer papilar siendo la variante agresiva más común de estos tumores. Posee un comportamiento agresivo, con mayor incidencia de invasión extratiroidea, linfovascular y metástasis a distancia, responsables de tasas de recurrencia más altas y peor pronóstico. Los casos aquí reportados reflejan las características que hacen sospechar mayor agresividad tumoral, desde el diagnóstico. Describimos dos pacientes de sexo femenino, entre 40 y 50 años, con historia de corta evolución, cuya presentación fue con síntomas de compresión locorregional y adenopatías metastásicas en cuello. Con hallazgos ecográficos e intraoperatorios de relevancia en cuanto la agresividad tumoral que hicieron sospechar la presencia de una variante agresiva del cáncer papilar. La histopatología de la variante de células altas posee una base molecular diferente respecto al papilar clásico que le confiere mayor morbi-mortalidad, constituyendo un factor de pronóstico independiente para la recurrencia. El tratamiento quirúrgico es la tiroidectomía total con vaciamiento profiláctico de los ganglios linfáticos centrales y eventualmente vaciamiento lateral de cuello según valoración preoperatoria, con posterior ablación postoperatoria de restos tiroideos mediante yodo radiactivo.


Papillary cancer constitutes approximately 80% of all thyroid cancer cases and 85% of differentiated tumors. The tall cell variant represents 1.3 to 12% of papillary cancers, being the most common aggressive variant of these tumors. It has an aggressive behavior, showing a higher incidence of extrathyroid and lymphovascular invasion and distant metastasis, responsible for higher recurrence rates and a worse prognosis. The cases reported here reflect characteristics that make us suspect tumor aggressiveness. These are female patients, between 40 and 70 years old, with a history of short evolution. They present locoregional symptoms or metastatic adenopathies, with ultrasound and intraoperative findings of relevance in terms of tumor aggressiveness that led to the suspicion of the presence of an aggressive variant of papillary cancer. The histopathology of the tall cell variant has a different molecular basis that confers its own morbidity and mortality, being an independent prognostic factor for recurrence. Total thyroidectomy is recommended with prophylactic dissection of the central lymph nodes and eventually lateral neck dissection according to preoperative evaluation followed by postoperative ablation with radioactive iodine.


Subject(s)
Humans , Female , Adult , Middle Aged , Thyroid Neoplasms/diagnosis , Thyroid Neoplasms/pathology , Carcinoma, Papillary/diagnosis , Carcinoma, Papillary/pathology , Thyroid Cancer, Papillary/diagnosis , Thyroid Cancer, Papillary/pathology , Thyroid Neoplasms/surgery , Carcinoma, Papillary/surgery , Thyroid Cancer, Papillary/surgery , Neoplasm Invasiveness , Neoplasm Recurrence, Local
3.
Medicina (B.Aires) ; 81(4): 611-616, ago. 2021. graf
Article in Spanish | LILACS | ID: biblio-1346514

ABSTRACT

Resumen Para evaluar la utilidad diagnóstica del estudio patológico intraoperatorio (EPI) en cirugía tiroidea se realizó una revisión retrospectiva de sus resultados en 350 pacientes en comparación con la biopsia preoperatoria por punción con aguja fina (PAAF) y el est udio patológico diferido (EPD). Los resultados de la PAAF se clasificaron según el sistema de Bethesda en categoría II (91 casos, 26.0%), III (21 casos, 6.0%), IV (73 casos, 21.9%), V (54 casos, 15.4%) y VI (111 casos, 31.7%). El EPI mostró lesiones benignas en 137 casos (39.1%), malignas en 169 (48.2%), y resultados no definitivos en 44 (12.6 %). El EPD informó patología benigna en 161 casos (46%) y carcinoma en 189 (54%); se encontró carcinoma en 8 pacientes (5.8%) en quienes el EPI había informado lesión benigna y en 12 (27.2%) en quienes había informado no definitivo; 13 de estos 20 casos fueron microcarcinomas incidentales. El EPI no informó ningún falso positivo (especificidad 100%, sensibilidad 89.4%, valor predictivo positivo 100%, valor predictivo negativo 90.0%, exactitud 94.2%). Los resultados de malignidad con EPI y EPD, según categorías de Bethesda fueron respectivamente: II 3 (3.3%) y 7 (7.7%); III 8 (38.1%) y 10 (47.6%); IV 3 (4.1%) y 10 (13.7%); V 47 (87.0%) y 52 (96.3%); VI 108 (97.3%) y 110 (99.1%). El EPI no dio información adicional a la biopsia por PAAF en la mayoría de los casos ni detectó microcarcinomas en otros, por lo que no parece justificado indicarlo rutinariamente.


