Volumen plaquetario medio e índice de plaquetas-linfocitos como factores de pronóstico en cáncer papilar de tiroides.

BACKGROUND: Papillary thyroid cancer is the most common endocrine neoplasia. There are prognostic factors that establish risk of recurrence and mortality; however, patients considered low risk may have a less favorable evolution and hence the importance of finding new markers. OBJECTIVE: To assess whether the mean platelet volume (MPV) and the platelet-lymphocyte index (PLI) show a relationship with the clinical staging in papillary thyroid cancer. METHOD: Retrospective, observational and analytical study. Preoperative MPV and PLI were recorded, its relationship with TNM and MACIS systems was sought, as well as locally advanced invasion and tumor focality. RESULTS: 107 cases treated from November 2017 to February 2020. No statistically significant difference was observed in these two preoperative parameters with advanced and initial stages, risk groups or tumor focality. The statistical analysis used was one-way ANOVA with SPSS 25, a 95% confidence interval and p < 0.05. CONCLUSIONS: Despite the logical reasoning of tumor pathophysiology, our study did not find a relationship between papillary thyroid carcinoma with MPV and PLI, and should be complemented with more extensive studies.

ANTECEDENTES: El cáncer papilar de tiroides es la neoplasia endocrina más frecuente. Existen factores pronósticos que establecen el riesgo de recurrencia y mortalidad; sin embargo, los pacientes considerados de bajo riesgo pueden llegar a presentar una evolución menos favorable, y de ahí la importancia de encontrar nuevos marcadores. OBJETIVO: Evaluar si el volumen plaquetario medio (VPM) y el índice plaquetas-linfocitos (IPL) presentan una relación con la etapificación clínica en el cáncer papilar de tiroides. MÉTODO: Estudio retrospectivo, observacional y analítico. Se registraron el VPM y el IPL preoperatorios, y se buscó su relación con los sistemas TNM y MACIS, así como con la invasión localmente avanzada y la focalidad del tumor. RESULTADOS: Se trataron 107 casos de noviembre de 2017 a febrero de 2020. No se observó diferencia estadísticamente significativa en estos dos parámetros preoperatorios o en estadios avanzados e iniciales, grupos de riesgo ni focalidad del tumor. El análisis estadístico utilizado fue ANOVA de una vía, con SPSS 25, con intervalo de confianza del 95% y p < 0.05. CONCLUSIONES: Pese al razonamiento lógico de la fisiopatología tumoral, en nuestro estudio no se encontró relación entre el carcinoma papilar de tiroides, el VPM y el IPL, y debiera complementarse con estudios más extensos.

Variante células altas de cáncer papilar de tiroides: reporte de casos / Tall cell variant of papillary thyroid cancer: case report

El cáncer papilar constituye aproximadamente el 80% de todos los casos de cáncer de tiroides y el 85% de los tumores diferenciados. La variante de células altas representa el 1,3 al 12% del cáncer papilar siendo la variante agresiva más común de estos tumores. Posee un comportamiento agresivo, con mayor incidencia de invasión extratiroidea, linfovascular y metástasis a distancia, responsables de tasas de recurrencia más altas y peor pronóstico. Los casos aquí reportados reflejan las características que hacen sospechar mayor agresividad tumoral, desde el diagnóstico. Describimos dos pacientes de sexo femenino, entre 40 y 50 años, con historia de corta evolución, cuya presentación fue con síntomas de compresión locorregional y adenopatías metastásicas en cuello. Con hallazgos ecográficos e intraoperatorios de relevancia en cuanto la agresividad tumoral que hicieron sospechar la presencia de una variante agresiva del cáncer papilar. La histopatología de la variante de células altas posee una base molecular diferente respecto al papilar clásico que le confiere mayor morbi-mortalidad, constituyendo un factor de pronóstico independiente para la recurrencia. El tratamiento quirúrgico es la tiroidectomía total con vaciamiento profiláctico de los ganglios linfáticos centrales y eventualmente vaciamiento lateral de cuello según valoración preoperatoria, con posterior ablación postoperatoria de restos tiroideos mediante yodo radiactivo.

