Ultrasonographic Detective Flow Imaging for Evaluating Parathyroid Adenoma in Patients with Primary Hyperparathyroidism.

BACKGROUND: Detective flow imaging (DFI) is a new imaging technology that displays low-velocity blood flow, which is difficult to visualize on conventional color Doppler ultrasonography (CDU). In this study, we compared the usefulness of DFI with that of CDU and methoxy-isobutyl-isonitrile (MIBI) scintigraphy for detecting parathyroid adenoma (PA) in patients with primary hyperparathyroidism (PHPT). METHODS: From March 2021 to March 2023, 87 PHPT patients underwent surgery, and 66 had a single PA. We performed preoperative conventional ultrasonography with CDU, MIBI scintigraphy, and DFI for 42 patients (5 males and 37 females; mean age: 61.6 ± 15.4 years). RESULTS: MIBI scintigraphy detected PA in 85.7% (36/42) patients, and both CDU and DFI detected PA in all patients. The rates of vascularity in PA detected by CDU and DFI were 71.4% (30/42) and 85.7% (36/42), respectively. Vascularity was detected by DFI in 6 patients who were negative for vascularity on MIBI scintigraphy. Furthermore, DFI detected blood supply in 6 of the 12 patients with undetectable blood supply on CDU. Fisher's exact test revealed that high or low blood flow, as determined by DFI, was significantly associated with detection of feeding vessels in PA by CDU (P < 0.001). CONCLUSIONS: DFI was useful for preoperative detection of PA blood flow.

Downhill Varices in the Hypopharynx of a Patient with a Large Thyroid Tumor: A Case Report.

Downhill varices are usually caused by superior vena cava (SVC) obstruction due to bronchogenic carcinoma or mediastinal tumors. These structures exhibit retrograde blood flow and are located in the proximal esophagus. Varices in the hypopharynx resulting from mediastinal thyroid tumor are extremely rare. A 70-year-old man with a 35-year history of a growing thyroid tumor on the right side of his neck visited a local hospital. Fine-needle aspiration cytology of the tumor revealed benign goiter. Contrast-enhanced computed tomography showed a huge tumor (13 × 10 × 5 cm) in the right to left lobe of the thyroid that extended into the mediastinum. A well-enhanced mass mimicking hypopharyngeal cancer was identified in the hypopharynx. Endoscopic examination showed varices in the postcricoid region, so biopsy was contraindicated. The preoperative diagnosis was adenomatous goiter and hypopharyngeal varices caused by obstruction of the internal jugular and brachiocephalic vein by the goiter. Total thyroidectomy was performed and the hypopharyngeal varices had disappeared by the next day. The histopathological diagnosis of the thyroid tumor was poorly differentiated carcinoma. Mediastinal thyroid tumor rarely causes downhill varices due to SVC obstruction. However, signs of SVC obstruction were absent in this case, and varices were present in the hypopharynx, not in the upper esophagus. Obstructed venous flow from the thyroid plexus might circulate via the superior laryngeal vein and cause varices in the postcricoid region. When a patient with a large mediastinal tumor has a tumor-like lesion in the hypopharynx, downhill varices should be considered before scheduling a biopsy.

RNA recovery from specimens of duct-washing cytology performed contemporaneously with mammary ductoscopy.

OBJECTIVE: Conventional cytological diagnosis including duct-washing cytology (DWC) is sometimes performed using ductal epithelial cells collected during mammary ductoscopy; it is useful for detection of early-stage breast cancer such as ductal carcinoma in situ (DCIS). However, conventional cytological diagnosis focuses exclusively on cellular morphology; false negatives and false positives may be caused by inadequate specimen preparation (triggering cell degeneration) or poor examiner diagnostic skills. Molecular diagnosis using RNA biomarkers is expected to compensate for the weaknesses of cytological diagnosis. We previously employed microarray analysis to identify highly expressed genes in DCIS, suggesting that they may be useful for DCIS diagnosis. Here, we explored whether DWC samples yielded RNA of sufficient quantity and quality for RNA biomarker-based diagnosis. RESULTS: We extracted RNAs from 37 DWC samples. RNA from 12 samples exhibited RNA integrities of ≥ 6, indicative of moderate-to-high quality. We then showed that cocaine and amphetamine regulated transcript prepropeptide (CARTPT) and breast cancer-associated transcript 54 (BRCAT54) mRNA-previously shown by microarray analysis to be highly expressed in DCIS-were detectable in these samples. Therefore, DWC samples may be useful for molecular diagnosis involving RNA biomarkers.

