RESUMO
BACKGROUND: We present the case of a woman with cancer, which weakened the immune system and increased the risk of infection. Thus, infections are a frequent complication of cancer. The development of community-acquired pneumonia, an acute respiratory infectious disease that damages the lung parenchyma, caused by the invasion of pathogenic microorganisms, can lead to respiratory failure with multiorgan failure due to respiratory sepsis. CASE PRESENTATION: Case report of a 38-year-old mixed-race woman with diabetes mellitus and irregular treatment, who was admitted with community-acquired pneumonia complicated by type I respiratory failure requiring mechanical ventilation. During her hospital stay, she developed ventilator-associated pneumonia, recurrent empyema, bronchopleural fistula, refractory septic shock and multiorgan dysfunction despite multiple interventions. The patient required prolonged mechanical ventilation, vasopressor support and antibiotic therapy. After 62 days, metastatic papillary thyroid carcinoma was diagnosed. She presented with hypoparathyroidism and permanent hypocalcemia. She died after multiple complications and a refractory critical condition. CONCLUSION: The case exemplifies the potential severity of community-acquired pneumonia in a patient with risk factors such as diabetes and immunosuppression. It highlights the complexity of treating multiple comorbidities and the importance of multidisciplinary management with close surveillance for timely interventions for complications.
Assuntos
Infecções Comunitárias Adquiridas , Pneumonia , Neoplasias da Glândula Tireoide , Humanos , Feminino , Adulto , Neoplasias da Glândula Tireoide/complicações , Evolução Fatal , Respiração Artificial , Hospedeiro Imunocomprometido , Adenocarcinoma Folicular/complicações , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapiaRESUMO
BACKGROUND: Thyroid crisis is a life-threatening condition in thyrotoxic patients. Although differentiated thyroid cancer is one of the causes of hyperthyroidism, reports on thyroid crisis caused by thyroid cancer are quite limited. Here, we describe a case of thyroid crisis caused by metastatic thyroid cancer. CASE PRESENTATION: A 91-year-old woman was admitted to our hospital because of loss of appetite. Two years prior to this hospitalization, she presented with subclinical thyrotoxicosis and was diagnosed with histologically unidentified thyroid cancer with multiple metastases, and she refused aggressive medical interventions. On admission, she exhibited extreme thyrotoxicosis, and the presence of fever, severe tachycardia, impaired consciousness, and heart failure revealed the presence of thyroid crisis. All thyroid autoantibodies were negative. Multidisciplinary conservative treatment was initiated; however, she died on the fifth day after admission. Autopsy revealed the presence of primary anaplastic thyroid carcinoma and multiple metastatic foci arising from follicular thyroid carcinoma. Both primary and metastatic follicular thyroid carcinoma likely induced thyrotoxicosis, which could have been exacerbated by anaplastic thyroid carcinoma. CONCLUSIONS: Even though the trigger of thyroid crisis in this patient is not clear, the aggravated progression of her clinical course suggests that careful monitoring of thyroid hormones and appropriate intervention are essential for patients with thyroid cancer.
Assuntos
Adenocarcinoma Folicular/complicações , Carcinoma Anaplásico da Tireoide/complicações , Crise Tireóidea/etiologia , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/complicações , Adenocarcinoma Folicular/diagnóstico por imagem , Adenocarcinoma Folicular/patologia , Adenocarcinoma Folicular/secundário , Idoso de 80 Anos ou mais , Evolução Fatal , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/secundário , Carcinoma Anaplásico da Tireoide/diagnóstico por imagem , Carcinoma Anaplásico da Tireoide/patologia , Crise Tireóidea/diagnóstico por imagem , Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
Background: We report the therapeutic use of K1-70™, a thyrotropin receptor (TSHR) antagonist monoclonal antibody, in a patient with follicular thyroid cancer (FTC), Graves' disease (GD), and Graves' ophthalmopathy (GO). Methods: A 51-year-old female patient, who smoked, presented in October 2014 with FTC complicated by GD, high levels of TSHR autoantibodies with high thyroid stimulating antibody (TSAb) activity, and severe GO. K1-70 was administered at 3 weekly intervals with the dose adjusted to block TSAb activity. Her cancer was managed with lenvatinib and radioiodine therapy. Results: Following initiation of K1-70 therapy, TSAb activity measured in serum decreased and GO (proptosis and inflammation) improved. On K1-70 monotherapy during the pause in lenvatinib, several metastatic lesions stabilized while others showed progression attenuation compared with that before lenvatinib therapy. Conclusions: These observations suggest that blocking TSHR stimulation with K1-70 can be an effective treatment for GO and may also benefit select patients with FTC and GD.
