RESUMEN
OBJECTIVE: Papillary thyroid carcinoma, per se, is the most common type of thyroid cancer, and Hashimoto's thyroiditis is the most frequent autoimmune disease of the papillon gland. The liaison between Hashimoto's thyroiditis and thyroid cancers is still an ongoing debate in thyroidology. The aim of the study was to discuss the frequency of the co-occurrence of Hashimoto's thyroiditis and papillary thyroid carcinoma. METHODS: This study is designed as a retrospective analytical cohort study. The institutional database and archive of histopathology scanning identified the patients who had undergone thyroidectomy between January 2022 and January 2016. The Statistical Package for Social Sciences v21.0 program was used for statistical purposes. Descriptive and chi-square tests were applied, and a p<0.05 was considered significant. RESULTS: Of 498 patients who had undergone thyroidectomy for 4 years, 99 (20%) were male and 399 (80%) were female. Of note, papillary thyroid carcinoma was revealed in 160 (32%) patients, and Hashimoto's thyroiditis was recognized in 178 (35.74%) patients. The prevalence of Hashimoto's thyroiditis in cases with papillary thyroid carcinoma was 43.8%, while the prevalence in patients with Hashimoto's thyroiditis was 41.1%. CONCLUSION: A debate still remains on the propriety of these two phenomena. Herewith, we recognized a correlation between the presence of papillary thyroid carcinoma and Hashimoto's thyroiditis. Providers should be vigilant about the coexistence of these phenomena. We might postulate the so-called total thyroidectomy for cases with a cytologic diagnosis of Hashimoto's thyroiditis with a papillary thyroid carcinoma. As a matter of fact, this issue merits further investigation.
Asunto(s)
Enfermedad de Hashimoto , Cáncer Papilar Tiroideo , Neoplasias de la Tiroides , Tiroidectomía , Humanos , Enfermedad de Hashimoto/complicaciones , Enfermedad de Hashimoto/epidemiología , Enfermedad de Hashimoto/patología , Femenino , Masculino , Estudios Retrospectivos , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/epidemiología , Neoplasias de la Tiroides/complicaciones , Persona de Mediana Edad , Adulto , Cáncer Papilar Tiroideo/patología , Cáncer Papilar Tiroideo/epidemiología , Cáncer Papilar Tiroideo/complicaciones , Prevalencia , Carcinoma Papilar/patología , Carcinoma Papilar/epidemiología , Brasil/epidemiología , Anciano , Adulto Joven , Enfermedades EndémicasRESUMEN
PURPOSE: Non-invasive encapsulated follicular variant of papillary thyroid cancer was reclassified as non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). These neoplasms have an extremely low malignant potential. The aim of this study was (1) to assess the prevalence of NIFTP in patients with papillary thyroid carcinoma, (2) to evaluate their outcomes, and (3) to determine their molecular profile. METHODS: Multicenter, descriptive, retrospective study. Patients with papillary thyroid cancer diagnosed from January 2006 to December 2016 from 11 referral centers were included. Diagnosis of NIFTP was based on criteria described by Nikiforov et al. in 2018. At least two pathologists agreed on the diagnosis. Two thousand six hundred and seventy-seven papillary thyroid cancer patients were included; 456 (17%) of them were follicular variant papillary thyroid cancer, and 30 (1.12%) fulfilled diagnostic criteria for NIFTP. RESULTS: Each of the 30 included patients underwent a total thyroidectomy, and 50% were treated with radioiodine (median dose 100 mCi). After a median follow-up of 37 months, 84% of patients had an excellent response, 3% had an indeterminate response and data was missing in the remaining 13%. No metastatic lymph nodes, distant metastases or recurrences were found. RAS mutations were detected in 4 patients (13%). CONCLUSION: The prevalence of NIFTP in our series is amongst the lowest reported. Excellent outcomes of patients underscore their low malignant potential. Molecular findings differ from other series, probably related to environmental or ethnic features of our population and the meticulous criteria for diagnosing NIFTP.