Usefulness of ultrasonographic detective flow imaging to diagnose parathyroid tumors: two case reports.

Parathyroid tumors (PTs) are sometimes difficult to diagnose because they are small and have a low-velocity blood flow, which can be missed by current imaging modalities. PTs consist of parathyroid adenoma (PA), parathyroid cyst, and parathyroid carcinoma (PC). Detective flow imaging (DFI) is a new imaging technology that displays a low-velocity blood flow. Herein, we report two cases in which DFI was useful for the diagnosis of PTs. One case consisted of a PA and a parathyroid cyst in close proximity, and the other was a PC. To the best of our knowledge, this is the first report to demonstrate the usefulness of DFI in the diagnosis of PTs.

Microarray analysis of ductal carcinoma in situ samples obtained by puncture from surgical resection specimens.

OBJECTIVE: The incidence of ductal carcinoma in situ (DCIS) is increasing due to more widespread mammographic screening. DCIS, the earliest form of breast cancer, is non-invasive at the time of detection. If DCIS tissues are left undetected or untreated, it can spread to the surrounding breast tissue. Thus, surgical resection is the standard treatment. Understanding the mechanism underlying the non-invasive property of DCIS could lead to more appropriate medical treatments, including nonsurgical options. DATA DESCRIPTION: We conducted a microarray-based genome-wide transcriptome analysis using DCIS specimens obtained by puncture from surgical specimens immediately after surgery.

Macrofollicular variant of papillary thyroid carcinoma: its clinicopathological features and long-term prognosis.

Macrofollicular variant is a rare entity of papillary carcinoma. We previously demonstrated that this variant accounts for 0.3% of papillary carcinoma in Japan. In this study, we investigated the biological characteristics of 5 cases of macrofollicular variant. We reviewed the diagnosis and clinical course of 5 patients with macrofollicular variant. On preoperative ultrasonographic study, 2 cases were diagnosed as having benign nodule and the remaining 3 suspected of having papillary carcinoma, although they lacked typical ultrasonographic findings of papillary carcinoma. Cytological findings suggested papillary carcinoma for 3 cases and the remaining 2 were diagnosed as indeterminate. Based on both examinations, 4 of 5 patients were diagnosed as having or suspected of having papillary carcinoma. All patients underwent thyroidectomy with lymph node dissection. Three patients underwent central node dissection and the remaining 2 underwent modified radical neck dissection. None of these patients showed clinically apparent node metastasis or massive extrathyroid extension, although 3 of these patients had latent node metastasis confirmed by pathological examination. All patients survived with no evidence of carcinoma recurrence during follow-up (145-235 months). It is therefore suggested that patients with macrofollicular variant can be diagnosed as having or suspected of having papillary carcinoma if ultrasonographic and cytological examinations are appropriately performed and show an excellent prognosis possibly because this variant lacks the aggressive characteristics of papillary carcinoma.

The Reality of Multiple Endocrine Neoplasia Type 2B Diagnosis: Awareness of Unique Physical Appearance Is Important.