Abstract To evaluate the usefulness of intraoperative pathology (IP) in thyroid surgery, a retrospective review of its results in 350 patients was performed in comparison with the results of the preoperative fine-needle biopsy (FNB) and the surgical pathology report (SPR). The FNB was reported according to the Bethesda system as type II in 91 cases (26.0%), type III in 21 (6.0%), type IV in 73 (21.9%), type V in 54 (15.4%), and type VI in 111 (31.7%). The IP showed benign lesions in 137 cases (39.1%), malignancy in 169 (48.2%), and inconclusive results in 44 (12.6%). The SPR results were benign pathology in 161 cases (46%) and carcinoma in 189 (54%); carcinoma was found in 8 patients (5.8%) in whom the IP had reported benignity, and in 12 (27.2%) with IP inconclusive results; 13 of those 20 cases were incidental microcarcinomas. The IP did not report any false positive result (specificity 100 %, sensitivity 89.4%, positive predictive value 100%, negative predictive value 90.0%, and accuracy 94.2%). When discriminated by Bethesda types, the malignant lesions detected by IP and SPR were, respectively: II 3 (3.3%) and 7 (7.70%); III 8 (38.1%) and 10 (47.6%); IV 3 (4.1%) and 10 (13.7%); V 47 (87.0%) and 52 (96.3%); VI 108 (97.3%) and 110 (99.1%). In most cases, the IP did not provide additional information to the FNB report nor did it detect microcarcinomas in others, so it does not seem justified to perform it routinely.


Subject(s)
Humans , Thyroid Neoplasms/surgery , Thyroid Neoplasms/diagnosis , Carcinoma , Thyroid Nodule/surgery , Retrospective Studies , Sensitivity and Specificity , Biopsy, Fine-Needle
4.
Int. j. med. surg. sci. (Print) ; 8(2): 1-10, jun. 2021. tab
Article in English | LILACS | ID: biblio-1284419

ABSTRACT

Introduction.Thyroid cancer is currently the first most common cancer in women in Ecuador. This study aimed to assess the changes in clinical presentation and diagnosis of differentiated thyroid cancer at a third level hospital in Quito, Ecuador.Methods and Materials.This is a retrospective case series performed in three consecutive periods from 1990 to 2019 at a tertiary level hospital, in Quito, Ecuador. The clinical records of 875 patients who had been diagnosed and surgically treated for differentiated thyroid cancer were reviewed. Demographic, clinical, imaging, and pathological data were collected and analyzed.Results. Significant trends toward older age, higher educational level, less palpable primary tumors, less palpable neck nodes, less distant metastases, more ultrasound, tomography and cytology exams, smaller primary tumors, more stage I patients, and more histological variant description, were found. Introduction.Thyroid cancer is currently the first most common cancer in women in Ecuador. This study aimed to assess the changes in clinical presentation and diagnosis of differentiated thyroid cancer at a third level hospital in Quito, Ecuador.Methods and Materials.This is a retrospective case series performed in three consecutive periods from 1990 to 2019 at a tertiary level hospital, in Quito, Ecuador. The clinical records of 875 patients who had been diagnosed and surgically treated for differentiated thyroid cancer were reviewed. Demographic, clinical, imaging, and pathological data were collected and analyzed.Results. Significant trends toward older age, higher educational level, less palpable primary tumors, less palpable neck nodes, less distant metastases, more ultrasound, tomography and cytology exams, smaller primary tumors, more stage I patients, and more histological variant description, were found.


Introducción. El cáncer de tiroides es actualmente el cáncer más frecuente en la mujer en Ecuador. El presente estudio ha tenido como objetivo evaluar los cambios en la presentación clínica y el diagnóstico del cáncer diferenciado de tiroides en un hospital de tercer nivel de Quito, Ecuador. Material y Métodos. El presente es un estudio retrospectivo de casos realizado en tres períodos consecutivos desde 1990 a 2019 en un hospital del tercer nivel en Quito, Ecuador. Los expedientes clínicos de 875 pacientes tratados quirúrgicamente por un cáncer diferenciado de tiroides fueron revisados. Los datos demográficos, clínicos, de imagen y patología fueron extraídos y analizados. Resultados. Se encontraron tendencias significativas hacia una edad más avanzada, nivel educativo más alto, menos tumores palpables, menos adenopatías regionales palpables, menos metástasis a distancia, más exámenes de ultrasonido y tomografía, más estudios de citología, más tumores pequeños y pacientes con estadío I y más descripciones de las variantes histológicas. Conclusiones. El cáncer de tiroides no sólo que ha aumentado continuamente en su frecuencia en los años recientes, sino que la presentación clínica, el manejo diagnóstico y terapéutico ha cambiado significativamente en las tres últimas décadas.


