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1.
AJR Am J Roentgenol ; 214(4): 761-765, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31967497

RESUMO

OBJECTIVE. The purpose of this article was to assess thin-section CT features of ciliated muconodular papillary tumors (CMPTs) of the lung and correlations between radiologic and pathologic findings. MATERIALS AND METHODS. Thin-section CT findings of 16 patients (10 men and six women; mean age, 70.7 years) with surgically resected CMPTs were retrospectively analyzed. Size, location, and internal characteristics of the tumors were evaluated. The amount of mucin in the tumors was assessed histopathologically and compared with CT findings. Tumor growth speed was calculated on the basis of size changes on thin-section CT. RESULTS. In all 16 patients, tumors were detected as a solitary pulmonary nodule. Thirteen tumors (81.3%) were located in the lower lobes, and 10 (62.5%) were adjacent to the pleura. Mean maximal diameter of the tumors was 9.1 mm (range, 6-14 mm). One tumor (6.3%) presented as a pure ground-glass nodule (GGN), seven (43.8%) as dense GGNs, and eight (50.0%) as solid nodules. Pathologically, the pure GGN and five of seven dense GGNs had a large amount of mucin, whereas seven of eight solid nodules had an intermediate or small amount of mucin. The mean annual tumor growth rate (in diameter) was 0.49 mm/y. CONCLUSION. CMPTs appear as solitary, small, and peripheral pulmonary nodules with very slow growth rates. CMPTs appearing as pure GGNs and dense GGNs tend to contain more mucin than CMPTs appearing as solid nodules.


Assuntos
Carcinoma Papilar/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Nódulo Pulmonar Solitário/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Idoso , Carcinoma Papilar/patologia , Cílios/patologia , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Estudos Retrospectivos , Nódulo Pulmonar Solitário/patologia
2.
Eur Radiol ; 30(1): 1-10, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31278580

RESUMO

OBJECTIVES: Various imaging methods have been evaluated regarding non-invasive differentiation of renal cell carcinoma (RCC) subtypes. Dual-energy computed tomography (DECT) allows iodine concentration (IC) analysis as a correlate of tissue perfusion. Microvascular density (MVD) in histopathology specimens is evaluated to determine intratumoral vascularization. The objective of this study was to assess the potential of IC and MVD regarding the differentiation between papillary and clear cell RCC and between well- and dedifferentiated tumors. Further, we aimed to investigate a possible correlation between these parameters. METHODS: DECT imaging series of 53 patients with clear cell RCC (ccRCC) and 15 with papillary RCC (pRCC) were analyzed regarding IC. Histology samples were stained using CD31/CD34 monoclonal antibodies; MVD was evaluated digitally. Statistical analysis included performance of Mann-Whitney U test, ROC analysis, and Spearman rank correlation. RESULTS: Analysis of IC demonstrated significant differences between ccRCC and pRCC (p < 0.001). A cutoff value of ≤ 3.1 mg/ml at IC analysis allowed identification of pRCC with an accuracy of 86.8%. Within the ccRCC subgroup, G1/G2 tumors could significantly be differentiated from G3/G4 carcinomas (p = 0.045). A significant positive correlation between IC and MVD could be determined for the entire RCC cohort and the ccRCC subgroup. Limitations include the small percentage of pRCCs. CONCLUSIONS: IC analysis is a useful method to differentiate pRCC from ccRCC. The significant positive correlation between IC and MVD indicates valid representation of tumor perfusion by DECT. KEY POINTS: • Analysis of iodine concentration using DECT imaging could reliably distinguish papillary from clear cell subtypes of renal cell cancer (RCC). • A cutoff value of 3.1 mg/ml allowed a distinction between papillary and clear cell RCCs with an accuracy of 86.8%. • The positive correlation with microvascular density in tumor specimens indicates correct display of perfusion by iodine concentration analysis.


