BACKGROUND Multiple primary malignant neoplasms(MPMNs)are rare,while synchronous MPMNs(SMPMNs)are even less common.Owing to the progression of medical technology and the extension of life expectancy,its incidence is g...BACKGROUND Multiple primary malignant neoplasms(MPMNs)are rare,while synchronous MPMNs(SMPMNs)are even less common.Owing to the progression of medical technology and the extension of life expectancy,its incidence is gradually increasing.CASE SUMMARY Although reports of breast and thyroid dual cancers are common,cases of an additional diagnosis of kidney primary cancer within the same individual are rare.CONCLUSION We present a case of simultaneous MPMN of three endocrine organs,reviewing the relevant literature to enhance our understanding of SMPMNs while emphasizing the increasingly important need for accurate diagnosis and multidisciplinary management whenever this challenging situation arises.展开更多
Thyroid cancer is the most common endocrine malignancy.While there has been no appreciable increase in the observed mortality of well-differentiated thyroid cancer,there has been an overall rise in its incidence world...Thyroid cancer is the most common endocrine malignancy.While there has been no appreciable increase in the observed mortality of well-differentiated thyroid cancer,there has been an overall rise in its incidence worldwide over the last few decades.Patients with papillary thyroid carcinoma(PTC)and clinical evidence of central(cN1)and/or lateral lymph node metastases require total thyroidectomy plus central and/or lateral neck dissection as the initial surgical treatment.Nodal status in PTC patients plays a crucial role in the prognostic evaluation of the recurrence risk.The 2015 guidelines of the American Thyroid Association(ATA)have more accurately determined the indications for therapeutic central and lateral lymph node dissection.However,prophylactic central neck lymph node dissection(pCND)in negative lymph node(cN0)PTC patients is controversial,as the 2009 ATA guidelines recommended that CND“should be considered”routinely in patients who underwent total thyroidectomy for PTC.Although the current guidelines show clear indications for therapeutic CND,the role of pCND in cN0 patients with PTC is still debated.In small solitary papillary carcinoma(T1,T2),pCND is not recommended unless there are high-risk prediction factors for recurrence and diffuse nodal spread(extrathyroid extension,mutation in the BRAF gene).pCND can be considered in cN0 disease with advanced primary tumors(T3 or T4)or clinical lateral neck disease(cN1b)or for staging and treatment planning purposes.The role of the preoperative evaluation is fundamental to minimizing the possible detrimental effect of overtreatment of the types of patients who are associated with low disease-related morbidity and mortality.On the other hand,it determines the choice of appropriate treatment and determines if close monitoring of patients at a higher risk is needed.Thus,pCND is currently recommended for T3 and T4 tumors but not for T1 and T2 tumors without high-risk prediction factors of recurrence.展开更多
Objective: Preablative stimulated thyroglobulin(ps-Tg) has the potential to be used in identifying distant metastatic differentiated thyroid carcinoma(DM-DTC), but its single level can be affected by remnant thyroid t...Objective: Preablative stimulated thyroglobulin(ps-Tg) has the potential to be used in identifying distant metastatic differentiated thyroid carcinoma(DM-DTC), but its single level can be affected by remnant thyroid tissue and thyrotropin(TSH). The objective of this retrospective study was to evaluate the value of serial ps-Tg measurements in identifying DM-DTC specifically.Methods: A total of 317 DTC patients with serial measurements of ps-Tg, TSH and anti-Tg antibody were divided into M1(n=72) and M0(n=245) according to the presence of distant metastasis(DM) or not. The initial psTg measurement, with a corresponding TSH exceeding 30 μIU/m L, was marked as Tg1, and ps-Tg measured right before radioactive iodine(RAI) therapy was defined as Tg2, with a median interval of 8 days. ΔTg denotes Tg2–Tg1, and ΔTSH denotes TSH2–TSH1. Tg1, Tg2, ΔTg, and ΔTg/ΔTSH were tested for efficacy in identifying DM-DTC using receiver operating characteristic(ROC) curve analysis, and further compared with chest computed tomography(CT) and posttreatment whole-body RAI scan(Rx WBS).Results: Compared with single ps-Tg measurement(Tg1 or Tg2), both ΔTg and ΔTg/ΔTSH were more narrowly distributed around zero in the M0 group, which made their distribution in the M1 group more distinguished in a relatively dispersed way. ΔTg/ΔTSH manifested a higher accuracy(88.64%) and specificity(90.20%) in identifying DM-DTC than Tg1 or Tg2 measurements, with a much higher specificity than chest CT(90.20% vs. 66.00%) and a much higher sensitivity than Rx WBS(83.33% vs. 61.11%).Conclusions: Serial ps-Tg measurements even over as short an interval as 8 days hold incremental value in identifying DM-DTC. ΔTg/ΔTSH is a specific early biochemical marker for DM-DTC.展开更多
