[Thyroid metastasis of kidney cancer]. / Métastase intrathyroïdienne d'un cancer du rein.

Thyroid metastasis of solid tumors is rare and often asymptomatic. Differential diagnosis with malignant thyroid tumor is difficult. We report a 65-year-old man who presented with a solitary intrathoracic thyroid nodule of the left lobe, inaccessible to fine needle biopsy. His past medical history was remarkable for a nephrectomy for a kidney clear cell carcinoma one year before. The PET-scan did not show any abnormal fixation. A left lobo-isthmectomy was performed. Histologic examination revealed an intrathyroid metastasis of kidney carcinoma.

Diabetes and inflammation: fundamental aspects and clinical implications.

AIM: The aim of this paper is to provide the fundamental background of the inflammation theory associated with type 2 diabetes, to discuss the clinical consequences of low-grade inflammation, particularly in terms of cardiovascular risk, and to infer some clinical therapeutic strategies deriving from drugs that already exist or are in development. METHODS: This non-exhaustive work is the result of a Pubmed(®) research, based on requests including the following keywords: diabetes, inflammation, innate immunity, obesity, reticulum endoplasmic stress, cytokines, endothelial dysfunction. RESULTS: Obesity and type 2 diabetes are linked with a low-grade inflammation state that reflects the activation of innate immunity where metabolic, environmental and genetic factors are implicated. The role of endoplasmic reticulum stress and unfold protein response is underlined. Inflammation markers are predictive for the risk to develop diabetes, and are associated with an increased cardiovascular risk. While lifestyle modifications are followed by an improvement in inflammation markers, treatments inferred from the inflammation theory are of great interest, although quite moderate effects on glycaemic control have been observed with some of them. CONCLUSION: The development of molecules targeting different inflammatory mechanisms could lead in diabetic patients to improvement of both glycaemia and cardiovascular prognosis.

[Papillary carcinoma in a thyroglossal duct cyst, a case report: Which management]. / Carcinome papillaire sur kyste du tractus thyréoglosse à propos d'un cas : quelle prise en charge ?

Cysts of the thyroglossal duct are common but malignant degeneration is rare, occurring only in 1% of the cases. The most frequent histological type is papillary carcinoma. The clinical presentation of these cancers is generally nonspecific, diagnosis being established postoperatively using the Sistrunk method. Debate remains open concerning appropriate management strategies and post-therapeutic follow-up for this type of neoplasia. We report the case of a 45-year-old patient who underwent surgery for an anterior neck mass that had developed over three years. Histology favored multifocal papillary carcinoma in a thyroglossal duct remant. Total thyroidectomy was performed. The postoperative protocol, established empirically due to the absence of consensus, included radioactive iodine and hormone suppression even though the thyroid was intact. After one year of follow-up, outcome has remained favorable.

[An historical case of malignant hyperparathyroidism with unusual metastatic sites]. / A propos d'une hyperparathyroïdie maligne historique à localisations métastatiques inhabituelles.

We report a historical case of hyperparathyroidism in a young patient hospitalized for an array of osteolytic foci and incomplete fracture associated with a swollen neck, revealing a very special form of a metastatic parathyroid carcinoma with unusual multiple locations and exceptional medullary flooding. Carcinoma of the parathyroid gland produces a malignant hypersecreting tumor particularly difficult to diagnose. Treatment of this rare tumor is primarily surgical. The preoperative syndrome is unusually severe primary hyperparathyroidism. Intraoperatively, the size of the tumor and its local extension to surrounding tissue are highly suggestive. Confirmation requires pathological analysis of the operative specimens and can be further supported by the clinical course of local recurrence or metastasic spread. Specific immunohistochemical techniques have recently been shown to be contributive. The diagnosis is strengthened in the presence of associated Schantz and Castelman criteria. Foci of local extension can be identified preoperatively with ultrasound, (99m)Tc-sestamibi scintigraphy and MRI of the neck and mediastinum. The prognosis depends mainly on the possibility of achieving complete resection at the initial surgery. In some cases, very aggressive complementary postoperative radiotherapy is likely to improve locoregional control of the tumor. Chemotherapy alone or in combination with radiation has not demonstrated its effectiveness. The disease course and control can be monitored by regular assay of serum calcium and the parathormone.

[Severe rhabdomyolysis revealing a myopathy linked to autoimmune hypothyroidism]. / Rhabdomyolyse sévère révélant une myopathie hypothyroïdienne d'origine auto-immune A propos de deux cas.

While muscular manifestations are common of hypothyroidism, hypothyroid myopathy is most often limited to myalgia, muscular stiffness and cramps with, in some patients, elevated levels of muscle enzymes. We report two cases of rhabdomyolysis related to hypothyroid myopathy. One of the patients developed acute renal failure. Thyroid hormone replacement therapy improved thyroid and renal function with involution of rhabdomyolysis. Hypothyroidism appears to be an authentic cause of rhabdomyolysis and should be carefully ruled out in all patients with elevated serum levels of muscle enzymes.