Assuntos
Carcinoma Papilar/patologia , Carcinoma de Células Renais/patologia , Neoplasias Renais/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Papilar/irrigação sanguínea , Carcinoma Papilar/diagnóstico por imagem , Carcinoma de Células Renais/irrigação sanguínea , Carcinoma de Células Renais/diagnóstico por imagem , Transformação Celular Neoplásica/patologia , Meios de Contraste/farmacocinética , Feminino , Humanos , Iodo/farmacocinética , Neoplasias Renais/irrigação sanguínea , Neoplasias Renais/diagnóstico por imagem , Masculino , Microvasos/diagnóstico por imagem , Microvasos/patologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Estatísticas não Paramétricas , Tomografia Computadorizada por Raios X/métodos , Carga Tumoral
3.
Int Braz J Urol ; 46(1): 26-33, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31851455

RESUMO

PURPOSE: Clear cell papillary (CCP) renal cell carcinoma (RCC) is a new subtype of RCC that was formally recognized by the International Society of Urological Pathology Vancouver Classification of Renal Neoplasia in 2013. Subsequently, CCP RCC was added to the 2016 World Health Organization Classification of Tumors of the Urinary System and Male Genital Organs. In this study, we retrospectively investigated the computed tomography (CT) findings of pathologically diagnosed CCP RCC. MATERIALS AND METHODS: This study included 12 patients pathologically diagnosed with CCP RCC at our institution between 2015 and 2017. We reviewed the patient's CT data and analyzed the characteristics. RESULTS: Nine solid masses and 3 cystic masses with a mean tumor size of 22.7 ± 9.2mm were included. Solid masses exhibited slight hyper-density on unenhanced CT with a mean value of 34 ± 6 Hounsfi eld units (HU), good enhancement in the corticomedullary phase with a mean of 195 ± 34HU, and washout in the nephrogenic phase with a mean of 133 ± 29HU. The walls of cystic masses enhanced gradually during the corticomedullary and nephrogenic phases. Solid and cystic masses were preoperatively diagnosed as clear cell RCC and cystic RCC, respectively. CONCLUSIONS: The CT imaging characteristics of CCP RCCs could be categorized into either the solid or cystic type. These masses were diagnosed radiologically as clear cell RCC and cystic RCC, respectively.


Assuntos
Carcinoma Papilar/diagnóstico por imagem , Carcinoma de Células Renais/diagnóstico por imagem , Neoplasias Renais/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Carcinoma Papilar/patologia , Carcinoma de Células Renais/patologia , Feminino , Humanos , Imuno-Histoquímica , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estudos Retrospectivos , Carga Tumoral
4.
Nan Fang Yi Ke Da Xue Xue Bao ; 39(9): 1094-1098, 2019 Sep 30.
Artigo em Chinês | MEDLINE | ID: mdl-31640963

RESUMO

OBJECTIVE: To explore the feasibility of radiomics for predicting lymph node metastasis in the central region of the neck in patients with thyroid papillary carcinoma (PTC). METHODS: A total of 189 patients with PTC confirmed by thyroid fine needle aspiration biopsy were prospectively enrolled in this study. The cross-sectional and longitudinal ultrasound images and the images of both sections were analyzed for predicting central lymph node metastasis using a radiomics approach with pathological results as the gold standard. RESULTS: In the 189 patients, the accuracy, sensitivity and specificity of preoperative thyroid ultrasonography for diagnosis of central lymph node metastasis was 69.39%, 64% and 73%, respectively. Based on the ultrasound images of the cross-sections, longitudinal sections and both sections, the accuracy, sensitivity and specificity of radiomics for predicting central lymph node metastasis was 66.06%/68.12%/77.69%, 53%/46%/40%, and 52%/53%/51%, respectively. CONCLUSIONS: Radiomics with combined analysis of the ultrasound images on the cross-section and longitudinal section images achieves a higher accuracy for predicting central lymph node metastasis than analysis a single section, and its diagnostic accuracy is much higher than that of conventional ultrasound examination.


Assuntos
Carcinoma Papilar/diagnóstico por imagem , Metástase Linfática/diagnóstico por imagem , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Carcinoma Papilar/patologia , Humanos , Interpretação de Imagem Assistida por Computador , Linfonodos , Pescoço , Estudos Prospectivos , Neoplasias da Glândula Tireoide/patologia , Ultrassonografia
5.
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
6.
G Chir ; 40(3): 234-237, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31484015

RESUMO

Papillary thyroid carcinoma (PTC) is the most common mali gnancy of the thyroid gland. In 21-90% of the patients occult lymph node metastases may occur. The case reported here describes a woman who underwent a total thyroidectomy for multinodular goiter and who presented an enlarged lymph node on the left side of the neck, which showed a metastasis from PTC. The patient underwent imaging investigation with CT and FNAB. The pathological examination diagnosed a papillary thyroid cancer metastases. The pT underwent a I131 total body scan, negative for secondary localization.


