The sentinel lymph node in papillary cancer of the thyroid including histological subtype.

BACKGROUND: The aim of this work was to reveal through sentinel node study the intraoperative presence of preoperatively undetected pathological lymph nodes. MATERIALS AND METHODS: At the Surgical Science Department of La Sapienza University of Rome The Authors studied from January 2003 to June 2004 18 patients with papillary carcinoma of the thyroid, who presented no clinical evidence of lymph node metastasis; they performed a total thyroidectomy in all cases, removing and histologically examining all lymph nodes of the upper anterior mediastinum. Where negative they were then subjected to immunohistochemical analysis with Pan Cytokeratin. RESULTS: The method was positive in 10 patients: 2 pure papillary carcinomas, 1 papillary carcinoma with poorly differentiated areas, 1 tall cell papillary carcinoma, 5 sclerosing carcinoma and 1 follicular variant papillary carcinoma; and negative in 8:5 pure papillary carcinomas, 2 sclerosing carcinoma and 1 case of follicular variant papillary carcinoma. Lymph node micrometastasis was found in 2 cases through study with Pan Cytokeratin on final histological examination. CONCLUSIONS: Analysis of the Authors' preliminary data shows that sentinel lymph node detection has 83.3% sensitivity and 100% specificity for Upper Anterior Mediastinum lymph nodes. The Authors can propose two main applications: select for dissection only patients with a positive sentinel node and reduce the number of cases to be subjected to postoperative treatment with iodine ablation, in patients with "low risk" thyroid tumours and negative sentinel nodes.

Papillary thyroid carcinoma in thyroglossal duct cyst: case reports and literature review.

Although thyroglossal duct cysts represent a common developmental abnormality of the thyroid gland, malignant transformation is rare and occurs in only 1% of cases. This article describes four clinical cases observed at the Surgical Science Department of "La Sapienza" University of Rome between 1996 and 2000. Histologic examination indicated two pure papillary carcinomas, a sclerosing papillary carcinoma, and a follicular variant of papillary carcinoma. In all cases, treatment involved removal of the body of the hyoid bone and total thyroidectomy, which we associated with removal of the thyroglossal duct cyst. In one case, laterocervical lymphectomy was performed. Carcinoma multifocality was found in one patient. We recommend associating total thyroidectomy with removal of the tumor of the thyroglossal duct and of the body of the hyoid bone, because the carcinoma may be multifocal and there may be lymphatic invasion of the thyroid and to ensure a correct follow-up.

[Ontogenesis of congenital abnormalities of the left gonadal vein and their clinical relevance]. / Ontogenesi delle anomalie congenite della vena gonadica sinistra e loro rilevanza clinica.

The anatomy of the gonadal vein has been the subject of several studies relating particularly to the aetiology and therapy of varicocele and left ovarian vein syndrome. Venography shows the presence of valves, the collateral branches, the anastomoses between the left gonadal vein and the retroperitoneal venous networks and the effective pathways of venous reflux. The authors observed a particular congenital anomaly of the left gonadal vein in the dissection of a female cadaver, and studied the venographic pattern of a male patient with left idiopathic varicocele. The aim of this study was to investigate, with the aid of a review of the literature, the embryo-pathogenetic basis of congenital abnormalities of the left gonadic vein, stressing those factors most conducive to errors in the diagnosis and therapy of varicocele and left ovarian vein syndrome, particularly in the scleroembolisation therapy of idiopathic varicocele.

Transduodenal excision of giant tumour of the ampulla of Vater: a case report.

Carcinoma of the papilla is a rare cancer of the digestive tract; 5% of all gastrointestinal tract malignant neoplasms are periampullary. The authors report and discuss the case of one of their patients aged 79 years suffering from a tumour of the papilla. The case was characterized by the large size of the neoplasm (5.5 cm in diameter) and by the poor clinical conditions of the patient, who was suffering from Parkinson's disease and was at high operative risk. The surgical strategy chosen involved transduodenal excision of the tumour with duodenum-bile duct anastomosis and internal duodenum-Wirsung duct anastomosis. The authors first examine the hypothesis that carcinoma of the papilla may represent the evolution of an adenomatous lesion and then go on to assess the therapeutic strategy adopted in the treatment of these neoplasms: in patients at high operative risk a transduodenal excision of the tumour with duodenum-bile duct anastomosis and internal duodenum-Wirsung duct anastomosis may be a valid alternative to the conventional Whipple procedure.