1/12. Three cases of papillary carcinoma and three of adenoma in thyroglossal duct cysts: clinical-diagnostic comparison with benign thyroglossal duct cysts.The clinical and diagnostic findings of 3 cases of papillary thyroid carcinoma in thyroglossal duct cyst (TDC) were compared to those of 3 cases of adenoma in TDC and 2 cases of benign TDC. The neck masses of the subjects with benign TDC grew slowly, whereas those of 2 patients with papillary carcinoma and 1 of the patients with adenoma grew rapidly (especially those with carcinoma). On the other hand, one case of carcinoma, and two cases of adenoma in TDC were diagnosed incidentally. Benign TDC had an anechoic pattern at US, whereas the cysts containing carcinoma and adenoma showed the presence of a mural nodule at US. Microcalcifications in the mural mass were present in one patient with carcinoma. The 3 patients with carcinoma in TDC underwent total thyroidectomy. The histology was negative in all 3 patients for thyroid cancer and thyroid nodules. However, in 2 of them it revealed the carcinoma invading the cyst wall and adjacent tissues, 1 of which also exhibited 2 metastatic lymph nodes in the central neck area. The cases reported illustrate the utility of enhancing one's clinical suspicion of carcinoma in patients bearing TDC, even when incidentally discovered. In particular, rapid growth of the cystic mass, and the presence of a mural nodule on US, especially with calcifications, must raise the physician's suspicion for a cancer arising in TDC.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/12. Chemotherapy-induced radiation recall myositis.Myofasciitis syndrome encompasses a group of disorders characterized by chronic inflammation and/or fibrosis of the subcutaneous septa and muscular fascia. We report on a patient in whom myositis was diagnosed in the areas previously irradiated for papillary thyroid carcinoma and anal canal carcinoma respectively 21 and 3 years after radiotherapy. We are not able to explain why myopathy developed at the same time in two different sites at a different interval from the two radiotherapic schemes. We can suppose that the patient developed a subclinical regional myopathy after the first radiotherapic scheme. radiation induced heritable mutations within surviving cells that were unable to tolerate the second damage by systemic chemotherapy. It is unclear how radiosensitization correlates with an ability to reactivate latent effects in normal tissue. physicians using chemotherapic radiosensitizers should be aware of their potential to induce a delayed form of radiosensitization. We report this case to encourage physicians to be alert to the knowledge of the clinical, histologic and morphologic characteristics of radiation myositis in order to distinguish it from an infectious or immune fasciitis or myositis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/12. Intratracheal ectopic thyroid tissue: a case report and literature review.We discuss a case of intratracheal ectopic thyroid tissue (ETT) that was retrieved from the files of the Otorhinolaryngic--head and neck pathology Registry at the Armed Forces Institute of pathology. The patient was a 54-year-old man who had a history of papillary thyroid carcinoma, which had been treated with a subtotal thyroidectomy. During routine follow-up 4 years later, the patient's primary care physician detected an elevated thyroglobulin level. Further referrals and evaluations revealed that the patient had intratracheal ETT. The patient refused to undergo surgical excision and remains without evidence of recurrent carcinoma. In a medline literature review, we found only 13 other well-documented cases of intratracheal ETT since 1966; in all but two cases, patients had benign disease. Once the possibility of thyroid carcinoma has been eliminated by histologic examination, intratracheal ETT can be managed by complete surgical excision with the prospect of an excellent long-term clinical outcome.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/12. Insular carcinoma of the thyroid in an adolescent: a case report and review of the literature.A 15-year-old girl was referred for a thyroid gland mass, which rapidly enlarged in the brief interval between initial evaluation and surgery. Fine needle aspiration of the mass suggested a diagnosis of papillary thyroid carcinoma. Upon pathological examination of this aggressive tumor, an "insular" pattern of tumor was identified. Insular carcinoma of the thyroid gland is unusual in the pediatric age group, however its aggressive nature and prognosis have important management implications for those physicians involved in the care of affected patients. Aggressive surgical debulking, very close observation of the course of disease, and adjunctive radioiodine therapy may all be indicated as were performed in this case. A description of the pathology of this condition, and a review of the clinical experience with insular carcinoma in childhood and adolescence are presented.