Warthin-like papillary thyroid carcinoma: a case report and comprehensive review of the literature.

Background: Papillary Thyroid Carcinoma (PTC) is the most frequent endocrine malignancy with a variety of histological presentations. Warthin-like Papillary Thyroid Carcinoma (WLPTC) is an uncommon neoplasm that is recognized as a distinct subtype of PTC in the WHO classification of thyroid tumors. In this report, we present a novel case of WLPTC in a female patient and provide an in-depth review of the available literature on its clinical, pathological, and therapeutic characteristics. Case presentation: A 27-year-old female patient was referred for neck swelling. Ultrasound showed two suspicious thyroid nodules leading to a thyroidectomy. She was diagnosed with intermediate-risk bifocal foci of classic PTC and WLPTC, arising from a background of chronic lymphocytic thyroiditis (CLT). This pT1b(m) N1b M0 malignancy was treated with adjuvant isotopic ablation and suppressive thyroxine therapy. The 1-year outcomes were favorable. Literature review: It covered articles published from 1995 to 2022, by searching PubMed and Google Scholar using specific terms. Out of 148 articles reviewed by two authors, 25 relevant articles were selected, including 13 case reports and 12 case series. The study included 150 cases of WLPTC. Data related to clinical presentation, imaging, histological features, management, and outcomes, were extracted. The mean age of diagnosis was 39 years, with a female predominance. The most common clinical presentation was neck swelling. Thyroid autoimmunity was positive in 71.6% of patients. Lymph node metastases were present in 28% of cases, with no reported distant metastases. Overall, the outcomes were favorable. Conclusion: WLPTC shares similar clinical and radiological presentations as classic PTC. The hallmark histological features of WLPTC are papillae lined with oncocytic tumor cells with papillary nuclear changes and lymphoid stroma. WLPTC is almost constantly associated with CLT. The management of WLPTC aligns with that of classic PTC with comparable stage and risk category, often resulting in favorable outcomes.

Cost analysis of a medical procedure using the full cost method: The example of a trans-thoracic scan-guided biopsy.

INTRODUCTION: Trans-thoracic scan-guided biopsy (TTB) is a crucial examination for exploring thoracic lesions, particularly in the case of tumor pathologies. To make informed decisions in cost-effectiveness analyses, it is important to understand the actual costs of this procedure. AIM: To quantify the cost of performing TTB using a microeconomic approach. METHODS: We used the full cost method, which is the reference method in cost accounting. This method subdivides costs into direct and indirect costs. Direct costs are divided into variable and fixed components. Variable costs include consumables and wages of personnel involved in the "labor" act. Fixed direct costs are those that do not vary during the study period; they include the costs of purchasing, depreciation, maintenance, and repair of the scanner room equipment. Indirect costs include overhead costs that cannot be directly attributed to the TTB procedure. RESULTS: The total direct cost of the TTB procedure amounts to 310.191 TND when using a coaxial and 256.390 TND in the absence of a coaxial, including fixed and variable costs. Indirect costs were not included in this study due to the absence of cost accounting at the hospital. CONCLUSION: Accurate knowledge of the costs of any medical procedure is essential for making informed decisions in cost-effectiveness analyses. This study provides a precise estimate of the direct costs of TTB and can help improve the efficiency of resource allocation for performing this procedure.

Health-Related Quality of Life and Service Barriers among Adults with Sickle Cell Disease in Saudi Arabia.

Background: The burden of sickle cell disease (SCD) is high in Saudi Arabia, with a significant impact on patients' quality of life (QoL). This study aimed to assess the health-related quality of life (HRQoL) among adults with SCD. Methods: A cross-sectional study was conducted among adults with SCD attending hematology clinics at Qatif Central Hospital in the Eastern Province of Saudi Arabia. The questionnaire included subsections to collect information from participants, including sociodemographic attributes, SCD characteristics, HRQoL based on SF-36, and opinions regarding barriers to service. Results: Among 272 SCD patients, the highest mean score of HRQoL was observed in the social functioning (SF) domain (65.0±23.4), whereas the lowest score was observed in the role limitations due to physical health (RP) domain (47.2±40.4). The mean score for participants' opinions regarding service provision was 19.27±4.68 (min-max:10-30), and only 24.6% had a positive opinion regarding the accessibility of service provision. A total of 38.6% of the respondents acknowledged shortcomings in the services offered by healthcare staff, and 43% identified weaknesses in communication with healthcare staff. Moreover, 40.1% agreed about feeling stigmatized about their condition. SCD patients who were <40 years old, males, had a university degree, had health insurance, waited <15 minutes before receiving health care, and had positive opinions regarding service provision were more likely to have better HRQoL scores. Conclusion: Adults with SCD exhibited low HRQoL in general, and different factors were related to low HRQoL scores. Counselling, empowerment, and improvement of doctor-patient communication are important strategies to improve healthcare provision, and consequently, HRQoL among adults with SCD.

