Thyroid Leiomyoma: Case Report.

37-year-old Colombian male with mass in the anterior region of the neck. Initial ultrasonography and computed tomography (CT) scan showed a large solid mass (67 × 20.7 mm), dependent on the thyroid isthmus. Total thyroidectomy (TT) was performed. The latest pathological and immunohistochemical findings showed a mesenchymal neoplasm compatible with primary thyroid leiomyoma. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-04356-2.

Reliability of radioguided occult lesion localization in reoperation of loco-regional persistent/recurrent differentiated thyroid cancer: Retrospective cohort study.

OBJECTIVES: We aimed to determine the radioguided occult lesion localization (ROLL) reliability in the reoperation of patients with differentiated thyroid cancer (DTC) and persistent or recurrent non-palpable loco-regional disease who underwent surgery at the Instituto Nacional de Cancerología between 2012 and 2021. DESIGN: Observational retrospective cohort study. PARTICIPANTS: We included data from patients with DTC that underwent resection with ROLL. MAIN OUTCOME MEASURES: Reliability analysed as percentage of patients with complete resection of tumour lesion using ROLL, disease-free survival, second loco-regional relapse, adequate resectability and complications. RESULTS: Two hundred and four cases were obtained. Pathological examination revealed papillary thyroid carcinoma in 202 patients, and follicular thyroid carcinoma in 2. Reliability was 96.57% in patients who underwent ROLL. When wide resection was performed-at surgeon's discretion-the reliability increased to 97.5%. CONCLUSIONS: The high reliability obtained suggests that ROLL was effective to localize non-palpable relapsing lesions. To our knowledge, this is the largest sample size published on this topic to date.

Second Adjuvant Radioiodine Therapy after Reoperation for Locoregionally Persistent or Recurrent Papillary Thyroid Carcinoma.

Introduction Differentiated thyroid carcinoma (DTC) has increased incidence. Intermediate- and high-risk patients have lymph node relapse rate ranging from 10 to 50%, and receive multiple reinterventions, increasing the morbidity of the disease. Currently, there are no established guidelines for the use of second radioactive iodine (RAI) therapy after the reintervention for local recurrence. Materials and Methods This is a retrospective review of the medical records of 1,299 patients treated from January 2016 to July 2019 with DTC. We included 48 patients who received total thyroidectomy, RAI remnant ablation, surgery to remove the locally recurrent/persistent papillary thyroid carcinoma (PTC), and received a second RAI therapy. Results There were no significant differences between thyroglobulin (Tg) levels before reoperation (Tg0), Tg levels postoperatively (Tg1), and Tg levels after 6 months of second adjuvant RAI therapy (Tg2). However, we evidenced a 69.79% drop in first Tg levels (Tg0: 24.7 vs. Tg1: 7.56, p =0.851) and 44.4% decrease in second Tg levels (Tg1: 7.56 vs. Tg2: 4.20, p =0.544). Also, 77.1% of the patients did not have another documented recurrence. The median relapse-free time was 10.9 months (range: 1.3-58.2 months). Conclusion The results of the study cannot assess that a second RAI treatment after reoperation for locoregionally persistent or recurrent disease have a significant impact on treatment outcomes in intermediate- or high-risk patients with PTC. However, the 77.1% of patients have not presented a second documented recurrence and the median values of Tg and TgAb levels showed a substantial decrease after surgery and second RAI treatment.

[Intrathyroidal thymus can cause confusion in the diagnosis of a thyroid mass. A case report]. / Timo intratiroideo: una causa de confusión en el diagnóstico de masas tiroideas infantiles. Reporte de caso.

Intrathyroidal thymus tissue (ITTT) is a rare, benign condition; its diagnosis can prove challenging due to unfamiliarity with this entity. However, it has ultrasonographical and cytological characteristics which can suggest its presence and thus should be considered in the differential diagnosis of thyroid nodules. Presently, immunohistochemistry can be used with fine needle aspiration (FNA) cytology, thus decreasing the need for unnecessary surgery. We discuss the usefulness of immunohistochemistry in thyroid cytology, with reference to a case of a 10-year-old patient, who underwent partial thyroidectomy for a suspicious thyroid nodule which was eventually diagnosed as ITTT by the histopathology of the surgical specimen.

Transoral robotic surgery for parapharyngeal carcinoma ex-pleomorphic adenoma: A case report.

