Merits of the PMiT (papillary microtumor) terminology in the definition of a subset of incidental papillary microcarcinomas of the thyroid.

An exponential increase in the detection of papillary thyroid microcarcinomas (PTMCs) has been observed in recent times, possibly because of recent improvements in the management of thyroid lesions and extensive histological examination. However, no definitive treatment guideline has been developed for PTMC, resulting in patients undergoing overtreatment. In 2003, the term papillary microtumor of the thyroid (PMiT) was proposed for small (< or =1 cm) intrathyroidal tumors with excellent prognostic prospects along with strict definition criteria. Since then, the term PMiT has been adopted by clinicians and surgeons. In this article, the authors report a series of 50 consecutive cases of PMiT collected and treated at the University Hospital of Turin, Italy. From the authors' experience, this terminology, which demarks a subset of PTMC, should be widely adopted as it is biologically sound, well accepted by both clinicians and patients, decreases the danger of overtreatment, minimizes the psychological anxiety engendered by a diagnosis of carcinoma, and maintains the patient's eligibility for health insurance.

Does the risk of compressive hematoma after thyroidectomy authorize 1-day surgery?

BACKGROUND: Compressive hematoma after thyroidectomy is a rare complication (1%) but can potentially be severe. The aim of this study was to search for risk factors, in particular the use of anticoagulants or antiplatelet medication, and to see if the delay of hematoma formation would require 1-day surgery performed in a careful manner. MATERIALS AND METHODS: Retrospective review of 6,830 patients undergoing thyroidectomy in a single institution (1991 to 2006) identified 70 patients with hematomas requiring reoperation. Case controls (210 patients) were matched for age, gender, year of operation, type of thyroid disease, and type of operation. The notion of anticoagulant or antiplatelet medication was particularly studied. The delay of hematoma formation and the cause of bleeding were studied in univariate analysis by a chi-squared test and a Fischer's test. RESULTS: In univariate analysis, the formation of hematoma is not related to age, gender, type of thyroid disease, or type of bleeding. The pre or intraoperatory administration of anticoagulant or antiplatelet medication did not influence hematoma formation. Thirty-seven hematomas (53%) presented within 6 h postoperatively, 26 (37%) between 7 and 24 h and seven (10%) beyond 24 h. CONCLUSION: Patients undergoing anticoagulant or antiplatelet treatment are not a high-risk population for hematoma formation. Forty-seven percent of the patients presented postoperative hematomas beyond 6 h postoperatively, leading to the conclusion that 1-day surgery is not safe.

Thyroidectomy for Graves' hyperthyroidism. Retrospective study of patients' appreciation.

AIM OF THE STUDY: To retrospectively investigate the patients' views of surgical treatment of Graves' hyperthyroidism. METHODS: One hundred two patients were included in the study and submitted to extensive subtotal thyroidectomy or total thyroidectomy between 1993-2003. Data were acquired from the responses to a questionnaire, that was completed by 83 patients. RESULTS: Before the operation the working/studying ability and the social/emotional relations were impaired in 20% and 22% of cases. Preoperative information was adequate for 84% of patients. The perception of the hospital efficiency was favourable in 89% of cases, and the interpersonal relations with clinicians and nurses were very positive for 96% of patients. After the operation, all patients were hypothyroid on levothyroxine (l-T4); unexpected problems with l-T4 therapy occurred in 6% of cases. Voice changes or neck discomfort were reported by 29% and 8% of patients. The aesthetic appearance of the scar was very satisfactory for 70% of patients, but 11% were unsatisfied. The working/studying ability and the social/emotional relations improved in 63% and 59% of cases. Eye symptoms improved in 71% of the patients with endocrine ophthalmopathy, but got worse in 60%. The quality of life, expressed with a 0 to 10 scale, improved from a mean preoperative score of 4.7 to a mean score of 7.9 (P = 0.000). Only 5% of patients expressed hesitation to recommend surgery to a friend with similar disease. CONCLUSIONS: Surgery is an effective therapy for selected cases of Graves' disease and meets the expectations of the majority of patients. Nevertheless some possible factors for dissatisfaction are pointed out.

alpha-fetoprotein expression in a dedifferentiated liposarcoma.

Extremely rare cases of paraneoplastic syndromes or ectopic production of proteins associated with liposarcoma are reported in literature. We describe a unique case of relapsing retroperitoneal dedifferentiated liposarcoma with biochemical, immunohistochemical, and molecular evidence of alpha-fetoprotein (AFP) ectopic production. The lesion was associated to elevated AFP plasma levels that subsided after tumor removal. Immunohistochemical studies showed AFP production by a minority of tumor cells and reverse transcriptase polymerase chain reaction confirmed AFP mRNA expression. Finding of MDM2 and CDK4 iperexpression by immunohistochemistry confirmed the diagnosis of dedifferentiated liposarcoma.