Subject(s)
Humans , Male , Female , Middle Aged , Thyroid Neoplasms/diagnosis , Thyroid Neoplasms/epidemiology , Time Factors , Thyroid Neoplasms/pathology , Clinical Evolution , Demography , Retrospective Studies , Self-Examination , Ecuador/epidemiology , Tertiary Care Centers
6.
Rev. medica electron ; 42(6): 2598-2608, nov.-dic. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1150040

ABSTRACT

RESUMEN Introducción: el cáncer de tiroides representa un 1% del total de todos los tipos de cáncer. Su incidencia parece aumentar un 4% cada año, y en la actualidad es el octavo cáncer más frecuente en mujeres. Objetivo: determinar el comportamiento clínico epidemiológico de los pacientes operados de cáncer de tiroides. Materiales y métodos: se realizó un estudio retrospectivo, observacional y descriptivo con todos los pacientes ingresados con cáncer tiroides en el servicio de Cirugía General del Hospital Universitario Comandante "Faustino Pérez Hernández", en el período desde enero del 1993 a diciembre de 2018. Se empleó un modelo recolector de datos con las variables de interés para el estudio y los datos se presentaron en tablas de frecuencia, números y porciento. Resultados: el cáncer de tiroides fue más frecuente en el grupo etario de 31 a 50 años, predomino el sexo femenino, la variedad histológica papilar fue la más frecuente, el lóbulo derecho fue el más afectado. Conclusiones: el cáncer de tiroides es más frecuente en pacientes relativamente jóvenes y del sexo femenino, a forma clínica de nódulo solitario con función tiroidea normal y el carcinoma papilar la variedad más frecuente (AU).


ABSTRACT Introduction: Thyroid cancer represents 1% of the total of all kinds of cancer. Its incidence seems to increase 4% every year, and at the present time it is the eighth more frequent cancer in women. Objective: to determine the clinical epidemiological behaviour of the patients who underwent thyroid cancer surgery. Materials and methods: a retrospective, observational and descriptive study was carried out in all the patients who were admitted in the service of General Surgery of the University Hospital "Comandante Faustino Pérez Hernández" with thyroid cancer, in the period from January 1993 to December 2018. A data collector model was used with the variables of interest for the study and the data were presented by charts of frequency, numbers and percent. Results: thyroid cancer was more frequent in the age group of 31 to 50 years; the female sex prevailed; the most frequent variety was the histological papillary one, and the right lobe was the most affected. Conclusions: thyroid cancer is more frequent in relatively young, female patients; the clinical form of solitary nodule with normal thyroid function and papillary carcinoma the most frequent variety (AU).


Subject(s)
Humans , Male , Female , Thyroid Neoplasms/epidemiology , Health Behavior , Signs and Symptoms , Thyroid Neoplasms/diagnosis , Risk Factors , Thyroid Cancer, Papillary/diagnosis
7.
Arch. endocrinol. metab. (Online) ; 64(2): 185-189, Mar.-Apr. 2020. tab, graf
Article in English | LILACS | ID: biblio-1131063

ABSTRACT

SUMMARY The EIF1AX gene mutations have been recently associated with papillary thyroid carcinoma and anaplastic thyroid cancer. According with these reports, the gene as been considered as a drive gene for thyroid cancer development. However, the occurrence of these alterations in benign thyroid lesions is not known and is still under investigation. Some authors have already reported the presence of EIF1AX variants in follicular adenomas and hyperplastic nodules. Here, we describe for the first time a case of a man with the EIF1AX c.338-2A>T splice site mutation in an indeterminate FNA lesion with trabecular adenoma at final histology in the absence of other pathogenetic mutations, demonstrating that further studies are required to better understand EIF1AX role in the tumorigenesis of thyroid carcinoma.


Subject(s)
Humans , Male , Thyroid Neoplasms/diagnosis , Thyroid Neoplasms/genetics , Adenoma/diagnosis , Adenoma/genetics , Eukaryotic Initiation Factor-1/genetics , Mutation/genetics , Biopsy, Fine-Needle , Middle Aged
8.
Int. arch. otorhinolaryngol. (Impr.) ; 24(1): 73-79, Jan.-Mar. 2020. tab
Article in English | LILACS | ID: biblio-1090558

ABSTRACT

Abstract Introduction Papillary and follicular thyroid carcinoma are common head and neck cancers. This cancer expresses a thyroid stimulating hormone (TSH) receptor that plays a role as a cancer stimulant substance. This hormone has a diagnostic value in the management of thyroid carcinoma. Objective The present study aimed to determine the difference in TSH levels between differentiated thyroid carcinoma and benign thyroid enlargement. Methods The present research design was a case-control study. The subjects were patients with thyroid enlargement who underwent thyroidectomies at the Dr. Sardjito General Hospital, Yogyakarta, Indonesia. Thyroid stimulating hormone levels were mea- sured before the thyroidectomies. The inclusion criteria for the case group were: 1) differentiated thyroid carcinoma, and 2) complete data; while the inclusion criteria for the control group were: 1) benign thyroid enlargement, and 2) complete data. The exclusion criteria for both groups were: 1) patients suffering from thyroid hormone disorders requiring therapy before thyroidectomy surgery, 2) patients receiving thyroid suppression therapy before the thyroidectomy was performed, and 3) patients suffering from severe chronic diseases such as renal insufficiency, and severe liver disease. Results There were 40 post-thyroidectomy case group patients and 40 post-thyroidect- omy control group patients. There were statistically significant differences in TSH levels between the groups with differentiated thyroid carcinoma and benign thyroid enlargement (p = 0.001; odds ratio [OR] = 8.42; 95% confidence interval [CI]: 3.19-36.50). Conclusion Based on these results, it can be concluded that there were significant differences in TSH levels between the groups with differentiated thyroid carcinoma and benign thyroid enlargement.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Thyroid Neoplasms/diagnosis , Thyrotropin/blood , Adenocarcinoma, Follicular/diagnosis , Thyroid Cancer, Papillary/diagnosis , Thyroidectomy , Thyroid Neoplasms/surgery , Thyroid Neoplasms/pathology , Biomarkers, Tumor/blood , Case-Control Studies , Adenocarcinoma, Follicular/pathology , Diagnosis, Differential , Thyroid Cancer, Papillary/pathology
9.
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
10.
Rev. chil. endocrinol. diabetes ; 13(4): 145-149, 2020. ilus, tab
Article in Spanish | LILACS | ID: biblio-1123619