Currently, thyroid cancer is one of the most common endocrine cancer in the United States. A recent involvement of sub-population of stem cells, cancer stem cells, has been proposed in different histological types of ...Currently, thyroid cancer is one of the most common endocrine cancer in the United States. A recent involvement of sub-population of stem cells, cancer stem cells, has been proposed in different histological types of thyroid cancer. Because of their ability of self-renewal and differentiation into various specialized cells in the body, these putative cells drive tumor genesis, metastatic activity and are responsible to provide chemo- and radioresistant nature to the cancer cells in the thyroid gland. Our Review was conducted from previously published literature to provide latest apprises to investigate the role of embryonic, somatic and cancer stem cells, and discusses the hypothesis of epithelial-mesenchymal transition. Different methods for their identification and isolation through stemness markers using various in vivo and in vitro methods such as flow cytometry, thyrosphere formation assay, aldehyde dehydrogenase activity and ATP-binding cassette sub-family G member 2 efflux-pump mediated Hoechst 33342 dye exclusion have been discussed. The review also outlines various setbacks that still remain to target these tumor initiating cells. Future perspectives of therapeutic strategies and their potential to treat advanced stages of thyroid cancer are also disclosed in this review.展开更多
Background: Controversy exists over the extent of surgical treatment of papillary thyroid cancer.Reoperations may carry a significant risk of surgical complications. The aim of this study is to investigate the complic...Background: Controversy exists over the extent of surgical treatment of papillary thyroid cancer.Reoperations may carry a significant risk of surgical complications. The aim of this study is to investigate the complications following surgical treatment of thyroid cancer and the association between the?extent of surgery and complication rates. Methods: A total of 196 patients with papillary thyroid cancer were retrospectively reviewed to identify extent of surgery and associated complications, between 2009 and 2018 atSouth Egypt Cancer Institute Assiut University. Results: Primary procedures included less-than-total thyroidectomy (near total thyroidectomy in 5.1%, subtotal thyroidectomy in 4.1%, thyroid lobectomy in 3.1%) and total thyroidectomy in 87.8% (18.9% of them are completion thyroidectomy). No lymph nodes dissection was done in 10.7%, Berry picking in 6.1%, central compartment neck dissection in 41.8%, central compartment neck dissection with modified ipsilateral radical neck dissection in 12.2%, central compartment neck dissection with modified bilateral radical neck dissection in 26.0%, central compartment dissection with both modified bilateral radical neck dissection and superior mediastinal lymph node dissection 3.1%. The most common surgical complication were transient hypoparathyroidism (16.7% - 45.8%) and 2.0% permanent, transient vocal cord palsy (7.3% - 16.7%), and 3.9% permanent, hematoma 1.5%, seroma 7.1% and chyle fistula in 2.6% of patients. Conclusion: Thyroid cancer surgeries are safe. The transient complication rates of hypoparathyroidism increased significantly with increasing the extent of surgery.展开更多
