A Time Trend Analysis of 5,000 Robotic Thyroidectomies via Bilateral Axillo-Breast Approach.

BACKGROUND: This study aimed to investigate the time trends of surgical outcomes in patients who underwent bilateral axillo-breast approach robotic thyroidectomy (BABA RT) over the last 14 years. METHODS: From February 2008 to September 2021, we conducted a retrospective medical chart review of 5,011 consecutive patients who underwent BABA RT at three Seoul National University-affiliated hospitals. The patients were divided into three groups based on the main model of the da Vinci robotic surgical system to evaluate trends in surgical treatment strategies and outcomes after BABA RT. RESULTS: Of the 5,011 patients (4,706 malignant and 305 benign), the most common histological subtype was papillary thyroid carcinoma (n = 4,584; 97.4%). The mean tumor size significantly increased from 0.8 cm to 1.2 cm (p < 0.05). The mean numbers of metastatic and harvested lymph nodes from the central neck dissection and the lateral neck dissection showed a significant difference and tendency to increase (from 0.9 to 1.6, 4.7 to 6.2, p < 0.05, and from 0.6 to 3.9, 5.3 to 17.9, p < 0.05), respectively, throughout the study period. Permanent hypoparathyroidism decreased from 3.4 to 2.9%. The rate of transient and permanent vocal cord palsy decreased from 15.2 to 2.7% and from 0.7 to 0.2%, respectively. CONCLUSION: With advancements in robotic surgical systems and improvements in the BABA RT technique, surgical indications have expanded to include more advanced thyroid diseases, and surgical outcomes have improved over the last 14 years.

[Clinical outcomes of transoral endoscopic thyroidectomy vestibular approach assisted with submental mini-incision for early thyroid papillary carcinoma].

Objective: To investigate the efficacy of transoral endoscopic thyroidectomy vestibular approach (TOETVA) assisted with submental mini-incision in early thyroid papillary carcinoma. Methods: A total of 63 patients with early papillary thyroid carcinoma (cT1N0M0) were included who underwent TOETVA from December 2019 to May 2021 in Department of Thyroid Surgery of the Affiliated Hospital of Jining Medical University. There were 4 males and 59 females, aged from 17 to 46 years old. Of those 36 patients received traditional TOETVA as control and 27 patients accepted modified TOETVA assisted with submental mini-incision. The clinical outcomes of patients in two groups were compared. Chi-square test and t test were used in statistical analyses. Results: Compared to control group, modified TOETVA group had the less mean operation time [(146.63±38.62) minutes vs. (167.78±36.71) minutes, t=-2.21, P=0.031], the shorter time required for returning to normal diet after operation [(2.11±0.89) days vs. (2.72±1.16) days, t=-2.28, P=0.026], and the lower probability of mandibular numbness (0 vs. 16.67%, χ2=4.97, P=0.026). There was no significant difference between two groups in intraoperative blood loss, postoperative drainage volume, number of central lymph nodes dissection, and postoperative complications such as gas embolism, postoperative bleeding, postoperative infection, skin burns, subcutaneous effusion and so on(all P>0.05). After 6 months of operation, the thyroid ultrasound of the patients in two groups showed no recurrence, and the patients were satisfied with their surgical incision appearances. Conclusion: Both the modified and traditional TOETVA show similar efficacies for treatments of early thyroid papillary carcinoma, but the modified TOETVA can reduce the operation time and improve the quality of life.