ABSTRACT

Es bien conocido que ha existido en las últimas décadas un incremento en los casos de cáncer diferenciado de tiroides, especialmente los microcarcinomas. Diversos factores han contribuido a pesquisar pequeños cánceres como el aumento de la disponibilidad de exámenes imagenológicos. Estos pequeños cánceres tiroideos pueden tener un comportamiento no agresivo y no producir letalidad; esto es lo que se conoce como sobrediagnóstico. Esto último tiene implicancias tanto médicas como económicas por terapias agresivas. Así, desde el año 2015, un grupo de expertos cambia la nomenclatura en anatomía patológica del carcinoma papilar tiroideo variante folicular encapsulado (NIEFVPTC de sus siglas en inglés) por Neoplasia folicular tiroidea no invasiva con características nucleares de tipo papilar (NIFTP de sus siglas en inglés). Este cambio se basó en un estudio de Nikiforov donde los NIEFVPTC no tenían efectos adversos ni mortalidad en su seguimiento. Así, la intención inicial del cambio de nomenclatura es eliminar la palabra cáncer y evitar los sobretratamientos innecesarios. Presentamos un caso clínico de una paciente que se sometió a cirugía por un nódulo tiroideo clasificado Bethesda III donde la biopsia definitiva posterior a cirugía evidenció que se trataba de un NIFTP. A raíz de este caso analizamos la literatura hasta la fecha de esta nueva entidad y hacemos un repaso histórico de los carcinomas papilares tiroideos variante folicular. Además, desarrollamos nuevas interrogantes que se plantean desde este nuevo diagnóstico anatomopatológico, de cómo sospecharlo previo a una cirugía, cuál es la cirugía de elección, y cómo debiera ser el seguimiento una vez diagnosticado.


It is well known that there has been an increase in cases of differentiated thyroid cancer in recent decades, especially microcarcinomas. Several factors have contributed to diagnose small cancers such as the increased availability of imaging tests. These small thyroid cancers can have a non-aggressive behavior and not cause lethality, this is what is known as overdiagnosis. The latter has medical as well as economic implications for aggressive therapies. Thus, since 2015, a group of experts has changed the nomenclature in pathological anatomy of encapsulated variant papillary thyroid carcinoma (NIEFVPTC) for non-invasive thyroid follicular neoplasia with papillary nuclear characteristics (NIFTP). This change was based on a Nikiforov study where the NIEFVPTC had no adverse effects or mortality in their follow-up; thus, the initial intention of the nomenclature change is to eliminate the word cancer and avoid unnecessary over-treatments. We present a clinical case of a patient who underwent surgery for a thyroid nodule classified Bethesda III where the definitive biopsy after surgery showed that it was a NIFTP. Following this case, we analyze the literature to date of this new entity and make a historical review of the follicular variant papillary thyroid carcinomas. In addition, we develop new questions that arise from this new pathological diagnosis, how to suspect it prior to surgery, what is the surgery of choice, and what should the follow-up once diagnosed.


Subject(s)
Humans , Female , Adult , Thyroid Neoplasms/diagnosis , Thyroid Cancer, Papillary/diagnosis , Biopsy , Thyroid Neoplasms/surgery , Thyroid Neoplasms/pathology , Ultrasonography , Thyroid Cancer, Papillary/surgery , Thyroid Cancer, Papillary/pathology
11.
Clinics ; 75: e1594, 2020. tab, graf
Article in English | LILACS | ID: biblio-1133448

