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1.
Int J Surg Oncol ; 2019: 2715260, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31737363

RESUMO

Background: Despite a large amount of data, the optimal surgical management of differentiated thyroid cancer remains controversial. Current guidelines recommend total thyroidectomy if primary thyroid cancer is >4 cm, while for tumors that are between 1 and 4 cm in size, either a bilateral or a unilateral thyroidectomy may be appropriate as surgical treatment. In general, total thyroidectomy would seem to be preferable because subtotal resection can be correlated with a higher risk of local recurrences and cervical lymph node metastases; on the other hand, total thyroidectomy is associated with more complications. Methods: This is a retrospective study conducted on 359 patients with differentiated thyroid cancer, subjected to total thyroidectomy. Our aim was to correlate clinical and pathological features (extrathyroid tumor growth, bilaterality, nodal and distant metastasis) with patient (gender and age) and tumor (size and histotype) characteristics. Moreover, we recorded postoperative complications, including hypoparathyroidism and laryngeal nerve damage. Results: In our study, we found a high occurrence of pathological features indicating cancer aggressiveness (bilaterality, nodal metastases, and extrathyroid invasion). On the other hand, total thyroidectomy was associated with relatively low postsurgical complication rates. Conclusions: Our data support the view that total thyroidectomy remains the first choice for the routine treatment of differentiated thyroid cancer.


Assuntos
Neoplasias da Glândula Tireoide/patologia , Tireoidectomia , Adenocarcinoma Folicular/patologia , Adenocarcinoma Folicular/cirurgia , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Complicações Pós-Operatórias , Estudos Retrospectivos , Câncer Papilífero da Tireoide/patologia , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia
2.
Horm Metab Res ; 51(10): 634-638, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31578049

RESUMO

Basal thyroglobulin (b-Tg) measured with second-generation assay or stimulated Tg (s-Tg) can be used to define the response to therapy of differentiated thyroid carcinoma. However, they do not always define the same category and guidelines do not establish "if" or "when" s-Tg needs to be obtained. We studied 304 patients without clinically apparent disease or disease detected by neck ultrasonography and without anti-Tg antibodies 9-12 months after therapy. Based on b-Tg, 196 patients had an excellent response and 108 had an indeterminate response. Based on s-Tg, a change in category occurred in 10.2% of the patients with an initial excellent response (all to indeterminate response) and in half the patients with an initial indeterminate response (44.4% to excellent response and 5.5% to biochemical incomplete response). One case of recurrence was observed among patients with an initial excellent response but whose response changed to indeterminate after s-Tg, while no disease was detected among those who remained in the initial category; however, this difference was not significant. In patients with an initial indeterminate response, no recurrence was detected among those whose response changed to excellent after s-Tg, while 11.1 and 33.3% of those who remained in the initial category or whose response changed to biochemical incomplete, respectively, had structural disease. This study suggest that, in low- or intermediate-risk patients, s-Tg better defines the response to therapy with 131I when it is classified as indeterminate based on b-Tg using second-generation assay. However, s-Tg is not necessary when b-Tg defines the response as excellent.


Assuntos
Adenocarcinoma Folicular/terapia , Carcinoma Papilar/terapia , Radioisótopos do Iodo/uso terapêutico , Recidiva Local de Neoplasia/diagnóstico , Tireoglobulina/sangue , Neoplasias da Glândula Tireoide/terapia , Tireoidectomia/métodos , Adenocarcinoma Folicular/sangue , Adenocarcinoma Folicular/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Carcinoma Papilar/sangue , Carcinoma Papilar/patologia , Terapia Combinada , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Prognóstico , Neoplasias da Glândula Tireoide/sangue , Neoplasias da Glândula Tireoide/patologia , Adulto Jovem
3.
J Vet Diagn Invest ; 31(6): 913-916, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31646945

RESUMO

An 18-y-old female llama (Lama glama) in Saskatoon, Saskatchewan was examined during a routine herd check, and a mass was detected in the ventral cervical area just below the angle of the jaw. No clinical signs were evident except for the mass and chronic loss of body condition. Postmortem examination revealed bilateral enlargement of the thyroid gland with multiple cysts. Histopathology of the thyroid gland revealed follicular compact-cellular carcinoma lesions, with infiltration of neoplastic thyroid follicular cells in regional lymph nodes.


