Italian consensus on diagnosis and treatment of differentiated thyroid cancer: joint statements of six Italian societies.

BACKGROUND: Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. METHODS: Six scientific Italian societies entitled to cure thyroid cancer patients (the Italian Thyroid Association, the Medical Endocrinology Association, the Italian Society of Endocrinology, the Italian Association of Nuclear Medicine and Molecular Imaging, the Italian Society of Unified Endocrine Surgery and the Italian Society of Anatomic Pathology and Diagnostic Cytology) felt the need to develop a consensus report based on significant scientific advances occurred in the field. OBJECTIVE: The document includes recommendations regarding initial evaluation of thyroid nodules, clinical and ultrasound criteria for fine-needle aspiration biopsy, initial management of thyroid cancer including staging and risk assessment, surgical management, radioiodine remnant ablation, and levothyroxine therapy, short-term and long-term follow-up strategies, and management of recurrent and metastatic disease. The objective of this consensus is to inform clinicians, patients, researchers, and health policy makers about the best strategies (and their limitations) relating to the diagnosis and treatment of differentiated thyroid cancer.

Mini-invasive tension-free surgery for female urinary incontinence.

The Authors describe the techniques they perform of prepubic, retropubic and transobturator mini-invasive anti-incontinence surgical procedures and point-out some technical details. The state of art and the results of these three main surgical procedure are compared and discussed. Data from the Literature have been reviewed in order to evaluate the efficacy of the techniques. A Medline search has been performed, and 65 relevant articles from 1996 to 2012 were selected. Literature showed similar cure rates among retropubic (71,4-91%), trans-oburator (77,3-95%) and prepubic (81-87,2%) anti-incontinence procedures. Cystoscopy was considered necessary in the retropubic, optional in transobturator and in the prepubic techniques. Intra-operative cough stress test was believed useful only in the retropubic and prepubic procedures. Obstruction symptoms prevailed in the retropubic, were rare in the transobturator and missing in the prepubic technique. Erosion rate was very low and similar for all the three techniques. Intra-operative vascular and perforating risks prevailed in the retropubic technique, due to the danger present in the retropubic space, whereas late infective complications overcame in the transobturator procedure. Severe complications in the prepubic procedure were not reported, but the procedure is performed only in few centers.

Surgical repair of rectocele. Comparison of transvaginal and transanal approach and personal technique.

Rectocele is defined as a herniation of the rectal wall inside the vagina due to a defect of the recto-vaginal septum. It is traditionally considered a posterior compartment damage with weakness of posterior vaginal wall support resulting in a bulging of the rectum into the vaginal cavity. One of the main causes of rectal prolapse is the operative vaginal birth, although the evidence of the defect may occur after many years The treatment of rectocele is surgical, and the approach can be transperineal, transvaginal, and transanal or, in selected cases, transperitoneal through open or laparoscopic techniques. In this study we compare two transvaginal surgical techniques - i.e. the perineal body anchorage to the posterior septum and the traditional Denonvilliers' transversal suture after removing of the vaginal skin, with the mostly performed transanal procedure, the STARR - comparing the data from the literature on their results. Mean hospital stay, rectal symptoms, dyspareunia, quality of life, recurrence rate and postoperative complications have been considered. Both transvaginal and transrectal surgical techniques are effective to solve posterior compartment defect and to improve the quality of life. Vaginal approach may interfere with the sexual activity; furthermore it is associated with minimal postoperative pain than the transanal approach. Better anatomic results are assured after endovaginal surgery, while better rectal function prevail after the transanal approach. Vaginal techniques are more suitable to gynecologists, whereas the transrectal ones are usually performed by colo-proctologists or general surgeons.

Cryptorchidism and its long-term complications.

Cryptorchidism is the most frequent defect of the male urogenital tract at birth. It represents a risk factor for primitive testiculopathy associated with long-term complications (infertility, testicular neoplasia, and hormonal changes). An only consensus exists: "children with bilateral cryptorchidism who are not treated in early age are certainly set to become infertile". The majority of Authors agrees that the cryptorchid testicle will be in for structural and functional alterations and the rate of infertility is inversely proportional to the age at the time of orchidopexy. Cryptorchidism causes secretory primitive testicular pathology responsible for infertility. It is correlated to a non-specific severe histopathological pattern that can be useful to predict future infertility at the moment of orchidopexy. Also cryptorchidism represents the major risk factor associated with germ cell testicular neoplasia (5-10 times more probably than a normal testicle) due to genetic, hormonal, environmental factors.

