Lateral and median cysts of the neck.

THE AIM OF THE STUDY: was to present clinical picture, indications for surgery, immediate and remote results of surgical treatment for lateral and median cysts of the neck. MATERIAL AND METHODS: A total of 17247 patients were operated between 1 January 1990 and 31 December 2011 for neck tumors. RESULTS: Neck cysts were diagnosed in 34 (0.2%) patients, including lateral in 12 (35.3%) and median in 22 (64.7%). Lateral cyst once descended to the mediastinal. Nodular goitres were diagnosed in 17 (50%) of them--with the lateral cysts 4x and median cysts 13x. Guided fine-needle aspiration biopsy of the cyst-like lesions revealed the presence of protein masses in all patients. The lesions were found to have inflammatory character in 6 patients (17.6%) regarding median cysts (5x) or lateral cyst (1x). Out of them, 3 patients developed purulent inflammatory process. All patients were operated. The operation consisted of radical resection of the cyst only or plus partial resection of both thyroid lobes and total resection of pyramidal lobe if concomitant goitre was found. Two patients required one-stage resection of the enlarged lymph nodes in the neck. Suspected focus of thyroid papillary cancer was found by intra-operative examination in neck median cyst wall in one patient. However, paraffin tests did not confirm the suspicion. Another patient was found by histopathological examination to have active tuberculotic process within both lateral cyst and lymph nodes. The patient received intensive antituberculotic treatment postoperatively. CONCLUSIONS: 1. Median cysts of the neck are more often accompanied by thyroid tumor-like goitres than lateral cysts. 2. Radical resection of the cysts in operative treatment results in good long term patient condition and prevent in recurrence of the illness.

Diagnosis of metastatic tumours to the thyroid gland by fine needle aspiration biopsy.

INTRODUCTION: Malignant metastases are rarely found in the thyroid gland, the incidence reaching approximately 2% of all thyroid malignant neoplasms. They are most often caused by tumours of the kidneys, lungs, mammary glands, ovary, and colon or by melanomas. The aim of the study was to evaluate the usefulness of fine needle aspiration biopsy (FNA) for diagnosing tumour metastases to thyroid glands. MATERIAL AND METHODS: A total of 15122 patients were operated between 1990 and 2009 for goitres. Malignant neoplasm was diagnosed in 733 (4.8%) patients. Malignant metastases to the thyroid gland were detected in 10 patients, namely 2 men and 8 women aged 48-89 years. The group made up 1.4% of all patients operated for malignant thyroid tumour. Preoperative diagnostic procedure consisted of thyroid scintigraphy, thyroid ultrasonography, and cytology of the material obtained through FNA. In addition, the hormonal activity of the thyroid gland was examined. The range of operation was established through clinical assessment of the tumour, preoperative cytology, and intra-operative histopathology. RESULTS: Among 7 patients with thyroid metastases from renal clear cell carcinoma, as diagnosed postoperatively, cytology of the thyroid material obtained through FNA revealed follicular tumour in 3 (43%) patients, tumour cells in 2 (28.5%) and atypical cells in the other 2 (28.5%). Intraoperative histopathology confirmed the presence of metastasis from renal clear cell carcinoma (1) and indicated thyroid medullary cancer (1), follicular tumour (4), or trabecular adenoma with necrosis (1). Among two patients with thyroid metastases from breast cancer, cytology confirmed a metastasis from breast cancer in one (the woman was disqualified for surgical treatment) and indicated follicular tumour in one. Intraoperative histopathology suggested thyroid anaplastic cancer. Examination of biopsy specimen revealed epithelial cells accompanied by cell atypia in one patient with thyroid metastasis from lung cancer. Intra-operative examination also indicated cellular atypia in the same patient. CONCLUSIONS: Follicular tumour diagnosed by fine needle aspiration biopsy in patients after treatment for other cancers, especially renal clear cell carcinoma, should alert the surgeon to the possibility that it could be a metastasis of this cancer to the thyroid gland.

[Malignant thyroid lymphoma--diagnostic and treatment problems]. / Chloniaki zlosliwe tarczycy--problemy rozpoznawcze i lecznicze.

UNLABELLED: The aim of this study was to present our experience in the diagnostics and treatment of primary malignant thyroid lymphoma (PMTL). Five patients at the age of 48-72 years with PMTL were treated at the Department of General Surgery in Bytom in the years 1988-1999. They made up 0.04% of patients operated on at this time in our Department because of different types of goiter and 1.05% because of thyroid carcinoma. The clinical examinations included ultrasonography, radioisotope diagnostics, preoperative thin needle biopsy and hormonal examination of thyroid gland. All patients were operated on under general anesthesia and with intraoperative histopathological examination. They were treated with chemo- and/or radiotherapy in postoperative period. The appearance of PMTL was preceded by nodular goiter or Hashimoto disease. In three cases we observed neck compression symptoms and in two the dramatic course of disease. Ultrasonography revealed hypoechogenic thyroid gland with nodular structures characterized by the decreased J131 uptake. In one case thin needle biopsy confirmed the diagnosis of PMTL. Evident hypothyreosis was diagnosed in one and subclinical in two patients. Surgical treatment--partial excision of neoplastic tumor--was complicated by tracheostomy in two cases. One case with almost total resection of thyroid gland was complicated by lesion of esophagus which was sutured. After operation one patient was treated with chemotherapy, one with radiotherapy and two cases using both of methods. Three patients died: in 3rd, 32nd day and after 3 months since surgery. We confirmed the remission of the disease in two the youngest patients with not advanced state. One of them was treated with Co 60 therapy and the second one with chemotherapy according to COP and radiotherapy. CONCLUSIONS: PMTL is a rare disease and difficult to diagnose. The biopsy is useful. The treatment of PMTL combined, including surgical treatment, chemo- and radiotherapy. The prognosis is uncertain and depends on the disease period.