BACKGROUND Papillary thyroid cancer(PTC)has good prognosis so that the local recurrence or distant metastasis can occur later on the lifetime follow up.In this study,we report recurrence of PTC in subcutaneous area co...BACKGROUND Papillary thyroid cancer(PTC)has good prognosis so that the local recurrence or distant metastasis can occur later on the lifetime follow up.In this study,we report recurrence of PTC in subcutaneous area combined with lymph node metastasis.A suspicion of needle tract implantation after core needle biopsy was found.CASE SUMMARY A 66-year-old female patients who underwent right thyroid lobectomy for PTC complained of palpable nodule on anterior neck area.The location of the palpable nodule was not associated with her postoperative scar.After excision of the skin tumor,it was diagnosed as recurrence of PTC.Furthermore,results of subsequent imaging showed lymph node metastasis on her right cervical area.According to the previous medical records,the patient received core needle biopsy through the neck of the patient midline and hematoma was noted after the procedure.The time interval from the first diagnosis to local recurrence or metastasis to the skin and lymph nodes was ten years.As treatment,the patient underwent lymph node dissection in the right and completion thyroidectomy for radioisotope treatment.CONCLUSION Needle tract implantation can occur after core needle biopsy.Further studies are needed to compare core-needle biopsy and fine-needle aspiration.展开更多
Objective: To study the relation of age and clinicopathologic pattern to the aggressiveness of thyroid cancer cases and the treatment results of patients from western region of Saudi Arabia with differentiated thyroid...Objective: To study the relation of age and clinicopathologic pattern to the aggressiveness of thyroid cancer cases and the treatment results of patients from western region of Saudi Arabia with differentiated thyroid carcinoma referred for treatment in King Abdulaziz Hospital and Oncology Center, Jeddah, Saudi Arabia. Methods: Retrospective review of 174 patients with differentiated thyroid carcinoma and analysis of the clinicopathologic characteristics, age correlation to different risk factors, treatment protocol and results were performed. Results: Analysis of the clinicopathologic pattern showed no statistically significant difference between patients in the different age groups except for extrathyroid extension and lymph node involvement. Patients older than 45 years had a statistically significant lower incidence of nodal involvement and a higher rate of extrathyroid extension (<0.02). In this study, we used a high dose method (Radioiodine-131 dose 75 - 100 mCi) for thyroid remnant ablation after thyroidectomy (total or near total) in 134 patients. An Iodine-131 dose of 200 mCi was used in 8 patients with distant metastases. In 24 patients with radioiodine-avid cervical lymph nodes and six patients with a gross residual tumor, an Iodine-131 dose of 150 mCi was used. For the whole study group, the 5-year overall survival and disease-free survival were 96% and 88%. Conclusion: Despite the fact that differentiated thyroid carcinoma is among the most curable cancer some patients are still at high risk for recurrent and increased mortality.展开更多
BACKGROUND The recognized pattern of cervical lymph node metastasis(CLNM)of papillary thyroid carcinoma involves a stepwise route.Contralateral lymph node skip metastasis is very rare.In addition,the patient in our ca...BACKGROUND The recognized pattern of cervical lymph node metastasis(CLNM)of papillary thyroid carcinoma involves a stepwise route.Contralateral lymph node skip metastasis is very rare.In addition,the patient in our case report also suffered from a breast carcinoma accompanied by left supraclavicular lymphadenopathy,which made it difficult to distinguish the origin of the CLNM.Based on this case,we recommended that more detailed physical and imaging examinations are needed for patients with uncommon cervical lymphatic metastasis of primary cancer.CASE SUMMARY A 53-year-old women was admitted to the hospital for a neck mass in the left cervical region that had existed for 2 mo.The neck mass was suspected to be an enlarged lateral LN originating from papillary thyroid microcarcinoma of the contralateral thyroid lobe,according to ultrasound and ultrasound-guided fine needle aspiration biopsy.The patient underwent total thyroidectomy and radical cervical LN dissection.Postoperative pathology confirmed the diagnosis of papillary thyroid microcarcinoma with contralateral lymphatic skip metastasis.Unfortunately,a breast cancer was discovered 4 mo later,which was accompanied by ipsilateral supraclavicular LN metastasis.She accepted neoadjuvant chemotherapy and subsequent left modified radical mastectomy for treatment.The patient is currently receiving postoperative radiotherapy,and no local recurrence was observed in the 6-mo follow-up after surgery.CONCLUSIONWe present a rare case of papillary thyroid microcarcinoma with contralateral lymphatic skipmetastasis and breast cancer with supraclavicular lymphatic metastasis.展开更多
基金Shanxi Soft Science General Program,No.2018041032-2.