ABSTRACT

OBJECTIVE: Fine-needle aspiration cytology is the risk stratification tool for thyroid nodules, and ultrasound elastography is not routinely used for the differential diagnosis of thyroid cancer. The current study aimed to compare the diagnostic parameters of ultrasound elastography and fine-needle aspiration cytology, using surgical pathology as the reference standard. METHODS: In total, 205 patients with abnormal thyroid function test results underwent ultrasound-guided fine-needle aspiration cytology on the basis of the American College of Radiology Thyroid Imaging-Reporting and Data System classification and strain ultrasound elastography according to the ASTERIA criteria. Histopathological examination of the surgical specimens was performed according to the 2017 World Health Organization classification system. Moreover, a beneficial score analysis for each modality was conducted. RESULTS: Of 265 nodules, 212 measured ≥1 cm. The strain index value increased from benign to malignant nodules, and the presence of autoimmune thyroid diseases did not affect the results (p>0.05 for all categories). The sensitivities of histopathological examination, ultrasound elastography, and fine-needle aspiration cytology for detection of nodules measuring ≥1 cm were 1, 1, and 0.97, respectively. The working area for detecting nodule(s) in a single image was similar between strain ultrasound elastography and fine-needle aspiration cytology for highly and moderately suspicious nodules. However, for mildly suspicious, unsuspicious, and benign nodules, the working area for detecting nodule(s) in a single image was higher in strain ultrasound elastography than in fine-needle aspiration cytology. CONCLUSION: Strain ultrasound elastography for highly and moderately suspicious nodules facilitated the detection of mildly suspicious, unsuspicious, and benign nodules.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Thyroid Gland/diagnostic imaging , Thyroid Neoplasms/diagnosis , Thyroid Nodule/diagnostic imaging , Biopsy, Fine-Needle/methods , Elasticity Imaging Techniques/methods , Thyroid Gland/pathology , Thyroid Neoplasms/pathology , Thyrotropin/blood , Predictive Value of Tests , Retrospective Studies , Sensitivity and Specificity , Thyroid Nodule/pathology , Diagnosis, Differential
12.
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
13.
Epidemiol. serv. saúde ; 29(4): e2019503, 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1124754

ABSTRACT

Objetivo: Descrever o perfil clínico-epidemiológico de casos hospitalares de câncer primário de tireoide no Brasil. Métodos: Estudo descritivo dos casos informados pelos registros hospitalares de câncer que tiveram primeira consulta para tratamento no período 2000-2016 e cujo acompanhamento foi realizado pela instituição do registro informante. Resultados: Dos 52.912 casos, 83,4% eram femininos e 96,9% eram carcinomas diferenciados. Apresentaram menor tempo mediano para diagnóstico os casos anaplásicos (11 dias) e os residentes da região Sul do país (5 dias). O tratamento foi iniciado em até 60 dias em 88,8% dos casos que chegaram à instituição do registro sem diagnóstico e em 34,9% dos que chegaram com diagnóstico. Conclusão: Os achados são consistentes com a epidemiologia do câncer de tireoide, com predominância do sexo feminino e do carcinoma diferenciado. A análise do tempo para início do tratamento sugere dificuldades de acesso para aqueles que chegaram às instituições dos registros com diagnóstico.


Objetivo: Describir el perfil clínico y epidemiológico de los casos de cáncer de tiroides en Brasil. Métodos: Estudio descriptivo de casos reportados por los registros hospitalarios de cáncer que tuvieron su primera consulta de tratamiento en el período 2000-2016 y el monitoreo fue realizado por la institución del registro. Resultados: De los 52.912 casos, 83,4% eran mujeres y 96,9% era de carcinomas diferenciados. El tiempo promedio hasta el diagnóstico fue menor en los anaplásicos (11 días) y en la región Sur (5 días). El tratamiento se inició dentro de los 60 días en 88.8% de los casos que llegaron a la institución de registro sin diagnóstico y en 34.9% de los que llegaron con diagnóstico. Conclusión: Los resultados son consistentes con la epidemiología del cáncer de tiroides, con predominio del sexo femenino y carcinomas diferenciados. El análisis del tiempo de tratamiento sugiere dificultades de acceso para casos que llegaron con diagnóstico.


Objective: To describe the clinical and epidemiological profile of primary thyroid cancer hospital cases in Brazil. Methods: This is a descriptive study of cases held on hospital cancer records who had their first consultation for treatment in the period 2000-2016 and who were monitored by the hospitals providing those records. Results: Of the 52,912 cases, 83.4% were female and 96.9% were differentiated carcinoma cases. The median time to diagnosis was shorter for anaplastic cases (11 days) and for those living in Brazil's Southern region (5 days). Treatment was initiated within 60 days in 88.8% of cases that arrived at the hospitals without diagnosis and in 34.9% of those who arrived with diagnosis. Conclusion: The findings are consistent with thyroid cancer epidemiology, with a predominance of female cases and differentiated carcinomas. Analysis of time-to-treatment suggests access difficulties for those who already had diagnosis when they arrived at the hospitals.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Thyroid Neoplasms/diagnosis , Thyroid Neoplasms/epidemiology , Hospital Records/statistics & numerical data , Time-to-Treatment/trends , Health Information Systems , Thyroid Gland/physiopathology , Health Profile , Brazil , Epidemiology, Descriptive
14.
Int. braz. j. urol ; 45(4): 834-842, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1019873

