Search

Key Clinical Message This unusual case of concurrent eccrine adenocarcinoma, phyllodes tumor, and multinodular goiter serves to alert the oncologic community to the high prevalence of second cancers after childhood radiotherapy. Increased surveillance and index of suspicion are recommended to successfully diagnose and treat second primary cancers in this vulnerable population.

Described is a rare presentation of ectopic thyroid tissue as a lateral neck mass. This case raises the awareness that a lateral neck mass (including ectopic thyroid mass) needs appropriate investigations to rule out malignancy.

A 53-year-old man was referred to our department with a history of cough, especially at night, for 3 months. He was found to have a huge retrosternal goiter. We applied a novel combined cervical and robot-assisted approach to resect this difficult goiter. Using the da Vinci robot system, the intrathoracic part of the goiter was dissected and mobilized completely from the mediastinum to the inlet of the thorax. The dissected part of the goiter was left in the thorax. A right cervical half-collar incision about 6 cm was then performed. The goiter was finally removed from the neck incision. Histopathologic examination reported a multinodular goiter. By the method shown in the case, resection of huge retrosternal goiters through a combined cervical and robot-assisted approach is feasible and safe. This method provides an alternative option to the more invasive traditional approaches.

DICER1 syndrome is an inherited disorder associated with at least a dozen rare, mainly pediatric-onset tumors. Its characterization remains incomplete. Some studies suggested that neuroblastoma (NB) may be involved in this syndrome. Here, we describe the case of a 14-year-old female presenting with a multinodular goiter (MNG) and a collision tumor composed of NB and cystic nephroma (CN). She is a carrier of a deleterious germline mutation in exon 23 of DICER1 and harbored different somatic mutations in the CN and MNG. However, no second hit was found in the NB, questioning its status as a DICER1-related tumor.

Objectives:(1) Present a case series of patients with hyperthyroidism and thyroid cancer. (2) Look at the clinical characteristics and outcomes of these patients to determine which patients require further investigation.Methods:Retrospective review of case notes of all patients with a histopathological diagnosis of thyroid cancer and biochemical evidence of hyperthyroidism treated at a thyroid cancer center between January 2006 and October 2013.Results:During the study period, 66 patients were diagnosed with thyroid cancer. Eight patients had biochemical evidence of hyperthyroidism (12.1%). The mean age of these patients was 56.1 years (range, 29-87 years). All patients were female. Of these patients, 3 patients were diagnosed with Graves’ disease, 1 patient with toxic multinodular goiter, and 4 patients with an autonomously functioning toxic nodule (AFTN). Five patients had suspicious features on their preoperative ultrasound. All patients were diagnosed with papillary thyroid carcinoma. The mean size of...

Objective To compare rates of hypothyroidism following three types of partial thyroidectomy for multinodular goiter. Study Design and Methods All cases of partial thyroidectomies (hemi-, near-total, or subtotal) carried out at one Israeli and one Russian medical center (1990-2006) were retrospectively studied to determine the incidence of hypothyroidism after each procedure. Results There were 881 near-total, 1538 subtotal, and 1051 hemithyroidectomies (total 3470). Postoperative follow-up was 2 to 15 years. Twenty-eight percent of the hemithyroidectomy patients suffered permanent hypothyroidism compared to 100% of the near-total and 87% of the subtotal patients. Forty-six percent of the hemithyroidectomy patients suffered temporary hypothyroidism compared to 100% of the near-total and 93% of the subtotal patients. Conclusion Subtotal and near-total thyroidectomies produced a rate of hypothyroidism close to that of total thyroidectomy compared to 28% after hemithyroidectomy. Significance Partial thyroidectomies provide no decisive advantage over total thyroidectomies in terms of subsequent requirements of supplemental hormone therapy.

Objective: 1) To evaluate the efficacy and safety of cervicoscopic and coblation assisted surgery (CCAS) of thyroid. 2) To present a rare case of myofibroblastic nodule with focal embryonal tissue in a 72-year-old woman. 3) To understand these rare presentations for effective management.Method: To evaluate the safety and efficacy of outcomes CCAS and conventional thyroid surgical procedures from October 2008 to September 2010. Arthrocare EVac 70 Xtra Plasma Wand was used for hemostasis and subcapsular dissection.Results: One representative case includes a 72-year-old Afro-Caribbean woman who presented with 3-year history of progressive exertional dyspnea and hoarse voice due to diffuse multinodular goiter with a dominant solid nodule on ultrasound and a thy2 on needle aspirate. She was refused general anaesthesia. CCAS of thyroid under cervical block as a day case, revealed moth-eaten appearance thyroid follicles with areas of hemorrhage and cholesterol clefts with focal embryonal thyroid tissue and a pro...