Caracterización de enfermos con cáncer de tiroides operados en el Hospital Clínico Quirúrgico General "Freyre de Andrade" / Characterization of Patients with Thyroid Cancer Operated on in "Freyre de Andrade" General Clinical Surgical Hospital

Introducción: El cáncer de tiroides es el tumor más común de los malignos originados en órganos endocrinos (más del 92 por ciento) y comprende un grupo de tumores que son diferentes clínicamente, epidemiológicamente y en cuanto a pronóstico. Objetivo: Caracterizar a los enfermos con cáncer de tiroides operados en el Hospital Clínico Quirúrgico General "Freyre de Andrade". Métodos: Se realizó un estudio descriptivo, retrospectivo de corte longitudinal en el Hospital Clínico Quirúrgico General "Freyre de Andrade" en el período 2014-2019. El universo estuvo constituido por 32 enfermos operados de cáncer de tiroides. Fueron analizadas variables sociodemográficas, clasificación de Bethesda, diagnóstico histológico, técnica quirúrgica empleada y complicaciones. Resultados: El cáncer de tiroides predominó en mujeres (87,5 por ciento) entre 51 - 60 años (25,0 por ciento). Según la clasificación de Bethesda prevaleció la categoría VI (15,62 por ciento). Predominó el carcinoma papilar (65,62 por ciento). A todos los enfermos se le realizó una tiroidectomía total y las complicaciones fueron el hematoma posoperatorio (6,25 por ciento) y el granuloma (6,25 por ciento). Conclusiones: El cáncer tiroideo predomina en mujeres entre la quinta y sexta década de la vida. La técnica quirúrgica que se utiliza es la tiroidectomía total con baja morbilidad. Predomina la variante histológica del carcinoma papilar(AU)

Introduction: Thyroid cancer is the most common malignant tumor originating in endocrine organs (more than 92 percent) and comprises a group of clinically, epidemiologically and prognostically different tumors. Objective: To characterize patients with thyroid cancer operated on at Freyre de Andrade General Clinical Surgical Hospital. Methods: A descriptive, retrospective and longitudinal study was carried out at Freyre de Andrade General Clinical Surgical Hospital in the period 2014-2019. The universe consisted of 32 patients operated on for thyroid cancer. Sociodemographic variables, Bethesda classification, histological diagnosis, used surgical technique and complications were analyzed. Results: Thyroid cancer predominated in women (87.5 percent) between 51 and 60 years of age (25.0 percent). According to the Bethesda classification, category VI prevailed (15.62 percent). Papillary carcinoma predominated (65.62 percent). All patients underwent total thyroidectomy, while the complications were postoperative hematoma (6.25 percent) and granuloma (6.25 percent. Conclusions: Thyroid cancer predominates in women between the fifth and sixth decades of life. The used surgical technique is total thyroidectomy, reporting low morbidity. The histological variant of papillary carcinoma predominates(AU)

Urothelial carcinoma of the graft kidney with molecular analyses: a rare case report.

BACKGROUND: Malignancy after transplantation is a leading cause of death among kidney transplant recipients. However, donor-derived malignancies are rare. We report a case of a high grade papillary urothelial carcinoma arising in a transplanted kidney. CASE PRESENTATION: A 62-year-old female who received a kidney transplantation more than 30 years ago presented with urinary tract infection, acute renal failure, and hydronephrosis of the transplant kidney. Anterograde nephrostogram showed a large filling defect in the lower pole of the transplant kidney and in the proximal 3-4 cm of the ureter. A biopsy from the renal pelvic mass showed a high grade urothelial carcinoma. She underwent an anterior exenteration, resection of both transplant and native kidneys and bilateral pelvic lymph node dissection. Pathologic examination showed a high grade papillary urothelial carcinoma which appeared to arise in the pelvis of the graft kidney, involve the graft ureter and native urinary bladder. The tumor had metastasized to one left obturator lymph node but spared the two native kidneys and ureters. Short tandem repeat (STR) analysis confirmed the tumor to be of donor origin. Next-generation sequencing identified amplification of TERT and loss of CDKN2A/CDKN2B in the primary tumor. CONCLUSION: While it is known that transplant recipients have an increased risk of urothelial carcinoma compared to the general population, the lack of the well-documented risk factors, such as older age at transplantation, BK polyomavirus infection, and prolonged post-transplantation history and dissemination of the tumor in this case shed light on the de novo tumorigenesis of the graft kidney within the host microenvironment. Amplification of Telomerase reverse transcriptase (TERT) and loss of cyclin dependent kinase inhibitor 2A/2B (CDKN2A/CDKN2B) detected in the tumor by next gene sequencing suggests that they may play an important role in this case.