Assuntos
Adenocarcinoma Folicular/complicações , Adenocarcinoma Folicular/tratamento farmacológico , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/uso terapêutico , Doença de Graves/complicações , Doença de Graves/tratamento farmacológico , Oftalmopatia de Graves/complicações , Oftalmopatia de Graves/tratamento farmacológico , Receptores da Tireotropina/antagonistas & inibidores , Neoplasias da Glândula Tireoide/complicações , Neoplasias da Glândula Tireoide/tratamento farmacológico , Adenocarcinoma Folicular/imunologia , Anticorpos Monoclonais/farmacologia , Antineoplásicos/uso terapêutico , Autoanticorpos/sangue , Feminino , Doença de Graves/imunologia , Oftalmopatia de Graves/imunologia , Humanos , Imunoglobulinas Estimuladoras da Glândula Tireoide/sangue , Radioisótopos do Iodo/uso terapêutico , Pessoa de Meia-Idade , Compostos de Fenilureia/administração & dosagem , Compostos de Fenilureia/uso terapêutico , Quinolinas/administração & dosagem , Quinolinas/uso terapêutico , Compostos Radiofarmacêuticos/uso terapêutico , Receptores da Tireotropina/imunologia , Neoplasias da Glândula Tireoide/imunologia , Resultado do TratamentoRESUMO
We present the clinical and molecular studies of a family with Pendred syndrome, in which one affected individual developed follicular thyroid cancer. Two siblings with classic Pendred syndrome triad were operated on because of enormous multinodular goiter. Histopathology showed a follicular thyroid cancer in the male and a multinodular goiter in the female. PDS gene analysis revealed G-to-A transition in the splice donor site of intron 8 (IVS8+1G>A/c.1001+1G>A). Careful surveillance is needed in all cases of thyroid nodules in patients with Pendred syndrome, due to the high risk of malignancy.
Assuntos
Adenocarcinoma Folicular/complicações , Bócio Nodular/complicações , Perda Auditiva Neurossensorial/complicações , Adolescente , Feminino , Bócio , Humanos , Masculino , Mutação , Linhagem , Adulto JovemAssuntos
Adenocarcinoma Folicular/complicações , Adenocarcinoma Folicular/diagnóstico , Doença de Graves/etiologia , Doença de Graves/cirurgia , Adenocarcinoma Folicular/patologia , Adenocarcinoma Folicular/cirurgia , Adulto , Diagnóstico Tardio , Diagnóstico Diferencial , Feminino , Doença de Graves/diagnóstico , Humanos , Imunoglobulinas Estimuladoras da Glândula Tireoide/efeitos adversos , Imunoglobulinas Estimuladoras da Glândula Tireoide/metabolismo , Nódulo da Glândula Tireoide/complicações , Nódulo da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/cirurgia , Tireoidectomia/efeitos adversos , Tireoidectomia/métodos , Falha de TratamentoRESUMO
Although acromegaly has been reported in patients with Neurofibromatosis type 1 (NF1), these cases have not been associated with growth hormone (GH)-producing somatotroph adenoma, but with optic pathway glioma. A 68 year-old Japanese woman, who had been clinically diagnosed with NF1, was referred to our hospital due to a thyroid tumor and hypercalcemia. Acromegaly was suspected due to her facial features, and subsequent examinations revealed the presence of GH excess with a pituitary tumor, leading to the diagnosis of acromegaly. Histological and immunohistochemical analysis demonstrated an eosinophilic pituitary adenoma with diffuse positivity for GH, indicating typical somatotroph adenoma. In addition, her thyroid tumor was diagnosed histologically as follicular thyroid carcinoma (FTC) with primary hyperparathyroidism (PHPT). To investigate the pathogenesis of this untypical multiple endocrine tumor case of NF1, genetic analysis was performed using peripheral leukocytes and tissue of resected tumors. A heterozygous novel germline nonsense mutation (p.Arg1534*) in exon 35 of the NF1 gene was detected from peripheral leukocytes, which results in a truncated protein lacking the critical domain for GTPase activity, strongly suggesting its causal role in NF1. The loss of heterozygosity (LOH) in exon 35 of the NF1 gene was not detected in the somatotroph adenoma, parathyroid adenoma, and FTC. Although any mutations of the following genes; MEN1, CDKN1B, and PAX8-PPARγ were not detected, a heterozygous GNAS R201C mutation was detected in the somatotroph adenoma. To our knowledge, this is the first rare MEN1-like case of genetically diagnosed NF1 complicated with acromegaly caused by a somatotroph adenoma.
