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7. Thyroglobulin in lymph node fine-needle aspiration biopsy washout fluid. A tertiary center experience

Author

Deacu, Laura, Niculescu, Dan Alexandru, Caragheorgheopol, Andra, Terzea, Dana, and Poiană, Cătălina

Subjects
body regions, surgical procedures, operative, endocrine system diseases, lymph nodes, washout thyroglobulin, papillary thyroid carcinoma, fine-needle aspiration biopsy, Original Study, skin and connective tissue diseases
Abstract

Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer. Most PTC secretes thyroglobulin, a useful marker in monitoring preoperative staging and postoperative progression; in addition to serum thyroglobulin, fine needle aspiration washout thyroglobulin (FNA-Tg) is also used. Our aim was to determine the cut-off value for FNA-Tg in our center and to describe major discrepancies between FNA-Tg, cytology and pathology results of the lymph nodes. Methods: We retrospectively retrieved from the electronic database of our endocrinology center all the FNA-Tg measurements between December 10, 2019 and September 2021. For each measurement we also retrieved the corresponding sex, FNAB results and the pathology reports. FNA-Tg was measured by ECLIA immunoelectro-chemiluminescent method. Results: There were 58 FNAB and FNA-Tg of suspect cervical lymph nodes in 40 patients. There were 17 cytologically benign lymph nodes of which 13 had low and 4 had high FNA-Tg; 3 non-diagnostic cytology results of which one had high FNA-Tg; 38 PTC metastases of which 6 had low and 32 had high FNA-Tg titers. The cut-off value of FNA-Tg in our center is 10 ng/ml, with a sensitivity of 86.6% (in those with pathology reports available after surgery). Conclusions: Washout TG is useful in suspicious lymph nodes and has added value to cytology in selected cases. The cut-off value of FNA-Tg in our center is 10 ng/ml, with a sensitivity of 86.6%. However, we must consider the possible false negative results that may occur in some histological types of PTC.

Published
2021

8. An unusual association between medullary thyroid carcinoma and testicular seminoma: Chemotherapy-induced complications, genetic predisposition or random relationship?

Author

Septar, AIlin, primary, Smarandache, Romeo, additional, Niculescu, Dan Alexandru, additional, Goldstein, Andrei, additional, Braha, Elena, additional, Muresan, Andrei, additional, Caragheorgheopol, Andra, additional, Terzea, Dana, additional, Constantin, Teodor, additional, Buduluca, Larisa, additional, and Musat, Madalina, additional

Published
2022
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10. Cytomorphological study of thyroid carcinoma

Author

Mohorea, Iuliana, Terzea, Dana, Mihalache, Daniela, Socea, Bogdan, Şerban, Dragoş, and Ceausu, Mihai

Subjects
thyroid cytomorphology, Cancer Research, Immunology and Microbiology (miscellaneous), cytopuncture of the thyroid, histopathology, thyroid tumors, fine-needle aspiration, Articles, General Medicine, thyroid carcinoma
Abstract

The most common neoplasm of the endocrine system is found in the thyroid gland with a significant increase in recent decades largely due to modern diagnostic methods. Thyroid tumors generally have a favorable evolution, but there are also aggressive variants with a poor prognosis. In these aggressive tumors, the most reliable method of detecting and making a differential diagnosis is represented by ultrasound-guided fine-needle cytopuncture, confirmed by histopathological examination. Although fine-needle aspiration puncture and cytological examination are considered to have a high sensitivity and specificity, diagnostic certainty is established later only by histopathological examination. Fine-needle aspiration cytopuncture of the thyroid gland correlated with histopathological examination has played a crucial role in recognizing and identifying variants of papillary carcinoma known to have aggressive biological behavior, especially in cases of poorly differentiated carcinoma. Recognition of aggressive variants of papillary carcinoma is of major importance in the prognosis and clinical management of patients. The aim of this study was to present the correlations found in a series of thyroid tumors from patients treated in surgery and oncology departments, as well as tumors accidentally detected during autopsies in the department of forensics. All the cases selected in the study benefited from a complex histopathological diagnosis adapted to each case in order to ensure maximum efficiency.