Assuntos
Adenocarcinoma Folicular/veterinária , Camelídeos Americanos , Neoplasias da Glândula Tireoide/veterinária , Adenocarcinoma Folicular/diagnóstico , Adenocarcinoma Folicular/patologia , Animais , Evolução Fatal , Feminino , Saskatchewan , Células Epiteliais da Tireoide/patologia , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/patologia
4.
J Ayub Med Coll Abbottabad ; 31(3): 461-463, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31535529

RESUMO

Metastatic skull deposits from follicular thyroid carcinoma are rare, and let alone this being the primary presenting symptom with no history of thyroid cancer is exceptionally rarer. A 40-yearold female patient presented with a mass in the temporal and occipital region of the skull. Fine needle aspiration cytology confirmed multiple fragments of a neoplasm composed of variably sized follicles lined by tumour cells having pleomorphic hyperchromatic nuclei. Further workup revealed Follicular thyroid carcinoma and subsequently, total thyroidectomy was done. Skull resection was not possible due to the extensive nature of disease and patient was advised radioactive iodine ablation therapy but couldn't survive past 4 months.


Assuntos
Adenocarcinoma Folicular/diagnóstico , Neoplasias Orbitárias/diagnóstico , Neoplasias da Glândula Tireoide/diagnóstico , Adenocarcinoma Folicular/patologia , Adenocarcinoma Folicular/secundário , Adulto , Biópsia por Agulha Fina , Evolução Fatal , Feminino , Humanos , Radioisótopos do Iodo , Osso Occipital , Neoplasias Orbitárias/patologia , Neoplasias Orbitárias/secundário , Osso Temporal , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia
5.
S Afr J Surg ; 57(3): 55, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31392867

RESUMO

BACKGROUND: The histological type of thyroid cancer in well-resourced countries is predominantly papillary. Follicular carcinoma is predisposed by iodine deficiency that was present the Black population of South Africa until salt iodination in 1995. The aim of this study was to analyse the profile of thyroid cancer in Black South Africans from January 2001 to December 2017 and to identify any temporal changes in thyroid cancer histological subtypes since salt iodination. METHOD: Histopathological reports of patients who underwent thyroidectomy for cancer at Chris Hani Baragwanath Academic Hospital in Johannesburg, South Africa between January 2001 and December 2017 were retrospectively assessed. Data captured included name, age, gender, race, the date when the specimen was sent and the detailed histopathological report. RESULTS: Of the 143 thyroidectomies performed for malignancy, papillary thyroid cancer was the predominant type (65%) with a papillary to follicular thyroid cancer ratio of 4:1. Follicular, medullary and anaplastic cancers were 16.8%, 9.8% and 2.8% respectively. The reports were incomplete in 5 cases and there were 3 non-epithelial neoplasms. CONCLUSION: There is a gradual temporal increase in the frequency of resected papillary cancer over a 16 year period while follicular has remained static. These changes may be attributable to better salt iodination.


Assuntos
Adenocarcinoma Folicular/cirurgia , Grupo com Ancestrais do Continente Africano , Carcinoma Neuroendócrino/cirurgia , Câncer Papilífero da Tireoide/cirurgia , Carcinoma Anaplásico da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Centros Médicos Acadêmicos , Adenocarcinoma Folicular/patologia , Adulto , Carcinoma Neuroendócrino/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , África do Sul , Câncer Papilífero da Tireoide/patologia , Carcinoma Anaplásico da Tireoide/patologia , Tireoidectomia
6.
Genet Test Mol Biomarkers ; 23(9): 681-687, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31411490

RESUMO

Aims: To compare fine-needle aspiration cytology (FNAC) with imprinted gene detection in the differential diagnosis of benign and malignant thyroid nodules. Methods: A total of 34 patients (35 cases of thyroid nodules) were examined using fine-needle puncture biopsy under ultrasound guidance, and the biopsy tissues were examined by cytologic examination and imprinted gene detection. Combined with postoperative pathology and follow-up results, the diagnostic value and consistency of the two methods were analyzed and compared. Results: The detection of benign and malignant thyroid nodules by ARHI imprinted gene had a high consistency with FNAC, and ARHI imprinted gene detection had a higher detection rate, sensitivity, and accuracy. Conclusions: Imprinted gene detection has high accuracy and sensitivity in the differential diagnosis of benign and malignant thyroid nodules. It provides a scientific reference for clinical treatment and should be incorporated into diagnostic protocols for thyroid tumor.


