Antonieta Solar G

Características de presentación del microcarcinoma papilar del tiroides: Experiencia retrospectiva de los últimos 12 años

BACKGROUND Thyroid microcarcinoma is a tumor of 10 mm or less, that should have a low risk of mortality. However, a subgroup of these carcinomas is as aggressive as bigger tumors. AIM To describe the pathological presentation of these tumors, and compare them with larger tumors. MATERIAL AND METHODS All pathological samples of thyroid carcinoma that were obtained between 1992 and 2003, were studied. In all biopsies, the pathological type, tumor size, the focal or multifocal character, the presence of lymph node involvement and the presence of lymphocytic thyroiditis or thyroid hyperplasia, were recorded. RESULTS One hundred eighteen microcarcinomas and 284 larger tumors were studied. The mean age of patients with microcarcinoma and larger tumors was 42.7+/-14 and 49.3+/-16 years respectively (p <0,001) and 83% were female, without gender differences between tumor types. Mean size of microcarcinomas was 8.6 mm and 116 (98%) were papillary carcinomas. Of these, 109 (94%) were well differentiated and seven (6%) were moderately differentiated. Thirty six (31%) were multifocal and in 10 (8,6%), there was lymph node involvement. The mean size of larger tumors was 23.8 mm and 241 (85%) were papillary carcinomas. Of these, 200 (83%) were well differentiated, and 41 (17%) were moderately differentiated. Eighty five (35%) were multifocal and in 44 (18%) there was lymph node involvement. The prevalence of thyroiditis and hyperplasia was significantly higher among microcarcinomas than in larger tumors (15 and 2.5%, respectively, p <0.001, for the former; 32.4 and 1.7%, respectively, p <0.001, for the latter). CONCLUSIONS In this series, one third of microcarcinomas were multifocal and 10% had lymph node involvement. Therefore, the aggressiveness of these tumors is higher than what is reported in the literature and they should be treated with total thyroidectomy.

Tumor del cuerpo carotídeo: A propósito de 10 casos tratados

A fluid coupling includes a socket and a plug and is used to connect two fluid hoses, whereby the plug has a neck that can be inserted into the socket with an annular groove for engaging with a locking element. The locking element includes a push-button that can be activated in a radial manner from the exterior of the socket and from which two flexible fork arms protrude that engage into a hub of the socket and have diagonal ramp surfaces on the two opposing inner faces of the fork arms, whereby the diagonal ramp surfaces engage around the neck in the area of the annular groove around a part of the circumference of the neck. The annular groove is delimited by two opposing and diverging diagonal surfaces.

Necrosis cutánea: un desafío para el médico

Skin necrosis must be considered as a syndrome, because it is a clinical manifestation of different diseases. An early diagnosis is very important to choose the appropriate treatment. Therefore, its causes should be suspected and confirmed quickly. We report eleven patients with skin necrosis seen at our Department, caused by different etiologies: Warfarin-induced skin necrosis, loxoscelism, diabetic microangiopathy, ecthyma gangrenosum, disseminated intravascular coagulation, necrotizing vasculitis, paraneoplastic extensive necrotizing vasculitis, livedoid vasculopathy, necrotizing fasciitis, necrosis secondary to the use of vasoactive drugs and necrosis secondary to the use of cocaine. We also report the results of our literature review on the subject.

COMPROMISO OSEO EN HISTIOCITOSIS DE CELULAS DE LANGERHANS EN EL NIÑO: ESTUDIO RADIOLOGICO SIMPLE. PRESENTACION CLINICA Y DIAGNOSTICO RADIOLOGICO

Introduccion. La Histiocitosis de celulas de Langerhans (HCL) es una patologia poco frecuente, con diferentes manifestaciones radio-logicas. Su causa es desconocida y se caracteriza por una proliferacion de las celulas de Langerhans. Sus manifestaciones varian desde lesiones oseas aisladas hasta el compromiso sistemico. Muchas veces el primer estudio diagnostico corresponde a la radiografia simple de la zona afectada y sus hallazgos pueden ser dificiles de interpretar. El diagnostico diferencial debe incluir fundamen-talmente osteomielitis, sarcoma de Ewing y linfoma. Objetivos: Mostrar las manifestaciones radiologicas de la HCL, que permiten al radiologo sospechar el diagnostico. Material y metodos: Analisis retros-pectivo de las manifestaciones clinicas y radiologicas en los casos de HCL confirmados con histologia, que forman parte del Registro Nacional de Tumores Oseos (RENATO) y que fueron incorporados a este entre los anos 1959 y 1999. Resultados: Se obtuvo un total de 59 pacientes, 34 (58 %) varones y 25 (42%) ninas en quienes el estudio histologico fue compatible con el diagnostico de HCL. El rango de edad vario desde 0.8 hasta 17 anos (promedio 6.1 anos). Se tuvo acceso a las historias clinicas en 56 de los casos. El tiempo promedio de duracion de los sintomas fue de 5,5 meses, y el motivo de consulta mas frecuente fue dolor del sitio afectado (n= 50). Del total, 48 (81%) presentaron lesion osea unica y 11 (19 %) dos o mas lesiones. En 35 pacientes hubo compromiso de huesos largos y en 26, del esqueleto axial. El patron radiologico predominante fue el de una lesion osteolitica pura (45 pacientes). En 13 pacientes se observo un patron permeativo y 3 se presentaron con una vertebra plana. En 30 habia reaccion periostica y 29 tenian aumento de volumen de las partes blandas vecinas. Conclusiones: El patron de presentacion radiologica de la HCL es variado, sin embargo su diagnostico debe ser sospechado por el medico radiologo. Esta revision, permite caracterizar las manifestaciones oseas de esta enfermedad y es de utilidad en el enfrentamiento y en el diagnostico diferencial de una lesion osea en el paciente pediatrico