Asunto(s)
Adenocarcinoma Folicular , Neoplasias de la Tiroides , Adenocarcinoma Folicular/diagnóstico , Adenocarcinoma Folicular/epidemiología , Adenocarcinoma Folicular/genética , Argentina/epidemiología , Humanos , Radioisótopos de Yodo , Estudios Retrospectivos , Cáncer Papilar Tiroideo/diagnóstico , Cáncer Papilar Tiroideo/epidemiología , Cáncer Papilar Tiroideo/genética , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/epidemiología , Neoplasias de la Tiroides/genéticaRESUMEN
Background: Two recurrent TERT (telomerase reverse transcriptase) promoter mutations, C228T and C250T, have been reported in thyroid carcinomas and were correlated with high-risk clinicopathological features and a worse prognosis. Although far more frequent in the poorly differentiated and undifferentiated thyroid cancer, the TERT promoter mutations play a significant role on PTC recurrence and disease-specific mortality. However, the prevalence varies considerably through studies and it is uncertain if these differences are due to population variation or the methodology used to detect TERT mutations. In this study we aim to compare three different strategies to detect TERT promoter mutations in PTC. Methods: DNA was isolated from formalin-fixed paraffin-embedded (FFPE) specimens from 89 PTC and 40 paired lymph node metastases. The prevalence of the hot spot TERT C228T and C250T mutations was assessed in FFPE samples using TaqMan SNP genotyping assays. Random samples were tested by Sanger Sequencing and droplet digital PCR (ddPCR). Results: In general, 16 out of 89 (18%) PTC samples and 14 out of 40 (35%) lymph node metastases harbored TERT promoter mutations by TaqMan assay. Sanger sequencing, performed in random selected samples, failed to detect TERT mutations in four samples that were positive by TaqMan SNP genotyping assay. Remarkably, ddPCR assay allowed detection of TERT promoter mutations in six samples that harbor very low mutant allele frequency (≤ 2%) and were negative by both genotype assay and Sanger Sequencing. Conclusion: This study observed a good concordance among the methodologies used to detect TERT promoter mutations when a high percentage of mutated alleles was present. Sanger analysis demonstrated a limit of detection for mutated alleles. Therefore, the prevalence of TERT promoter mutations in PTC may be higher than previously reported, since most studies have conventionally used Sanger sequencing. The efficient characterization of genetic alterations that are used as preoperative or postoperative diagnostic, risk stratification of the patient and individualized treatment decisions, mainly in highly heterogeneous tumors, require highly sensitive and specific approaches.
Asunto(s)
Mutación , Regiones Promotoras Genéticas , Análisis de Secuencia de ADN/métodos , Telomerasa/genética , Cáncer Papilar Tiroideo/diagnóstico , Cáncer Papilar Tiroideo/genética , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/genética , Alelos , ADN/genética , Reacciones Falso Negativas , Genotipo , Humanos , Metástasis Linfática , Polimorfismo de Nucleótido Simple , Prevalencia , Pronóstico , Reproducibilidad de los Resultados , Cáncer Papilar Tiroideo/epidemiología , Neoplasias de la Tiroides/epidemiologíaRESUMEN
Background: The risk of malignancy (RoM) of indeterminate thyroid nodules (ITNs) shows a high variability in interinstitutional cohorts. The RoM is partially associated with the cytological degree of atypia and the ultrasound (US) pattern. This study evaluated the cancer risk of ITNs by jointly considering the cytological subcategory and the American Thyroid Association (ATA)-based US risk classification. Methods: This study features a retrospective cohort from two Brazilian centers comprising 238 ITNs with confirmed outcomes. US classification, according to ATA-based guidelines, and cytological subcategorization were determined. The cytological subgroups were as follows: (1) nuclear atypia (NA) related to papillary thyroid carcinoma (PTC) but insufficient to categorize the cytology as suspicious for malignancy; (2) architectural atypia without NA (AA); (3) both architectural and nuclear atypia (ANA); (4) oncocytic pattern (OP) without NA; and (5) NA not related to PTC (NANP). NA was divided into three subgroups: nuclear size and shape, nuclear membrane appearance, and/or chromatin aspects. Results: The overall frequency of malignancy was 39.5%. Among the cytological subcategories, the highest RoM was related to the NA (43.9%) and to the ANA (43.5%), followed by AA (29.4%), and OP (9.4%). NA was positively and independently associated with cancer (odds ratio [OR]: 4.5; confidence interval [CI: 1.2-16.6]) as was the occurrence of ANA (OR 6.6 [CI 1.5-29.5]). AA and OP were not independently associated with cancer. Both ATA-based high- and intermediate-risk categories showed an independent association with cancer (OR 6.8 [CI 2.9-15.5] and OR: 2.6 [CI 1.1-5.8], respectively). ITNs with cytological findings of NA or ANA when combined with intermediate US patterns had RoM values of 47.5% and 56.7%, respectively. Both cytological subcategories, when combined with the ATA high-suspicion class reached an RoM >70%. The type of NA with the highest odds for cancer was related to the nuclear membrane (OR 11.5). Conclusions: The RoM of ITNs can reach almost 80% when both NA and ATA-based high-risk US features are present. The presence of such cytological features also increased the RoM in the ATA-based intermediate-risk US category. In addition, AA and OP were not independently related to higher cancer risk. These results strengthen the recommendations for combing cytological subcategorization and US risk classification in the workup for ITNs before the decision of a molecular testing, clinical observation, or diagnostic surgery.