Assuntos
Neoplasias da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/diagnóstico , Proteínas rho de Ligação ao GTP/genética , Adenocarcinoma Folicular/diagnóstico , Adenocarcinoma Folicular/patologia , Adolescente , Adulto , Idoso , Biópsia por Agulha Fina , Carcinoma Papilar, Variante Folicular/diagnóstico , Carcinoma Papilar, Variante Folicular/patologia , Diagnóstico Diferencial , Células Epiteliais/citologia , Feminino , Impressão Genômica , Bócio Nodular/diagnóstico , Bócio Nodular/patologia , Doença de Hashimoto/diagnóstico , Doença de Hashimoto/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/patologia , Tireoidite Subaguda/diagnóstico , Tireoidite Subaguda/patologia , Ultrassonografia , Adulto Jovem
7.
Zhonghua Zhong Liu Za Zhi ; 41(8): 594-598, 2019 Aug 23.
Artigo em Chinês | MEDLINE | ID: mdl-31434450

RESUMO

Objective: To explore the molecular characteristics of follicular variant papillary thyroid carcinoma (FVPTC), follicular thyroid adenoma (FTA) and follicular thyroid carcinoma (FTC), and investigate their role in tumorigenesis, differential diagnosis and prognosis evaluation in patients with follicular thyroid neoplasm. Methods: We retrospectively analyzed 50 surgical resection samples of follicular thyroid neoplasm. DNA was obtained from formalin-fixed, paraffin-embedded tissue, and subjected to next-generation sequencing (NGS) to analyze 50 hotspots for mutation in genes. Results: 47 samples passed quality control, including 29 FVPTCs, 8 FTAs and 10 FTCs. 75.9% of FVPTCs harbored mutated genes: BRAF V600E (31.0%, 9/29) was the most frequent, followed by TP53 (27.6%, 8/29), and N/KRAS (20.7%, 6/29). In contrast, 37.5% (3/8) FTAs carried NRAS Q61R mutation with 12.5% (1/8) FTA carrying mutated BRAF G466E. 20% (2/10) FTCs harbored NRAS Q61R mutation, and 20% (2/10) FTCs with TP53 mutations. BRAF V600E gene mutation only appeared in FVPTC, and was associated with age of onset and lymph node metastasis. There was no significant correlation between N/KRAS mutations and clinical pathologic features. Patients with lymph node metastasis group seems to have more TP53 mutation. Conclusions: BRAF V600E gene mutation can be used to identity FVPTC from FTA/FTC. N/KRAS mutations cannot be used as the exclusive indicator of benign and malignant in thyroid follicular tumor. TP53 mutations play an important role in the process of follicular thyroid neoplasm, indicating more aggressive behavior and poor prognosis.


Assuntos
Adenocarcinoma Folicular/genética , Adenocarcinoma Folicular/patologia , Neoplasias da Glândula Tireoide/genética , Neoplasias da Glândula Tireoide/patologia , Humanos , Metástase Linfática/genética , Mutação , Estudos Retrospectivos , Proteína Supressora de Tumor p53/genética
8.
Best Pract Res Clin Endocrinol Metab ; 33(4): 101292, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31434622

RESUMO

Follicular thyroid carcinoma is the second most prevalent form of differentiated thyroid carcinoma, following papillary thyroid carcinoma. Preoperative diagnosis is hampered by the fact that fine-needle aspiration cytology as well as supplemental molecular analysis cannot unambiguously distinguish between follicular thyroid carcinoma and benign follicular thyroid adenoma. The 2017 WHO classification defines three histological subtypes of follicular thyroid carcinoma: minimally invasive (excellent prognosis), encapsulated angioinvasive, and widely invasive type (higher risk of recurrence and metastatic spread). The fact that definite characterization of follicular neoplasms is predominantly a postoperative histological diagnosis (core criteria: capsular, vascular and adjacent tissue invasion) translates into the challenge for the thyroid surgeon to plan preoperatively for presence of malignancy and, if required, to adapt the surgical strategy according to intraoperative (frozen section) or postoperative histological findings. Until improved tools for pre-/intraoperative diagnosis are available, the malignant potential of a follicular thyroid lesion can be assessed by stratifying the patient according to clinical risk factors (presence of metastases, advanced patient age, tumor size). A stepwise, escalating surgical approach with restricted primary resection (hemithyroidectomy) and completion surgery based on the definite histopathology is another option to solve this dilemma. The currently recommended surgical treatment strategies for FTCs as published by ATA, BTA, CAEK and ESES are discussed. There is consensus that prophylactic lymphadenectomy is not required for FTCs and that hemithyroidectomy is sufficient in low-risk FTCs (capsular invasion only) whereas thyroidectomy with postoperative radioiodine therapy is indicated in high-risk FTCs (angioinvasion; widely invasive FTC).