BACKGROUND: Multiple endocrine neoplasia type 2B (MEN2B) is an extremely rare syndrome mainly caused by RET918 germline mutations. MEN2B typically causes medullary thyroid carcinoma (MTC), pheochromocytoma, and unique physical characteristics including mucosal neuroma, distinctive facial appearance, and Marfanoid habitus. Most patients have abdominal symptoms such as bloating, intermittent constipation, and diarrhea. MTC is the most important determinant of mortality in patients with MEN2B. Establishing the diagnosis of MEN2B at a curative stage of MTC is crucial. CASE PRESENTATION: We have encountered four patients with MEN2B. Two were hereditary cases from the same family, and two were considered de novo cases with phenotypically normal parents. Mean age at diagnosis was 25.5 years (range, 13-39 years). Although all patients had shown mucosal neuroma on the lips and tongue, in addition to gastrointestinal symptoms from infancy, diagnoses were made from symptomatic MTC even for the hereditary patients (our index case was a 14-year-old girl, whose mother was subsequently diagnosed with advanced MTC). Genetic tests for RET mutations revealed the M918T mutation in all patients. Two patients developed pheochromocytoma, two died from distant metastases of MTC, and two received treatment for multiple metastases of MTC (one with vandetanib). CONCLUSIONS: In our patients with MEN2B, prophylactic or early thyroidectomy could not be performed. The characteristic phenotype associated with MEN2B is almost always seen prior to detection of MTC or pheochromocytoma. Knowledge about the non-endocrine manifestations of MEN2B needs to be shared among pediatricians and gastroenterologists.

Photodynamic identification of human parathyroid glands with 5-aminolevulinic acid.

Tumors synthesize fluorescent and photosensitizing endogenous protoporphyrin after administrations of 5-aminolevulinic acid (5-ALA). Localization of tumors and tumor-like lesions in various organs that are labeled with fluorescing porphyrins has thus developed into a diagnostic method. Intraoperative photodynamic detection of malignant gliomas is the most common application, and has been widely performed since 1998. Although several methods to identify parathyroid glands have been employed, photodynamic methods have not yet been used for this application. In 2004, Shimizu et al. showed that human parathyroid glands could be identified photodynamically with 5-ALA. We have performed photodynamic identification of human parathyroid glands in an additional 19 cases. In hyperparathyroidism, detection of morbid parathyroid glands is extremely important. On the other hand, the identification and preservation of normal parathyroid glands is important for preventing hypoparathyroidism after thyroid surgery. Our method allows the visualization of both morbid and normal parathyroid glands. We believe that intraoperative photodynamic identification of human parathyroid glands is feasible and practical, allowing less-invasive, more-precise neck surgery.

Trial of autotransplantation of cryopreserved thyroid tissue for postoperative hypothyroidism in patients with Graves' disease.

BACKGROUND: Some patients with Graves' disease who select surgical therapy so they can discontinue antithyroid medication require lifelong levo-thyroxin (l-T4) replacement therapy because of irreversible postoperative hypothyroidism. The aim of this study was to enable the replacement of absent thyroid hormone through autotransplanted thyroid tissue that had been cryopreserved since the initial thyroid operation, and to release these patients from lifelong l-T4 administration. STUDY DESIGN: At the time of subtotal thyroidectomy for Graves' disease, the surgical specimen was partially cryopreserved at -196 degrees C until it was used for autotransplantation. After obtaining sufficient informed consent, four patients with postoperative hypothyroidism underwent autotransplantation of cryopreserved thyroid tissues. These patients required 50 to 150 microg/day of l-T4 at 1.8, 3.4, 3.5, and 2.8 years after operation. For the transplantation, 2.5 to 3.5 g of cryopreserved thyroid tissue was autotransplanted into the forearm muscle of each patient. RESULTS: In three of the patients, l-T4 administration could be discontinued and the clinical symptoms of hypothyroidism disappeared because of an improved serum thyroid-stimulating hormone level. Pathologic and immunohistochemical examinations of the thawed cryopreserved tissue demonstrated well-preserved thyroid structure and thyroglobulin-positive follicular cells and colloids, suggesting that the transplanted material was functional. In addition, 123I scintiscanning in patients 1 and 2 indicated an accumulation of radioactive iodine at the transplantation sites. One patient, who was able to discontinue l-T4 administration for 6 months, subsequently required l-T4 again because of recurrent hypothyroidism. BACKGROUND: Despite a few remaining uncertainties that must be resolved before this procedure is optimized, autotransplantation of cryopreserved thyroid tissue promises to be a useful therapeutic procedure for treating permanent postoperative hypothyroidism in patients with Graves' disease.