BACKGROUND: Carcinoma ex-pleomorphic adenoma (Ca ex-PA) comprises 0.5% of head and neck neoplasms. Transoral robotic surgery (TORS) is an approach being used to treat a variety of benign and malignant head and neck neoplasms. Recently, this technique has gained popularity as an alternative for parapharyngeal space (PPS) tumor resection. To our knowledge, this is the first case of Ca ex-PA managed successfully by TORS of the PPS. CASE: Fifty-nine-year-old male with incidental mass in PPS, initial diagnosis of pleomorphic adenoma, who underwent transoral robotic resection. The histopathology diagnosis with minimally invasive Ca ex-PA findings and malignant component of high-grade epithelial/myoepithelial carcinoma and salivary duct carcinoma. Patient discharged on the fifth post-operative day without complications. CONCLUSION: Based on our findings, TORS may be a safe procedure to remove selected Ca ex-PA from the PPS; however, further research is needed.

Advantages of Sentinel Lymph Node Mapping by Single Photon Emission Computed Tomography/Computed Tomography in Early-Stage Malignant Head-and-Neck Skin Tumors.

Background: The aim of this study was to determine the advantages of preoperative sentinel lymph node mapping (SLNM) by single photon emission computed tomography/computed tomography (SPECT / CT) in patients with early-stage cutaneous head-and-neck malignancies. Materials and Methods: We conduct a 7-year and 6 months retrospective, cross-sectional study. Patients with early-stage malignant head-and-neck skin tumors and cutaneous adnexa who underwent SLNM by SPECT/CT from March 2012 and December 2019, were included in the study. Results: We retrospectively analyzed 28 patients: Melanoma was the most frequent tumor (64.2%), followed by squamous cell carcinoma (25%). The anterior cheek was the most common functional subsite (25%). Twenty-seven patients (96.4%) had a successful SLN detection with SPECT/CT. Neck lymph node dissection was performed in 23 patients (82.1%). According to the pathological specimen, lymph nodes were found in all of them; hence, the efficacy of the SPECT/CT for SLNM was 100%. At 7-year follow-up, systemic recurrence was found in one patient (3.6%), another had locoregional recurrence (3.6%), and the mortality rate was 3.6%. Conclusions: In early-stage malignant head-and-neck skin tumors, there is a high concordance between SLN found by SPECT/CT and the histopathological results. Preoperative SPECT/CT accurately detects the SLN, assesses unexpected lymph nodes and their drainage pathways, and facilitates their location by reliably showing the relationships between sentinel nodes and important anatomic structures. This allows to perform a clear preoperative evaluation, an accurate staging for all patients and to avoid excessive dissections that could result in cosmetic and functional deformities.

Transoral robotic resection of unusual spindle cell/pleomorphic lipoma of the larynx.

Spindle cell/pleomorphic lipoma (SC/PL) is a subcutaneous mass usually localised on nape, shoulder or upper back. It is a benign lipogenic tumour composed of primitive CD34-positive spindle cells, floret-like multinucleated giant cells and mature adipocytes. Complete surgical excision is the optimal treatment. This unusual tumour in the larynx has only been reported in the medical literature once and was treated surgically by open approach. Actually, transoral robotic surgery (TORS) is most suitable because provides tridimensional magnified view plus a greater mobility with instruments, allowing complete and safe removal of the supraglottic mass, allowing rapid healing and recovery. We present the first case of a SC/PL of larynx managed with TORS. Four hours after surgery, the patient was able to take a soft diet and was discharged 2 h later. The follow-up showed an excellent clinical and functional outcome.

Radioguided Surgery of Non-palpable Neck Lymph Node in Lymphoma Patients.

Lymphomas have frequent relapses; early diagnosis is important to treat and improve outcomes. Clinical exam and imaging are useful but confirmation with biopsy is always required. Minimally exploratory surgery is a tool to take good samples with precision and safety. Evaluate the use of ROLL technique to track non-palpable lesions on the neck which were suspicious of recurrence in lymphoma patients. A retrospective review of the patients with high probability of lymphoma relapse who were biopsied using ROLL technique. Suspicious lesions on the neck where identified on the follow up of five lymphoma patients. Roll technique was used successfully to guide the biopsy. There were no complications. Relapse was confirmed in two patients; the other three was reactive follicular hyperplasia. Management was redirected on relapsing patients. ROLL technique proved to be a simple, safe and effective method to detect and biopsy non- palpable lesions on the neck of patients with suspicious relapsing lymphoma.

Advantages of the 99mTc-sestamibi Single-Photon Emission Computed Tomography/Computed Tomography in Occult Parathyroid Adenoma and Concomitant Thyroid Papillary Carcinoma.