Etiologic heterogeneity of clear-cell and papillary renal cell carcinoma in the Netherlands Cohort Study.

At present, mostly case-control and retrospective studies have investigated the association between etiologic risk factors and the development of histologic subtypes of renal cell carcinoma (RCC). Therefore, we assessed the heterogeneity between body mass index (BMI), cigarette smoking, alcohol consumption and hypertension across clear-cell RCC (ccRCC) and papillary RCC (pRCC) risk in the prospective Netherlands Cohort Study on diet and cancer. In 1986, 120 852 participants aged 55 to 69 completed a self-administered questionnaire on diet and other risk factors for cancer. Participants were followed up for cancer through record linkage. Tumor histology was assessed through centralized revision by two experienced uropathologists. After 20.3 years of follow-up, 384 histologically verified RCC cases, including 315 ccRCC and 46 pRCC cases and 4144 subcohort members were eligible for case-cohort analysis. Hazard ratios and 95% confidence intervals were estimated by multivariable-adjusted proportional hazards models. Overall, BMI was associated positively with ccRCC risk, but inversely with pRCC risk. Cigarette smoking was associated with an increased ccRCC, but a decreased pRCC risk. Alcohol consumption was inversely associated with both ccRCC and pRCC risk. Hypertension was associated with an increased risk of both ccRCC and pRCC. Statistically significant etiologic heterogeneity was observed for BMI, BMI change since age 20, and smoking duration in current smokers across ccRCC and pRCC risk. In conclusion, we observed potential heterogeneity for BMI, BMI change and smoking duration across ccRCC and pRCC risk.

Follicular carcinoma arising from struma ovarii. A case report.

Struma ovarii is a monodermal variant of ovarian teratoma. Thyroid-type carcinoma arising in struma ovarii is rare. The most common type is papillary carcinoma, followed by typical follicular carcinoma. A 75-year-old hypertensive patient consulted for the sensation of a painless pelvic mass that has been progressing for six months. The abdominopelvic ultrasound showed a right lateralized abdominopelvic mass measuring 14x13x8 cm with a solid and cystic double component. The patient underwent a unilateral right adnexectomy. Grossly, the tumor was encapsulated and lobulated. On cut sections, it was solid brown whitish in color and gelatinous. On histological examination, it was formed of follicular structures of variable size filled with a dense colloid. From this goiter a malignant tumor proliferation arose, arranged in sheets, trabeculae and follicular structures, and the tumor cells were cubic or polyhedral moderately atypical with few mitotic figures. There were no papillary-like nuclear features. There was focal capsular and vascular invasion. Immunohistochemical study showed positive immunostaining of tumor cells with TTF1. Postoperative course was uneventful. The exact prognosis of thyroid-type carcinoma arising in struma ovarii is still unclear because of its rarity, inadequate follow-up, and the absence of consensus in diagnosis and treatment.

Does the ATA Risk Stratification Apply to Patients with Papillary Thyroid Microcarcinoma?

BACKGROUND: The incidence of papillary thyroid microcarcinoma (PTMC) has increased over the past decade. The American Thyroid Association (ATA) suggests that these patients may undergo either thyroid lobectomy or active surveillance. It remains unclear whether there exists a subgroup of PTMC patients who may benefit from more aggressive treatment due to increased risk of recurrence. METHODS: We retrospectively reviewed 357 patients with PTMC who underwent surgery at a single institution from 2004 to 2016. Patients were classified according to 2015 ATA risk stratification for structural disease recurrence. Demographic, oncologic, and clinicopathologic data were compared between groups. RESULTS: Out of 357 patients, 246 were classified as low-risk PTMC, 93 were intermediate-risk, and 18 were high-risk. There were more male patients in the high-risk group (38.9%) than the intermediate- (31.2%) or low-risk groups (15.4%) (p < 0.001). Patients with low-risk microcarcinomas were more likely to have an incidental PTMC when compared to intermediate- or high-risk groups (98[39.8%], 15[16.1%], 1[5.6%], respectively, p < 0.001). Patients with high-risk PTMCs, compared to those with intermediate- and low-risk PTMCs, were more likely to have rising postoperative thyroglobulin levels after total thyroidectomy (6[40.0%], 4[5.1%], 9[5.7%], respectively, p = 0.001) and structural recurrence after lobectomy or total thyroidectomy (3[16.7%], 0[0%], 0[0%], respectively, p < 0.001). The median follow-up time was 17.5 (IQR 3-55) months. CONCLUSIONS: Patients with high-risk PTMC have an increased risk of recurrence when compared to low- and intermediate-risk microcarcinomas, whereas intermediate-risk PTMC may behave similarly to low-risk tumors. ATA risk stratification may inform clinical decision making for patients with PTMC.

