Résumé
Los carcinomas de tiroides derivados de células foliculares de alto grado (HGFDTC) son tumores poco frecuentes con un pronóstico intermedio entre carcinomas tiroideos bien diferenciados y anaplásicos. La clasificación de la OMS más reciente identifica dos tipos distintos de HGFDTC: 1) carcinoma de tiroides mal diferenciado (arquitectura sólida, trabecular o insular, falta de características nucleares de núcleos nucleares papilares y contorneados, necrosis mitosis (≥3/2mm2), y 2 ) Diferenciar carcinoma de tiroides de alto grado (recuento mitótico alto (≥5/mm2) y/o necrosis). Estos tumores son frecuentemente refractarios de radioyodo, tienen una alta propensión a metástasis distantes y una mala supervivencia general a largo plazo. Desde un punto de vista molecular, HGFDTC comparten mutaciones del controlador es decir, BRAF) y, con menos frecuencia, las fusiones genéticas (es decir, NTRK, RET) con arcinomas de tiroides diferenciados. A medida que ocurre la desdiferenciación, se adquieren alteraciones secundarias (como el promotor TERT y TP53). En esta revisión, nuestro objetivo es describir las características clínicas, moleculares y patológicas de HGFDTC, así como su gestión e investigación futura
High-grade follicular cell derived thyroid carcinomas (HGFDTC) are infrequent tumors with a prognosis intermediate between well differentiated and anaplastic thyroid carcinomas. The most recent WHO classification identifies two distinct types of HGFDTC: 1) Poorly differentiated thyroid carcinoma (solid, trabecular or insular architecture, lack of nuclear features of papillary nuclear and either convoluted nuclei, necrosis or mitosis (≥3/2mm2), and 2) differentiated high-grade thyroid carcinoma (high mitotic count (≥5/mm2) and/or necrosis). These tumors are frequently radioiodine refractory, have a high propensity for distant metastases, and poor long term overall survival. From a molecular standpoint, HGFDTC share driver mutations (ie BRAF) and, less frequently, gene fusions (ie NTRK, RET) with differentiated thyroid carcinomas. As dedifferentiation occurs, secondary alterations (such as TERT promoter, and TP53) are acquired. In this review, we aim to describe the clinical, molecular and pathological characteristics of HGFDTC, as well as their management and future research
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Humains , Mâle , Femelle , Tumeurs de la thyroïde/diagnostic , Adénocarcinome folliculaire/anatomopathologie , Carcinome anaplasique de la thyroïde/anatomopathologie , Cellules épithéliales thyroïdiennes/anatomopathologieRésumé
Objective To explore the diagnostic efficacy of American Thyroid Association(ATA)guidelines,American College of Radiology Thyroid Imaging Report and Data System(ACR-TIRADS),and Chinese Thyroid Imaging Reporting and Data System(C-TIRADS)alone and combined with BRAFV600E mutation in atypia of undetermined significance/follicular lesion of undetermined significance(AUS/FLUS).Methods A total of 138 patients who underwent ultrasound-guided fine needle aspiration(FNA)in the Chinese PLA General Hospital from January 2020 to May 2023 were selected.The clinicopathological and ultrasound characteristics were retrospectively analyzed for each nodule.Each nodule underwent preoperative BRAFV600E mutation testing and was diagnosed according to the ATA guidelines,ACR-TIRADS,and C-TIRADS.The diagnostic efficacy of ATA guidelines,ACR-TIRADS,and C-TIRADS alone and combined with BRAFV600E mutation was assessed based on the results of histopathological diagnosis.Results The 138 AUS/FLUS thyroid nodules included 45(32.6%)benign ones and 93(67.4%)malignant ones.The patient age(t=1.444,P=0.151),gender(χ2=0.259,P=0.611),and location of nodules(χ2=2.055,P=0.358)had no statistical significance for the differentiation between benign and malignant nodules,while nodule size(Z=2.500,P=0.012),echo(χ2=14.693,P<0.001),composition(χ2=17.075,P<0.001),aspect ratio ≥1(χ2=9.477,P=0.002),and microcalcification(χ2=6.892,P=0.009)were of significance for the differentiation.When applied alone,BRAFV600E mutation showed high specificity(95.56%)and positive predictive value(95.65%).Among the three ultrasound grading systems,ACR-TIRADS had the highest sensitivity(χ2=37.923,P<0.001;χ2=40.462,P<0.001)and accuracy(χ2=81.595,P<0.001;χ2=76.912,P<0.001),while C-TIRADS had the highest specificity(χ2=11.746,P<0.001;χ2=21.235,P<0.001).However,the three systems showed no statistically significant difference in the diagnostic efficiency when applied alone(Z=1.177,P=0.239;Z=0.213,P=0.831;Z=1.016,P=0.310).The combination of BRAFV600E mutation with ACR-TIRADS or C-TIRADS improved the diagnostic efficacy of BRAFV600E mutation in distinguishing the benign and malignant AUS/FLUS nodules(Z=2.107,P=0.035;Z=2.752,P=0.006).The combination of ATA guidelines with BRAFV600E mutation increased the diagnostic accuracy of BRAFV600E mutation(χ2=20.679,P<0.001),while it had no statistically significant difference in distinguishing the benign and malignant AUS/FLUS nodules(Z=1.321,P=0.186).The combination of ATA guidelines,ACR-TIRADS,or C-TIRADS with BRAFV600E mutation improved the diagnostic efficacy of ultrasound grading systems for AUS/FLUS nodules(Z=2.770,P=0.006;Z=2.770,P=0.006;Z=2.890,P=0.004).Specifically,ACR-TIRADS combined with BRAFV600E mutation showed the highest sensitivity(χ2=4.712,P=0.030;χ2=4.712,P=0.030),while C-TIRADS combined with BRAFV600E mutation showed the highest accuracy(χ2=77.627,P<0.001;χ2=85.827,P<0.001).However,there were no statistically significant differences in diagnostic performance between the combinations(Z=1.276,P=0.202;Z=0.808,P=0.419;Z=1.615,P=0.106).Conclusion ATA guidelines,ACR-TIRADS,and C-TIRADS combined with BRAFV600E mutation can improve the diagnostic efficacy of BRAFV600E mutation or ultrasound grading system alone in AUS/FLUS nodules,which can facilitate the further management and treatment of such patients.