Assuntos
Acromegalia/etiologia , Adenoma/complicações , Adenoma Hipofisário Secretor de Hormônio do Crescimento/complicações , Neurofibromatose 1/complicações , Adenocarcinoma Folicular/complicações , Adenocarcinoma Folicular/patologia , Adenoma/patologia , Idoso , Códon sem Sentido , Proteínas de Drosophila , Feminino , Genes da Neurofibromatose 1 , Adenoma Hipofisário Secretor de Hormônio do Crescimento/patologia , Humanos , Hiperparatireoidismo/complicações , Japão , Imageamento por Ressonância Magnética , Neoplasia Endócrina Múltipla Tipo 1/genética , Neurofibromatose 1/genética , Neurofibromatose 1/patologia , Neoplasias das Paratireoides/genética , Neoplasias das Paratireoides/patologia , Neoplasias da Glândula Tireoide/complicações , Neoplasias da Glândula Tireoide/patologiaRESUMO
BACKGROUND: Thyroid cancer, one of the most common endocrine malignancies in developed areas and China, is associated with favorable prognosis. However, the presence of spinal metastases will remarkably reduce the life expectancy for patients with thyroid cancer. In addition, limited information is available about such disease. METHODS: Various potential clinical factors were submitted to univariate and multivariate analyses to identify the independent variables that predicted the prognosis for patients. In addition, the survival rate was estimated according to the Kaplan-Meier method, and statistic differences were calculated by the log-rank test. Moreover, factors with a P value of ≤0.1 were performed multivariate analysis using a multivariate Cox proportional hazards model, and factors with a P value of <0.05 were considered as statistically significant. RESULTS: Seven potential independent prognostic factors had been identified through univariate analysis, which were then subjected to multivariate analysis. Our results suggested that age of ≤50 years, single segment involved, and follicular thyroid cancer were the independent favorable prognostic factors. CONCLUSIONS: Findings in this study indicate that age of ≤50 years, single segment involved, and follicular thyroid cancer are favorable prognostic factors for patients with thyroid cancer spinal metastases.
Assuntos
Adenocarcinoma Folicular/cirurgia , Compressão da Medula Espinal/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Adenocarcinoma Folicular/complicações , Adenocarcinoma Folicular/mortalidade , Adenocarcinoma Folicular/secundário , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/mortalidade , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/mortalidade , Neoplasias da Coluna Vertebral/secundário , Taxa de Sobrevida , Câncer Papilífero da Tireoide/complicações , Câncer Papilífero da Tireoide/mortalidade , Câncer Papilífero da Tireoide/secundário , Neoplasias da Glândula Tireoide/mortalidade , Neoplasias da Glândula Tireoide/patologia , Resultado do TratamentoAssuntos
Adenocarcinoma Folicular/complicações , Desarticulação , Raios gama/efeitos adversos , Artéria Subclávia/cirurgia , Neoplasias da Glândula Tireoide/complicações , Extremidade Superior/cirurgia , Adenocarcinoma Folicular/radioterapia , Humanos , Masculino , Pessoa de Meia-Idade , Ombro/irrigação sanguínea , Ombro/patologia , Ombro/cirurgia , Artéria Subclávia/patologia , Artéria Subclávia/efeitos da radiação , Neoplasias da Glândula Tireoide/radioterapia , Extremidade Superior/irrigação sanguínea , Extremidade Superior/patologiaAssuntos
Adenocarcinoma Folicular/complicações , Adenocarcinoma Folicular/diagnóstico , Síndrome do Hamartoma Múltiplo/complicações , Síndrome do Hamartoma Múltiplo/diagnóstico , Neoplasias da Glândula Tireoide/complicações , Adenocarcinoma Folicular/terapia , Adolescente , Seguimentos , Predisposição Genética para Doença , Síndrome do Hamartoma Múltiplo/genética , Humanos , Masculino , Monoéster Fosfórico Hidrolases/metabolismo , Doenças Raras , Medição de Risco , Testes de Função Tireóidea , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/terapia , Resultado do TratamentoRESUMO
Thyroglossal duct cyst carcinoma is a rare malignancy, with an incidence of 0.7% to 1.6%. Most cases of thyroglossal duct cyst carcinoma are papillary carcinoma, with follicular carcinoma having been rarely reported. In this study, a 33-year-old man presented with a typical thyroglossal duct cyst and underwent surgical resection of the cyst, which was determined to be follicular carcinoma. We have reported this rare case to increase the awareness of such entities within the general otolaryngology and the community of head and neck surgeons, as well as among endocrine surgeons. SIMILAR CASES PUBLISHED: 10.
