Follicular and Hurthle cell carcinoma of the thyroid in iodine-sufficient area: retrospective analysis of Korean multicenter data

BACKGROUND/AIMS: Follicular thyroid carcinoma (FTC) and Hurthle cell carcinoma (HCC) of the thyroid are relatively uncommon thyroid malignancies in iodine-sufficient areas. In this study we evaluated the clinical behavior, prognostic factors and treatment outcomes of FTC and HCC in Korea. METHODS: This multicenter study included 483 patients with FTC and 80 patients with HCC who underwent an initial surgery between 1995 and 2006 in one of the four tertiary referral hospitals in Korea. We evaluated clinicopathological factors associated with distant metastases and recurrence during a median of 6 years of follow-up. RESULTS: HCC patients were significantly older (49 years vs. 43 years; p < 0.001) and had more lymphovascular invasions (22% vs. 14%; p = 0.03) compared with FTC patients. Distant metastases were confirmed in 40 patients (8%) in the FTC group and in two patients (3%) in the HCC group (p = 0.07). Distant metastases were significantly associated with older age, widely invasive cancer and extrathyroidal invasion. Only 14 patients (3%) had recurrent disease and there was no significant difference between FTC and HCC groups (p = 0.38). Recurrence was associated with larger tumor size and cervical lymph node metastasis. CONCLUSIONS: HCC patients were older and had more lymphovascular invasions than FTC patients. However, FTC and HCC patients had similar initial clinicopathological features. Older age, wide invasiveness and extrathyroidal invasion were independent risk factors for predicting distant metastases in FTC and HCC patients.

Estrumosis peritoneal: reporte de caso y revisión de la literatura / Peritoneal strumosis: a case report and literature review

Objetivo: se presenta un caso de estrumosis peritoneal para hacer una revisión de la literatura publicada acerca de las características histológicas y clínicas de estos tumores. Presentación del caso: paciente de 48 años de edad con historia de ooforectomía izquierda hace 34 años por tumor ovárico benigno, consulta al Hospital Universitario del Caribe, centro de referencia del departamento de Bolívar, por presentar dolor en hipocondrio izquierdo. Examen físico: masa abdominal confirmada mediante ultrasonido y tomografía computarizada abdominal. Se encontró masa retroperitoneal de 15,5 x 10,5 x 7 cm, en la laparotomía exploratoria, la cual se resecó. El análisis microscópico reveló tejido tiroideo constituido por folículos con estructura típica, lo cual indicó una estrumosis peritoneal. Materiales y métodos: se realizó una revisión bibliográfica en cinco bases de datos (Medline, Ebsco, PubMed, Science Direct y Cochrane Reviews), utilizando como encabezados de búsqueda [Título/Resumen]: peritoneal struma, peritoneal strumosis, struma ovarii. Se incluyeron 15 citas bibliográficas. Conclusiones: la estrumosis peritoneal es una lesión poco frecuente, asociada al teratoma quístico maduro del ovario, cuyo diagnóstico preoperatorio es difícil. Este es un nuevo caso publicado en la literatura mundial...

Objective: a case of peritoneal strumosis is presented for making a review of the literature published about these histological tumors and their clinical characteristics. Case presentation: a 48-year-old patient, having a history of left side oophorectomy 34 beforehand due to a benign ovarian tumor, consulted at the Caribe Teaching Hospital (a reference centre for the Bolívar department) as she had pain in the left hypochondrium. Physical exam: abdominal mass confirmed by ultrasound and abdominal computerized tomography. A 15.5 x 10.5 x 7 cm retroperitoneal mass was found during exploratory laparotomy which was removed. Microscope analysis revealed thyroid tissue consisting of follicles having typical structure, constituting a peritoneal strumosis. Materials and methods: a literature review was made of five databases (Medline, Emsco, PubMed, Science Direct and Cochrane Reviews), using search keywords [Title/Summary]: “peritoneal struma”, “peritoneal strumosis” ad “struma ovarii”; 15 bibliographical citations were included. Conclusions: peritoneal strumosis is an infrequently occurring lesion which is associated with mature cystic teratoma of the ovary, whose pre-operation diagnosis is difficult. This is a new case published in the worldwide literature...

