Thyroglossal duct cyst carcinoma case series-Management strategy and outcomes / Serie de casos de carcinoma del conducto tirogloso: estrategias de tratamiento y resultados

Objective: To review the clinical presentation, diagnosis, pathology and management strategies in a modern cohort of patients with thyroglossal duct cyst carcinoma. Study design: Retrospective case series following PROCESS Guidelines. Setting Comprehensive cancer centre. Methods: Data recorded included: gender, age at diagnosis, clinical presentation, thyroid function, diagnostic investigations, cytological results, final histology, staging and follow up status. The risk of malignancy in cytological analysis was stratified according to the Royal College of Pathologists classification in United Kingdom. Results: Twelve patients were included. The majority of patients (66.7%) presented with an isolated thyroglossal duct cyst. Only 4 patients had preoperative cytological suspicion of carcinoma (sensitivity: 33.3%). At the time of presentation all patients were euthyroid. Following diagnosis of malignancy, a total thyroidectomy was performed in all patients, with the exception of 2, who had a thyroglossal duct cyst carcinoma of less than 10mm. Among the 10 patients who underwent total thyroidectomy, 7 (70%) patients had proven carcinoma in the thyroid gland, 3 with deposits of less than 10mm. The average size of the thyroid cancer deposits was 7.2mm (1–20mm). With a mean follow-up of is 44 months (5–120), all patients were alive and free of recurrence at the end of the study period. Conclusion: Thyroglossal duct cyst carcinoma is a rare condition and its management should be discussed in a multidisciplinary meeting. As with differentiated thyroid cancer originating in the thyroid gland, it bears extraordinary survival rates. Accordingly, the management of these cancers has shifted towards a more conservative approach although its peculiarities must be taken into account: ease of extracystic invasion and possible different lymph node invasion. (AU)

Objetivo: Revisar la presentación clínica, el diagnostico, la histología y las estrategias de tratamiento en una cohorte moderna de pacientes con carcinoma del conducto tirogloso. Diseño del estudio: Serie de casos retrospectiva utilizando PROCESS Guidelines. Localización: Unidad de cáncer de cabeza y cuello. Métodos: Los datos incluidos fueron: sexo, edad al diagnóstico, presentación clínica, función tiroidea, investigaciones diagnósticas, resultados citológicos, histología final, estadificación y estado durante el seguimiento. El riesgo de malignidad en el análisis citológico fue estratificado de acuerdo con la clasificación del Royal College of Pathologists del Reino Unido. Resultados: Se incluyeron 12 pacientes. La mayoría de ellos (66,7%) presentaron solamente un quiste del conducto tirogloso al diagnóstico. Solamente 4 pacientes tuvieron sospecha de malignidad de acuerdo con los resultados de la citología preoperatoria. En el momento de la presentación, todos los pacientes tenían función tiroidea normal. Después del diagnóstico, se realizó tiroidectomía total a todos los pacientes menos dos, que tuvieron carcinoma del conducto tirogloso menor de 10mm. Entre los 10 pacientes que recibieron tiroidectomía total, 7 (70%) sufrieron carcinoma en la glándula tiroides, 3 de ellos con depósitos menores de 10mm. El tamaño medio de los depósitos de carcinoma en la glándula tiroides fue de 7,2mm (1-20mm). Con una media de seguimiento de 44meses (5-120), todos los pacientes estaban vivos y libres de recidiva al final del periodo estudiado. Conclusión: El carcinoma del conducto tirogloso es una entidad poco frecuente y su manejo debe ser realizado por un equipo multidisciplinario. Igual que en el carcinoma diferenciado de tiroides que se origina en la glándula tiroides, las tasas de supervivencia son excelentes. ... (AU)

Thyroglossal duct cyst carcinoma case series-Management strategy and outcomes.