Assuntos
Carcinoma Papilar/diagnóstico por imagem , Carcinoma Papilar/secundário , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Carcinoma Papilar/complicações , Feminino , Bócio/cirurgia , Humanos , Achados Incidentais , Metástase Linfática , Pessoa de Meia-Idade , Neoplasias da Glândula Tireoide/complicações , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia
7.
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
8.
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
9.
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
10.
Arkh Patol ; 81(4): 53-58, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31407719

RESUMO

OBJECTIVE: To carry out a clinical and morphological analysis of thyroid cancer cases in the children of the Chelyabinsk Region. SUBJECT AND METHODS: Thyroid tumor pathology was verified in 50 of the 196 patients aged 7-17 years, who had been operated on in 2000-2016. Clinical and morphological features, including immunohistochemical and ultrastructural characteristics of thyroid cancer, were studied. RESULTS: Over the past 17 years, there has been a decline in the number of children with surgical thyroid diseases, including thyroid carcinomas. There is a predominance of papillary carcinoma (70%) that is characterized by more aggressive clinical and morphological signs than follicular and medullary thyroid carcinoma. The immunophenotype of follicular cell tumors in children is characterized by the expression of growth factors (TTF-1, EGFR-384) and malignancy markers (mesothelial cell, AMACR (P504S), S 100). CONCLUSION: The vector change (decrease) in the long-term unfavorable trend toward an increasing incidence of thyroid cancer in children of the Chelyabinsk Region is currently accompanied by the pathomorphism of thyroid carcinoma.


Assuntos
Carcinoma Papilar , Neoplasias da Glândula Tireoide , Adolescente , Carcinoma Papilar/diagnóstico por imagem , Criança , Humanos , Racemases e Epimerases , Federação Russa , Neoplasias da Glândula Tireoide/diagnóstico por imagem
11.
Int J Hyperthermia ; 36(1): 897-904, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31464140

RESUMO

Objectives: To compare the clinical outcomes of ultrasound-guided laser ablation (LA) and surgery for treatment of solitary papillary thyroid microcarcinoma (PTMC). Methods: A total of 81 consecutive patients with solitary PTMC were included in this retrospective study. Among them, 36 received LA and 45 underwent surgery. Surgery was performed by hemithyroidectomy with unilateral central neck dissection. The follow-up consisted of a physical examination, neck ultrasonography, chest X-ray or CT scan and thyroid function tests. The procedure time, hospital stay, complication and recurrence rates were compared between the two groups after treatment. Results: The follow-up period for the LA and surgical group were 49.2 ± 4.5 months (range, 30-54 months) and 48.5 ± 6.2 months (range, 24-54 months), respectively. The mean hospital stay and procedure time in the LA group were shorter than those in the surgical group. After LA, the largest diameter and average volume decreased from 4.7 ± 1.4 mm to 0.2 ± 0.8 mm, and from 43.2 ± 38.8 mm3 to 0.7 ± 4.1 mm3 (p < .05 for both), respectively. The complication rates and recurrence rates did not differ between the LA group (2.8% [1 of 36] and 5.6% [2 of 36]) and the surgical group (6.7% [3 of 45] and 6.7% [3 of 45]) (p > .05 for both). No distant metastasis occurred in the either group during the follow-up period. Conclusions: Compared with hemithyroidectomy with unilateral central neck dissection, ultrasound-guided LA was also a safe and effective therapy for treating solitary PTMC, and it may be considered as a treatment alternative for patients who are ineligible or refusal to undergo surgery.


