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1.
Ann R Coll Surg Engl ; 102(5): e107-e110, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32233872

RESUMO

The brain is a particularly rare site of metastasis from papillary microcarcinoma, with only few cases described in the literature. We present a case of 59-year-old man who presented with seizures and dysphasia due to left frontal lobe cystic mass, which was excised and turned out on histopathology to be of thyroid origin. Total thyroidectomy was performed and histology showed multifocal papillary microcarcinoma with the largest focus of 3mm with no other adverse features. The patient had ablative radioactive iodine postoperatively, with subsequent exit scan showing no uptake in the brain. Follow-up brain magnetic resonance imaging showed continuous regression of the surgical cavity. Although rare, such cases should be aggressively treated and followed up over the long term, because of reported associated high mortality.


Assuntos
Neoplasias Encefálicas/diagnóstico , Carcinoma Papilar/diagnóstico , Procedimentos Neurocirúrgicos , Convulsões/etiologia , Neoplasias da Glândula Tireoide/patologia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Encéfalo/cirurgia , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/cirurgia , Carcinoma Papilar/secundário , Carcinoma Papilar/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Glândula Tireoide/patologia , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/secundário , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia
2.
Medicine (Baltimore) ; 99(16): e19892, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32312017

RESUMO

RATIONALE: The unpredictability of thyroid cancer can be striking, as the disease may rapidly progress to death in some individuals. Herein, we reported a rare case of aggressive papillary thyroid cell carcinoma (PTC) in an elderly patient de-differentiated into squamous cell carcinoma (SCC). PATIENT CONCERNS: We describe a case of a 79-year-old Thai woman presented with hoarseness and neck mass for 2 months and she had been diagnosed with a 3-cm papillary thyroid carcinoma (PTC) in the right side of the thyroid gland. Later on PTC de-differentiated into SCC within 3 years after initial presentation. DIAGNOSIS: De-differentiation from papillary thyroid carcinoma to squamous cell carcinoma. INTERVENTIONS: The patient underwent a total thyroidectomy at the initial hospital and received high dose radioactive iodine (RAI) treatment at our hospital 1 month following the surgery and then was lost to follow-up. Two years later she came back with new development of right solid-cystic neck mass which was found to be recurrent PTC. A radical neck dissection was done and another high dose RAI treatment was given. However, she developed recurrent mass with tenderness at the site above previous solid cystic mass 6 months later. Re-exploration of the neck mass revealed an inflamed midline mass 2 cm with enlarged right lateral cervical lymph nodes. OUTCOMES: A histopathological examination of the midline neck mass showed poorly differentiated SCC with lymphatic invasion. The intermingling of two morphologically distinct tumors, a typical PTC and a poorly differentiated SCC, had been identified in 1 out of 14 excised cervical lymph nodes. The patient underwent external beam radiation without chemotherapy. She is still in stable condition at 18 months post-treatment. LESSONS: This case clearly demonstrated that SCC transformed from a pre-existing PTC. The clinician should consider a possible transformation of papillary thyroid cancer into more aggressive histological types in elderly patients who present with rapidly progressive clinical behavior. However, some patients could have long-term survival if the tumor did not transform into anaplastic thyroid cancer.


Assuntos
Carcinoma Papilar/patologia , Carcinoma de Células Escamosas/patologia , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Idoso , Grupo com Ancestrais do Continente Asiático/etnologia , Carcinoma Papilar/radioterapia , Carcinoma Papilar/cirurgia , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirurgia , Diferenciação Celular , Feminino , Humanos , Radioisótopos do Iodo/uso terapêutico , Perda de Seguimento , Excisão de Linfonodo/métodos , Esvaziamento Cervical/métodos , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Câncer Papilífero da Tireoide/radioterapia , Câncer Papilífero da Tireoide/cirurgia , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/radioterapia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Resultado do Tratamento
3.
J Surg Oncol ; 121(6): 958-963, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32189352

RESUMO

The incidence of papillary thyroid microcarcinoma (microPTC) has dramatically increased in the last decades. Most of these tumors remain small and clinically "silent", only small number progress. Although thyroid surgery used to be the only therapeutic approach, recent guidelines now consider active surveillance for low-risk microPTC. For this reason, more accurate risk stratification of microPTC is needed. The optimal management of low-risk microPTC through accurate risk stratification represents a major clinical issue.