Hyperparathyroidism and concurrent thyroid nodular disease are prominent. In contrast, concomitant papillary thyroid cancer and hyperparathyroidism are uncommon (1%-2%). Parathyroid adenomas in unusual locations are difficult to detect by conventional diagnostic imaging. 99mTc-sestamibi single-photon emission computed tomography/computed tomography (SPECT/CT) has increased the localizing success rate of these lesions since it provides specific functional and anatomical information, improving exploratory parathyroid surgery planning and decreasing operative time, unnecessary dissections, complications, and morbidity. We confirmed its usefulness in a patient with an occult parathyroid adenoma that was clearly identified by 99mTc-sestamibi SPECT/CT 2 weeks after a thyroidectomy for papillary carcinoma. The SPECT/CT results allowed us to successfully perform efficient reexploration of the thyroid bed, in a retroesophageal parathyroid adenoma by minimally invasive surgery.

Single Photon Emission Computed Tomography/Computed Tomography Detects a Second Ignored Intrathyroidal Parathyroid Adenoma.

The primary hyperparathyroidism (PHPT) is a result of high levels of parathyroid hormone and serum calcium, the most frequent cause is a solitary parathyroid adenoma. Double parathyroid adenoma is <5% of the PHPT. Intrathyroidal parathyroid adenoma (IPA) occurs< 3.2%. We present a case of 58-year-old female with persistent primary hyperparathyroidism due to a second undetected IPA, suspected by ultrasound and confirmed by 99mTc sestamibi single-photon emission computed tomography/computed tomography.

Cervical lymphangioma in adults: case report and current treatment

ABSTRACT Introduction: Cystic tumors of the neck are rare in adults. Some of them include metastatic nodes, branchial cysts, thyroglossal cysts and lymphangiomas, among others. Clinically speaking, lymphangiomas are slow-growing soft masses located in different spaces of the neck. Case report: This paper reports the case of a 36-year-old woman presenting with lymph-angioma, who consulted due to a right lateral mass in the neck of 20 days of evolution without associated systemic symptoms. Although relapse is frequent, the patient was successfully treated with surgery, without evidence of recurrence at 12 months of follow-up. Discussion: When cystic tumors of the neck occur in children, surgical urgencies may arise due to obstruction of the airway. However, lymphangioma in adults only produce contour deformity and rarely require urgent intervention, which allows for conservative management such as observation, repeated drainage or sclerotherapy that can be done using OK-432 (Picibanil). Nevertheless, surgery remains a good treatment option, but some complications may occur. Conclusion: Different treatment options were reviewed, which led to conclude that surgical resection of lymphangiomas continues to be a good treatment for this complex neck lesion.

RESUMEN Introducción: Los tumores quísticos del cuello son inusuales en los adultos. Sin embargo, se pueden encontrar metástasis a ganglios, quistes branquiales, quistes tiroglosos, linfangiomas, entre otros. Clínicamente, estos últimos son masas blandas de crecimiento lento que se localizan en diferentes espacios del cuello. Reporte de caso: Se reporta un caso de linfangioma en una mujer de 36 años, quien consultó por masa lateral derecha del cuello con evolución de 20 días sin síntomas sistémicos asociados. A pesar de que la recaída es frecuente, la paciente fue tratada con cirugía exitosa sin evidencia de recidiva durante 12 meses de seguimiento. Discusión: Cuando se presentan en niños, los tumores quísticos del cuello se pueden convertir en urgencias quirúrgicas debido a obstrucción de la vía aérea; no obstante, en los adultos solo producen deformidad de contorno y rara vez requieren una intervención apremiante, lo que permite conductas conservadoras como la observación, el drenaje repetido o la escleroterapia. Esta última puede hacerse con el OK-432 (Picibanil); sin embargo, la cirugía es una buena opción de tratamiento sin estar exenta de complicaciones. Conclusión: Se realizó revisión de las diferentes opciones de tratamiento y se concluyó que la resección quirúrgica de los linfagiomas continúa siendo la opción más adecuada para el manejo de esta compleja lesión del cuello.