Asunto(s)
Cáncer Papilar Tiroideo/epidemiología , Neoplasias de la Tiroides/epidemiología , Nódulo Tiroideo/diagnóstico por imagen , Nódulo Tiroideo/patología , Adenocarcinoma Folicular/diagnóstico por imagen , Adenocarcinoma Folicular/epidemiología , Adenocarcinoma Folicular/patología , Adenoma Oxifílico/diagnóstico por imagen , Adenoma Oxifílico/epidemiología , Adenoma Oxifílico/patología , Adulto , Biopsia con Aguja Fina , Carcinoma Neuroendocrino/diagnóstico por imagen , Carcinoma Neuroendocrino/epidemiología , Carcinoma Neuroendocrino/patología , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Medición de Riesgo , Sociedades Médicas , Cáncer Papilar Tiroideo/diagnóstico por imagen , Cáncer Papilar Tiroideo/patología , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/patología , Nódulo Tiroideo/clasificaciónRESUMEN
El cáncer de tiroides es la neoplasia maligna más frecuente del sistema endocrino, siendo el más frecuente el cáncer bien diferenciado (papilar y folicular). El propósito de este trabajo es recoger nuestra experiencia clínica en el manejo y resultados del cáncer diferenciado de tiroides. Material y métodos: Estudio retrospectivo de 50 casos de pacientes con tumores malignos tiroideos, intervenidos de tiroidectomía total por nuestro servicio durante el periodo de 2015 a 2018. Se han recogido variables clínico-epidemiológicas que han sido procesadas con el programa SPSS versión 25. Se realiza estudio descriptivo y de asociación entre las diferentes variables según el tipo anatomo-patológico de tumor. Se analiza la probabilidad de recidiva del cáncer de tiroides y se utiliza el modelo de Cox para ajustar los efectos sobre la recidiva de diferentes variables en un modelo predictivo. Resultados: El 84% eran carcinoma papilar y 16% eran carcinoma folicular. Al finalizar el periodo de seguimiento (72 meses), el 14% presentaba recidiva, y habían fallecido el 8%. El carcinoma folicular fue el que mostró menor supervivencia. El tiempo medio sin recaída, fue de 129 meses. Las variables que influían en la supervivencia fueron: existencia de complicaciones en el postoperatorio, valor de tiroglobulina y antitiroglobulina y TIRADS. Conclusión: Coincidimos con el resto de autores en los aspectos epidemiológicos y clínicos. El carcinoma papilar es el más frecuente y tiene mejor pronóstico. Entre los factores que influyen en la supervivencia destacan el sexo y el tipo anatomo-patológico. Otros factores a considerar son: la existencia de complicaciones en el postoperatorio, la categoría TIRADS previa al tratamiento, y los valores de tiroglobulina y antitiroglobulina en los controles postoperatorios. (AU)
Thyroid cancer is the most frequent malignant neoplasm of the endocrine system, with well-differentiated cancer (papillary and follicular) being the most frequent. The purpose of this work is to collect our clinical experience in the management and results of well-differentiated thyroid cancer. Material and methods: Retrospective study of 50 cases of patients with malignant thyroid tumors, who underwent total thyroidectomy by our service during the period from 2015 to 2018. Clinical-epidemiological variables were collected and processed using the SPSS version 25 program. We have conducted a descriptive and association study between different variables according to anatomo-pathological tumor type. The probability of recurrence of thyroid cancer is analyzed and Cox model is used to adjust the effects on recurrence of different variables in a predictive model. Results: 84% were papillary carcinoma, and 16% were follicular carcinoma. At the end of the follow-up period (72 months), 14% had recurrence, and 8% had died. Follicular carcinoma showed the lowest survival. The mean time without relapse was 129 months. The variables that influenced survival were existence of postoperative complications, thyroglobulin and antithyroglobulin value, and TIRADS. Conclusion: We agree with the rest of the authors in the epidemiological and clinical aspects. Papillary carcinoma is the most frequent and has a better prognosis. Among the factors that influence survival, sex and anatomo-pathological type stand out. Other factors to consider are the existence of complications in the postoperative period, TIRADS category prior to treatment, and thyroglobulin and antithyroglobulin values in postoperative controls. (AU)
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Neoplasias de la Tiroides/cirugía , Carcinoma Papilar Folicular/cirugía , Cáncer Papilar Tiroideo/cirugía , Tiroidectomía , Neoplasias de la Tiroides/epidemiología , Análisis Multivariante , Análisis de Regresión , Estudios Retrospectivos , Estudios de Seguimiento , Carcinoma Papilar Folicular/epidemiología , Supervivencia sin Enfermedad , Cáncer Papilar Tiroideo/epidemiología , Recurrencia Local de NeoplasiaRESUMEN
Objectives Thyroid cancer is the most common endocrine neoplasm in childhood. There are few studies characterizing pediatric population in Colombia. We intend to detail the clinical, histological characteristics, BRAFV600E mutational status and NIS (sodium-iodine symporter) expression of children with papillary thyroid carcinoma (PTC) managed at Hospital de La Misericordia. Methods Medical records of the Department of Pediatric Surgery and Pathology from 2009 to 2018 were scrutinized in search of cases of differentiated thyroid carcinoma. A descriptive analysis was made. Paraffin embedded tumoral tissue was recovered to assess BRAF V600E mutational status by PCR and NIS expression by immunohistochemistry. Results Sixteen patients were selected, 81.2% were girls. Average age of presentation was 11.8 years. Only one patient had previous radiation exposure. Most frequent symptom was cervical adenopathy with a mean time of 29.2 weeks before diagnosis. 93.7% underwent total thyroidectomy and lymphadenectomy. 62.5% were PTC combining both classic and follicular pattern. 6.25% cases had BRAFV600E mutation and 25% showed NIS focal reactivity. Conclusions We found greater female predominance, lower percentage of risk factors described and a high percentage of patients requiring aggressive surgical treatment. We consider important to contemplate thyroid cancer as a differential diagnosis of cervical lymph node enlargement in children. Diagnosis can be challenging in benign and indeterminate categories of the FNA cytology and biomolecular profiles such as BRAF and NIS could be determinant in guiding treatment. More studies with larger sample size, complete genetic analysis, evaluation to iodine response and long term follow up are required.