Health-related quality of life in long-term differentiated thyroid cancer survivors: A cross-sectional Tunisian-based study.

Background and Aim: The incidence of differentiated thyroid cancer (DTC) has risen dramatically worldwide. Despite an excellent prognosis, the growing DTC survivors' community often features poor health-related quality of life (HRQoL), which challenges long-term DTC care, particularly in developing Southern Mediterranean and African countries. We aimed to assess the HRQoL and to investigate its determinants in disease-free Tunisian DTC survivors. Methods: We conducted a three-month cross-sectional study that included 266 patients diagnosed with DTC. We assessed the HRQoL in eligible participants using the short form-36 health survey, in comparison with 76 healthy controls. Results: The 86 eligible DTC survivors were predominantly female (89.5%) with an average age of 44.3 ± 12.5 years. Physical-functioning (PF), role-physical (RP), and pain domains were substantially altered compared to the reference population. Age was negatively associated with PF, RP, role-emotional (RE), and social functioning (SF). Tumor size and lymph node metastases affected general health and PF, respectively. The cancer-free survival duration was positively correlated with mental health (MH). Poor neck scar healing and persistent post-operative hypoparathyroidism significantly deteriorate MH. Pain perception was positively correlated with the radioactive iodine cumulative dose. Subclinical hyperthyroidism significantly reduced PF and RP scores. TSH suppression was negatively and strongly correlated with MH and SF scores. Conclusion: HRQoL is substantially reduced in DTC survivors compared to the normative Tunisian population. These results could be extrapolated to similar individuals in other South Mediterranean and African countries. The development of coordinated multidisciplinary aftercare interventions in this region is warranted to preserve HRQoL in DTC survivors.

Evaluating the Prevalence and the Risk Factors of Gram-Negative Multi-Drug Resistant Bacteria in Eastern Saudi Arabia.

PURPOSE: Multidrug-resistant organisms (MDROs) among Gram-negative bacteria (GNB) are a major public health concern worldwide, which can even lead to death. This study was conducted to determine the prevalence of MDROs among isolated GNB in the Security Forces Hospital Dammam (SFHD) and identify its associated risk factors. MATERIALS AND METHODS: A cross-sectional study was performed on the most commonly isolated GNB in SFHD, Acinetobacter spp., Enterobacter spp., Escherichia coli (E. coli), Klebsiella pneumoniae, Proteus spp., and Pseudomonas aeruginosa, of non-duplicated clinical samples collected from all hospital units throughout the period from January 2017 to December 2018. Data were collected retrospectively from patients' medical records, and analyses were conducted using the chi-square test and logistic regression models. RESULTS: Of the 1508 GNB included in the study, 969 were multidrug-resistant (MDR; 64.3%). The most commonly identified multidrug-resistant GNB (MDR-GNB) were found in female patients (66.4%) and those aged between 20 and 29 years (21.8%). Urine samples had the highest number of isolated GNB (926 of a total of 1508, 61.4%), and E. coli isolates (53.8%) were the most frequently isolated GNB. Enterobacter spp. had the highest rate of multidrug resistance during the 2 years (64 out of 74, 86.5%). Mechanical ventilation for three or more calendar days was a significant direct risk factor for the development of MDR-GNB (odds ratio [OR]: 2.600, 95% confidence interval [CI]: 1.124-6.012, P = 0.025). CONCLUSION: Multidrug resistance is common among GNBs in SFHD. Antimicrobial stewardship programs in hospitals should be supported and implemented. Medical and public awareness of antibiotic use is another significant way to decrease the burden of MDR.

[Uveal metastasis of thyroid carcinomas. About 3 cases]. / Métastases uvéales des carcinomes thyroïdiens. À propos de 3 cas.

