ABSTRACT
BACKGROUND: Papillary thyroid microcarcinomas are tumors often found accidentally after thyroidectomy for other thyroid disorders. METHODS: Patients with enlarged lateral cervical masses, with unknown thyroid disease, found to have metastases from papillary thyroid carcinoma =10 mm in diameter, were compared to patients operated on for nodular or multinodular goiter, who were incidentally found to have papillary thyroid microcarcinomas. RESULTS: Group A included 24 patients with an enlarged lateral cervical mass whereas group B included 30 patients presenting with nodular or multinodular goiter. Patients in both groups underwent surgery. After thyroidectomy and lymph node dissection, pathology revealed multifocal papillary carcinomas of 1-10 mm, with invasion of the thyroid capsule and surrounding soft tissue in most of the cases in group A. Two patients presented with distant metastases at diagnosis which were surgically removed. During follow up, 3 patients (12.5%) presented with new cervical metastases which were surgically removed or treated with additional radioactive iodine. At last follow-up, all patients were alive. In contrast, all patients in group B had unifocal papillary thyroid carcinoma 1-10 mm in maximum diameter, with no infiltration or extension into the adjacent tissue, or cervical lymph node metastases. CONCLUSION: Two groups of papillary thyroid microcarcinomas characterized by different clinical and biological behaviours are identified. Significant differences were found between these groups concerning the age, tumor size, number of tumor foci, lymph nodes metastases and extrathyroidal extension of the tumor. Papillary thyroid carcinomas of small (=10 mm) size may have aggressive behaviour or be metastatic, and this subgroup should be treated and followed up as are other large, differentiated thyroid cancers.
ABSTRACT
BACKGROUND: Thyroid carcinoma has been reported in patients operated for different types of hyperthyroidism and the probability of a hot nodule being malignant seems to be low. The aim of the present study was to explore the relationship between thyroid cancer, hyperthyroidism and outcome in a large cohort of patients who presented to a tertiary cancer centre in Northern Greece. PATIENTS: Among 720 patients treated for thyroid cancer, 60 had a concomitant diagnosis of hyperthyroidism due to Graves' disease (n=14), solitary autonomous adenoma (n=17), or multinodular goiter (n=29). Adverse prognostic factors were common in patients with a previous history of hyperthyroidism at the time of diagnosis of thyroid cancer, including cases where the cancer was discovered coincidentally after thyroid surgery for hyperthyroidism and cases where tumor size was more than 10 mm. RESULTS: In 10 out of 17 patients with hyperthyroidism due to solitary autonomous adenomas, the tumor was located within the hot nodule and two of these patients developed local and distant metastases and died from the disease 4 and 15 years after thyroidectomy. CONCLUSION: Clinicians managing patients with hyperthyroidism need to be aware of the possible increased risk of thyroid cancer in this patient group.
Subject(s)
Hospital Mortality/trends , Hyperthyroidism/complications , Hyperthyroidism/mortality , Thyroid Neoplasms/complications , Thyroid Neoplasms/mortality , Aged , Cohort Studies , Female , Follow-Up Studies , Humans , Hyperthyroidism/pathology , Male , Middle Aged , Oncology Service, Hospital/trends , Thyroid Neoplasms/pathologyABSTRACT
Medullary thyroid carcinoma (MTC) as a neuroendocrine tumour arising from C cells of the thyroid gland secrets hormonal peptides; among them, calcitonine (CT) and carcino-embryonic antigen (CEA). These two peptides are used for the diagnosis and treatment response of MTC cases. In patients with advanced MTC, scintigraphy by [(111)In-DTPA-d-phe1]-octreotide is able to detect somatostatin receptors (SSTR) and thus identify regional lymph nodes and/or distal metastases. In this article, we have studied the use of [(111)In-DTPA-d-phe1]-octreotide in the treatment of patients with advanced MTC, and a positive octreotide scan. Twenty-two patients were studied, 16 with persistent MTC and six with relapsed MTC. All patients' tumours were detected by [(111)In-DTPA-d-phe1]-octreotide-scan to be SSTR positive. All patients were treated with the somatostatin analog (SST-A) octreotide, for 3-21 months. Nine patients were treated only with SST-A (Group A). The remaining 13 patients (Group B) received adjuvant treatment as follows: six patients received chemotherapy (Ch), five patients received both Ch and external radiotherapy (eRT) and two patients received only eRT. Results were as follows: Group B patients as compared to Group A patients had about the same objective and biological response. Patients of Group B had relatively better subjective response (less diarrheas and abdominal cramps) versus Group A patients, although this finding was not significant. Group B patients had a longer mean survival time after treatment as compared to Group A patients: 39 months (with a range of 4-72 months) versus 20 months (with a range of 3-60 months) respectively, (P<0.05). Also Group B patients had longer than Group A patients mean total survival time - measured from the start of the disease: 138 (18-270) versus 97 (13-235) months respectively (P<0.05). Based on the above findings, it is the opinion of the authors that patients with advanced MTC and SSTR tumor expression in vivo as indicated by [(111)In-DTPA-d-phe1]-octreotide scanning, when submitted to treatment with SST-A octreotide and adjuvant Ch and/or eRT treatment may have a better treatment response than if submitted to treatment with SST-A octreotide alone. More cases are being studied by us at the present.