Assuntos
Adenocarcinoma Folicular/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Adenocarcinoma Folicular/patologia , Humanos , Guias de Prática Clínica como Assunto , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia/normas
9.
Klin Onkol ; 32(4): 300-302, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31426647

RESUMO

INTRODUCTION: Bone metastasis is seen in 2.3-12.7% of thyroid follicular carcinomas. Bone metastasis most commonly occurs in the vertebrae, costas and hip bones. In this report we discuss the diagnosis and treatment of a patient followed up due to skull metastasis of thyroid follicular carcinoma in light of literature. CASE REPORT: A 51-year-old female patient underwent surgery due a mass in the scalp. The histopathological examination was reported as metastasis of follicular thyroid carcinoma. No radiotherapy was indicated because of the total excision of the mass and the benign surgical margins. The patient, in whom fine needle aspiration biopsy showed the result of follicular carcinoma underwent a total bilateral thyroidectomy. Whole-body I-131 scintigraphy revealed diffuse activity involvement in the thyroid gland, and lung and bone (skull, sacrum, right acetabulum) metastasis. The patient was scheduled for radioactive iodine therapy. CONCLUSION: Total/near total thyroidectomy and metastasectomy should be the treatment of choice in skull metastasis. Postoperative radioactive iodine and radiotherapy should be offered. Radiotherapy should be reserved for inoperable and residual tumour cases.


Assuntos
Adenocarcinoma Folicular/patologia , Neoplasias Cranianas/radioterapia , Neoplasias Cranianas/secundário , Neoplasias da Glândula Tireoide/patologia , Adenocarcinoma Folicular/cirurgia , Biópsia por Agulha Fina , Feminino , Humanos , Radioisótopos do Iodo , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Radioterapia/métodos , Neoplasias Cranianas/diagnóstico por imagem , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Tomografia Computadorizada por Raios X
10.
Artigo em Chinês | MEDLINE | ID: mdl-31446725

RESUMO

Objective:The aim of this study is to summarize and analyze the clinical features of thyroid cancer surgery patients, and provide information and guidance for clinical diagnosis and treatment. Method:The medical records of 854 patients with thyroid cancer who met the inclusion criteria from January 2013 to December 2018 were collected from the hospital's medical record system. Patients were grouped by age group and their stratified studies were performed on age, gender, pathological type, and cervical lymph node metastasis. Result:The total number of patients with thyroid cancer surgery in 2013-2018 showed an increasing trend. There was no significant difference in the age composition of thyroid cancer patients between different years (P>0.05), but the age of 20-54 years old gradually increased with age, and reached a peak at 50-54 years old, then gradually decreased. There was no significant difference in gender composition between patients with thyroid cancer surgery in 2013-2018 (P>0.05), but in 40-44 years old, the prevalence of women in the 50-54 age group was higher than that in men (P<0.05), The prevalence of men in the 70-74 age group was higher than that in women (P<0.05), and the peak period of both was 50-54 years old. Papillary carcinoma accounted for a high proportion (96.8%) in the pathological types of thyroid cancer surgery patients in 2013-2018, and the incidence of women in the 40-44 age group was higher than that in men(P<0.01), in the 70-74 age range. The incidence was higher than that of women (P<0.01). The incidence of follicular carcinoma (1%) was higher in men than in women (P<0.05). The incidence of lymph node metastasis in women with thyroid cancer was lower than that in men (P<0.05). Conclusion:The incidence of thyroid cancer in different age groups has its own characteristics, and prevention and control measures should be formulated according to age groups.


