Treated Wilm's tumor in childhood as potential risk factor for second thyroid cancer.

The potential risk of a treatment-induced second neoplasia affecting the thyroid is well known after radiation therapy for several types of cancer, but few cases have been related to incidental irradiation for Wilms' tumor. We report a case of a papillary thyroid carcinoma discovered in a young patient 15 years after treatment of a Wilms' tumor. An 18-year-old man was referred to our Endocrinological Department for a single 3 cm nodule in the right lobe of the thyroid. His past medical history included at the age of 2 years surgical resection, chemotherapy (actinomycin-D and vincristine) and cesium radiation therapy to the right side for a Wilms' tumor in stage III: a total dose of 7700 rads was delivered to an area of 17 x 10 cm in the right flank. After fine-needle demonstration of a follicular thyroid lesion, the patient underwent right lobectomy, followed by total thyroidectomy for histologic diagnosis of a follicular variant papillary cancer. Residual thyroid tissue was ablated by iodine-131 administration (3700 MBq), but scanning after therapeutic iodine showed radioactive uptake in the left regional lymph nodes, with elevated serum thyroglobulin off therapy (830 ng/ml). Magnetic resonance imaging confirmed the presence of lymph node enlargements and bilateral neck dissection was performed, followed by radioiodine treatment (3700 MBq) and thyroxine suppressive therapy. After 3-year follow-up the patient is disease-free. Although few cases of thyroid cancer have been reported in the literature after irradiation for a Wilms' tumor during childhood, this association should be considered in the long-term follow-up.

Impacto da citologia aspirativa da tiróide com agulha fina: estudo da precisäo diagnóstica / Impact of fine needle aspiration biopsy of the thyroid: diagnostic accuracy study

A identificaçao de nódulos tiroidianos malignos, entre um grande número de bócios inocentes pelos métodos usuais de exploraçao, é cara, pouco sensível e inespecífica. A punçao biópsia aspirativa com agulha fina, reconhecida em outros países, está começando a ser melhor aceita em nosso meio. OBJETIVO. Avaliar a eficiência diagnóstica de 915 punçoes biópsias aspirativas (PBA) com agulha fina, em pacientes com nódulos tiroidianos, em dez anos de atendimento num hospital-escola de 400 leitos. MATERIAL E MÉTODO. 915 exames citológicos e comparaçao de 126 destes aos exames histológicos das mesmas pacientes. RESULTADOS. Sensibilidade de 91,2 por cento, especificidade de 90,5 por cento, precisao de 90,9 por cento, falsos negativos de 5,5 por cento e falsos positivos de 3,3 por cento. A proporçao de neoplasias encontrada nas ressecçoes cirúrgicas destas glândulas foi de 20 por cento quando a PBA nao era ainda disponível e de 48 por cento após introduçao deste exame no serviço. A aceitaçao dos pacientes foi boa e as complicaçoes raras e sem gravidade. CONCLUSAO. Nossos resultados indicam que a PBA da tiróide é eficiente, segura, bem tolerada e facilmente aplicada, mesmo num hospital com pequeno movimento, mas suas limitaçoes devem ser levadas em conta, principalmente ao se analizar o resultado negativo.

[The impact of fine needle aspiration biopsy: diagnostic accuracy study]. / Impacto da citologia aspirativa da tiróide com agulha fina: estudo da precisão diagnóstica.

UNLABELLED: The malign thyroid nodules identification, in the middle of a large number of innocent ones, by usual methods of exploration, is expensive, inespecific and of low accuracy. The fine needle aspiration biopsy, accepted in other places, is beginning to be used in our country. OBJECTIVE: To evaluate the diagnostic efficiency of 915 fine needle aspiration biopsies (FNAB) of patients with thyroid nodules in a period of 10 years at a 400 bed general teaching hospital. MATERIAL AND METHOD: 915 cytologic examinations and comparison of 126 of them with the histologic ones. RESULTS: Sensitivity, 91.2%; specificity, 47%; accuracy, 90.9%; false-positive, 3.6%; false negative, 5.5%. The proportion of neoplasms found in thyroidectomies was 20% when FNAB was not available yet and 48% after the introduction of this procedure. Patient acceptance was quite good, complications were infrequent and with no gravity. CONCLUSIONS: FNAB of the thyroid is efficient, safe, well tolerated and easily applied even in a small hospital, but its limitations must be emphasized, mainly when we analyse the negative results.

111In-octreotide scintigraphy in endocrine tumors. Preliminary data.

