Efficacy comparison of different operations in treatment of papillary thyroid carcinoma / 重庆医学

Objective To compare the operative efficacy of low collar incision and L-shaped incision plus cervical plexus preser-ving lymphadenectomy in treating papillary thyroid carcinoma.Methods 9 3 inpatients with papillary thyroid carcinoma were ran-domly divided into the low collar incision group (n=37)and the L-shaped incision group(n=56)according to the random number table.The low collar incision group underwent the low collar type cervical plexus preserving lymphadenectomy,while the L-shaped incision group received the L-incision cervical plexus preserving lymphadenectomy.The postoperative 24-month follow up was per-formed.Then the clinical efficacy and the life quality of the patient were evaluated and compared between the two groups.Results (1)1 case of lymph node recurrence in the district Ⅱ after 20 months was found in the low collar incision group,1 case of lymph node recurrence in the district Ⅰ after 12 months and 1 case of lymph node recurrence in the districtⅣ after 22 months was found in the L-shaped incision group;no case of distant metastasis in the low collar incision group occurred during the follow up period, but 1 case of pulmonary metastasis in postoperative 5 months and 1 case of bone metastasis in postoperative 24 months occurred in the L-shpaed incision group.The differences in the occurrence rates of postoperative recurrence and metastasis had no statistical sig-nificance (2.70%vs.7.14%).(2)The scores of neck shoulder pain and numbness,incision appearance satisfaction degree in the low collar incision group were significantly higher than those of the L-shaped incision group (P<0.05).Conclusion Compared wtih L-shaped incision cervical lymphadenectomy,low collar incision cervical plexus preserving cervical lymphadenectomy has simi-lar high clinical efficacy,can significantly reduce neck shoulder pain and numbness,meet aesthetic requirements and especially is suitable for the patients with higher demands of the neck function preserving and the neck appearance.

Aggressive form of thyroglossal duct cyst carcinoma: role of ablative dose of Iodine-131

Ectopic thyroid tissue carcinoma is very rare and has usually good prognosis. It could arise in 1 percent of thyroglossal duct cysts (TDC), the most common nonodontogenic cysts that occur in the neck, which results from a failure in obliterating the embryogenic duct produced during thyroid migration. TDC is most often diagnosed during the childhood but may be discovered later in adult age. In most of the cases reported in the literature, thyroid carcinoma arising in the TDC is limited to the cyst without local extension and its efficient treatment consist of the surgical removal of the cyst by Sistrunk's operation. However, some controversies remain regarding the indication of total thyroidectomy when thyroid investigations are normal. Cases of aggressive thyroid carcinomas of the TCD with metastatic cervical lymph nodes are exceptional, mainly when histological findings of the thyroid gland are normal. We report a case of an aggressive form of a thyroglossal duct cyst carcinoma complicated with several infiltrated cervical lymph nodes but normal thyroid gland. The therapeutic strategy adopted in this case shows the decisive role of the post-operative ablative dose of Iodine-131 both for treatment and staging of aggressive form of thyroid carcinoma arising in thyroglossal duct cyst.

Carcinoma papilar quístico y del tiroides: Estudio de 4 casos / Tryroid cyst papillary carcinoma: Study of four cases

Se presentaron 4 casos de carcinoma papilar quístico en el período de 4 años. Se realizó examen físico de todos los casos; se encontró una masa cervical firme en la cara anterior del cuello y en 2 de ellos, se palparon adenopatías cervicales. Se aplicaron técnicas de imagen (ecografía cervical y gammagrafía tiroidea); se completó el estudio con BAAF, que tuvo valor diagnóstico en el 75 % de los casos. Se realizó un estudio anatomopatológico de todas las piezas obtenidas. Se hizo la resección del quiste, biopsia intraoperatoria y si se confirmó el diagnóstico de carcinoma papilar quístico, se le realizó una tiroidectomía total y si fue necesario, linfadenectomía. Se completó el tratamiento con I131 a dosis ablativa y tratamiento hormonal supresor de la TSH. Se destacó el papel de la BAAF en el estudio preoperatorio.

4 cases of cyst papillary carcinoma in a period of 4 years were presented. All of them underwent physical examination. A firm cervical mass was found in the anterior side of the neck and cervical adenopathies were palpated in 2 of them. Imaging techniques (cervical echography and thyroid gammagram) were applied. The study was completed with FNAB, which had a diagnostic value in 75 % of the cases. An anatomopathological study of all the pieces obtained was conducted. Resection of the cyst and intraoperatory biopsy were performed. In those cases with confirmed diagnosis of cyst papillary carcinoma, total thyroidectomy was carried out and, if necessary, lymphadenectomy. The treatment was concluded with I131 at ablative doses and TSH -supressing hormonal treatment. The role of FNAB in the preoperative study was stressed.