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Humains , Nourrisson , États-Unis , Tumeurs de la thyroïde/génétique , Protéines proto-oncogènes B-raf/génétique , Adénocarcinome folliculaire/anatomopathologie , Études rétrospectives , Systèmes de données , Nodule thyroïdien/génétique , Échographie/méthodes , Mutation , Chine , RadiologieRésumé
The mandibular metastatic spread of carcinoma from the thyroid gland is exceedingly rare. Follicular thyroid carcinoma is the second most common type of thyroid carcinoma,accounting for approximately 10% to 15% of all thyroid cancers. The prognosis of FTC is relatively satisfactory. Due to its rich blood transport, it is easy to metastasize hematological, with the main sites of metastasis are bone and lung. However,mandibular metastasis of thyroid follicular carcinoma is rare. We report a case of thyroid follicular carcinoma that metastasized to the ascending ramus of the mandible 21 years after surgery.The operation was successfully completed, and there was no recurrence during postoperative follow-up. Due to the absence of obvious clinical symptoms in the patient, the diagnosis and treatment were challenging. We have provided detailed radiographic and pathological images to facilitate understanding and discussion of the disease.
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Humains , Adénocarcinome folliculaire/anatomopathologie , Tumeurs de la thyroïde/chirurgie , Pronostic , MandibuleRésumé
Abstract Introduction Papillary and follicular thyroid carcinoma are common head and neck cancers. This cancer expresses a thyroid stimulating hormone (TSH) receptor that plays a role as a cancer stimulant substance. This hormone has a diagnostic value in the management of thyroid carcinoma. Objective The present study aimed to determine the difference in TSH levels between differentiated thyroid carcinoma and benign thyroid enlargement. Methods The present research design was a case-control study. The subjects were patients with thyroid enlargement who underwent thyroidectomies at the Dr. Sardjito General Hospital, Yogyakarta, Indonesia. Thyroid stimulating hormone levels were mea- sured before the thyroidectomies. The inclusion criteria for the case group were: 1) differentiated thyroid carcinoma, and 2) complete data; while the inclusion criteria for the control group were: 1) benign thyroid enlargement, and 2) complete data. The exclusion criteria for both groups were: 1) patients suffering from thyroid hormone disorders requiring therapy before thyroidectomy surgery, 2) patients receiving thyroid suppression therapy before the thyroidectomy was performed, and 3) patients suffering from severe chronic diseases such as renal insufficiency, and severe liver disease. Results There were 40 post-thyroidectomy case group patients and 40 post-thyroidect- omy control group patients. There were statistically significant differences in TSH levels between the groups with differentiated thyroid carcinoma and benign thyroid enlargement (p = 0.001; odds ratio [OR] = 8.42; 95% confidence interval [CI]: 3.19-36.50). Conclusion Based on these results, it can be concluded that there were significant differences in TSH levels between the groups with differentiated thyroid carcinoma and benign thyroid enlargement.
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Humains , Mâle , Femelle , Adolescent , Adulte , Adulte d'âge moyen , Sujet âgé , Tumeurs de la thyroïde/diagnostic , Thyréostimuline/sang , Adénocarcinome folliculaire/diagnostic , Cancer papillaire de la thyroïde/diagnostic , Thyroïdectomie , Tumeurs de la thyroïde/chirurgie , Tumeurs de la thyroïde/anatomopathologie , Marqueurs biologiques tumoraux/sang , Études cas-témoins , Adénocarcinome folliculaire/anatomopathologie , Diagnostic différentiel , Cancer papillaire de la thyroïde/anatomopathologieRésumé
ABSTRACT The very rare thyroid-like carcinoma of the kidney (TLCK) is microscopically similar to thyroid follicular cell carcinoma (TFCC). Differential diagnosis with secondary thyroid tumors depends on non-reactivity to immunohistochemical (IHC) markers for TFCC (thyroglobulin - TG and TTF1). We herein describe the fourth Pediatric case in literature and extensively review the subject. Only 29 cases were published to the moment. Most cases were asymptomatic and incidentally detected. Most tumors are hyperechoic and hyperdense with low grade heterogenous enhancement on CT and MRI. Most patients were treated with radical nephrectomy, but partial nephrectomy was used in some cases, apparently with the same results. Metastases are uncommon and apparently do not change prognosis, but follow-ups are limited. Up to the moment, TLCK presents as a low grade malignancy that may be treated exclusively with surgery and frequently with partial kidney renal preservation. A preoperative percutaneous biopsy is a common procedure to investigate atypical tumors in childhood and adult tumors. To recognize the possibility of TLCK is fundamental to avoid unnecessary thyroidectomies in those patients, supposing a primary thyroid tumor.