Asunto(s)
Proteínas Proto-Oncogénicas B-raf/genética , Simportadores/genética , Cáncer Papilar Tiroideo , Neoplasias de la Tiroides , Adolescente , Edad de Inicio , Sustitución de Aminoácidos/genética , Niño , Colombia/epidemiología , Femenino , Regulación Neoplásica de la Expresión Génica , Ácido Glutámico/genética , Humanos , Incidencia , Masculino , Mutación Missense , Pronóstico , Simportadores/metabolismo , Cáncer Papilar Tiroideo/diagnóstico , Cáncer Papilar Tiroideo/epidemiología , Cáncer Papilar Tiroideo/genética , Cáncer Papilar Tiroideo/cirugía , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/epidemiología , Neoplasias de la Tiroides/genética , Neoplasias de la Tiroides/cirugía , Tiroidectomía/métodos , Tiroidectomía/estadística & datos numéricos , Resultado del Tratamiento , Valina/genéticaRESUMEN
BACKGROUND/AIM: Thyroid cancer is the only tumor in which age is an important prognostic factor. In papillary thyroid carcinomas (PTC), 45 years of age seems to be a key point that divides adult patients into two groups, with different clinical features. The aim of the study was to perform a microarray-based analysis in two groups of patients (<45 and ≥45 years old), in order to verify the occurrence of specific copy number alterations (CNAs) that could be associated to different patient behaviors associated with age. PATIENTS AND METHODS: In order to search and compare genomic alterations that may be related to age, we evaluated the occurrence of CNAs in the genome of 24 PTC samples, divided in two groups (<45 and ≥45 years old). RESULTS: We identified only one region showing a statistically significant difference between the groups (p=0.00357): a deletion of approximately 537 kps in 1p35.3., which was more frequent in patients aged 45 years or older. This is the region where, among others, the gene SESN2 is located, which is activated under oxidative stress and plays an antioxidant role, in addition to protecting the genetic material from damage generated by reactive oxygen species (ROS). CONCLUSION: This is the first time that a CNA involving the deletion of the SESN2 gene is associated with papillary thyroid carcinomas, particularly in patients aged 45 years and older, indicating that this deletion would lead to a more malignant and prominent tumoral behavior associated to a worst prognosis.
Asunto(s)
Biomarcadores de Tumor/genética , Predisposición Genética a la Enfermedad , Proteínas Nucleares/genética , Cáncer Papilar Tiroideo/epidemiología , Neoplasias de la Tiroides/epidemiología , Adolescente , Adulto , Factores de Edad , Anciano , Envejecimiento/genética , Variaciones en el Número de Copia de ADN , Daño del ADN , Progresión de la Enfermedad , Femenino , Eliminación de Gen , Humanos , Masculino , Persona de Mediana Edad , Análisis de Secuencia por Matrices de Oligonucleótidos , Pronóstico , Medición de Riesgo/métodos , Factores de Riesgo , Cáncer Papilar Tiroideo/genética , Cáncer Papilar Tiroideo/patología , Glándula Tiroides/patología , Neoplasias de la Tiroides/genética , Neoplasias de la Tiroides/mortalidad , Neoplasias de la Tiroides/patología , Adulto JovenRESUMEN
BACKGROUND: The increasing incidence of thyroid cancer has been described worldwide. Overdiagnosis, improved imaging, and increased environmental risk factors have contributed to the rising incidence. The objective of this study was to analyze the population incidence rate and trends during the period of 2000-2013 in children, adolescents and young adults (AYAs) in Brazil. METHODS: Data were extracted from 11 population-based cancer registries (PBCRs) encompassing the five geographic regions of Brazil. Incidence rates per million in children (0-14) and AYAs (15-39) according to world population were analyzed according to sex, age, and type of carcinoma. Incidence trends were evaluated using joinpoint regression. RESULTS: During 2000 to 2013, we identified 11,081 children and AYAs (0-39 years) with thyroid carcinoma in 11 PBCRs, with an age-adjusted incidence rate (AAIR) of 42 cases per million. Females had a higher AAIR of 66 cases per million versus 14 cases per million in males. Age-specific incidence rate (ASR) increased with age. Geographic variation was also observed; the Midwest and Southeast regions had the highest ASR in all age groups. The lowest ASR in all age groups was seen in the North region. Papillary subtype was the most common. Overall, the incidence rates in children and AYAs significantly increased from 0.2 in 2000 to 2.8 in 2013 and from 47.1 to 115.3, respectively, with an annual average percent change of 18.8 [8.1; 30.6] for children and 7.9 [CI 5.6; 10.3] for AYAs. CONCLUSIONS: Rates of thyroid cancer, particularly the papillary subtype, are steadily increasing in children and AYAs, especially among females. There are variations among geographic areas. This increased incidence is unlikely to be explained by screening, as children less than 14 years of age do not typically undergo medical surveillance. Environmental risk factors must be investigated.