A large number of endocrine tumors express somatostatin receptors, and the use of radiolabeled somatostatin analogs has been recently introduced for their localization. Using in vivo scintigraphy with 111In-pentetreotide, primary tumor localizations were demonstrated in 3/3 carcinoids (2 intestinal carcinoids and 1 lung ACTH-secreting carcinoid; in 2 patients liver metastases larger than 1 cm were visualized), in 1/1 GH-secreting pituitary macroadenoma, and in 1/1 thyroid localization of MTC. Bone and/or lymph node metastases were imaged in 2/4 patients previously treated for MTC, with persistently high CT and CEA levels; in the other 2 patients the other scintigraphic techniques were also negative. Octreotide scintigraphy was negative in 2/2 insulinomas and in 2/2 ACT-producing pituitary adenomas. In 2 patients with carcinoid syndrome and 1 patient with Cushing syndrome due to ectopic ACTH, octreotide therapy induced a significant decrease in tumoral markers. Our preliminary data are in agreement with the results of larger series reported in literature: octreotide scintigraphy is a useful noninvasive tool to detect endocrine tumors expressing somatostatin receptors, particularly for carcinoids. It is of great use in the differential diagnosis of Cushing syndrome due to ectopic ACTH. Moreover, 111In-pentetreotide scintigraphy may be useful in selecting patients who may benefit from octreotide therapy to control hormonal hypersecretion effects.

[Malignant pheochromocytoma of the adrenal gland. Diagnosis 14 years after an incidental discovery of a contralateral pheochromocytoma]. / Phéochromocytome malin de la surrénale. Découverte occasionnelle 14 ans après un incidentalome. Phéochromocytome controlatéral.

The authors present a case of malignant adrenal phaeochromocytoma incidentally discovered 14 years after a similar finding in the controlateral adrenal gland. The rarity of incidentally discovered malignant adrenal phaeochromocytoma (second report in the literature) and the importance of isotope scan with MIGB for the investigation of asymptomatic and nonfunctioning phaeochromocytomas are outlined.

Atypical McCune-Albright syndrome associated with growth hormone-prolactin pituitary adenoma: natural history, long-term follow-up, and SMS 201-995--bromocriptine combined treatment results.

A 35-yr-old woman is described as having atypical McCune-Albright syndrome, associated with acromegaly and hyperprolactinemia due to pituitary adenoma. The patient did not present sexual precocity, but primary amenorrhea. After transphenoidal adenomectomy, the GH plasma levels returned to normal, whereas the PRL values decreased; bromocriptine therapy normalized PRL levels and induced ovulatory menses. After 4 uneventful yr the patient developed relapse of active acromegaly that did not recover after a second neurosurgical exploration. Bromocriptine treatment maintained normal PRL levels but did not significantly reduce GH ones; the association with long-acting somatostatin analog SMS 201-995 by continuous sc pump infusion induced definitive control of GH and somatomedin-C secretion. These results suggest an additive inhibitory effect on GH secretion exerted by the two drugs.

[The hypothalamic-hypophyseal-adrenal axis in obesity]. / Studio dell'asse ipotalamo-ipofisi-surrene (IIS) nell'obesità.

The HHA axis was assessed in 26 women with essential obesity using a CRF test, insulin hypoglycemia and oral glucose load. Basal values of ACTH and cortisol were similar in obese subjects and controls, whereas peak ACTH values following CRF administration were significantly lower in obese subjects. The net integrated areas under ACTH and cortisol curves after CRF injection were lower in obese subjects but not statistically significant. Glucose inhibited cortisol levels in controls but not in obese subjects. Insulin hypoglycemia provoked a ACTH and cortisol response in obese women which was significantly higher than that provoked by CRF. The lesser response of ACTH to CRF in obesity might be the result of an altered hypophyseal response to CRF mediated by other factors; in addition, the increased ACTH and cortisol response to the insulin stimulus compared to CRF observed in obese subjects leads to suppose that the metabolic stimulus involves the release of other factors.

Hyperthyroidism and high serum levels of TSH associated with pituitary tumour.

We report a 28-year-old male with persistent clinical and laboratory findings of hyperthyroidism associated with marked elevated serum levels of TSH and no response to TRH despite hemithyroidectomy and subsequent antithyroid drug therapy two years previous to admission to our hospital. Subsequent skull X-rays, CT scans and angiographic findings demonstrated the presence of a pituitary tumour. After operation and radiation therapy T3, T4 and TSH levels returned to normal values. Seven years later the patient is still euthyroid. We conclude that hyperthyroidism in our patient was due to excessive secretion of TSH by the pituitary tumour.