Sujets)
Humains , Femelle , Enfant , Tumeurs de la thyroïde/anatomopathologie , Adénocarcinome folliculaire/anatomopathologie , Tumeurs du rein/chirurgie , Tumeurs de la thyroïde/diagnostic , Imagerie par résonance magnétique , Néphrocarcinome/chirurgie , Néphrocarcinome/diagnostic , Néphrocarcinome/anatomopathologie , Adénocarcinome folliculaire/chirurgie , Adénocarcinome folliculaire/diagnostic , Diagnostic différentiel , Tumeurs du rein/diagnostic , Tumeurs du rein/anatomopathologie , Lymphadénectomie/méthodes , Néphrectomie/méthodesRésumé
Abstract Introduction Increased body mass index is known to be associated with the high prevalence of differentiated thyroid cancers; however data on its impact on survival outcome after thyroidectomy and adjuvant therapy is scanty. Objective We aimed to evaluate the impact of body mass index on overall survival and disease free survival rates in patients with differentiated thyroid cancers. Methods Between 2000 and 2011, 209 patients with differentiated thyroid cancers (papillary, follicular, hurthle cell) were treated with thyroidectomy followed by adjuvant radioactive iodine-131 therapy and thyroid-stimulating hormone suppression. Based on body mass index, patients were divided into five groups; (a) <18.5 kg/m2 (underweight); (b) 18.5-25 kg/m2 (normal weight); (c) 26-30 kg/m2 (overweight); (d) 31-40 kg/m2 (obese) and (e) >40 kg/m2 (morbid obese). Various demographic, clinical and treatment characteristics and related toxicity and outcomes (overall survival, and disease free survival) were analyzed and compared. Results Median follow up period was 5.2 years (0.6-10). Mean body mass index was 31.3 kg/m2 (17-72); body mass index 31-40 kg/m2 was predominant (89 patients, 42.6%) followed by 26-30 kg/m2 seen in 58 patients (27.8%). A total of 18 locoregional recurrences (8.6%) and 12 distant metastasis (5.7%) were seen. The 10 year disease free survival and overall survival rates were 83.1% and 58.0% respectively. No significant impact of body mass index on overall survival or disease free survival rates was found (p = 0.081). Similarly, multivariate analysis showed that body mass index was not an independent prognostic factor for overall survival and disease free survival. Conclusion Although body mass index can increase the risk of thyroid cancer, it has no impact on treatment outcome; however, further trials are warranted.
Resumo Introdução Sabe-se que o aumento do índice de massa corpórea está associado à alta prevalência de câncer diferenciado de tireoide; entretanto, os dados sobre seu impacto no desfecho de sobrevivência após tireoidectomia e terapia adjuvante são escassos. Objetivo Objetivou-se avaliar o impacto do índice de massa corpórea nas taxas de sobrevida global e sobrevida livre de doença em pacientes com câncer diferenciado de tireoide. Método Entre 2000 e 2011, 209 pacientes com câncer diferenciado de tireoide (papilar/folicular/de células de Hurthle) foram tratados através de tireoidectomia, seguida de tratamento com iodo radioativo-131 adjuvante e supressão de hormônio estimulante da tireoide. Com base no índice de massa corpórea, os pacientes foram divididos em cinco grupos; (a) < 18,5 kg/m2 (baixo peso); (b) 18,5-25 kg/m2 (peso normal); (c) 26-30 kg/m2 (sobrepeso); (d) 31-40 kg/m2 (obesos) e (e) > 40 kg/m2 (obesos mórbidos). Várias características demográficas, clínicas e de tratamento e toxicidade associada e desfechos (sobrevida global e sobrevida livre de doença) foram analisadas e comparadas. Resultados O período médio de acompanhamento foi de 5,2 anos (0,6-10). O índice de massa corpórea médio foi de 31,3 kg/m2 (17-72); o índice de massa corpórea de 31-40 kg/m2 foi predominante (89 pacientes, 42,6%), seguido por 26-30 kg/m2, observado em 58 pacientes (27,8%). Observaram-se 18 recidivas locorregionais (8,6%) e 12 metástases distantes (5,7%). As taxas de sobrevida livre de doença e sobrevida global de 10 anos foram de 83,1% e 58,0%, respectivamente. Não foi encontrado impacto significativo do índice de massa corpórea nas taxas de sobrevida global ou sobrevida livre de doença (p = 0,081). Da mesma forma, a análise multivariada mostrou que o índice de massa corpórea não foi um fator prognóstico independente para sobrevida global e sobrevida livre de doença. Conclusão Embora o índice de massa corpórea possa aumentar o risco de câncer de tireoide, ele não tem impacto no resultado do tratamento; contudo, outros estudos são necessários.
Sujets)
Humains , Mâle , Femelle , Tumeurs de la thyroïde/mortalité , Tumeurs de la thyroïde/thérapie , Indice de masse corporelle , Adénocarcinome folliculaire/mortalité , Pronostic , Thyroïdectomie , Tumeurs de la thyroïde/anatomopathologie , Taux de survie , Études rétrospectives , Facteurs de risque , Association thérapeutique , Adénocarcinome folliculaire/anatomopathologie , Adénocarcinome folliculaire/secondaire , Adénocarcinome folliculaire/thérapie , Survie sans rechute , Radio-isotopes de l'iode/usage thérapeutique , Récidive tumorale localeSujets)
Humains , Tumeurs de la thyroïde/diagnostic , Tumeurs de la thyroïde/anatomopathologie , Carcinome papillaire/diagnostic , Carcinome papillaire/anatomopathologie , Adénocarcinome folliculaire/diagnostic , Adénocarcinome folliculaire/anatomopathologie , Diagnostic différentiel , Métastase lymphatique/diagnostic , Métastase lymphatique/anatomopathologie , Invasion tumoraleRésumé
ABSTRACT Objective The present study describes the clinical and tumor characteristics of patients that died from differentiated thyroid cancer and reports on the cause and circumstances of death in these cases. Subjects and methods Retrospective analysis of all the differentiated thyroid cancer (DTC) related deaths at a single institution over a 5-year period, with a total of 33 patients. Results Most of the patients were female (63.6%), with a mean age at diagnosis of 58.2 years. The most common histologic type was papillary (66.7%) and 30.3% were follicular. The distribution according to the TNM classification was: 15.4% of T1; 7.7% T2; 38.4% T3; 19.2% of T4a and 19.2% of T4b. Forty-four percent of cases were N0; 20% N1a and 36.6% of N1b. Twelve patients were considered non-responsive to radioiodine. Only one of the patients did not have distant metastases. The most common metastatic site was the lung in 69.7%. The majority of deaths were due to pulmonary complications related to lung metastases (17 patients, 51.5%), followed by post-operative complications in 5 cases, neurological disease progression in 3 cases, local invasion and airway obstruction in one patient. Median survival between diagnosis and death was reached in 49 months while between disease progression and death it was at 22 months. Conclusion Mortality from DTC is extremely rare but persists, and the main causes of death derive from distant metastasis, especially respiratory failure due to lung metastasis. Once disease progression is established, median survival was only 22 months.