Potential Impact of BMI on the Aggressiveness of Presentation and Clinical Outcome of Differentiated Thyroid Cancer.

BACKGROUND: Obesity is a risk factor for several cancers, including differentiated thyroid cancer (DTC). Moreover, it has also been investigated as a potential risk factor for aggressiveness of DTC, but the data gathered so far are conflicting. The aim of our study was to evaluate the relationship between body mass index (BMI), aggressiveness of DTC at diagnosis, and clinical outcome. METHODS: We evaluated 1058 consecutive DTC patients treated with total thyroidectomy and enrolled at the time of first radioactive iodine (131I) treatment. Patients were divided into 4 groups based on their BMI: underweight (< 18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), and obese (≥ 30 kg/m2). Histological aggressiveness of DTC at the time of diagnosis and clinical outcome according to 2015 American Thyroid Association (ATA) guidelines were evaluated. RESULTS: No differences in histological features, ATA risk of recurrence, activity of 131I administered and prevalence of 131I avid metastatic disease after first131I treatment, have been demonstrated among the groups. Furthermore, at the end of follow up (median = 5.7 years), no differences were evident in the number of further treatments performed as well as in the clinical response. CONCLUSIONS: In our study group of Caucasian subjects, we could not demonstrate any association between BMI and aggressiveness of DTC, neither at the time of diagnosis nor during follow-up. These data indicate that postsurgical assessment and therapeutic attitude for treatment and follow-up of DTC should be based on the class of risk applied to the general population, with no concern for BMI.

iPSC-Derived Embryoid Bodies as Models of c-Met-Mutated Hereditary Papillary Renal Cell Carcinoma.

Hereditary cancers with cancer-predisposing mutations represent unique models of human oncogenesis, as a driving oncogenic event is present in germline. Currently, there are no satisfactory models to study these malignancies. We report the generation of IPSC from the somatic cells of a patient with hereditary c-met-mutated papillary renal cell carcinoma (PRCC). From these cells we have generated spontaneous aggregates organizing in structures which expressed kidney markers such as PODXL and Six2. These structures expressed PRCC markers both in vitro and in vivo in NSG mice. Gene-expression profiling showed striking molecular similarities with signatures found in a large cohort of PRCC tumor samples. This analysis, applied to primary cancers with and without c-met mutation, showed overexpression of the BHLHE40 and KDM4C only in the c-met-mutated PRCC tumors, as predicted by c-met-mutated embryoid bodies transcriptome. These data therefore represent the first proof of concept of "hereditary renal cancer in a dish" model using c-met-mutated iPSC-derived embryoid bodies, opening new perspectives for discovery of novel predictive progression markers and for drug-screening for future precision-medicine strategies.

Smoking Cessation and the Risk of Bladder Cancer among Postmenopausal Women.