Background Though thyroid growths are considered to be a frequent cause of Horner's syndrome, concurrent headache attacks are not commonly seen. Case A 63-year-old woman presented with severe, daily occurring, unilateral headache attacks with ipsilateral Horner's syndrome. Magnetic resonance imaging arteriography showed a multinodular goiter displacing the left common carotid artery. Conclusion This case exemplifies the combination of headache attacks and Horner's syndrome due to mechanical pressure of an enlarged thyroid, mimicking the symptoms both of carotid dissection as well as trigeminal autonomic cephalgias like paroxysmal hemicrania.

Surgical management of multinodular goiter (MNG) poses an ongoing dilemma between radical resection with its associated complications and partial resection, which carries the risk of recurrence and increased morbidity and difficulty for rethyroidectomy. This study was designed to evaluate the recurrence rate and need for reoperation in a carefully selected population of MNG patients, after nontotal thyroidectomy. The study addressed a highly selected population of patients who were treated and thoroughly evaluated at one surgical department for several years. We analyzed the recurrence rate of MNG in 124 patients. The follow-up duration extended from 6 to 516 months (mean 93 months). The general recurrence rate for all nontotal bilateral thyroidectomies was 21% (21/100 patients), increasing from 13.4% to 60% according to the extent of resection. The average time for recurrence was 105 months (8.75 years). Among the patients with recurrent MNG, only 4 (4% of the patients with nontotal bilateral thyroidectomy) required secondary surgical interventions with no resultant morbidity. In our series of very highly selected patients, the recurrence rate for nontotal thyroidectomy was high (21%); however, the need for secondary surgical intervention was low (4%). Thus nontotal thyroidectomy for MNG is legitimate. However, we suggest that the surgical procedure of choice be tailored according to the severity of the disease and the patient's general condition.

Thyroid hemiagenesis is a rare congenital abnormality in which one thyroid lobe fails to develop. It is frequently diagnosed at the time of assessment for another condition or during evaluation of other thyroid diagnoses. Similar disorders seen with normal thyroid development may present within a hemithyroid remnant. We present a case of an asymptomatic thyroid hemiagenesis and review recommendations within the literature concerning the diagnosis.

Introduction: Thyroid disease is relatively common among the general population, and certain thyroid conditions may be more common among pregnant women. These are usually hyperthyroid states. Additionally, the physiologic changes of pregnancy can mimic thyroid disease or cause a true remission or exacerbation of underlying disease. Indications for surgery in the pregnant patient include failure of medical management of thyrotoxicosis, compromise of the patient’s vision secondary to hyperthyroid orbitopathy or if obstructive enlargement causing airway compression is present. Acute airway comprise coupled with a complicated pregnancy is a rare occurrence. Management of these patients can be complex. We describe a patient who presented to our institution in her third trimester of pregnancy, with a large neck mass and worsening respiratory symptoms. Because these patients are generally young and healthy, they are usually able to compensate well which can delay the diagnosis of compressing masses or thyroid disease. Additionally, failure to prepare for possible complications in managing these patients can result in catastrophic outcomes.

Thirty-one children under the age of 15 years with verified medulloblastoma were treated at Addenbrookes Hospital from 1940 to 1976. In addition to surgical treatment, all received high dose irradiation to the whole neuraxis. Nine were still alive in 1979, of whom eight were examined. All these patients showed some residual problems, but five were leading active lives and had only minor physical disability. There was evidence of disturbance in growth, with shortening of the spine in relation to the limbs, in all the children. The height centile was lower than expected from parental height in four and one was severely dwarfed. Growth hormone secretion in response to exercise was, however, normal in five of six patients tested. Three children also showed failure of growth of the jaw sufficiently severe to be a cosmetic problem. Frank mental retardation was present in three children. A raised resting TSH level was found in two children, one of whom had a multinodular goiter. Of the three children with severe problems, two had been treated when under two years of age. Long-term follow-up of children who survive medulloblastoma is clearly necessary and consideration should perhaps be given to revision of current treatment regimes in very young children.

Nuclear crease or grooving was found to be a diagnostic feature of papillary thyroid carcinoma (PTC) in fine-needle aspiration (FNA) biopsies. The FNA biopsies of 37 cases of PTC, 50 cases of multinodular goiter, and 50 cases of follicular neoplasms (45 follicular adenomas and five follicular carcinomas) were examined. The diagnosis was histologically verified in all the cases. The nuclear crease was found to be present in 34 of 37 cases of PTC and in two of five cases of follicular carcinoma. There was no nuclear crease in any of the other cases examined. Thus, it is concluded that the nuclear crease is a fairly constant and characteristic feature of PTC in FNA biopsies and can be used as a valuable diagnostic criterion.