Assuntos
Adenocarcinoma Folicular/patologia , Fatores Etários , Carcinoma Papilar/patologia , Neoplasias da Glândula Tireoide/patologia , Adenocarcinoma Folicular/cirurgia , Adulto , Idoso , Carcinoma Papilar/cirurgia , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Adulto Jovem
11.
Acta otorrinolaringol. esp ; 70(4): 200-206, jul.-ago. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185396

RESUMO

Introducción y objetivos: El tratamiento principal de los carcinomas diferenciados de tiroides es la cirugía seguida de radioyodo. El propósito de este estudio es exponer nuestra experiencia en el manejo de estos tumores. Material y método: Se presenta un estudio retrospectivo de los 55 pacientes intervenidos quirúrgicamente de un carcinoma diferenciado de tiroides en nuestro hospital entre los años 2007 y 2011. Resultados: La edad media al diagnóstico fue de 49 años, con un predominio femenino (78% de los casos). El 78% de los pacientes se encontraban en fases iniciales (estadios i y ii). El diagnóstico histopatológico definitivo fue de carcinoma papilar en el 84% y folicular en el 16% restante. A todos, salvo a 2 pacientes (4%), se les realizó una tiroidectomía total, acompañada de linfadenectomía en el 58% de los casos. Un 9% de los pacientes presentó hipoparatiroidismo permanente y aunque un 18% sufrió parálisis recurrencial unilateral transitoria, un 40% de ellos se recuperó completamente a los 6 meses. Se administró radioyodo en el postoperatorio al 89% de los pacientes. Se produjo un 40% de recidivas, la mayor parte de las cuales (29% de los pacientes) se localizaron a nivel cervical. La supervivencia a los 5 años fue del 87%, siendo del 95% en el subtipo papilar y descendiendo al 56% en el folicular (p = 0,001). Discusión/conclusiones: Los carcinomas diferenciados de tiroides son tumores con un pronóstico excelente tras un tratamiento quirúrgico adecuado previa valoración preoperatoria exhaustiva y seguimiento postoperatorio estricto debido a las tasas significativas de recidiva


Introduction and objectives: Radioiodine is the principal treatment for differentiated thyroid carcinomas. The aim of this study is to present our experience in the management of these tumours. Material and method: We present a retrospective study of 55 patients operated for differentiated thyroid carcinoma in our hospital between 2007 and 2011. Results: The mean age at time of diagnosis was 49 years, and females predominated (78% of cases). Seventy eight percent of the patients were in the initial stages (stages i and ii). The definitive histopathological diagnosis was papillary carcinoma in 84% and follicular carcinoma in the remaining 16%. All of the patients, with the exception of 2 (4%), underwent total thyroidectomy, with lymphadenectomy in 58% of cases. Nine percent of the patients had permanent hypoparathyroidism and although 18% suffered transitory unilateral paralysis, 40% of these female patients had completely recovered after 6 months. Eighty-nine percent of the patients were given radioiodine postoperatively. There was a recurrence rate of 40% most of which was at cervical level (29% of the patients). Survival at 5 years was 87%, 95% of the papillary subtype, falling to 56% of the follicular subtype (P = .001). Discussion/conclusions: The prognosis for differentiated thyroid carcinomas is excellent after appropriate surgical treatment, thorough preoperative assessment,and strict postoperative follow-up due to the significant recurrence rates


Assuntos
Humanos , Masculino , Feminino , Adulto , Adenocarcinoma Folicular/cirurgia , Carcinoma Papilar/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Adenocarcinoma Folicular/patologia , Adenocarcinoma Folicular/radioterapia , Biópsia por Agulha Fina , Carcinoma Papilar/patologia , Carcinoma Papilar/radioterapia , Seguimentos , Radioisótopos do Iodo/uso terapêutico , Estimativa de Kaplan-Meier , Metástase Neoplásica , Recidiva Local de Neoplasia/epidemiologia , Prognóstico , Radioterapia Adjuvante , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/radioterapia , Tireoidectomia
13.
J Pediatr Endocrinol Metab ; 32(8): 895-901, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31271555

RESUMO

Background The American Thyroid Association (ATA) recommendations for the follow-up of thyroid nodules with benign fine needle aspiration (FNA) cytology in children are largely based on adult data, despite well-characterized differences between thyroid nodules in adults and children. We aimed to determine the optimal time interval for repeat evaluation of an FNA-benign thyroid nodule in a pediatric patient. Methods This is a retrospective chart review of patients <19 years of age from 2003 to 2013 with a benign thyroid nodule by FNA cytology. Results We identified 43 patients with benign thyroid nodule cytology on FNA. The average age at diagnosis was 15.6 years, with female predominance (91%). Initial ultrasound (US) findings showed an average nodule size of 2.5 cm, 10% with calcifications, 37% hyperemia, 29% hypoechogenicity and 7% lymphadenopathy. Follow-up US was done in 42%. The first follow-up US occurred on average at 15 months after the initial US. Four patients had nodules with significant growth over time. One patient with papillary thyroid carcinoma (PTC) on final pathology initially had a decreasing nodule size, and then a subsequent increase in the nodule size after 4.5 years. Thyroid nodules were surgically removed in 33% with the final pathology showing a benign cytology in four patients, follicular adenoma in eight patients and PTC in two patients. Conclusions The majority of patients with benign thyroid nodules had no significant increase in nodule size in the first year of follow-up, including one patient who was subsequently found to have PTC. We recommend follow-up US at 1 year after initial presentation in low-risk pediatric patients with benign thyroid nodule cytology.