A rare case of primary thyroid amyloidosis.

INTRODUCTION: Amyloid goiter is due to the deposition of amyloid in the thyroid, resulting with enlargement of the gland and compressive symptoms. CASE: We herein present a case of a 45-year-old male patient who complained of a big swelling in the neck. Ultrasound showed an enlarged thyroid gland with mediastinal involvement. The multinodular appearance was consistent with the diagnosis of multinodular goiter. He had a history of multiple myeloma but no sign of systemic amyloidosis. DISCUSSION: Thyroid gland was removed and the histopathological examination revealed a diffuse deposition of amyloid associated with metaplastic lipomatosis of the stroma. CONCLUSIONS: The treatment of choice in patients with amyloid goiter is total thyroidectomy to solve compression symptoms.

Erectile vascular dysfunction and analysis of the risk factors related to it: clinical experience.

AIM: Preliminarily we analyzed the rate incidence of organic and psychological causes of erectile dysfunction in large cohort of patients observed during last year. Particularly we wanted to analyze the factors of risk correlated to the vascular erectile dysfunction. METHODS: The epidemiological study has been conducted on a cohort of 101 patients (age 25-75 years) suffering from erectile dysfunction since 1-10 years (average: 2.6 years) and administrated during the last year by the Institute of Andrology at the University of Catania. RESULTS: The organic erectile dysfunction had a frequency more elevated in comparison to the psychological erectile dysfunction, respectively engraving in 54.5% and in 45.5%. Between the organic causes of erectile dysfunction, the vascular arterial forms of erectile dysfunction represented highest rates (32.7% of the patients). The group of patients affected by vascular arterial erectile dysfunction showed several factors of risk, present in all the patients in single or combined way (comorbidity). The rate of such factors was >30% for 4 examined factors: hypertension (57.5%), smoke (45.4%), diabetes mellitus (39.3%), hyperlipidaemia (33.3%). CONCLUSIONS: The erectile dysfunction is frequently associated to organic causes, prevalently of arterial vascular nature. The correction of the factors of risk could lead to a better control of the erectile dysfunction and reduce the extension of the vascular arterial damage to other districts.

Foot soft tissue myopericytoma: Case-report and review.

INTRODUCTION: Myopericytoma is a rare tumor of deep soft tissues, originating from pericytes and characterized by numerous thin walled blood vessels. CASE REPORT: We report a case of myopericytoma found at the level of the second toe of the right foot.A patient came to the Endocrinology Surgery Department of Catania Polyclinic because of a presence of a small swelling in the plantar region, between the 2nd and 3rd toe of the right foot. At the anatomopathological examination, the escalated lesion showed a neoformation of 0.6 cm in diameter, well circumscribed, capsulated, with myopericytoma diagnosis. DISCUSSION: Its histopathological appearance is similar to myofibromatic lesions from glomic and angiomyoma tumors. It is a rare tumor that affects all ages with a peak after 50 years 3. The most frequent localization is at the lower extremities, particularly in soft subcutaneous tissues, but can rarely occur in other sites. CONCLUSION: At the anatomopathological evaluation, the immunohistochemical examination for the correct formulation of the diagnosis is essential and an adequate surgical excision is important.

Mono or bilateral inflammatory postmicrobial prostato-vesciculo-epididymitis: differences in semen parameters and reactive oxygen species production.

AIM: The aim of this study was to analyse possible differences in sperm characteristics (including seminal leukocyte concentration, number of spermiophagies, and sperm reactive oxygen species [ROS] production) between patients with monolateral and bilateral prostate-vesciculo-epididymitis (PVE). METHODS: Seventy-eight selected consecutively enrolled patients (mean age 34 years, range 24-40) with chronic inflammatory postmicrobial PVE and 30 infertile (aged-matched) patients (control group) with inflammatory postmicrobial prostatitis underwent sperm analysis, including seminal leukocyte concentration, number of spermiophages, and ROS production. RESULTS: Sperm concentration and total sperm number were significantly lower in the patients with bilateral PVE than in those with monolateral PVE. The percentage of cases with oligozoospermia or hyperspermia was significantly higher among patients with bilateral PVE with than those with monolateral PVE. Although the remaining cytologic and physicochemical sperm characteristics and ROS production (both in 45% and 90% Percoll fractions) were not significantly different between the 2 PVE groups, both groups showed median and relative percentages of frequency of abnormal sperm characteristics worse than those in the control group. CONCLUSIONS: Although sperm abnormalities (including seminal leukocyte concentration, number of spermiophages, and ROS production) can distinguish patients with PVE from those with prostatitis alone, the abnormalities did not discriminate between unilateral and bilateral PVE. In diagnostic suspicion of PVE, didymo-epididymal and prostato-vescicular ultrasonography can help discriminate monolateral from bilateral forms of PVE, and is a useful aid in the follow-up of these patients.

