ABSTRACT
BACKGROUND: The 2014 British Thyroid Association thyroid cancer guidelines recommend lifelong follow-up of all thyroid cancer patients. This is probably unnecessary, particularly for differentiated thyroid cancer (DTC) patients with an excellent response to treatment and places significant demand on health service resources. DESIGN: Single centre retrospective cohort analysis of patients diagnosed and treated at the Leeds Cancer Centre between 2001 and 2014. PATIENTS: A total of 756 patients were dynamically risk-stratified (DRS) as having 'excellent response to treatment' after total thyroidectomy and radioiodineremnant ablation (RRA) for DTC. RESULTS: Median follow-up was 11.2 (range: 6.5-18.5) years. Radiological recurrence occurred in 15/756 (2.0%) patients and was always preceded by a raised thyroglobulin or thyroglobulin antibody level. The vast majority of tumour recurrences (13/15, 85%) were identifiable within 5 years of diagnostic surgery. Patients classified as having high-risk disease as per American Thyroid Association (ATA) guidelines had an almost threefold higher recurrence rate (2/34 [5.9%] vs. 13/722 [1.8%]) than those with ATA low-risk or intermediate-risk disease. Tumour histology subtype was a significant contributing factor, with Hürthle cell cancer having a worse prognosis than papillary thyroid cancer (PTC) (5/68 [7.4%] vs. 9/582 [1.5%]; relative risk: 4.76 [95% confidence interval: 1.64-13.8]). CONCLUSIONS: The recurrence rate of DRS patients with excellent response to treatment is low. It is reasonable to consider discharge of ATA low-risk or intermediate-risk patients with PTC who remain disease-free after 5 years of secondary care follow-up. Lifelong follow-up, however, currently remains the standard for subgroups at greater risk.
Subject(s)
Thyroglobulin , Thyroid Neoplasms , Humans , Neoplasm Recurrence, Local/surgery , Retrospective Studies , Thyroid Cancer, Papillary/diagnosis , Thyroid Cancer, Papillary/surgery , Thyroid Neoplasms/pathology , Thyroidectomy , United StatesABSTRACT
The global incidence of thyroid cancer is increasing, and metastatic spread to the lymph nodes is common in papillary thyroid carcinoma. The metastatic course of thyroid carcinoma is an intricate process involving invasion, angiogenesis, cell trafficking, extravasation, organ specific homing, and growth. A key aspect in this process involves a multitude of interactions between chemokines and their receptors. Chemokines are a group of small proteins, which act to elicit normal physiologic and immune responses principally through recruitment of specific cell populations to the site of infection or malignancy. Thyroid cancer cells, like other tumors, possess the ability to corrupt the chemokine system to their advantage by altering cell movement into the tumor microenvironment and affecting all aspects of thyroid cancer progression.
Subject(s)
Carcinoma/metabolism , Chemokines/metabolism , Lymph Nodes/metabolism , Thyroid Neoplasms/metabolism , Animals , Carcinoma/immunology , Carcinoma/secondary , Chemokines/immunology , Humans , Lymph Nodes/immunology , Lymph Nodes/pathology , Lymphatic Metastasis , Prognosis , Receptors, Chemokine/metabolism , Signal Transduction , Thyroid Neoplasms/immunology , Thyroid Neoplasms/pathology , Tumor MicroenvironmentABSTRACT
We present a rare case of obstructive sleep apnoea (OSA) secondary to a deep lobe parotid pleomorphic adenoma and discuss its management, including the need for a thorough examination and multidisciplinary approach. Only a few cases of pleomorphic adenoma of the deep lobe of the parotid gland causing OSA have been reported. Our case is not only extremely rare but also highlights that key diagnoses maybe missed if a thorough assessment is not performed.
Subject(s)
Adenoma, Pleomorphic/complications , Parotid Neoplasms/complications , Sleep Apnea, Obstructive/etiology , Adenoma, Pleomorphic/diagnosis , Adenoma, Pleomorphic/surgery , Continuous Positive Airway Pressure , Diagnosis, Differential , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Parotid Neoplasms/diagnosis , Parotid Neoplasms/surgery , Sleep Apnea, Obstructive/therapyABSTRACT
Epstein-Barr virus-related adenotonsillar hypertrophy is a precursor to post-transplantation lymphoproliferative disorder. We report a case of a 4-year-old child with severe obstructive sleep apnoea, who had liver transplantation at the age of 7 months. She had gross lymphoid hypertrophy in the oropharynx and supraglottis. We performed an adenotonsillectomy and aryepiglottoplasty which improved her symptoms. We emphasise the importance to consider the diagnosis of post-transplantation lymphoproliferative disorder in post-transplantation immunosuppressed patients who present with adenotonsillar hypertrophy.
Subject(s)
Adenoids/pathology , Epstein-Barr Virus Infections/complications , Liver Transplantation , Palatine Tonsil/pathology , Postoperative Complications/etiology , Sleep Apnea, Obstructive/etiology , Child, Preschool , Female , Humans , Hypertrophy/etiology , Severity of Illness IndexABSTRACT
This article outlines two cases of snoring and obstructive sleep apnoea (OSA) secondary to parapharyngeal space tumours. Both patients were referred to a specialist sleep clinic where oropharyngeal masses were seen and biopsied. Both underwent surgery and this was curative of both their snoring and their OSA. Parapharyngeal space tumours are an extremely rare cause of OSA and snoring. However, all patients with OSA and snoring should have a full head and neck examination before referral; in rare cases this could enable early detection of a parapharyngeal space tumour.