Subject(s)
Carcinoma, Medullary/diagnostic imaging , Carcinoma, Medullary/radiotherapy , Octreotide/analogs & derivatives , Pentetic Acid/analogs & derivatives , Thyroid Neoplasms/diagnostic imaging , Thyroid Neoplasms/radiotherapy , Adolescent , Adult , Aged , Carcinoma, Medullary/drug therapy , Carcinoma, Medullary/mortality , Chemotherapy, Adjuvant/methods , Child , Female , Greece/epidemiology , Humans , Male , Middle Aged , Pentetic Acid/therapeutic use , Prognosis , Radionuclide Imaging , Radiopharmaceuticals/therapeutic use , Risk Assessment/methods , Risk Factors , Severity of Illness Index , Survival Analysis , Survival Rate , Thyroid Neoplasms/drug therapy , Thyroid Neoplasms/mortality , Treatment OutcomeABSTRACT
OBJECTIVE: To define clinical presentation, surgical complications, follow-up characteristics, and survival of 23 children and adolescents with thyroid carcinoma. DESIGN: Retrospective analysis of data of 23 children and adolescents with thyroid carcinoma cared for in the Theagenion Cancer Hospital, Thessaloniki. RESULTS: At the time of diagnosis cervical lymph node metastases were present in 18 (78.2%), mediastinal in 2 (8.69%), and pulmonary in 3 patients (13%). Total thyroidectomy was performed in 21 patients, with lymph node dissection in 18 and subtotal thyroidectomy in 2. No significant post-operative complications were observed. Histological examination revealed differentiated thyroid carcinoma (DTC). Tumor was multifocal in 11 (47.8%) and bilateral in 7 subjects (63.6%). Thyroid capsule invasion, vascular invasion, soft tissue involvement, and parathyroid gland invasion was observed in 12 out of 23 patients (52.1%). All patients received thyroxine suppressive therapy and 21 of them additional therapy with radioactive iodine (131I). During follow-up (5.5 years), 6 out of the 23 patients presented new metastases in the cervical and mediastinal lymph nodes, lungs, and bones. At last follow-up, 11 patients (47.8%) had residual disease but all were alive. CONCLUSIONS: Thyroid carcinoma in children and adolescents can be quite aggressive. When a young patient presents thyroid nodule or multinodular goiter or palpable lymph nodes, the existence of thyroid carcinoma must be seriously considered.
Subject(s)
Carcinoma/secondary , Carcinoma/therapy , Lung Neoplasms/secondary , Neoplasm Invasiveness/pathology , Thyroid Neoplasms/pathology , Thyroid Neoplasms/therapy , Adolescent , Biopsy, Needle , Carcinoma/mortality , Child , Cohort Studies , Female , Follow-Up Studies , Greece , Humans , Immunohistochemistry , Iodine Radioisotopes/therapeutic use , Lung Neoplasms/mortality , Lung Neoplasms/pathology , Lung Neoplasms/therapy , Lymph Node Excision/methods , Male , Neoplasm Staging , Radiotherapy, Adjuvant , Retrospective Studies , Risk Assessment , Survival Analysis , Thyroid Neoplasms/mortality , Thyroidectomy/methods , Treatment OutcomeABSTRACT
Brain metastasis is an uncommon complication of differentiated thyroid carcinoma. Even more, cerebellar metastases from papillary thyroid carcinoma (PTC) are exceptional. We report a 69-year-old male patient with infiltrative PTC who developed high levels of thyroglobulin (Tg) and deteriorated neurological symptoms four years after the initial diagnosis. Computerized tomography (CT) of the brain demonstrated a cerebellar mass and the patient underwent surgery. Pathology revealed metastasis from PTC. Immunochemistry was positive for Tg. The patient had no other sites of distant metastases. Although PTC has generally a good prognosis, metastases to the cerebellum can occur, even as the first metastatic site, despite the fact that appropriate therapy (surgery, radioactive iodine therapy, TSH suppression therapy, chemotherapy and external radiotherapy) had been given for the primary tumour.
Subject(s)
Carcinoma, Papillary/secondary , Cerebellar Neoplasms/diagnosis , Cerebellar Neoplasms/secondary , Thyroid Neoplasms/pathology , Adult , Antineoplastic Agents/therapeutic use , Carcinoma, Papillary/blood , Carcinoma, Papillary/pathology , Carcinoma, Papillary/therapy , Cerebellar Neoplasms/diagnostic imaging , Cerebellar Neoplasms/therapy , Combined Modality Therapy , Humans , Immunohistochemistry , Male , Thyroglobulin/analysis , Thyroglobulin/blood , Thyroid Neoplasms/blood , Thyroid Neoplasms/therapy , Thyroidectomy , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: The case of a 60-year-old male patient with follicular thyroid cancer who developed a pituitary mass proved to be a metastasis from thyroid cancer. METHODS: Assessment with whole-body scan, ultrasound, computed tomography and thyroglobulin measurements. RESULTS: Despite surgery and repeated doses of radioiodine, the patient developed diplopia and ptosis of the right eyelid, along with increasing thyroglobulin levels. A pituitary mass was discovered, with no signs of pituitary deficiency. The mass was removed and found to consist of neoplastic cells immunohistochemically positive to thyroglobulin. CONCLUSIONS: Distant metastases may develop in cases of follicular thyroid carcinoma, even after repeated doses of (131)I. Metastatic follicular thyroid carcinoma to the pituitary is a rare entity.