Outcomes of patients with bone metastases from differentiated thyroid cancer

ABSTRACT Objective Bone metastases (BM) from differentiated thyroid cancer (DTC) are associated with poor survival rates. Due to the low frequency of this entity, we performed a multicentric retrospective study that aimed to evaluate the presentation, outcome and causes of death in this population. Subjects and methods We reviewed file records from 10 databases. BM were diagnosed by: i) biopsy and/or ii) radioiodine (RAI) bone uptake + elevated thyroglobulin (Tg) levels and/or c) bone uptake of 18-FDG in the PET-CT scan + elevated Tg levels. Results Fifty-two patients with DTC were included (44% male, mean age 54 years); 58% had papillary histology. BM were synchronous with DTC diagnosis in 46% of the participating cases. BM were symptomatic in 65% of the cases. Multiple BM were present in 65% of patients, while simultaneous metastatic disease in additional sites was found in 69%. Ninety-eight percent of patients received treatment for the BM, which included RAI therapy in 42 patients; 30 of them received cumulative RAI doses that were larger than 600 mCi 131I. The mean follow-up after a BM diagnosis was 34 months. The 2- and 5-year survival rates after diagnosis of the first BM were 64% and 38%, respectively. The status on the last evaluation was DTC-related death in 52% of the patients; 26% of them died from direct complications of BM or their treatments. Conclusion BM are usually radioiodine-refractory and are associated with a short overall survival, although most of the patients died of causes not directly related to the BM.

Carcinoma papilar de tiroides localmente invasivo en tráquea: Tratamiento oncológico y posterior traqueoplastia alejada por dehiscencia de anastomosis traqueal / Locally invasive papillary thyroid carcinoma with tracheal invasion: Oncological treatment and subsequent remote tracheoplasty due to tracheal anastomotic dehiscence

Introducción: El objetivo del tratamiento del carcinoma diferenciado de tiroides con invasión traqueal es resecar satisfactoriamente la enfermedad conservando las funciones. Caso clínico: Mujer de 27 años, con masa tiroidea con compromiso traqueal evidenciado por tomografía computarizada. Se efectuó tiroidectomía total, linfadenectomía central y selectiva II-V bilateral, resección segmentaria y anastomosis traqueal. En el postoperatorio presentó dehiscencia de la anastomosis, requiriendo traqueostomía. Posteriormente, se efectuó traqueoplastia con evolución favorable. Discusión: La resección traqueal segmentaria es de elección en casos de compromiso local sin enfermedad a distancia. La traqueoplastia permite obtener un resultado funcional satisfactorio en estos casos en centros de alto volumen.

Introduction: The aim of surgery in well-differentiated thyroid cancer with tracheal invasion is to remove all the tumour while preserving functional structures. Clinical case: A 27 year old female presented with a thyroid mass with tracheal invasion on the computed tomography. She underwent total thyroidectomy, bilateral central compartment and selective II-V neck dissection, and tracheal resection with end-to-end anastomosis. She subsequently had anastomotic dehiscence, which required a tracheostomy. Tracheoplasty was later performed with good functional results. Discussion: Segmentary tracheal resection is the procedure of choice in differentiated thyroid cancer with local invasion and with no distant disease. Tracheoplasty, performed in highvolume centres, leads to a satisfying functional outcome.

Soft tissue metastases from differentiated thyroid cancer diagnosed by 18F FDG PET-CT / Metástases em tecidos moles de câncer de tireoide diagnosticadas por 18F FDG PET-CT

Distant metastases of differentiated thyroid cancer are unusual; lung and bones are the most frequently affected sites. Soft tissue metastases (STM) are extremely rare. We describe two cases of patients with differentiated thyroid cancer metastasizing to soft tissues. Both patients had widespread metastatic disease; clinically asymptomatic soft tissue metastases were found by 18-Fluordeoxyglucose positron emission tomography/computed tomography (18F FDG PET-CT), and confirmed by cytological and/or histopathological studies. These findings underscore the ability of 18F FDG PET-CT in accurately assessing the extent of the disease, as well as the utility of the method to evaluate regions of the body that are not routinely explored.