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/12. Aggressive management of recurrent ovarian cancer--the challenge of individualizing cancer therapy illustrated by a case report.BACKGROUND: In clinical practice, treatment recommendations and the patient's wishes often diverge, facing the physician with difficult choices. CASE REPORT: The clinical course of a 36-year-old patient with 'platinum-refractory' ovarian cancer is reported. The patient experienced a symptomatic relapse 7 months after debulking surgery and completion of platinum-based first-line chemotherapy. As she had given birth to a son 22 months before diagnosis, she fought with outmost determination against her disease. Her husband supported her, and both asked for maximal therapy, including intensive care treatment for recurrent respiratory tract infections and total parenteral nutrition (TPN). For the patient, it was of major importance to stay with her family and make sure that her son would be able to remember his mother. Problems related to TPN and progression of disease affected her individual perception of quality of life to a much lower extent than expected and perceived by her caretakers. All professional health care providers were more than once very reluctant to continue treatment and only after extensive counseling gave in to the demand of the patient for further treatment, considering the effort futile - only to be surprised by treatment response and recovery. After 3 years of palliation, the tumor was resistant to all cytotoxic regimens and the patient died 2 months after withdrawal of chemotherapy. CONCLUSION: This case report illustrates that also in the age of evidence-based medicine individualized treatment beyond proven strategies can offer patient benefit. Taking the child's development into account makes it impossible to determine the cost-benefit ratio.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/12. Long-term semi-permanent catheter use for the palliation of malignant ascites.BACKGROUND: Malignant ascites is a common complication of advanced or recurrent ovarian cancer and multiple other neoplasms, causing significant patient morbidity as well as a large treatment obstacle for the physician. While multiple methods of peritoneal drainage have been reported, including large volume therapeutic paracentesis, peritoneogastric, peritoneourinary, and peritoneovenous shunting procedures, peritoneal port-a-catheter placement and hemodialysis catheter drainage, all have their associated limitations and adverse effects. CASE: We report off label semi-permanent catheter placement in a patient for treatment of malignant ascites that functioned effectively with drainage of 2 l daily for approximately 18 months, the longest reported use in the literature. CONCLUSION: Long-term semi-permanent catheter use is a potentially valuable modality for the palliation of malignant ascites.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/12. hyperthyroidism and thyroid cancer. A report of three cases.In patients with hyperthyroidism and a palpable solitary nodule, the physician should be alert to the need for further evaluation before a method of therapy is chosen. In our opinion, surgery should be the treatment of choice for a hyperthyroid patient with a "cold" solitary thyroid nodule. We no longer believe that hyperthyroidism minimizes the possibility of coexistent thyroid carcinoma in hyperthyroid patients with hypofunctioning nodules. We would also suggest a reexamination of the concept of thyroid carcinoma being dependent on thyroid-stimulating hormone.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/12. Exposure to radioiodine in the preconception and conception periods. A case report.A case of radiation exposure shortly before conception is presented. The patient refused abortion and was delivered of a healthy infant. On reconsideration of the case, it was decided that the recommendation to terminate the pregnancy on the grounds of excessive exposure to radiation was unjustified. We feel that physicians should be aware that abortion in such cases is not always necessary.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/12. Uptake of I-131 by an abdominal neurilemoma mimicking metastatic thyroid carcinoma.I-131 whole-body imaging may show characteristic findings in functioning, metastatic differentiated thyroid carcinoma. Nonthyroidal tumor uptake of I-131 is rare, but may mislead the physician to inappropriate treatment. A case is reported of a 59-year-old woman with papillary thyroid carcinoma who demonstrated strong uptake of I-131 in an abdominal cystic neurilemoma. Her serum thyroglobulin concentration at that time was low, at 3.35 ng/ml. Although the concentrating mechanism of I-131 was not clear, several clues pointed to the possibilities of nonthyroidal tumor uptake: 1) faster clearing of radioactivity than usual thyroid tissue, 2) persistent low serum thyroglobulin concentration, and 3) the presence of a cystic component in the nonthyroidal tumor.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/12. Papillary intraperitoneal neoplasia resembling ovarian carcinoma after removal of benign ovaries.Ovarian cancer continues to be a major cause of death in women since there are no reliable screening methods and because symptoms usually do not appear until the disease has progressed to Stage III or IV, when the chances of cure are very poor. Prophylactic oophorectomy is being considered by some physicians for any woman undergoing hysterectomy after age 40-45. Even with the removal of benign ovaries, intraperitoneal carcinomatosis histologically resembling ovarian cancer can occur. This article describes a case of primary papillary intraperitoneal neoplasia resembling serous adenocarcinoma of the ovary which presented two years after removal of benign ovaries.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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