Assuntos
Carcinoma Papilar/diagnóstico , Carcinoma Papilar/terapia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/terapia , Carcinoma Papilar/patologia , Carcinoma Papilar/cirurgia , Humanos , Estadiamento de Neoplasias , Fatores de Risco , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia
4.
J Surg Oncol ; 121(6): 952-957, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32189361

RESUMO

BACKGROUND: In 2010, a Japanese trial of nonoperative management for papillary thyroid microcarcinomas (PTmC) was published. This study determines if the prevalence of nonoperative management in the United States has changed and if there are predictors of this approach. METHODS: Patients treated for PTmC between 2004 and 2015 in the National Cancer Data Base were identified. Inclusion criteria were: classic or follicular variant papillary cancer histology, tumor size 1 to 10 mm, cN0 disease and no extrathyroidal extension or metastatic disease. Nonoperative management was assessed over time and compared between 2004-2010 and 2010-2015. Logistic regression identified factors associated with nonoperative management. RESULTS: Of 65 381 PTmC patients, 344 (0.5%) were treated nonoperatively. The annual rate of nonoperative management was similar at 0.6% in 2004 to 0.4% in 2010 (P = .755) but increased to 0.9% in 2015 (P < .001). There was no difference in patient age, race, comorbidities, or reason for nonoperative management between the two periods. Academic centers managed more patients nonoperatively. Multivariable logistic regression suggests older age, facility type, location, Hispanic, Asian, and Native American ethnicity were associated with nonoperative management. CONCLUSION: The vast majority of PTmC in the United States is treated with an operation. A small but significant increase in nonoperative management occurred between 2004-2010 and 2010-2015.


Assuntos
Carcinoma Papilar/epidemiologia , Carcinoma Papilar/terapia , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/terapia , Carcinoma Papilar/cirurgia , Feminino , Humanos , Modelos Logísticos , Masculino , Oncologia/métodos , Oncologia/estatística & dados numéricos , Pessoa de Meia-Idade , Prevalência , Oncologia Cirúrgica/métodos , Oncologia Cirúrgica/estatística & dados numéricos , Taxa de Sobrevida , Neoplasias da Glândula Tireoide/cirurgia , Estados Unidos/epidemiologia
6.
Niger J Clin Pract ; 22(12): 1772-1777, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31793487

RESUMO

Background: There are various endoscopic techniques for thyroid carcinoma dissection but few reports regarding the scarless neck technique and central compartment dissection (CCD) via the breast approach, especially for bilateral CCD are available. In this study, we reported 45 cases with scarless neck endoscopic total or near-total thyroidectomy plus CCD via the breast approach. Materials and Methods: Forty-five female patients with papillary thyroid carcinoma (PTC) were enrolled in the study, from January 2011 to March 2013. In brief, 5 mm ultrasonic coagulation device (Harmonic Scalpel, HS; Ethicon Endosurgery, USA) was used to perform thyroid vessel management and thyroidectomy. Twenty patients underwent total thyroidectomy and 25 underwent near-total thyroidectomy. CCD was performed in all 45 patients, including 13 with bilateral CCD and 32 with ipsilateral CCD. Results: The procedure was successful for all 45 patients. Sixteen patients (35.6%) had lymph node metastases in central compartments. Postoperative transient adverse events included voice changes (9 patients) and hypocalcemia (18 patients), including 7 (21.9%) in the unilateral group and 11 (84.6%) in bilateral group. There was no permanent hypocalcemia or recurrent laryngeal nerve (RLN) palsy. None of the case were converted to open surgical procedure. All patients were satisfied with the cosmetic result of the scarless neck endoscopic thyroidectomy (SET). No evidence of residual or recurrent disease was found during a mean follow-up of 22.84 months (range, 12-34 months). Conclusions: Experienced thyroid surgeons performed the scarless neck endoscopic total or near-total thyroidectomy plus unilateral or bilateral CCD via the breast approach for selected PTC patients. The procedure was safe and feasible with excellent cosmetic results.