Video-assisted minimally invasive endoscopic thyroid surgery using a gasless neck skin lifting method--153 cases of benign thyroid tumors and applicability for large tumors.

Endoscopic surgery is often considered to be 'minimally invasive surgery' in the light of recent developments. In particular, endoscopic endocrine neck surgery is desirable from a cosmetic viewpoint. Here we compared the usefulness of our original endoscopic method of video-assisted neck surgery (the VANS method) with conventional surgery when challenged with the removal of thyroid tumors measuring more than 5 cm in diameter, based on our experience with 167 cases (162 thyroid tumors, five parathyroid tumors). The percentage of patients who underwent the VANS method of the total number of patients who underwent neck surgery was determined and the operative procedures used in the different surgeries were analyzed. The operating time and blood loss for 153 benign thyroid tumors were statistically compared between the small-tumor group (n = 130, < 5 cm) and the large-tumor group (n = 23, > or = 5 cm). More than 60% of the benign and 5.3% of the malignant thyroid tumors were operated on by the VANS method. Near- or subtotal lobectomy was the most common procedure (64.1%) for benign tumors. Malignancy was defined as papillary carcinoma less than 1 cm in diameter. Total lobectomy with lymph node clearance was performed for all malignant tumors. Although the operating time and the blood loss were statistically greater in the large-tumor group than the small-tumor group, with increased experience it was possible to remove tumors of up to 7.4 cm safely. Our findings support the idea that the VANS method is feasible, practical, and safe, and has great cosmetic benefits, even for the removal of large benign tumors.

[Endocrine surgery: the tenth report. Diagnosis, surgical indications and operative strategy of renal hyperparathyroidism].

In Japan, there are many dialysis patients because of the successful development and wide application of dialysis techniques. Almost all patients require long-term hemodialysis treatment because kidney transplantation is performed rarely. Renal hyperparathyroidism is one of the serious complications for hemodialysis patients. According to the overview of regular dialysis treatment reported by the Japanese Society for Dialysis Therapy, parathyroidectomy is required in 9.2%of patients who remain on hemodialysis more than 10 years and in 33.5%of those who so remain for more than 25 years. In this paper, we will describe the diagnosis, surgical indications, and operative strategy of renal hyperparathyroidism. The symptoms and biochemical variables were high serum parathyroid hormone (PTH) level, hyperphosphatemia, bone and joints pain, itching, irritability, muscle weakness, severe skeletal deformity, progression of ectopic calcification, and anemia. The clinical indications for performing parathyroidectomy to treat renal hyperparathyroidism in our institute are based on the indications reported by Tominaga et al. These are 1) high serum PTH level, 2) detection of enlarged parathyroid glands, 3) detection of osteitis fibrosa cystica on radiography or detection of high bone turnover by bone metabolic markers or bone scintigram, 4) resistance of symptoms to medical treatment. The routine operative procedure for renal hyperparathyroidism is total parathyroidectomy with forearm autograft. For autotransplantation, 30 pieces sliced 1x1x3 mm of diffuse hyperplasia are implanted into 30 pockets in the forearm without arteriorvenous (A-V) fistula for hemodialysis. In any surgical procedure for renal hyperparathyroidism, it is crucial to identify all parathyroid glands, including supernumerary glands and ectopic glands. At the initial operation for renal hyperparathyroidism, the surgeon must remove all parathyroid glands to avoid persistent and recurrent hyperparathyroidism and choose proper and adequate parathyroid tissue for autograft.

[Endocrine surgery. The ninth report: the latest data on and clinical characteristics of the epidemiology of thyroid carcinoma].

