Naevi and Other Developmental Defects

Background:

Sentinel node biopsy (SNB) is employed as standard treatment in some solid organ cancers to assess lymph node spread and enable targeted treatment. Several studies have investigated the role of SNB in thyroid cancer. This is a systematic review and meta-analysis of the role of SNB in the management of thyroid cancer.



Methods:

A systematic search was performed in the PubMed database to identify all original articles on the role of SNB in thyroid cancer. Data on methodologies used, short-term outcomes and adverse effects were summarized, and used to address relevant clinical questions related to the application of the SNB technique in thyroid cancer.



Results:

Twenty-four studies were included. The overall sentinel node (SN) detection rates for the blue dye, radioisotope and combined techniques were 83·7, 98·4 and 96 per cent respectively. A positive SN was seen in 42·9 per cent of patients with papillary thyroid cancer with an identified SN. The overall false-negative rates for the blue dye, radioisotope and combined techniques were 7·7, 16 and 0 per cent respectively. A negative frozen-section examination of the SN was unreliable in 12·0 per cent of patients. Immunohistochemical assessment of the SN showed evidence of nodal metastases in an additional 15 per cent of patients (7 of 47 sentinel nodes).



Conclusion:

SNB in thyroid cancer is a promising technique that has the potential to avoid prophylactic lymph node surgery in up to 57 per cent of patients with clinically node-negative thyroid cancer. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Systematic review and meta‐analysis of sentinel node biopsy in thyroid cancer

Thyroid cancers arising from a thyroglossal duct cyst (TGDC) are rarely reported No clear consensus exists regarding optimal management In this light, TGDC carcinomas recently treated at Asan Medical Center, as well as previously reported cases in the literature, were reviewed There were ten patients who were diagnosed with TGDC carcinoma at our institution All patients underwent pre-operative fine-needle aspiration biopsy (FNAB) Nine patients were suspected of having papillary carcinoma following cytology The Sistrunk operation (SO) was performed in four patients, SO with total thyroidectomy (SO/TT) was performed in three patients, and SO/TT with neck dissection was performed in three patients Six patients who received total thyroidectomy underwent radioactive iodine (RAI) therapy and T4 suppression With a median follow-up period of 285 months, two patients showed recurrence and one of them died of the disease We analyzed 163 cases from 1990 to 2012 with three or more cases TGDC carcinoma, including the present study Among 48 patients who underwent FNAB, 75% had papillary thyroid carcinoma (PTC) SO, SO/TT, or SO/TT with neck dissection was performed in 27%, 41%, and 32% of patients, respectively Among 119 patients who received total thyroidectomy, 36% had concomitant PTC in the thyroid Among 52 patients who received neck dissection, 69% had cervical nodal involvement The results of our review suggest that when TGDC carcinoma is suspected, ultrasonography and, if necessary, FNAB should be performed If these tests reveal a suspected lesion in the thyroid or lymph node, SO/TT and lymph node dissection should be performed

Papillary thyroid carcinoma arising from a thyroglossal duct cyst: a single institution experience

Most well-differentiated liposarcomas can be readily distinguished from lipomas on histologic grounds alone. However, occasional retroperitoneal lipomatous tumors show no cytologic atypia. To determine whether these tumors are well-differentiated liposarcomas devoid of cytologic atypia or lipomas was the major aim of this investigation. We comprehensively and prospectively studied 19 retroperitoneal adipocytic tumors devoid of cytologic atypia at the cytogenetic and molecular genetic levels. Median patient age was 56 years (range: 36 to 78 y). Median tumor size was 21 cm (range: 8 to 46 cm) and the median weight was 1127 g (range: 173 to 2440 g). All tumors were well-circumscribed and showed no cytologic atypia. Standard cytogenetic analysis demonstrated rearrangements of 12q15 in 4 (of 7) cases. None showed ring or giant marker chromosomes. Fluorescence in situ hybridization failed to identify amplification of MDM2, carboxypeptidase M(CPM), SAS, CDK4, DDIT3, or HMGA2 in all cases. HMGA2 rearrangement was observed in 8 (of 19) cases (42%) and was more common in larger tumors (P=0.046). HMGA2-LPP fusion was seen in only 1 case. All tumors were completely excised. Follow-up information was available from 10 cases (median, 6 mo; range: 1 to 58 mo). No tumor recurred or metastasized. In contrast, a control group of 20 well-differentiated liposarcomas diagnosed during the same time period (matched per year of diagnosis) showed 4 instances of local recurrence. We conclude that this group of retroperitoneal lipomatous tumors shows clinico-pathologic and genetic features more akin to lipomas than well-differentiated liposarcomas. Owing to their apparent rarity, additional studies are necessary to more fully understand their natural biology in this anatomic location.

Retroperitoneal lipomatous tumors without cytologic atypia: are they lipomas? A clinicopathologic and molecular study of 19 cases.