Assuntos
Carcinoma Papilar/cirurgia , Terapia a Laser , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Ultrassonografia de Intervenção , Adulto , Carcinoma Papilar/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Resultado do Tratamento
13.
Rev. chil. endocrinol. diabetes ; 12(3): 175-178, jul. 2019. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-1006639

RESUMO

Los nódulos tiroideos suelen ser benignos en más del 95% de los casos y eutiroideos. La probabilidad de cáncer de tiroides en el hipertiroidismo es baja. Al enfrentarse a un nódulo tiroideo la importancia radica en excluir patología maligna, pero se debe mantener el orden en el algoritmo de estudio para evitar un diagnóstico incorrecto y caer en costos innecesarios. Se presenta el caso de una mujer de 23 años de edad con hipertiroidismo que en la ecografía aparece un nódulo tiroideo y adenopatía derecha, ambos con elementos sospechosos de malignidad, por lo que se pide punción de ambas estructuras, y se confirma el carcinoma papilar en el nódulo tiroideo, no así en la adenopatía. En el centellograma se observa un nódulo caliente que coincide con el nódulo maligno. Se realiza biopsia intraoperatoria de la adenopatía sospechosa y resulta ser una metástasis de carcinoma papilar. Se procedió a la tiroidectomía total con vaciamiento ganglionar central y lateral derecho. La anatomía patológica confirmó la presencia del carcinoma papilar clásico con metástasis de la adenopatía sospechosa. Posteriormente se administraron 130 mCi de radioyodo. Se debe considerar que los carcinomas pueden enmascararse ocasionalmente como nódulos «calientes¼ en el centellograma y en este caso, si bien en principio no estaría indicada la punción con aguja fina del nódulo dado que es hipercaptante en el centellograma, la ecografía demuestra elementos sospechosos contundentes de malignidad. En este caso el hilo conductor fue la ecografía y se rompió con el esquema clásico en la solicitud de estudios paraclínicos, obteniendo finalmente la confirmación diagnóstica de un cáncer y se realizó el tratamiento adecuado del mismo.


Thyroid nodules are usually benign in more than 95% of cases and euthyroid. The likelihood of thyroid cancer in hyperthyroidism is low. When dealing with a thyroid nodule the importance lies in excluding malignant pathology, but order must be maintained in the study algorithm to avoid an incorrect diagnosis and to fall into unnecessary costs. We present the case of a 23-year-old woman with hyperthyroidism who presented a thyroid nodule and right adenopathy on ultrasound, both with suspicious elements of malignancy, so puncture of both structures was requested, and papillary carcinoma was confirmed in the thyroid nodule, but not in adenopathy. In the scintigraphy a hot nodule is observed that coincides with the malignant nodule. Intraoperative biopsy of the suspected adenopathy is performed and it turns out to be a metastasis of papillary carcinoma. Total thyroidectomy was performed with central and right lateral lymph node dissection. The pathological anatomy confirmed the presence of classic papillary carcinoma with metastasis of the suspected adenopathy. Subsequently, 130 mCi of radioiodine was administered. It should be considered that carcinomas can occasionally be masked as «hot¼ nodules in the scintigraphy and in this case, although in principle the fine needle puncture of the nodule is not indicated given that it is hypercaptant in the scintigraphy, the ultrasound shows blunt suspicious elements of malignancy. In this case, the common thread was ultrasound and it was broken with the classic scheme in the request for paraclinical studies, finally obtaining the diagnostic confirmation of a cancer and the appropriate treatment was carried out.


Assuntos
Humanos , Feminino , Adulto Jovem , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Carcinoma Papilar/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico por imagem , Tireoidectomia , Neoplasias da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/patologia , Carcinoma Papilar/cirurgia , Carcinoma Papilar/patologia , Cintilografia , Ultrassonografia , Nódulo da Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/patologia , Pertecnetato Tc 99m de Sódio , Hipertireoidismo
14.
Diagn Interv Radiol ; 25(4): 251-256, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31147310

