ABSTRACT
La tiroidectomía es el procedimiento más común en cirugía endocrina. La incisión cervical de Kocher es el «gold standard» para abordar el tiroides desde que fuera presentado por este a finales del siglo xix. Desde entonces, la tiroidectomía tal y como ahora la conocemos ha demostrado ser una técnica eficaz y segura, pero no por ello ha dejado de evolucionar habiendo conseguido además unos indicadores de calidad difíciles de superar. El advenimiento de nuevas tecnologías y un intento constante por mejorar la cosmética de la cirugía han dado lugar a «nuevos abordajes». En este artículo hacemos una revisión de estos intentando mostrar sus beneficios y limitaciones. Actualmente, ninguno ha demostrado ser mejor que la cirugía convencional más allá del valor añadido del beneficio cosmético, pero permanecerán si demuestran que han sido eficientes en el tratamiento de la enfermedad y en mejorar la calidad de vida de nuestros pacientes. (AU)
Thyroidectomy is the most frequent procedure in endocrine surgery. The conventional approach through a collar incision, as described by Kocher in XIXth century, has become the gold standard. It is continuously evolving in spite of, many years ago, it showed to be safe and efficient with quality standards difficult to beat. Endoscopic and robotic surgery have developed new approaches to thyroid in order to improve the cosmetic results, looking even for invisible scars. We have done a thoughtful review of most of them trying to understand their benefits and drawbacks. Currently none of these new approaches have been shown to be better than conventional open thyroidectomy beyond offering a better cosmetic result. Besides, only a small percentage of patients can benefit of them. However, most of these approaches will remain if they treat the diseased thyroid and also improve the quality of life of our patients. (AU)
Subject(s)
Humans , Thyroidectomy , Thyroid Gland/surgery , Robotic Surgical Procedures , Cicatrix , EndoscopyABSTRACT
SUMMARY Medullary thyroid carcinoma (MTC) is a relatively rare neuroendocrine tumor that originates in the parafollicular C cells of the thyroid gland. It is characterized by the synthesis and secretion of calcitonin. Usually, serum calcitonin is used as part of the diagnosis and follow-up of these patients. Few cases of MTC with negative calcitonin have been reported worldwide, whose diagnosis is a clinical challenge.
El carcinoma medular de tiroides (MTC) es un tumor neuroendocrino relativamente raro que se origina en las células C para foliculares de la glándula tiroides. Se caracteriza por la síntesis y secreción de calcitonina. Por lo general, la calcitonina sérica se utiliza como parte del diagnóstico y seguimiento de estos pacientes. Se han notificado pocos casos de MTC con calcitonina negativa en todo el mundo, cuyo diagnóstico es un desafío clínico.
ABSTRACT
Thyroidectomy is the most frequent procedure in endocrine surgery. The conventional approach through a collar incision, as described by Kocher in XIXth century, has become the "gold standard". It is continuously evolving in spite of, many years ago, it showed to be safe and efficient with quality standards difficult to beat. Endoscopic and robotic surgery have developed "new approaches" to thyroid in order to improve the cosmetic results, looking even for invisible scars. We have done a thoughtful review of most of them trying to understand their benefits and drawbacks. Currently none of these "new approaches" have been shown to be better than conventional open thyroidectomy beyond offering a better cosmetic result. Besides, only a small percentage of patients can benefit of them. However, most of these approaches will remain if they treat the diseased thyroid and also improve the quality of life of our patients.
ABSTRACT
The intrathyroidal thymic carcinoma is a rare neoplasm. The probable origin of this neoplasm is the presence of ectopic thymic tissue or remnants of the third and fourth branchial arch. The case of a 49-year-old female with an initial diagnosis of medullary thyroid cancer is presented. When she was operated for regional recurrence, 16 years later, the pathology report demonstrates the presence of a intrathyroidal thymic carcinoma. Intrathyroidal thymic carcinoma is considered an independent type of thyroid carcinoma because this entity has specific clinical-pathological characteristics similar to thymic carcinomas and different prognosis than known thyroid carcinomas. We present the case of a patient initially treated as having a medullary thyroid carcinoma who, upon presenting recurrence, the presence of intrathyroidal thymic carcinoma was demonstrated.
El carcinoma tímico intratiroideo es una neoplasia rara. El origen probable de esta neoplasia es la presencia de tejido tímico ectópico o de restos del tercer y cuarto arcos branquiales. Se presenta el caso de una mujer de 49 años con diagnóstico inicial de cáncer medular de tiroides. Cuando fue operada por recurrencia regional, 16 años después, se demostró la presencia de un carcinoma tímico intratiroideo, que se considera un tipo independiente de carcinoma tiroideo debido a que tiene características clínico-patológicas específicas similares a los carcinomas tímicos y un pronóstico diferente a los carcinomas de tiroides conocidos. Este caso se trató inicialmente como carcinoma medular de tiroides y al presentar recurrencia se demostró la presencia de un carcinoma tímico intratiroideo.
Subject(s)
Thymoma , Thymus Neoplasms , Thyroid Neoplasms , Diagnostic Errors , Female , Humans , Middle Aged , Neoplasm Recurrence, Local , Thymoma/diagnostic imaging , Thymoma/surgery , Thymus Neoplasms/diagnostic imaging , Thymus Neoplasms/surgery , Thyroid Neoplasms/diagnosis , Thyroid Neoplasms/surgeryABSTRACT
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