As metástases a distância em carcinoma diferenciado de tireoide são raras. Pulmão e ossos são os lugares mais frequentemente atingidos. As metástases em tecidos moles são extremamente infrequentes. Neste artigo, descrevemos dois casos de pacientes com câncer diferenciado de tireoide com metástases em tecidos moles. Ambos os pacientes padeciam de enfermidade avançada. As metástases em partes moles foram assintomáticas e detectadas mediante 18-Fluordeoxyglucose positron emission tomography/computed tomography (18F FDG PET-CT), sendo confirmadas por citologia e/ou histopatologia. Esses achados ressaltam o valor do 18F FDG PET-CT para a avaliação correta da extensão da enfermidade e a utilidade do método para avaliar regiões do corpo que não são exploradas nos estudos de rotina.

Síndrome de Frey por submaxilectomía y tratamiento con toxina botulínica / Frey syndrome secondary to submaxillectomy and botulinic treatment

El síndrome de Frey (SF) se caracteriza por rubor, calor y sudación en la región maseterina y geniana durante las comidas. El SF se observa en el 20-60% de los pacientes sometidos a parotidectomía. Presentamos un caso con SF secundario a la ablación de la glándula submaxilar en un varón de 30 años de edad, sin antecedentes patológicos, que consultó en el año 2000 por adenopatía cervical izquierda. La misma fue biopsiada y la anatomía patológica informó carcinoma medular de tiroides. El paciente presentaba múltiples metástasis hepáticas y pulmonares, motivo por el cual recibió tratamiento quimioterápico con cisplatino plus doxorrubicina (seis ciclos) con respuesta completa, finalizando dicho esquema en marzo del 2002. En julio del 2002 se realizó tiroidectomía total más vaciamiento ganglionar izquierdo con resección de la glándula submaxilar. Durante la cirugía se lesionó la rama mentoniana del nervio cervicofacial, rama del VII par craneal. En septiembre del 2004 consultó por episodios de sudación durante las comidas en la región submaxilar izquierda. Se realizó prueba de Minor y luego se procedió a aplicar toxina botulínica tipo A en la región afectada, a razón de 2.5 UI por punto (cm2), a un total de 17 puntos. El control a los 21 días demostró más de un 95% de efectividad en la resolución del SF. El efecto duró un año, y una segunda reinfiltración mostró similar respuesta. No hallamos descripciones anteriores de SF en región submaxilar; se presenta su tratamiento satisfactorio con toxina botulínica tipo A.

A case of Frey syndrome (FS) secondary to submaxillar gland exeresis is presented and the results of the treatment with botulinum toxin (BTX) type A. FS is a condition of sweating cheek and preauricular area during mealtime as a sequel detected in about 20-60% of patients after parotidectomy. The clinical symptoms include swelling, flushing and hyperhidrosis. The treatment choice for this condition is intracutaneous injection of BTX type A which blocks acetylcholine release at the sweat glands. A 30-year-old man, with thyroid medullar carcinoma diagnosed in 2002 received 6 cicles of cisplatin plus doxorubicin previous to the thyroidectomy with anterolateral neck dissection. During surgery the left ramus marginalis mandibulae was damaged. Two years later the patient referred sweating in submaxillar region during meals. CT scan demonstrated the absence of left submaxillar gland. Minor's test disclosed the affected area and BTX type A was injected (2.5 U/cm2/17 points). A twenty-one-day control showed a 95% reduction of the affected skin area. Persistent efficacy was observed up to one year followup time when he was reinjected. The FS, also known as "gustatory hyperhidrosis", was probably first reported by M. Duphenix in 1757. Lucja Frey considered its physiopathology as a disorder of both sympathetic and parasympathetic innervation. In our case the FS was caused by a misdirected regeneration of postganglionic parasympathetic nerve fibers that arrised from the nervus lingualis rami ganglionares of the nervus trigeminus. After nerve injury the colinergic parasympathetic fibers seek out colinergic receptors -sympathetic receptors of the skin- innervating sweat glands and small skin vessels. All previous cases were located at masseter region post-parotidectomy. We have not found any description of FS in the submaxillary region. The self-assessed efficacy of the treatment with a hyperhidrosis disease severity scale revealed a very satisfied patient at 20 months follow-up after being injected twice with BTX type A.

Evaluación del estado nutricional en pacientes con Esclerosis Lateral Amiotrófica. Comparación del valor de diferentes parámetros antropométricos / Evaluation of the nutritional condition in patients with amyotrophic lateral sclerosis. Comparison amongst different anthropometric measurements

En los pacientes con Esclerosis Lateral Amikotrófica (ELA) el déficit nutriciional es un factor predictivo negativo indpendiente de sobrevida. Por este motivo, la intervención nutricional es parte del tratamiento paliativo. Nuestro objetivo fue evaluar el estado nutricional en pacientes con ELA