Assuntos
Adenocarcinoma Folicular/cirurgia , Cisto Tireoglosso/cirurgia , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Adenocarcinoma Folicular/complicações , Adenocarcinoma Folicular/diagnóstico , Adulto , Humanos , Masculino , Cintilografia , Cisto Tireoglosso/complicações , Cisto Tireoglosso/diagnóstico , Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/complicações , Neoplasias da Glândula Tireoide/diagnóstico , Tomografia Computadorizada por Raios XAssuntos
Adenocarcinoma Folicular/veterinária , Doenças do Cão/patologia , Hiperpigmentação/veterinária , Neoplasias da Glândula Tireoide/veterinária , Adenocarcinoma Folicular/complicações , Adenocarcinoma Folicular/patologia , Animais , Antibacterianos/efeitos adversos , Autopsia/veterinária , Diagnóstico Diferencial , Cães , Hiperpigmentação/induzido quimicamente , Hiperpigmentação/patologia , Coxeadura Animal/etiologia , Masculino , Minociclina/efeitos adversos , Neoplasias da Glândula Tireoide/complicações , Neoplasias da Glândula Tireoide/patologiaRESUMO
RATIONALE: Thyroid follicular carcinoma-like renal tumor (TFCLRT) is a rare primary renal epithelial tumor that was first reported in 2006. We report a case diagnosed of TFCLRT by us to observe the pathological feature and analyze comparatively the clinical and pathologic characteristics with all cases of reviewed literatures. PATIENT CONCERNS: A 54-year-old female patient had the urinary frequency with the symptom of right flank pain with a history of more than half a year of hypertension and received uterine fibroid resection 12 years ago. B-mode ultrasound examination and renal magnetic resonance showed a right renal sinus nodule. DIAGNOSES: Histopathology revealed thyroid follicle-like structures of different sizes, containing a colloid-like substance, while the periodic acid-Schiff (PAS) and diastase-resistant PAS staining confirmed that it was mucus protein. Immunohistochemical staining showed that it expresses the transcription factor PAX-8 but does not express the thyroid-specific antibodies TG and TTF-1. INTERVENTIONS: The patient underwent a tumor enucleation of right kidney. No other treatment was conducted after surgery. OUTCOMES: No metastases to lymph nodes and other organs were found, and 9-months of follow-up did not reveal any tumor progression. LESSONS: We should differentially diagnose the renal metastasis of thyroid follicular carcinoma or papillary carcinoma. Some related literatures reported that the tumour cells had significant heteromorphism, several of which metastasized to lymph nodes or distal organs. Its biological behavior need to be studied intensively by further expanding the number of cases.
Assuntos
Adenocarcinoma Folicular/patologia , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/secundário , Rim/diagnóstico por imagem , Adenocarcinoma Folicular/complicações , Adenocarcinoma Folicular/metabolismo , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/cirurgia , Proteínas de Ligação a DNA/metabolismo , Feminino , Humanos , Imuno-Histoquímica , Rim/patologia , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Pessoa de Meia-Idade , Fator de Transcrição PAX8/metabolismo , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/metabolismo , Neoplasias da Glândula Tireoide/patologia , Fator Nuclear 1 de Tireoide/metabolismo , Fatores de Transcrição/metabolismo , Resultado do TratamentoAssuntos
Adenocarcinoma Folicular/veterinária , Doenças do Cão/diagnóstico , Neoplasias da Glândula Tireoide/veterinária , Adenocarcinoma Folicular/complicações , Adenocarcinoma Folicular/diagnóstico , Animais , Biópsia por Agulha Fina/veterinária , Doenças do Cão/diagnóstico por imagem , Doenças do Cão/patologia , Cães , Masculino , Cisto Tireoglosso/complicações , Cisto Tireoglosso/diagnóstico , Cisto Tireoglosso/veterinária , Neoplasias da Glândula Tireoide/complicações , Neoplasias da Glândula Tireoide/diagnóstico , Tomografia Computadorizada por Raios X/veterináriaAssuntos
Adenocarcinoma Folicular/secundário , Neoplasias Cranianas/secundário , Neoplasias da Glândula Tireoide/patologia , Adenocarcinoma Folicular/complicações , Adenocarcinoma Folicular/diagnóstico por imagem , Adenocarcinoma Folicular/cirurgia , Edema/etiologia , Feminino , Cefaleia/etiologia , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Neoplasias Cranianas/complicações , Neoplasias Cranianas/diagnóstico por imagem , Neoplasias Cranianas/cirurgia , Osso Temporal/diagnóstico por imagem , Osso Temporal/cirurgia , Neoplasias da Glândula Tireoide/complicações , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Tomografia Computadorizada por Raios XRESUMO
