RESUMO
From 1986 to 1996 the Authors have surgically treated 34 patients affected with Hürthle cell neoplasm of the thyroid (23 benign and 11 malignant). Preoperative diagnosis was obtained mainly by fine needle aspiration biopsy. In thyroid surgery we routinely prepare laryngeal nerve and take great care to avoid devascularization fo the parathyroid glands. Operative procedures performed were hemithyroidectomy plus isthmectomy (18), subtotal thyroidectomy (2) and total thyroidectomy (14). No cervical lymph node dissection was requested, neither we observed post-operative morbidity. Mean follow-up was 116 months. During observation period we documented. No hematogenous metastasis was observed. All patients are now well and alive free of disease. This series stresses the favourable behavior of Hürthle cell neoplasm of the thyroid--even through a prolonged follow-up. A thorough review of the Literature on the topic is conducted. The Authors are in favour of total thyroidectomy as first choice procedure for lesions larger than 40 mm in order to reduce the need of completion thyroidectomy and the potential morbidity.
Assuntos
Adenocarcinoma/cirurgia , Adenoma Oxífilo/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Adenocarcinoma/patologia , Adenoma Oxífilo/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Terminologia como Assunto , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Fatores de TempoRESUMO
We have analysed the results of surgical treatment for microcarcinoma of the thyroid (MCT). In sixteen patient clinical and follow-up data were retrospectively evaluated during a 35.1-month follow-up. Thyroid hyperfunctional state us was present in two subjects. A single nodule was detected by echotomography in 11 patients, while multinodular diffuse goitre was revealed in 3 patients. In the last two subjects, thyroid gland appeared completely normal at ultrasonography, despite laterocervical lymph node metastases. Fine-needle aspiration biopsy was performed in 6 patients and its diagnostic accuracy was high (83,3%). MCT was classified as "incidental" in 12 patients and "occult" in the remaining 4 patients. Eight subjects underwent total thyroidectomy and 8 hemithyroidectomy plus isthmectomy. No postoperative complications were recorded. In 10 patients MCT histotype was papillar adenocarcinoma, in 5 was follicular adenocarcinoma and in the remaining case it was medullary carcinoma. Goitre was associated in 75% of the cases. Only in a patient disease progressed to death because of hematogenous metastases. In conclusion, we believe that incidental MCT is a low-grade malignancy with a benign biological behaviour. Occult MCT is a potentially lethal disease. We did not observe differences in the long-term results between different surgical treatments of MCT.
Assuntos
Adenocarcinoma Folicular/cirurgia , Adenocarcinoma Papilar/cirurgia , Carcinoma Medular/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Adenocarcinoma Folicular/diagnóstico , Adenocarcinoma Folicular/patologia , Adenocarcinoma Papilar/diagnóstico , Adenocarcinoma Papilar/patologia , Adulto , Idoso , Biópsia por Agulha , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/secundário , Carcinoma Medular/diagnóstico , Carcinoma Medular/patologia , Diagnóstico Diferencial , Feminino , Seguimentos , Bócio Nodular/diagnóstico , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Cintilografia , Estudos Retrospectivos , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/patologia , Fatores de TempoRESUMO
Medullary thyroid carcinoma is an uncommon neoplasia among other differentiated carcinomas or the thyroid gland. We have retrospectively analysed four new cases of medullary thyroid carcinoma and a careful review or the literature on the subject has been conducted.
Assuntos
Carcinoma Medular/diagnóstico , Neoplasias da Glândula Tireoide/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Medular/patologia , Carcinoma Medular/cirurgia , Feminino , Humanos , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , TireoidectomiaRESUMO
The authors report on 2 patients affected by well-differentiated, locally advanced, thyroid carcinoma infiltrating the major mediastinal veins. Removal of the neoplastic mass was possible through a combined cervical and trans-sternal approach. Surgical indication, operative strategy and follow up are discussed. A review of the literature is also reported.
Assuntos
Adenocarcinoma/cirurgia , Carcinoma Papilar/cirurgia , Mediastino/irrigação sanguínea , Neoplasias da Glândula Tireoide/cirurgia , Adenocarcinoma/patologia , Idoso , Carcinoma Papilar/patologia , Feminino , Humanos , Metástase Linfática , Masculino , Mediastino/cirurgia , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia , Veias/cirurgiaRESUMO
Hepatic artery resistance index (I.R.) was evaluated in six pigs through Doppler scan after progressive gauge reduction of the portal vein up to complete clamping. The I.R. values were (mean +/- S.D.): 0.48 +/- 0.01 in basal conditions; 0.37 +/- 0.03, and 0.33 +/- 0.01 with a reduction of 1/3 and 2/3 respectively; 0.27 +/- 0.02 after complete portal clamping. These data confirm the close relationship existing in the hepatic circulation between changes of the arterious resistence and those of the portal flow. The same animals, subsequently, underwent heterotopic liver transplantation in the right paracolic gutter. Immediately after surgery the I.R. values of the transplanted hepatic artery were recorded without clamping (basal portal flow 0.52 +/- 0.02) and after clamping of the transplanted portal vein (0.33 +/- 0.03), while maintaining clamped the recipient portal vein at the hilus. These values were comparable to those obtained in the recipient hepatic artery. These data suggest that, in spite of parenchymal damages secondary to surgical procedure and of the haemodynamically unfavorable site in which the organ is transplanted, heterotopic liver transplantation does not produce significant changes in hepatic arterious resistance.