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1.
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
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.
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
4.
Medicine (Baltimore) ; 98(45): e17859, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702649

RESUMO

BACKGROUND: To investigate the diagnostic performance of cytology (fine-needle aspiration cytology [FNAC]), thyroglobulin (fine-needle aspiration thyroglobulin [FNA-Tg]), and combination of them in the washout of fine-needle aspiration for those patients who have suspicious metastatic lymph nodes of differentiated thyroid cancer. METHODS: Databases, including PubMed, EMbase, Web of Science and Cochrane Library were searched up to June 2019. The quality assessment of diagnostic accuracy scale-2 was used to conduct quality assessments, and publication bias was evaluated using the Deeks funnel plot. STATA version 14.0 was used to perform the meta-analysis. RESULTS: A total of 2257 patients with 2786 samples of suspicious metastatic lymph nodes of differentiated thyroid cancer were included in the meta-analysis. The results showed that the diagnostic value for detecting lymph node metastasis of differentiated thyroid cancer was as follows: combination of FNAC and FNA-Tg > FNA-Tg > FNAC. All differences of superiority among them are statistically significant. The sensitivity of the combination was 0.968 (95% confidence interval [CI]: 0.942-0.983), the specificity was 0.932 (95% CI: 0.856-0.969), the diagnostic score was 6.036 (95% CI: 4.892-7.181), the diagnostic odds ratio was 418.424 (95% CI: 133.167-1314.729), and the score of summary receiver operating characteristic was 0.99 (95% CI: 0.97-0.99). CONCLUSIONS: The combination of FNAC and FNA-Tg is an excellent procedure in diagnosis of lymph nodes metastasis of patients with differentiated thyroid cancer, which should be highly recommended.


Assuntos
Carcinoma Papilar/patologia , Metástase Linfática/patologia , Tireoglobulina/análise , Neoplasias da Glândula Tireoide/patologia , Área Sob a Curva , Biomarcadores Tumorais/análise , Biópsia por Agulha Fina , Humanos , Metástase Linfática/diagnóstico , Valor Preditivo dos Testes
5.
Indian J Pathol Microbiol ; 62(4): 544-548, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31611437

RESUMO

Context: Atypia of undetermined significance/Follicular lesion of undetermined significance [AUS/FLUS] is a heterogeneous category with a wide range of risk of malignancy [ROM] reported in the literature. The Bethesda system for reporting thyroid cytopathology [TBSRTC], 2017 has recommended subcategorization of AUS/FLUS. Aims: To evaluate the ROM in thyroid nodules categorized as AUS/FLUS, as well as separate ROM for each of the five subcategories. Settings and Design: Retrospective analytic study. Methods and Materials: A retrospective audit was conducted for all thyroid fine-needle aspiration cytology (FNAC) from January 2013 to December 2017. Slides for cases with follow-up histopathology were reviewed, classified into the five recommended subcategories, and differential ROM was calculated. Statistical Analysis Used: z test for comparison of proportions was done to evaluate the difference in ROM among different subcategories of AUS/FLUS. The P value of less than 0.05 was taken as statistically significant. Results: Total number of thyroid FNACs reported was 1,630, of which 122 were AUS/FLUS (7.5%). Histopathology was available in 49 cases, out of which 18 were malignant (ROM = 36.7%). The risk of malignancy (ROM) for nodules with architectural and cytologic atypia was higher (43.8%) than ROM for nodules with only architectural atypia (16.7%). Conclusions: The sub-classification of AUS/FLUS into subcategories as recommended by TBSRTC, 2017 may better stratify the malignancy risk and guide future management guidelines.