Thyroid disease is comparatively prevalent, and it is important to perform careful palpation of the anterior neck when patients are first examined. In this paper, the latest data on and clinical characteristics of the epidemiology of thyroid carcinoma are described. According to Japanese cancer statistics, in 1996, the number of cases of thyroid carcinoma was 1,390 men and 5,437 women. The female to male ratio was 3.91: 1. The crude rate of thyroid carcinoma per 100,000 population was 2.3 men and 8.5 women. The age-adjusted incidence rate showed a gradual increase with age, and the peak of the age-adjusted incidence rate was over 80 years old among men, and from 70 to 80 years old among women. According to the Japanese Thyroid Cancer Registration Committee, from 1977 to 1999, papillary thyroid carcinoma accounted for more than 85% (30,256) of thyroid carcinomas among 35,312 patients. Medullary thyroid carcinoma (1.4%) and anaplastic thyroid carcinoma (1.6%) were rare. The female to male ratio of thyroid carcinoma was 6.1: 1. Registration was made in accordance with the general rules issued by the Japanese Society of Thyroid Surgery. According to the vital statistics, mortality related to thyroid carcinoma among all cancer-related deaths was 0.23% among men (411) and 0.76% among women (887) in 2000. The female to male ratio of mortality was 2.16: 1. The peak of mortality was from 70 to 80 years old among men, and from 80 to 90 years old among women. Most patients with differentiated thyroid carcinoma had a low mortality rate, but anaplastic carcinoma had a poor prognosis. Lung and bone were the main distant metastatic sites, and respiratory insufficiency was the most common specific fatal condition.

Surgical therapy in Hashimoto's thyroiditis.

Hashimoto's thyroiditis (HT) is usually considered to be manageable by levothyroxine (L-T4) administration, which can reduce the thyroid volume and supplement the lack of hormone. However, we sometimes encounter a huge goiter that has not shrunk in response to L-T4 therapy. These goiters continue to produce symptoms of compression and an unsightly appearance. Here we discuss the surgical indication and procedure for HT. Thirteen patients with clinically diagnosed Hashimoto's thyroiditis involving a huge diffuse goiter that produced pressure symptoms or nodular lesions were treated with surgery. The gender, age distribution, total dose and period of L-T4 administration prior to the operation, and clinical symptoms caused by the large goiter were evaluated in each case. The titer of antibodies was extremely elevated in 8 HT patients with a diffusely enlarged goiter. The total period of L-T4 medication ranged from 6 to 25 years. A subtotal thyroidectomy in which a small amount of thyroid was left in the posterior area of the bilateral lobes was performed in the 8 cases of diffusely enlarged goiter. Pressure symptoms and the unsightly appearance caused by the goiter were relieved by the surgery in all cases. No surgical complications developed. In conclusion, the surgery is an effective therapy for HT patients who have persistent compression symptoms and/or an unsightly neck appearance due to a large goiter despite long-term L-T4 treatment.

Immunohistochemical, biochemical and immunoelectron microscopic analysis of antigenic proteins on neuroendocrine cell tumors using monoclonal antibody HISL-19.

The monoclonal antibody HISL-19 was originally generated after immunizing BALB/c mice with human islet cells. We used this antibody to study a wide variety of neuroendocrine (NE) and non-NE tumors by immunohistochemical, immunoelectron microscopic, and biochemical (Western blotting) techniques. Of the thyroid tumors, HISL-19 specifically immunoreacted with medullary carcinoma of the thyroid (MCT); of the pancreatic tumors, it reacted with islet cell tumors such as insulinomas and a gastrinoma; of the adrenal tumors, it reacted with pheochromocytoma. HISL-19 showed particularly strong immunoreactivity to a gross granular material at the perinuclear area in the MCT and malignant pheochromocytoma but not in the benign pheochromocytoma, although the latter cells showed a faint and homogenous positive reactivity in the cytoplasm. The strongly HISL-19-positive material was found to consist of newly synthesized antigenic proteins with a molecular weight between 60 and 65 kilodaltons (kDa) by Western blotting. Immunoelectron microscopic analysis revealed that this antigenic protein was located in the secretory granules that appear markedly in malignant endocrine tumors, usually located close to the nucleus. Thus, HISL-19 is a useful and specific marker for the immunohistochemical diagnosis of NE cell tumors. The specific antigenic proteins of HISL-19 were defined in MCT and malignant pheochromocytoma. These proteins are speculated to be actively synthesized and more highly produced in the secretory granules of malignant endocrine tumors than benign ones. Thus, a preoperative immunohistochemical study using HISL-19 might be useful for predicting the grade of malignancy of endocrine malignant tumors and thus help determine an appropriate operative procedure, in addition to being a useful marker of neuroendocrine cell tumors.