ABSTRACT

ABSTRACT The very rare thyroid-like carcinoma of the kidney (TLCK) is microscopically similar to thyroid follicular cell carcinoma (TFCC). Differential diagnosis with secondary thyroid tumors depends on non-reactivity to immunohistochemical (IHC) markers for TFCC (thyroglobulin - TG and TTF1). We herein describe the fourth Pediatric case in literature and extensively review the subject. Only 29 cases were published to the moment. Most cases were asymptomatic and incidentally detected. Most tumors are hyperechoic and hyperdense with low grade heterogenous enhancement on CT and MRI. Most patients were treated with radical nephrectomy, but partial nephrectomy was used in some cases, apparently with the same results. Metastases are uncommon and apparently do not change prognosis, but follow-ups are limited. Up to the moment, TLCK presents as a low grade malignancy that may be treated exclusively with surgery and frequently with partial kidney renal preservation. A preoperative percutaneous biopsy is a common procedure to investigate atypical tumors in childhood and adult tumors. To recognize the possibility of TLCK is fundamental to avoid unnecessary thyroidectomies in those patients, supposing a primary thyroid tumor.


Subject(s)
Humans , Female , Child , Thyroid Neoplasms/pathology , Adenocarcinoma, Follicular/pathology , Kidney Neoplasms/surgery , Thyroid Neoplasms/diagnosis , Magnetic Resonance Imaging , Carcinoma, Renal Cell/surgery , Carcinoma, Renal Cell/diagnosis , Carcinoma, Renal Cell/pathology , Adenocarcinoma, Follicular/surgery , Adenocarcinoma, Follicular/diagnosis , Diagnosis, Differential , Kidney Neoplasms/diagnosis , Kidney Neoplasms/pathology , Lymph Node Excision/methods , Nephrectomy/methods
15.
Medicina (B.Aires) ; 79(4): 271-275, ago. 2019. tab
Article in Spanish | LILACS | ID: biblio-1040520

ABSTRACT

Existe mucha controversia sobre los beneficios de la medición de la calcitonina sérica (CT) durante la evaluación inicial de pacientes con nódulos tiroideos. El objetivo del estudio fue evaluar la identificación temprana del carcinoma medular de tiroides (CMT) a través de la medición rutinaria de CT sérica en una cohorte de Buenos Aires, Argentina. Se estudiaron consecutivamente a los pacientes con enfermedad nodular de la tiroides (n=1017). La CT se midió por quimioluminiscencia (valor normal: hasta 18 pg/ml en hombres y 12 pg/ml en mujeres). En dos pacientes, la hipercalcitoninemia se confirmó en mediciones repetidas. La aspiración con aguja fina con medición de CT en el líquido obtenido identificó la presencia del CMT. El estudio genético fue positivo en uno (mutación exón 14, Val804Met, CMT familiar). El otro presentó un polimorfismo (heterocigoto exón 13 L769L - heterocigoto exón 15 S904S). En ambos casos, la CT se normalizó 3 meses después de la cirugía y se mantuvo en valores normales después de 6 años de seguimiento. La medición rutinaria de la CT en nódulos tiroideos fue útil para detectar dos casos de CMT, uno de ellos esporádico y el otro familiar en la cohorte seguida. La prevalencia de CMT fue de 0.2%.


There is much controversy about the benefits of the use of serum calcitonin (CT) in the initial evaluation of patients with thyroid nodules. The objective of the study was to early identify medullary thyroid carcinoma (MTC) through the routine measurement of CT in thyroid nodular pathology in a large cohort of patients from Buenos Aires, Argentina. Consecutive patients with nodular thyroid disease (n=1017) were studied. CT was measured by chemiluminescence, normal value: up to 18 pg/ml in men and 12 pg/ml in women. In two patients, hypercalcitoninemia was confirmed in repeated measurements. Fine needle aspiration with CT measurement in the needle wash fluid identified MTC in nodules with citology abnormalities. The genetic study was positive in one patient (mutation exon 14, Val804Met, MTC familiar). The other presented a polymorphism (exon 13 L769L heterozygous - exon 15 S904S heterozygous). In both cases, CT was normalized 3 months after surgery and remained normal after 6 years of follow-up. The routine measurement of CT in thyroid nodular pathology was useful to detect two cases of MTC, one of them sporadic and the other familiar in this cohort. The prevalence of MTC was 0.2%.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Calcitonin/blood , Thyroid Neoplasms/diagnosis , Thyroid Nodule/pathology , Carcinoma, Neuroendocrine/diagnosis , Thyroid Neoplasms/pathology , Thyroid Neoplasms/blood , Immunohistochemistry , Biomarkers/blood , Cohort Studies , Sensitivity and Specificity , Thyroid Nodule/blood , Carcinoma, Neuroendocrine/pathology , Carcinoma, Neuroendocrine/blood , Biopsy, Fine-Needle , Early Diagnosis , Luminescence
16.
Rev. fac. cienc. méd. (Impr.) ; 16(1): 45-51, ene.-jun. 2019. ilus
Article in Spanish | LILACS | ID: biblio-1024446