Assuntos
Mama/cirurgia , Carcinoma Papilar/cirurgia , Endoscopia/métodos , Esvaziamento Cervical/métodos , Câncer Papilífero da Tireoide/cirurgia , Tireoidectomia/métodos , Adulto , Carcinoma Papilar/patologia , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Câncer Papilífero da Tireoide/patologia , Resultado do Tratamento
7.
Khirurgiia (Mosk) ; (12): 18-27, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825339

RESUMO

OBJECTIVE: To analyze own initial experience of transoral thyroid surgery. MATERIAL AND METHODS: There were 7 patients thyroid nodules who underwent surgery for the period from March 2018 to May 2019. All patients signed an informed consent to be included in the study. Surgical approach was performed through three incisions in the lower arch of the vestibule of the mouth with deployment of 10 mm endoscope and two 5 mm tools. Gas insufflation was used. All patients were females aged 43.3±11.8 years. Thyroidectomy was performed in 2 cases, hemithyroidectomy - in 5 patients. Dimensions of nodules varied from 10 to 42 mm. RESULTS: Mean time of hemithyroidectomy and thyroidectomy was 206.4±63.8 and 232±37.5 min, respectively. Papillary carcinoma was histologically verified in 1 case. Injuries of recurrent laryngeal nerve, postoperative hypocalcemia and local complications were absent. Drainage was not applied. Postoperative hospital-stay was 3.7±1.1 days. CONCLUSION: Transoral approach to the thyroid gland is technically feasible with standard endoscopic instruments, safe for important anatomical structures and more precise due to the optical capabilities of endoscopic equipment. Any types of procedures are possible. Undoubtedly, aesthetic outcome is also favorable.


Assuntos
Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Cirurgia Endoscópica por Orifício Natural/métodos , Nódulo da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Adulto , Carcinoma Papilar/cirurgia , Estudos de Viabilidade , Feminino , Humanos , Pessoa de Meia-Idade , Boca/cirurgia , Neoplasias da Glândula Tireoide/cirurgia
8.
World J Gastroenterol ; 25(36): 5569-5577, 2019 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-31576101

RESUMO

BACKGROUND: Intraductal papillary neoplasm of the bile duct (IPNB) is a type of tumor that presents in the intra- or extrahepatic bile ducts. Cystic-type intrahepatic IPNB often mimics simple liver cysts, making the diagnosis difficult. Because the growth of IPNB is slow, careful follow-up and timely therapeutic intervention is recommended. There are few reports with a follow-up period longer than a decade; thus, we report the case of a patient with an IPNB that grew for over 13 years. CASE SUMMARY: A 65-year-old man was diagnosed, 13 years prior with a cystic hepatic tumor with abnormal imaging findings. The targeted tumor biopsy results showed no malignancy. Biannual follow-up examinations were performed because of the potential for malignancy. The cystic lesions showed gradual enlargement over 11 years and a 4 mm papillary proliferation appeared on the cyst wall, which is compatible with IPNB. The tumor was observed for another 2 years because of the patient's wishes. The imaging findings showed enlargement to 8 mm and a new 9 mm papillary proliferation of the cystic tumor. Contrast-enhanced ultrasonography showed hyperenhancement during the arterial phase in both cyst walls, indicating intraductal tumor progression in both tumors. Thus, liver segment 8 subsegmentectomy was performed. The pathological findings indicated that the tumors contained mucin, and high-grade atypia was observed in the papillary lesions, showing IPNB. CONCLUSION: The development of IPNB should be monitored in patients with cystic lesions and ultrasonography are useful tool for the evaluation.


Assuntos
Neoplasias dos Ductos Biliares/diagnóstico , Ductos Biliares Intra-Hepáticos/patologia , Carcinoma Papilar/diagnóstico , Cistos/patologia , Idoso , Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Biópsia , Carcinoma Papilar/patologia , Carcinoma Papilar/cirurgia , Colangiografia , Cistos/cirurgia , Hepatectomia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia
9.
Ann Saudi Med ; 39(5): 345-349, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31580696

