Tamotsu Yokozawa

Prognosis After Reoperation for Local Recurrence of Papillary Thyroid Carcinoma

PurposeTo investigate the factors associated with a favorable prognosis after reoperation for local recurrent papillary thyroid carcinoma (PTC), we reviewed 45 patients who underwent surgery for first local recurrence of PTC.MethodsWe divided the patients into two groups. Group A (n = 28) had no second recurrence, and group B (n = 17) had second local recurrence after surgery for recurrence.ResultsThe mean follow-up period after reoperation was 56.9 months. The mean age at the time of reoperation in group A was significantly lower than that in group B, at 48.1 years versus 62.3 years, respectively (P = 0.0007). The mean age at the time of the initial operation in group A was also significantly lower than that in group B, at 40.1 years versus 55.1 years, respectively (P = 0.0006). Patients with recurrent tumors only outside the area dissected at the initial operation (n = 27) had a better outcome than those with recurrence within the dissected area (n = 18; P = 0.0127). Patients who underwent systematic partial or modified neck dissection (n = 36) had a better outcome than those who underwent only simple local resection (n = 9; P = 0.0169).ConclusionFor local recurrent PTC, systematic neck dissection is recommended over local resection of recurrent tumors.

An evaluation of the intraoperative staining technique using methylene blue for the detection of hyperplastic parathyroid glands

Intraoperative staining with methylene blue was employed during parathyroid surgery on 50 glands from 13 patients, 5 with primary and 8 with secondary hyperparathyroidism. Forty-seven out of the 50 glands (94 per cent) were visualized by the staining and 2 out of the 13 patients were revealed to have supernumerary parathyroid glands. Since we started using this technique, there have been no cases of persistent hypercalcemia. The results of this study support the clinical usefulness of this staining procedure for detecting hyperplastic parathyroid glands in both primary and secondary hyperparathyroidism.

Encapsulated Anaplastic Thyroid Carcinoma Without Invasive Phenotype with Favorable Prognosis : Report of a Case

Abstract.We herein report a case of anaplastic thyroid carcinoma in a 77-year-old woman with long-term disease-free survival. The tumor measured 7.5 × 6.0 cm in size and was diagnosed to be anaplastic carcinoma. We investigated the biological aggressiveness of this carcinoma by means of immunohistochemistry and found it have a high cell-proliferating activity, a disruption in the mechanism of apoptosis, and a high potential of cell spreading, similar to that observed in usual anaplastic carcinomas. The only unique point was that this tumor was encapsulated and no invasion of carcinoma cells beyond the capsule was microscopically observed. To avoid an obstruction of the trachea, a lobectomy without lymph node dissection was performed as a “palliative operation.” Although neither adjuvant chemotherapy nor radiotherapy was carried out due to her age, she has nevertheless survived with no evidence of recurrence for 57 months after surgery. The presence of such a type of anplastic carcinoma should thus be noted by surgeons and pathologists, even though the occurrence of such cases seems to be very rare.

Parathyroid imaging: Comparison of201Tl-99mTc subtraction scintigraphy, computed tomography and ultrasonography

From 1982 to 1985, twenty-nine patients with suspected hyperparathyroidism were examined using201Tl-99mTc subtraction scintigraphy (Tl-Tc), computed tomography (CT) and ultrasonography (US). For diagnosing neoplasm (adenoma or cancer), the sensitivities of the three procedures were 80 per cent or more, with no statistically significant differences. For diagnosing hyperplasia of the parathyroid glands, CT scan had the highest sensitivity (47 per cent). The most frequent source of error was minimally enlarged glands, weighing less than 500 mg. The second highest source of error was thyroid nodules, such as adenomatous goiter or cancer. Serum calcium and c-PTH levels were significantly higher in those with a parathyroid neoplasm than in those with hyperplasia (p<0.01, p<0.05, respectively). We concluded that hyperplasia is less easy to detect than neoplasm, and CT scan is superior to Tl-Tc or US scan for localizing hyperplasia.

Reconstruction of the carotid artery using a temporary shunt during an operation for advanced thyroid carcinoma ― A case report

A case of a patient who required reconstruction of the carotid artery during a radical operation for advanced thyroid cancer is reported herein. The patient, a 64-year-old female who had had three previous operations for thyroid cancer, underwent a two-stage operation. In the first stage, the left cervical lymphnodes were dissected, but as a large metastatic node invading the left carotid artery could not be completely removed, some carcinoma tissue was left attached to the wall of the artery. The second stage involved a temporary shunt being set up between the common carotid artery and the internal carotid artery following heparinization, after which the invaded portion was resected, and the defect patched with a saphenous vein graft. Monitoring with a Doppler flow-meter and EEG were conducted throughout the operation. At present, cancer has recurred in the left submandibular and supraclavicular regions.

Techniques of Ultrasound-Guided FNA Biopsy

The use of ultrasound guided fine needle aspiration (UG FNA) biopsy has increased because its accuracy in diagnosing thyroid nodules far exceeds that of conventional blind biopsy. We use a drill-spin technique for UG FNA (1,2,3,4), and have applied this technique to more than 14,000 patients with a wide variety of thyroid nodules. Because of the accuracy of diagnosing thyroid nodules using this technique, the number of unnecessary operations has decreased and the number of microcancers has increased in our hospital. In this chapter, we describe our drill-spin technique of performing UG FNA biopsy and a practical approach to different types of thyroid nodules.