Temporal trend, clinicopathologic and sociodemographic characterization of age at diagnosis of breast cancer among US women diagnosed from 1990 to 2009.

ABSTRACT: This paper investigates the distribution of age at diagnosis of female breast cancer and its association with temporal trend, clinicopathologic and sociodemographic variables in the presence of two latent clusters that are directly unobservable. Such clusters help to identify two subpopulations of either young or old patients whose etiologies are thought to be different. A large sample drawn from registry data from the National Cancer Institute's Surveillance, Epidemiology, and End Results program from 1990 to 2009 was analyzed using a two-component Gaussian mixture model. Evidence of a steady delay of age at diagnosis and an increasing proportion of young patients being diagnosed during the 20-year period was found. Histopathologic effects indicate that duct and lobular carcinomas differ significantly in regard to subpopulation membership, which confirms that they represent different etiologies. While the presence of estrogen receptor status in the model overlaps the effects of other important variables it is highly correlated with, it is found that the grade, extension and size of the tumor along with lymph node involvement status, race and marital status are important predictors of age at diagnosis. The results highlight the significant impacts that such features can have on breast cancer control efforts, and point to the importance of ensuring that medical decision making should use them along with an indicator of the age subpopulation a patient may belong to.

[Intrathyroid parathyroid adenomas: right and lower]. / Adenomas paratiroideos de localización intratiroidea: derechos y bajos.

INTRODUCTION: Intrathyroidal parathyroid adenomas (IPA) are a not an uncommon cause of persistent hyperparathyroidism. There is no consensus on their prevalence, embryological origin and position within the thyroid. PATIENTS AND METHOD: Retrospective review of prospectively recorded surgical protocols of patients having had parathyroidectomy for primary (n = 437) or secondary (n = 137) hyperparathyroidism by the same surgeon. Cases with IPA were identified and the following data were recorded: age, most probable embryological origin, position within the thyroid (side and height), results of imaging techniques and surgical implications. RESULTS: Seventeen IPA were detected in 16 patients (6M, 10F, prevalence 3.2%); 9 belonged to IIIP and 8 to IVP. Three lower IPA were supernumerary glands. Eight IPA were included within the right lower thyroid lobe. Twelve IPA (70.6%), were found during the initial parathyroidectomy: 3 were enucleated and 9 were treated with a partial thyroidectomy or hemithyroidectomy. Of the 3 enucleations, 2 had a local benign recurrence due to an incomplete capsule resection. No patients treated with thyroidectomy had a recurrence. The remaining 5 IPA, found in 4 patients, were not identified initially and caused persistence of the disease leading to 5 reinterventions. CONCLUSIONS: IPA are present in 3% of patients submitted to parathyroidectomy. They predominate in the right thyroid lobe and can be IIIP, IVP and supernumerary. They often cause persistence. Thyroid resection affords the best results since complete enucleation can be difficult and leaving behind a fragment of the IPA results in local recurrence.

Adenomas paratiroideos de localización intratiroidea: derechos y bajos / Intrathyroid parathyroid adenomas: right and lower

Introducción. Los adenomas paratiroideos intratiroideos (API) son una de las causas de hiperparatiroidismo persistente. No existe consenso sobre su origen embriológico, posición dentro de la glándula tiroides y tratamiento quirúrgico idóneo. Material y método. Estudio retrospectivo en que se analizan los protocolos quirúrgicos recogidos prospectivamente de los pacientes intervenidos por hiperparatiroidismo primario (n = 437) y secundario (n = 137) en dos centros hospitalarios terciarios. Se han identificado los casos con API y se ha analizado su origen embriológico más probable, posición dentro del lóbulo tiroideo (lado y altura), resultados de las técnicas de imagen e implicaciones quirúrgicas. Resultados. Se hallaron 17 API en 16 pacientes (6 varones y 10 mujeres; prevalencia, 3%); 9 correspondieron a paratiroides inferiores y 8 a superiores; 3 API inferiores eran quintas glándulas; 8 estaban incluidos en la porción inferior del lóbulo tiroideo derecho; 12 (70,6 %) se localizaron dentro del lóbulo derecho tiroideo. En 12 pacientes, el API se identificó antes o durante la cirugía, y se extirparon en la paratiroidectomía inicial: 3 eran enucleados y en 9 se asoció tiroidectomía parcial o hemitiroidectomía. De las 3 enucleaciones, 2 presentaron recidiva local. Los 5 API restantes (en 4 pacientes) no fueron identificados inicialmente y ello causó persistencia de la enfermedad, que condujo a 5 reintervenciones. Conclusiones. Los API se encuentran en un 3% de los pacientes intervenidos por hiperparatiroidismo. Predominan en el lóbulo derecho y su procedencia puede ser tanto de la tercera como de la cuarta bolsa faríngea o ser supernumerarios. La resección tiroidea ofrece los mejores resultados terapéuticos (AU)

Introduction. Intrathyroidal parathyroid adenomas (IPA) are a not an uncommon cause of persistent hyperparathyroidism. There is no consensus on their prevalence, embryological origin and position within the thyroid. Patients and method. Retrospective review of prospectively recorded surgical protocols of patients having had parathyroidectomy for primary (n = 437) or secondary (n = 137) hyperparathyroidism by the same surgeon. Cases with IPA were identified and the following data were recorded: age, most probable embryological origin, position within the thyroid (side and height), results of imaging techniques and surgical implications. Results. Seventeen IPA were detected in 16 patients (6M, 10F, prevalence 3.2%); 9 belonged to IIIP and 8 to IVP. Three lower IPA were supernumerary glands. Eight IPA were included within the right lower thyroid lobe. Twelve IPA (70.6%), were found during the initial parathyroidectomy: 3 were enucleated and 9 were treated with a partial thyroidectomy or hemithyroidectomy. Of the 3 enucleations, 2 had a local benign recurrence due to an incomplete capsule resection. No patients treated with thyroidectomy had a recurrence. The remaining 5 IPA, found in 4 patients, were not identified initially and caused persistence of the disease leading to 5 reinterventions. Conclusions. IPA are present in 3% of patients submitted to parathyroidectomy. They predominate in the right thyroid lobe and can be IIIP, IVP and supernumerary. They often cause persistence. Thyroid resection affords the best results since complete enucleation can be difficult and leaving behind a fragment of the IPA results in local recurrence (AU)

Metastatic small cell carcinoma to the thyroid gland: a pathologic and molecular study demonstrating the origin in the urinary bladder.