文摘BACKGROUND Multiple primary malignant neoplasms(MPMNs)are rare,while synchronous MPMNs(SMPMNs)are even less common.Owing to the progression of medical technology and the extension of life expectancy,its incidence is gradually increasing.CASE SUMMARY Although reports of breast and thyroid dual cancers are common,cases of an additional diagnosis of kidney primary cancer within the same individual are rare.CONCLUSION We present a case of simultaneous MPMN of three endocrine organs,reviewing the relevant literature to enhance our understanding of SMPMNs while emphasizing the increasingly important need for accurate diagnosis and multidisciplinary management whenever this challenging situation arises.
文摘Thyroid cancer is the most common endocrine malignancy.While there has been no appreciable increase in the observed mortality of well-differentiated thyroid cancer,there has been an overall rise in its incidence worldwide over the last few decades.Patients with papillary thyroid carcinoma(PTC)and clinical evidence of central(cN1)and/or lateral lymph node metastases require total thyroidectomy plus central and/or lateral neck dissection as the initial surgical treatment.Nodal status in PTC patients plays a crucial role in the prognostic evaluation of the recurrence risk.The 2015 guidelines of the American Thyroid Association(ATA)have more accurately determined the indications for therapeutic central and lateral lymph node dissection.However,prophylactic central neck lymph node dissection(pCND)in negative lymph node(cN0)PTC patients is controversial,as the 2009 ATA guidelines recommended that CND“should be considered”routinely in patients who underwent total thyroidectomy for PTC.Although the current guidelines show clear indications for therapeutic CND,the role of pCND in cN0 patients with PTC is still debated.In small solitary papillary carcinoma(T1,T2),pCND is not recommended unless there are high-risk prediction factors for recurrence and diffuse nodal spread(extrathyroid extension,mutation in the BRAF gene).pCND can be considered in cN0 disease with advanced primary tumors(T3 or T4)or clinical lateral neck disease(cN1b)or for staging and treatment planning purposes.The role of the preoperative evaluation is fundamental to minimizing the possible detrimental effect of overtreatment of the types of patients who are associated with low disease-related morbidity and mortality.On the other hand,it determines the choice of appropriate treatment and determines if close monitoring of patients at a higher risk is needed.Thus,pCND is currently recommended for T3 and T4 tumors but not for T1 and T2 tumors without high-risk prediction factors of recurrence.