[Indications for and limitations of endoscopic thyroid surgery].

Endoscopic thyroid surgery has become a common procedure in recent years, mainly because of its cosmetic advantages. Generally two methods are used to obtain a working space: CO2 insufflation and anterior neck skin lifting. The incision sites for approaching the thyroid are the chest wall, mammary areolar area, axillary and submandibular area, in addition to the neck. Among the new operative devices, the ultrasonically activated scalpel has contributed to the development of endoscopic thyroid surgery. Based on our experience of more than 180 cases using our original endoscopic method, video-assisted neck surgery(the VANS method), we here report the clinical outcome and usefulness of the method. The operating time and blood loss in patients with 161 benign thyroid tumors were statistically compared between the small-tumor group (n = 138, < 5 cm) and the large-tumor group (n = 23, > or = 5 cm). More than 60% of the benign and 7.1% of the malignant thyroid tumors were operated on using the VANS method. Near or subtotal lobectomy was the most common procedure (64.4%) for benign tumors. Malignancy was defined as a papillary carcinoma < 1 cm in diameter. Total lobectomy with lymph node clearance was performed for all malignant cases. Although the operating time and blood loss were statistically greater in the large-tumor group than the small-tumor group, with increased experience it was possible to remove tumors of up to 7.4 cm safely. Our findings show that the VANS method is feasible, practical, and safe, and has great cosmetic benefits. However, it must be remembered that the intrinsic surgical goal of treatment should not be compromised in the pursuit of less-invasive surgery. Care must be taken to select appropriate patients carefully and to train surgeons sufficiently in the techniques required.

Identification of pathological and normal parathyroid tissue by fluorescent labeling with 5-aminolevulinic acid during endocrine neck surgery.

BACKGROUND: When performing parathyroid or thyroid surgery, surgeons must distinguish parathyroid tissue from the surrounding thyroid tissue, to preserve healthy parathyroid tissue while excising diseased thyroid tissue or to completely remove pathological parathyroid lesions. Here, we explored the feasibility of labeling the parathyroid glands for easy identification by administering 5-aminolevulinic acid (5-ALA) orally to patients undergoing endocrine neck surgery, because 5-ALA accumulates in the parathyroid and has a fluorescent metabolite, protoporphyrin IX. METHODS: Twenty-nine patients about to undergo endocrine (parathyroid or thyroid gland) neck surgery were orally given 5-ALA, a nontoxic substance that occurs naturally in the human body and has no known major side effects. During surgery, we used blue light to excite protoporphyrin IX, the fluorescent metabolite of 5-ALA, and viewed the resulting bright red fluorescence through an optical filter. RESULTS: In the majority of the patients, the parathyroid glands were defined by a clear fluorescence. In 23 patients with pathological parathyroid tissue, the fluorescence enabled us to identify and completely remove diseased parathyroid tissue. In 3 patients with thyroid disease, we were able to easily remove diseased thyroid tissue, and an accidentally removed parathyroid gland was autotransplanted during surgery. CONCLUSIONS: In all but a few cases, 5-ALA clearly labeled parathyroid tissue, allowing for its clean removal or preservation according to the purpose of the surgery. This simple, benign technique is extremely useful for identifying parathyroid tissue, whether pathological or normal, during endocrine neck surgery.

The miR-221/222 cluster, miR-10b and miR-92a are highly upregulated in metastatic minimally invasive follicular thyroid carcinoma.

