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1.
Rev. chil. endocrinol. diabetes ; 15(1): 7-11, 2022. ilus
Article in Spanish | LILACS | ID: biblio-1359332

ABSTRACT

El cáncer diferenciado de tiroides incluye el tipo papilar y folicular que representan más del 80% de los casos y tienen un excelente pronóstico. Existen varios subtipos histológicos y las variantes foliculares son probablemente las más comunes. La incidencia de cáncer papilar variante folicular ha ido en aumento. En un reporte de un solo centro, cerca del 40% de los cánceres papilares eran variantes foliculares1. El subtipo infiltrativo de la variante folicular presenta sectores que invaden el parénquima tiroideo no neoplásico y carece de una cápsula tumoral bien definida. Tiene un comportamiento biológico y un perfil molecular que es más similar al tumor papilar clásico2. Existen características clínicas y patológicas asociadas con riesgo más alto de recurrencia tumoral y mortalidad; entre ellos se describen el tamaño del tumor primario y la presencia de invasión de tejidos blandos3. En la invasión de estructuras adyacentes, los sitios más comprometidos incluyen los músculos pretiroideos, el nervio laríngeo recurrente, el esófago, la faringe, laringe y la tráquea. Además, puede haber otras estructuras involucradas como: la vena yugular interna, la arteria carótida y los nervios vago, frénico y espinal4. El compromiso de los ganglios linfáticos y la incidencia de metástasis ganglionares en adultos depende de la extensión de la cirugía. Entre los que se realizan una disección radical modificada del cuello, hasta el 80% tienen metástasis en los ganglios linfáticos y el 50% de ellas son microscópicas5. Clínicamente los tumores localmente avanzados cursan con disfonía, disfagia, disnea, tos o hemoptisis, pero la ausencia de síntomas no descarta la invasión local. Según las guías de la American Thyroid Association6 son variables de mal pronóstico: la edad del paciente, el tamaño del tumor primario, la extensión extra tiroidea y la resección quirúrgica incompleta.


Differentiated thyroid cancer includes papillary and follicular types that represent more than 80% of cases and have an excellent prognosis. There are several histologic subtypes, and follicular variants are probably the most common. The incidence of papillary follicular variant cancer has been increasing. In a singlecenter report, about 40% of papillary cancers were follicular variants1. The infiltrative subtype of the follicular variant presents sectors that invade the non-neoplastic thyroid parenchyma and lacks a well-defined tumor capsule. It has a biological behavior and a molecular profile that is more similar to the classic papillary tumor2. There are clinical and pathological characteristics associated with a higher risk of tumor recurrence and mortality; These include the size of the primary tumor and the presence of soft tissue invasion3. In the invasion of adjacent structures, the most compromised sites include the pre-thyroid muscles, the recurrent laryngeal nerve, the esophagus, the pharynx, larynx and trachea. In addition, there may be other structures involved such as: the internal jugular vein, the carotid artery and the vagus, phrenic and spinal nerves4. The involvement of the lymph nodes and the incidence of lymph node metastases in adults depends on the extent of the surgery. Among those who undergo a modified radical neck dissection, up to 80% have lymph node metastases and 50% of them are microscopic5. Clinically locally advanced tumors present with dysphonia, dysphagia, dyspnea, cough, or hemoptysis, but the absence of symptoms does not rule out local invasion. According to the American Thyroid Association guidelines6, there are variables with a poor prognosis: the age of the patient, the size of the primary tumor, the extra-thyroid extension, and incomplete surgical resection.


Subject(s)
Humans , Female , Adult , Thyroid Neoplasms/pathology , Carcinoma, Papillary, Follicular/pathology , Thyroid Cancer, Papillary/pathology , Neoplasm Invasiveness
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.
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
4.
Rev. medica electron ; 43(1): 2739-2747, tab
Article in Spanish | LILACS, CUMED | ID: biblio-1156771

