World Journal of Endocrine Surgery

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Volume 15, Number 3, September-December 2023
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Original Article

Channa VK Rao, Vijayendra Kedage, Bharath S Veerabhadrappa, Rajgopal S Kallya

Evaluation of Ultrasound Characteristics and Serum TSH Level in Predicting Malignancy among Patients Undergoing Thyroidectomy with FNAC-proven Diagnosis of Multinodular Goiter and Follicular Neoplasia: A Prospective Observational Study

[Year:2023] [Month:September-December] [Volume:15] [Number:3] [Pages:4] [Pages No:59 - 62]

Keywords: Multinodular goiter, Follicular neoplasia, Fine needle aspiration cytology, Thyroid stimulating hormone level, Ultrasound of thyroid, Predictors of thyroid malignancy

   DOI: 10.5005/jp-journals-10002-1460  |  Open Access |  How to cite  | 

Abstract

Background: Thyroid nodules are one of the most common diseases encountered in surgical practice. Predicting malignancy in patients with multinodular goiters (MNGs) becomes difficult due to the presence of multiple nodules. Targeting the nodule which might be malignant is of utmost importance. The task becomes difficult due to the presence of many different ultrasound scoring systems. This study aims to evaluate ultrasound characteristics and thyroid stimulating hormone (TSH) levels in predicting malignancy in patients with benign goiters and follicular neoplasia. Materials and methods: Our study was a prospective observational study that was conducted between April 2021 and September 2022. Patients aged 18 years and above with fine needle aspiration cytology (FNAC) suggestive of MNGs and follicular neoplasia were included in the study. Analysis of the variables was done by using statistical analysis in a social science application. Results: The final analysis was conducted on 106 patients who met the inclusion criteria. Ultrasound of the thyroid detected microcalcifications in 8.5% of patients, hypervascularity in 33%, solid components in 40.6%, and hypoechoic areas in 47.2% of the patients. The study showed that a TSH value of greater than 1.88 mIU/mL and solid components in ultrasonograph (USG) have high sensitivity and specificity in predicting malignancy. Conclusion: This study shows that ultrasound characteristics of microcalcifications, hypervascularity, solid component, and TSH level greater than 1.88 mIU/mL are statistically significant and can be fairly used for predicting malignancy in benign goiter and follicular neoplasia. The presence of these features may warrant a surgical excision to confirm the diagnosis, even if the FNAC is reported as benign.

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Original Article

Jyotsna Yesodharan, Jyothin Benchamin, Bindhu M Rajamma

Utility of Reticulin Algorithm in Diagnosis of Adrenocortical Tumors: A Re-visit

[Year:2023] [Month:September-December] [Volume:15] [Number:3] [Pages:4] [Pages No:63 - 66]

Keywords: Adenoma, Adrenal cortical neoplasm, Carcinoma, Reticulin algorithm

   DOI: 10.5005/jp-journals-10002-1462  |  Open Access |  How to cite  | 

Abstract

Aim: This study aimed primarily at the assessment of the usefulness of the reticulin algorithm (RA) in the diagnosis of adrenocortical tumors in comparison with conventional multiparametric reporting systems in routine use. Materials and methods: It was a retrospective study and included 40 adrenocortical tumors reported between 2013 and 2021 in the histopathology division of our institute, a tertiary care center in Kerala, South India. The demographic, clinical, and biochemical profiles, as well as macroscopic details of these cases, were recorded, and selected formalin-fixed paraffin-embedded blocks of the tumor were stained for reticulin fibers by Foot's modification. The two-step RA, which defines malignancy through a qualitative/quantitative alteration in reticulin framework along with at least one of the three histopathological parameters i.e., necrosis, venous invasion, and high mitotic rate, was applied to all tumors. The diagnosis thus obtained was compared with the original histopathology report based on the conventional scoring systems. Results: Our cohort included 28 cases originally reported as adrenocortical adenomas and 12 as adrenocortical carcinomas (ACC) as per the classical scoring systems. On application of the two-step RA, all carcinomas were diagnosed correctly with diffusely altered reticulin framework. All but one case in the adenoma group were rightly classified as adenoma as per the RA as they failed to meet the two-tiered requirements for a diagnosis of carcinoma. The single discordant case was that of a huge adenoma with extensive hemorrhage, cystic degeneration, and necrosis, which showed only qualitative reticulin alterations probably attributable to the degenerative changes and lacked vascular invasion and high mitotic rate. Conclusion: The RA provides a fast, cheap, and easy-to-apply method for the diagnosis of ACCs with good reproducibility and reduces dependence on multiple other morphological parameters included in conventional scoring systems, thus bringing down subjectivity. However, the procedure of reticulin staining is technically demanding, and extreme caution needs to be exercised at every step for good results.