Assuntos
Neoplasias , Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/classificação , Nódulo da Glândula Tireoide/patologia , Biópsia por Agulha Fina , Carcinoma Papilar/patologia , Humanos , Estudos Retrospectivos , Fatores de Risco , Neoplasias da Glândula Tireoide/patologia
6.
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
7.
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
8.
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
9.
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
10.
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
11.
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
12.
Int J Mol Sci ; 20(18)2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31514388

RESUMO

The thyroid is a major component of the endocrine system and its pathology can cause serious diseases, e.g., papillary carcinoma (PC). However, the carcinogenic mechanisms are poorly understood and clinical useful biomarkers are scarce. Therefore, we determined if there are quantitative patterns of molecular chaperones in the tumor tissue and circulating exosomes that may be useful in diagnosis and provide clues on their participation in carcinogenesis. Hsp27, Hsp60, Hsp70, and Hsp90 were quantified by immunohistochemistry in PC, benign goiter (BG), and normal peritumoral tissue (PT). The same chaperones were assessed in plasma exosomes from PC and BG patients before and after ablative surgery, using Western blotting. Hsp27, Hsp60, and Hsp90 were increased in PC in comparison with PT and BG but no differences were found for Hsp70. Similarly, exosomal levels of Hsp27, Hsp60, and Hsp90 were higher in PC than in BG, and those in PC were higher before ablative surgery than after it. Hsp27, Hsp60, and Hsp90 show distinctive quantitative patterns in thyroid tissue and circulating exosomes in PC as compared with BG, suggesting some implication in the carcinogenesis of these chaperones and indicating their potential as biomarkers for clinical applications.


Assuntos
Exossomos/metabolismo , Proteínas de Choque Térmico/metabolismo , Glândula Tireoide/imunologia , Glândula Tireoide/patologia , Carcinoma Papilar/imunologia , Carcinoma Papilar/metabolismo , Carcinoma Papilar/patologia , Exossomos/ultraestrutura , Feminino , Bócio/metabolismo , Bócio/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Glândula Tireoide/metabolismo
13.
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
14.
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
15.
Ann Surg Oncol ; 26(11): 3709-3710, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31407182

RESUMO

BACKGROUND: Solid pseudopapillary tumors (SPPTs) are low malignant potential entities found mainly in young females.1,2 Pancreatectomy without tumor rupture is the treatment of choice, and the laparoscopic approach is indicated.3,4 Limited pancreatectomy is possible due to the low risk of malignancy (< 10%) based on the low risk of lymph node invasion or true vascular invasion.1,2 Centrally located large SPPTs can be treated by extended central pancreatectomy with or without vascular resection to avoid pancreatoduodenectomy or distal pancreatectomy. METHODS: A 24-year-old woman was admitted with abdominal pain. A 6-cm SPPT was discovered at the neck-body junction in close contact with the anterior aspect of the mesentericoportal vein (MPV) and the splenic vessels, with signs of segmental portal hypertension. To avoid an extended pancreatectomy for this young patient, an extended central pancreatectomy was performed, with resection of the splenic vessels, and the MPV was freed from the tumor under clamping for 10 min, with no need for vascular reconstruction. The duration of the surgery was 260 min, with 200 ml of blood loss and no transfusion. RESULTS: The woman's postoperative course was uneventful, with a hospital stay of 16 days. Histology confirmed the diagnosis of a 6-cm SPPT tumor (R0 and N0). The patient was asymptomatic 1 year later, with no tumor recurrence and no pancreatic insufficiency. Between 2011 and 2018 the authors performed 72 laparoscopic central pancreatectomies, with SPPT performed for 13 patients (18%). Laparoscopic central pancreatectomy was extended (n = 5) or standard (n = 8) with no conversion, no recurrence, and no pancreatic insufficiency. CONCLUSION: An SPPT tumor is a good indication for the laparoscopic approach because this entity is found in young patients with a low risk of malignancy. Large centrally located tumors can be treated by extended central pancreatectomy to avoid a large pancreatectomy with greater early and long-term disadvantages.