Ganglio centineaa en melanoma de cara: abordaje inicaal / Sentinel ganglion in melanoma of the face: an initial approach

A pesar de las campañas preventivas no se ha logrado disminuir la incidencia de las neoplasias cutáneas, probablemente por las alteraciones de la capa de ozono, con el consecuente aumento de la radiación ultravioleta, por eso en países del trópico se presentan lesiones como el melanoma de piel, que es considerado como una de las lesiones tumorales más agresivas. La cara y el cuello son zonas del cuerpo con una alta exposición solar, reflejándose en un mayor número de casos de este sombrío tumor. El mayor factor pronóstico en contra de los pacientes que padecen esta enfermedad es la presencia de metástasis ganglionares, por eso el grupo tratante debe esclarecer si están presentes, debido a esto hace varias décadas se realizan disecciones de cuello profilácticas, pero en la mayoría de los casos los ganglios extirpados son negativos. Una posible solución para evitar esto, es la extracción del o de los primeros ganglios que drenan el sitio del tumor primario (Ganglio Centinela). En el área de cabeza y cuello usualmente están presentes varios a la vez, lo que dificulta tomar la decisión de cuál extirpar. En nuestro grupo hemos iniciado la estandarización de esta técnica, y como abordaje inicial se realizó el primer caso de una paciente con melanoma de la cara a quien se practicó resección local amplia del tumor y extracción de los centinelas marcados por linfogammagrafía y a la vez disección de los relevos ganglionares positivos para drenaje demostrados por este estudio de medicina nuclear.

In spite of preventative campaigns having been mounted, it still has not been possible to reduce cutaneous neoplasia incidence, probably due to alterations in the ozone layer. This has led to a consequent increase in ultraviolet radiation and thus lesions occurring in tropical countries such as skin cancer (melanoma), considered as being one of the most aggressive tumour lesions. The face and neck are the body areas having the highest exposure to the sun, being reflected in a greater number of such tumour cases. The presence of ganglion metastasis is the greatest negative prognostic factor for patients suffering from this disease; the treating group must thus clarify whether this is present as prophylactic neck dissections were made several decades ago, but the ganglions so removed were negative in most cases. Extracting the first ganglions draining the primary tumour site (sentinel ganglion) represents a possible solution for avoiding this. Several of them are usually present at the same time in the head and neck area, thereby hampering taking a decision as to which should be removed. Our group has begun to standardise such technique; an initial approach has involved the first case of a patient with melanoma of the face who underwent wide local resection of the tumour and extraction of the sentinel ganglions. These were dyed and lymphogammagraphy was used, at the same time as dissection of positive ganglion relief for drainage, as demonstrated by this nuclear medicine study.

Carcinoma escamccelular de labio superior en paciente adolescente / Squamous cell carcinoma of the upper lip in an adolescent patient

El cáncer de la cavidad oral es un problema mayor de salud pública en todo el mundo, como lo describieron AlRawi y Talabani. Es más frecuente en pacientes después de la quinta década de la vida, con una razón hombre a Sin embargo ha aumentado la frecuencia en este grupo de edad. Se presenta el caso de una joven de 11 años, con carcinoma escamocelular de labio superior. Mediante linfogammagrafia preoperatoria se determinó la necesidad de disección selectiva de cuello supraomohioidea, excluyéndose el grupo parotídeo, a pesar de la localización del tumor, con lo cual se disminuyó en forma muy importante la morbilidad operatoria. Se resecó el tumor del labio superior con cirugía micrográfica de Mohs y posteriormente se rotó un colgajo de Yotsuyanagi. Seguimiento postoperatorio durante 18 meses sin evidencia de recaída local, regional, ni a distancia. Los autores recomiendan que el manejo de casos similares sea realizado en forma multidisciplinaria (dermatología, cirugía de cabeza y cuello, medicina nuclear, cirugía plástica), con lo cual se podrían disminuir la morbilidad y las alteraciones funcionales, aumentando la probabilidad de sobrevida libre de recurrencia.

Cancer of the oral cavity is a major public health problem around the world (Al-Rawi and Talabani); it occurs more frequently in patients after the fifth decade of life (2:1 male:female ratio). This entity is very unusual in children; however, frequency has become increased in this agegroup. This article presents the case of an 11-year-old child suffering squamous cell carcinoma of the upper lip. Preoperative lymphogammagraphy identified the need for selective dissection of the supraomohyoideal neck, excluding the parothydeal group, in spite of the tumour's location, thereby greatly reducing operative morbidity. Mohs micrographic surgery was used for tumour resection of the upper lip and then a Yotsuyanagi flap was rotated. 18-month post-operation follow-up revealed no local, regional or distant relapse regarding cancer foci. The authors recommend that similar cases should be managed in a multidisciplinary way (dermatology, head and neck surgery, nuclear medicine, plastic surgery), thereby being able to reduce morbidity and functional alterations and increasing the probability of recurrence-free survival.