ABSTRACT

RESUMEN Introducción: la citología con aguja fina se mantiene como el estudio fundamental ante un nódulo tiroideo, pero el diagnóstico de neoplasia folicular es aún su punto débil para definirlo. Se mantiene como conducta su extirpación quirúrgica para alcanzarlo. Objetivo: determinar la correlación citopatológica en las neoplasias foliculares del tiroides. Materiales y métodos: se realizó un estudio prospectivo y descriptivo que incluyó a 80 pacientes operados con diagnóstico citológico de neoplasia folicular del tiroides, en el Hospital "Comandante Faustino Pérez" de la ciudad de Matanzas, de marzo del 2012 a febrero del 2016. Se evaluaron las variables: edad, sexo, tamaño, localización, número de nódulos y diagnóstico histológico definitivo. Resultados: predominaron las lesiones benignas con 56 para el 70 % dentro de ellas, los bocios multinodulares con 33,75 % y los adenomas foliculares con el 31,25 %. Los tumores malignos ocuparon el 30 %. El carcinoma papilar, variedad folicular con 12 para el 15 %, seguido del carcinoma papilar clásico con 10 para el 12,50 %. Conclusiones: el porcentaje de malignidad de este estudio fue del 30 % con predominio del carcinoma papilar variedad folicular y el carcinoma papilar clásico. Entre las lesiones benignas predominaron los bocios multinodulares y los adenomas foliculares (AU).


ABSTRACT Introduction: fine needle cytology is still the main study against a thyroidal nodule, but the follicular neoplasia diagnosis is still its weak point to define it. The surgical removal keeps being used to reach it. Objective: to determine the cytopathological correlation in follicular thyroid neoplasia. Materials and methods: a prospective, descriptive study was carried out including 80 patient with diagnosis of follicular thyroid neoplasia in the Hospital "Comandante Faustino Pérez" of Matanzas, who underwent a surgery from March 2012 to February 2016. The assessed variables were age, sex, size, location, quantity of nodes and final histological diagnosis. Results: benign lesions predominated, with 56 for 70 %; among them, multinodular goiters with 33.75 % and follicular adenomas with 31.25 %. Malignant tumors were 30 %: papillary carcinoma, follicular variety with 12 for 15 %, followed by the classical papillary carcinoma with 10 for 12.50 % Conclusions: the malignity percent of this study was 30 % with the predominance of the papillary carcinoma, follicular variant and the classic papillary carcinoma. Multinodular goiters and follicular adenomas predominated among the benign lesions (AU).


Subject(s)
Humans , Thyroid Neoplasms/pathology , Adenoma , Carcinoma, Papillary, Follicular , Thyroid Neoplasms/surgery , Thyroid Neoplasms/epidemiology , Thyroid Neoplasms/diagnostic imaging , Epidemiology, Descriptive , Prospective Studies , Goiter, Nodular
5.
Rev. chil. endocrinol. diabetes ; 14(2): 77-80, 2021.
Article in Spanish | LILACS | ID: biblio-1283556

ABSTRACT

El carcinoma oculto de tiroides está poco reportado. Se presenta el caso de una mujer de 59 años. Durante un control por hipotiroidismo se solicitó ecografía cervical, la que mostró áreas hipoecogénicas en lóbulo derecho, una formación nodular hiperecogénica circunscrita no sospechosa de 8 mm y una adenopatía cervical periglandular derecha de 20 x 12 x 8 mm con áreas quísticas y microcalcificaciones, asociadas a hipervascularización. Se solicitó punción aspirativa por aguja fina del ganglio linfático, con resultado de citología negativa para células neoplásicas. El examen microscópico es compatible con tiroiditis, por lo que no es posible descartar metástasis. Se realizó biopsia del ganglio linfático, el que se informa como metástasis ganglionar linfática de 1.3 cm, histología de carcinoma papilar variedad folicular, sin invasión extracapsular. Se realizó tiroidectomía total y disección cervical derecha. El estudio anatomopatológico reportó una tiroiditis crónica de Hashimoto con un nódulo fibroso hialinizado de 0,4 cm negativo para tumor maligno y metástasis en 4 de 28 ganglios linfáticos, sin invasión extracapsular. El tamaño de la metástasis fue de 0,3 a 0,9 cm. Posteriormente se administró 100 mci de radioyodo. Actualmente, la paciente está en buenas condiciones y mantiene controles con ecografía y tiroglobulina periódicos.