Assuntos
Carcinoma Papilar/cirurgia , Laparoscopia/métodos , Veias Mesentéricas/cirurgia , Neoplasias Pancreáticas/cirurgia , Veia Porta/cirurgia , Baço/cirurgia , Adulto , Carcinoma Papilar/patologia , Feminino , Humanos , Veias Mesentéricas/patologia , Neoplasias Pancreáticas/patologia , Veia Porta/patologia , Prognóstico , Baço/patologia , Instrumentos Cirúrgicos , Adulto Jovem
16.
J Surg Oncol ; 120(6): 1023-1030, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31407354

RESUMO

BACKGROUND: Papillary thyroid microcarcinoma exhibits an indolent clinical course and could be a candidate for active surveillance in the appropriate setting. It remains unknown whether papillary microcarcinoma is biologically different from larger papillary carcinoma >1 cm. METHODS: We analyzed clinicopathological information and transcriptome data of papillary thyroid cancer samples from The Cancer Genome Atlas. Propensity-score matching was used to construct a matched cohort consisting of 29 microcarcinomas and 58 carcinomas. Principal component analysis and unsupervised hierarchical cluster analysis were carried out to investigate the similarity of gene expression profiles. RESULTS: After adjustment for differences in baseline clinicopathological and genetic factors, transcriptome could be grouped mainly on the basis of tumor class (BRAF-like vs RAS-like) and tumor size (microcarcinoma vs carcinoma). The gene set enrichment analysis showed that extracellular matrix-associated pathways were enriched in the MSigDB database. CONCLUSION: Papillary thyroid microcarcinomas display a distinct gene expression pattern different from the corresponding carcinomas. We hypothesize that tumor microenvironment may play a role in the microcarcinoma/carcinoma phenotypic divergence.


Assuntos
Biomarcadores Tumorais/genética , Carcinoma Papilar/patologia , Pontuação de Propensão , Neoplasias da Glândula Tireoide/patologia , Transcriptoma , Adulto , Carcinoma Papilar/classificação , Carcinoma Papilar/genética , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Mutação , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Neoplasias da Glândula Tireoide/classificação , Neoplasias da Glândula Tireoide/genética
17.
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
19.
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
20.
Ann Endocrinol (Paris) ; 80(4): 229-233, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31400862

RESUMO

CONTEXT: Yearly incidence of thyroid cancer has nearly tripled in the past four decades, due to improvements in and better use of diagnostic procedures, enabling detection of smaller tumors, and notably micropapillary carcinoma (MPC: ≤10 mm). OBJECTIVES: The aim of our study was to confirm increasing incidence, to describe the characteristics and circumstances of discovery, and to examine the reasons for this rise in incidence of MPCs, based on the French Marne-Ardennes registry for 1975-2014. DESIGN: This was a retrospective observational cohort study. RESULTS: Two thousand six hundred and seventy-one patients with thyroid cancer were included for the period 1975-2014, with 966 (36.2%) MPCs. The percentage increased from 18.9% for 1975-1984 to 45.1% for 2005-2014. Standardized incidence per 100,000 patient-years increased from 0.86 for 1975-1984 to 6.20 for 2005-2014. Incidence increase was higher in women (ranging from 1.15 to 8.91) than in men (from 0.20 to 2.54). Incidence increased more in ≥50 year-olds (from 0.41 to 4.21) than in <50 year-olds (from 0.45 to 1.99). Most MPCs (84.6%) were discovered incidentally on histology, and were mainly unifocal (79.4%). Incidental MPCs were smaller, affected older patients and were less multifocal than those suspected before surgery. MPCs were associated with excellent survival and low morbidity, with <1.9% progression. CONCLUSION: The present study confirmed the large rise in incidence of MPCs reported elsewhere. Most MPCs were discovered incidentally on histological examination in the context of surgery for benign pathology. Changes in access to health care and in physicians' and pathologists' practices are likely explanations for our findings.


Assuntos
Carcinoma Papilar/epidemiologia , Neoplasias da Glândula Tireoide/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Papilar/patologia , Estudos de Coortes , Feminino , França/epidemiologia , História do Século XX , História do Século XXI , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/patologia , Carga Tumoral
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