Smoking is the strongest established risk factor for bladder cancer. Former smokers have a lower risk of bladder cancer compared with current smokers, but findings on the dose-response relationship between years after quitting and the risk of bladder cancer are inconsistent. A total of 143,279 postmenopausal women from the Women's Health Initiative Study were included. Cox proportional hazards regression models were applied for estimating age- and multivariable-adjusted HRs and their 95% confidence intervals (CI). There were 870 bladder cancer cases identified over an average of 14.8 years of follow-up. After adjusting for pack-years of smoking, bladder cancer risk among former smokers declined by 25% within the first 10 years of cessation and continued to decrease as cessation time increased but remained higher than never smokers after 30 years of quitting (HR, 1.92; 95% CI, 1.43-2.58). Smokers who quit smoking had a lower risk of bladder cancer compared with current smokers (HR, 0.61; 95% CI, 0.40-0.94). We conclude that among postmenopausal women, there is a significant reduction in the risk of bladder cancer after quitting smoking. In addition to primary prevention, smoking cessation is critical to prevent the incidence of bladder cancer in older women.

Distinct Clinical Manifestations of Thyroid Cancer After Hematopoietic Stem Cell Transplantation.

BACKGROUND: The incidence of a secondary solid malignancy after hematopoietic cell transplantation (HCT) is increasing in long-term survivors. OBJECTIVE: The aim of this study was to compare the clinicopathological characteristics of HCT recipients with secondary thyroid cancer (STC), with those of non-HCT thyroid cancer patients. METHODS: We retrospectively investigated 5184 patients who received HCT between 1983 and 2016. Of these, 18 patients developed STC and underwent thyroidectomy due to differentiated thyroid cancer. We compared the clinicopathological characteristics of post-HCT thyroid cancer patients (post-HCT group) with those of a primary differentiated thyroid carcinoma cohort (cohort group) from Seoul St. Mary's Hospital. RESULTS: The mean ages at HCT and thyroidectomy after HCT were 22.0 and 31.8 years, respectively, and the median time interval between HCT and thyroidectomy was 5 years (range 1-16). Compared with the cohort group, the post-HCT group was younger at cancer onset and frequently had a palpable mass at initial diagnosis. The post-HCT group had more aggressive features, including larger tumor size, frequent extrathyroidal extension, lymphatic invasion, perineural invasion, and frequent lateral neck node metastasis and distant metastasis, relative to the cohort group; however, most patients (83.2%) in the post-HCT group were stage I or II. Additionally, BRAF V600E mutation was less frequent in the post-HCT group. CONCLUSIONS: We found that STC after HCT showed younger presentation and more aggressive clinical presentation. Therefore, a policy of regular screening, including neck ultrasound examination, may promote early detection and treatment in HCT recipients.

Thyroid Antibody Status is Associated with Central Lymph Node Metastases in Papillary Thyroid Carcinoma Patients with Hashimoto's Thyroiditis.

OBJECTIVE: The aim of this study was to explore the impact of thyroid antibody status on central lymph node metastases (CLNM) in papillary thyroid carcinoma (PTC) patients with Hashimoto's thyroiditis (HT). METHODS: A retrospective analysis was performed on 346 PTC patients with HT who underwent thyroidectomy and ipsilateral central lymph node dissection (CLND). Histopathological characteristics of the tumor and serum levels of thyroid hormone, as well as antibodies, were collected and analyzed. RESULTS: The multivariate logistic regression analysis showed that being male [odds ratio (OR) 3.269, 95% confidence interval (CI) 1.240-8.619], tumor size > 1 cm [1 cm < diameter (D) ≤ 2 cm: OR 6.947, 95% CI 2.886-16.722; 2 cm < D: OR 5.880, 1.937-17.846], and antibody status [thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) double negative: OR 3.791, 95% CI 1.391-10.331; TPOAb and TgAb double positive: OR 4.047, 95% CI 1.509-10.856; TgAb single positive: OR 6.024, 95% CI 2.019-17.970] were independent risk factors for CLNM. Additionally, a risk-score scale, including sex, antibody status, and tumor size, was established to predict CLNM. The sensitivity, specificity, positive predictive value, and negative predictive value were 55.7%, 84.4%, 74.4%, and 70%, respectively, when the cut-off point was chosen as 3. CONCLUSIONS: Antibody status is a critical independent risk factor for CLNM in PTC patients with HT. For the CLND strategy, a more conservative option could be considered in a low-risk cohort with the following characteristics: female sex, smaller tumor size, and TPOAb single positive.