ABSTRACT

A las masas o protuberancias en la glándula tiroides se les llama nódulos tiroideos, la mayoría son benignos, pero alrededor de 2-3 de 20 son cancerosos. El carcinoma anaplásico, representa alrededor del 2%, es más frecuente en el sexo femenino (proporción 3:1). Objetivo: presentar un caso atípico de tumor canceroso en tiroides, técnicas diagnósticas y tratamiento aplicado. Presentación decaso clínico: paciente femenina de 51 años, procedente de Tegucigalpa, evangélica, ama de casa, con historia de masa en región anterior del cuello de un año de evolución, crecimiento progresivo, dolorosa a la palpación, que presentaba úlcera sangrante de un mes de evolución y 8 cm de diámetro. Examen físico: masa de 15 x 15 cm, móvil, asimétrica, bordes irregulares, consistencia dura, adherida a planos profundos. Exámenes complementarios: T4 libre 1.14 ng/dL, hormona estimulante tiroidea 2.10 mU/mL. Ultrasonido de cuello + Doppler:masa sólida, lóbulos aumentados de tamaño y con microvascularidad. Tomografía contrastada: masa en cartílago tiroides de 7.6 x 6.9 cm, bordes definidos, múltiples calcificaciones, sin áreas de necrosis, sin compresión de estructuras adyacentes; ganglios bilaterales aumentados de tamaño. Biopsia por Aspiración con Aguja Fina:carcinoma anaplásico de tiroides con focos de neoplasia papilar y variante de células altas. Tratamiento: tiroidectomía total, mostrando glándula tiroides aumentada de tamaño, peso aproximado de 200 g; levotiroxina 100 µg vía oral c/día de por vida, calcio 2 tabletas vía oral c/día por un mes. Conclusión: El estudio confirmatorio de cáncer anaplásico de tiroides es la biopsia por aspirado con aguja fina; sin embargo, la biopsia por disección, confiere un diagnóstico definitivo cuando existen dudas sobre la toma de muestra o cuando la clínica del paciente no corresponda con el diagnóstico de la biopsia por aspiración con aguja fina...(AU)


Subject(s)
Humans , Female , Middle Aged , Thyroid Neoplasms/diagnosis , Thyroid Nodule/complications , Thyroidectomy/methods , Anaplasia
17.
Arch. endocrinol. metab. (Online) ; 63(2): 107-112, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1001216

ABSTRACT

ABSTRACT Objectives: This observational study analyzed telomerase reverse transcriptase (pTERT) mutations in 45 fine-needle aspiration (FNA) specimens obtained from thyroid nodules followed by postoperatively confirmation of papillary thyroid cancer (PTC) diagnosis, examining their relationship with clinicopathologic aspects and the BRAFV600E mutation. Subjects and methods: Clinical information was collected from patients who presented to Ribeirao Preto University Hospital for surgical consultation regarding a thyroid nodule and who underwent molecular testing between January 2010 to October 2012. Tests included a DNA-based somatic detection of BRAFV600E and pTERT mutations. Results: We found coexistence of pTERTC228T and BRAFV600E mutations in 8.9% (4/45) of thyroid nodules. All nodules positive for pTERT mutations were BRAFV600E positives. There was a significant association between pTERTC228T/BRAFV600E with older age and advanced stage compared with the group negative for either mutation. Conclusions: This series provides evidence that FNA is a reliable method for preoperative diagnosis of high-risk thyroid nodules. pTERTC228T/BRAFV600E mutations could be a marker of poor prognosis. Its use as a personalized molecular medicine tool to individualize treatment decisions and follow-up design needs to be further studied.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Thyroid Neoplasms/genetics , Thyroid Nodule/genetics , Telomerase/genetics , Proto-Oncogene Proteins B-raf/genetics , Thyroid Cancer, Papillary/genetics , Prognosis , Thyroid Neoplasms/diagnosis , Thyroid Neoplasms/pathology , DNA Mutational Analysis , Predictive Value of Tests , Age Factors , Promoter Regions, Genetic/genetics , Thyroid Nodule/diagnosis , Thyroid Nodule/pathology , Biopsy, Fine-Needle , Preoperative Period , Thyroid Cancer, Papillary/diagnosis , Thyroid Cancer, Papillary/pathology , Lymphatic Metastasis/diagnosis , Mutation/genetics , Neoplasm Staging
18.
An. bras. dermatol ; 94(1): 76-78, Jan.-Feb. 2019. graf
Article in English | LILACS | ID: biblio-983748

ABSTRACT

Abstract: Cutaneous metastases are uncommon in daily practice, although very important, since they may be the first manifestation of an undiscovered primary neoplasm or the first indication of recurrence. Cutaneous metastases from the breast are the most frequent in women and cutaneous metastases from the lung are the most frequent in men. Thyroid carcinoma, despite representing the most frequent endocrine neoplasm, is considered a rare neoplasm, corresponding to 1% of malignant neoplasms diagnosed. Cutaneous metastases from follicular carcinoma are rare and occur mainly in the head and neck area. We report a case of cutaneous metastasis in a patient with follicular thyroid carcinoma and breast carcinoma. Because of the association of these two neoplasms, the possibility of Cowden Syndrome - multiple hamartoma syndrome - was raised, but was excluded by genetic analysis of PTEN gene.