OBJECTIVE: To review the clinical presentation, diagnosis, pathology and management strategies in a modern cohort of patients with thyroglossal duct cyst carcinoma. STUDY DESIGN: Retrospective case series following PROCESS Guidelines. SETTING: Comprehensive cancer centre. METHODS: Data recorded included: gender, age at diagnosis, clinical presentation, thyroid function, diagnostic investigations, cytological results, final histology, staging and follow up status. The risk of malignancy in cytological analysis was stratified according to the Royal College of Pathologists classification in United Kingdom. RESULTS: Twelve patients were included. The majority of patients (66.7%) presented with an isolated thyroglossal duct cyst. Only 4 patients had preoperative cytological suspicion of carcinoma (sensitivity: 33.3%). At the time of presentation all patients were euthyroid. Following diagnosis of malignancy, a total thyroidectomy was performed in all patients, with the exception of 2, who had a thyroglossal duct cyst carcinoma of less than 10mm. Among the 10 patients who underwent total thyroidectomy, 7 (70%) patients had proven carcinoma in the thyroid gland, 3 with deposits of less than 10mm. The average size of the thyroid cancer deposits was 7.2mm (1-20mm). With a mean follow-up of is 44 months (5-120), all patients were alive and free of recurrence at the end of the study period. CONCLUSION: Thyroglossal duct cyst carcinoma is a rare condition and its management should be discussed in a multidisciplinary meeting. As with differentiated thyroid cancer originating in the thyroid gland, it bears extraordinary survival rates. Accordingly, the management of these cancers has shifted towards a more conservative approach although its peculiarities must be taken into account: ease of extracystic invasion and possible different lymph node invasion.

Protocol for a MULTI-centre feasibility study to assess the use of 99mTc-sestaMIBI SPECT/CT in the diagnosis of kidney tumours (MULTI-MIBI study).

INTRODUCTION: The incidence of renal tumours is increasing and anatomic imaging cannot reliably distinguish benign tumours from renal cell carcinoma. Up to 30% of renal tumours are benign, with oncocytomas the most common type. Biopsy has not been routinely adopted in many centres due to concerns surrounding non-diagnostic rate, bleeding and tumour seeding. As a result, benign masses are often unnecessarily surgically resected. 99mTc-sestamibi SPECT/CT has shown high diagnostic accuracy for benign renal oncocytomas and other oncocytic renal neoplasms of low malignant potential in single-centre studies. The primary aim of MULTI-MIBI is to assess feasibility of a multicentre study of 99mTc-sestamibi SPECT/CT against a reference standard of histopathology from surgical resection or biopsy. Secondary aims of the study include obtaining estimates of 99mTc-sestamibi SPECT/CT sensitivity and specificity and to inform the design and conduct of a future definitive trial. METHODS AND ANALYSIS: A feasibility prospective multicentre study of participants with indeterminate, clinical T1 renal tumours to undergo 99mTc-sestamibi SPECT/CT (index test) compared with histopathology from biopsy or surgical resection (reference test). Interpretation of the index and reference tests will be blinded to the results of the other. Recruitment rate as well as estimates of sensitivity, specificity, positive and negative predictive value will be reported. Semistructured interviews with patients and clinicians will provide qualitative data to inform onward trial design and delivery. Training materials for 99mTc-sestamibi SPECT/CT interpretation will be developed, assessed and optimised. Early health economic modelling using a decision analytic approach for different diagnostic strategies will be performed to understand the potential cost-effectiveness of 99mTc-sestamibi SPECT/CT. ETHICS AND DISSEMINATION: Ethical approval has been granted (UK HRA REC 20/YH/0279) protocol V.5.0 dated 21/6/2022. Study outputs will be presented and published nationally and internationally. TRIAL REGISTRATION NUMBER: ISRCTN12572202.

Bladder paragangliomas: a pictorial review.