Sujets)
Humains , Mâle , Femelle , Adulte d'âge moyen , Sujet âgé , Tumeurs de la thyroïde/mortalité , Carcinome papillaire/mortalité , Adénocarcinome folliculaire/mortalité , Facteurs temps , Brésil , Tumeurs de la thyroïde/anatomopathologie , Carcinome papillaire/anatomopathologie , Tomodensitométrie , Études rétrospectives , Facteurs de risque , Cause de décès , Répartition par sexe , Adénocarcinome folliculaire/anatomopathologie , Évolution de la maladie , Estimation de Kaplan-Meier , Tumeurs du poumon/secondaire , Stadification tumoraleRésumé
We describe herein histologic, immunohistochemical, and molecular findings and clinical manifestations of a rare case of an extremely well differentiated papillary thyroid carcinoma (EWD-PTC). Similarly, it is also difficult to diagnose follicular variant papillary thyroid carcinoma (FVPTC), whose diagnosis is still met with controversy. A recently reported entity of well-differentiated tumor of uncertain malignant potential (WDT-UMP) is added to the diagnostic spectrum harboring EWD-PTC and FVPTC. We report this case, because EWD-PTC is different from FVPTC in its papillary architecture, and also from WDT-UMP in its recurrence and metastatic pattern. These morphologically deceptive entities harbored diagnostic difficulties in the past because the diagnosis depended solely on histology. However, they are now diagnosed with more certainty by virtue of immunohistochemical and molecular studies. We experienced a case of EWD-PTC, which had been diagnosed as adenomatous hyperplasia 20 years ago and manifested recurrence with lymph node (LN) metastasis 7 years later. After another 7 years of follow-up, a new thyroid lesion had developed, diagnosed as FVPTC, with LN metastasis of EWD-PTC. One year later, the patient developed metastatic FVPTC in the skull. Immunohistochemically, the EWD-PTC was focally positive for CK19, negative for galectin-3, and focally negative for CD56. Molecular studies revealed BRAF-positivity and K-RAS negativity. The FVPTC in the left thyroid showed both BRAF and K-RAS negativity. In conclusion, EWD-PTC and FVPTC share similar histologic features, but they are different tumors with different molecular biologic and clinical manifestations. A large cohort of EWD-PTC should be included in further study.
Sujets)
Adulte , Femelle , Humains , Mâle , Adulte d'âge moyen , Adénocarcinome folliculaire/anatomopathologie , Carcinome papillaire folliculaire/anatomopathologie , Galectine -3/analyse , Hyperplasie/anatomopathologie , Métastase lymphatique , Récidive tumorale locale/anatomopathologie , Tumeurs du crâne/secondaire , Tumeurs de la thyroïde/anatomopathologieRésumé
Background: The finding of follicular neoplasm, using a FNAP, is an indication for partial or total thyroidectomy, to obtain the definitive malignant or benign histology. Frequently, it is possible to identify significant additional histological diagnosis. Aim: To obtain the definitive histological findings in patients with follicular neoplasm by FNAP. Patients and Method: Transversal analysis of 133 patients that underwent to total thyroidectomy between 2003 and 2009, that filled de requirements for adequate histological assessment. Results: In 33.1 percent of the treated patients the final diagnosis was indeed a follicular neoplasm (adenoma in 26.3 percent and cancer in 6.8 percent). In the 51.9 percent the finding was follicular colloidal hyperplasia and other thyroid cancer in 8.3 percent. The total malignant prevalence in the whole gland was 29.3 percent. Conclusions: The thyroidec-tomy is the treatment of choice and the final diagnostic procedure for these patients. The histological findings of cancer different from follicular not only in the punctioned nodule are a secondary and an additional argument for reinforcing the surgical indication.
Introducción: El hallazgo de una neoplasia folicular por PAAF, obliga a realizar una tiroidectomía parcial o total, para definir la naturaleza maligna o benigna definitiva de la lesión tiroidea. Junto a este diagnóstico preoperatorio se identifican finalmente con alta frecuencia lesiones histológicas adicionales. Objetivo: Conocer y describir los hallazgos anatomopatológicos definitivos que se encuentran en tiroidectomías por neoplasias foliculares diagnosticadas por PAAF. Materiales y Métodos: Revisión transversal de las biopsias definitivas de 133 pacientes sometidos a tiroidectomía total entre 2003 y 2009, que cumplieron los requisitos establecidos para evaluar la histología definitiva del nódulo puncionado y de la glándula tiroides completa. Resultados: En el 33,1 por ciento de los pacientes el diagnóstico definitivo del nódulo puncionado fue efectivamente una neoplasia folicular (adenoma en el 26,3 por ciento y cáncer en el 6,8 por ciento). El 51,9 por ciento correspondió a hiperplasia folicular y el 8,3 por ciento otro cáncer. La prevalencia de malignidad final en la glándula completa fue de un 29,3 por ciento. Conclusiones: Siendo la indicación de tiroidectomía en estos pacientes un tratamiento y procedimiento diagnóstico aceptado y necesario, se concluye que la alta prevalencia de lesiones malignas (29,3 por ciento) tanto en el nódulo puncionado como, adicionalmente, en el resto de la glándula, reforzaría la necesidad de este tratamiento quirúrgico.