Urothelial Carcinoma Detected by Ultrasonography in a Renal Transplant Recipient.

Urothelial cell carcinoma in renal transplant recipients has been rarely reported. Here, we report a case of high-grade papillary urothelial carcinoma in a renal transplant recipient who presented with hematuria. Sonographic evaluations (gray-scale ultrasonography, Doppler imaging, and strain sonoelastography) helped with diagnosis in our initial approach to the patient. Computed tomography was performed to confirm solid ureteral masses and staging of the disease. The patient, who underwent nephro-ureterectomy of the graft kidney, had that kidney for 6 years, 6 months. After surgery, the patient was symptom free and without evidence of recurrence or metastasis in 3 years of follow-up. Sonographic examinations have an important role in the evaluation of urothelial carcinoma of transplanted kidneys.

Follow-up of parenchymal changes in the thyroid gland with diffuse autoimmune thyroiditis in children prior to the development of papillary thyroid carcinoma.

PURPOSE: To present the outcomes of ultrasound (US) follow-ups in children with autoimmune thyroid disease who did not have a thyroid nodule on admission but developed papillary thyroid carcinoma (PTC) and to characterize the parenchymal changes in the thyroid gland prior to the development of PTC. METHODS: A retrospective thyroid US scan review of 327 patients diagnosed with AIT was performed. Forty patients (40/327, 12.2%) presented nodular AIT variant with a normoechogenic background. Eleven patients (11/327, 3.4%, 11/40, 27.5%) presenting this variant were diagnosed with PTC (nine females-mean age 15.3 years; two males aged 11 and 13 years). In five of 11 patients, the suspicious nodule that was later confirmed to be PTC was detected on the initial US at presentation. For the remaining six females (6/11) who developed PTC during the follow-up, we retrospectively analysed their US thyroid scans and these patients were selected for analysis in this study. RESULTS: On admission, the US evaluation revealed an enlarged normoechogenic thyroid gland in three patients and a hypoechogenic thyroid gland with fibrosis as indicated by irregular, chaotic hyperechogenic layers in three patients. No thyroid nodules were identified. Ultrasound monitoring revealed increasing echogenicity of the thyroid parenchyma during the follow-up. PTC developed in a mean time of 4.6 years (1 9/12-7 4/12 years) since referral to the outpatient thyroid clinic and 2.9 years (6/12-6 9/12) since the last nodule-free US thyroid scan. CONCLUSIONS: Sonographic follow-up assessments warrant further exploration as a strategy to determine PTC susceptibility in the paediatric population.

Follow-up and results in patients with differentiated thyroid carcinoma in Castilla-La Mancha (2001-2015). The CADIT-CAM study. / Resultados del seguimiento de pacientes con carcinoma diferenciado de tiroides en Castilla-La Mancha (2001-2015). Estudio CADIT-CAM.

OBJECTIVE: The CADIT-CAM study was designed to retrospectively analyze the clinical characteristics, treatments, and outcomes of patients with differentiated thyroid carcinoma (DTC) in Castilla La Mancha. PATIENTS AND METHODS: A total of 1434 patients from 7 hospitals in Castilla La Mancha were enrolled into the study from 2001 to 2015. RESULTS: Seventy-seven percent of patients were female, with a mean age at diagnosis of 48 years. Papillary thyroid carcinoma accounted for 93% of cases. Mean tumor size was significantly smaller at final follow-up (P<.05). Radioiodine ablation (RA) was performed in 84% of patients, and its use decreased during the study, especially in tumors with low recurrence risk. Recurrence occurred in 22% of patients and was associated to male gender, greater tumor size, multifocality, lymph node metastases, extrathyroid involvement, distant metastases and increasing thyroglobulin antibody titers. At the end of follow-up 76.2% of patients were alive and free of disease, 2.4% had died from DTC. Overall survival of the cohort was 95.1% at 15 years of follow-up. CONCLUSIONS: Characteristics of DTC in this Spanish cohort are similar to those reported in other studies in our country. Final results were excellent and use of treatment (RA) was consistent with risk-stratified recommendations.