Bladder paragangliomas (bPGL) are rare neuroendocrine tumors arising from the sympathetic paraganglia present in the bladder wall. Bladder PGLs are typically submucosal or intramural but when subserosal may not be readily visible at cystoscopy. The average size at presentation is 3.9 cm (range 1.0-9.1 cm). When small, bPGL are usually spherical, well-marginated and homogeneous. Larger bPGL are typically more complex with peri- and intra-tumoral neovascularity and central necrosis. On ultrasound, increased color Doppler signal is typical. The increased soft tissue resolution of MRI enables localization of bPGL within the bladder wall more accurately than CT. Restricted diffusion and avid contrast enhancement help differentiate small bPGLs from leiomyomas, which have similar appearances on ultrasound and CT. Nuclear medicine techniques identify bPGLs and their metastases with high specificity, 68Ga-DOTATATE PET/CT having largely replaced 123I-mIBG SPECT/CT as the first line functional investigation. Imaging is essential to aid surgical planning, as endoscopic resection is often not possible or incomplete due to tumor location. For patients with advanced disease, 68Ga-DOTATATE PET/CT and 123I-mIBG SPECT/CT assess suitability for peptide receptor radionuclide therapy. Up to 63% of bPGL patients have a germline mutation, most commonly in the SDHB subunit gene, increasing their risk of developing pheochromocytomas and further paragangliomas; lifelong annual biochemical and periodic imaging screening from skull base to pelvis is therefore recommended.

Tumour detection and outcomes of surveillance screening in SDHB and SDHD pathogenic variant carriers.

OBJECTIVE: Succinate dehydrogenase subunit (SDHx) pathogenic variants predispose to phaeochromocytoma and paraganglioma (PPGL). Lifelong surveillance is recommended for all patients to enable prompt detection and treatment. There is currently limited evidence for optimal surveillance strategies in hereditary PPGL. We aim to detail the clinical presentation of PPGL in our cohort of non-index SDHB and SDHD pathogenic variant carriers. METHODS: Retrospective analysis of medical and genetic records from a single tertiary referral centre identified SDHB or SDHD pathogenic variants in 74 non-index cases (56 SDHB and 18 SDHD). Surveillance screening for asymptomatic relatives consisted of annual plasma metanephrine measurement and whole-body MRI with contrast at 3-5 yearly intervals. RESULTS: Twenty-three out of 74 non-index patients (10 SDHB and 13 SDHD) were diagnosed with PPGL, 17 patients through surveillance screening (24 tumours in total) and 6 diagnosed prior to commencement of cascade screening with symptomatic presentation. MRI with contrast identified PPGL in 22/24 screen-detected tumours and 5/24 tumours had elevated plasma metanephrine levels. Penetrance in non-index family members was 15.2 and 47.2% for SDHB carriers and 71.6 and 78.7% for SDHD carriers at age of 50 and 70 years, respectively. CONCLUSION: Surveillance screening with combined biochemical testing and imaging enables early detection of PPGL in asymptomatic relatives with SDHx pathogenic variants. The presence of disease at first screen was significant in our cohort and hence further multi-centre long-term data are needed to inform counselling of family members undergoing lifelong surveillance.

Suffering in Silence: Stories of Indian Women with Chronic Mental Illness and Sexual Coercion.

BACKGROUND: Patriarchy exposes women to various forms of discrimination and oppression. Women are more often blamed for mental illness, which can result in social isolation and stigma. METHOD: Case Study. RESULTS: Psycho-social intervention aided in empowering women by giving them voices to speak as well as by utilizing their strengths and available community resources to develop a sense of self-efficacy, coping strategies, and support system. CONCLUSION: Women with chronic mental illness have unique needs and challenges. Mentally ill women face sexual coercion in childhood or adulthood. The factors related to help-seeking in the context of abuse were family reactions, social support, and stigma. Our findings highlight the need to conduct risk assessments and provide community-based and coordinated services during follow-up visits. KEY MESSAGES: Trauma-focused intervention should be culturally appropriate and should focus on reducing emotional distress, restoring self-adaptation, and enhancing social support.

Homelessness in mental illness: Opportunities & prospects in the Indian context.