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Humains , Mâle , Adulte , Femelle , Adulte d'âge moyen , Adénocarcinome folliculaire/chirurgie , Adénocarcinome folliculaire/anatomopathologie , Tumeurs de la thyroïde/chirurgie , Tumeurs de la thyroïde/anatomopathologie , Adénocarcinome folliculaire/diagnostic , Adénocarcinome folliculaire/épidémiologie , Ponction-biopsie à l'aiguille , Études transversales , Résultats fortuits , Tumeurs de la thyroïde/diagnostic , Tumeurs de la thyroïde/épidémiologie , Soins préopératoires , Prévalence , ThyroïdectomieSujets)
Adénocarcinome folliculaire/complications , Adénocarcinome folliculaire/diagnostic , Adénocarcinome folliculaire/anatomopathologie , Adénomes/complications , Adénomes/diagnostic , Adénomes/anatomopathologie , Carcinomes/complications , Carcinomes/diagnostic , Carcinomes/anatomopathologie , Carcinome papillaire/complications , Carcinome papillaire/diagnostic , Carcinome papillaire/anatomopathologie , Humains , Glande thyroide/anatomopathologie , Tumeurs de la thyroïde/diagnostic , Tumeurs de la thyroïde/anatomopathologieRésumé
A associação entre carcinoma diferenciado de tireoide (CDT) e tireoidite linfocitária crônica (TLC) tem sido relatada na literatura. OBJETIVO: Avaliar a incidência desta associação e determinar se a TLC pode influenciar no estadiamento tumoral do CDT quando associada a outras variáveis de risco. FORMA DE ESTUDO: Coorte histórica (retrospectiva). MATERIAL E MÉTODO: Avaliaram-se 52 prontuários e laudos de pacientes portadores de CDT, no período de 1999 a 2009, divididos em dois grupos. O primeiro, composto de 35 pacientes portadores de CDT sem TLC; o segundo, com 17 pacientes, associado à TLC. O tratamento instituído para todos os pacientes foi a tireoidectomia total. Variáveis comuns a ambos os grupos como idade, gênero, padrão histológico, diâmetro tumoral, metástase locorregional e à distância, invasão extratireoidiana, multifocalidade e presença de cápsula tumoral foram comparadas. Aplicou-se os testes t-Student e Qui-quadrado para análise dos dados. RESULTADOS: A incidência de CDT isolado foi maior do que a de CDT+TLC (p=0,0126). Nenhuma diferença estatística quanto às variáveis comuns analisadas foi observada. CONCLUSÕES: A presença de TLC ocorreu em 33 por cento dos pacientes com CDT. Todos os casos de CDT eram em estádios iniciais.
The association between differentiated thyroid carcinoma (DTC) and chronic lymphocytic thyroiditis (CLT) has been reported in literature. AIM: To evaluate the incidence of this association and to determine whether the CLT may influence on the early initial staging of DTC when associated with other variable risks. STUDY DESIGN: Historical (retrospective) cohort. MATERIALS AND METHODS: Fifty two patients with DTC were evaluated from 1999 to 2009. They were divided into two groups. The first group had 35 patients with DTC without DLT; the second had 17 patients with CLT. Total thyroidectomy was the treatment chosen for all patients. Similarities shared in both groups such as age, gender, histological tumor type, tumor diameter, regional only or with distant metastases, extrathyroidal invasion, multifocality and presence of tumor capsule were considered. T-Student tests and Chi-square tests were applied to analyze the data. RESULTS: The incidence of DTC without CLT was higher that of DTC+CLT (p=0.0126). We noticed no statistic differences between the common variables analyzed. CONCLUSIONS: CLT occurred in 33 percent of the patients with DCT. All cases of DTC were in the early stages.
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Adolescent , Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Femelle , Humains , Mâle , Adulte d'âge moyen , Jeune adulte , Adénocarcinome folliculaire/anatomopathologie , Carcinome papillaire/anatomopathologie , Maladie de Hashimoto/complications , Tumeurs de la thyroïde/anatomopathologie , Adénocarcinome folliculaire/complications , Études de cohortes , Carcinome papillaire/complications , Maladie de Hashimoto/anatomopathologie , Stadification tumorale , Études rétrospectives , Tumeurs de la thyroïde/complicationsRésumé
OBJECTIVE: To report the results of cytology and histology obtained for a series of systematically resected thyroid nodules > 4 cm. METHODS: A group of 151 patients with thyroid nodules > 4 cm was submitted to surgery despite the cytology result. RESULTS: Malignancy was confirmed histologically in 22.5 percent of the patients. Excluding cases of insufficient material, cytology was benign in only 3/31 carcinomas (90.3 percent sensitivity). The frequency of malignancy was 35 percent among nodules with indeterminate cytology (follicular neoplasm), and there was a predominance (77 percent) of papillary carcinoma. The negative predictive value of benign cytology was 96.4 percent. CONCLUSIONS: The false-negative rate of cytology in thyroid nodules > 4 cm does not justify systematic resection of these nodules in asymptomatic patients with benign cytology.
OBJETIVO: Reportar os resultados da citologia e da histologia em uma s¨¦rie de n¨®dulos tireoidianos > 4 cm sistematicamente ressecados. MÉTODOS: Foram submetidos ¨¤ cirurgia 151 pacientes com n¨®dulo tireoidiano > 4 cm, a despeito do resultado da citologia. Apenas a histologia referente a este n¨®dulo foi considerada nos resultados. RESULTADOS: Malignidade foi confirmada histologicamente em 22,5 por cento dos pacientes. Excluindo os casos com material insuficiente, a citologia foi benigna somente em 3/31 carcinomas (sensibilidade 90,3 por cento). A frequ¨ºncia de malignidade foi de 35 por cento nos n¨®dulos com citologia indeterminada (neoplasia folicular), predominando o carcinoma papil¨ªfero (77 por cento). O valor preditivo negativo da citologia benigna foi 96,4 por cento. CONCLUSÕES: A taxa de falso-negativo da citologia em n¨®dulos tireoidianos > 4 cm não justifica a ressecção sistem¨¢tica destes em pacientes assintom¨¢ticos com citologia benigna.