RESUMO

BACKGROUND: Thyroid malignancy, the most diagnosed cancer of the endocrine system, represents 2% of all malignancies worldwide. The increasing incidence of thyroid cancer has been linked to the increasing sensitivity of modern diagnostic methods which overdiagnosis small thyroid tumors. OBJECTIVES: Assess the distribution and trends in thyroid cancer among thyroidectomy patients. DESIGN: Descriptive, based on medical record review. SETTINGS: Two tertiary care centers in Riyadh. PATIENTS AND METHODS: We included patients who underwent thyroid surgery from January 1, 2004 to December 31, 2016 who ranged in age from 9-90 years regardless of initial diagnosis. MAIN OUTCOME MEASURES: Distribution of thyroid carcinomas by type, age and sex and trends over the time period. SAMPLE SIZE: 979 patients. RESULTS: Of 979 patients, 84.5% were <55 years old, with the majority being female. Thyroid malignancy ranked second to benign tumors, and the most common type of thyroid cancer was papillary thyroid carcinoma (91% of malignant tumors), followed by follicular thyroid cancer (4.7% of malignant tumors). After thyroid microcarcinomas were isolated from the sample and studied separately, we found the overall trend for thyroid cancer to be stable, and that the annual increases in rates were due to increased diagnosis of thyroid microcarcinoma in the period from 2010 to 2016. CONCLUSION: Our study shows that increases in thyroid cancers may be attributed to a rise in the rates of diagnosis of thyroid microcarcinomas. LIMITATIONS: The main limitation is the retrospective nature of this design. Also, a multicenter collaboration would prove beneficial in evaluating the trends of thyroid cancer in Saudi Arabia on a much larger scale. CONFLICT OF INTEREST: None.


Assuntos
Carcinoma Papilar/epidemiologia , Neoplasias da Glândula Tireoide/epidemiologia , Tireoidectomia/métodos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Carcinoma Papilar/patologia , Carcinoma Papilar/cirurgia , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Arábia Saudita , Distribuição por Sexo , Centros de Atenção Terciária , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Adulto Jovem
10.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 44(9): 1009-1015, 2019 Sep 28.
Artigo em Chinês | MEDLINE | ID: mdl-31645490

RESUMO

OBJECTIVE: To investigate the experience and efficacy of endoscopic thyroidectomy for papillary thyroid microcarcinoma (PTMC) through total areola approach.
 Methods: A total of 117 PTMC patients, who were diagnosed pathologically in Minimally Invasive Surgical Center, Second Xiangya Hospital, Central South University from June 2016 to December 2017, were divided into a endoscopic surgery group (n=72) and an open surgery group (n=45). The number of dissected central lymph nodes, blood loss, amount of drainage, occurrence of postoperative complication and recurrence were collected and compared.
 Results: Compared with the open surgery group, the blood loss was less and the operative time was longer in the endoscopic surgery group (P<0.05). There were no significant differences between the 2 groups in the number of dissected central lymph nodes, amount of drainage and occurrence of postoperative complication (all P>0.05). The mean follow-up time was more than 20 months, and there was no recurrence in the 2 groups. 
 Conclusion: Endoscopic thyroidectomy with central compartment neck dissection through total areola approach is safe and feasible in patients with PTMC. It has many advantages, such as no scar on neck, less blood loss, shorter hospital stay and more acceptable to young patients.


Assuntos
Carcinoma Papilar/cirurgia , Endoscopia , Neoplasias da Glândula Tireoide/cirurgia , Humanos , Mamilos , Tireoidectomia
11.
Arch Endocrinol Metab ; 63(5): 456-461, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31482953

RESUMO

The indolent evolution of low-risk papillary thyroid microcarcinoma (mPTC) in adult patients and the consequences of thyroidectomy require a revision of the management traditionally recommended. Aiming to spare patients unnecessary procedures and therapies and to optimize the health system in Brazil, we suggest some measures. Fine-needle aspiration of nodules ≤ 1 cm without extrathyroidal extension on ultrasonography should be performed only in nodules classified as "very suspicious" (i.e., high suspicion according to ATA, high risk according to AACE, TI-RADS 5) and in selected cases [age < 40 years, nodule adjacent to the trachea or recurrent laryngeal nerve (RLN), multiple suspicious nodules, presence of hypercalcitoninemia or suspicious lymph nodes]. Active surveillance (AS) rather than immediate surgery should be considered in adult patients with low-risk mPTC. Lobectomy is the best option in patients with unifocal low-risk mPTC who are not candidates for AS because of age, proximity of the tumor to the trachea or RLN, or because they opted for surgery. The same applies to patients who started AS but had a subsequent surgical indication not due to a suspicion of tumor extension beyond the gland or multicentricity. Molecular tests are not necessary to choose between AS and surgery or, in the latter case, between lobectomy and total thyroidectomy. The presence of RAS or other RAS-like mutations or BRAFV600E or other BRAF V600E-like mutations should not modify the management cited above; however, the rare cases of mPTC exhibiting high-risk mutations, like in the TERT promoter or p53, are not candidates for AS.