ESTUDIO RADIOLOGICO SIMPLE EN EL DIAGNOSTICO DEL TUMOR DE CELULAS GIGANTES EN POBLACION PEDIATRICA. CORRELACION ANATOMORADIOLOGICA

Abstract: Background. Giant cell tumor (GCT) is an uncommon primary bone neoplasm in pediatric patients. Plain radiograph of the affected area is the first diagnostic approach in most cases.Objective. To show radiographic features that could allow the radiologist to suspect the diagnosis of GCT through plain radiological study.Methods. Records from the National Bone Tumor File between 1959 and 1999 were retrospectively analyzed. Twenty-nine cases of patients under 20 years with biopsy proven diagnosis of GCT were found. The radiological study was available in 14 cases.Results. From a total of 29 patients, 83% were females and 17% males. Age ranged from 7 to 19 years, with an average of 16.3 years. In cases with radiological study, 93% of them presen -ted epiphyseal involvement of long bones. Osteolytic lesions with metaphyseal extension were the most frequent radiological pattern. One case showed malignancy with metastases.Conclusions. GCT is regarded as an infrequent occu -rrence in pediatric patients and its diagnosis can be suspected based on plain radiographic findings.

Tiroglobulina y sus limitaciones en el seguimiento del carcinoma diferenciado del tiroides: Report of two cases

Thyroid carcinoma is the most prevalent endocrine tumor, and the papillary carcinoma (PC) is the most common histological type. In the follow-up, after thyroidectomy serum thyroglobulin (s-Tg) is used as a marker to evaluate recurrence of thyroid carcinoma. In most cases, this parameter allows an adequate diagnosis, but occasionally s-Tg may miss the detection of a recurrence. We report a 57 year-old female and a 36 year-old male subjected to a total thyroidectomy for a papillary thyroid carcinoma with intermediate and high-risk of recurrence. Both had a cervical recurrence without a concomitant increase in s-Tg levels. In both, Tg staining was positive in the tumor cells. These cases confirm that in these patients, the follow-up must be done with measurement of s-Tg and complementary diagnostic tests.Thyroid carcinoma is the most prevalent endocrine tumor, and the papillary carcinoma (PC) is the most common histological type. In the follow-up, after thyroidectomy serum thyroglobulin (s-Tg) is used as a marker to evaluate recurrence of thyroid carcinoma. In most cases, this parameter allows an adequate diagnosis, but occasionally s-Tg may miss the detection of a recurrence. We report a 57 year-old female and a 36 year-old male sujected to a total thyroidectomy for a papillary thyroid carcinoma with intermediate and high-risk of recurrence. Both had a cervical recurrence without a concomitant increase in s-Tg levels. In both, Tg staining was positive in the tumor cells. These cases confirm that in these patients, the follow-up must be done with measurement of s-Tg and complementary diagnostic tests