Papillary cancer constitutes approximately 80% of all thyroid cancer cases and 85% of differentiated tumors. The tall cell variant represents 1.3 to 12% of papillary cancers, being the most common aggressive variant of these tumors. It has an aggressive behavior, showing a higher incidence of extrathyroid and lymphovascular invasion and distant metastasis, responsible for higher recurrence rates and a worse prognosis. The cases reported here reflect characteristics that make us suspect tumor aggressiveness. These are female patients, between 40 and 70 years old, with a history of short evolution. They present locoregional symptoms or metastatic adenopathies, with ultrasound and intraoperative findings of relevance in terms of tumor aggressiveness that led to the suspicion of the presence of an aggressive variant of papillary cancer. The histopathology of the tall cell variant has a different molecular basis that confers its own morbidity and mortality, being an independent prognostic factor for recurrence. Total thyroidectomy is recommended with prophylactic dissection of the central lymph nodes and eventually lateral neck dissection according to preoperative evaluation followed by postoperative ablation with radioactive iodine.

Papillary thyroid microcarcinoma with minimal extrathyroidal extension. Is its course so indolent that it requires a less aggressive treatment?

BACKGROUND: Although the incidence of papillary thyroid microcarcinoma (PTMC) has increased in recent decades, the role played by minimal extrathyroidal extension (mETE) in the prognosis of PTMC is still unclear. The aim of this study is to analyze the factors associated with PTMC with mETE and its long-term prognosis. MATERIAL AND METHODS: We conducted a retrospective study on patients with a histological diagnosis of PTMC. We excluded patients who had previously undergone thyroid surgery, those who had other synchronous malignancies, those with an ectopic location of the PTMC, and those lost to follow-up within two years. We compared group 1 (PTMC without extrathyroidal extension) to group 2 (PTMC with mETE) and performed a multivariate analysis. RESULTS: We observed PTMC with mETE in 11.2% (n = 18) of patients. On the multivariate analysis, mETE was associated with an age ≥45 years (OR: 4.383; 95% CI: 1.051-18.283, p = .043), tumor size ≥8 mm (OR: 5.913; 95% CI: 1.795-19.481; p = .003), bilaterality (OR: 4.430; 95% CI: 1.294-15.173; p = .018) and metastatic lymph nodes (OR: 12.588; 95% CI: 2.919-54.280; p = .001). Over the mean follow-up period of 119.8 ±â€¯65 months, one case of recurrence was detected in group 2 (0% vs. 5.6%; p = .112). No patients died of the disease. Disease-free survival was lower in group 2 (124.9 ±â€¯5.6 vs. 97.4 ±â€¯10.3 months; p = .034). CONCLUSIONS: The mETE of PTMC is a factor of worse prognosis associated with the presence of metastatic lymph nodes and a lower rate of disease-free survival.

Microcarcinoma papilar de tiroides con extensión extratiroidea mínima. ¿Tiene un curso tan indolente para precisar un tratamiento menos intensivo? / Papillary thyroid microcarcinoma with minimal extrathyroidal extension. Is its course so indolent that it requires a less aggressive treatment?

Introducción Aunque el microcarcinoma papilar de tiroides (MCPT) ha sufrido un incremento en la incidencia en las últimas décadas, todavía no está claro qué papel desempeña la extensión extratiroidea mínima (EETm) en su pronóstico. El objetivo de este estudio es analizar los factores asociados al MCPT con EETm y su pronóstico a largo plazo. Material y métodos Estudio retrospectivo cuya población a estudio la constituyen los pacientes con diagnóstico histológico de MCPT. Se excluye a los pacientes con: cirugía tiroidea previa, otras enfermedades malignas sincrónicas, localización ectópica del MCPT o pérdida durante el seguimiento antes de los 2 años. Se comparan 2grupos: grupo 1 (MCPT sin extensión extratiroidea) y grupo 2 (MCPT con EETm). Se realiza un análisis multivariante. Resultados El 11,2% (n = 18) de los pacientes presentaron MCPT con EETm. En el análisis multivariante, la EETm se asoció con la edad ≥ 45 años (OR: 4,383; IC del 95%: 1,051-18,283; p = 0,043), el tamaño tumoral ≥ 8mm (OR: 5,913; IC del 95%; 1,795-19,481; p = 0,003), la bilateralidad (OR: 4,430, IC del 95%; 1,294-15,173; p = 0,018) y las adenopatías metastásicas (OR: 12,588; IC del 95%; 2,919-54,280; p = 0,001). Durante un seguimiento medio de 119,8 ± 65 meses, una recurrencia fue detectada en el grupo 2 (0% vs. 5,6%; p = 0,112). Ningún paciente falleció debido a la enfermedad. La supervivencia libre de enfermedad fue menor en el grupo 2 (124,9 ± 5,6 vs. 97,4 ± 10,3 meses; p = 0,034). Conclusión La EETm del MCPT es un factor de peor pronóstico, asociada a la presencia de adenopatías metastásicas y a una menor supervivencia libre de enfermedad (AU)