Assuntos
Carcinoma Papilar/diagnóstico por imagem , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico por imagem , Biópsia por Agulha Fina , Carcinoma Papilar/cirurgia , Prova Pericial , Humanos , Neoplasias da Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/cirurgia , Tireoidectomia
12.
Medicine (Baltimore) ; 98(36): e16935, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490376

RESUMO

BACKGROUND: Although several previous studies demonstrated the feasibility and efficacy of indocyanine green (ICG) for thyroid cancer surgery, ICG was administered through venous injection and focused on parathyroid gland protection. We thus aimed to study the feasibility of imaging using ICG combined with carbon nanoparticles (CNs) in the identification of sentinel lymph nodes (SLNs) in patients diagnosed with papillary thyroid microcarcinoma (PTMC). METHODS: Two approaches were applied to detect lymph nodes in PTMC surgery. Patients were randomized into 2 groups. ICG and CNs were injected into the thyroid in Group A. In Group B, only CNs was injected. Black-stained or fluorescent nodes observed using near-infrared fluorescence imaging systems were defined as SLNs. SLN and central lymph node (CLN) dissection was completed in both groups. The pathological and postoperative outcomes were compared between 2 groups. RESULTS: There were 40 patients in Group A and 60 in Group B. A total of 138 SLNs were identified; 72 and 66 SLNs were detected and dissected in Groups A and B, respectively. The number of SLNs identified (per patient) in Group A was higher than that in Group B (P = .027). The number of harvested CLNs was 161 and 192 in Groups A and B, respectively, out of which 45 and 48 lymph nodes with metastasis were confirmed by permanent pathology. The CLN metastatic rate in Group A was higher than that in Group B (P = .048). CONCLUSION: Imaging using ICG combined CNs is feasible and safe for SLN identification in PTMC patients. Compared with using only CNs, more SLNs can be removed and more metastatic lymph nodes can be confirmed when using the combined method. Although the combined method appears to accurately stage tumors, further research is needed.


Assuntos
Carbono/administração & dosagem , Carcinoma Papilar/patologia , Verde de Indocianina/administração & dosagem , Excisão de Linfonodo/métodos , Nanopartículas/administração & dosagem , Linfonodo Sentinela/cirurgia , Neoplasias da Glândula Tireoide/patologia , Adulto , Carbono/química , Carcinoma Papilar/cirurgia , Corantes/administração & dosagem , Estudos de Viabilidade , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Nanopartículas/química , Imagem Óptica/métodos , Linfonodo Sentinela/patologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos
13.
Cir Cir ; 87(S1): 62-67, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31501633

RESUMO

Background: Primary hyperparathyroidism (PHPT) is characterized by an increase in parathyroid hormone (PTH) and hypercalcemia, which, when present during pregnancy, increases both maternal and fetal morbidity and mortality. Objective: Emphasize the importance of surgical intervention in primary hyperparathyroidism during pregnancy. Clinical case: A 27-year-old female with a pregnancy of 27.2 weeks of gestation, with a diagnosis of symptomatic primary hyperparathyroidism secondary to parathyroid adenoma, a history of nephrolithiasis and severe acute pancreatitis, surgery was decided upon finding intrathyroid right parathyroid adenoma, post-surgical course with adequate evolution and remission of hyperparathyroidism. Conclusions: Parathyroidectomy in primary hyperparathyroidism during pregnancy is safe.