Occult thyroid carcinoma is under-reported. The case of a 59-year-old woman is presented. During a check-up for hypothyroidism, a cervical ultrasound was requested, which showed hypoechogenic areas in the right lobe, an 8 mm nonsuspicious circumscribed hyperechogenic nodular formation and a 20 x 12 x 8 mm right cervical periglandular lymphadenopathy with cystic areas and microcalcifications, associated with hypervascularisation. Fine needle aspiration of the lymph node was requested, with negative cytology results for neoplastic cells. Microscopic examination was compatible with thyroiditis, so metastasis could not be ruled out. A biopsy of the lymph node was performed, which was reported as a 1.3 cm lymph node metastasis, histology of papillary carcinoma of the follicular variety, without extracapsular invasion. Total thyroidectomy and right cervical dissection were performed. The anatomopathological study reported chronic Hashimoto's thyroiditis with a 0.4 cm hyalinised fibrous nodule negative for malignant tumour and metastases in 4 of 28 lymph nodes, without extracapsular invasion. The size of the metastasis was 0.3 to 0.9 cm. Subsequently, 100 mci of radioiodine was administered. The patient is currently in good condition and maintains regular ultrasound and thyroglobulin monitoring.


Subject(s)
Humans , Female , Middle Aged , Thyroid Neoplasms/pathology , Thyroid Cancer, Papillary/secondary , Lymphatic Metastasis/pathology , Biopsy, Fine-Needle , Lymph Nodes/pathology
6.
Rev. chil. endocrinol. diabetes ; 14(3): 115-117, 2021. ilus
Article in Spanish | LILACS | ID: biblio-1293385

ABSTRACT

La ecografía tiroidea es la principal herramienta diagnóstica en el manejo de los nódulos tiroideos, siendo la presencia de microcalcificaciones un signo de malignidad. Sin embargo, existen escasas publicaciones acerca de la presencia de microcalcificaciones en ausencia de nódulo identificable y su asociación con cáncer de tiroides. Presentamos un caso de una mujer de 26 años, que, tras hallazgo incidental de bocio, se describe en ecografía un tiroides con alteración difusa de su ecogenicidad e imágenes compatibles con microcalcificaciones sin claro nódulo definido en su polo inferior. Tras realización de punción aspiración con aguja fina de la lesión con resultado Bethesda categoría 5, se decide realizar tiroidectomía total, presentando estudio histológico con diagnóstico de carcinoma papilar de tiroides variante clásica con metástasis ganglionares p(T1bN1a). Tras una revisión sistemática, los estudios hasta hoy publicados sugieren que la presencia de microcalcificaciones aisladas sin nódulo identificable debe considerarse un importante factor de riesgo de cáncer de tiroides, especialmente en gente joven, y en aquellas asentadas sobre una tiroiditis de Hashimoto. Por ende, resulta imperativo mantener una alta sospecha ante el hallazgo de este tipo de lesiones, recomendando una valoración exhaustiva de las mismas con la realización de una punción aspiración con aguja fina a todas las lesiones con dichas características.


Thyroid ultrasound is the main diagnostic tool in the management of thyroid nodules, with the presence of microcalcifications being a sign of malignancy. However, there are few publications about the presence of microcalcifications in the absence of an identifiable nodule and its association with thyroid cancer. We present a case of a 26-year-old woman who, after an incidental finding of goiter, a thyroid with diffuse echogenicity alteration and images compatible with microcalcifications without a clear nodule defined in the lower pole of the lobe is described on the ultrasound. After performing a fine needle aspiration of the lesion resulting in a Bethesda category 5, a total thyroidectomy was performed, presenting in the histological study a diagnosis of a classic variant of a papillary thyroid carcinoma with lymph node metastases p (T1bN1a). After a systematic review, the studies previously published suggest that the presence of isolated microcalcifications without an identifiable nodule should be considered an important risk factor for thyroid cancer, especially in young people, and in those with a concomitant Hashimoto's thyroiditis. Therefore, it is imperative to maintain a high suspicion of the discovery of this type of lesion, recommending an exhaustive assessment of them with the performance of a fine needle aspiration to all lesions with these features.


Subject(s)
Humans , Female , Adult , Calcinosis/diagnostic imaging , Thyroid Neoplasms/diagnostic imaging , Carcinoma/diagnostic imaging , Thyroid Nodule/diagnostic imaging , Thyroidectomy , Calcinosis/surgery , Calcinosis/pathology , Thyroid Neoplasms/surgery , Thyroid Neoplasms/pathology , Carcinoma/surgery , Carcinoma/pathology , Ultrasonography , Thyroid Nodule/surgery , Thyroid Nodule/pathology , Biopsy, Fine-Needle
7.
Autops. Case Rep ; 11: e2021320, 2021. tab, graf
Article in English | LILACS | ID: biblio-1285403