Background Although the incidence of papillary thyroid microcarcinoma (PTMC) has increased in recent decades, the role played by minimal extrathyroidal extension (mETE) in the prognosis of PTMC is still unclear. The aim of this study is to analyze the factors associated with PTMC with mETE and its long-term prognosis. Material and methods We conducted a retrospective study on patients with a histological diagnosis of PTMC. We excluded patients who had previously undergone thyroid surgery, those who had other synchronous malignancies, those with an ectopic location of the PTMC, and those lost to follow-up within 2years. We compared group 1 (PTMC without extrathyroidal extension) to group 2 (PTMC with mETE) and performed a multivariate analysis. Results We observed PTMC with mETE in 11.2% (n=18) of patients. On the multivariate analysis, mETE was associated with age ≥45 years (OR: 4.383; 95% CI: 1.051-18.283, p = .043), tumor size ≥8mm (OR: 5.913; 95% CL: 1.795-19.481; p = .003), bilaterality (OR: 4.430; 95% CI: 1.294-15.173; p = .018) and metastatic lymph nodes (OR: 12.588; 95% CI: 2.919-54.280; p = .001). During a mean follow-up of 119.8±65 months, one recurrence was detected in group 2 (0% vs. 5.6%; p = .112). No patients died of the disease. Disease-free survival was lower in group 2 (124.9±5.6 vs. 97.4±10.3 months; p = .034). Conclusions The mETE of PTMC is a factor of worse prognosis associated with the presence of metastatic lymph nodes and a lower rate of disease-free survival (AU)

Metástasis raras de cáncer papilar de tiroides en músculo esquelético: serie de casos / Rare metastases of papillary thyroid cancer in skeletal muscle: case series

Las metástasis del carcinoma papilar de tiroides (CPT) generalmente son a nivel locorregional, la diseminación a distancia es poco habitual, sin embargo la invasión de tejidos blandos aunque inusual puede ocurrir, y afecta negativamente la supervivencia. El presente estudio describe una serie de casos de Metástasis Musculares de CPT. Se realizó un estudio transversal de un solo centro que evaluó diez pacientes con CPT con metástasis en músculo. La edad de los pacientes fue entre 46 a 77 años, siendo la edad promedio de 60 años, 7 de los cuales fueron de sexo masculino que corresponde al 70%, todos con antecedente de CPT con respuesta estructural incompleta, además de las metástasis en músculo presentaron afectación de tres o más órganos, con necesidad de varios tratamientos, cada paciente registró entre 1 a 8 cirugías, recibieron entre 100 a 780mCi de I131 (yodo radiactivo), ocho ameritaron radioterapia, todos tuvieron indicación de tratamiento con ITK, sin embargo solo cuatro pacientes tuvieron acceso a dicho medicamento. La mayoría de las metástasis del CPT en músculo fueron diagnosticadas en los estudios de imagen PET/ CT, después de la tiroidectomía el tiempo de su presentación fue muy variable entre 1 a 18 años, el número de músculos comprometidos se reporta entre uno a cuatro, siendo el glúteo (4 casos) el músculo metastásico más frecuente. La presencia de metástasis musculares empeora el pronóstico en nuestra serie de pacientes.

Metastases of thyroid papillary carcinoma (CPT) are generally at the locoregional level, the dissemination from a distance is unusual, however the invasion of soft tissues, although rare can occur, and it negatively affects survival. The present study describes several Muscular Metastases of CPT cases. A transversal study in one only center was performed and assessed ten patients CPT metastases in muscles.The patients age ranged from 46 to 77, being the average age of 60, and 7 of them were male, corresponding to the 70%, everyone with CPT records with an incomplete structural response. Besides muscular metastases they also presented issues with three or more organs, needing many treatments. Each patient registered between 1 to 8 surgeries, they received between 100 to 780mCi of I131. Eight required radiotherapies, everyone required treatment with ITK, however, just four patients had access to that medication. Most of the CPT metastases in muscles were diagnosed in PET/CT image studies, after the thyroidectomy, the time for its presentation was very variable between 1 to 18 years, the number of compromised muscles is reported between one to four, being the buttock (4 cases) the most frequently muscle with metastases. The presence of muscular metastases aggravates the prognosis in our series of patients.