Homelessness is considered a serious public health concern. Bidirectional relationship has been established between homelessness and mental illness by research studies and its association with compromised well-being, poor quality of life and low productivity. Recent legislative enactments in India have necessitated on the part of the state to address issues related to the rights of persons with mental illness including shelter and housing. Therefore, it becomes imperative to discuss opportunities and prospects in India towards rehabilitating homeless mentally ill in context of existing programs, policies and legislations.

Children's Reactions to Flood Disaster in Kashmir.

BACKGROUND: The flood disaster of 9th-10th September 2014 wreaked havoc in the Jammu and Kashmir region of India. Incessant rains and deluge claimed 283 lives and damaged 2.53 lakh houses. This article presents the findings of the psychosocial care team from the National Institute of Mental Health and Neuro Sciences, Bengaluru, India, during the early phase of disaster. MATERIALS AND METHODS: The team assessed posttraumatic stress symptoms of 64 child survivors from six villages of two districts struck by floods using Children's Revised Impact of Event Scale (CRIES)-8 and qualitative narrations. RESULTS: Children showed high levels of intrusion and avoidance in the aftermath of floods. Both boys and girls showed moderate to severe level of psychological impact on the domains of CRIES-8. The narrations by the children centred on the theme of "water" and "enjoyment in seeing lots of water;" followed by "fearing of the parent's life," later on "fear of their own life," and subsequently to avoidance to go near the river and nightmares like "floating in the water." CONCLUSION: Disasters immensely impact children because of their particular stage of psychological and social development. This highlights the need for psychosocial interventions to minimize the impact of disasters on children at the earliest using simple psychosocial care techniques by employing available community-based manpower.

Radionuclide bone SPECT/CT in the evaluation of knee pain: comparing two-phase bone scintigraphy, SPECT and SPECT/CT.

OBJECTIVE:: To assess the role of single photon emission computed tomography (SPECT/CT) in the evaluation of knee pain as well as comparing bone scintigraphy (BS), SPECT and SPECT/CT, and assessing the incremental value of SPECT/CT. METHODS:: BS, SPECT and SPECT/CT of patients with knee pain (39 patients, 65 knees, 105 lesions) were directly compared for lesion detection, localisation and characterisation using lesion-based, knee-based and patient-based analyses in this retrospective study. RESULTS:: Lesion detection: BS (91.4%), SPECT (100%) and SPECT/CT (100%). SPECT and SPECT/CT detected significantly more lesions than BS (p < 0.05). Lesion localisation: BS (38.5-41.7%), SPECT (74.4-83.3%) and SPECT/CT (100%). SPECT localised significantly more lesions than BS; SPECT/CT localised significantly more lesions than BS and SPECT (p < 0.01). Lesion characterisation: BS (23.0-52.1%), SPECT (30.8-56.2%) and SPECT/CT (92.3-96.9%). SPECT/CT characterised significantly more lesions than BS and SPECT (p < 0.01). Characterisation of non-arthropathy lesions: BS (6.25%), SPECT (12.5%) and SPECT/CT (93.75%). SPECT/CT characterised significantly more non-arthropathy lesions than BS and SPECT (p < 0.01). BS and SPECT detected none, while SPECT/CT detected 100% of the causative/contributing/associated conditions that co-existed with osteoarthritis. Therefore SPECT/CT detected not only just osteoarthritis but also the causative/contributing/associated conditions. CONCLUSION:: SPECT/CT added significant incremental value to BS and SPECT irrespective of whether evaluation was lesion-based, knee-based or patient-based. SPECT/CT represents a viable alternative to MRI, and addition of SPECT/CT to BS and SPECT should be considered in the evaluation of knee pain. ADVANCES IN KNOWLEDGE:: Incremental value of bone SPECT/CT in knee pain.

Incidence and Significance of Incidental Focal Thyroid Uptake on (18)F-FDG PET Study in a Large Patient Cohort: Retrospective Single-Centre Experience in the United Kingdom.