Asunto(s)
Neoplasias de la Tiroides/epidemiología , Adenocarcinoma Folicular/epidemiología , Adolescente , Adulto , Factores de Edad , Brasil/epidemiología , Niño , Preescolar , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Sistema de Registros , Cáncer Papilar Tiroideo/epidemiología , Factores de Tiempo , Adulto JovenRESUMEN
Introducción: El gen FOXE1 (Forkhead box E1) codifica para un factor de transcripción involucrado en la morfogénesis tiroidea. El cáncer papilar de tiroides (CPT) se ha asociado con polimorfismos (SNP) de FOXE1 rs1867277 y rs965513 en población asiática y europea. Nuestro objetivo fue investigar la frecuencia y asociación de SNP rs1867277 y rs965513 con CPT y el riesgo de recurrencia de CPT en sujetos chilenos. Métodos: Se reclutaron sujetos con y sin CPT, se describieron sus características epidemiológicas y la forma de presentación clínica (AJCC VIII y MINSAL 2013). Se aisló ADN de leucocitos periféricos y evaluó ambos SNP mediante PCR-HRM y secuencia. Se compararon las frecuencias alélicas y genotípicas entre casos CPT y controles, y entre pacientes CPT de distintos riesgos de recurrencia. Se compararon frecuencia y se estimó el riesgo con test de Fisher y cálculo de odds-ratio (OR). Resultados: De los 184 sujetos, 156 (85%) eran mujeres, edad 39,3±12,3 años; 90 con CPT y 94 sin CPT 26 (28,9%) pacientes eran de riesgo muy bajo, 45 (50%) bajo, 16 (17,8%) intermedio y 3 (3,3%) alto según MINSAL 2013. En relación a la frecuencia de alelo menor (MAF) calculada en sujetos control y CPT, fue 31,7% y 24,5% (SNP rs965513), y 36,7% y 30,1% 8 (rs1867277), respectivamente (p NS). Tampoco fueron diferentes las MAF calculados y comparados entre pacientes con CPT de riesgo bajo e intermedio/alto. Sin embargo, la combinación de los genotipos rs1867277GG y rs965513AA se asoció a mayor riesgo de CPT. Conclusiones: En pacientes chilenos, se describe una frecuencia MAF de los SNP rs1867277 y rs965513 cercana a un 30%, las cuales no se asocian a CPT ni riesgo de recurrencia, sin embargo, sujetos con una combinación genotípica particular podrían tener mayor riesgo de CPT.
FOXE1 gene (Forkhead E1 box) codes for a transcription factor involved in thyroid morphogenesis. Papillary thyroid cancer (PTC) has been associated with FOXE1 polymorphisms (SNPs) rs1867277 and rs965513 in Asian and European population. Our aim was to investigate the frequency and the association of SNPs rs1867277 and rs965513 with PTC and the risk of recurrence of PTC in Chilean subjects. Methods: We recruited subjects with and without PTC. In those with PTC, their epidemiological characteristics and clinical features presentation are described according to AJCC VIII and MINSAL 2013 scales. Peripheral leukocyte DNA was isolated and both SNPs were evaluated using PCR-HRM and sequencing. Allelic and genotypic frequencies were compared between PTC cases and controls, and between PTC patients with different recurrence risks. Results: Of the 184 subjects, 156 (85%) were women, age 39.3 ± 12.3 years; 94 (51%) without PTC and 90 with PTC (49%): 26 (28.9%) patients had very low, 45 (50%) low, 16 (17.8%) intermediate and 3 (3.3%) high risk of recurence according to MINSAL 2013. Regarding the minor allele frequency (MAF) calculated on control and PTC subjects, was 31.7% and 24.5% (SNP rs965513), and 36.7% and 30.1% (rs1867277), respectively (p NS). In patients with PTC, MAFs were not different between patients with low and intermediate/high risk PTC. However, the combination of rs1867277GG and rs965513AA genotypes were associated with an increased risk of PTC. Conclusions: In Chilean patients, the MAF frequency of SNPs rs1867277 and rs965513 is near 30%, and they are are not associated with PTC or its risk of recurrence. However, subjects with a particular genotypic combination may have an increased risk of PTC.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Neoplasias de la Tiroides/epidemiología , Polimorfismo de Nucleótido Simple , Cáncer Papilar Tiroideo/epidemiología , Polimorfismo Genético , Neoplasias de la Tiroides/genética , Biomarcadores de Tumor/genética , Chile/epidemiología , Reacción en Cadena de la Polimerasa , Medición de Riesgo , Predisposición Genética a la Enfermedad , Factores de Transcripción Forkhead/genética , Cáncer Papilar Tiroideo/genética , Frecuencia de los Genes , Genotipo , Recurrencia Local de Neoplasia/epidemiologíaRESUMEN
Objetivo: Avaliar o perfil epidemiológico de pacientes com diagnóstico de carcinoma diferenciado de tireoide. Métodos: Estudo analítico descritivo, realizado por meio da análise e da coleta de dados de 34 prontuários de pacientes em seguimento em um ambulatório de endocrinologia de um hospital público em São Paulo. Foram incluídos todos os pacientes em acompanhamento no ambulatório com diagnóstico de tumores diferenciados; foram excluídos os menores de 18 anos e/ou com diagnóstico de outras neoplasias de tireoide (que não tumores diferenciados). Resultados: A idade dos pacientes variou de 25 a 84 anos ao diagnóstico, com média de 51 anos, tendo sido representados por 32 mulheres (94,11%) e 2 homens (5,88%). A maioria dos tumores (41,17%) possuía tamanho entre 1 e 2cm. A maior parte dos pacientes tinha baixo risco de recorrência, e todos foram tratados cirurgicamente. Conclusão: O tumor diferenciado mais frequente é o subtipo papilífero. Sua prevalência se dá em mulheres, com média de idade ao diagnóstico de 51 anos. (AU)