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Original Article

Keat How Teoh, Imisairi Ab Hadi

Anaplastic Thyroid Carcinoma: A 20-year Institutional Review

[Year:2023] [Month:September-December] [Volume:15] [Number:3] [Pages:4] [Pages No:67 - 70]

Keywords: Anaplastic thyroid cancer, Cancer, Endocrine, Surgery, Thyroid, Thyroid cancer

   DOI: 10.5005/jp-journals-10002-1463  |  Open Access |  How to cite  | 

Abstract

Background: Anaplastic thyroid cancers (ATC) are highly aggressive and lethal. Despite their low incidence, they account for a significant portion of thyroid cancer-related deaths. In this review, we will examine the clinical characteristics of ATC patients at our center over the past 20 years and their prognosis. Materials and methods: We retrospectively reviewed all ATCs diagnosed at Hospital Raja Perempuan Zainab II, Kota Bharu, Malaysia, from 2004 to 2023. Patients were identified from our lab database, and their clinical details were obtained from their medical records. Results: There were 42 patients, with a female-to-male ratio of 1.6:1 and a median age of 62 years. The majority (92.6%) presented with goiter larger than 4 cm and were female (61.9%). Only one patient had a history of differentiated thyroid cancer (DTC). Most patients (76.2%) presented with goiters lasting <10 years, while only 10 patients had a history lasting for >10 years. Hyperthyroidism was observed in only nine cases, while the rest were euthyroid. Common presenting complaints included dysphagia (59.5%), dyspnea (59.5%), and hoarseness of voice (57%). A large portion of the patients presented with advanced disease, with 26 patients showing distant metastasis, 28 patients exhibiting extrathyroidal extension, and 23 patients having lymph node involvement. The majority (66.7%) survive <3 months from the time of diagnosis. Conclusion: The management of ATC has evolved from palliative care to personalized therapies. However, the prognosis still remains grim. Further research and clinical trials are needed to optimize treatment strategies to improve quality of life and overall survival (OS).

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Original Article

Sidhu R Sekhar, Revathy Ajayachandran K Nair, Misha JC Babu, Gopalakrishnan Nair, Riju R Menon, Pradeep Jacob, Anoop V Pillai

Long-term Outcome of Follicular Thyroid Carcinoma: A Retrospective Cohort Study on 10-year Outcome of Follicular Thyroid Carcinoma

[Year:2023] [Month:September-December] [Volume:15] [Number:3] [Pages:5] [Pages No:71 - 75]

Keywords: Differentiated thyroid cancer, Distant metastasis, Follicular thyroid carcinoma

   DOI: 10.5005/jp-journals-10002-1465  |  Open Access |  How to cite  | 

Abstract

Papillary thyroid cancer (PTC) is the most common subtype of differentiated thyroid cancer and shows an increase in incidence globally. However, follicular thyroid carcinoma shows a decreasing trend in incidence but has aggressive biological behavior. The study focused on the long-term outcomes of follicular thyroid carcinoma and features predictive of adverse outcomes. After reviewing the histology, 22 patients with follicular thyroid carcinoma and these patients were treated during the study period. The median period of follow-up was 132 months. Disease-free survival (DFS) at the end of the study period was 59%, and adverse outcomes were recorded at 36%. Evident or obscure distant metastasis at the time of diagnosis was the strong predictor of adverse outcomes, which included disease-specific mortality. The most typical site of distant metastases was the lungs. The osseous metastases did not respond fully, even when iodine avidity was retained. Follicular thyroid carcinoma is an aggressive subtype of differentiated thyroid carcinoma (DTC) and requires aggressive management.