Assuntos
Adenoma/complicações , Hiperparatireoidismo Primário/etiologia , Neoplasias das Paratireoides/complicações , Paratireoidectomia , Complicações Neoplásicas na Gravidez/cirurgia , Doença Aguda , Adenoma/diagnóstico , Adenoma/cirurgia , Adulto , Transfusão de Componentes Sanguíneos , Cálcio/metabolismo , Carcinoma Papilar/diagnóstico , Carcinoma Papilar/cirurgia , Feminino , Hormônios/sangue , Humanos , Hipercalcemia/etiologia , Hiperparatireoidismo Primário/sangue , Achados Incidentais , Nefrolitíase/etiologia , Pancreatite/etiologia , Neoplasias das Paratireoides/diagnóstico , Neoplasias das Paratireoides/cirurgia , Gravidez , Complicações Neoplásicas na Gravidez/sangue , Complicações Neoplásicas na Gravidez/diagnóstico , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia
14.
Med Sci Monit ; 25: 6943-6949, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31522188

RESUMO

BACKGROUND This study aimed to assess the utility and characteristics of preoperative ultrasonography (US) in patients transferred to referral hospitals from local clinics with a diagnosis of malignancy on US-guided fine-needle aspiration cytology of thyroid nodules. MATERIAL AND METHODS From January 2018 to June 2018, 109 transferred patients underwent preoperative US in our hospital for suspected thyroid malignancy on cytological analysis after US-guided fine-needle aspiration of thyroid nodules in local clinics. Preoperative US was performed by a single radiologist in all patients. Among them, 6 were excluded from the study because of refusal of thyroid surgery. Preoperative US and histopathological results were compared in all patients. RESULTS After thyroid surgery, pathological examination revealed papillary thyroid carcinoma (PTC) (n=98), follicular adenoma (n=1), and nodular hyperplasia (n=4). Of the 103 patients, 91 exhibited suspicious US findings on the preoperative US, whereas 12 did not. In the 91 patients with suspicious US findings, PTC (n=90) and follicular adenoma (n=1) were confirmed after thyroid surgery. In the 12 patients with no suspicious US findings, PTC (n=8) and nodular hyperplasia (n=4) were confirmed after thyroid surgery. On repeat analysis of the cytological slides of the 4 nodular hyperplasia cases from the local clinics, Bethesda category II (n=1) and III (n=3) were determined. CONCLUSIONS In the transferred patients with a malignant cytology, preoperative US might be helpful to detect false-positive cytology cases.


Assuntos
Cuidados Pré-Operatórios , Utilização de Procedimentos e Técnicas , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/patologia , Ultrassonografia , Adolescente , Adulto , Idoso , Biópsia por Agulha Fina , Carcinoma Papilar/diagnóstico por imagem , Carcinoma Papilar/patologia , Carcinoma Papilar/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transferência de Pacientes , Estudos Retrospectivos , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/cirurgia , Adulto Jovem
15.
Int J Pediatr Otorhinolaryngol ; 127: 109673, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31546062

RESUMO

INTRODUCTION: Thyroid cancer in children is a hot topic because of the large clinical heterogeneity and the risk of severe complications. We aimed to study 1. The frequency, 2. Etiology, and 3. Risk factors of post-surgery complications of thyroid cancer. MATERIAL AND METHODS: A retrospective analysis including risk factors for post-surgery complications of patients treated for thyroid malignancies in years 2006-2018 was performed. RESULTS: Over a period of 12 years 22 patients with thyroid malignancy (68% female; 12.6 ±â€¯4.0 years of age, median follow-up 6 years) were identified. Histologically, 12 (55%) patients had papillary carcinoma. Six patients (27.3%) had multiple endocrine neoplasia type 2 (MEN2) syndrome, 3 (13.7%) patients had medullary carcinoma and 1 patient had follicular carcinoma. Neck lymph node metastases were diagnosed in 8 (36.4%), distant metastases in 6 (27.3%), and both locations were involved in 4 (18.2%) patients. Six (27.3%) children had surgical complications: 1 child had unilateral vocal cord paralysis and transient hypoparathyroidism and 5 had transient hypoparathyroidism. The higher risk of surgery complications in forward stepwise logistic regression was associated in with distant metastases (R2 = 0.584, OR 52.63, p = 0.010). CONCLUSIONS: Postoperative complications were significantly associated with presence of distant metastases. Favorable results were observed in with children with MEN2 syndrome.


