An apparent primitive mass of the mesentery: A case report.

INTRODUCTION: Neuroendocrine tumours (NETs) are rare tumors. 55% of NETs originate in the gastrointestinal tract and the liver is the most common site of distant metastases. Serum chromogranin A is the most common biomarker for assessing the extent of disease and monitoring treatment; carcinoid syndrome occurs in 19% of NETs and is characterized by chronic diarrhea or flushing. Primary mesenteric NETs are rare and have been described only in case reports in literature; our case is an apparent primary mesenteric NETs with a surgical program to remove the mesenteric mass and subrenal interaortocaval and retrocaval lymphadenectomies. PATIENT CONCERNS: A 73-year old man came to us because he had been experiencing abdominal pain for a year and he had recently developed diabetes mellitus. He was an active smoker with arterial hypertension. DIAGNOSIS: After a computed tomography scan and 68 Gallium-positron emission tomography, a diagnosis of what appeared to be a primary mesenteric NET with retrocaval and interaortocaval lymph nodes was made. Laparoscopic biopsy showed NET G2 positive for serotonin, chromogranin A, synaptophysin. INTERVENTIONS: The intraoperative finding of a primitive ileum-NET changed the surgical program. We removed the mesenteric mass with the lymph nodes of the superior mesenteric vessel and the middle distal ileum along with the cecum. OUTCOMES: The postoperative course was normal, and the patient was discharged on the seventh postoperative day without signs of short bowel syndrome. Follow-up at 6 months revealed no evidence of short bowel syndrome or disease progression. CONCLUSION: 68 Gallium-positron emission tomography does not show NETs smaller than 0.5 mm. Accurate palpation of the intestine is essential during surgery for NETs for two reasons: to find the primitive, and because of the risk of multiple intestinal primitives.

Solitary intrathyroidal metastasis of renal clear cell carcinoma in a toxic substernal multinodular goiter.

INTRODUCTION: Thyroid gland is a rare site of clinically detectable tumor metastasis. CASE REPORT: A 71-year-old woman was referred to our department for an evaluation of toxic multinodular substernal goiter. She had a history of renal clear cell carcinoma of the left kidney, which had been resected 2 years previously. US confirmed the multinodular goiter. Total thyroidectomy with neuromonitoring was performed on March 2008. A histological examination revealed a solitary metastasis of a clear cell renal cancer in a diffuse multinodular goiter. No distant metastases are detected. CONCLUSION: Although uncommon, it is important for the endocrine surgeon and endocrine oncologist to be able to recognize and differentiate intrathyroid metastases from more primary common thyroid neoplasms. The diagnosis can be suspected if the patient has a thyroid tumor and a past history of extrathyroid cancer. These tumors, on the whole, tend to behave more aggressively and, in most cases, the use of multimodality therapy is recommended.

Prospectives and surgical usefulness of perioperative parathyroid hormone assay in thyroid surgery.

Hypocalcemia is the most frequent complication after thyroid surgery. The incidence varies and has been reported as ranging from 1.2 to 40%. Permanent hypoparathyroidism occurs in less than 3% of patients, whereas transient postoperative hypocalcemia is much more common. Postoperative hypoparathyroidism is traditionally detected by serial measurement of serum calcium concentrations and requires multiple venepunctures and, potentially, several days of hospitalization following the procedure. The parathyroid hormone (PTH) molecule is a polypeptide composed of an 84-amino acid sequence with an active amino terminal on one end and an inactive carboxyl unit on the other. Measurement of the intact PTH (iPTH) is an accurate representation of the true parathyroid state. In recent years, iPTH assay has been under investigation for thyroid surgery in many centers as an early iPTH measurement may be of value for prediction of postoperative symptomatic hypocalcemia, guiding the surgeon for parathyroid autotransplatation, and selection of patients requiring onset of calcium substitution or safe discharge home. This paper reviews the relevant medical literature published regarding the influence of PTH assay technology on the quality of thyroid surgery, as well as on the prevention of postoperative symptomatic hypocalcemia. Searches were last updated in April 2008.

Safe incorporation of new technologies in thyroid surgery.

The history of thyroid surgery starts with Billroth, Kocher and Halsted, who developed the technique for thyroidectomy between the years of 1873 and 1910. In general the essential objectives for thyroidectomy are: sparing the parathyroid glands, avoidance of injury to the laryngeal nerves, an accurate hemostasis and an excellent cosmesis. In the last 10 years, major improvements and new technologies have been proposed and applied in thyroid surgery. These include mini-invasive thyroidectomy, new devices for achieving hemostasis and dissection, regional anesthesia, intraoperative neuromonitoring, parathyroid hormone assay technology and genetic screening. This paper reviews the relevant medical literature published on the influence of these new technologies on the quality of thyroid surgery, as well as prevention of postoperative morbidity and mortality. Searches were last updated in April 2008.