Metástasis ganglionar como presentación de un carcinoma papilar de tiroides oculto, variedad folicular: reporte de caso / Lymph node metastasis as a presentation of an occult papillary thyroid carcinoma, follicular variety: case report

El carcinoma oculto de tiroides está poco reportado. Se presenta el caso de una mujer de 59 años. Durante un control por hipotiroidismo se solicitó ecografía cervical, la que mostró áreas hipoecogénicas en lóbulo derecho, una formación nodular hiperecogénica circunscrita no sospechosa de 8 mm y una adenopatía cervical periglandular derecha de 20 x 12 x 8 mm con áreas quísticas y microcalcificaciones, asociadas a hipervascularización. Se solicitó punción aspirativa por aguja fina del ganglio linfático, con resultado de citología negativa para células neoplásicas. El examen microscópico es compatible con tiroiditis, por lo que no es posible descartar metástasis. Se realizó biopsia del ganglio linfático, el que se informa como metástasis ganglionar linfática de 1.3 cm, histología de carcinoma papilar variedad folicular, sin invasión extracapsular. Se realizó tiroidectomía total y disección cervical derecha. El estudio anatomopatológico reportó una tiroiditis crónica de Hashimoto con un nódulo fibroso hialinizado de 0,4 cm negativo para tumor maligno y metástasis en 4 de 28 ganglios linfáticos, sin invasión extracapsular. El tamaño de la metástasis fue de 0,3 a 0,9 cm. Posteriormente se administró 100 mci de radioyodo. Actualmente, la paciente está en buenas condiciones y mantiene controles con ecografía y tiroglobulina periódicos.

Occult thyroid carcinoma is under-reported. The case of a 59-year-old woman is presented. During a check-up for hypothyroidism, a cervical ultrasound was requested, which showed hypoechogenic areas in the right lobe, an 8 mm nonsuspicious circumscribed hyperechogenic nodular formation and a 20 x 12 x 8 mm right cervical periglandular lymphadenopathy with cystic areas and microcalcifications, associated with hypervascularisation. Fine needle aspiration of the lymph node was requested, with negative cytology results for neoplastic cells. Microscopic examination was compatible with thyroiditis, so metastasis could not be ruled out. A biopsy of the lymph node was performed, which was reported as a 1.3 cm lymph node metastasis, histology of papillary carcinoma of the follicular variety, without extracapsular invasion. Total thyroidectomy and right cervical dissection were performed. The anatomopathological study reported chronic Hashimoto's thyroiditis with a 0.4 cm hyalinised fibrous nodule negative for malignant tumour and metastases in 4 of 28 lymph nodes, without extracapsular invasion. The size of the metastasis was 0.3 to 0.9 cm. Subsequently, 100 mci of radioiodine was administered. The patient is currently in good condition and maintains regular ultrasound and thyroglobulin monitoring.

Papillary thyroid microcarcinoma with minimal extrathyroidal extension. Has it so indolent course to require a less aggressive treatment? / Microcarcinoma papilar de tiroides con extensión extratiroidea mínima. ¿Tiene un curso tan indolente para precisar un tratamiento menos intensivo?

BACKGROUND: Although the incidence of papillary thyroid microcarcinoma (PTMC) has increased in recent decades, the role played by minimal extrathyroidal extension (mETE) in the prognosis of PTMC is still unclear. The aim of this study is to analyse the factors associated with PTMC and mETE and the long-term prognosis of PTMC. MATERIAL AND METHODS: We conducted a retrospective study with a population consisting of patients with a histological diagnosis of PTMC. We excluded patients who had previously undergone thyroid surgery, those who had other synchronous malignancies, those with an ectopic location of the PTMC and those lost to follow-up within 2years. We compared group 1 (PTMC without extrathyroidal extension) versus group 2 (PTMC with mETE) and performed a multivariate analysis. RESULTS: We observed PTMC with mETE in 11.2% (n=18) of the patients. In the multivariate analysis, mETE was associated with an age ≥45 years (OR, 4.383; 95% CI 1.051-18.283, p=.043), a tumour size ≥8mm (OR, 5.913; 95% CI 1.795-19.481; p=.003), bilaterality (OR, 4.430; 95% CI 1.294-15.173; p=.018) and metastatic lymph nodes (OR, 12.588; 95% CI 2.919-54.280; p=.001). During a mean follow-up of 119.8±65 months, one recurrence was detected in group 2 (0% vs. 5.6%; p=.112), but none of the patients died due to the disease. Disease-free survival was lower in group 2 (124.9±5.6 vs. 97.4±10.3 months; p=.034). CONCLUSIONS: The mETE of MCPT is a factor of worse prognosis, associated with the presence of metastatic lymph nodes and lower disease-free survival.

Risk Factors of Metastatic Lymph Nodes in Papillary Thyroid Microcarcinoma. / Factores de riesgo de metástasis ganglionares en el microcarcinoma papilar de tiroides.