Obesity and High Risk Pathological Features of Papillary Thyroid Carcinoma: A Retrospective Analysis of a University Hospital in Pakistan.

BACKGROUND: Incidence of papillary thyroid carcinoma (PTC) and the frequency of obesity is increasing globally. In literature, relationship between excessive body weight and bad prognostic features of PTC is still debatable. In this study, we aimed to explore the association of obesity with high risk pathological features of PTC in a population treated by total thyroidectomy +/- neck dissection. MATERIALS AND METHODS: Retrospective analysis of patients at Aga Khan University Hospital from January 2013 to December 2014, who underwent total thyroidectomy +/- neck dissection due to PTC. Patients were grouped according to World Health Organization (WHO) classification of BMI. They were categorized into two groups, i.e. normal (BMI= 18.5 - 24.9 kg/m2) and obese (BMI = 30 kg/m2) as none of our patients lie in underweight and overweight category. Pathological features i.e. T-stage, multifocality, bilaterality, extrathyroidal extension, vascular invasion and N-stage were assessed. All tumors were staged according to TNM staging system proposed by 2010 American Joint Committee on Cancer (AJCC). Odds ratio (OR) with 95% confidence interval was used to examine the association between BMI ∧ pathological characteristics of PTC. RESULTS: A total of 53 patients were treated for PTC in two-years period. There were 38 female and 15 male patients. Twenty-eight patients had BMI in normal while twenty-five in obese category. Patients who were in obese category had a significantly greater risk of having a multifocal tumor (OR=5.55, p-value=0.02) and bilaterality (OR=6.54, p-value=0.01) compared to normal weight patients. No positive associations were identified between BMI and extrathyroidal extension, high T-stage, vascular invasion and N-stage. CONCLUSION: Obesity is not associated with high risk pathological features such as extrathyroidal extention, high T-stage, vascular invasion and N-stage in PTC. Although it has been correlated with multifocal and bilateral tumors in this retrospective study, the presence of these factors alone is not adequate to support the association conclusively.

Influence of chronic lymphocytic thyroiditis on the risk of persistent and recurrent disease in patients with papillary thyroid carcinoma and elevated antithyroglobulin antibodies after initial therapy / Influência da tireoidite linfocítica crônica sobre o risco de doença persistente e recorrente em pacientes com carcinoma papilífero de tireoide e anticorpos antitireoglobulina elevados após a terapia inicial

Abstract Introduction In patients with papillary thyroid carcinoma who have negative serum thyroglobulin after initial therapy, the risk of structural disease is higher among those with elevated antithyroglobulin antibodies compared to patients without antithyroglobulin antibodies. Other studies suggest that the presence of chronic lymphocytic thyroiditis is associated with a lower risk of persistence/recurrence of papillary thyroid carcinoma. Objective This prospective study evaluated the influence of chronic lymphocytic thyroiditis on the risk of persistence and recurrence of papillary thyroid carcinoma in patients with negative thyroglobulin but elevated antithyroglobulin antibodies after initial therapy. Methods This was a prospective study. Patients with clinical examination showing no anomalies, basal Tg < 1 ng/mL, and elevated antithyroglobulin antibodies 8-12 months after ablation were selected. The patients were divided into two groups: Group A, with chronic lymphocytic thyroiditis on histology; Group B, without histological chronic lymphocytic thyroiditis. Results The time of follow-up ranged from 60 to 140 months. Persistent disease was detected in 3 patients of Group A (6.6%) and in 6 of Group B (8.8%) (p = 1.0). During follow-up, recurrences were diagnosed in 2 patients of Group A (4.7%) and in 5 of Group B (8%) (p = 0.7). Considering both persistent and recurrent disease, structural disease was detected in 5 patients of Group A (11.1%) and in 11 of Group B (16.1%) (p = 0.58). There was no case of death related to the disease. Conclusion Our results do not support the hypothesis that chronic lymphocytic thyroiditis is associated with a lower risk of persistent or recurrent disease, at least in patients with persistently elevated antithyroglobulin antibodies after initial therapy for papillary thyroid carcinoma.