ABSTRACT

Papillary thyroid carcinoma with desmoid-type fibromatosis (PTC-DTF) or nodular fasciitis-like stroma (PTC-NFS) is a rare morphological variant of PTC with a favorable prognosis. There is a paucity of molecular data regarding this entity. We present the case of a 20-year-old female who presented with a palpable mass over the anterior aspect of the neck for the past 3-4 months, which was diagnosed as PTC-NFS. Ultrasonogram of the neck revealed a bulky left lobe of thyroid that contained a well-defined heterogenous lesion measuring around 24 × 26 × 36 mm with involvement of the adjacent isthmus. She underwent a total thyroidectomy with central compartment lymph node dissection. Histological examination revealed a biphasic tumor with epithelial and stromal components resembling nodular fasciitis. Two dissected lymph nodes showed metastasis of the epithelial component only. On immunohistochemistry, BRAF mutant protein expression was evident in the epithelial component only, while β-catenin was negative in both the components. The histopathological diagnosis of papillary thyroid carcinoma with nodular fasciitis-like stroma was offered. Sanger sequencing revealed a BRAFV600E (c.1799T>A, Val600Glu) mutation. Post-operatively, no residual tumor was detected on ultrasound and radioiodine scans. The patient was doing well at follow-up of 9 months. PTC-NFS/DTF is a histological variant of PTC with a favorable prognosis. Our index case was associated with the BRAF mutation, which was restricted to the epithelial component. Thorough sampling of the excised specimen is essential in order not to miss the epithelial component, which, in most reported cases (including ours) appears to be small.


Subject(s)
Humans , Female , Adult , Thyroid Neoplasms/pathology , Thyroid Cancer, Papillary/pathology , Thyroidectomy , Proto-Oncogene Proteins B-raf , beta Catenin , Fasciitis , Myofibroblasts , Lymph Node Excision , Mutation
8.
Article in English | LILACS, BBO | ID: biblio-1155000

ABSTRACT

ABSTRACT Objective: To evaluate the level of inflammatory factors of erythrocyte sedimentation rate and reactive protein C in benign and malignant thyroid nodules. Material and Methods: In this case-control study, patients who were referred because of an enlarged thyroid gland were selected, patients who had undergone surgery for the thyroid nodule were included in the study. Erythrocyte sedimentation rate and reactive protein C were measured before surgery in patients who were candidates for thyroid surgery. The histopathological records of patients were retrospectively reviewed. Relevant cases had a cytological evaluation of thyroid nodules by fine-needle aspiration cytology (FNAC). The mean of ESR / CRP in both groups was compared using an independent t-test (p>0.05). Results: In malignant tumor type, in all patients, with Pill (PTC), analyzes in the malignant group showed a significant difference between the mean ESR / CRP in both groups with and without thyroid history. Sub-analyzes in the malignant group were significantly different between the mean ESR / CRP in both groups with and without thyroid histories (p=0.009) (40.16 ± 28.81). The association between ESR and CRP, ESR / CRP and tumor size, ESR / CRP and age in each group as well as in the whole patients were evaluated using Pearson correlation test, which showed a positive association between ESR age and ESR (p=0.024, r=0.375). In the malignant group, a negative correlation was found between the age and the CRP rate (p=0.027, r=-0.441), and in the total patients between the age and the rate (ES=0.043, r=-0.256). Conclusion: Factors such as ESR and CRP, which are considered acute phase reactors and their levels increase in acute inflammatory conditions, may not have a significant increase in chronic inflammatory conditions and malignancies.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Blood Sedimentation/drug effects , Protein C , Thyroid Neoplasms/pathology , Thyroid Neoplasms/diagnostic imaging , Case-Control Studies , Chi-Square Distribution , Cross-Sectional Studies/methods , Data Interpretation, Statistical , Thyroid Nodule/diagnostic imaging , Iran/epidemiology
9.
An. Fac. Cienc. Méd. (Asunción) ; 53(2): 67-72, 20200800.
Article in Spanish | LILACS | ID: biblio-1119431