Condrosarcoma lrríngeo: una patología poco usual / Laryngeal chondrosarcoma: a very unusual pathology

El condrosarcoma es el tercer tumor más frecuente de los huesos, luego del mieloma y el osteosarcoma, y constituye aproximadamente el 20% de todos los tumores óseos malignos. Generalmente se localiza en los huesos largos y de la pelvis y tan sólo 2 a 5% se ubican en la cabeza y el cuello, principalmente en el maxilar. Los síntomas iniciales suelen ser muy bizarros y en ocasiones sólo la sensación de masa del cuello hace que el paciente acuda al médico. Por la íntima relación de la laringe y de la glándula tiroides, este tumor puede llevar a una falsa impresión diagnóstica. Como ocurrió en este caso, una paciente que consultó por masa del nivel VI (zona central del cuello), con ecografía de nódulo tiroideo y aspiración con aguja fina (ACAF) positiva para un bocio tiroideo. En la TAC por infiltración del cricoides se sospechó la presencia de un carcinoma tiroideo invasivo, y sólo hasta la intervención quirúrgica en orientación con la biopsia por congelación intraoperatoria y el estudio definitivo de patología se realizó el diagnóstico de condrosarcoma bien diferenciado (Grado 1). Como es un caso de difícil diagnóstico y una patología muy infrecuente se reportó y se revisó el tema.

Chondrosarcoma is the third most frequently occurring bone tumor, following myeloma and osteosarcoma; it accounts for around 20% of all malign bone tumors. They are usually localized in the long bones and the bones of the pelvis; only 2% to 5% are located in the head and neck, mainly in the maxillary bone. Initial symptoms are usually very bizarre and sometimes only a sensation of having a neck mass means that a patient goes to see a doctor. Due to the larynx's intimate relationship with the thyroid gland, this tumor may give a false diagnostic impression. As happened in this case, a patient consulted due to level 4 mass (central neck area), echography of the thyroid nodule and fine needle aspiration (FNA) having proved positive for thyroid goiter. The presence of an invasive thyroid carcinoma was suspected in the TAC due to infiltration of the cricoid cartilage; a well-differentiated diagnosis of chondrosarcoma (grade 1) was only made during surgical intervention orientated by biopsy following intraoperation exposure and the definitive study of the pathology. This case has been reported and the topic reviewed as it was difficult case to diagnose and involved a very infrequently occurring pathology.

Colgajo fasciocutáneo en isla de la arteria supraclavicular para reconstruir la región anterior del cuello / Fasciocutaneous Supraclavicular Artery Island Flap on the Fore Part of the Neck

El mayor desafío para el cirujano siempre es el cierre de los defectos posteriores a la resección de una lesión; en especial, cuando se trata de zonas muy visibles, como lo son la cara y el cuello. Por esta razón nos surgió la inquietud de comunicar un caso clínico que recientemente intervinimos en Instituto Nacional de Cancerología. Se trata de un paciente de 83 años con lesión escamocelular primaria de la piel del cuello, de tres años de evolución. Una vez realizamos la resección quirúrgica del tumor y la disección ganglionar posterolateral, decidimos reconstruir el defecto quirúrgico con un colgajo fasciocutáneo en isla de la arteria supraclavicular, con cierre primario de la zona donante. A pesar de que se realizó la disección de cuello, se pudo preservar el pedículo de la arteria cervical transversa, a pesar de que hay autores que consideran que no es posible hacerlo. La evolución postoperatoria fue satisfactoria y la patología demostró márgenes libres de tumor. Después de haber llevado a cabo varios colgajos de este tipo, lo recomendamos para reconstruir defectos secundarios a resección de tumores de piel de la región anterior del cuello, siempre y cuando se conozcan en detalle la anatomía de la zona y la técnica quirúrgica.

The major challenge for surgeons subsequent to lesion resection is the closure of defects, especially those on the face and neck. We profile an 83 year-old patient with a primary squamous cell lesion on neck skin that had evolved over 3 years. Following surgical resection of the tumor and posterolateral ganglion dissection, surgical defect reconstruction consisted of a fasciocutaneous supraclavicular artery island flap with primary closure of the donor zone. Despite neck dissection, it was possible to preserve the pedicle of the transverse cervical artery—a feat some authors consider to be impossible. Postoperative recovery was satisfactory and pathology results revealed tumor free margins. As a result of several such successful flap surgeries, it is recommended that this procedure be used for the reconstruction of side effects subsequent to resection of neck skin tumors.