基金supported by the Ministry of Health Industry Special Scientific Research Projects of China (No. 201202012)the National Natural Science Foundation of China (No. 81571714)
文摘Objective: Preablative stimulated thyroglobulin(ps-Tg) has the potential to be used in identifying distant metastatic differentiated thyroid carcinoma(DM-DTC), but its single level can be affected by remnant thyroid tissue and thyrotropin(TSH). The objective of this retrospective study was to evaluate the value of serial ps-Tg measurements in identifying DM-DTC specifically.Methods: A total of 317 DTC patients with serial measurements of ps-Tg, TSH and anti-Tg antibody were divided into M1(n=72) and M0(n=245) according to the presence of distant metastasis(DM) or not. The initial psTg measurement, with a corresponding TSH exceeding 30 μIU/m L, was marked as Tg1, and ps-Tg measured right before radioactive iodine(RAI) therapy was defined as Tg2, with a median interval of 8 days. ΔTg denotes Tg2–Tg1, and ΔTSH denotes TSH2–TSH1. Tg1, Tg2, ΔTg, and ΔTg/ΔTSH were tested for efficacy in identifying DM-DTC using receiver operating characteristic(ROC) curve analysis, and further compared with chest computed tomography(CT) and posttreatment whole-body RAI scan(Rx WBS).Results: Compared with single ps-Tg measurement(Tg1 or Tg2), both ΔTg and ΔTg/ΔTSH were more narrowly distributed around zero in the M0 group, which made their distribution in the M1 group more distinguished in a relatively dispersed way. ΔTg/ΔTSH manifested a higher accuracy(88.64%) and specificity(90.20%) in identifying DM-DTC than Tg1 or Tg2 measurements, with a much higher specificity than chest CT(90.20% vs. 66.00%) and a much higher sensitivity than Rx WBS(83.33% vs. 61.11%).Conclusions: Serial ps-Tg measurements even over as short an interval as 8 days hold incremental value in identifying DM-DTC. ΔTg/ΔTSH is a specific early biochemical marker for DM-DTC.
文摘Currently, thyroid cancer is one of the most common endocrine cancer in the United States. A recent involvement of sub-population of stem cells, cancer stem cells, has been proposed in different histological types of thyroid cancer. Because of their ability of self-renewal and differentiation into various specialized cells in the body, these putative cells drive tumor genesis, metastatic activity and are responsible to provide chemo- and radioresistant nature to the cancer cells in the thyroid gland. Our Review was conducted from previously published literature to provide latest apprises to investigate the role of embryonic, somatic and cancer stem cells, and discusses the hypothesis of epithelial-mesenchymal transition. Different methods for their identification and isolation through stemness markers using various in vivo and in vitro methods such as flow cytometry, thyrosphere formation assay, aldehyde dehydrogenase activity and ATP-binding cassette sub-family G member 2 efflux-pump mediated Hoechst 33342 dye exclusion have been discussed. The review also outlines various setbacks that still remain to target these tumor initiating cells. Future perspectives of therapeutic strategies and their potential to treat advanced stages of thyroid cancer are also disclosed in this review.
文摘Background: Controversy exists over the extent of surgical treatment of papillary thyroid cancer.Reoperations may carry a significant risk of surgical complications. The aim of this study is to investigate the complications following surgical treatment of thyroid cancer and the association between the?extent of surgery and complication rates. Methods: A total of 196 patients with papillary thyroid cancer were retrospectively reviewed to identify extent of surgery and associated complications, between 2009 and 2018 atSouth Egypt Cancer Institute Assiut University. Results: Primary procedures included less-than-total thyroidectomy (near total thyroidectomy in 5.1%, subtotal thyroidectomy in 4.1%, thyroid lobectomy in 3.1%) and total thyroidectomy in 87.8% (18.9% of them are completion thyroidectomy). No lymph nodes dissection was done in 10.7%, Berry picking in 6.1%, central compartment neck dissection in 41.8%, central compartment neck dissection with modified ipsilateral radical neck dissection in 12.2%, central compartment neck dissection with modified bilateral radical neck dissection in 26.0%, central compartment dissection with both modified bilateral radical neck dissection and superior mediastinal lymph node dissection 3.1%. The most common surgical complication were transient hypoparathyroidism (16.7% - 45.8%) and 2.0% permanent, transient vocal cord palsy (7.3% - 16.7%), and 3.9% permanent, hematoma 1.5%, seroma 7.1% and chyle fistula in 2.6% of patients. Conclusion: Thyroid cancer surgeries are safe. The transient complication rates of hypoparathyroidism increased significantly with increasing the extent of surgery.