ABSTRACT

Introducción: El Cáncer de tiroides es la neoplasia maligna más frecuente del sistema endócrino. Durante las últimas décadas se ha observado un aumento de su incidencia de forma progresiva en numerosos países y regiones del mundo. Objetivos: Determinar la prevalencia de Cáncer de tiroides y, los tipos histológicos, en 3 hospitales de referencia en Paraguay. Materiales y métodos: Estudio observacional, descriptivo, retrospectivo, de corte transversal. Se incluyó a todos los pacientes sometidos a tiroidectomía parcial o total en el Hospital de Clínicas, Instituto de Previsión Social e Instituto Nacional del Cáncer, entre los años 2011 y 2015. Resultados: La prevalencia de cáncer de tiroides fue de 23,7% de 1913 pacientes sometidos a tiroidectomía. El 85,7% fueron del sexo femenino. La edad media fue de 43±14 años. El 85,4 % de los pacientes presentó Carcinoma Papilar; el 9,5% Carcinoma Folicular; el 3,1% Carcinoma Medular; el 1,6% Carcinoma Anaplásico y el 0,4% Carcinoma Papilar + Carcinoma Folicular en el mismo paciente. El sexo femenino fue más frecuente en todos los tipos histológicos y, el Carcinoma Medular resultó igual en ambos sexos. La edad media de los pacientes con Carcinoma Papilar fue de 42±13 años, Carcinoma Medular 49±15 años, del Carcinoma Folicular 50±18 años y Carcinoma Anaplásico 69±11 años. El tamaño promedio del Carcinoma Papilar fue de 19±17 mm, del Carcinoma Folicular 53±24 mm, del Carcinoma Medular 40±22 mm, y el Carcinoma Anaplásico 50±35 mm. Conclusión: Aproximadamente 1 de cada 4 pacientes sometidos a tiroidectomía presentó cáncer de tiroides, siendo más frecuente en el sexo femenino y, el Carcinoma Papilar es el tipo histológico más frecuente.


Introduction: Thyroid cancer is the most frequent malignant neoplasm of the endocrine system. During the last decades, an increase in its incidence has been observed progressively in many countries and regions of the world. Objectives: To determine the prevalence of thyroid cancer and its histological types in thyroidectomies carried out in reference hospitals in Paraguay. Materials and methods: Observational, descriptive, retrospective, cross-sectional study. All patients undergoing partial or total thyroidectomy at the Hospital de Clínicas, Instituto de Previsión Social and Instituto Nacional del Cáncer between 2011 and 2015 were included. Results: The prevalence of thyroid cancer was 23.7% of 1913 patients undergoing thyroidectomy. 85.7% were female. The mean age was 43 ± 14 years. 85.4% of the patients presented Papillary Carcinoma; 9.5% Follicular Carcinoma; 3.1% Medullary Carcinoma; 1.6% Anaplastic Carcinoma and 0.4% Papillary Carcinoma + Follicular Carcinoma in the same patient. The mean age of the patients with Papillary Carcinoma was 42 ± 13 years, Medullary Carcinoma 49 ± 15 years, Follicular Carcinoma 50 ± 18 years, and Anaplastic Carcinoma 69 ± 11 years. The average size of Papillary Carcinoma was 19 ± 17 mm, Medullary Carcinoma 40 ± 22 mm, Anaplastic Carcinoma 50 ± 35 mm, and Follicular Carcinoma 53 ± 24 mm. Conclusion: About 1 in 4 patients undergoing thyroidectomy has thyroid cancer, it is more frequent in women, and the most frequent histological type is Papillary Carcinoma.


Subject(s)
Thyroid Neoplasms , Thyroid Neoplasms/pathology , Paraguay , Prevalence
10.
Rev. méd. Chile ; 148(7): 1025-1030, jul. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1139405

ABSTRACT

Pancreatic metastases of papillary thyroid carcinoma (PTC) are exceptional. We report a 80-year-old man consulting for obstructive jaundice and dysphonia. Abdominal ultrasonography showed biliary dilation and abdominal magnetic resonance imaging (MRI) showed a pancreatic head mass of 36 mm. A left vocal cord paralysis was confirmed and cervical computed tomography (CT) showed multiple thyroid nodules of up to 35 mm associated with bilateral cervical lymph nodes (LN). Positron emission tomography ( 18 F-FDG PET/CT) evidenced hyper-metabolic activity in bilateral cervical LN, lungs, pancreas and left intercostal soft tissue, as well as left gluteus. Thyroid biopsy reported a tall-cell variant of PTC, and endoscopic ultrasound guided fine needle aspiration (EUS-FNA) of pancreatic mass confirmed PTC metastasis. The molecular study was positive for BRAFV600E. Pancreatic metastasis from PTC can be accurately diagnosed with 18 F-FDG PET/CT and EUS-FNA, which is consistent with a predominant expression of BRAFV600E mutation and, thus, an aggressive presentation with poor short-term survival.