RESUMO

PURPOSE: We aimed to investigate multimodality imaging findings of intraductal tubulopapillary neoplasms (ITPN) of the pancreas. METHODS: This study was approved by the institutional review board with waived informed consent. A total of eight patients were histopathologically diagnosed with pancreatic ITPN in a single institution over a 6-year period. The imaging findings of dynamic contrast-enhanced computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasonography (EUS), and positron emission tomography-computed tomography (PET-CT) were reviewed and correlated with clinicopathologic findings. RESULTS: Histopathologically, an invasive carcinoma component was found in 5 of 8 patients (62.5%). The median diameter of the lesions and the main pancreatic ducts were larger in ITPN with invasive carcinoma (19 mm, 13.3-98.0 mm and 13 mm, 5.9-16.3 mm, respectively) than in ITPN without invasive carcinoma (13 mm, 12.7-18.5 mm and 6 mm, 5.6-6.1 mm, respectively), but not significantly (lesions, P = 0.229 and main pancreatic ducts, P = 0.143). Pancreatolithiasis accompanied invasive carcinoma in 3 of 5 patients (60%). Intraductal solid tumors were demonstrated on CT (5/8, 62.5%), MRCP (5/7, 71.4%), and EUS (7/7, 100%). In addition, various imaging findings mimicking chronic autoimmune pancreatitis or pancreatic ductal adenocarcinoma were found in 3 patients (37.5%) on multimodality imaging. The lesion multiplicity and synchronous or metachronous biliary cancer occurred in 3 patients (37.5%), respectively. CONCLUSION: Patients with associated invasive carcinoma from pancreatic ITPN may have presented a trend toward larger tumor size and dilated pancreatic duct with pancreatoliths, but the difference was not statistically significant. Further studies with a larger number of patients are needed to provide better insight into these findings. Pancreatic ITPN can show various atypical imaging findings as well as typical intraductal solid tumor on multimodality imaging. The presence of lesion multiplicity and synchronous or metachronous biliary cancer can be helpful for assisting with the diagnosis of pancreatic ITPN.


Assuntos
Carcinoma Ductal Pancreático/diagnóstico por imagem , Imagem Multimodal/métodos , Pâncreas/diagnóstico por imagem , Adulto , Idoso , Carcinoma Ductal Pancreático/patologia , Carcinoma Papilar/diagnóstico por imagem , Carcinoma Papilar/patologia , Colangiopancreatografia por Ressonância Magnética , Endossonografia , Feminino , Humanos , Litíase/complicações , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/diagnóstico por imagem , Invasividade Neoplásica/patologia , Pâncreas/patologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
15.
Pancreatology ; 19(5): 699-709, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31227367

RESUMO

BACKGROUND: Solid pseudopapillary neoplasms (SPN) are rare and represent approximately 4% of all cystic pancreatic tumors. The prognosis is excellent, although 10-15% of SPN patients show metastasis at the time of surgery or tumor recurrence during follow-up after pancreatectomy. Aim of the study was to analyze surgical management, risk factors for malignancy as well as long-term outcome and prognosis of this distinct tumor entity. METHOD: All patients with pancreatic resection for SPN between 10/2001 and 07/2018 in the authors' institution were identified from a prospective database. Clinicopathologic details, perioperative data and long-term follow-up results were retrospectively analyzed. RESULTS: Fifty-two patients were identified, 44 (85%) of them were female and the median age was 29 years (IQR 9-71). Seven (13%) patients showed a malignant behaviour of SPN with N1 (n = 2) or M1 (n = 1) disease at resection; 5 patients developed tumor recurrence, after a median of 21 months. During follow-up time (median 54 months) all patients were alive, the 5- and 10-year rates for disease-free survival were 89.0% and 81.6%, respectively. Significant risk factors for recurrence were age <18 years (p = 0.0087) and parenchyma-preserving surgical approaches (p = 0.0006). The postoperative long-term outcome showed ECOG = 0-1 in all patients, with resection related exocrine insufficiency in 20 (41%) and diabetes mellitus in 2 (4%) patients. CONCLUSIONS: Age < 18 years is a significant risk factor for malignancy in SPN, and parenchyma preserving resections harbor a significant risk for tumor recurrence. As recurrence may occur late, a systematic life-long follow-up should be performed.