Objective: To evaluate the epidemiological profile of patients with differentiated thyroid carcinoma. Methods: Th is i s a d escriptive, analytical study performed through the analysis and collection of data from 34 medical records of patients being followed in an endocrinology clinic of a public hospital in the city of São Paulo. All patients being followed at the outpatients' department with a diagnosis of differentiated thyroid carcinoma were included, and those under 18 and/or with diagnosis of other cancer of the thyroid (other than differentiated tumors) were excluded. Results: the patients' ages ranged from 25 to 84 years at diagnosis, an average of 51 years represented by 32 women (94.11%) and 2 men (5.88%). Most tumors (41.17 %) were between 1 and 2cm. Most patients showed low risk of recurrence, and all were surgically treated. Conclusion: The most frequent differentiated tumor was the papillary one. Its prevalence was on women, with an average age at diagnosis of 51 years. There were only two patients with recurrent disease, and one with metastasis to the lung that died. (AU)
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Perfil de Salud , Cáncer Papilar Tiroideo/epidemiología , Recurrencia , Tiroidectomía/estadística & datos numéricos , Registros Médicos , Prevalencia , Cáncer Papilar Tiroideo/cirugía , Cáncer Papilar Tiroideo/clasificación , Cáncer Papilar Tiroideo/tratamiento farmacológico , Yodo/administración & dosificación , Yodo/uso terapéutico , Metástasis de la NeoplasiaRESUMEN
Background: The papillary thyroid carcinoma is the most common cancer among well-differentiated thyroid carcinoma. Exposure to environmental radiation adn edical X-Ray can be considered as an iportant risk factor. The aim of the study to evaluate the prevalence of papillary thyroid carcinoma among patients underwent thyroidetomy and the possible relation to X-Ray exposure. Patient and methods: A prospective clinically randomized trial was conducted in the department of surgery in Diwaniyah Teaching Hospital during the period from February 2016 to October 2018 on 432 patients with goiter from those 62 patients proved to be papillary thyroid carcinoma. Results: out of 432 patients with goiter underwent thyroidectomy 62 patients proved to be papillary carcinoma, female was 49 (79 %), and male was 13 (21%) with solitary thyroid nodule predominant (61.3%) the radiation exposure is higgly significant in patients proved to be papillary thyrid carcinoma about (85.48%), the FNAC sensitivity was low about 37%. There were 14 patients re-explored either for remnant thyroid tissue in 11 or neck disection in 3 patients. Only there patients presented with occult papillary thyroid carcinoma. Conclusion: Papillary thyroid carcinoma is the most common thyroid malignancy with salient increased incidence and female predominant in this region. X-ray exposure carries a significant risk factor for thyroid malignancy. However, further national clinical studies recommended confirming the results
Asunto(s)
Ensayos Clínicos Controlados Aleatorios como Asunto , Exposición a la Radiación/prevención & control , Cáncer Papilar Tiroideo/cirugía , Cáncer Papilar Tiroideo/epidemiologíaRESUMEN
ABSTRACT Objectives: We aimed to investigate the prevalence of the BRAF (V600E) mutation in consecutive cases of papillary thyroid carcinoma (PTC) in patients diagnosed and treated at the Hospital Sao Rafael (Salvador, BA, Brazil) and evaluate its association with clinical and pathological characteristics of PTC. Subjects and methods: We retrospectively enrolled in the study a total of 43 consecutive PTC patients who underwent total thyroidectomy. We performed DNA extraction from formalin-fixed paraffin-embedded (FFPE) tumour tissue samples. Polymerase chain reaction (PCR) and direct sequencing were used to determine BRAF (V600E) mutation status. Univariate and multivariate logistic regression analyses were employed to identify independent associations. Results: The prevalence of BRAF (V600E) mutation was 65.1% (28/43). A high frequency of older patients (p value: 0.004) was observed among the BRAF-mutated PTC group and, in contrast, a low frequency of concurrent Hashimoto's thyroiditis (HT) (p value: 0.011) was noted. Multivariate analysis confirmed that older age (OR: 1.15; 95% CI: 1.00 - 1.33; p value: 0.047) and HT (OR: 0.05; 95% CI: 0.006-0.40; p value: 0.005) were independent factors associated with BRAF (V600E) mutation. Conclusion: We found a high prevalence of BRAF (V600E) mutation in PTC cases. Older age and no concurrent HT were independently associated with BRAF (V600E) mutation.
Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Neoplasias de la Tiroides/genética , Proteínas Proto-Oncogénicas B-raf/genética , Cáncer Papilar Tiroideo/genética , Mutación/genética , Pronóstico , Brasil/epidemiología , Neoplasias de la Tiroides/epidemiología , Análisis Mutacional de ADN , Prevalencia , Estudios Transversales , Estudios Retrospectivos , Factores de Edad , Enfermedad de Hashimoto/complicaciones , Enfermedad de Hashimoto/genética , Cáncer Papilar Tiroideo/complicaciones , Cáncer Papilar Tiroideo/epidemiologíaRESUMEN
BACKGROUND: The incidence of thyroid carcinoma has increased in most populations, including pediatric patients. The increase is almost exclusively due to an increase in the incidence of papillary thyroid carcinoma (PTC). Genetic alterations leading to mitogen-activated protein kinase (MAPK) pathway activation are highly prevalent in PTC, with BRAF V600E mutation being the most common event in adult PTC. Although a lower prevalence of BRAF V600E had been reported among pediatric patients, a higher prevalence of BRAF fusion has been identified in both radiation-exposed and sporadic pediatric PTC. However, little is known about the prognostic implications of BRAF fusions in pediatric PTC. PROCEDURE: In this study, we investigated the prevalence of BRAF alterations (AGK-BRAF fusion and BRAF V600E mutation) in a large set of predominantly sporadic pediatric PTC cases and correlate with clinicopathological features. Somatic AGK-BRAF fusion was investigated by RT-PCR and confirmed by FISH break-apart. The BRAF V600E mutation was screened using Sanger sequencing. RESULTS: AGK-BRAF fusion, found in 19% of pediatric PTC patients, was associated with distant metastasis and younger age. Conversely, the BRAF V600E, found in 15% of pediatric PTC patients, was correlated with older age and larger tumor size. CONCLUSION: Collectively, our results advance knowledge concerning genetic bases of pediatric thyroid carcinoma, with potential implications for diagnosis, prognosis, and therapeutic approaches.
Asunto(s)
Mutación Missense , Proteínas de Fusión Oncogénica , Fosfotransferasas (Aceptor de Grupo Alcohol) , Proteínas Proto-Oncogénicas B-raf , Cáncer Papilar Tiroideo , Neoplasias de la Tiroides , Adolescente , Factores de Edad , Sustitución de Aminoácidos , Niño , Preescolar , Femenino , Humanos , Masculino , Metástasis de la Neoplasia , Proteínas de Fusión Oncogénica/genética , Proteínas de Fusión Oncogénica/metabolismo , Fosfotransferasas (Aceptor de Grupo Alcohol)/genética , Fosfotransferasas (Aceptor de Grupo Alcohol)/metabolismo , Proteínas Proto-Oncogénicas B-raf/genética , Proteínas Proto-Oncogénicas B-raf/metabolismo , Cáncer Papilar Tiroideo/epidemiología , Cáncer Papilar Tiroideo/genética , Cáncer Papilar Tiroideo/metabolismo , Cáncer Papilar Tiroideo/patología , Neoplasias de la Tiroides/epidemiología , Neoplasias de la Tiroides/genética , Neoplasias de la Tiroides/metabolismo , Neoplasias de la Tiroides/patologíaRESUMEN
OBJECTIVES: We aimed to investigate the prevalence of the BRAF (V600E) mutation in consecutive cases of papillary thyroid carcinoma (PTC) in patients diagnosed and treated at the Hospital Sao Rafael (Salvador, BA, Brazil) and evaluate its association with clinical and pathological characteristics of PTC. SUBJECTS AND METHODS: We retrospectively enrolled in the study a total of 43 consecutive PTC patients who underwent total thyroidectomy. We performed DNA extraction from formalin-fixed paraffin-embedded (FFPE) tumour tissue samples. Polymerase chain reaction (PCR) and direct sequencing were used to determine BRAF (V600E) mutation status. Univariate and multivariate logistic regression analyses were employed to identify independent associations. RESULTS: The prevalence of BRAF (V600E) mutation was 65.1% (28/43). A high frequency of older patients (p value: 0.004) was observed among the BRAF-mutated PTC group and, in contrast, a low frequency of concurrent Hashimoto's thyroiditis (HT) (p value: 0.011) was noted. Multivariate analysis confirmed that older age (OR: 1.15; 95% CI: 1.00 - 1.33; p value: 0.047) and HT (OR: 0.05; 95% CI: 0.006-0.40; p value: 0.005) were independent factors associated with BRAF (V600E) mutation. CONCLUSION: We found a high prevalence of BRAF (V600E) mutation in PTC cases. Older age and no concurrent HT were independently associated with BRAF (V600E) mutation.