Tadalafil and modifications in peak systolic velocity (Doppler spectrum dynamic analysis) in the cavernosal arteries of patients with type 2 diabetes after continuous tadalafil treatment.

AIM: In this study peak systolic velocity (PSV) was measured by penile duplex Doppler spectrum dynamic analysis in diabetic patients with erectile dysfunction (ED) administered continuous treatment with tadalafil for 3 months in a weekly regimen (Monday-Wednesday-Friday). Responses to the Structured Interview on Erectile Dysfunction (SIEDY) questionnaire and hormonal blood levels (LH, testosterone, prolactin) were studied before and after treatment. METHODS: The study sample was 20 diabetic patients (mean age 60 years; range 55-65) with organic vascular arterial ED at enrollment into the study. All patients were eligible for receiving tadalafil. Patients were randomly assigned to 2 different treatment groups according to a computer-generated list. The first random set of numbers was assigned to group A, the second to group B. Group A (n=10) received tadalafil 20 mg per os on demand for 3 months (Cialis, Lilly ICOS; London, UK). Group B (n=10) received tadalafil 20 mg per os on weekly fixed days (Monday-Wednesday-Friday) for 3 months. All patients underwent duplex penile sonographic dynamic evaluation after intracavernosal injection of alprostadil 20 microg (Caverject, Pharmacia SpA; Milan, Italy); SIEDY questionnaire responses and changes in blood hormonal levels (LH, testosterone, prolactin) before and after treatment were compared. RESULTS: Increased PSV at 10 min and 20 min after alprostadil administration was found in 30% of Group A patients and in 60% of Group B patients. In 40% of Group B patients, the increase in PSV was so significant as to justify reclassification to a less severe diagnostic category (Benson classification) in vascular profile. No changes in hormonal levels after treatment were found in either group. Analysis of the questionnaires showed a more marked reduction in the global total scores in Group B, with a greater frequency and a clearer improvement in global scores. CONCLUSIONS: This study on a group of 20 patients with organic vascular arterial ED disclosed at least 2 basic aspects: 1) a higher percentage of Group B patients (fixed-day treatment regimen) showed a greater improvement in PSV than the controls; 40% of these patients were reclassified according to the Benson classification; 2) within the context of a clinical study, monitoring and supportive care to increase the frequency and quality of sexual intercourse led to a resumption of and a greater interest in sexual activity. This finding cannot be explained by changes in hormonal levels; instead, there appeared a sort of effect placebo that the continuous therapy, like conventional treatment for other health reasons, had on the patient.

Kidney transplantation from donors with viral B and C hepatitis.

INTRODUCTION: The success of renal transplantation as a treatment for end-stage renal disease has created a chronic shortage of donor organs. We present our experience in transplanting kidneys from donors with hepatitis B virus (HBV) or hepatitis C virus (HCV) among matched serology-positive recipients. MATERIALS AND METHODS: From January 2002 to November 2005, 44 patients with end-stage renal disease and HCV seropositivity underwent kidney transplantation. In 28 transplants in HCV+ recipients, the donor was HCV+ (DC+/RC+) and in 16 of these cases the donor (one living donor) was HCV- (DC-/RC+). In the same period 14 patients with HBV infection and HbsAg seropositivity underwent kidney transplantation: eight received their graft from a cadaveric HbsAg-positive donor (DB+/RB+), while six patients received their graft from an HbsAg-negative donor. RESULTS: Viral reactivation was higher among DC+/RC+ (21.4%) than DC-/RC+ patients (6%). Graft survivals were 90% and 88% for DC+/RC+ and DC-/RC+, respectively; patient survivals were 100% for DC+/RC+ and 94% for DC-/RC+. Among the group of DB+/RB+, all the patients developed an HBV-DNA positivity in the early postoperative period. Patient and graft survivals were 100% in both groups. CONCLUSIONS: Our results suggest that HBV- and HCV-positive donors can be considered as an alternative donor source, because their kidneys are allocated to the matched serology-positive recipients, shortening their time on the waiting list.