Assuntos
Carcinoma Papilar/cirurgia , Pancreatectomia/métodos , Neoplasias Pancreáticas/cirurgia , Adolescente , Adulto , Fatores Etários , Idoso , Carcinoma Papilar/diagnóstico por imagem , Carcinoma Papilar/patologia , Pré-Escolar , Bases de Dados Factuais , Intervalo Livre de Doença , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/patologia , Pancreaticoduodenectomia , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
16.
Nuklearmedizin ; 58(3): 258-264, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31075799

RESUMO

INTRODUCTION: Thyroid scintigraphy with 99mTc-methoxyisobutylisonitrile (MIBI) is a helpful tool for the risk stratification of thyroid nodules (TN). Whereas a nodule with low or hypointense MIBI uptake has a low risk for malignancy, a hyperintense uptake may indicate a malignant nodule, which requires surgical resection. The appropriate diagnostic or therapeutic regimen of an isointense nodule with an uptake similar to the paranodular tissue is discussed controversially. Aim of this study was to assess the interobserver agreement (IA) for the assignment of TN to the three categories: hypo-, iso-or hyperintense. METHODS: Retrospective analysis of planar and SPECT images of MIBI scintigraphy was performed in 36 randomly selected patients with hypofunctioning TN and histological diagnosis. Four observers with different levels of experience in MIBI-scintigraphy analyzed MIBI uptake and assigned the nodules to the appropriate category. To assess the IA, Fleiss' Kappa was calculated. RESULTS: The study cohort included 11 patients with papillary thyroid carcinoma (diameter 20.3 mm) and 25 patients with benign nodules (diameter 24.8 mm). The IA for all nodules using planar images was 0.76 compared to 0.80 for SPECT images. The IA was better in the subgroup of malignant nodules for planar images as well as SPECT images (Kappa 0.91 and 0.90, respectively) compared to benign nodules (0.65 and 0.76, respectively). Using SPECT images, only one thyroid carcinoma presented with hypointense uptake, the remainder with hyper- or isointense uptake. In contrast, benign nodules were found in all categories. CONCLUSION: MIBI scintigraphy shows a good IA for the interpretation of thyroid carcinoma. The IA is further improved if MIBI scintigraphy is performed in SPECT technique.


Assuntos
Carcinoma Papilar/patologia , Cintilografia/métodos , Tecnécio Tc 99m Sestamibi/metabolismo , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/patologia , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Carcinoma Papilar/diagnóstico por imagem , Seguimentos , Humanos , Variações Dependentes do Observador , Prognóstico , Compostos Radiofarmacêuticos/metabolismo , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico por imagem
17.
Medicine (Baltimore) ; 98(19): e15609, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31083255

RESUMO

Thyroidectomy or hemithyroidectomy may be performed as treatment for papillary thyroid microcarcinoma (PTMC). However, in cases of bilateral PTMCs, only thyroidectomies should be recommended. Sometimes bilateral PTMC may be undetected in presurgical evaluations, so reoperation might be necessary after a partial thyroid resection. The aim of this study was to assess the occurrence of and predictive factors for the multifocality and bilaterality of PTMCs.We performed a retrospective review of 4716 consecutive patients with thyroid tumors. Of these patients, 434 (9.2%) had thyroid malignancies. All patients underwent thyroidectomies with central and/or lateral lymph node dissection between January 2008 and December 2017. PTMC was identified in 177 (3.75%) individuals.Solitary PTMC was observed in 114 (64.4%) patients, multifocal PTMC was seen in 48 (27.1%) patients, and bilateral PTMC was detected in 15 (8.5%) patients. The occurrence of solitary PTMC increased from 11.1% in 2008 to 61.9% in 2017. The occurrence of multifocal tumors significantly decreased from 77.8% in 2008 to 6.3% to 18.4% in 2013 to 2016 (P < .05). The occurrence of bilateral tumors, with respect to all PTMC cases, did not change during the 10-year period. We observed significantly higher rates of hypoechogenicity, more microcalcifications, more irregular margins, larger tumor sizes, and higher vascularity in the patients with multifocal and bilateral tumors than in the patients with solitary tumors (P < .0001 for all).The occurrence of bilateral PTMC is not very common. In patients with PTMC, thyroidectomy should be considered when microcalcifications, an irregular tumor shape, unclear margins, hypoechogenicity, high vascularity, and a large tumor size are observed. These clinicopathological features are prognostic factors for multifocal and bilateral PTMC.


