Ioannis Vasileiadis

Papillary thyroid microcarcinoma: clinicopathological characteristics and implications for treatment in 276 patients

Eur J Clin Invest 2012; 42 (6): 657–664

Clinical and pathological characteristics of incidental and nonincidental papillary thyroid microcarcinoma in 339 patients

We analyzed the incidence and the clinicopathological characteristics of papillary thyroid microcarcinoma (PTMC) in a high prevalence region of goiter with the purpose to investigate differences between incidental and nonincidental PTMC.

Association of Intraoperative Neuromonitoring With Reduced Recurrent Laryngeal Nerve Injury in Patients Undergoing Total Thyroidectomy

Importance Injury of the recurrent laryngeal nerve (RLN) is one of the most serious complications of thyroid surgery. Intraoperative neuromonitoring (IONM) has been introduced to verify RLN function integrity and may be a helpful adjunct in nerve dissection. Objective To determine whether the use of IONM can reduce the incidence of RLN injury in patients undergoing total thyroidectomy. Design, Setting, and Participants This cohort study included 2556 patients who underwent total thyroidectomy between January 2002 and December 2012 in the Department of Otolaryngology-Head and Neck Surgery of Venizeleio General Hospital, Heraklion, Greece. Patients who had IONM during the procedure (n = 1481) were compared with patients who underwent surgery with nerve visualization alone (n = 1075). All patients underwent indirect laryngoscopy-fiberoptic nasopharyngoscopy both preoperatively and on day 2 after surgery to assess vocal cord motility. Main Outcomes and Measures Use of IONM and incidence of RLN injury. Results A total of 2556 patients (2028 women and 528 men [5112 RLNs at risk]; mean [SD] age, 51.35 [14.18] years; age range, 18-89 years) underwent total thyroidectomy. Univariate analysis showed that the use of IONM resulted in a significant reduction in RLN injury incidence (3.3% vs 0.7%) with a relative risk reduction of 2.6% (odds ratio [OR], 5.15; 95% CI, 3.12-8.49; number needed to treat, 19). Multivariate logistic regression showed that no use of IONM was an independent risk factor for RLN injury in patients who underwent total thyroidectomy (adjusted OR [AOR], 5.44; 95% CI, 3.26-9.09). Additional risk factors for RLN injury were operative time (AOR, 12.91; 95% CI, 6.66-25.06), maximum diameter greater than 45 mm of right thyroid lobe (AOR, 4.91; 95% CI, 3.12-8.56) and left thyroid lobe (AOR, 2.24; 95% CI, 1.39-4.32), extrathyroid extension (AOR, 3.26; 95% CI, 1.62-6.59), incidental parathyroidectomy (AOR, 3.30; 95% CI, 2.13-5.09), and tumor size larger than 10 mm (AOR, 3.24; 95% CI, 1.59-6.62). Conclusions and Relevance Our findings showed that the use of IONM decreased significantly both temporary and permanent RLN injuries. The technology of IONM is safe and reliable, and this technique is an important adjunct in nerve dissection and functional neural integrity. The routine use of IONM reduced pitfalls and provided guidance for our surgeons in difficult cases, reoperations, and high-risk patients.

Complete restoration of auditory impairment in a pediatric case of Cogan's syndrome: Report of a rare case with long-term follow-up and literature review

Cogans syndrome is characterized by interstitial keratitis, vestibular impairment and hearing loss, commonly bilateral. Many patients, especially children, experience a delay in proper diagnosis which may delay treatment and thus impact on prognosis of hearing restoration. Less than 10 pediatric cases of Cogans syndrome have been reported in literature and only five of them were reported with long-term follow-up. We report an extremely rare pediatric case of Cogans syndrome typical form with long-term follow-up and evaluation of hearing impairment. Cogans syndrome must be familiar to otorhinolaryngologists, pediatricians and ophthalmologists because early diagnosis and rapid administration of the proper therapy increase the probability of recovering hearing loss.

Bilateral versus unilateral papillary thyroid microcarcinoma: predictive factors and associated histopathological findings following total thyroidectomy.