OBJECTIVE: To study the characteristics of ocular metastases of thyroid carcinomas through three observations of patients. RESULTS: Three patients aged respectively 41, 55 and 66 years were followed for thyroid carcinoma. All patients were treated by surgery followed by IRA therapy. They developed ocular metastases after a mean period of 10 years after thyroidectomy. They presented in addition multiple secondary sites such as bone, lungs and cerebrum. The uveal lesion was unilateral and localized at the choroid or iris. The predominant symptomatology was decreased visual acuity. The diagnosis was based on ophthalmoscopic examination and post-IRA therapy scan and was confirmed by anatomopathological study. Treatment options were respectively IRA therapy, sectoral iridectomy and enucleation. Evolution was fatal in 2 cases and towards aggravation for one case. CONCLUSION: Uveal metastases of thyroid cancer are associated with a pejorative prognosis. Ophthalmologic follow-up is necessary when patient presents warning sign mainly with metastatic follicular carcinoma. Conversely, thyroid carcinoma should be considered in the differential diagnosis of a uveal mass of unknown origin.

Clinical features of bone metastasis for differentiated thyroid carcinoma: A study of 21 patients from a Tunisian center.

INTRODUCTION: The differentiated thyroid cancers have a good prognosis unless the presence of metastasis. These distant metastases, especially in bone, are a major cause of impaired quality of life and death requiring intensive management. The aim of our work was to study the patients' data, the disease characteristics and to analyze the therapeutic management of these patients. RESULTS: This study concerned a cohort of 21 patients treated for differentiated thyroid cancer during the period from 1995 to 2011. Eighteen of our patients were aged over 45 years. A majority of them had follicular carcinoma. Bone metastases were often multiple and located at the axial skeleton. They were associated with other types of metastases, especially lung metastasis. A majority of patients received 131I treatment, following surgery or external beam radiotherapy for a palliative purpose. Overall survival was 65% at 5 years and 49% at 10 years. A long-term survival was achieved in 10% of the patients benefiting from a multidisciplinary care adapted to each case. CONCLUSION: Bone metastases often have a pejorative turning in the natural history of differentiated thyroid cancers. The right selection of individuals with better prognosis, for whom more aggressive curative treatment was indicated, requires a better understanding of the features of bone involvement.

Association of EGFR and HER2 polymorphisms with risk and clinical features of thyroid cancer.

The epidermal growth factor receptor family plays a critical role in the control of many physiological processes. Genetic alterations and/or variations in the gene encoding these receptors have been implicated in a variety of human cancers. In this study we evaluate the association of two single-nucleotide polymorphisms (SNP), R497K and I655V, of the EGFR and HER2 genes, respectively, with thyroid cancer risk. The analysis was performed with 302 healthy individuals and 106 thyroid cancer patients. No significant difference was found in the allelic and genotypic frequency distribution of the SNP R497K between the control and patient groups. While for the SNP I655V, the allele G is more frequent in patients than in controls and was associated with an increased risk of thyroid cancer (odds ratio = 1.88; 95% confidence intervals: 1.18-3.01; p = 0.007). We have also investigated the relationship between these two polymorphic sites and clinicopathological characteristics such as thyroid-stimulating hormone level, off-thyroxin, serum thyroglobulin, tumor histology, metastasis, tumor status, tumor stage, and survival. No significant association was observed. Tumor status was found significantly associated with HER2 I655V as well as with two previously studied markers in the thyroid hormone receptor A and estrogen receptor 1 (ESR1) genes (D17S2189 and D6S440, respectively). We also report a correlation between thyroglobulin level and genotypes for SNP rs2228480 in exon 8 of the ESR1 gene. In conclusion, our results suggest that the SNP HER2 I655V, but not the EGFR R497K, was associated with thyroid cancer risk.

Association of polymorphisms in estrogen and thyroid hormone receptors with thyroid cancer risk.

The receptors for thyroid hormone (THR) and oestrogen (ESR) are prototypes of nuclear transcription factors that regulate the expression of target genes. Genetic alterations in the genes of these receptors were found to be involved in cancer development. In this study we investigated the association of one SNP (rs2228480, T594T) and one microsatellite marker (D6S440) within the ESR1 gene and a dinucleotide repeat (D17S2189) within the THRA gene, with thyroid cancer risk. A case-control association study was conducted with 299 healthy individuals and 106 patients with thyroid cancer. Genotypic and allelic frequencies for the dinucleotide repeat in the ESR1 gene were similar between thyroid cancer patients and controls. For the AC repeat in the THRA gene, a slightly significant difference was found for the genotype 18/20 between the two groups (P = 0.034), which suggests that alleles with less than 20 repeats might have a protective effect in thyroid cancer risk. For the SNP T594T, the A allele was much more prevalent in patients than in controls and was highly associated with the risk of thyroid cancer (OR: 4,56; IC: 3.23-6.44; P < 10(-18)) and seems to have an additive mode of action. In conclusion, our data suggest that the SNP T594T but not the D6S440 and D17S189 is associated with thyroid cancer risk.