Thyroid cancer and Graves' disease may present simultaneously in one patient. The incidence of the development of hyperthyroidism from metastatic differentiated thyroid carcinoma is rare. We herein report a case of metastatic follicular carcinoma complicated with Graves' disease after total thyroidectomy. A 57-year-old woman underwent right hemithyroidectomy for follicular carcinoma. Metastatic lesions appeared in the lungs and skull two years after the first surgery, and remnant thyroidectomy was performed for radioactive iodine-131 (RAI) therapy, during which the TSH receptor antibody (TRAb) was found to be negative. The patient was treated with RAI therapy four times for four years and was receiving levothyroxine suppressive therapy. Although radioiodine uptake was observed in the lesions after the fourth course of RAI therapy, metastatic lesions had progressed. Four years after the second surgery, she had heart palpitations and tremors. Laboratory data revealed hyperthyroidism and positive TRAb. She was diagnosed with Graves' disease and received a fifth course of RAI therapy. 131I scintigraphy after RAI therapy showed strong radioiodine uptake in the metastatic lesions. As a result, the sizes and numbers of metastatic lesions decreased, and thyroid function improved. Metastatic lesions produced thyroid hormone and caused hyperthyroidism. RAI therapy was effective for Graves' disease and thyroid carcinoma.
Assuntos
Adenocarcinoma Folicular/secundário , Neoplasias Ósseas/secundário , Neoplasias Encefálicas/secundário , Doença de Graves/patologia , Neoplasias Pulmonares/secundário , Neoplasias da Glândula Tireoide/patologia , Adenocarcinoma Folicular/complicações , Adenocarcinoma Folicular/cirurgia , Feminino , Doença de Graves/complicações , Humanos , Pessoa de Meia-Idade , Neoplasias da Glândula Tireoide/complicações , TireoidectomiaRESUMO
A 67-year-old man was referred with a history of a right-sided neck lump and dysphonia, secondary to a lesion in the thyroid gland. After undergoing a total thyroidectomy, he was found to have an exceedingly rare combination of follicular carcinoma, insular carcinoma, thyrolipomatosis and an amyloid goitre in his thyroid gland. He subsequently underwent further radioactive iodine ablation and has been in remission. He was also later incidentally diagnosed with systemic amyloidosis, which explained the amyloid deposition in his thyroid gland.
Assuntos
Adenocarcinoma Folicular/patologia , Amiloidose/diagnóstico , Bócio/patologia , Amiloidose de Cadeia Leve de Imunoglobulina/diagnóstico , Lipomatose/patologia , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Adenocarcinoma Folicular/complicações , Adenocarcinoma Folicular/radioterapia , Adenocarcinoma Folicular/cirurgia , Idoso , Amiloidose/complicações , Bócio/cirurgia , Humanos , Amiloidose de Cadeia Leve de Imunoglobulina/complicações , Lipomatose/complicações , Masculino , Radioterapia Adjuvante , Doenças Raras , Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/radioterapia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , UltrassonografiaRESUMO
OBJECTIVE: Substernal goiters are classified as primary or secondary intrathoracic goiters. Here, we report the diagnosis, symptoms, treatment, and postoperative complications of 44 substernal goiters (2 primary mediastinal goiter and 42 secondary mediastinal goiters). METHODS: A retrospective chart review of 351 patients undergoing thyroidectomy at the Department of Otolaryngology-Head and Neck Surgery of the Tokyo Metropolitan Tama Medical Center. Between 2009 and 2015, 44 patients underwent surgery for substernal goiter. RESULTS: The frequency of primary and secondary mediastinal goiters was 0.5% and 11.9%, respectively. The preoperative symptoms were neck mass, dyspnea, and dysphagia. Eight patients were asymptomatic. Thirty-nine patients had benign masses and 5 patients had malignant masses. Most patients were operated on for adenomatous goiters (52.2%). In ten cases beyond the aortic arch, the tumors were benign and there were eight cases of adenomatous goiter. All patients underwent a successful transcervical incision without sternotomy. Even the primary intrathoracic goiters were extracted after total thyroidectomy via the cervical approach without complications. Although one case showed unilateral recurrent nerve paralysis as a postoperative complication, phonetic function improved in 6 postoperative months. No instances of postoperative bleeding or definitive hypoparathyroidism occurred, and tracheostomy was not performed in any of the cases. CONCLUSION: The cervical approach was safely performed in almost all substernal goiters without an extracervical procedure. Selected cases of primary mediastinal goiter may be excised via the cervical approach.