OBJECTIVE: The extent of thyroidectomy for papillary thyroid microcarcinoma (PTMC) is debatable. This study investigated the rate and predictive factors of bilateral versus unilateral PTMC with the objective of identifying those patients who may benefit from total thyroidectomy. DESIGN: between January 2001 and December 2008, 2019 patients who underwent total thyroidectomy were examined. A total of 319 patients diagnosed histopathologically as PTMC were included in the study. The predictive value of age at diagnosis, gender, tumor size, multifocality, lymph node metastasis, thyroid capsule invasion and nonincidental diagnosis using univariate and multivariate analyses were retrospectively analyzed. RESULTS: Of the 319 patients with PTMC, 77 (24.1%) presented bilateral disease. In univariate analysis, size of tumor ≥5mm (p<0.001), multifocality (p<0.001), lymph node metastases (p<0.001), thyroid capsule invasion (p<0.001) and nonincidental diagnosis (p=0.002) were significantly associated with bilaterality. In multivariate analysis, tumor size (p<0.001), multifocality of the primary tumor in the unilateral lobe (p<0.001) and lymph node metastasis (p<0.001) were independent predictive factors for bilateral PTMC. CONCLUSIONS: Tumor size ≥5mm and multifocality of the primary carcinoma in the unilateral lobe were independent risk factors for bilateral PTMC. Total thyroidectomy should be considered for these patients, which is of importance for the prediction of possible recurrence of disease.

Can a giant cervical osteophyte cause dysphagia and airway obstruction? A case report

ZusammenfassungZervikale Spondylose ist eine häufige Erkrankung, von der hauptsächlich ältere Personen betroffen werden. Oft führt sie zu exzessivem Knochenbau (Osteophyten). Dadurch können Schmerzen und neurologische Defizite wegen radikulärer Kompression verursacht werden. Dysphagie und Atemwegsobstruktion aufgrund eines riesigen vorderen Osteophyts der Halswirbelsäule sind äußerst selten. Wir berichten von einem 81 jährigen Patienten mit Dysphagie und geringer Dyspnöe aufgrund eines solchen Osteophyts. Osteophytenresektion wurde durchgeführt und der Patient wurde von seinen Symptomen befreit. Dieser Fall zeigt, dass ein großes zervikales Osteophyt eine seltene Ursache für simultane Dysphagie und Dyspnöe sein kann und deswegen im entsprechenden differenzialdiagnostischen Vorgehen eingeschlossen werden sollte.SummaryCervical spondylosis is a common disorder mainly affecting elderly people. It frequently presents with excessive bone formation (osteophytes). These may lead to pain and neurological deficits due to root compression. Dysphagia and airway obstruction due to a giant anterior osteophyte of the cervical spine are extremely rare. We present the case of an 81-year-old patient suffering from dysphagia and slight dyspnoea due to a giant cervical osteophyte. Osteophyte resection was performed and the patient was relieved from symptoms. This case highlights that a large cervical osteophyte may, albeit rarely, be the cause of simultaneously presenting dysphagia and dyspnoea, and should, therefore, be included in the diagnostic workup in such cases.

Rapidly Growing Chondroid Syringoma of the External Auditory Canal: Report of a Rare Case

Introduction. Chondroid syrinoma of the external auditory canal is an extremely rare benign neoplasm representing the cutaneous counterpart of pleomorphic adenoma of salivary glands. Less than 35 cases have been reported in the international literature. Case Presentation. We report a case of a 34-year-old male in whom a rapidly growing, well-circumscribed tumor arising from the external auditory canal was presented. Otoscopy revealed a smooth, nontender lesion covered by normal skin that almost obstructs the external auditory meatus. MRI was performed to define the extension of the lesion. It confirmed the presence of a 1.5 × 0.8 cm T2 high-signal intensity lesion in the superior and posterior wall of EAC without signs of bone erosion. The patient underwent complete resection of the tumor. The diagnosis was confirmed by histopathologic examination. Conclusion. Although chondroid syringoma is extremely rare, it should always be considered in the differential diagnosis of an aural polyp. Chondroid syringomas are usually asymptomatic, slow-growing, single benign tumors in subcutaneous or intradermal location. In our case, the new information is that this benign tumor could present also as a rapidly growing lesion, arising the suspicion for malignancy.