Resumo Introdução Em pacientes com carcinoma papilífero de tireoide e com tireoglobulina sérica negativa após a terapia inicial, o risco de doença estrutural é maior entre aqueles com anticorpos antitireoglobulina elevados em comparação com pacientes sem anticorpos antitireoglobulina. Outros estudos sugerem que a presença de tireoidite linfocítica crônica está associada a um menor risco de persistência/recorrência do carcinoma papilífero de teireoide. Objetivo Este estudo prospectivo avaliou a influência da tireoidite linfocítica crônica sobre o risco de persistência e recorrência do carcinoma papilífero de tireoide em pacientes com tireoglobulina negativa, mas com anticorpos antitireoglobulinas elevados após a terapia inicial. Método Esse foi um estudo prospectivo, no qual foram selecionados pacientes com exame clínico sem anomalias; tireoglobulina basal < 1 ng/mL e anticorpos antitireoglobulina elevados 8-12 meses após ablação. Os pacientes foram divididos em dois grupos: Grupo A, com tireoidite linfocítica crônica no exame histológico; Grupo B, histologicamente sem tireoidite linfocítica crônica. Resultados O tempo de seguimento variou de 60 a 140 meses. Doença persistente foi detectada em 3 pacientes do Grupo A (6,6%) e em 6 do Grupo B (8,8%) (p = 1,0). Durante o seguimento, as recidivas foram diagnosticadas em 2 pacientes do Grupo A (4,7%) e em 5 do Grupo B (8%) (p = 0,7). Considerando tanto a doença persistente quanto a recorrente, doença estrutural foi detectada em 5 pacientes do Grupo A (11,1%) e em 11 do Grupo B (16,1%) (p = 0,58). Não houve nenhum caso de óbito relacionado à doença. Conclusão Nossos resultados não apoiam a hipótese de que a tireoidite linfocítica crônica esteja associada a um menor risco de doença persistente ou recorrente, pelo menos em pacientes com anticorpos antitireoglobulina persistentemente elevados após a terapia inicial do carcinoma papilífero de tireoide.

Differentiated thyroid carcinomas associated with chronic thyroiditis: biological and clinical properties.

AIM: To determine biological and clinical features of papillary and follicular thyroid carcinomas associated or not associated with chronic thyroiditis. MATERIALS AND METHODS: The study was conducted by retrospective analysis of medical histories of 2,459 patients with thyroid cancer. Tumor size, its category according to the TNM system, multi-focal properties of tumor growth, carcinoma invasiveness, as well as disease stage, rates of relapses and metastasis, and also cumulative survival rates were analyzed. RESULTS: The tumor size in patients with papillary or follicular carcinoma associated with thyroiditis was smaller compared to the patients without thyroiditis. In the first case, the invasion frequency into extrathyroid structure and into the capsule was also lower. Multi-focal growth of both carcinoma types was registered more frequently in the presence of thyroiditis. The frequency of papillary carcinoma metastasis to lateral cervical lymph nodes was lower in the presence of thyroiditis, the frequency being equal for metastasis into lymph nodes of the VI lymph outflow zone in both groups of patients (with and without thyroiditis). In the presence of thyroiditis, the frequency of distant papillary carcinoma metastasis was decreased, no metastases were detected in patients with follicular carcinoma. In the group of patients with papillary carcinoma there was found no relation between the presence of thyroiditis and disease stage, relapse rates, and mortality levels; however, the risk of follicular carcinoma relapse was significantly lower in patients with thyroiditis. CONCLUSIONS: The presence of chronic thyroiditis in papillary carcinoma patients showed a certain positive impact on the course of the disease, in particular, primary tumor growth, invasion, and metastasis. Such effect is even more expressed in the patients with follicular thyroid carcinoma.