OBJECTIVE: To assess the prevalence and pathological nature of incidental focal thyroid uptake on (18)F-FDG (2-[(18)F]-fluoro-2-deoxy-D-glucose) PET (positron emission tomography) and examine the role of the maximum standardised uptake value (SUVmax) to differentiate benign from malignant thyroid pathology. MATERIAL AND METHODS: (18)F-FDG PET reports were retrospectively reviewed. Incidental focal tracer uptake in the thyroid was noted in 147 patients (0.5%). Patients with known primary thyroid malignancy were excluded. The final diagnosis was made following ultrasonography of the neck, fine-needle aspiration cytology (FNAC) or histopathology of the surgically resected specimen where surgery was indicated. A Mann-Whitney U test was used to compare the SUVmax of benign and malignant thyroid pathology. Receiver operating characteristic (ROC) analysis was performed to identify an SUVmax cutoff in differentiating benign from malignant pathology. RESULTS: A final diagnosis was achieved in 47/147 (32%) of the patients. The diagnoses included benign lesions in 36 patients and malignancy in 9 patients. In 2 patients, FNAC demonstrated indeterminate follicular lesions; however, surgical excision was not performed. There was a highly significant difference in the mean SUVmax of malignant focal thyroid uptake (15.7 ± 5.9) compared to that of benign lesions (7.1 ± 6.8) with a p value of 0.000123. An SUVmax of 9.1 achieved a sensitivity of 81.6%, specificity of 100% and area under the curve of 0.915 in the ROC analysis differentiating benign from malignant disease. CONCLUSION: The malignancy potential of incidental focal thyroid uptake remains high and warrants prompt and appropriate follow-up by the clinician. The SUVmax may aid in further characterisation of the lesion and its management.

Clinical Utility of SPECT/CT Imaging Post-Radioiodine Therapy: Does It Enhance Patient Management in Thyroid Cancer?

BACKGROUND: The aim of this study was to evaluate post-therapy iodine-131 single-photon emission computed tomography/computed tomography ((131)I-SPECT/CT) imaging in comparison to conventional planar (131)I whole-body imaging, and to assess its clinical impact on the management of patients. METHODS: We retrospectively reviewed planar (131)I whole-body and (131)I-SPECT/CT imaging findings in 67 patients who underwent (131)I therapy for thyroid cancer. Two nuclear medicine physicians reviewed the scans independently. The foci of increased tracer uptake were identified in the neck, thorax and elsewhere. Within the neck, the foci of (131)I-increased uptake were graded qualitatively as probable or definite uptake in thyroid remnants and probable or definite uptake in the lymph nodes. Serum thyroglobulin level, histopathology and other imaging findings served as the reference standard. RESULTS: Of the 67 patients, 57 (85%) had radioiodine avid disease and 10 (15%) demonstrated non-radioiodine avid disease. Overall, post-therapy (131)I-SPECT/CT downstaged lymph node staging in 10 patients and upstaged it in 4 patients. This translated into a change of management for 9/57 (16%) patients with radioiodine avid disease. A change of management was observed in 5/10 patients with non-radioiodine avid disease confirmed in the post-(131)I-SPECT/CT study. Additionally, clinically significant findings such as incidental lung cancer, symptomatic pleural effusion and consolidation were also diagnosed in both groups of patients. CONCLUSION: In patients with thyroid cancer, (131)I-SPECT/CT is a valuable addition to standard post-therapy planar imaging. SPECT/CT also improved diagnostic confidence and provided crucial clinical information leading to change of management for a significant number of these patients.

Can (18)F-FDG PET/CT reliably assess response to primary treatment of head and neck cancer?