Adenocarcinoma tiroideo en un faisán versicolor (Phaisanus versicolor): Informe de caso / Thyroid adenocarcinoma in a versicolor pheasant (Phaisanus versicolor): Case report

Different kinds of adenocarcinoma have been described in a variety of species; nevertheless, thyroid adenocarcinomas are relatively rare in birds. In this study, pathological findings of a thyroid adenocarcinoma in a pheasant versicolor (Phasianus versicolor) are described in order to be considered in the differential diagnosis of chronic diseases in wild birds of the Galliform order. The anatomicopathological findings belonged to a six year old male pheasant, which showed respiratory difficulty without secretion 24 h before its death. At necropsy, a non-encapsulated soft tissue multinodular mass was found at tracheal bifurcation, extending to the cranial area of lungs and left side costal bones. According to the histological features and its location, the diagnosis is consistent with thyroid follicular adenocarcinoma. The present study will be useful for the differential diagnosis of chronic diseases in the pheasant versicolor species.

Diversos tipos de adenocarcinomas se han descrito en diferentes especies, pero los adenocarcinomas tiroideos son raros en aves. Aquí se describen hallazgos patológicos de un adenocarcinoma tiroideo en faisán versicolor (Phaisanus versicolor), para considerarlo en el diagnóstico diferencial de enfermedades crónicas en aves silvestres del orden Galliforme. El hallazgo anatomopatológico se describe en un faisán macho, de seis años de edad, que presentó dificultad respiratoria sin secreción 24 horas antes de morir. A la necropsia se halló masa multinodular no encapsulada de consistencia suave, desde la bifurcación de la tráquea, que se extiende hacia la parte craneal de los pulmones, hasta la cara interna de los huesos costales del lado izquierdo. Las características histológicas y localización de la neoplasia establecieron el diagnóstico de adenocarcinoma tiroideo con patrón folicular. Este trabajo deja el precedente de una lesión que puede incluirse en el diagnóstico diferencial de enfermedades crónicas para la especie faisán versicolor.

A Clinical Analysis of Recurrence in Differentiated Thyroid Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Differentiated thyroid carcinoma (DTC) is a known malignant tumor arising from the follicular epithelium in thyroid gland. Although the prognosis for patients with DTC is generally good, appropriate surgical management can further reduce recurrence and cancer death rates significantly. The therapeutic methods performed are total thyroidectomy plus radioactive iodine (131I) therapy and life-long thyroid-stimulating hormone (TSH) suppression. Histopathologically, DTC contains papillary and follicular adenocarcinoma. In numerous studies, staging systems-AMES, AGES, MACIS, etc-have been created to evaluate prognostic outcome. By applying staging systems, we have treated 394 patients with DTC since 1998. The purpose of our study was to analyze characteristics of recurrent cases and evaluate remission rates of recurrent cases according to diagnostic methods. MATERIALS AND METHOD: From January 1998 to December 2001, we performed 630 thyroidectomies and 487 malignant tumors (421 papillary, 28 follicular, 20 medullary, 12 undifferentiated carcinoma and 6 other malignant tumors). We analyzed 394 DTC cases; excluding other malignancy, 65 cases were recurrent cancer (58 papillary and 7 follicular carcinoma). The medical records of 394 patients with DTC treated at our hospital were reviewed retrospectively. We analyzed impact of primary surgery on recurrence in 65 recurrent patients and compared the remission rates of those patients using physical examination with those using laboratory tests and imaging studies. RESULTS: 347 patients with DTC were treated initially in our hospital and 18 patients showed recurrence. Among them, lobectomy was performed as a primary surgery in 69 patients of whom one (1.4%) had recurrence. Forty-seven patients with DTC treated initially in other hospitals were referred to our hospital. Lobectomy was performed as a primary surgery in 23 patients (54.7%). Recurrence of 32 patients was detected by palpation. Of these patients, the remission rate was 25.0%, whereas patients diagnosed by laboratory tests and imaging systems showed 53.3% remission rate (p=0.056). CONCLUSION: The extent of primary thyroid resection appeared to have significant impact on the recurrence of DTC. In view of this, we should apply staging system strictly in treating DTC-total thyroidectomy and central neck dissection in high-risk groups. In following up patients, we should check the thyroglobulin level and use image tests like computed tomography and positron emission tomography to detect recurrence earlier.