Microcarcinoma tiroideo de evolución agresiva: Report of one case

The treatment of papillary thyroid carcinoma of less than 10 mm diameter is a matter of controversy. The incidental finding of papillary microcarcinomas in autopsies is frequent and some authors postulate that these tumors are biologically inactive and should only be observed. We report a 21 years old woman with a papillary thyroid cancer of 6x5x5 mm and bilateral paratracheal metastases, that was subjected to a total thyroidectomy. She received 200 mCi of radioiodine. Two years after surgery, a new nodule of 9.6 mm diameter was detected by ultrasound, that was treated with a new dose of 200 mCi of radioiodine. One year later a suprasternal mass of 2 cm diameter and 3 enlarged lymph nodes were detected. She was subjected to a surgical lymph node dissection of the neck and the biopsy confirmed the presence of cancer. She received a new dose of 300 mCi of radioiodine. The mother of the patient had a 7 mm thyroid nodule that was also a papillary carcinoma (Rev Med Chile 2005; 133: 323-6)The treatment of papillary thyroid carcinoma of less than 10 mm diameter is a matter of controversy. The incidental finding of papillary microcarcinomas in autopsies is frequent and some authors postulate that these tumors are biologically inactive and should only be observed. We report a 21 years old woman with a papillary thyroid cancer of 6 x 5 x 5 mm and bilateral paratracheal metastases, that was subjected to a total thyroidectomy. She received 200 mCi of radioiodine. Two years after surgery, a new nodule of 9.6 mm diameter was detected by ultrasound, that was treated with a new dose of 200 mCi of radioiodine. One year later a suprasternal mass of 2 cm diameter and 3 enlarged lymph nodes were detected. She was subjected to a surgical lymph node dissection of the neck and the biopsy confirmed the presence of cancer. She received a new dose of 300 mCi of radioiodine. The mother of the patient had a 7 mm thyroid nodule that was also a papillary carcinoma.

TUBERCULOSIS GANGLIONAR RETROPERITONEAL Y MESENTERICA: CASO CLINICO

Abstract: The changes of retroperitoneal lymphnodes in CT in a patient with AIDS are described.Differences with the compromise with M avium-intracellulare are discussed an also the differentialdiagnosis with other lymph node pathologies.Key words: Abdominal lymph nodes, AIDS,Disseminated Mycobacterium avium-intracellulare,Intraabdominal Mycobacterium tuberculosis,Tuberculous lymph nodes.Resumen: Se describen las caracteristicas delcompromiso ganglionar por Mycobacteriumtuberculosis en un paciente con SIDA en quien sedemuestra alteraciones de linfonodulosretroperitoneales y mesentericos en tomografiacomputada. Se discute las diferencias con elcompromiso secundario a infeccion porMycobacterium avium intracellulare y ademas eldiagnostico diferencial con otras formas decompromiso ganglionar.Palabras claves: Linfonodulos abdominales,Mycobacterium Avium-intracelular, M. Tuberculoso,TBC ganglionar, SIDA.IntroduccionLos informes del Ministerio de Salud para elano 2002 muestran una tendencia estacionaria dela tuberculosis (TBC) en Chile durante los ultimos 3anos, con una tasa de prevalencia de 19.3 x 100.000en este ano; siendo la forma pulmonar la massignificativa epidemiologicamente

INCIDENCIA DE PATOLOGÍA SALIVAL SINTOMÁTICA ALEJADA EN PACIENTES TRATADOS CON YODO RADIOACTIVO POR CÁNCER DIFERENCIADO DE TIROIDES

incidence of sympthomatic salivary disease in patients with differentiated thyroid cancer treated with radioactive iodine Background: The radioactive iodine therapy for differentiated thyroid cancer can produce severe and frequent salivary symptoms, during the treatment or later. aim: To analyze the incidence, severity and charactheristics of the salivary signs and symptoms in these patients. Patients and Method: Retrospective and descriptive analisis of 106 patients with confirmed diagnosis of differentiated thyroid cancer, treated with surgery and radioactive iodine, that completed a telephonic survey for the evaluation of salivary symptoms. results: 26 (24.52%) patients presented with salivary symptoms or signs after the radioactive iodine therapy (mean 5 months). The average doses of I 131 was 128,5 mCi. Xerostomy, pain, xeroftalmy, inflammation, sialoadenitis and dysgeusia, were the most frequent clinical symptoms. conclusions: After radioactive iodine therapy the salivary symptoms and signs incidence is high. We conclude that the indication for this treatment must be selective, but in accordance with the oncological risk of each patient.

Correlación entre el nivel preoperatorio de paratohormona y el volumen y peso del adenoma de glándula paratiroides extirpado, en pacientes con hiperparatiroidismo primario mejorados

Correlation of preoperative parathormone level with estimated volume and weight of the parathyroid adenoma in patientes with primary hyperparathyroidism Background: Primary hyperparathyroidism is caused mostly by a single adenoma and it is the most frequent cause of hypercalcemia in outpatients. Hyperplasia of the four glands and cancer are the other ethiological diagnosis. It has been postulated that the bigger and heavier an adenoma is the higher the preoperative PTH level. Objective: To evaluate a mathematical relation between adenoma estimated volume and weight and preoperative parathormone level (prPTH). Method: Retrospective analysis of 71 evaluable treated patients biopsies and preoperative PTH level. Results: A mathematical positive and weak correlation between volume, weight and preoperative PTH was obtained. This correlation was positive and strong between volumen and weight. Conclusions: In this group we found a positive and weak mathematical relation between weight, volume and preoperative PTH levels. These aspects alone are useful but only in combination with others for the correct interpretation of pre and intraoperative findings.