Subject(s)
Humans , Female , Middle Aged , Skin Neoplasms/secondary , Breast Neoplasms/pathology , Thyroid Neoplasms/pathology , Adenocarcinoma, Follicular/secondary , Neoplasms, Multiple Primary/pathology , Skin Neoplasms/diagnosis , Biopsy , Breast Neoplasms/diagnosis , Thyroid Neoplasms/diagnosis , Immunohistochemistry , Adenocarcinoma, Follicular/diagnosis , Neoplasms, Multiple Primary/diagnosis
19.
Arch. endocrinol. metab. (Online) ; 63(1): 79-83, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-989300

ABSTRACT

SUMMARY Thyroid carcinoma (TC) is rare in children, particularly in those aged < 10 years. Several studies have demonstrated a correlation between neoplasms and hyperinsulinemia and insulin resistance, which are often associated with a higher risk for and/or aggressiveness of the neoplasm. Congenital generalized lipodystrophy (CGL) with autosomal recessive inheritance is a rare disease and is characterized by the lack of adipose tissue, severe insulin resistance, and early metabolic disturbances. Here, we reported a rare case of a type 2 CGL in a girl who presented with a papillary TC (PTC) at the age of 7 years. She had no family history of TC or previous exposure to ionizing radiation. She had a generalized lack of subcutaneous fat, including the palmar and plantar regions, muscle hypertrophy, intense acanthosis nigricans, hepatomegaly, hypertriglyceridemia, severe insulin resistance, and hypoleptinemia. A genetic analysis revealed a mutation in the BSCL2 gene (p.Thr109Asnfs* 5). Ultrasound revealed a hypoechoic solid nodule measuring 1.8 × 1.0 × 1.0 cm, and fine needle aspiration biopsy suggested malignancy. Total thyroidectomy was performed, and a histopathological examination confirmed PTC with vascular invasion and parathyroid lymph node metastasis (pT3N1Mx stage). This is the first report to describe a case of differentiated TC in a child with CGL. Severe insulin resistance that is generally observed in patients with CGL early in life, especially in those with type 2 CGL, may be associated with this uncommon presentation of aggressive PTC during childhood.


Subject(s)
Humans , Female , Child , Thyroid Neoplasms/diagnosis , Lipodystrophy, Congenital Generalized/diagnosis , Thyroid Cancer, Papillary/complications , Thyroid Cancer, Papillary/genetics , Thyroid Neoplasms/complications , Thyroid Neoplasms/genetics , Lipodystrophy, Congenital Generalized/complications , Lipodystrophy, Congenital Generalized/genetics , Thyroid Cancer, Papillary/diagnosis
20.
Arch. endocrinol. metab. (Online) ; 63(1): 5-11, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-989299

ABSTRACT

ABSTRACT Objective: The 8th TNM system edition (TNM-8) released in 2018 presents significant changes when compared to the 7th edition (TNM-7). The aim of this study was to assess the impact of changing the TNM staging criteria on the outcomes in a Brazilian cohort of differentiated thyroid carcinoma (DTC). Subjects and methods: DTC patients, attending a tertiary, University-based hospital, were classified by TNM-7 and TNM-8. Prediction of disease outcomes status of the two systems was compared in a retrospective cohort study design. Results: Four hundred and nineteen DTC patients were evaluated, comprised by 82% (345/419) women, with mean age at diagnosis of 46.4 ± 15.6 years, 89% (372/419) papillary thyroid carcinoma, with a median tumor size of 2.3 cm (P25-P75, 1.3-3.5). One hundred and sixty patients (38%) had lymph node metastases and 47 (11%) distant metastases at diagnosis. Using the TNM-7 criteria, 236 (56%) patients were classified as Stage I, 50 (12%) as Stage II, 75 (18%) as Stage III and 58 (14%) as Stage IV. When evaluated by the TNM-8, 339 (81%) patients were classified as Stage I, 64 (15%) as Stage II, 2 (0.5%) as Stage III and 14(3%) as Stage IV. After a median follow-up of 4.4years (P25-P75 2.6-6.6), the rate of incomplete biochemical and/or structural response was 54% vs. 92% (P = 0.004) and incomplete structural response was 42% vs. 86% (P = 0.009) for patients classified as stage IV by TNM-7 vs TNM-8, respectively. Only 4 (1%) disease-related deaths were recorded. Conclusions: In our cohort, 37% of DTC patients were down staged with the application of TNM-8 (vs. TNM-7). Additionally, TNM-8 seems to better stratify the risk of structural incomplete response at follow-up.


Subject(s)
Humans , Male , Female , Middle Aged , Thyroid Neoplasms/diagnosis , Neoplasm Staging/standards , Prognosis , Thyroid Neoplasms/mortality , Thyroid Neoplasms/therapy , Retrospective Studies , Risk Factors , Cohort Studies , Neoplasm Staging/mortality
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