[Benign thyroid nodule: what is the treatment? Personal experience]. / Tireopatia nodulare benigna: quale trattamento terapeutico? Esperienza personale.

INTRODUCTION: Solitary thyroid nodule is an important pathology with an incidence of 2-5% in the Italian population. The diagnosis was based on clinical exam, laboratory tests and ultrasonographic evaluation. MATERIALS AND METHODS: The study undertook has the purpose to assess the usefulness between lobe-isthmusectomy (with corresponding risk of possible relapse and complications for reintervention) and total thyroidectomy (with corresponding post-surgical treatment complications), for benign thyroid disease with solitary nodule, on selected cases for disease and corresponding risk factors, in the retrospective clinical study, using laboratory tests and ultrasonographic evaluation. The study was conducted on 80 patients admitted from 1994 to 2000 with diagnosis of benign thyroid nodule and operated with lobe-isthmusectomy. In seven patients the operation had to be converted in total thyroidectomy. RESULTS: Operative mortality was nil and long-term results at a mean follow-up of three years are encouraging. DISCUSSION: The main advantages of lobe-isthmusectomy for benign solitary thyroid nodule consist in less postoperative complications and less hospital stay. CONCLUSIONS: Therefore our experience has carried us to consider the lobectomy which treatment of choice for all those benign thyroid diseases with solitary nodule.

Surgery and polychemotherapy of non-functional endocrine pancreatic tumors: a case report with a dramatic clinical response.

Endocrine pancreatic tumors (EPT) are a rare clinical entity, representing 5% of all pancreatic tumors. Nonfunctional subtypes (NF-EPT) often present themselves at diagnosis in a locally advanced or metastatic stage. Therapeutic planning of these neoplasias is based on a multidisciplinary integration of surgery and medical treatments. The Authors describe a case of NF-EPT with massive metastatic spread after cytoreductive surgery, with impressive response to polychemotherapy with 5-fluorouracil, epirubicin and dacarbazine. The various options concerning chemotherapic treatment of these tumors are reviewed.

Psoas abscess: a rare complication of Crohn's disease.

UNLABELLED: Psoas abscess is a rare complication of Crohn's disease. METHODS AND MATERIALS: We evaluated the incidence of psoas abscess on 312 patients with Crohn's disease, seen at our institution between 1992-2001. RESULTS: We encountered three cases of psoas abscess (0.9%). One patient was managed with ileocolic resection and immediate anastomosis, while in two patients a percutaneous drainage was first performed and then, after 12 days of total parenteral nutrition, a resection of the diseased bowel with immediate reconstruction was carried out. CONCLUSIONS: A correction of the nutritional deficiencies is mandatory. Percutaneous computed-tomography guided drainage of the abscess with intestinal resection with immediate anastomosis, performed after a parenteral hyperalimentation, should be the method of choice in the management of such patients.

[The superior laryngeal nerve: an anatomical structure at risk during thyroid surgery]. / Il nervo laringeo superiore (NLS): una struttura anatomica a rischio nella chirurgia tiroidea.

The effects of injury to the external branch of the superior laryngeal nerve (ESLN) during thyroid surgery are well known, while the frequency and consequences of ESLN lesions aren't today well known. The Authors report their own experience of the incidence of ESLN injuries in thyroid surgery.

[Hypocalcemia after total thyroidectomy. Therapeutic considerations]. / La ipocalcemia post-tiroidectomia totale. Considerazioni terapeutiche.

One of the post-operative complications of total thyroidectomy is the onset of a transitory or permanent hypocalcemic syndrome. Hypocalcemia is caused by different physiopathological mechanisms that operate either individually or in association (parathyroidal deficit, deficiency of bone calcium subsequent to parathyroid osteodystrophy, acute emission of calcitonin into the circulation). Calcemia levels were studied p.o. in a selected group of 25 patients who had undergone total extracapsular thyroidectomy with the apparent preservation of the parathyroid glands. Totals thyroidectomy has been performed in 15 patients with euthyroid goitre, in 4 with papillary carcinoma, in 3 with diffuse toxic goitre and in 3 with multinodular toxic goitre. Eight patients received drug and diet therapy since calcemia levels were lower than 7.5 mg/ml. Fifteen days after the operation, calcemia levels in 21 patients were subliminal and dihydrotachysterol therapy was commenced. Hypocalcemia was permanent in only one case.