Sujets)
Adolescent , Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Enfant , Femelle , Humains , Mâle , Adulte d'âge moyen , Jeune adulte , Adénocarcinome folliculaire/anatomopathologie , Carcinome papillaire/anatomopathologie , Tumeurs de la thyroïde/anatomopathologie , Nodule thyroïdien/anatomopathologie , Adénocarcinome folliculaire/épidémiologie , Brésil/épidémiologie , Carcinome papillaire/épidémiologie , Faux négatifs , Valeur prédictive des tests , Tumeurs de la thyroïde/épidémiologie , Tumeurs de la thyroïde/chirurgie , Procédures superflues , Jeune adulteRésumé
Differentiated thyroid carcinoma has a good prognosis with a 90 percent survival at 10 years. Follicular carcinoma is more aggressive than papillary carcinoma Aim: To study the clinical presentation, evolution and prognosis of differentiated thyroid carcinoma. Material and Methods: The pathological registries of differentiated thyroid cancer processed in a pathology service of a general hospital, between 1984 and 2007, were searched. The clinical records of patients were reviewed. Results: One hundred six pathology registries were identified but only 89 patients had complete medical records. Seventy six patients aged 44 +/- 16 years had a papillary carcinoma and 13 patients aged 42 +/- 15 years had a follicular carcinoma. After a mean follow up of 53 months, 65 patients with papillary and 12 patients with follicular thyroid cancer were alive. Five patients with papillary carcinoma and one with follicular carcinoma had a local or distant relapse. Calculated actuarial survival at 10 years was 84 and 100 percent for papillary and follicular carcinoma, respectively. Ten year survival for stage I, II, III and IV tumors was 100, 92, 68 and 0 percent, respectively. Mortality was associated with the presence of distant metastases, a stage IV tumor, vascular or lymphatic tumor infiltration, tumor size, lymph node involvement, extra capsular invasion and a multi focal lesions. The relative risk for mortality increases between 2.7 and 9 times with the presence of lymph node infiltration and distant metastases. Conclusions: The prognosis of differentiated thyroid cancer is related to lymph node infiltration and the presence of distant metastases.
Los objetivos del presente estudio son identificar la forma de presentación clínica y evolución del cáncer diferenciado de tiroides (CDT); definir la curva de sobrevivencia para ambos tipos histológicos e identificar los factores clínicos e histológicos de mal pronóstico. Se presentan 89 pacientes portadores de cáncer diferenciado (papilar y folicular) de tiroides (75 CP Y 13 CF) tratados en los Hospitales de Coquimbo y La Serena, entre 1984 y 2007. La forma de presentación de ambos tumores fue similar. La mediana de seguimiento fue 53 meses. El 75 por ciento de los pacientes tuvo un seguimiento mínimo de 7 años y el 86,4 por ciento de los pacientes (64 cáncer papilar y 12 cáncer folicular) se encuentran vivos y libres de enfermedad; el intervalo libre de enfermedad fue de 52,7 meses con rango entre 3 meses y 16 años. La sobrevida actuarial a 10 a±os para cáncer papilar es 84 por ciento y, para cáncer folicular 100 por ciento. Por estadios, a los 10 años la sobrevida es de 100 por ciento en estadio I, 92 por ciento en estadio II, 68 por ciento en estadio III y 0 por ciento en estadio IV. El riesgo de muerte se asoció a la presencia de metástasis distantes, T4 e infiltración histológica vascular y/o linfática, p = 0,02. Otros factores no mostraron asociación: tamaño del tumor < T4, compromiso de linfonodos, invasión extracapsular y multifocalidad histológica. Sin embargo, el RR se incrementa 2,7 y 9 veces con invasión linfática o con presencia de metástasis, 1,6 veces con el aumento del tamaño tumoral, y 1,33 con multifocalidad neoplásica en la glándula. La presencia de metástasis linfáticas en cáncer papilar representa un RR de 1,22. Aunque el seguimiento de esta casuística es reducido (mediana 5 años), los resultados sugieren que el mal pronóstico se asocia fundamentalmente a compromiso linfático y metástasis a distancia y, por otra parte, a que el planteamiento terapéutico ha resultado efectivo para el control de la enfermedad en estadio I y II.
Sujets)
Humains , Mâle , Femelle , Adulte , Adulte d'âge moyen , Adénocarcinome folliculaire/mortalité , Adénocarcinome folliculaire/anatomopathologie , Carcinome papillaire/mortalité , Carcinome papillaire/anatomopathologie , Tumeurs de la thyroïde/mortalité , Tumeurs de la thyroïde/anatomopathologie , Adénocarcinome folliculaire/chirurgie , Évolution Clinique , Carcinome papillaire/chirurgie , Chili/épidémiologie , Études longitudinales , Stadification tumorale , Tumeurs de la thyroïde/chirurgie , Pronostic , Taux de survie , ThyroïdectomieRésumé
Iodine is a trace element that is essential for the synthesis of thyroid hormone. Both chronic iodine deficiency and iodine excess have been associated with hypertrophy and hyperplasia of follicular cells, attributed to excessive secretion of TSH. This may be associated to thyroid cancer risk, particularly in women. Experimental studies have documented thyroid cancer induction by elevation of endogenous TSH, although in a small number of animals. Iodine deficiency associated with carcinogenic agents and chemical mutagens will result in a higher incidence of thyroid malignancy. Inadequate low iodine intake will result in increased TSH stimulation, increased thyroid cell responsiveness to TSH, increased thyroid cell EGF-induced proliferation, decreased TGFbeta 1 production and increased angiogenesis, all phenomena related to promotion of tumor growth. Epidemiological studies associating iodine intake and thyroid cancer led to controversial and conflicting results. There is no doubt that introduction of universal iodine prophylaxis in population previously in chronic iodine-deficiency leads to a changing pattern of more prevalent papillary thyroid cancer and declining of follicular thyroid cancer. Also anaplastic thyroid cancer is practically not seen after years of iodine supplementation. Iodine excess has also been indicated as a possible nutritional factor in the prevalence of differentiated thyroid cancer in Iceland, Hawaii and, more recently, in China. In conclusion: available evidence from animal experiments, epidemiological studies and iodine prophylaxis has demonstrated a shift towards a rise in papillary carcinoma, but no clear relationship between overall thyroid cancer incidence and iodine intake.