Small cell carcinomas may occur in the thyroid gland. Infrequently, they are primary tumors, and have been interpreted as variants of medullary thyroid carcinoma. However, the vast majority of small cell carcinomas involving the thyroid gland are metastatic tumors. In some cases, demonstration of the primary tumor is not easy. An example of a small cell carcinoma metastatic to the thyroid is presented in this report. The primary tumor was a small cell carcinoma that occurred as a minor component in a transitional carcinoma of the urinary bladder. The microscopical and immunohistochemical features of both tumors, in the thyroid and the bladder, were identical. Moreover, both tumors exhibited an identical mutation in p53, as well as similar loss of heterozygosity at 10q23 and RASSF1A promoter hypermethylation, clearly indicating that the bladder tumor was the site for the primary tumor of the patient.

Miositis nodular aislada y citomegalovirus / Localised nodular myositis and citemagalovirus

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A forgotten method to induce experimental chronic renal failure in the rat by ligation of the renal parenchyma.

BACKGROUND: Animal models of chronic renal failure have been widely used in the experimental nephrology laboratories. The most common technique used is the 5/6 reduction of renal mass, either by surgical resection or by infarction. METHODS: In the present work, we describe a forgotten technique based in the ligation of the renal parenchyma in both renal poles. This technique combines the advantages of the resection model, like the reproducibility and homogeneity, with the ones of the infarction technique, like the absence of bleeding. RESULTS: 8 weeks after the procedure, animals showed a decrease in creatinine clearance together with an increase in plasma creatinine. Furthermore, glomeruli of animals with 5/6 nephrectomy showed a marked hypertrophy, with a glomerular volume significantly higher than control animals. Serum levels of parathyroid hormone were also increased, consistent with the development of secondary hyperparathyroidism. CONCLUSIONS: We conclude that the present technique is a valid and improved tool for the study of chronic renal failure.

Malignant peripheral nerve sheath tumor of the thyroid: a clinicopathological and ultrastructural study of one case.

Thyroid malignant peripheral nerve sheath tumors (TMPNST) are very uncommon neoplasms that can be confused with anaplastic carcinoma, Riedel's thyroiditis, or other soft tissue tumors that may occur in the thyroid region. An example of TMPNST is presented in this report. The tumor occurred in a 56-yr-old woman. Fine needle aspiration did not provide adequate material. After thyroidectomy, the lesion posed important problems in differential diagnosis. Immunohistochemical, molecular, and electron microscopic features were taken into consideration to arrive at the correct diagnosis. Tumor cells were focally positive for keratins, a feature that has not been described in peripheral nerve sheath tumors of the thyroid, but that has been occasionally seen in tumors from other locations. After thyroidectomy, the patient received radiotherapy. She is well without evidence of recurrence 10 mo after surgery.

Impacto de la hospitalización a domicilio en la cirugía tiroidea: estudio comparativo con la hospitalización convencional / Impact of hospital at home care in thyroid surgery: comparative study with inpatient hospitalization

Objetivo: Valorar el impacto de la hospitalización a domicilio en el seguimiento postoperatorio de la cirugía benigna tiroidea, comparándolo con la hospitalización convencional, en cuanto a la estancia hospitalaria y a la existencia de complicaciones- Material y métodos: Se realiza un estudio comparativo entre dos series homogéneas de pacientes operados de enfermedad benigna de tiroides entre 1993 y 1999 en el Servicio de Cirugía General del Hospital Universitario Arnau de Vilanova. Las series se diferenciaban sólo en función del lugar donde se había realizado el postoperatorio: totalmente en el hospital (hospitalización convencional) o parte en el hospital y parte en el domicilio, a cargo de una unidad de hospitalización a domicilio. La inclusión en el grupo de hospitalización a domicilio dependía solamente de dos factores: residir en la zona de cobertura de la unidad y que el paciente y la familia estuviesen de acuerdo. Se recogieron los siguientes datos: lugar de residencia, edad, sexo, tipo de intervención, días de estancia hospitalaria, días de seguimiento domiciliario y complicaciones que fueron analizados estadísticamente mediante el programa informático SPSS 9.0 Resultados: Entre los resultados destaca la elevada frecuencia de mujeres en la serie (90 por ciento), la diferencia en la estancia hospitalaria entre las dos series, siendo de 5,81 días en el caso de hospitalización convencional y de 2,78 días en el caso de hospitalización a domicilio, aunque en este caso se le habrán de añadir los 2,18 días de control en su domicilio. Por último el porcentaje de complicaciones menores (38 por ciento), similar en las dos series. Conclusiones: La hospitalización a domicilio reduce los días de hospitalización convencional en este tipo de cirugía, ya que incluso si aparecen complicaciones no se alarga la estancia hospitalaria, porque son controladas en el domicilio. Además parece que la hospitalización a domicilio es tan segura como la convencional en la cirugía benigna de tiroides. Por último, se podría considerar una buena opción terapéutica la combinación de cirugía de corta estancia y hospitalización a domicilio en pacientes previamente seleccionados (AU)