Assuntos
Adenocarcinoma Folicular/patologia , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/patologia , Ultrassonografia/métodos , Adenocarcinoma Folicular/diagnóstico por imagem , Adenocarcinoma Folicular/epidemiologia , Adenocarcinoma Folicular/cirurgia , Adolescente , Adulto , Biópsia por Agulha Fina , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Prognóstico , Estudos Retrospectivos , Rhode Island/epidemiologia , Câncer Papilífero da Tireoide/diagnóstico por imagem , Câncer Papilífero da Tireoide/epidemiologia , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/diagnóstico por imagem , Tireoidectomia , Adulto Jovem
14.
Eur J Endocrinol ; 181(4): 389-396, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31340203

RESUMO

Objective: The second version of The Bethesda System for Reporting Thyroid Cytopathology endorsed the introduction of non-invasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) as a distinct entity with low malignant potential into clinical practice. Consequently, the risk of malignancy (ROM) of cytological diagnoses has changed, but the magnitude of the change remains uncertain. The present systematic review was undertaken to obtain more robust information about the true impact of NIFTP on the ROM among patients undergoing surgery following a fine-needle aspiration cytology (FNAC) diagnosis of suspicious for malignancy (Bethesda V) or malignant (Bethesda VI). As they are managed surgically, these two diagnostic categories are the primary entities that are clinically impacted by the advent of NIFTP. Design: Systematic review and meta-analysis. Methods: A comprehensive literature search of online databases was performed in November 2018. The search was conducted looking for data of histologically proven NIFTP with preoperative FNAC. Results: One-hundred fifty-seven articles were identified and nine were included in the study. Overall, there were 13,752 thyroidectomies with a cancer prevalence of 45.7%. When NIFTP was considered non-malignant, the pooled risk difference for ROM was 5.5%. Applying meta-analysis, the pooled prevalence of NIFTP among nodules with FNAC of Bethesda V or Bethesda VI was 14 and 3%, respectively. Conclusion: This meta-analysis shows that the inclusion of NIFTP leads to a reduction in the ROM for the Bethesda V and Bethesda VI FNAC diagnostic categories by 14 and 3%, respectively. Clinicians should be aware of these data to avoid overtreatment.


Assuntos
Adenocarcinoma Folicular/cirurgia , Citodiagnóstico/tendências , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/tendências , Adenocarcinoma Folicular/patologia , Biópsia por Agulha Fina/tendências , Humanos , Invasividade Neoplásica/patologia , Fatores de Risco , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia
16.
Medicine (Baltimore) ; 98(30): e16187, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348230

RESUMO

BACKGROUND: Recently, many studies have been carried out to investigate the clinicopathological significance of E-cadherin expression in thyroid cancer. However, the results remained inconsistent. In the present study, we performed a meta-analysis to evaluate the associations of E-cadherin expression with susceptibility and clinicopathological characteristics of thyroid cancer. METHODS: Eligible studies were searched from Medicine, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang databases. The strength of associations between E-cadherin expression and susceptibility and clinicopathological features of thyroid cancer were assessed by pooled odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Forty-six studies with 1700 controls and 2298 thyroid cancer patients were included for this meta-analysis. Pooled results indicated that E-cadherin expression was significantly associated with susceptibility of papillary cancer and follicular cancer (papillary cancer, ORs = 14.31, 95% CIs = 3.42-59.90; follicular cancer, ORs = 10.14, 95% CI = 4.52-22.75). Significant association between E-cadherin expression and thyroid cancer risk was also observed in the subgroup analysis based on control group (normal thyroid tissue, ORs = 28.28, 95% CI = 8.36-95.63; adjacent thyroid tissue, ORs = 8.83, 95% CI = 3.27-23.85; benign thyroid tissue, ORs = 43.96, 95% CI = 9.91-194.95). In addition, E-cadherin expression was significantly correlated with lymph node metastasis, differentiation, and tumor-node-metastasis (TNM) stage of thyroid cancer (lymph node metastasis, ORs = 3.21, 95% CI = 1.98-5.20; differentiation, ORs = 0.25, 95% CI = 0.07-0.82; TNM stage, ORs = 4.85, 95% CI = 2.86-8.25). CONCLUSIONS: The present study showed that E-cadherin expression was significantly associated with susceptibility and clinicopathological characteristics of thyroid cancer, which suggested that E-cadherin expression might be a potential predictive factor for clinical progression of thyroid cancer.