INTRODUCTION: Papillary thyroid microcarcinoma (PTMC) usually has an indolent course, but some have worse prognostic factors, such as the presence of central (6.9%-51.5%) and lateral (3%-49.6%) lymph node metastases. The aim of this study is to analyze the factors associated with PTMC with metastatic lymph nodes and its long-term prognosis. METHODS: Retrospective study whose study population consists of patients with PTMC (size ≤1cm). Patients with previous thyroid surgery, other synchronous malignancies and ectopic location of the PTMC were excluded. Two groups were compared: PTMC without metastatic lymph nodes (group 1) and PTMC with metastatic lymph nodes (group 2). A multivariate analysis using a logistic regression model and a Kaplan-Meier survival analysis with log-rank test were performed. RESULTS: Out of the 161 selected patients, 9.3% (n=15) had metastatic lymph nodes. Multifocality (OR 5.284, 95%CI 1.056-26.443; P=.043) and extrathyroidal extension (OR 7.687, 95%CI 1.405-42.050; P=.019) were associated with the presence of metastatic lymph nodes. In PTMC with metastatic lymph nodes, more aggressive treatments were performed: lymphadenectomy (4.8% vs. 100%; P<.001) and radioactive iodine (24.7% vs. 100%; P<.001). During a mean follow-up of 119.8±65 months, one recurrence was detected in group 2 (0% vs. 6.7%; P=.093). No patients died due to the disease. CONCLUSIONS: Multifocality and extrathyroidal extension of PTMC were associated with the presence of metastatic lymph nodes. Metastatic PTMC, with more aggressive treatments, presents an excellent long-term prognosis.

Incidental versus clinical diagnosis of papillary thyroid microcarcinoma. Long-term prognosis. / Diagnóstico incidental versus clínico del microcarcinoma papilar de tiroides. Pronóstico a largo plazo.

INTRODUCTION: The incidence of papillary thyroid microcarcinoma (PTMC) has increased in recent years, especially in patients operated on for presumably benign thyroid disease. The aim of this study was to analyze the differences between PTMC incidentally diagnosed and PTMC clinically diagnosed, as well as its long-term prognosis. MATERIAL AND METHODS: The study population consisted of patients with a histological diagnosis of PTMC. Patients with previous thyroid surgery, other synchronous thyroid or extrathyroid malignancies and an ectopic location of PTMC were excluded. Two groups were compared: patients with PTMC incidentally diagnosed (group 1) and patients with PTMC clinically diagnosed (group 2). A multivariate analysis of differentiating factors was performed. RESULTS: PTMC clinically diagnosed had a high frequency of hypothyroidism (4.6% vs. 18.9%; P=.004), extrathyroidal extension (5.7% vs. 17.6%; P=.018), metastatic lymph nodes (1.1% vs. 18.9%; P<.001) and lymphocytic thyroiditis (5.7% vs. 27%; P<.001). In the multivariate analysis, metastatic lymph nodes (OR: 22.011, IC 95%: 2.621-184.829; P=.004) and lymphocytic thyroiditis (OR: 4.949; IC 95%: 1.602-15.288; P=.005) were associated with the clinical diagnosis of PTMC. During a mean follow-up of 119.8±65.1 months, one recurrence was detected in group 2 (0% vs. 1,4%; P=.460). No patient died due to the disease. CONCLUSIONS: PTMC clinically diagnosed, although it has more aggressive histopathological characteristics (extrathyroidal extension and metastatic lymph nodes), presents a long-term prognosis similar to the PTMC incidentally diagnosed. The presence of metastatic lymph nodes and lymphocytic thyroiditis were independent factors associated with PTMC clinically diagnosed.

Factores de riesgo asociados a recidiva de carcinoma papilar de tiroides / Risk factors associated with recurrence of papillary thyroid carcinoma