文摘BACKGROUND Papillary thyroid cancer(PTC)has good prognosis so that the local recurrence or distant metastasis can occur later on the lifetime follow up.In this study,we report recurrence of PTC in subcutaneous area combined with lymph node metastasis.A suspicion of needle tract implantation after core needle biopsy was found.CASE SUMMARY A 66-year-old female patients who underwent right thyroid lobectomy for PTC complained of palpable nodule on anterior neck area.The location of the palpable nodule was not associated with her postoperative scar.After excision of the skin tumor,it was diagnosed as recurrence of PTC.Furthermore,results of subsequent imaging showed lymph node metastasis on her right cervical area.According to the previous medical records,the patient received core needle biopsy through the neck of the patient midline and hematoma was noted after the procedure.The time interval from the first diagnosis to local recurrence or metastasis to the skin and lymph nodes was ten years.As treatment,the patient underwent lymph node dissection in the right and completion thyroidectomy for radioisotope treatment.CONCLUSION Needle tract implantation can occur after core needle biopsy.Further studies are needed to compare core-needle biopsy and fine-needle aspiration.
文摘Objective: To study the relation of age and clinicopathologic pattern to the aggressiveness of thyroid cancer cases and the treatment results of patients from western region of Saudi Arabia with differentiated thyroid carcinoma referred for treatment in King Abdulaziz Hospital and Oncology Center, Jeddah, Saudi Arabia. Methods: Retrospective review of 174 patients with differentiated thyroid carcinoma and analysis of the clinicopathologic characteristics, age correlation to different risk factors, treatment protocol and results were performed. Results: Analysis of the clinicopathologic pattern showed no statistically significant difference between patients in the different age groups except for extrathyroid extension and lymph node involvement. Patients older than 45 years had a statistically significant lower incidence of nodal involvement and a higher rate of extrathyroid extension (<0.02). In this study, we used a high dose method (Radioiodine-131 dose 75 - 100 mCi) for thyroid remnant ablation after thyroidectomy (total or near total) in 134 patients. An Iodine-131 dose of 200 mCi was used in 8 patients with distant metastases. In 24 patients with radioiodine-avid cervical lymph nodes and six patients with a gross residual tumor, an Iodine-131 dose of 150 mCi was used. For the whole study group, the 5-year overall survival and disease-free survival were 96% and 88%. Conclusion: Despite the fact that differentiated thyroid carcinoma is among the most curable cancer some patients are still at high risk for recurrent and increased mortality.
基金Supported by The Project of Shanghai Municipal Health Commission,No. 20214Y0223
文摘BACKGROUND The recognized pattern of cervical lymph node metastasis(CLNM)of papillary thyroid carcinoma involves a stepwise route.Contralateral lymph node skip metastasis is very rare.In addition,the patient in our case report also suffered from a breast carcinoma accompanied by left supraclavicular lymphadenopathy,which made it difficult to distinguish the origin of the CLNM.Based on this case,we recommended that more detailed physical and imaging examinations are needed for patients with uncommon cervical lymphatic metastasis of primary cancer.CASE SUMMARY A 53-year-old women was admitted to the hospital for a neck mass in the left cervical region that had existed for 2 mo.The neck mass was suspected to be an enlarged lateral LN originating from papillary thyroid microcarcinoma of the contralateral thyroid lobe,according to ultrasound and ultrasound-guided fine needle aspiration biopsy.The patient underwent total thyroidectomy and radical cervical LN dissection.Postoperative pathology confirmed the diagnosis of papillary thyroid microcarcinoma with contralateral lymphatic skip metastasis.Unfortunately,a breast cancer was discovered 4 mo later,which was accompanied by ipsilateral supraclavicular LN metastasis.She accepted neoadjuvant chemotherapy and subsequent left modified radical mastectomy for treatment.The patient is currently receiving postoperative radiotherapy,and no local recurrence was observed in the 6-mo follow-up after surgery.CONCLUSIONWe present a rare case of papillary thyroid microcarcinoma with contralateral lymphatic skipmetastasis and breast cancer with supraclavicular lymphatic metastasis.