INTRODUCTION: Where chemoradiotherapy or radiotherapy alone with curative intent is used as the primary treatment of locally advanced head and neck cancers, salvage surgery may offer a second chance of cure in the face of recurrent or residual disease. Early detection of recurrent or residual disease is therefore the key to facilitating timely and efficacious salvage surgery. CT and MRI can be difficult to interpret in the posttreatment neck. Functional imaging, such as F-FDG PET/CT, has the potential to improve restaging accuracy. The aim of our study was to assess the efficacy of F-FDG PET/CT performed 3 months following primary treatment of head and neck cancer. METHODS: We retrospectively reviewed 35 patients with head and neck squamous cell cancer (mean age, 61 years; 28 male patients) who underwent F-FDG PET/CT imaging at 3 months following primary treatment, which included chemoradiotherapy (n = 31) or radiotherapy alone (n = 4). Patient follow-up was available for at least 12 months (range, 12-48 months; median, 36 months). Scans were categorized as true positive, true negative, false positive, and false negative based on clinicoradiological follow-up and histology. RESULTS: Twenty patients had negative scans with no recurrence during the follow-up period, and 3 had false-negative scans with recurrent disease at 5, 8, and 12 months. Eleven patients had true-positive scans, confirmed histologically in all, and there was 1 false-positive scan giving a sensitivity of 79%, specificity of 96%, positive predictive value of 92%, negative predictive value of 87%, and overall accuracy of 89%. CONCLUSIONS: F-FDG PET/CT is an accurate method for assessing response after primary locally advanced head and neck cancer treatment. Although false-positive scans are rare, a few patients will have a relapse after a negative scan, and so continued close follow-up is required.

Value of SPECT/CT in the evaluation of knee pain.

Bone scintigraphy (BS) has a good sensitivity but limited specificity. Moreover, planar imaging limits localization of lesion especially of overlapping structures in close proximity. SPECT allows tomographic imaging, resulting in better localization and characterization of the lesion. Addition of CT to SPECT in hybrid SPECT/CT further improves the precision of localization and accuracy of characterization of the lesion. Combining functional and anatomical imaging is complementary with improved sensitivity, specificity, and diagnostic confidence. These advantages of SPECT/CT are illustrated by 3 cases where diagnostic confidence was higher with SPECT/CT compared to BS or CT alone, highlighting the incremental value of SPECT/CT in assessing knee pain.

Heterotrophic ossification in a patient suspected of having osteomyelitis: additional value of SPECT/CT.

A 46-year-old man, with a history of bilateral amputations, presented with a long-standing chronic nonhealing wound at the left below-knee amputation, which was sustained after a crush injury. The patient was referred for a bone scan to exclude osteomyelitis of the left stump. The bone scan showed increased uptake in the left below-knee amputation stump, raising the possibility of an infection. However, SPECT/CT of this area confirmed the uptake to correspond to the heterotrophic ossification of the left below-knee stump and no evidence of osteomyelitis.

Beware of the focal uptake at the ischium on the bone scan in prostate cancer.

RATIONALE: The isotope bone scan is routinely used in the management of prostate cancer as the skeleton is the second most common area of metastasis after lymph nodes. A classic site of involvement in the pelvis is the ischium, and the aim of this study was to assess the value of single-photon emission computed tomography/computed tomography (SPECT/CT) imaging in patients with focal ischial uptake on the planar scan. MATERIALS AND METHODS: This was a retrospective study of consecutive 150 patients with prostate cancer who were referred for a whole-body bone scan between August 2007 and 2008. Two experienced nuclear medicine consultants along with a musculoskeletal radiologist reviewed the scans. RESULTS: Sixty-eight patients were diagnosed with widespread metastases and 46 patients showed typical degenerative disease changes on planar whole-body imaging. SPECT/CT imaging was done in 36 patients to clarify the diagnosis in areas of indeterminate uptake noted on planar whole-body imaging. Ten of these 36 patients who had focal increased ischial uptake were included in the study. Only three of these 10 patients were diagnosed as having a metastatic lesion with the presence of an enthesopathy, a common finding. CONCLUSION: Isolated focal uptake in the ischium is a relatively common finding in patients with prostate cancer and there is concern that this, on occasion, could be misinterpreted as metastasis. SPECT/CT imaging has an important role in differentiating a benign from a malignant lesion.