[Thyroid diseases in elderly patients]. / Disfunzioni tiroidee in età geriatrica.

AIM OF THE STUDY: To evaluate the differences about incidence, kind and clinical features of thyroid diseases in young and elderly patients. MATERIALS AND METHODS: Our study has been conducted in Endocrine Surgery Unit, "S. Luigi and S. Currò" Hospital in Catania, from January 2001 to December 2003. In this period 621 patients affected with different thyroidopathies were observed. They were divided in two groups: elderly (65 years or older), named Group A, and young subjects (under 65 years old), named Group B. Group A included 147 people aged between 65 and 89, with F:M = 3.9:1. Our study was founded on clinical and laboratory evaluation of thyroid hormones and antibodies (AAT, AMT) and subsequently an ultrasonographical evaluation, that has been completed, in some cases, with cytologic examination (FNAc). CONCLUSION: The main aspect about thyroid diseases is the different and atypical presentation in the elderly in comparison to young patients, with subsequent difficult diagnosis due to common symptoms to thyroidopathies rather than to physiological ageing. The most common thyroid dysfunctions in elderly are the autoimmune thyroidopathies, responsible of hypothyroidism. Such condition, in elderly, is often clinically irrelevant.

[Some ecomorphologic aspects of nodular goiter]. / Su alcuni aspetti ecomorfologici dei noduli tiroidei.

AIM OF THE STUDY: Determine microcalcifications' rule in nodular goiter, to classify those calcifications and identify US features suspect for tumoral pathology. MATERIAL AND METHODS: In Endocrine Surgery Unit we ultrasonographically detected 655 patients in a period of twelve months (Jan to Dec 2005). Patients aged from 22 to 75 years. Multinodular goiter were 42% and solitary nodular 33.8%, higher than other studies, as we checked selected patients. We determined microcalcification' incidence in nodular goiter and thyroiditis and studied their correlations with tumours. We also studied other US features suspect for malignant lesions. We divided microcalcifications in four groups. Thyroiditis prevalence was 55.8%. Microcalcifications' prevalence was 32.3%, divided as follow: Type I 18.1%, type II 4%, type III 81.8%, type IV 9%. In 9% of patients was present more than one kind of calcifications. Microcalcification rate was 28.9% in inflammatory disease, 55.17% in multinodular goiter and 18, 18% in single thyroid nodules. "Suspect" microcalcifications were present in 9% of whole thyroid pathology and in 12% of MNG. The majority of microcalcifications belonged to type III and their nature is questionable. Several Authors mentioned microcalcifications as a sensitive and highly specific feature for tumour diagnosis. Microcalcifications have a 59.2% sensitivity rate and a specificity rate of 85.8-95%. Their diagnostic accuracy is 77.4%. Other us suspect features are hypoecogenicity and irregular nodule outline. CONCLUSIONS: Ultrasonography remains an operator-dependent exam and it's necessary a correct interpretation of morphological data. Meticulous characterization of all ultrasonographic criteria enounced above is useful to reach satisfactory results and identify suspect lesions.

[Papillary carcinoma in an isthmic thyroglossal duct cyst: clinical considerations]. / Il carcinoma papillifero in cisti del dotto tireoglosso a sviluppo istmico: considerazioni su un' osservazione clinica.

Cancer in a thyroglossal duct cyst is uncommon (incidence: approximately 1%). There are about 250 reported cases in the literature, most of which are papillary cancers or, less frequently, squamous or follicular carcinomas. The preoperative diagnosis of thyroglossal duct cyst carcinoma may be facilitated by an ultrasound neck examination or fine needle aspiration cytology (FNAc). As reported in the literature, however, the diagnosis is often obtained only at histopathological examination. We describe a case of a 43-year-old male patient with a papillary carcinoma in an isthmic thyroglossal duct cyst. Ultrasound of the neck demonstrated a nodular hypo-anechogenic cystic neoformation of the isthmus of the thyroid, while Fnac was not diagnostic. An isthmectomy of the thyroid was initially performed. Frozen examination of the cystic lesion revealed a papillary carcinoma in the thyroglossal duct cyst. A total thyroidectomy with central lymphectomy was therefore performed. Carcinoma in the thyroglossal duct has a low mortality (5-year mortality: < 2%), but a long-term follow-up is mandatory, due to the low, short-and medium-term recurrence rate.

[Thyroid microcarcinoma in benign thyroid diseases]. / Il microcarcinoma tiroideo nelle tireopatie benigne.

INTRODUCTION: Thyroid microcarcinoma is a malignant thyroid tumor with potential multifocality and a maximum of 1 cm of diameter. This carcinoma has been discovered more frequently like incidentaloma. AIM OF THE STUDY: To appraise the incidence of MCT in the benign thyroid diseases and the advantages offered from the total thyroidectomy, performed for benign diffused thyroid diseases, which surgical treatment "therapeutic" performed for these malignant tumors. MATERIALS AND METHODS: The study was conducted on 600 patients operated with total thyroidectomy for benign thyroid disease, admitted from 1999 to 2003. RESULTS: All patients were alive and free of disease at last control. DISCUSSION: The MCT is a carcinoma that presents frequently a behavior little malignant and a good prognosis. His principal characteristic is the absence of clinical demonstrations. Therefore his discovery, almost always accidental on a thyroid removed for other pathology, it has signaled by histologic study CONCLUSIONS: Thyroid microcarcinoma is a slow growing tumor, with a good prognosis and with a good disease-free survival. It can present a better aggressiveness for his multifocal localization and invasion. Therefore total thyroidectomy can be considered best treatment and also be surgical treatment oncologically correct for this tumor.

[Zuckerkandl's tuberculum: could it be useful in thyroid surgery?]. / Il tubercolo di Zuckerkandl: è un ausilio nella chirurgia della tiroide?

A thorough knowledge of thyroid anatomy could reduce the incidence of lesions to the inferior laryngeal nerve. In view of its relationship with the recurrent laryngeal nerve and the parathyroid gland, Zuckerkandl's tuberculum should be considered an anatomical landmark for the recurrent laryngeal nerve in thyroid surgery. The aim of the study was to verify whether the identification of Zuckerkandl's tuberculum could be useful to reduce the incidence of recurrent laryngeal nerve lesions. Four hundred and thirty-two patients underwent thyroid surgery over the period from January 2001 to December 2003 for benign (377 patients) or malignant disease (55 patients). Three-hundred and forty-eight (81%) underwent total thyroidectomy. Zuckerkandl's tuberculum was found in 74.5% of patients, with a high prevalence in the right lobe: in 5% of patients it was grade I, in 50% grade II and in 45% grade III. Its presence was associated with the recurrent laryngeal nerve in almost all cases. Eight of the patients undergoing total thyroidectomy suffered recurrent nerve paralysis, only 4 of which proved definitive. Identification of Zuckerkandl's tuberculum allows safer isolation of the recurrent laryngeal nerve and superior parathyroid gland dissection.

[A case of pleomorphic liposarcoma involving a parahypopharyngeal site]. / Su un caso di liposarcoma pleomorfo a sede paraipofaringea.

Soft tissue sarcomas are uncommon, accounting for fewer than 1% of malignant neoplasms of the head and neck. The most frequent histotype is malignant fibrohistiocytoma (29%), while the least common is liposarcoma (1%). We report the case of a 20-year-old man with a malignant hypopharyngeal pleomorphic liposarcoma, successfully treated with surgery and adjuvant radio- and chemotherapy. The patient is doing well 8 years after the operation, without any signs of local recurrence or distant metastasis.