Marta Strutyńska-Karpińska

Clinical and histopathological characteristics of patients with incidental and nonincidental thyroid cancer

Introduction Thyroid nodules (TNs) are a common pathology. Their prevalence increases with age. Some of them are suspected of malignancy and qualified for surgery. Sometimes their malignant nature is detected incidentally after a surgical procedure. The aim of the study is to analyze clinical and histopathological characteristics of patients with incidental and nonincidental thyroid carcinoma (ITC vs. NITC). Material and methods The case records of 3,241 patients with solitary and multiple TNs who were treated consecutively between 2008 and 2014 were analyzed retrospectively. After the final selection 235 (7.25%) patients were included in the study (202 females and 33 males, mean age: 52.9 +16.5 years). Seventy-five (31.91%) cases were incidentally diagnosed and 160 (68.09%) were diagnosed before surgery. Results We did not observe any differences in age, gender or stage of disease at the time of diagnosis between the patients with ITC and NITC (p = 0.366, p = 0.850, p = 0.226 respectively). The occurrence of solitary nodules in patients with NITC was significantly higher compared to patients with ITC (p < 0.0001). There were no differences in histopathological types of thyroid cancer (TC). The logistic regression analysis showed that solitary TC was an independent predictor of NITC (p < 0.0001). Conclusions There are no differences in gender, age or histopathological type of cancer in patients with ITC and NITC. Papillary TC is the predominant type in both groups. Incidence of TC in a solitary nodule is significantly higher in NITC than ITC. Solitary type of TC is an independent predictor of NITC. The prevalence of ITC is associated with multifocal type of TC.

Ultrasound Guided Fine-Needle Aspiration Biopsy of Thyroid Nodules: Does Radiologist Assistance Decrease the Rate of Unsatisfactory Biopsies?

BACKGROUND Ultrasound guided fine-needle aspiration biopsy (UG-FNAB) is the main presurgical, minimally invasive, accurate and generally safe procedure for the diagnosis of thyroid pathology. At present it is recommended as a valuable diagnostic tool for the management of thyroid nodules. OBJECTIVES This study aimed to evaluate if a radiologists assistance in the UG-FNAB procedure decreased the rate of unsatisfactory biopsies. MATERIAL AND METHODS Over a 3-year period, 385 (100%) patients were enrolled to the study. All individuals had UG-FNAB performed for the first time due to multiple nodules of the thyroid gland. Patients with a family history of thyroid cancer, receiving radioactive iodine and other predispositions for thyroid malignancy were excluded. 184 (47.79%) patients were examined using UG-FNAB with a radiologists assistance (group 1) and 201 (52.21%) without such support (group 2). All biopsies were performed by the same surgeon. All specimens obtained were examined by two cytologists experienced in thyroid pathology. RESULTS The specimens from the UG-FNAB were more frequently diagnostic when obtained from procedures performed with a radiologists assistance (77.8% vs. 56.8%, p < 0.0001). The cellularity of the specimens obtained from the UG-FNAB performed with a radiologists assistance was higher than those obtained without such support (66.7% vs. 56.9%, p < 0.0001). CONCLUSIONS UG-FNAB of the thyroid nodules performed with a radiologists assistance makes it possible to obtain more valuable specimens, which may improve diagnostic accuracy in the preoperative management of thyroid pathology.

Multi- and Unifocal Thyroid Microcarcinoma: Are There Any Differences?