Subject(s)
Humans , Pancreatic Neoplasms/secondary , Thyroid Neoplasms/pathology , Thyroid Cancer, Papillary/pathology , Pancreatectomy , Pancreatic Neoplasms/surgery , Thyroidectomy , Thyroid Neoplasms/surgery , Treatment Outcome , Thyroid Cancer, Papillary/surgery , Lymph Node Excision , Lymphatic Metastasis
11.
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
12.
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
13.
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
14.
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
15.
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
16.
Rev. argent. cir ; 112(2): 185-188, 2020. ilus
Article in English, Spanish | LILACS | ID: biblio-1125800

ABSTRACT

La cirugía endoscópica transluminal a través de orificios naturales (NOTES) ha sido aplicada por primera vez por K. Witzel en el año 2008, introduciendo el abordaje transoral para la patología tiroidea en cadáveres y puercos. En el año 2016, A. Anuwong publicó la primera serie de casos en seres humanos por abordaje vestibular. Referimos en esta ocasión el caso de una paciente de 37 años, quien acudió a la consulta por presentar una tumoración cervical anterior de dos meses de evolución. Ecografía tiroidea con bocio polinodular. Punción aspiración con aguja fina: lesión con hiperplasia folicular en lóbulo derecho e izquierdo. Se decide realizar tiroidectomía transoral endoscópica por abordaje vestibular. La duración de la intervención fue de 180 minutos, la pérdida sanguínea fue de 20 mL. El dolor, escaso y el tiempo de internación, 36 horas. En el presente trabajo se propone el desarrollo de esta técnica y la experiencia en nuestro primer caso de tiroidectomía total en patología tiroidea benigna.


Natural orifice transluminal endoscopic surgery (NOTES) was applied for the first time by K. Witzel in 2008, introducing the transoral endoscopic resection of the thyroid gland in human cadavers and living pigs. In 2016, A. Anuwong published the first case series using the vestibular approach in humans. We report the case of a 37-year-old female patient with a mass in the anterior aspect of the neck which appeared two months before consultation. The thyroid ultrasound reported multinodular goiter. The fine-needle aspiration (FNA) biopsy reported hyperplastic follicular nodule in both lobes. The patient underwent transoral endoscopic thyroidectomy by vestibular approach. Operative time was 180 minutes and blood loss was 20 mL. Pain was minimal and hospital stay was 36 hours. We report our first experience with total thyroidectomy in a patient with benign thyroid nodules.


Subject(s)
Humans , Female , Adult , Thyroidectomy/methods , Natural Orifice Endoscopic Surgery/methods , Thyroid Gland , Thyroid Neoplasms/pathology
17.
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
18.
Arch. endocrinol. metab. (Online) ; 63(5): 536-544, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1038502

ABSTRACT

ABSTRACT Thyroid cancer has been rapidly increasing in prevalence among humans in last 2 decades and is the most prevalent endocrine malignancy. Overall, thyroid-cancer patients have good rates of long-term survival, but a small percentage present poor outcome. Thyroid cancer aggressiveness is essentially related with thyroid follicular cell loss of differentiation and metastasis. The discovery of oncogenes that drive thyroid cancer (such as RET, RAS, and BRAF), and are aligned in the MAPK/ERK pathway has led to a new perspective of thyroid oncogenesis. The uncovering of additional oncogene-modulated signaling pathways revealed an intricate and active signaling cross-talk. Among these, microRNAs, which are a class of small, noncoding RNAs, expanded this cross-talk by modulating several components of the oncogenic network - thus establishing a new layer of regulation. In this context, TGFβ signaling plays an important role in cancer as a dual factor: it can exert an antimitogenic effect in normal thyroid follicular cells, and promote epithelial-to-mesenchymal transition, cell migration, and invasion in cancer cells. In this review, we explore how microRNAs influence the loss of thyroid differentiation and the increase in aggressiveness of thyroid cancers by regulating the dual function of TGFβ. This review provides directions for future research to encourage the development of new strategies and molecular approaches that can improve the treatment of aggressive thyroid cancer.