Assuntos
Adenocarcinoma Folicular/patologia , Caderinas/biossíntese , Carcinoma Papilar/patologia , Neoplasias da Glândula Tireoide/patologia , Humanos , Metástase Linfática , Invasividade Neoplásica/patologia , Metástase Neoplásica/patologia , Medição de Risco , Fatores de Risco
17.
Diagn Cytopathol ; 47(10): 993-998, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31254313

RESUMO

BACKGROUND: Few studies focus on pediatric thyroid nodules categorized under indeterminate diagnostic categories. The current study was conducted to assess the risk of malignancy of indeterminate pediatric thyroid nodules. METHODS: A search of the institutional electronic pathology database from 01/2011 to 09/2018 was performed to identify pediatric (<21 years old) thyroid nodules that were interpreted as follicular lesion of undetermined significance (FLUS), suspicious for follicular neoplasm (SFN), or suspicious for malignancy (SFM) and subsequently managed with surgery, repeat fine-needle aspiration (FNA), or ≥ 6 months of clinical/imaging monitoring. Results of follow-up (F/U) surgical resections and repeat FNA/Afirma tests, and clinical and radiologic data were collected. RESULTS: We identified 46 cases from 42 patients (11-20 years old, 33 females and 9 males), including 30 FLUS, 10 SFN, and 6 SFM. Twenty-five FLUS, ten SFN, and six SFM cases underwent surgery. The histology revealed carcinomas in 36% of FLUS, 20% of SFN, and 100% of SFM categories; follicular adenomas in 32% of FLUS and 80% of SFN categories; and benign nodules in 32% of FLUS category. All five nonsurgically treated FLUS cases were considered benign based on the findings of repeat FNA/Afirma tests (n = 3, 3-22 months F/U) or clinical/radiologic exams (n = 2, 8-12 months F/U). CONCLUSIONS: Based on a limited study cohort, malignancy was identified in 36%, 20%, and 100% of surgically managed pediatric thyroid nodules categorized as FLUS, SFN, and SFM, respectively; suggesting a markedly higher malignant rate than the implied malignant risk for FLUS and SFM categories in adults.


Assuntos
Nódulo da Glândula Tireoide/patologia , Adenocarcinoma Folicular/epidemiologia , Adenocarcinoma Folicular/patologia , Adolescente , Biópsia por Agulha Fina/estatística & dados numéricos , Criança , Feminino , Humanos , Masculino , Nódulo da Glândula Tireoide/epidemiologia , Adulto Jovem
18.
Endocr Pathol ; 30(3): 246-248, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31154561

RESUMO

Follicular thyroid carcinoma (FTC) is not routinely diagnosed by a preoperative fine needle aspiration biopsy (FNAB), and the final diagnosis relies on histopathological criteria visible upon microscopic examination of the excised tumor. Several markers have been proposed as helpful in the identification of follicular thyroid tumors with malignant potential and worse prognosis, of which the specific point mutations C250T and C228T in the Telomerase Reverse Transcriptase (TERT) promoter region seem to be particularly promising. We describe a patient presenting with a large pelvic mass, in which a core needle biopsy was consistent with follicular-patterned thyroid tissue positive for a Q61R NRAS mutation and the C228T TERT promoter mutation. Upon clinical investigation, a 60-mm lesion was detected in the right thyroid lobe. The ensuing FNAB was consistent with a follicular thyroid tumor, Bethesda IV, positive for the same NRAS mutation and both the C228T and C250T TERT promoter mutations. A total thyroidectomy was performed, and a widely invasive FTC was diagnosed. Tumor tissue samples from various parts of the primary lesion were investigated for TERT promoter mutations, displaying C228T in three samples and C250T in one. Interestingly, the C228T mutations showed a coupling to areas with high Ki-67 proliferation indexes. Our data indicate that TERT promoter mutations can exhibit spatial heterogeneity in FTCs, with implications for clinical management as well as providing insights into the molecular biology underlying the tumoral etiology.