RESUMEN Introducción: Aunque el carcinoma papilar de tiroides (CPT) tiene una buena sobrevida, en el 30% de los casos recidivará a largo plazo. Se han descrito factores pronósticos como el tamaño, histopatología, procedimiento quirúrgico y administración de yodo radiactivo. Objetivo: Este trabajo pretende determinar factores de riesgo de recidiva a largo plazo. Material y método: Se realizó un estudio retrospectivo y observacional, se incluyeron a los pacientes sometidos a cirugía por CPT con seguimiento a 10 años, y se analizaron variables clínicas y bioquímicas relacionadas con la recidiva a largo plazo. Resultados: Se identificaron 91 pacientes con seguimiento de 10 años. No se encontró relación para recidiva con historia familiar oncológica, enfermedad tiroidea pre-via, pero sí con tabaquismo (p 0,040). Se encontraron a 27 (29%) con recidiva, en relación a lesiones >3 cm (p 0,05), y CPT multicéntrico (p 0,003). Conclusión: El tiempo de evolución prolongado favorece el crecimiento de las lesiones, y la diseminación de la enfermedad, así como la recidiva. El CPT es una enfermedad con capacidad metastásica a largo plazo, que requiere un seguimiento cercano y detección oportuna de pacientes susceptibles de recidiva. El tiempo entre el diagnóstico y la cirugía es un factor fundamental para el crecimiento de las lesiones y la propagación de la enfermedad, por lo que se debe reducir el tiempo de espera, evitando así las lesiones de mayor tamaño, diseminación de células tumorales y la recidiva con peor pronóstico para los pacientes.

ABSTRACT Introduction: The papillary thyroid cancer has good survival rate, however, 30% of the patients will have a recurrence. Prognostic factors have been described such as size, histopathology, surgical procedure and administration of radioactive iodine. Aim: To determine preventable risk factors for long-term recurrence. Material and method: This is a retrospective and observational study, patients undergoing surgery for CPT and 10 year follow up were included to analyze clinical and biochemical variables related to long-term recurrence. Results: Ninety-one patients with a 10-year follow-up were identified. No relationship was found for recurrence with oncological family history, previous thyroid disease, but smoking was a risk factor (p 0.040). We found 27 (29%) with relapse, in relation to lesions > 3 cm (p 0.05), and multicentric PTC (p 0.003). Conclusion: The long evolution time favors the growth of lesions, the spread of the disease, as well as the recurrence. The CPT is a disease with long-term metastatic capacity; it requires close monitoring and opportune detection of patients susceptible to recurrence. The time between diagnosis and surgery is a fundamental factor for the growth of the lesions and the spread of the disease, so the waiting time must be reduced, thus avoiding larger lesions, malignant cell dissemination and recurrence with worse prognosis for patients.

BRAF V600E mutation in papillary thyroid cancer and its effect on postoperative radioiodine (131I) therapy: Should we modify our therapeutic strategy? / Mutación del gen BRAF V600E en el cáncer papilar de tiroides y su efecto en la terapia con yodo radiactivo (131I) posquirúrgica: ¿deberíamos modificar nuestra estrategia terapéutica?

INTRODUCTION: The BRAF V600E mutation in papillary thyroid cancer (PTC) has been associated with resistance to 131I. Our aim was to quantify the response to 131I after surgery in patients who had the mutation (BRAF+) and those who did not have the mutated gene (BRAF-). METHOD: A prospective cohort study was designed, from September 2015 to February 2016, which included patients with PTC receiving therapy after surgical treatment. Variables were described for age, gender, histology, tumor stage, thyroglobulin values before, 48h after and 6months after 131I; absorbed dose and % activity on days 2 and 7 and elimination time. RESULTS: 41 patients giving in total 67 thyroid remnants were included. 61% were BRAF+. In stagesiii and iv, 80% were BRAF+. In lateral resection, 100% were BRAF+. The number of nodes was higher in BRAF+: 3.4 vs 1.2 (P=.01). The classic variant was predominant in BRAF+ (91.7% vs 8.3%, P=.03). 85.7% vs 14.3% of BRAF+ had desmoplastic reaction (P=.02). The BRAF+ had a lower absorbed dose than the administered activity (5.4Gy/MBq vs 20Gy/MBq, P=.02); lower% activity with respect to the unit of mass at 2 (0.046%/g vs 0.103%/g, P=.02) and at 7days (0.006%/gr vs 0.034%/gr, P=.04) CONCLUSIONS: The mutation of the BRAF V600E gene is related with greater resistance to postoperative treatment with 131I since the onset of the disease.

Estudio para determinar los niveles de calcio y paratohormona en pacientes con y sin vaciamiento central profiláctico, con diagnóstico de cáncer papilar de tiroides / Study to determine calcium and parathyroid hormone levels in patients with and without prophylactic central emptying, with diagnosis of papillary thyroid cancer

