Incidental papillary thyroid microcarcinoma: is completion surgery required?

BACKGROUND: The indications for completion surgery in patients with thyroid papillary microcarcinoma (PMC), incidentally found in thyroids removed for benign conditions, remains a subject of debate. METHODS: In a retrospective, transversal, cohort study of 187 incidental PMCs, found during histological examination of the thyroid gland in 2168 patients operated for benign thyroid conditions, we evaluated the influence of initial and completion surgery on pathological features associated to local recurrence and cancer-related mortality. RESULTS: In the patients with almost total or total thyroidectomy at the first operation, lymphadenectomy of lymph nodes with features suggestive of malignancy on postoperative ultrasound resulted in a statistically significant (p 0.01) increase of node positive patients in pathological examination. Completion surgery in 38 out of 42 patients who underwent less than a total thyroidectomy doesn't result in a significant increase of tumor size, number, multifocality, bilaterality, invasion or nodal metastases. There were no significant differences in postoperative complications between the two groups. CONCLUSIONS: In patients with less than total thyroidectomy and incidentally found PMC in resection specimens, 1-5 mm in greatest dimension and without extrathyroidal extension, completion surgery was not followed by a significant increase of pathological features associated to cancer related morbidity and mortality.

[Immunohistochemical screening of hMLH1 and hMSH2 gene mutations in patients diagnosed with colorectal cancer and microsatellite instability suspicion]. / Screeningul imunohistochimic al mutatiilor genelor hMLH1 respectiv hMSH2 la pacientii diagnosticati cu cancere colorectale si suspiciune de instabilitate microsatelitara.

STUDY AIM: Immunohistochemical screening of hMLH1 and hMSH2 gene mutations in patients diagnosed with colorectal cancers, suspected of having microsatellite instability, as diagnosed between January 2002 and December 2009 in the Surgery Department of the CF Clinical Hospital Cluj-Napoca (prospective non-randomised study). METHODS: Inclusion criteria were adenocarcinoma pathology finding and also minimum one of the revised Bethesda criteria for genetic testing of microsatellite instability in colorectal cancers. 110 eligible patients were divided in 2 study groups according to the number of Bethesda criteria met (group A - 1 criteria; group B - 2 or more criteria). Both groups were statistically compared considering the clinical and pathological parameters specific to the Lynch syndrome. We performed immunohistochemical staining to determine the expression of hMLH1 and hMSH2 genes in the tumors of all the patients. RESULTS: We found the differences in age, colorectal family history and right colon tumor site between the two groups to be statistically significant. Immunohistochemical stainings showed lack of hMLH1 gene expresion in 9 patients and of hMSH2 gene in 4 patients respectively. CONCLUSIONS: Immunohistochemical staining can identify patients who need to be genetically tested for mutations of the DNA mismatch repair genes, in order to establish the correct diagnostic of Lynch syndrome.