Assuntos
Adenocarcinoma Folicular/cirurgia , Carcinoma Neuroendócrino/cirurgia , Carcinoma Papilar/cirurgia , Neoplasia Endócrina Múltipla/cirurgia , Complicações Pós-Operatórias/etiologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/efeitos adversos , Adolescente , Criança , Feminino , Humanos , Hipoparatireoidismo/etiologia , Metástase Linfática , Masculino , Pescoço , Esvaziamento Cervical/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia/métodos , Paralisia das Pregas Vocais/etiologia
16.
Anticancer Res ; 39(8): 4569-4573, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366561

RESUMO

BACKGROUND/AIM: The aim of this study was to examine the clinicopathological features of intraductal papillary neoplasm of the bile duct (IPNB) and investigate their relationships with intraductal papillary mucinous neoplasm (IPMN). PATIENTS AND METHODS: Our study included 104 patients who underwent resection of tumors that showed papillary growth within the bile duct and pancreas. RESULTS: Comparisons were performed based on subtypes and histological grades. The presence of various histological grades was confirmed in both the IPNB group and the IPMN group, and statistical significance was found in the between-group comparisons of subtypes and histological grades. It was shown that while all patients who underwent IPNB resection did not match the classifications proposed by Nakanuma et al., they did reflect classification characteristics. CONCLUSION: IPNB and IPMN have common clinical histological features. Common features between IPNB subtype classifications were also identified, which may provide novel diagnostics.


Assuntos
Neoplasias dos Ductos Biliares/diagnóstico , Ductos Biliares Intra-Hepáticos/patologia , Carcinoma Papilar/diagnóstico , Neoplasias Intraductais Pancreáticas/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos/cirurgia , Carcinoma Papilar/patologia , Carcinoma Papilar/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas/patologia , Pâncreas/cirurgia , Pancreatectomia , Neoplasias Intraductais Pancreáticas/patologia , Neoplasias Intraductais Pancreáticas/cirurgia
17.
J Hepatobiliary Pancreat Sci ; 26(10): 467-472, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31419024

RESUMO

BACKGROUND: With the increasing detection of pancreatic cysts, many centers have applied endoscopic ultrasound-guided pancreatic cyst ablation (EUS-PCA), even in intraductal papillary mucinous neoplasms (IPMNs) of the pancreas based on early promising outcomes. However, long-term effects of ethanol ablation have been rarely reported, especially regarding oncologic outcomes. METHODS AND RESULTS: We report eight cases of malignancy conversion after EUS-PCA in patients with IPMNs who had worrisome features. Moreover, two patients showed tumor spillage or peritoneal seeding (carcinomatosis) after EUS-PCA. CONCLUSIONS: Endoscopic ultrasound-guided pancreatic cyst ablation must not be performed as a treatment for IPMNs, considering adverse results such as tumor spillage and the lack of oncological therapeutic effect.


Assuntos
Técnicas de Ablação/métodos , Adenocarcinoma Mucinoso/cirurgia , Carcinoma Ductal Pancreático/cirurgia , Carcinoma Papilar/cirurgia , Transformação Celular Neoplásica , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Neoplasias Pancreáticas/cirurgia , Neoplasias Peritoneais/secundário , Adenocarcinoma Mucinoso/diagnóstico por imagem , Adulto , Idoso , Carcinoma Ductal Pancreático/diagnóstico por imagem , Carcinoma Papilar/diagnóstico por imagem , Endossonografia , Etanol/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inoculação de Neoplasia , Neoplasias Pancreáticas/diagnóstico por imagem
18.
Eur J Radiol ; 118: 58-64, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31439259

RESUMO

PURPOSE: To summarize the published literature on microwave ablation (MWA) for the treatment of benign thyroid nodules and papillary thyroid microcarcinomas, and to evaluate the effectiveness and safety of MWA as a novel treatment strategy. METHODS: Two independent authors carried out the literature search using four databases, including PubMed, Embase, Cochrane, and Web of Science. The meta-analysis included prospective and retrospective data that compared pre-treatment values to post-treatment outcomes. RESULTS: From the 33 original articles, seven studies met the inclusion criteria for this meta-analysis. Of these, five were retrospective studies, two were prospective trials, one was controlled study, and one was a multi-center study. The results showed significant improvements in nodule volume, clinical symptom scores, and beauty scores between the baseline and final follow-up visits. In all of the studies, the most common adverse effects were hematomas, unbearable pain, and transient or permanent voice change in 3.8%, 2.2%, and 4.6% of patients, respectively. None of these incidents resulted in hospitalization or death. CONCLUSIONS: MWA is effective and safe for the treatment of benign thyroid nodules and papillary thyroid microcarcinomas. However, future studies should compare the efficacy of MWA, RFA, and surgical intervention.