Contexto: El cáncer papilar de tiroides representa una patología que va en aumento, y el manejo quirúrgico es complejo. Una disección profiláctica cervical central para los pacientes con cáncer papilar de tiroides es controvertida. Dado que los riesgos de complicaciones transitorias probablemente son altas, y los beneficios parecen ser pequeños, de tal forma, que para realizarlo se utiliza un enfoque selectivo, en función de factores de riesgo del paciente y el nivel de experiencia del cirujano. Objetivo: determinar en el postquirúrgico los niveles de calcio y paratohormona en pacientes adultos, de ambos sexos con sospecha alta de cáncer papilar de tiroides, a los cuales se les realizó o no, vaciamiento central en los hospital Eugenio Espejo de la ciudad de Quito, durante un año. Sujetos y métodos: observacional, analítico, epidemiológico transversal, de cohortes. Se estudiaron todos los pacientes con sospecha citológica de cáncer papilar de tiroides, sometidos a tiroidectomía total, con o sin vaciamiento central profiláctico; se midió a las 24 horas los niveles de calcio y paratohormona. Las variables cuantitativas se reportaron como promedios y las cualitativas con sus valores absolutos y relativos. Las comparaciones de variables cuantitativas se realizaron con la prueba t-Student, mientras que para las cualitativas se usaron pruebas de independencia para proporciones x2 y prueba exacta de Fisher. Se hizo un análisis multivariados con regresión logística reportada como Odds Ratios ajustados (ORadj). Resultados: con respecto al calcio el grupo con vaciamiento central presentó valores significativamente menores que el grupo sin vaciamiento, esta diferencia fue de -0.07 mmol/L (IC 95 %: -0.036, -0.097 mmol/L;p < 0.0001). Los pacientes sometidos a vaciamiento central tuvieron tasas significativamente menores de paratohormona (para valores inferiores a los 10pg/ml) hasta el 53.9%, mientras que en el grupo sin vaciamiento solo el 11.1%(IC 95%: 29.5, 56.2%; p < 0.0001). Conclusión: se observó que en el grupo de tiroidectomía con vaciamiento central profiláctico, hubo una tasa importante de hipocalcemia e hipoparatiroidismo, todos estos pacientes presentaron signos de hipocalcemia durante su periodo postquirúrgico, lo que prolongo su estadía hospitalaria, (AU)

Introduction: Papillary thyroid cancer is on the rise and surgical treatment is complex. Prophylactic central neck dissection for papillary thyroid cancer patients is controversial because of the possibility of higher risk of transient complications and the benefits of the surgery are low. As a result, the surgery is performed based of the risk factors of the patient and the experience of the surgeon. Objective: to determine the levels of calcium and parathyroid hormone post-surgery in adult male and female patients with suspected risk of papillary thyroid cancer, to who prophylactic central drainage, was and was not performed. Subjects and methods: this is an epidemiological, observational, analytic, cross-sectional, of cohorts. The research will be done on all patients suspected of cytological papillary thyroid cancer in Hospital Eugenio Espejo, and who underwent total thyroidectomy with and without prophylactic central drainage. Calcium and parathyroid hormone levels will be checked 24 hours post-surgery. The quantitative variables will be reported as averages and the qualitative variables as absolute and relative data. t-Student test was used to compare qualitative data. Qualitative data was compared using independent test with scales of x2 and the Fisher exact test. A logistic regression analysis was done and reported as Adjusted Odds ratios (AOR). Results: calcium level on the group with central drainage had significant lower levels compare to the group without central drainage, the difference was of -0.07 mmol/L (IC 95 %: -0.036, -0.097 mmol/L; p<0.0001). The patients with central drainage had significantly lower levels of parathyroid hormone (levels lower than 10pg/ml) up to 53.9%; while the group without central drainage only had 11.1% %(IC 95%: 29.5, 56.2%; p < 0.0001). Conclusion: though the study the thyroidectomy with prophylactic central drainage group had a significant rate of hypocalcemia and hypoparathyroidism. These patients had symptoms of hypocalcemia post-surgery, which prolong their hospital stay. (AU)

Cáncer tiroideo papilar: reporte de 4 casos familiares / Papillary thyroid cancer: case reports of four family cases

