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- Snook, KL, et al.
(författare)
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Recurrence after total thyroidectomy for benign multinodular goiter
- 2007
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Ingår i: World Journal of Surgery. - : Springer Science and Business Media LLC. - 0364-2313 .- 1432-2323. ; 31:3, s. 593-600
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Tidskriftsartikel (refereegranskat)abstract
- Background Total thyroidectomy is now the preferred option for the management of benign multinodular goiter (BMNG), and it ought not be associated with recurrent disease. The aim of the present study was to examine the efficacy of total thyroidectomy for BMNG and to review reasons for recurrence. Material and methods The study group comprised all patients from January 1980 to December 2005 who underwent a definitive procedure to remove all thyroid tissue for BMNG, and who were subsequently identified as having developed a recurrence. Included were patients who underwent primary total thyroidectomy at our unit, or a two or more stage procedure where a definitive secondary total thyroidectomy was performed at our unit. Results There were 3,044 total or secondary total thyroidectomies performed for BMNG during the study period. Ten patients were identified as having developed recurrent BMNG requiring reoperation despite previous complete “total” thyroidectomy. There were 11 sites of recurrence in 10 patients. Only one was a true local recurrence in the thyroid bed. Another 9 recurrences related to the embryology of the thyroid gland, 4 in the pyramidal tract and 5 in the thyrothymic tract. There was one recurrence at another site (submandibular) in a patient with presumed metastatic thyroid cancer despite benign histology. There were no complications in any of the 10 patients. Conclusions Total thyroidectomy for BMNG is not only a safe procedure but is efficacious in preventing recurrent disease. Failure to remove embryological remnants such as thyrothymic residue or pyramidal remnants during total thyroidectomy is the major cause of recurrence.
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| 2. |
- Stålberg, Peter, et al.
(författare)
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Cervical thymectomy for intrathymic parathyroid adenomas during minimally invasive parathyroidectomy
- 2007
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Ingår i: Surgery. - : Elsevier BV. - 0039-6060 .- 1532-7361. ; 141:5, s. 626-629
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Tidskriftsartikel (refereegranskat)abstract
- Background The development of an intrathymic parathyroid adenoma is common, and thymectomy is a significant component of the parathyroid surgeon’s technical armamentarium. Over the last decade, minimally invasive parathyroidectomy (MIP) has become the standard technique for removal of an abnormal parathyroid gland, and the requirement for thymectomy should remain unchanged during the era of minimally invasive techniques. The aim of this paper was to assess the feasibility and outcomes of cervical thymectomy for intrathymic parathyroid adenomas during MIP. Methods This is a retrospective case series. The study group comprised all patients undergoing parathyroidectomy in the University of Sydney Endocrine Surgical Unit during a 5-year period (January 2001 to December 2005). Patients undergoing MIP and open parathyroidectomy with a concomitant cervical thymectomy were compared. Results A total of 840 patients underwent parathyroid surgery for primary hyperparathyroidism (PHPT) during this period. A total of 30 MIP procedures with concurrent thymectomy were performed, and 99 open bilateral neck explorations with cervical thymectomy were performed. Of the MIP thymectomy group, there were 25 female and 5 male patients; the average age was 57 years (range, 22 to 82). A mean length of 34 mm of thymus was extracted via the minimally invasive approach (range, 8 to 85 mm). In 5 cases, only fatty tissue was identified histologically, and, in 5 cases, a small supernumerary parathyroid gland was identified in the histologic specimen. Only 1 patient suffered temporary, recurrent laryngeal nerve palsy; there were no cases of postoperative hemorrhage requiring return to the operating room. Conclusions Cervical thymectomy for removal of intrathymic parathyroid adenomas can be performed during lateral focused mini-incision MIP with a safety and efficacy equivalent to open bilateral neck explorations.
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| 4. |
- Tacon, Lyndal J., et al.
(författare)
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The glucocorticoid receptor is overexpressed in malignant adrenocortical tumors
- 2009
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Ingår i: Journal of Clinical Endocrinology and Metabolism. - : The Endocrine Society. - 0021-972X .- 1945-7197. ; 94:11, s. 4591-4599
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Tidskriftsartikel (refereegranskat)abstract
- CONTEXT: Adrenocortical carcinoma (ACC) is a rare tumor with a poor prognosis. The Weiss score is the most widely accepted method for distinguishing an ACC from an adrenocortical adenoma (ACA); however, in borderline cases, accurate diagnosis remains problematic. We recently discovered that the glucocorticoid receptor (GR) gene NR3C1 is significantly up-regulated in ACCs compared with ACAs in global gene expression studies. OBJECTIVE: Our objective was to study GR expression in adrenocortical tumors (ACTs) and to assess its utility as an adjunct to the Weiss score. DESIGN: Microarray analysis, real-time quantitative RT-PCR (qPCR), immunohistochemistry, Western blot, and direct sequencing were performed. RESULTS: Analysis of 28 ACTs by microarray and 49 ACTs by qPCR found NR3C1 expression to be up-regulated in ACCs compared with ACAs (P < 0.001). Western blotting and RT-PCR confirmed the presence of the GRalpha isoform in ACCs, and no mutations were detected on direct sequencing. Immunohistochemistry for GR in an overlapping cohort of ACTs demonstrated strongly positive nuclear staining in 31 of 33 ACCs (94%), with negative staining in 40 of 41 ACAs (98%) (P < 0.001). This finding was validated in an external cohort of ACTs, such that 14 of 18 ACCs (78%) demonstrated positive nuclear staining whereas 32 of 33 ACAs (94%) were negative (P < 0.001). CONCLUSIONS: The immunohistochemical finding of nuclear GR staining identified ACCs with high diagnostic accuracy. We propose that GR immunohistochemistry may complement the Weiss score in the diagnosis of ACC in cases that display borderline histology. The possibility that GR is transcriptionally active in these tumors, and may therefore be a therapeutic target, requires further study.
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