Assuntos
Técnicas de Ablação/métodos , Carcinoma Papilar/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/cirurgia , Técnicas de Ablação/efeitos adversos , Bases de Dados Factuais , Hospitalização/estatística & dados numéricos , Humanos , Micro-Ondas/uso terapêutico , Glândula Tireoide/cirurgia , Resultado do Tratamento
19.
Future Oncol ; 15(24s): 13-19, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31385546

RESUMO

We report a case of an elderly woman presenting with a huge cervical mass invading the tracheal lumen. Diagnosed as invasive poorly differentiated thyroid cancer, after an endotracheal biopsy, stenting and radiotherapy, it was judged eligible for total thyroidectomy, but surgery was delayed due to pulmonary thromboembolism. The patient was therefore treated with lenvatinib with a neoadjuvant intent until hemodynamic stability was obtained. Thyroidectomy and radioiodine therapy were then performed and the postdose scan revealed an area of modest uptake in the anterior part of the neck. The patient is now in a good clinical status and she continues her follow-up program without any adjuvant therapy.


Assuntos
Carcinoma Papilar/tratamento farmacológico , Compostos de Fenilureia/administração & dosagem , Quinolinas/administração & dosagem , Neoplasias da Glândula Tireoide/tratamento farmacológico , Idoso de 80 Anos ou mais , Carcinoma Papilar/diagnóstico por imagem , Carcinoma Papilar/patologia , Carcinoma Papilar/cirurgia , Feminino , Humanos , Radioisótopos do Iodo/administração & dosagem , Terapia Neoadjuvante , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia
20.
World J Surg Oncol ; 17(1): 137, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31387646

RESUMO

BACKGROUND: Both the 7th and 8th editions of the American Joint Committee on Cancer (AJCC) staging systems have been introduced for pancreatic adenocarcinoma. However, the applicability of these classifications for invasive intraductal papillary mucinous neoplasms (IPMN) has not been systematically examined. METHODS: Patients with invasive IPMN were retrieved from a cohort of 18 geographical sites (1973-2014 varying) in the Surveillance, Epidemiology, and End Results (SEER) cancer registry. The 7th and 8th editions of the AJCC staging were compared. Survival rates and multivariate analyses were computed. RESULTS: In total, 1216 patients with resected invasive IPMN were included. A major difference between the 7th and 8th systems is the definition of stage IIA (7th, beyond the pancreas without involvement of major arteries; 8th, maximum tumor diameter > 4 cm). The hazard ratio (HR) of stage IIA disease (versus stage IA, HR = 2.33, P < 0.001) was higher than that of stage IB disease (HR = 1.48, P = 0.087) by the 7th edition classification, whereas the HR of stage IIA disease (HR = 1.26, P = 0.232) was even lower than that of stage IB disease (HR = 1.48, P = 0.040) by the 8th edition classification. In addition, for the 8th edition staging system, tumor size was not a predictor of survival in patients with resectable tumor > 2 cm (size > 4 cm versus > 2 ≤ 4 cm, HR = 0.91, P = 0.420). CONCLUSIONS: The AJCC 7th edition staging classification is more applicable than the 8th edition classification for invasive IPMN.


Assuntos
Adenocarcinoma Mucinoso/patologia , Carcinoma Ductal Pancreático/patologia , Carcinoma Papilar/patologia , Estadiamento de Neoplasias/normas , Neoplasias Intraductais Pancreáticas/patologia , Adenocarcinoma Mucinoso/classificação , Adenocarcinoma Mucinoso/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Ductal Pancreático/classificação , Carcinoma Ductal Pancreático/cirurgia , Carcinoma Papilar/classificação , Carcinoma Papilar/cirurgia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias Intraductais Pancreáticas/classificação , Neoplasias Intraductais Pancreáticas/cirurgia , Programa de SEER , Taxa de Sobrevida , Adulto Jovem
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