Introducción: El cáncer papilar del tiroides (CPT) es la neoplasia endocrina más frecuente, siendo el 80% de los casos de la variedad papilar; sólo el 10 por ciento se manifiesta antes de los 21 años y tiene una incidencia estimada en este grupo de 0,54:100.000. Su comportamiento en la edad pediátrica se caracteriza por el diagnóstico en una etapa más avanzada de la enfermedad pero con buena respuesta terapéutica y muy baja mortalidad. Objetivo: Presentar 4 casos familiares de CPT, discutir las características particulares y la importancia del diagnóstico precoz en pacientes. Casos clínicos: Se presentan 4 familias con sujetos portadores de un carcinoma papilar familiar de Tiroides, en todas ellas el caso pediátrico se presentó con posterioridad a un caso de un adulto familiar directo, por lo que su búsqueda fue más precoz, y a pesar de un tratamiento oportuno ya tenían enfermedad avanzada al diagnóstico. Los casos pediátricos corresponden a 3 mujeres y 1 varón de edades promedio de 12 años 6 meses al momento del diagnóstico. Discusión: La variedad familiar del carcinoma papilar de tiroides (2 o más familiares de primer grado afectados), representa el 5 por ciento de los cánceres papilares. Se transmite a través de herencia autosómica dominante con penetrancia incompleta y expresividad variable. Se manifiesta a menor edad que el esporádico, es más agresivo con mayor invasión local (32 por ciento), recurrencia (20-50 por ciento) y metástasis linfática (57 por ciento), y se asocia a enfermedades tiroídeas benignas. Con frecuencia es multifocal. Conclusión: El cáncer familiar papilar de tiroides es una patología con peor pronóstico que la variedad esporádica por lo que se requiere una alto índice de sospecha en las familias afectadas para un diagnóstico y tratamiento precoz.

Introduction: Papillary thyroid cancer (PTC) is the most common endocrine malignancy, representing 80 percent of all thyroid cancers; only 10 percent of cases are manifested before age 21 and have an estimated incidence of 0.54 cases per 100,000 people. In children it is diagnosed at a more advanced stage of the disease but with good therapeutic response and very low mortality. Objective: To present four family cases with PTC, discuss the particular characteristics and the importance of early diagnosis. Case reports: 4 families with members affected by family papillary thyroid carcinoma are presented, all pediatric cases were manifested after a direct member adult case was diagnosed, therefore pediatric patients were early detected, but despite a timely treatment, the disease was advanced at the time of diagnosis. The pediatric cases are 3 females and 1 male with an average age of 12 ½ years old at diagnosis. Discussion: The family variety of papillary thyroid carcinoma (2 or more direct members affected), represents 5 percent of papillary cancers. It is transmitted through autosomal dominant inheritance with incomplete penetrance and variable expressivity. It occurs at a younger age than the sporadic type, and it is more aggressive with greater local invasion (32 percent), recurrence (20-50 percent) and lymphatic metastases (57 percent), and it is associated with benign thyroid diseases and often, it is multifocal. Conclusion: The family papillary thyroid cancer is a disease with worse prognosis than the sporadic variety; therefore, a high index of suspicion is required in affected families for early diagnosis and treatment.

Cáncer de quiste en conducto tirogloso / Thyroglossal duct cyst cancer

El quiste del conducto tirogloso es una de las anomalías del desarrollo que se presenta más frecuentemente en el cuello. La presencia en este de carcinoma aislado o concomitante con cáncer en tiroides, es muy infrecuente. Se expone aquí el caso de una paciente joven que se presentó con esta entidad. Se describe su presentación y manejo. Actualmente sigue su control en el Servicio de Endocrinología del Hospital San Vicente de Paúl, Heredia, Costa Rica...

Obstrucción súbita de la vía aérea superior secundaria a carcinoma tiroideo. presentación de un caso / Sudden obstruction of the upper airway secondary to thyroid carcinoma. presentation of a case

La obstrucci ón s úbita de la v ía aérea superior puede ser manifestaci ón de factores o condiciones tanto intr ínsecas como extr ínsecas. Como causa extr ínseca raramente asociada se encuentra el Carci - noma Papilar de Tiroides CPT, siendo este el subtipo m ás frecuente de Carcinoma de Tiroides que representa el 75 - 80% de los casos 1 . Se revisa un caso interesante de un paciente masculino de 13 a ños que se recibe en la emergencia del Hospital Mario Catarino Rivas con cuadro de dificultad respiratoria importante y estridor audible a distancia, que amerit ó intubaci ón inmediata y traslado a Unidad de Cuidados Intensivos Pedi átricos (UCIP). Con antecedentes de cuadro similar pero de menor intensidad 2 meses atr ás; tratado en su momento como sospecha fundada de Tuberculosis Pulmo- nar dado los hallazgos cl ínicos, antece dentes epidemiol ógicos de contacto con adulto en tratamiento antif ímico y hallazgos radiol ógicos de infiltrados miliares carac ter ísticos, en UCI P se complementan estu dios con TAC de Cuello que muestra cre cimiento Tiroideo con compresi ón de Tr áquea por lo que se programa para cirugí a ( Tiroidectom ía ) con estudio anato -mopatol ógico trans y postoperatorio el cual reporta Carcinoma Papilar de Tiroi des. Actualmente paciente en control con servi cio de Endocrinologí a y Hematoncologí a, en plan de recibir lodo Radioactivo...(AU)