O iodo é essencial para a síntese de hormônios tireóideos e tanto a deficiência crônica deste halogeno como o excesso nutricional de iodo levam a hiperplasia e hipertrofia dos elementos foliculares (por excesso de TSH). Esse fenômeno pode se associar a maior risco de câncer de tireóide, especialmente no sexo feminino. Estudos experimentais documentam indução de câncer de tireóide após prolongado excesso circulante de TSH, o qual induz aumento da proliferação celular medida por fator de crescimento epidermal (EGF), decréscimo de síntese de fator de transformação do crescimento (TGFbeta 1) e aumento da angiogenese. Estudos epidemiológicos entre nutrição de iodo e câncer de tireóide são conflitantes. É, todavia, aceito que a correção de prévia deficiência de iodo com aporte nutricional adequado deste halogeno leva à maior prevalência de carcinoma papilífero (e decréscimo de carcinoma folicular). Em alguns países, o excesso de iodo foi apontado como causa aparente de maior prevalência de câncer de tireóide. Em conclusão: não existe uma relação causa-efeito entre iodo nutricional e prevalência de câncer de tireóide, e outros fatores intervenientes ambientais devem ser considerados.
Sujets)
Animaux , Femelle , Humains , Mâle , Adénocarcinome folliculaire/étiologie , Adénocarcinome papillaire/étiologie , Iode , Tumeurs de la thyroïde/étiologie , Adénocarcinome folliculaire/épidémiologie , Adénocarcinome folliculaire/anatomopathologie , Adénocarcinome papillaire/épidémiologie , Adénocarcinome papillaire/anatomopathologie , Argentine/épidémiologie , Régime alimentaire , Modèles animaux de maladie humaine , Études épidémiologiques , Facteur de croissance épidermique/métabolisme , Hawaï/épidémiologie , Islande/épidémiologie , Iode/administration et posologie , Iode/déficit , Italie/épidémiologie , Glande thyroide/effets des médicaments et des substances chimiques , Glande thyroide/métabolisme , Tumeurs de la thyroïde/épidémiologie , Tumeurs de la thyroïde/anatomopathologie , Thyréostimuline/effets des médicaments et des substances chimiques , Thyréostimuline/métabolismeRésumé
OBJETIVO: Estudar o microcarcinoma papilífero observado nas tireoidectomias realizadas em nossa clínica privada. MATERIAL E MÉTODOS: Revisamos clínica e histologicamente 1.930 pacientes submetidos a tireoidectomias no período de 2002 a 2006, tendo 606 carcinomas e, desses, 332 como microcarcinomas papilíferos. Avaliamos sexo, idade, tipo histológico, tamanho da neoplasia, multifocalidade, freqüência do esvaziamento cervical, resultados da PCI e tireoglobulina sérica. RESULTADOS: Dos 332 pacientes, 48 eram do sexo masculino e 146 tinham idade superior a 45 anos. Todos foram submetidos a tireoidectomia total, 19 concomitantemente a esvaziamento cervical de necessidade (5,72 por cento), e 313 a iodoterapia (94,27 por cento). Tivemos metástase a distância em 5 pacientes (1,5 por cento). Após 1 ano, de 170 pacientes submetidos à PCI, temos 141 considerados livres de doença, 21 com anti-tireoglobulina positivo, 6 com tireoglobulina superior a 2 ng/ml, sendo 1 com metástase pulmonar e outro com recidiva linfonodal (0,3 por cento). CONCLUSÃO: Recomendamos que seja realizada a tireoidectomia total, esvaziamento cervical de necessidade e iodoterapia ablativa na presença de fatores clínicos e anátomo-patológicos de risco.
OBJECTIVE: The study of papillary microcarcinoma observed during the thyroidectomies in our private clinic. MATERIAL AND METHODS: We reviewed clinical and histopathological results of 1,930 consecutive patients submitted for thyroidectomies in the period from 2002 to 2006, 606 had thyroid carcinomas but only 332 were papillary microcarcinoma. We studied gender, age, histologic type, size, multifocality, frequency of neck dissection, and results of Whole Body Scan and thyroglobulin. RESULTS: Overall, we found 48 males and 146 older than 45 years old. Therapy included total thyroidectomy for all, therapeutic neck dissection in 19 (5.72 percent), and radioiodine for 313 (94.27 percent). We found 5 patients with distant metastases (1.5 percent). After 1 year, from 170 submitted to WBS, we consider 141 free of disease, 21 have positive thyroglobulin antibody, 6 have thyroglobulin level above 2 ng/ml, being 1 with lung metastases and other with lymph node recurrence (0.3 percent). CONCLUSION: We recommend total thyroidectomy, therapeutic neck dissection and radioiodine ablation when present clinical and pathological risk factors.
