Thyroglobulin - what is the postoperative threshold for the suspicion of thyroid cancer recurrence in the absence of anti-Tg antibody measurement?

BACKGROUND: Thyroglobulin (Tg) is used as a postoperative marker for the follow-up of patients with thyroid carcinoma, but there is no consensus regarding the value that may indicate possible recurrence. Aim. To evaluate Tg levels as a marker for recurrence of thyroid carcinoma. SUBJECTS AND METHODS: Demographics and survival of 80 patients who underwent total thyroidectomy for well-differentiated thyroid cancer were analysed and related to Tg levels. Tg measurements were performed when patients were euthyroid, after completion of treatment. RESULTS: The median Tg value was 1.3 ng/ml. Higher values were found in males, high-risk patients and patients with recurrent disease. Using the median Tg value as cut-off, patients were divided into two groups (group I ≤1.3 ng/ml and group II >1.3 ng/ml). There was a significant correlation between values >1.3 ng/ml and recurrence. When survival was related to Tg values, there was a tendency towards worse prognosis in group II. The best predictive cut-off value for recurrence was found to be 1.3 ng/ml, which had a sensitivity of 77% and a specificity of 57%. CONCLUSIONS: Although low, a cut-off Tg level of 1.3 ng/ml represents a simple indication for further investigation in patients receiving thyroxine after completion of treatment for thyroid cancer, in the absence of measurement of anti-Tg auto-antibodies.

Epidemiology and survival of patients with well-differentiated thyroid cancer subjected to total thyroidectomy in Thrace area, Northern Greece: a 20-year experience.

AIM: The aim of this study was to evaluate epidemiology and survival of patients with well-differentiated thyroid cancer (WTC) treated with total thyroidectomy (TT) in the area of Thrace, Northern Greece. METHODS: The study was conducted on 80 patients who underwent total thyroidectomy from January 1985 to December 2004 for WTC. Patients' medical records and demographics, including age, sex, histological type (papillary, follicular, mixed type papillary-follicular, Hurthle), stage according to TNM staging, coexistence or future postoperative occurrence of local recurrence or distal metastases and overall and specific survival were analyzed and survival rates were calculated. RESULTS: Papillary carcinoma was found in 56.3% and follicular in 43.8%. Statistical analysis revealed significant correlation of male gender with the high-risk population (P = 0.017), follicular carcinoma with high-risk population (P < 0.0001) and high-risk population with local recurrence or metastatic disease (P < 0.0001). Overall year, 5-year and 10-year survival were 100%, 94% and 91.8% respectively. Further analysis showed a significant reduction in survival regarding to age > 45 years (P = 0.03), follicular type (P = 0.009), high-risk population (P = 0.008), presence of local recurrence or metastatic disease (P < 0.0001) and not significant correlation with male gender (P = 0.086). CONCLUSION: In conclusion, total thyroidectomy should be the surgical treatment of choice in all cases with WTC, especially in male patients > 45 years of age since they have a higher frequency of advanced malignant disease at presentation, a fact that affects prognosis. Patients must be accurately categorized postoperatively, and follow-up must be personalized, in order to diagnose recurrence as early as possible.

Multifocality of thyroid carcinomas: a "privilege" of papillary tumors or not?

AIM: To study the frequency of multifocality in well-differentiated non-medullary thyroid carcinomas and correlate it with various epidemiological factors, as well as with patients' survival. PATIENTS AND METHODS: A retrospective study was conducted on 80 patients who underwent total thyroidectomy from January 1985 to December 2004 in the First Department of Surgery of University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece, for well-differentiated non-medullary thyroid cancer (papillary and follicular). Patients' medical records and demographics, including age, gender, histological type (papillary, follicular), multiple foci of tumors, overall and specific survival were analyzed. RESULTS: Multifocality was established in 17/80 patients (21,25%). Multifocal tumors were found in 4/20 male patients (20%) and 13/60 female ones (21,67%), percentages which are almost identical. Increased rates of multifocal tumors were found in the age groups of 20-29, 30-39 and 70-79 years old, while low rates were documented in the age groups of 0-9, 10-19 and 60-69 years old. Follicular tumors had a 20% rate, similar to papillary tumors (22,2%), and an impressive multifocal rate of mixed papillary-follicular neoplasms (75%) was found. Finally, survival was not found to be influenced by the multifocality of the tumor, under the prerequisition that total thyroidectomy is applied. CONCLUSIONS: Multifocality should not be considered as a "privilege" of papillary thyroid tumors, but as a privilege of thyroid carcinomas in general. If total thyroidectomy is applied in all benign and malignant thyroid diseases, the presence of multiple foci does not affect the prognosis and the survival of the patients.

Liposarcoma of the spermatic cord: a case report.

Liposarcomas are malignant tumors derived embryologically from mesodermal tissues. An unusual site of presentation is the spermatic cord, presenting as an inguinal or scrotal mass. We report a rare case of a liposarcoma of the spermatic cord, mimicking a testicular tumor. The patient was operated, and an orchidectomy, including the tumor, was performed. To our knowledge, there are about 185 similar cases reported in the literature.