[Anaplastic carcinoma of the thyroid: long-term survival]. / Il carcinoma anaplastico della tiroide: sopravvivenza a distanza.

Anaplastic carcinoma of the thyroid is a highly aggressive neoplasm with quickly total course. It is characterized by an average survival of 4-12 months. It infiltrates precociously into the windpipe, oesophagus, vessels of the neck and gives distant metastases in 10-48% of cases. In 30.8 to 80% of cases, this carcinoma originates in an old multinodular goiter. The hypothesis has been also advanced that this neoplasm could derive from a pre-existent well-differentiated carcinoma. The improvement in diagnostic techniques (especially immunohistochemistry) allows a more correct definition of this neoplasm, permitting a differential diagnosis with other tumours (lymphoma, medullary carcinoma, hemangioblastoma) with which in the past it has been erroneously identified. The results reported in the literature are controversial as regards long-term survival, but usually it is less than one year. Longer survival must lead to the suspicion of wrong diagnosis. A relatively better prognosis is observable in intraglandular forms, "minimi" neoplastic focus and young patients. The presence of regional metastatic lymph nodes doesn't seem to modify the prognosis. Instead, a factor which can condition the prognosis is the type of therapy. Now a days the most efficacious curative treatment is the multinodal one (surgery, radio- and chemotherapy). The best results about survival and quality of life have been obtained using chemo-radiotherapy before operation and chemotherapy after it.

[Short-stay in patients surgically treated for thyroid disease]. / Sull'invio precoce a domicilio del paziente operato per tireopatia.

The improvement in anesthesiology and greater experience of medical staff have permitted short-stay surgery. The authors in this pages report their knowledge of thyroid short-stay surgery. Their series numbers twenty-two lobectomies for uninodular the thyroid disease and one enucleoresection for a nodule of pyramidal lobe. Short-stay surgery has been proposed to euthyroid patients, selected according to age, residence and health (lack of associated pathologies such as cardiopathy, bronchopathy, hepatopathy, nephropathy, allergy, calcemic disorders and dysphony) and confirmed in the presence of histological extemporary diagnosis of "adenoma" (21 cases). The histological extemporary diagnosis of "carcinoma" has lengthened hospital stay. Among the lobectomies, 21 were executed in general anaesthesia and 1 in acupuncture. The enucleoresection was executed in local anaesthesia. Only in eighteen cases was a "Penrose" deainage used, removed after 24 hours. The choice of thyroid short-stay surgery, particularly in day-hospital, must arise from a careful selection of patients. Besides, this surgery requires an administrative and sanitary structure which permits a constant patient's check at hare too.

[Clinical and sperm follow-up after subinguinal varicocelectomy]. / Follow-up clinico e spermatico dopo varicocelectomia subinguinale.

In order to evaluate the sperm output and the adverse-side-effects after subinguinal varicoceloctomy, a follow-up study of 16 months was performed on 196 selected patients (aged from 22 to 43 years) affected by left varicocele (VR). In the pre-treatment, both Doppler ultrasonography and didymo-epididymal ultrasonography allowed to distinguish two homogeneous patient groups: group A (no. = 136), including patients affected by VR alone and, group B (n. = 60), including patients with VR combined to coincidental didymo-epididymal morphological abnormalities, DEMA). These DEMA lesions (testis size < 12 ml, epididymides abnormalities: increased head- > or = 12 mm- and/or tail- > or = 6 mm-diameter, multiple microcysts, large idrocele) were omolaterally to VR in 30/60 (50%), eterolaterally in 19/60 (31.7%) or bilaterally in 11/60 (18.3%). During sperm follow-up, group A patients showed both a significant temporal change (p < 0.01 ANOVA) of all sperm parameters studied (sperm density, total sperm count, motility and morphology) from month 8 onward and sperm values significantly higher than found in group B patients. On the contrary, the sperm parameters of group B patients did not change significantly during the follow-up observations. As far as the varicocelectomy-mediated clinical symptoms, some patients complained early and transiently (on 1-2-4 weeks following varicocelectomy) the following symptoms: didymal pain (1.5%), didymo-epididymal pain (4.1%) and parasthesiaes on the anterior-medial side of the left thigh (4.1%) or scrotal (3.1%); only four patients (2%) complained permanent paresthesiaes on the anterior-medial side of the left thigh. Furthermore, the clinical follow-up also revealed a low rate of complications: persistent VR (3.6%), hydrocele (1.5%), intrascrotal venous ecstasies (6.1%), epididymitis (0.5%). Some morpho-structural abnormalities at US scans were transient (1-2 weeks): scrotal oedema (6.1%), orchitis (2%), orchi-epididymitis (1%). Subinguinal varicocelectomy performed on large population demonstrated a significant improvement of the sperm output from month 8th onward in patients with VR alone, while sperm parameters did not show any significant change in patients with VR plus coincidental DEMA. This surgical technique also demonstrated safety since both low rates of symptoms and (transient) complications were registered.