Assuntos
Adenocarcinoma Folicular/genética , Mutação Puntual , Regiões Promotoras Genéticas/genética , Telomerase/genética , Neoplasias da Glândula Tireoide/genética , Adenocarcinoma Folicular/diagnóstico , Adenocarcinoma Folicular/patologia , Adenocarcinoma Folicular/cirurgia , Análise Mutacional de DNA , Diagnóstico Diferencial , Técnicas de Diagnóstico Endócrino , Feminino , Heterogeneidade Genética , Humanos , Pessoa de Meia-Idade , Metástase Neoplásica , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia
19.
Diagn Cytopathol ; 47(9): 881-889, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31211509

RESUMO

BACKGROUND: This study was designed to explore whether ultrasound of thyroid nodules facilitates the interpretation of the malignant risk of Bethesda III/IV thyroid nodules to inform further therapies. METHODS: We reviewed patient records in which the results of ultrasound-guided fine-needle aspiration (US-FNA) were classified by the Bethesda III/IV in our institution between January 2016 and June 2018. Studies were retrieved from PubMed, Cochrane Central Register of Controlled Trials, ISI Web of Science, Science Direct, Wiley Online Library, EMBASE, China National Knowledge Infrastructure, WanFang, and Chinese VIP. The odds ratio (OR) was used to measure associations between risk factors and thyroid nodule malignancy. RESULTS: Fifty-nine cases of Bethesda III/IV with corresponding surgeries were included, and the malignancy risk was 54.2%. Meta-analysis revealed irregular borders, solitary nodules, hypoechogenicity, microcalcifications, and being taller than wide, all of which increased the malignancy risk of thyroid nodules. Combined ORs for these factors were 4.08 (95% CI: 2.34-7.14, P < .001), 2.18 (95% CI: 1.39-3.42, P = .001), 2.02 (95% CI: 1.35-3.01, P = .001), 3.21 (95% CI: 2.26-4.56, P < .001), and 4.35 (95% CI: 3.07-6.15, P < .001), respectively. CONCLUSION: As the risk of malignancy for papillary thyroid carcinoma (PTC) is high, when any one of the five ultrasound features of malignancy were confirmed, repeated FNA is recommended to confirm PTC-type malignancy, even though nodules were Bethesda III/IV classification. However, repeated FNA should be avoided when none of these ultrasound features are identified because repeated FNA does not contribute to identifying non-PTC type malignancies, such as follicular thyroid carcinoma and poorly differentiated thyroid carcinoma.


Assuntos
Adenocarcinoma Folicular , Câncer Papilífero da Tireoide , Nódulo da Glândula Tireoide , Adenocarcinoma Folicular/diagnóstico , Adenocarcinoma Folicular/metabolismo , Adenocarcinoma Folicular/patologia , Adulto , Biópsia por Agulha Fina , Diagnóstico Diferencial , Feminino , Humanos , Biópsia Guiada por Imagem , Masculino , Pessoa de Meia-Idade , Câncer Papilífero da Tireoide/diagnóstico por imagem , Câncer Papilífero da Tireoide/metabolismo , Câncer Papilífero da Tireoide/patologia , Nódulo da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/metabolismo , Nódulo da Glândula Tireoide/patologia , Ultrassonografia
20.
Diagn Cytopathol ; 47(10): 1049-1050, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31190470

RESUMO

The risk of malignancy for some diagnoses in thyroid fine-needle aspirations is higher than the actual risk of clinical progression. Other measures of prognosis may be helpful in managing patients with indeterminate thyroid fine-needle aspiration diagnoses. We estimated the risk of death due to disease (RDDD) for well-differentiated thyroid carcinoma using a series of over 15 000 aspirates with over 2000 excisions and data from the SEER database. RDDD was low (1.3% or less for all categories). The RDDD of some indeterminate thyroid aspirates was higher than for malignant aspirates. The RDDD may provide additional information for patients and clinicians seeking to manage patients with indeterminate thyroid fine-needle aspirates.


Assuntos
Adenocarcinoma Folicular/patologia , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Adenocarcinoma Folicular/mortalidade , Biópsia por Agulha Fina/normas , Humanos , Valor Preditivo dos Testes , Prognóstico , Câncer Papilífero da Tireoide/mortalidade , Neoplasias da Glândula Tireoide/mortalidade
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