Subject(s)
Humans , Thyroid Gland/pathology , Thyroid Neoplasms/pathology , Transforming Growth Factor beta/metabolism , MicroRNAs/metabolism , Thyroid Neoplasms/metabolism , Signal Transduction , Cell Transformation, Neoplastic , Disease Progression , Neoplasm Invasiveness , Neoplasm Metastasis
19.
Arch. endocrinol. metab. (Online) ; 63(5): 462-469, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1038501

ABSTRACT

ABSTRACT Objectives To determine the percentage of patients with papillary thyroid carcinoma (PTC) who accepted active surveillance as an alternative to surgery in our clinical practice and to describe the clinical characteristics and outcomes of patients with Bethesda category V and VI thyroid nodules who chose active surveillance. Subjects and methods We included 136 PTC patients from the Hospital de Clínicas, University of Buenos Aires without (i) US extrathyroidal extension, (ii) tumors adjacent to the recurrent laryngeal nerve or trachea, and/or (iii) US regional lymph-node metastasis or clinical distant metastasis. PTC progression was defined as the presence of i) a tumor larger than ≥ 3 mm, ii) novel appearance of lymph-node metastasis, and iii) serum thyroglobulin doubling time in less than one year. For patients with these features, surgery was recommended. Results Only 34 (25%) of 136 patients eligible for active surveillance accepted this approach, and around 10% of those who accepted abandoned it due to anxiety. The frequency of patients with tumor enlargement was 17% after a median of 4.6 years of follow-up without any evidence of nodal or distant metastases. Ten patients who underwent surgical treatment after a median time of 4 years of active surveillance (AS) had no evidence of disease after a median of 3.8 years of follow-up after surgery. Conclusion Although not easily accepted in our cohort of patients, AS would be safe and easily applicable in experienced centers.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Thyroid Neoplasms/diagnostic imaging , Watchful Waiting/methods , Thyroid Cancer, Papillary/diagnostic imaging , Thyroidectomy , Thyroid Neoplasms/surgery , Thyroid Neoplasms/pathology , Follow-Up Studies , Tumor Burden , Thyroid Cancer, Papillary/surgery , Thyroid Cancer, Papillary/pathology
20.
Medisan ; 23(4)jul.-ago. 2019. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1091116

ABSTRACT

Introducción: El diagnóstico y tratamiento de pacientes con nódulo de tiroides son un desafío clínico, instrumental, imagenológico y patológico, y a pesar de que no representan un problema de salud en Cuba, afecta a un grupo importante de la población, fundamentalmente en edad laboral. Objetivo: Determinar las características clínicas, patológicas y epidemiológicas de pacientes con carcinoma bien diferenciado de tiroides. Métodos: Se realizó un estudio descriptivo y transversal de 30 pacientes con cáncer bien diferenciado de tiroides, operados en el Hospital Oncológico Conrado Benítez García de Santiago de Cuba, desde enero de 2014 hasta julio de 2017 y que recibieron tratamiento oncoespecífico, para lo cual se revisaron las historias clínicas y los informes de biopsia de cada uno. Resultados: En la serie predominaron las mujeres de 40-49 años de edad, los afectados de piel mestiza y negra, el aumento de volumen de la glándula, los nódulos hipoecogénicos, el tumor papilar, además de la infiltración capsular y la permeabilización vascular entre los factores pronósticos histológicos más comunes. Conclusiones: Existen elementos clínicos, epidemiológicos e imagenológicos para diagnosticar un presunto carcinoma bien diferenciado de tiroides.


Introduction: The diagnosis and treatment of patients with thyroid node are a clinical, instrumental, imagenological and pathological challenge, and although they does not represent a health problem in Cuba, they affect an important populational group, fundamentally in working periods. Objective: To determine the clinical, pathological and epidemiological characteristics of patients with well differentiated carcinoma of thyroid. Method: A descriptive and cross-sectional study of 30 patients with well differentiated cancer of thyroid, operated in Conrado Benítez García Oncological Hospital belonging to Santiago de Cuba was carried out from January, 2014 to July, 2017 and who received onchospecific treatment , for which the medical records and the biopsy reports were reviewed from each patient. Results: In the series the 40-49 year-old women , those patients affected of mestizo and black skin, the increase of the gland volume, the hypoechogenic nodules and the papillary tumor prevailed, besides the capsular infiltration and the vascular permeabilization among the most common histological prognosis factors. Conclusions: Clinical, epidemiological and imagenological elements exist to diagnose a presumed well differentiated carcinoma of thyroid.


Subject(s)
Thyroid Neoplasms , Thyroid Nodule , Thyroid Cancer, Papillary , Thyroid Neoplasms/pathology , Thyroid Neoplasms/epidemiology
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