Assuntos
Adenocarcinoma Folicular/cirurgia , Adenoma/cirurgia , Carcinoma/cirurgia , Bócio Subesternal/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Adenocarcinoma Folicular/complicações , Adenoma/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/complicações , Carcinoma Papilar , Tosse/etiologia , Transtornos de Deglutição/etiologia , Dispneia/etiologia , Feminino , Bócio Subesternal/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Câncer Papilífero da Tireoide , Neoplasias da Glândula Tireoide/complicaçõesAssuntos
Adenocarcinoma Folicular/complicações , Adenocarcinoma Folicular/diagnóstico , Síndrome de Williams/complicações , Síndrome de Williams/diagnóstico , Adenocarcinoma Folicular/terapia , Biópsia , Bandeamento Cromossômico , Terapia Combinada , Humanos , Masculino , Fenótipo , Resultado do Tratamento , Síndrome de Williams/genéticaRESUMO
The patient was a 61-year-old woman with thyroid enlargement since her 20s. She began to fall down repeatedly towards the end of June 2015. She was admitted to our hospital in the middle of August because of difficulty in walking. Upon admission, she presented with neck tremor and was unable to maintain a sitting position due to ataxia of the trunk and limbs. We studied serum anti-neuronal antibodies and obtained a positive result for anti-amphiphysin antibody (AMPH-Ab). Cerebrospinal fluid analysis revealed elevated protein levels and IgG index. Other than the thyroid mass, a tumor was not detected. The resected thyroid specimen showed follicular adenoma. After performing immunotherapies, the cerebrospinal fluid protein levels and IgG index decreased, and her ataxia did not progress. When subacute cerebellar ataxia is suspected, studying AMPH-Ab should be considered.
Assuntos
Adenocarcinoma Folicular/complicações , Autoanticorpos/sangue , Ataxia Cerebelar/diagnóstico , Ataxia Cerebelar/etiologia , Proteínas do Tecido Nervoso/imunologia , Síndromes Paraneoplásicas do Sistema Nervoso/diagnóstico , Síndromes Paraneoplásicas do Sistema Nervoso/etiologia , Neoplasias da Glândula Tireoide/complicações , Doença Aguda , Biomarcadores/sangue , Biomarcadores/líquido cefalorraquidiano , Ataxia Cerebelar/terapia , Proteínas do Líquido Cefalorraquidiano/análise , Feminino , Humanos , Imunoglobulina G/líquido cefalorraquidiano , Imunoterapia , Pessoa de Meia-Idade , Síndromes Paraneoplásicas do Sistema Nervoso/terapiaRESUMO
Oncocytic follicular adenomas (FAs) of the thyroid are neoplasms of follicular cell origin that are predominantly composed of large polygonal cells with eosinophilic and granular cytoplasm. However, the pathological characteristics of these tumors are largely unexplored. Both the initiation and progression of cancer can be caused by an accumulation of genetic mutations that can induce genomic instability. Thus, the aim of this study was to evaluate the extent of genomic instability in oncocytic FA. As the presence of p53-binding protein 1 (53BP1) in nuclear foci has been found to reflect DNA double-strand breaks that are triggered by various stresses, the immunofluorescence expression pattern of 53BP-1 was assessed in oncocytic and conventional FA. The association with the degree of DNA copy number aberration (CNA) was also evaluated using array-based comparative genomic hybridization. Data from this study demonstrated increased 53BP1 expression (i.e., "unstable" expression) in nuclear foci of oncocytic FA and a higher incidence of CNAs compared with conventional FA. There was also a particular focus on the amplification of chromosome 1p36 in oncocytic FA, which includes the locus for Tumor protein 73, a member of the p53 family implicated as a factor in the development of malignancies. Further evaluations revealed that unstable 53BP1 expression had a significant positive correlation with the levels of expression of Tumor protein 73. These data suggest a higher level of genomic instability in oncocytic FA compared with conventional FA, and a possible relationship between oncocytic FA and abnormal amplification of Tumor protein 73.