Published
2021

11. How Many Times Can One Go Back to the Drawing Board before the Accurate Diagnosis and Surgical Treatment of Glucagonoma?

Author

Martin, Carmen Sorina, primary, Parfeni, Ovidiu Dumitru, additional, Popa, Liliana Gabriela, additional, Mihai, Mara Madalina, additional, Terzea, Dana, additional, Herlea, Vlad, additional, Gherghe, Mirela, additional, Adam, Razvan, additional, Alnuaimi, Osama, additional, Calu, Valentin, additional, Miron, Adrian, additional, Negoita, Silvius, additional, Nitipir, Cornelia, additional, and Fica, Simona, additional

Published
2022
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21. Pheochromocytoma - 3 sides of the same story

Author

Ene, Cristina, primary, Nour-Dinca, Angelica, additional, Acatrinei, Eliza, additional, Casian, Marioara, additional, Enyedi, Mihaly, additional, Terzea, Dana, additional, Istrate, Adrian, additional, and Grozavu, Constantin, additional

Published
2019
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30. SPINE SURGERY FOR OSTEOPOROTIC VERTEBRAL FRACTURES: LONG TERM FOLLOW-UP.

Author

Păun, Diana Loreta, Carsote, Mara, Dumitrascu, Anda, Terzea, Dana, and Valea, Ana

Subjects
SPINAL surgery, THORACIC vertebrae, LUMBAR pain, HIP joint, INTRAVENOUS injections, KYPHOSIS
Abstract

Osteoporosis represents a worldwide problem due to under diagnosis, and under treatment. The major complications are fragility fractures as vertebral, etc. some of them requiring orthopedic and neurosurgical procedures. We introduce a case of a female adult who was first referred for spine surgery because of osteoporosis complications and then she was followed for a few years based on background skeleton condition. This is a 70-year old subject admitted for a new vertebral fracture assessment and therapy adjustment. She had 3 spine surgeries for multiple vertebral fractures (thoracic 7, 8, 9,10, and 12) during the last 5 years; she was intermittently treated with specific anti-osteoporotic drugs. On admission, the patient has severe kyphosis and secondary walk difficulties; intermittent non-specific lumbar pain. The mineral metabolism indicated no anomaly. DXA confirmed low T-score with reduced values compare to prior analysis. X-Ray assays at spine levels showed diffuse demineralization, multiple metallic implants at the level of thoracic vertebras T7, 8, 9, 10, 12 and another new one at T7, round kyphosis, increased physiological lordosis; osteophytosis including at hip joint. The patient was offered a yearly intravenous injection of zolendronic acid 5 mg in addition to 2000 Units of cholecalciferol and 800 units of calcium per day. Another spine surgery was considered unnecessary for the moment, but close follow-up is useful, including the management regarding therapy and lifestyle intervention for severe osteoporosis. The management of a patient with osteoporotic spine fracture is a complex and dynamic equation requiring a multidisciplinary team and life time follow-up. [ABSTRACT FROM AUTHOR]

Published
2018

31. LATE ANAPLASTIC SHIFT IN DIFFERENTIATED THYROID CARCINOMA: SURGERY AS PIECE OF MULTIDISCIPLINARY PUZZLE.

Author

Olaru, Maria, Dumitraşcu, Anda, Țupea, C., Carsote, Mara, Terzea, Dana, Petriș, Rodica, and Păun, Diana Loreta

Subjects
ANAPLASTIC thyroid cancer, THYROID cancer, THYROIDECTOMY, CARCINOMA, LARYNGEAL nerve palsy, FAMILY history (Medicine), THYROTROPIN
Abstract