Minimally invasive follicular thyroid carcinoma (MI-FTC) is characterized by limited capsular and/or vascular invasion with good long-term outcomes. However, some cases of MI-FTC show a poor prognosis because of severe distant metastasis (i.e., metastatic MI-FTC). Nonetheless, no method has been established for predicting the prognosis of MI-FTC. This study was conducted to identify novel prognostic factors for metastatic MI-FTC by the use of microRNA (miRNA). Thirty-four patients with MI-FTC were categorized into two groups: the metastatic group, M(+) (n=12) and the non-metastatic group, M(-) (n=22). In the M(+) group, distant metastasis was recognized after the initial operation established the diagnosis of MI-FTC. In the M(-) group, no distant metastasis was recognized postoperatively for ≥ 10 years. Using laser microdissection followed by quantitative real-time PCR and PCR arrays, we performed a comprehensive expression profiling of 667 miRNAs in formalin-fixed, paraffin-embedded samples from the initial MI-FTC operation. Furthermore, we assessed the potential use of miRNAs as novel biomarkers for the metastatic potential of MI-FTC by logistic regression analysis. Comprehensive quantitative analysis of miRNA expression in MI-FTC samples revealed that the miR-221/222 cluster (i.e., miR-221, miR-222 and miR-222*), miR-10b and miR-92a were significantly upregulated in the M(+) group compared with the M(-) group. Interestingly, the expression levels of these miRNAs were also shown to be upregulated in widely invasive FTC (WI-FTC; n=13) that has distant metastasis and worse prognosis, indicating a close similarity in the miRNA expression between metastatic MI-FTC and WI-FTC. Logistic regression analysis revealed that miR-10b made a significant contribution to prognosis (OR 19.759, 95% CI 1.433-272.355, p=0.026). Our findings suggest that miR-10b is a potential prognostic factor for evaluating the metastatic potential of MI-FTC at an initial operation stage.

Introduction and use of video-assisted endoscopic thyroidectomy for patients in Belarus affected by the Chernobyl nuclear disaster.

INTRODUCTION: We developed video-assisted neck surgery (VANS) - a feasible, simple, and safe endoscopic thyroid procedure with cosmetic benefits - in 1998. To date, we have performed this procedure 633 times. We have also introduced the VANS method in Belarus, a country that was left contaminated by the Chernobyl nuclear disaster. METHODS: From a mass screening, nine Belarusian patients, including two with papillary carcinoma of the thyroid, were selected to undergo an operation using the VANS method, performed by a single surgeon (author Shimizu). We compared indicating factors for minimally invasive surgery, specifically the operating time and blood loss, between the Belarusian cases and the 33 most recent cases performed at our institute in Tokyo. RESULTS: The procedures in Belarus were performed under very different working conditions than in Japan. However, operating time and blood loss improved for the Belarusian cases as the surgeon gained experience in this environment; all the cosmetic outcomes were excellent. Subsequently, over a 2-year period, surgeons in Belarus performed the VANS method, with modification, for 29 cases of thyroid tumor. CONCLUSION: The VANS method is easily learned by inexperienced surgeons without major technical problems.

Proteomic profiling of thyroid papillary carcinoma.

Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy. We performed shotgun liquid chromatography (LC)/tandem mass spectrometry (MS/MS) analysis on pooled protein extracts from patients with PTC and compared the results with those from normal thyroid tissue validated by real-time (RT) PCR and immunohistochemistry (IHC). We detected 524 types of protein in PTC and 432 in normal thyroid gland. Among these proteins, 145 were specific to PTC and 53 were specific to normal thyroid gland. We have also identified two important new markers, nephronectin (NPNT) and malectin (MLEC). Reproducibility was confirmed with several known markers, but the one of two new candidate markers such as MLEC did not show large variations in expression levels. Furthermore, IHC confirmed the overexpression of both those markers in PTCs compared with normal surrounding tissues. Our protein data suggest that NPNT and MLEC could be a characteristic marker for PTC.