Sri Lanka is considered an endemic region for goiter. Early researchers have suggested the existence of a goiter belt based on rainfall pattern. Subsequent studies done in school children have challenged this theory. Current study is a community-based cross-sectional study done to assess the epidemiology of goiters. Geographic information system (GIS) mapping of the goiter prevalence is developed for the first time in Sri Lanka.

Study subjects were selected using a multi-staged cluster sampling with probability proportionate to size (PPS) method. Examination for the presence of goiters was done by two trained investigators and graded. ArcGIS 10 software was used for geostatistical analysis and developing a map by interpolating the data collected for the first time in Sri Lanka.

A total of 5200 individuals (female—66%, median age—38 years; range 10–92 years) were assessed and 426 goiters were detected. The adjusted prevalence rate of goiters was 6.8%. Kriging interpolation method was used to develop the most appropriate epidemiological map clustering of high prevalence areas with scattered pockets of high prevalence was observed. Current map does not show a prevalence pattern in relation to the rainfall or elevation above sea level as proposed in the past.

Goiter prevalence in Sri Lanka appears to be different from earlier proposed patterns. Use of GIS has contributed to develop a comprehensive epidemiological map of goiters demonstrating the absence of an endemic goiter belt in the wet zone as proposed earlier.

Chandrasinghe P, Fernando R, Nandasena S, Pathmeswaran A. Epidemiology of Goiters in Sri Lanka with Geographic Information System Mapping: Population-based Cross-sectional study. World J Endoc Surg 2015;7(3):55-59.

Neuroendocrine tumors (NET) express different types of somatostatin receptors (SSTRs) that bind to synthetic analogs with variable affinity. It is important to know the expression profile of SSTRs to predict biological effect of somatostatin analogues. We studied SSTR2 and SSTR5 expression by immunohistochemistry (IHC) to assess the dominant subtype in NETs and correlate the expression with histological prognostic parameters.

Fifty-three consecutive cases of NET from all sites were evaluated for SSTR2 and SSTR5 expression by IHC. The expression was correlated with histological features of NETs.

Forty-four cases were resected specimens and 9 were small biopsies. Nine of 53 cases (16.9%) were functional tumors. There were 24 NETs from gastrointestinal tract (GIT), 19 from pancreas and 10 from miscellaneous sites. Overall SSTR expression was seen in 43 NETs (79.2%). Somatostatin receptor 2 was expressed in 30 cases (56.6%) and SSTR5 in 39 cases (73.6%). Somatostatin receptor 2 expression showed near significant negative correlation with tumor grade and lymph node metastasis (p = 0.05). Somatostatin receptor 5 expression showed significant negative correlation with lymph node metastasis (p = 0.008) and tumor size (p = 0.02). Anatomic location and tumor necrosis were not significantly different. Somatostatin receptor 5 was dominant subtype expressed in all NETs with intense expression.

Somatostatin receptor 5 expression was the dominant subtype and expressed in small sized tumors. Somatostatin receptor 2 was expressed more in low grade NETs. Somatostatin analogs can be effective both in functional and nonfunctional NETs and can be useful in both resectable and nonresectable or metastatic tumors.

Krishnani N, Kumari N, Singh RK, Shukla P. The Dominant Somatostatin Receptor in Neuroendocrine Tumors of North Indian Population. World J Endoc Surg 2015;7(3):60-64.

Primary adrenal diffuse large B-cell lymphoma are aggressive high grade lymphomas affecting elderly gentlemen and mostly present with bilateral enlarged adrenal masses associated with B symptoms, adrenal insufficiency and elevated lactate dehydrogenase. When imaged with CT or ultrasound, these lesions usually appear as heterogeneous complex large masses with low density. They appear metabolically active on PET scan. Confirmatory diagnosis is established by image guided biopsy or surgical excision. Treatment is usually with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) or CHOP like regimes. Surgery has very limited role, if any in the management of this condition. The prognosis is generally poor with only about a third of patients achieving partial or complete remission following treatment. A concise review of the literature (PubMed database; 1990–2014) on the clinical management of primary adrenal lymphoma along with a case example is discussed.

Parameswaran R, Chan DKH, Michelle PLM, Wang S. Primary Adrenal Diffuse Large B-cell Lymphoma: A Mini Review. World J Endoc Surg 2015;7(3):65-68.

Pandian TK, Thompson G, Benzon Dy. Extreme Nausea due to Hyperparathyroidism in Multiple Endocrine Neoplasia-1. World J Endoc Surg 2015;7(3):69-71.

Papillary thyroid carcinoma is the commonest thyroid cancer. Patients usually present with thyroid nodule and rarely with hyperthyroidism such that 2009 ATA guidelines recommended that cytological evaluation is not necessary in patients with hyperfunctioning nodules as they rarely harbor malignancy. We report a case of an unusual presentation of metastatic papillary thyroid carcinoma in a young patient.

A 17-year-old girl, presented to our hospital with 3 days of fever, cough and hemoptysis. Chest X-ray showed extensive miliary nodules and was treated for presumed miliary tuberculosis. Biochemical investigations revealed a hyperthyroid state (fT4 55.7 TSH < 0.02), with negative antibodies (TRAB and TSI). Radioisotope scan showed increased uptake on right lobe. She underwent bronchoscopy and biopsy which revealed metastatic papillary thyroid carcinoma.

Clinical examination revealed a small goiter with palpable cervical node at level III on the left. There were no clinical signs of Graves’ disease and she had no history of previous radiation or family history of endocrine disease. Ultrasound revealed multiple hypodense thyroid nodules with microcalcification and increased vascularity. Ultrasound of the neck showed the presence of abnormal lymphadenopathy.

She underwent total thyroidectomy, bilateral central neck dissection and left lateral modified neck dissection. Histology showed 1.3 cm papillary thyroid carcinoma involving the left lobe and multifocal papillary thyroid microcarcinomas involving both lobes. Ten out of 27 nodes were involved. She was BRAF mutation positive.

She recovered well postoperatively and was rendered hypothyroid. She underwent radioiodine ablation which showed no more disease in the neck but unfortunately there was no uptake in the lung metastases.

Metastatic papillary thyroid cancer developing in a young patient with hyperthyroidism is extremely rare and suggests a more aggressive behavior as confirmed by BRAF mutation.

Hu JSL, Parameswaran R. A Case of Miliary Nodules, Hemoptysis and Hot Thyroid Cancer: Unusual Presentation of Papillary Thyroid Cancer. World J Endoc Surg 2015;7(3):72-75.

Mayilvaganan S, Chekavar A, Kapoor R, Agarwal A. Conservative Management of Chyle Leak following Thyroid Surgery. World J Endoc Surg 2015;7(3):76-78.

Mishra A, Agarwal A, Singh RK, Tewari S. Pemberton Sign in Diagnosis of Retrosternal Goiter. World J Endoc Surg 2015;7(3):79-80.