There are three types of thyroid carcinoma originating from follicular cells, papillary carcinoma (PTC), follicular carcinoma (FTC) and anaplastic carcinoma (ATC). PTC and FTC have generally indolent nature but ATC, which is believed to arise from PTC and FTC, are very progressive and display a dire prognosis. PTC and FTC are called differentiated carcinoma and regarded as a single group, but biological characteristics of these two types of carcinoma significantly differ. PTC frequently metastasizes to the regional lymph nodes and FTC generally metastasizes to distant organs such as the lung and bone. Most PTC can be diagnosed on preoperative imaging studies and fine needle aspiration biopsy (FNAB) and can be treated as malignancy. However, it is difficult to diagnose FTC preoperatively and most FTC are diagnosed on postoperative pathological examination. In this review, we describe prognostic factors of PTC and FTC and their therapeutic strategies. Furthermore, recent advances of treatment for ATC are also described.
Lee F Starker,
Annabelle L Fonseca,
During the past decade and a half, studies of genetic predisposition, parathyroid tumorigenesis, and molecular genetics of familial hyperparathyroid disorders have started to unveil the molecular basis of pHPT. Primary HPT is found in several distinct disorders with autosomal dominant inheritance such as in multiple endocrine neoplasia type 1 (MEN1), MEN2A, the HPT-jaw tumor syndrome (HPT-JT), familial isolated hyperparathyroidism (FIHPT), autosomal dominant mild hyperparathyroidism (ADMH), and neonatal severe HPT (NSHPT).
Incidental adrenal masses are common, with most representing benign, nonfunctional cortical adenomas. The diagnostic approach should consist of a biochemical evaluation for hormonal hypersecretion, as well as an assessment of the risk of malignancy (primary adrenal cancer vs metastasis from another site). The size and appearance of the adrenal tumor on imaging studies are critical to management decisions. Computed tomography (CT) or T1 weighted chemical shift magnetic resonance imaging (MRI) can usually diagnose a cortical adenoma based on characteristics related to intracellular lipid content. However, 30% of cortical adenomas are lipid-poor, and will be classified as indeterminate on CT or MRI. Fluorodeoxyglucose-positron emission tomography (FDG-PET) is a useful method of further characterizing an indeterminate adrenal mass, particularly in an oncology patient in whom identification of an adrenal metastasis will affect disease stage and therapy. FDG-PET has been found to have a sensitivity of 93 to 100% and a specificity of 70 to 100% for the identification of an adrenal malignancy in both oncology and non-oncology patient populations. Indications for adrenalectomy include all functional adrenal tumors, known or suspected primary adrenal cancers that appear resectable, adrenal tumors > 4 cm, and isolated adrenal metastases.
Radioactive iodine (RAI) ablation for treatment of hyperthyroidism in Pediatric Graves' disease is effective but limited literature exists regarding its long-term safety. There is no long-term prospective randomized controlled study on long-term safety of pediatric Graves' disease receiving RAI ablation. There are concerns regarding development of both thyroid and non-thyroidal malignancy, and primary hyperparathyroidism in subjects receiving RAI. Current evidences donot support routine use of RAI ablation in such situation. Surgery is a safe option.
Pseudopheochromocytoma usually presents with the signs and symptoms suggestive of pheochromocytoma, yet investigations fail to show any evidence of the tumor. This case reports a man who presented with severe abdominal pain and hypertension without previous symptoms of anxiety, tremor or palpitations at the time of presentation. Initial 24 hours urinary metanephrines were raised which suggested a diagnosis of hemorrhage into a pheochromocytoma. Clinicians need to be aware of this scenario if unnecessary surgery is to be avoided.
Gregory W Randolph,
Carrie C Lubitz,
William C Faquin,
Randall D Gaz,
Richard A Hodin,
Antonia E Stephen
DOI: 10.5005/jp-journals-10002-1030 |
Open Access |
How to cite |
How To Cite
How to cite this article:
Randolph GW, Lubitz CC, Faquin WC, Gaz RD, Sareh P, Hodin RA, Stephen AE. Metastatic Melanoma to Thyroid: A Case Report and Institutional Review. World J Endoc Surg 2010; 2 (2):97-100.
To report a case of melanoma metastatic to the thyroid gland and to review our experience with secondary neoplasms of the thyroid.
We depict the presentation and treatment of the patient, illustrating pathologic and radiologic findings. All patients with pathologic confirmation of metastatic tumors of the thyroid undergoing thyroidectomy at the Massachusetts General Hospital were reviewed (1995- 2008).
A 59-year-old male presented with malignant melanoma of the scalp. Two months following his melanoma excision and lymphadenectomy, he underwent a hemi-thyroidectomy for fine-needle aspirate positive solitary metastasis. He initially did well, but on follow-up was noted to have diffuse metastases and expired from his disease eight months following initial diagnosis. Institutional review revealed 13 additional patients with pathologically confirmed secondary thyroid tumors.
FNA remains an indispensable diagnostic tool. Palliation from local compressive symptoms is an indication for surgery and long-term survival is seen in some patients undergoing resection of isolated metastases.
Episodic spells of headache, palpitations, and flushing may be the result of catecholamine-secreting tumors such as extra-adrenal paraganglia tissue – paragangliomas. Presentation, diagnostic implications, and radiographic imaging of paragangliomas are discussed within the context of a case presentation. Although the operative cure rate is high, the variable course of the disease requires life-long follow-up.
Goitre is an ancient art form being practiced world over for various reasons. We report a case where tattoo marking was used as a form of therapy for goitre. Tattoo therapy had failed to provide any benefit to the patient who later underwent total thyroidectomy with good post operative recovery