RESUMEN
PURPOSE: Persistent/recurrent disease in the neck is frequent in patients with papillary thyroid cancer (PTC). The goal of this study was to evaluate the efficacy of the reoperation and radioiodine (RAI) treatment for persistent/recurrent disease after the initial treatment. METHODS: A total of 30 patients (13 M/17 F) with PTC were enrolled in this study. All had been submitted to total thyroidectomy for PTC and subsequently to reoperation for local persistent/recurrent disease. All had received RAI, before and/or after reoperation. The mean age at initial thyroidectomy and cancer diagnosis was 41.4±15.2 years. Initial T status was T1 in 22 cases (73.3%), T2 in 4 cases (13.3%) and T3 in 4 cases (13.3%). Initial N status was N0 in 2 cases (6.6%), N1 in 15 cases (50%) and Nx in 13 cases (43.3%). RESULTS: Reoperation reduced the mean stimulated thyroglobulin (stimTg) serum concentration from 76.1±165.5 ng/mL to 20.1±28.8 ng/mL, p=0.002. The RAI treatment provided to 19 patients after reoperation reduced further the stimTg values from 28.6±32.4 ng/mL after reoperation, to 11.3±20.4 ng/mL, p=0.003. According to the dynamic risk stratification after the reoperation 7 patients (23.3%) had excellent response, 4 (13.3%) had biochemically incomplete response, 9 (30.0%) had indeterminate response and 10 (33.3%) had still structural incomplete response. CONCLUSION: Surgery for local persistent/recurrent disease in papillary thyroid carcinoma reduces tumor burden, improves the biochemical and structural disease. Administration of therapeutic RAI after lymph node resections appears to further improve biochemical disease.
Asunto(s)
Recurrencia Local de Neoplasia/radioterapia , Recurrencia Local de Neoplasia/cirugía , Cáncer Papilar Tiroideo/radioterapia , Cáncer Papilar Tiroideo/cirugía , Adolescente , Adulto , Anciano , Femenino , Humanos , Radioisótopos de Yodo/uso terapéutico , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND/AIM: Medullary thyroid carcinoma (MTC) originates from thyroid C-cells and is a calcitonin-secreting tumor. Calcitonin is also elevated in C-cell hyperplasia (CCH). The objective of the study was to determine the optimal basal (bCT) and peak stimulated calcitonin (psCT) cut-off value for differentiating MTC from CCH, and to examine the histological findings of thyroidectomy in patients with maximum psCT >100 pg/ml. PATIENTS AND METHODS: Fifty-five patients had a maximum calcium-psCT >100 pg/ml and underwent total thyroidectomy. RESULTS: A total of 20 patients were diagnosed with MTC and the remaining 35 with CCH. A bCT level >17.4 pg/ml and psCT level >452 pg/ml demonstrated the best sensitivity and positive predictive value for differenting MTC from CCH. CONCLUSION: The overlap of calcitonin levels between MTC and CCH reduces the accuracy of the calcium stimulation test. Remarkably, an appreciable number of patients with psCT levels >100 pg/ml harbor differentiated thyroid carcinoma of follicular origin.
Asunto(s)
Calcitonina/metabolismo , Calcio/metabolismo , Glándula Tiroides/metabolismo , Glándula Tiroides/cirugía , Neoplasias de la Tiroides/metabolismo , Neoplasias de la Tiroides/cirugía , Adolescente , Adulto , Anciano , Carcinoma Neuroendocrino , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tiroidectomía/métodos , Adulto JovenRESUMEN
Paragangliomas, also described as ectopic pheochromocytomas are infrequent neuroectodermal neoplasms that could be found wherever paraganglionic tissue exists. We present a rare case of a manifold non-functional primary hepatic paraganglioma in a 71 years old female. The combination of structural computed tomography and magnetic resonance imaging and of a functional modality, octreotide scan supported diagnosis. The role of nuclear medicine is crucial because it may help to determine future treatment in cases where there is suspicion of this tumour. However it has certain limitations, largely related to the physiological radionuclidic biodistribution. This case is described because of its relative rarity and also to emphasize the need to be studied by multidisciplinary collaboration.
Asunto(s)
Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/patología , Paraganglioma/diagnóstico por imagen , Paraganglioma/patología , Anciano , Diagnóstico Diferencial , Diagnóstico por Imagen , Femenino , Humanos , Radioisótopos de Yodo , Imagen por Resonancia Magnética/métodos , Tomografía de Emisión de Positrones/métodos , Radiofármacos , Enfermedades Raras/diagnóstico , Enfermedades Raras/diagnóstico por imagen , Somatostatina/análogos & derivados , Tomografía Computarizada por Rayos X/métodos , Imagen de Cuerpo Entero/métodosRESUMEN
UNLABELLED: The purpose of this study was to examine the clinical usefulness of preoperative lymphoscintigraphy (PLS) for sentinel node identification in patients undergoing lymphatic mapping during surgery for early cervical cancer. PATIENTS AND METHODS: Day-before PLS was performed in 42 patients who were candidates for open radical hysterectomy and intraoperative lymphatic mapping, using a combination of radiocolloid and blue dye technique. RESULTS: In 39 patients, at least one sentinel node (SN) was evident either in the lymphoscintigram or during the operation (detection rate 92.8%). Lymphoscintigraphy revealed unilateral SNs in 24 (61.5%) cases and bilateral SNs in 15 (38.5%). A total of 56 SNs were identified. Intraoperatively, 5 out of 24 patients with unilateral SNs on PLS had bilateral identification. The total number of SNs retrieved was 103 (2.6/patient). While one SN was identified in 25 cases on PLS, 32 patients had two or more SNs intraoperatively. The agreement between preoperative and intraoperative detection regarding laterality, number and location of SNs was poor (Kappa<0.69). CONCLUSION: PLS is of limited clinical value for intraoperative SN detection in early cervical cancer.
Asunto(s)
Ganglios Linfáticos/diagnóstico por imagen , Biopsia del Ganglio Linfático Centinela/métodos , Neoplasias del Cuello Uterino/diagnóstico por imagen , Neoplasias del Cuello Uterino/cirugía , Femenino , Humanos , Ganglios Linfáticos/patología , Metástasis Linfática , Estadificación de Neoplasias , Cintigrafía/métodos , Agregado de Albúmina Marcado con Tecnecio Tc 99m , Neoplasias del Cuello Uterino/patologíaRESUMEN
BACKGROUND: The sentinel lymph node (SLN) technique aims at predicting the absence of regional nodal metastasis and seems promising in the management of cervical cancer patients. PATIENTS AND METHODS: Forty patients undergoing surgery for early cervical cancer were submitted to the SLN procedure, using Blue Patente alone in 3, radiocolloid injection alone in 4 and both methods in 33 (82.5%). All patients underwent radical hysterectomy and pelvic lymphadenectomy. RESULTS: The detection rate was as follows: overall 85%, blue dye alone 66%, radiocolloid alone 75%, dual method 87%. Detection was successful in 34 patients, with one false-negative result. No micrometastases were demonstrated during ultrastaging of the sentinels. The detection rate was higher in tumors <2 cm (94.1%) than in larger tumors (78.2%, p>0.09). Significant negative correlation between lymphatic vascular space invasion (LVSI) and detection rate was found (p<0.001). CONCLUSION: SLN detection is feasible in early cervical cancer but presence of LVSI and a tumor size >2 cm negatively affect the detection rate and may increase the incidence of false negatives.