OBJECTIVE: Thyroglossal duct cyst (TGDC) carcinoma is a rare entity and its management is controversial. The aim of this retrospective study was to: (a) identify patients with TGDC carcinoma followed up in our clinic and (b) study specific characteristics of the disease and their association with thyroid carcinoma. DESIGN: Medical files of patients with TGDC carcinoma were reviewed and tumour characteristics, lymph node metastases, treatment and follow-up were evaluated. RESULTS: A total of 6 patients, 4 females and 2 males, mean age 39.3 years (median 33.5), were treated for papillary thyroid carcinoma arising in a TGDC carcinoma of the thyroid gland was found simultaneously in 4 of these patients, while in one patient thyroid carcinoma developed 10 years after the diagnosis of TGDC carcinoma. A variable clinical picture and presentation was recorded. The most aggressive manifestation of the disease in terms of local infiltration, local recurrence and lymph node metastases was observed in our youngest patients. CONCLUSIONS: Long-term follow-up is necessary for patients with thyroid carcinoma arising in a TGDC. In view of the frequent co-existence of thyroid cancer in these patients, we would recommend detailed thyroid evaluation and, eventually, total thyroidectomy at initial diagnosis of TGDC carcinoma.

/pdf/thyroglossal-duct-cyst-carcinomas-is-there-a-need-for-4vsootmmxg.pdf

Thyroglossal duct cyst carcinomas: is there a need for thyroidectomy?

Although thyroglossal duct cysts represent a common developmental abnormality of the thyroid gland, malignant transformation is rare and occurs in only 1% of cases This article describes four clinical cases observed at the Surgical Science Department of "La Sapienza" University of Rome between 1996 and 2000 Histologic examination indicated two pure papillary carcinomas, a sclerosing papillary carcinoma, and a follicular variant of papillary carcinoma In all cases, treatment involved removal of the body of the hyoid bone and total thyroidectomy, which we associated with removal of the thyroglossal duct cyst In one case, laterocervical lymphectomy was performed Carcinoma multifocality was found in one patient We recommend associating total thyroidectomy with removal of the tumor of the thyroglossal duct and of the body of the hyoid bone, because the carcinoma may be multifocal and there may be lymphatic invasion of the thyroid and to ensure a correct follow-up

Papillary thyroid carcinoma in thyroglossal duct cyst : Case reports and literature review

Retroperitoneal lipomas are a heterogeneous group of mesenchymal tumors. They are usually large and occur most frequently in the retroperitoneal, perineal and pelvic regions. Lipomas grow slowly surrounding the retroperitoneal and pelvic organs, with a displacement of bowel and vascular axis. A case of a 61-year-old male patient which referred urinary frequency, urgency and nocturia is presented. Urodynamics evidenced a detrusor instability in a low capacity bladder. CT scan demonstrated a bladder dome compression due to a huge retroperitoneal mass extending from the right hepatic lobe to the hypogastric region and the right thigh. Surgical complete resection was performed: histology demonstrated a lipoma with areas of well differentiated myxoid degeneration. After surgery the irritative urinary symptoms disappeared. This is the first case described in literature of detrusor instability due to bladder compression by retroperitoneal lipoma.

Retroperitoneal lipoma: Unusual presentation with detrusor instability

Background The aim of this work was to reveal through sentinel node study the intraoperative presence of preoperatively undetected pathological lymph nodes. Materials and methods At the Surgical Science Department of La Sapienza University of Rome The Authors studied from January 2003 to June 2004 18 patients with papillary carcinoma of the thyroid, who presented no clinical evidence of lymph node metastasis; they performed a total thyroidectomy in all cases, removing and histologically examining all lymph nodes of the upper anterior mediastinum. Where negative they were then subjected to immunohistochemical analysis with Pan Cytokeratin. Results The method was positive in 10 patients: 2 pure papillary carcinomas, 1 papillary carcinoma with poorly differentiated areas, 1 tall cell papillary carcinoma, 5 sclerosing carcinoma and 1 follicular variant papillary carcinoma; and negative in 8:5 pure papillary carcinomas, 2 sclerosing carcinoma and 1 case of follicular variant papillary carcinoma. Lymph node micrometastasis was found in 2 cases through study with Pan Cytokeratin on final histological examination. Conclusions Analysis of the Authors' preliminary data shows that sentinel lymph node detection has 83.3% sensitivity and 100% specificity for Upper Anterior Mediastinum lymph nodes. The Authors can propose two main applications: select for dissection only patients with a positive sentinel node and reduce the number of cases to be subjected to postoperative treatment with iodine ablation, in patients with "low risk" thyroid tumours and negative sentinel nodes.

The sentinel lymph node in papillary cancer of the thyroid including histological subtype.

The Authors present a rare case of voluminous retroperitoneal tumor in a 41 years old woman. CT scan showed a solid abdominal expansive mass, with compression and displacement of the left lobe of the liver, spleen, stomach, pancreas, and left kidney. The patient underwent surgery for excision of a giant retroperitoneal mass. Surgery was uneventful. The patients recovered well. Histology showed a mixed liposarcoma and angiosarcoma with high grade of malignancy and positivity for vimentin, factor VIII, CD34, CD31 and negativity for S-100, CD68, AMS, AML. The prognosis of these tumours is closely related to local recurrence, histological type, size and radical surgery. A low-grade malignancy tumor, small sized and completely resected leads to a good prognosis. Radiation therapy and chemotherapy do not seem to have a strong influence on the prognosis. An aggressive surgical approach is the first choice for the treatment of such tumors. The resection of adjacent organs may be required for radical surgery.

Retroperitoneal giant mixed sarcoma. Case report

Parotid metastases of Merkel cell carcinoma.

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