BACKGROUND Thyroid microcarcinoma (TMC) often occurs as two or more separate foci, therefore a completion of primary surgery might be necessary. OBJECTIVES To evaluate and compare the incidence, diagnostic accuracy, clinicopathological characteristics and surgical treatment of unifocal and multifocal thyroid microcarcinoma (UTMC vs. MTMC). MATERIAL AND METHODS We retrospectively analyzed 3,218 medical records of patients consecutively admitted and surgically treated in one center due to thyroid pathology. RESULTS In the end, we evaluated 246 (7.64%) patients with thyroid malignancy. Ninety-seven of them (39.43%) were diagnosed as TMC: 84 (86.59%) UTMC and 13 (13.41%) MTMC (p < 0.0001). All MTMC were unilateral tumors. The papillary type of cancer was found in 82 (97.62%) patients with UTMC and in 12 (92.31%) with MTMC (p = 0.8661). In the UTMC group, 1 (1.19%) patient had follicular and 1 (1.19%) the medullary type of TMC. 1 (7.69%) individual in the MTMC group had tumors composed of papillary and follicular cancer. The number of younger patients (age < 45) was comparable in both groups (p = 0.825). The trend was observed that ultrasound guided fine needle aspiration biopsy (UG-FNAB) revealed malignant processes before surgery in a greater number of patients with MTMC than UTMC (84.62% vs. 58.33%, p = 0.131). In the MTMC group, the number of larger tumors (> 5 mm) was greater (84.62% vs. 65.48%), however the difference was not statistically significant. Thirteen percent of patients with UTMC presented cervical lymph node involvement, compared to nearly 8% of patients with MTMC (p = 0.298). Disease-related mortality was not observed in either group. CONCLUSIONS The prevalence of UTMC was significantly higher than MTMC. The majority of UTMC and MTMC were composed of the papillary type of cancer. MTMC and UTMC were equally frequent in both age groups. The accuracy of UG-FNAB was higher in patients with MTMC. The dimensions of most UTMC and MTMC was above 5 mm. The involvement of the cervical lymph node at the time of diagnosis in both groups is comparable and not infrequent.

Spigelian Hernia Containing an Incarcerated Appendix- A Case Report and Literature Review

Background: A Spigelian Hernia (SH) is an uncommon clinical entity comprising 0.12% to 2% of all the abdominal wall hernias. Usually the symptoms of the hernia are non-specific and therefore a diagnosis based only on the clinical examination is difficult. Imaging studies are particularly useful during the diagnostic process, but sometimes do not give the proper presurgical diagnosis. Case presentation: We present the case of a 77-year-old woman with a suspected tumor of the blind gut, where only a more accurate preoperative examination later enabled the identification of the presence of a SH. Furthermore, during the less conventional classical surgery it was revealed that the appendix, which is an event that rarely occurs, was found incarcerated within the hernia contents. Conclusion: We present the clinical difficulty with diagnosis of SH with incarcerated appendix and the variety of the symptoms. Additionally, we present a brief literature review with a concomitant description of the clinical appearance, diagnostic approach, and treatment options concerning SH.

Diagnostics of Thyroid Malignancy and Indications for Surgery in the Elderly and Younger Counterparts: Comparison of 3,749 Patients

Background It seems valuable for clinicians to know if diagnostics of thyroid malignancy (TM) and indications for surgery in the elderly patients differ from these in younger counterparts. Materials and Methods Retrospective analysis of the medical records of 3,749 patients surgically treated for thyroid tumor. Data of patients with histopathology confirmed TM (n = 309) were studied. Results The rate of cytological prediction to malignancy was more than three times higher in elderly women. Compression was a main reason for surgery in the elderly (p < 0.0001). The final diagnosis of malignancy was significantly higher in older women (p = 0.002). Clinical suspicion of malignancy was positively correlated with histopathological diagnosis in total group of women (r = 0.543, p < 0.001) and total group of men (r = 0.560, p < 0.001). The subgroup of the eldest TM patients included a significantly higher number of subjects with advanced cancer and primary tumor progression (p < 0.0001). Distant metastases were significantly more presented among the elderly patients (p = 0.032). Conclusions The rate of cytological prediction to malignancy in elderly women is high. Tracheal compression is a common surgical indication in the elderly patients. The final diagnoses of malignancy predominate in elderly women. The oldest TM patients present a higher number of advanced thyroid tumors and distant metastases.