Asunto(s)
Mutación/genética , Proteínas Proto-Oncogénicas B-raf/genética , Cáncer Papilar Tiroideo/genética , Neoplasias de la Tiroides/genética , Adolescente , Adulto , Factores de Edad , Anciano , Brasil/epidemiología , Niño , Estudios Transversales , Análisis Mutacional de ADN , Femenino , Enfermedad de Hashimoto/complicaciones , Enfermedad de Hashimoto/genética , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Pronóstico , Estudios Retrospectivos , Cáncer Papilar Tiroideo/complicaciones , Cáncer Papilar Tiroideo/epidemiología , Neoplasias de la Tiroides/epidemiología , Adulto JovenRESUMEN
Antecedentes: en las últmas décadas se han extendido las indicaciones de duodenopancreatectomía cefálica (DPC). Sin embargo, las series con más de 1000 DPC provienen de unos pocos centros de los Estados Unidos y Europa y ninguna de Latinoamérica. Objetivo: evaluar la morbilidad y mortalidad de 1028 DPC consecutivas realizadas por un mismo equipo quirúrgico. Material y métodos: se analizaron los datos de una base prospectiva de 1028 DPC consecutivas. Se determinaron los datos demográficos, la indicación de la cirugía, el intervalo de tempo entre el inicio de los síntomas y la primera consulta, la clasificación de la American Society of Anesthesiologistis (ASA), el tipo de técnica quirúrgica, el tempo operatorio, la colocación de drenaje biliar previo, el diagnóstico anatomopatológico, la morbilidad y la mortalidad. Se compararon la morbilidad y la mortalidad de la DPC en dos centros de salud. Resultados: las 1028 DPC se realizaron en un período comprendido entre julio de 1994 y diciembre de 2014. La edad promedio fue 59,6 años y 565 pacientes (55%) fueron de sexo masculino. Las indicaciones más frecuentes fueron tumor de páncreas (n=262) y tumor de papila (n=249). En 670 casos se diagnosticó patología maligna. El promedio de tempo entre el inicio de los síntomas y la primera consulta fue de 71 días (rango 10 a 123 días). En 461 pacientes (44%) se drenó la vía biliar antes de la cirugía. En 399 pacientes (35,3%) se registraron una o varias complicaciones. La fistula pancreática (21%) y el vaciamiento gástrico retardado (11%) fueron las complicaciones más frecuentes. Se registró una mortalidad del 3,1% (32 pacientes). Todas las DPC fueron realizadas en dos centros, uno público (n=642) y el otro privado (n=386). Los pacientes operados en el centro público tuvieron en forma signi-ficativa mayor morbilidad (46% vs. 27%, p> 0,001) y mortalidad (4% vs. 1,5%, p< 0,001). Conclusión: la DPC realizada por cirujanos de alto volumen en cirugía pancreática tene elevada morbilidad, pero baja mortalidad. A pesar de los buenos resultados globales, la morbimortalidad de la DPC en un centro público fue significativamente mayor que la del centro privado.
Background: in recent decades the indicatons for pancreaticoduodenectomy (PD) has been extended. However, series of patentis with more than 1000 PD come from a few center in the USA and Europe and none from Latin America. Objective: to evaluate the morbidity and mortality of 1028 consecutive PD performed by the same surgical team. Material and methods: we analyzed data from a prospective data base of 1028 consecutive PD. The demographic data, the indicaton of surgery, the tme interval between the onset of symptoms and the frst consultaton, the classificaton of the ASA, the type of surgical technique, operative tme, placement of biliary drainage, the anatomopathological diagnosis, the morbidity and the mortality was determined. We compared the morbidity and mortality of the PD at two diferent health centers Resultis: the 1028 PD were performed in a period between July 1994 and December 2014. The mean age was 59.6 years and 565 (55%) were male. The most frequent indicatons were pancreatic tumor (n = 262) and ampullary tumor (n = 249). Malignant tumors were found in 670 patentis. The average tme between onset of symptoms and the frst consultaton was 71 days (range 10-123 days). Preoperative biliary drainage were performed in 461 (44%) patentis. Morbility was 35.3% (399 patentis). Pancreatic fistula (21%) and delayed gastric emptying (11%) were the most frequent complicatons. All PD were performed at two centers, one public (n = 642) and the other private (n = 386). Patentis operated at the private center had significantly lower morbidity (27% vs 46%, p <0.001) and mortality (1.5% vs 4%, p <0.001) Conclusion: the DPC performed by high-volume surgeons in pancreatic surgery has high morbility, but low mortality. Despite the overall good performance, morbidity and mortality of the DPC in a public center was significantly higher than the private center.