External Auditory Canal Mass as the First Manifestation of a Bronchogenic Carcinoma: Report of a Rare Case

Objectives: Metastatic tumors in the external auditory canal (EAC) are exceptionally rare. These metastases almost always occur in the latter stages of the disease process. Ten cases of metastatic tumors of the EAC have been reported in the literature. We report the first case of a metastatic bronchogenic adenocarcinoma that presented initially as an EAC mass. Methods: We present a case report and a literature review. Results: Although bronchogenic adenocarcinoma not uncommonly metastasizes to the temporal bone, metastasis to the EAC is extremely rare. We report the case of a 62-year-old woman who presented with a 6-week history of swelling in her right EAC and sudden onset of hearing loss. Physical examination revealed a small, polypoid, friable mass originating from the superior-posterior wall of the right EAC. Incision biopsy was performed, and the histopathologic examination of specimens revealed a moderately to poorly differentiated adenocarcinoma compatible with a bronchogenic origin. Conclusions: A patient with an aural mass presents a diagnostic dilemma. Metastatic tumors in the EAC are extremely rare, but they should be included in the differential diagnosis of a mass in this location.

Plexiform (Multinodular) Schwannoma of Soft Palate. Report of a Case

РЕЗЮМЕ Плексиформенная шваннома представляет собой доброкачественное образование нервной оболочки, характеризующееся мультинодулярной плексифор- менной моделью роста. Всего 5% шванном имеют плексиформенную или мультинодулярную модели роста. 25% экстракраниальных шванном локали- зуются в области головы и шеи, а только 1% имеют интраоральное происхождение. Интра- оральные шванномы поражают чаще всего язык, небо, слизистую оболочку рта, губы и десны. Для подтверждения диагноза делается микро- скопическое исследование. Характерные гистоло- гические признаки расположены палисадно, а верете- новидные шванновые клетки - вокруг центральной ацеллюлярной зоны, т.н. тела Verocay. Авторы описывают случай 21-летней женщины с гладким постоянно нарастающим образованием на мягком небе. Проведено хирургическое удаление образования, как и гистологическое и иммуногис- тологическое исследования поражения, подтвер- ждающие мультинодулярную шванному мягкого не- ба. За пациенткой проводится общее клиническое наблюдение в течение 17 мес.; признаки рецидива отсутствуют. О плексиформенных шванномах мягкого неба очень редко имеются данные в англоязычной литературе. На этот редкий вид доброкачественной опухоли следует обратить необходимое внимание и из-за факта, что ошибочно можно поставить диагноз „плексиформенная нейрофиброма”. ABSTRACT Plexiform schwannoma is a rare benign neoplasm of the neural sheath characterized by a multinodular plexiform growth pattern. Only 5% of schwannomas have a plexiform or multinodular growth pattern. Schwannoma apparently derives from the Schwann cells. Extracranially, 25% of all schwannomas are located in the head and neck region, but only 1% show an intraoral origin. The intraoral lesions show a predilection for the tongue, followed by the palate, buccal mucosa, lip and gingival. Microscopic examination is necessary to confi rm the diagnosis. Characteristic histological signs are the palisading of the spindleshaped Schwann cells around the central acellular area, so called Verocay bodies. We report a case of a 21-year-old woman with a smooth mass of the soft palate that was gradually increasing. Surgical excision of the mass was done and the histopathology and immunohistochemistry study of the excised lesion revealed a multinodular plexiform schwannoma of the soft palate. The patient is under regular clinical control, with no signs of recurrence after 17 months. Plexiform schwannomas of the soft palate are mentioned very rarely in the English literature. This rare benign tumor is worthy of recognition because it can be misdiagnosed as plexiform neurofi broma.