[The negative effect in patients with varicocele of coincidental didymo-epididymal morpho-pathology on sperm response before and after surgical correction]. / Influenza negativa in pazienti con varicocele di coincidentali morfo-patologie didimo-epididimarie sulla risposta spermatica prima e dopo correzione chirurgica.

In order to assess the relative incidence of varicocele (V) alone and V+ coincidental didymo-epididymal morphological abnormalities (DEMA) and the role of these pathologies on the pre- and post-surgical sperm outcome, 151 selected (previous exclusion of cases with bilateral V, seminal infections, antisperm autoAb) patients (aged 20-41 yrs) affected by left V at Doppler ultrasonography, underwent both ultrasound scrotal content examinations and semen analyses (sperm density, total sperm count, forward motility and normal morphology employing as frequency distribution) before and after varicocelectomy (on months 4-8-12, taking for statistical comparison the maximal post-surgical sperm value registered vs. mean correspective pre-treatment value). One-hundred two (67.5%) patients exhibited V alone (group A), whilst 49 (32.5%) patients showed V+DEMA (group B). As regards V, DEMA lesions (testis size < 12 ml; epididymides abnormalities: increased head (> 11 mm) and/or tail (> 6 mm) diameter, multiple microcysts; large idrocele) were omolaterally in 21/49 (42.8%) eterolaterally in 11/49 (22.5%) or bilaterally in 17/49 (34.7%). An additional group of 25 patients, exhibiting the above ultrasonic DEMA lesions alone without V, served as controls (group C) for semen statistical analysis in the pre-surgical period only. In this phase among groups A vs B, A vs C, B vs C, frequency distributions of all sperm parameters studied (excepted for density not significative only between B and C group patients) were significantly different. The following data were registered from A, B and C patient groups respectively: a) azoospermia was present in 12.7%, 34.8% and 24%; b) oligozoospermia (< 20 mil/ml) in 39.2%, 49% and 48%; c) normozoospermia in 48.1%, 16.3% and 8%; d) total sperm count was < 40 millions/ejaculate in 44.1%, 91.9% and 76%; e) asthenozoospermia (forward motility < 25%) was present in 32.3%, 71.4% e 72%; f) teratozoospermia (oval form <30%) was present in 34.3%, 62.3% and 48%. In the post-surgical follow-up examinations, significative changes with ameliorated frequency distributions of all semen parameters were observed within group A only, while these same parameters remained unmodified within group B patients, thus being together a significative difference between groups A vs B higher than that observed in the pretreatment. The coexistence of DEMA+V seems to determine two important effects on sperm output: a) in the pre-treatment, this selection judgement allowed to distinguish a different frequency distribution of semen parameters between patients affected by V alone and V+DEMA; b) since patients with V alone in comparison with V+DEMA patients groups had a favourable sperm outcome, the assessment of DEMA in patients with V seems to be mandatory for a better sperm prognostic judice.

[Papillary carcinoma of the thyroid: nosological aspects, prognostic factors and principles of therapy]. / Il carcinoma papillifero della tiroide: aspetti nosologici, fattori prognostici e principi di terapia.

Papillary carcinoma of thyroid, has not, until now, been considered prognostically and therapeutically clear, because it is not free from problematic questions regarding prognosis and treatment, though it has been studied for a long time. The Authors analyse this pathology under actual learning conditions, with reference to the nosologic, prognostic and therapeutic aspects.