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CASE SERIES

Shefali Gautam, Aparna Shukla, Pooja Ramakant, Sanjeev Kumar, Shashank Kumar, Rajput A Kumar

A Retrospective Case Series on Planned and Accidental Pheochromocytoma Resection Surgery: Role of Preoperative Preparation

[Year:2023] [Month:September-December] [Volume:15] [Number:3] [Pages:6] [Pages No:76 - 81]

Keywords: Anesthesia, Case report, Epinephrine, Norepinephrine, Paraganglioma, Pheochromocytoma

   DOI: 10.5005/jp-journals-10002-1461  |  Open Access |  How to cite  | 

Abstract

Successful anesthetic management of patients with adrenal tumors requires a well-orchestrated and multidisciplinary approach. We report the successful anesthetic management and outcomes of five rare cases of adrenal tumors in adult and pediatric patients. Careful attention was paid to patient hydration, and salt supplementation was concurrently administered. Pharmacological therapy was started and required investigations, optimization was done preoperatively, and patients were admitted 2–3 days before surgery. During surgery, pheochromocytoma requires keen vigilance, invasive monitoring, appropriate anesthetic techniques, and vasodilator use during the perioperative period to tackle hypertensive crisis; vasopressors may be required postoperatively. All patients were clinically stable after surgery and were successfully discharged.

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CASE SERIES

Amit S Nachankar, Sachin Modi, Shilika Lalwani, Mantha Santosha, Vikram Singh Shekhawat

Parathyroid Carcinoma: A Case Series and Review of Literature

[Year:2023] [Month:September-December] [Volume:15] [Number:3] [Pages:6] [Pages No:82 - 87]

Keywords: Case report, Hungry bone syndrome, Hypercalcemia, Parathyroid adenoma, Parathyroid carcinoma, Primary hyperparathyroidism

   DOI: 10.5005/jp-journals-10002-1464  |  Open Access |  How to cite  | 

Abstract

Introduction: Parathyroid carcinoma (PC) is one of the least common endocrine malignancies seen in <1% of cases of primary hyperparathyroidism (PHPT). The most common presentation is in the form of parathyroid hormone (PTH) dependent hypercalcemia mimicking parathyroid adenoma (PA). However, the hypercalcemia is severe, associated with severe bony manifestations, and often associated with markedly elevated serum PTH. Case series: Our three cases of PC were detected in a single center within a short span of 3 years. All were female between 5th and 7th decade of life. All had initial symptoms of hypercalcemia with a fragility fracture in one. The initial biochemical evaluation showed PTH-dependent hypercalcemia. Two patients had localization of parathyroid swelling on ultrasonography (USG) with confirmation on the sestamibi parathyroid scan. One patient had PA on fine needle aspiration (FNA) of the thyroid nodule. All patients had severe osteoporosis, and one had nephrolithiasis. All had histopathological confirmation of PC postoperatively, but none had metastatic disease. Conclusion: Parathyroid carcinoma (PC) is an extremely rare malignancy that usually presents as PTH-dependent severe hypercalcemia and is often diagnosed postoperatively during histopathology. The most common clues to the diagnosis are markedly elevated serum PTH levels and hypercalcemia of >14 mg/dL.

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Photo Assay

Abhishek Krishna, Tripti Verma, Niti Singhal, Roma Pradhan, Amit Agarwal, Madhumati Goel

Long-standing Renal Amyloidosis Leading to Massive Amyloid Goiter

[Year:2023] [Month:September-December] [Volume:15] [Number:3] [Pages:2] [Pages No:88 - 89]

   DOI: 10.5005/jp-journals-10002-1469  |  Open Access |  How to cite  | 

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