Sujets)
Adolescent , Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Enfant , Femelle , Humains , Mâle , Adulte d'âge moyen , Adénocarcinome folliculaire , Carcinome papillaire , Tumeurs de la thyroïde , Adénocarcinome folliculaire/anatomopathologie , Adénocarcinome folliculaire/chirurgie , Marqueurs biologiques tumoraux , Loi du khi-deux , Carcinome papillaire/anatomopathologie , Carcinome papillaire/chirurgie , Études de suivi , Radio-isotopes de l'iode/usage thérapeutique , Tumeurs du poumon/secondaire , Récidive tumorale locale , Thyroïdectomie , Thyroglobuline/sang , Tumeurs de la thyroïde/sang , Tumeurs de la thyroïde/anatomopathologie , Tumeurs de la thyroïde/chirurgieRésumé
Os nódulos tireóideos são encontrados em grande parte da população, mas somente 5 a 10 por cento são malignos. A ultra-sonografia da tireóide, por ser um método simples, não-invasivo e apresentar boa correlação com os aspectos macroscópicos da glândula tireóide, é cada vez mais utilizada para identificar os nódulos que apresentam maior risco de malignidade. A presença de algumas características ultra-sonográficas como hipoecogenicidade, microcalcificações, contornos irregulares e vascularização central ao Doppler, aumenta o risco de malignidade da lesão. Por outro lado, nódulos que apresentam características ultra-sonográficas benignas, como hiperecogenicidade e aspecto misto semelhante a uma esponja, apresentam concordância com a citologia, com valor preditivo negativo de 96,6 por cento. É importante, pois, examinarmos e classificarmos todas as lesões nodulares para selecionarmos aquelas suspeitas para a biópsia, principalmente em uma tireóide multinodular. A ultra-sonografia também apresenta alta sensibilidade para identificar gânglios cervicais suspeitos no seguimento de pacientes com carcinoma da tireóide, mesmo quando a PCI é negativa e a tireoglobulina (Tg) sérica, indetectável. É recomendável a dosagem da Tg no lavado da agulha da punção, pois esta tem-se mostrado mais sensível que a citologia no diagnóstico de metástase cervical, principalmente quando existe conteúdo líquido, e não é afetada pela presença de anticorpos anti-Tg.
Thyroid nodules are found in the vast majority of the population, but only 5 to 10 percent are malignant. Ultrasonography of the thyroid, by virtue of being a straightforward, non-invasive method presenting strong correlation with macroscopic aspects of the thyroid gland, is being increasingly used to identify nodules that present a higher risk of malignancy. The presence of certain ultrasonographic characteristics such as hypoechogenicity, microcalcifications, irregular contours and central vascularization on Doppler, increase the risk of the lesion being malignant. Conversely, nodules presenting benign ultrasonographic characteristics such as hyperechogenicity and a mixed sponge-like aspect, and a concordant cytology, have a negative predictive value of 96.6 percent. It is, thus, important to examine all nodular lesions and to identify suspicious lesions that need biopsy, especially in multinodular glands. Ultrasonography is also highly sensitive in the identification of suspicious cervical lymph nodes during the follow-up of patients with thyroid carcinoma, even when PCI is negative and serum thyroglobulin (Tg) levels are undetectable. Tg measurement in the needle wash-out content is recommended as this has proven to be more sensitive than cytology in the diagnosis of cervical metastasis, especially where there is liquid content, and it is not affected by the presence of anti-Tg antibodies.
Sujets)
Humains , Adénocarcinome folliculaire , Carcinome papillaire , Tumeurs de la thyroïde , Adénocarcinome folliculaire/anatomopathologie , Cytoponction/méthodes , Calcinose , Carcinome papillaire/anatomopathologie , Stadification tumorale/méthodes , Valeur prédictive des tests , Thyroglobuline/sang , Tumeurs de la thyroïde/anatomopathologie , Nodule thyroïdien/anatomopathologie , Nodule thyroïdien , Échographie-doppler couleur , Imagerie du corps entierRésumé
A classificação TNM segundo a UICC é usada para avaliar os resultados do acompanhamento do carcinoma de tireóide. A 6ª edição modificou a descrição do tumor primário (T), dos linfonodos regionais (N) e dos grupos de estadiamento. O objetivo deste estudo foi comparar a habilidade das 5ª e 6ª edições em predizer resultados. As duas classificações foram aplicadas em uma análise retrospectiva de 90 pacientes do HUCFF. Sessenta e nove pacientes apresentavam carcinoma papilífero, 14 folicular, 4 células de Hürthle e 3 misto. Os pacientes foram acompanhados por um período médio de 58,3 meses. Ao final do acompanhamento, 49 pacientes estavam em remissão, 23 com doença persistente, 4 com recorrência tumoral, 11 com metástases e 3 evoluíram para o óbito. De acordo com a 6ª edição, 19 pacientes foram classificados como T1, comparado com 7 pela 5ª edição; 19 pacientes T2 comparado com 30; 14 classificados como T3 comparado com 10; 22 como T4 comparado com 27, e 16 pacientes como Tx. Ambas as edições mostraram remissões comparáveis para os estágios I, II e III. Para o estágio IV houve uma mudança significativa na remissão, entretanto não houve diferença comparando IV e IV C.
The TNM classification of UICC is used for predicting the outcome of thyroid cancer. The 6th edition changed the description of primary tumor (T), regional lymph node (N) and the staging group. The aim of this study was to compare the ability of the 5th and the 6th editions to predict outcome. The two classifications were applied in a retrospective analysis of 90 patients from HUCFF. Sixty-nine patients had papillary carcinoma, 14 follicular, 4 Hürthle cell, and 3 mixed. Patients were followed for a mean period of 58.3 months. At the end of follow-up, 49 patients were disease-free, 23 persisted with disease, 4 had cervical recurrence, 11 had metastases and 3 died. According to the 6th edition, 19 patients were classified as T1, compared to 7 based on the 5th edition; 19 patients were T2 compared to 30; 14 were T3 compared to 10; 22 were T4 compared to 27, and 16 patients were Tx. Both editions showed comparable remissions for stages I, II, and III. For the stage IV there was a significant change in remission, however there was no difference comparing IV and IV C.