Assuntos
Carcinoma Papilar/epidemiologia , Carcinoma Papilar/patologia , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/patologia , Carcinoma Papilar/diagnóstico por imagem , Carcinoma Papilar/cirurgia , Feminino , Humanos , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Ultrassonografia
18.
Exp Clin Transplant ; 17(2): 259-262, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30945630

RESUMO

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.


Assuntos
Carcinoma Papilar/diagnóstico por imagem , Neoplasias Renais/diagnóstico por imagem , Transplante de Rim/efeitos adversos , Ultrassonografia Doppler em Cores , Urotélio/diagnóstico por imagem , Adulto , Carcinoma Papilar/etiologia , Carcinoma Papilar/patologia , Carcinoma Papilar/cirurgia , Humanos , Neoplasias Renais/etiologia , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Masculino , Gradação de Tumores , Nefrectomia , Valor Preditivo dos Testes , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Urotélio/patologia , Urotélio/cirurgia
19.
Breast J ; 25(3): 393-400, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30945398

RESUMO

Benign papillary and sclerosing lesions of the breast (intraductal papillomas, complex sclerosing lesions, radial scars) are considered high-risk lesions due to the potential for upgrade to carcinoma on subsequent surgical excision. Optimal clinical management of such lesions remains unclear due to variable reported upgrade rates. Apocrine metaplasia is a common finding in breast tissue and its role in MRI enhancing lesions is increasingly being recognized. The purpose of this study was to investigate the MRI features of papillary and sclerosing lesions of the breast, evaluate the clinical management and upgrade rate of such lesions, and examine the contribution of apocrine metaplasia to the imaging findings. A 13-year retrospective review of MRI-guided biopsies identified 70 MRI-detected and -biopsied papillary and sclerosing lesions. Sixteen lesions without atypia underwent surgical excision; only one case (6%) was upgraded to pleomorphic lobular carcinoma in situ. The majority (64%) of biopsies contained apocrine metaplasia either within or adjacent to the targeted lesion. We found that half of MRI-detected lesions had T2 hyperintense foci (2-5 mm) or masses (>5 mm) adjacent to the lesion. Histologic correlation showed apocrine cysts were likely responsible for this imaging finding in 56% of these cases.


Assuntos
Doenças Mamárias/diagnóstico por imagem , Doenças Mamárias/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Mamárias/cirurgia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/patologia , Carcinoma Intraductal não Infiltrante/cirurgia , Carcinoma Papilar/diagnóstico por imagem , Carcinoma Papilar/patologia , Carcinoma Papilar/cirurgia , Feminino , Seguimentos , Humanos , Biópsia Guiada por Imagem , Imagem por Ressonância Magnética , Glândulas Mamárias Humanas/diagnóstico por imagem , Glândulas Mamárias Humanas/patologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Esclerose
20.
Cancer Imaging ; 19(1): 16, 2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30894228

RESUMO

BACKGROUND: Over the past ten years, more papillary thyroid microcarcinoma (PTMC) has been diagnosed more frequently due to the development of imaging technology, and the incidence of PTMC has increased significantly. Ultrasound-guided percutaneous laser ablation (PLA) is mainly used for benign thyroid nodules, and few studies have been published on the use of PLA for PTMC. In the present study, a retrospective analysis was performed to explore the efficacy of PLA for PTMC. METHODS: A total of 37 patients with PTMC who underwent PLA were included in this study. Measurement of the lesion volume and serum thyroid hormone levels and clinical evaluation were performed at 1, 3, 6, and 12 months and every 6 months thereafter. RESULTS: We found that all patients were successfully treated with PLA without serious complications. At the last follow-up visit, 12/37 (32.4%) primary lesions had disappeared, and 24/37 (64.9%) remained as cicatricial hyperplasia. One patient (2.7%) had cervical lymph node metastasis at 24 months post-operatively and underwent open surgery. CONCLUSION: Our initial studies suggest that ultrasound-guided PLA is a safe and effective treatment for PTMC.


Assuntos
Carcinoma Papilar/cirurgia , Terapia a Laser , Neoplasias da Glândula Tireoide/cirurgia , Adulto , Idoso , Carcinoma Papilar/diagnóstico por imagem , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Resultado do Tratamento , Ultrassonografia de Intervenção , Adulto Jovem
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