Late anaplastic shift of differentiated thyroid carcinoma represent a very rare event, still controversial as genomic and epigenetic associated factors and also as adequate management. The neoplasia is resistant to traditional radioiodine therapy and TSH (Thyroid Stimulating Hormone) suppression treatment that works well for most of follicular and papillary thyroid cancers. We aim to introduce a case of mix anaplastic/undifferentiated and differentiated thyroid cancer of papillary type to which thyroid surgery was performed and close post-operative follow-up is also introduced. This is a 63-year old non-smoking male, with irrelevant personal and family medical and surgical history, admitted for recent dysphonia. Thyroid function was normal as well as serum calcitonin and parathormone. Specific thyroid autoimmune background was negative. Ultrasound showed a macronodule of 2.28 by 2.25 by 2.3 cm at the level of third median part of the left lobe with an irregular shape (the left lobe has 6.48 by 2.57 cm and the right lobe has 4.66 by 1.33 cm without any relevant nodule on this side). Paralysis of recurrent laryngeal nerve was also confirmed. Palliative subtotal thyroidectomy with left latero-cervical lymphadenectomy was done. Pathological report showed poorly differentiated/undifferentiated/anaplastic carcinoma (of 2.5 by 1.7 cm) with residual areas of papillary thyroid carcinoma associating tall and columnar cells of oxyphil type (oncocitar variant), and, also, out of 14 lymph nodes 7 had invasion of mostly papillary thyroid cancer with tall and columnar cells and restrain areas of undifferentiated carcinoma. Ki67 was 40% in undifferentiated areas versus 10% in papillary carcinoma. 5 months after, the patient had a large extensive mass at left thyroid area with local invasion. Radiotherapy was introduced. Despite recent advance in genetic features, therapeutical options are still limited for every day practice in cases with late anaplastic/undifferentiated shift from differentiated thyroid carcinoma and delayed diagnosis. Surgery is part of the management and probably is most useful in extremely early stages of disease, and every time when it is feasible the rational is to apply it since radioiodine therapy and chemotherapy as not useful in this particular situation. [ABSTRACT FROM AUTHOR]

Published
2018

41. Methylation status of HOXB4 gene in papillary thyroid carcinoma

Author

Brehar, Andreea, primary, Procopiuc, Camelia, additional, Paun, Diana, additional, Manda, Dana, additional, Oros, Sabina, additional, Caragheorgheopol, Andra, additional, Bulgar, Alexandra, additional, Brehar, Felix, additional, Plesa, Adriana, additional, Iancu, Iulia, additional, Botezatu, Anca, additional, Ghemigian, Mircea, additional, Stanescu, Bogdan, additional, Brasoveanu, Daniel, additional, Terzea, Dana, additional, Ioachim, Dumitru, additional, Dumitrescu, Cristina, additional, Gherlan, Iuliana, additional, Badiu, Corin, additional, and Dumitrache, Constantin, additional

Published
2014
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42. DNMT1 expression in papillary thyroid carcinoma

Author

Brehar, Andreea, primary, Procopiuc, Camelia, additional, Paun, Diana, additional, Manda, Dana, additional, Oros, Sabina, additional, Caragheorgheopol, Andra, additional, Bulgar, Alexandra, additional, Brehar, Felix, additional, Dumitrescu, Cristina, additional, Gherlan, Iuliana, additional, Ghemigian, Mircea, additional, Stanescu, Bogdan, additional, Brasoveanu, Daniel, additional, Terzea, Dana, additional, Ioachim, Dumitru, additional, Plesa, Adriana, additional, Huica, Irina, additional, Iancu, Iulia, additional, Badiu, Corin, additional, and Dumitrache, Constantin, additional

Published
2014
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43. A rare ovarian carcinoma

Author

Oros, Sabina Elena, primary, Rosca, Roxana Irina, additional, Paun, Diana Loreta, additional, Dumitrascu, Anda Simona, additional, Vladoiu, Susana Vilma, additional, Caragheorgheopol, Andra, additional, Stefanescu, Ana Maria, additional, Voinea, Silviu, additional, Radu, Madalina Gabriela, additional, and Terzea, Dana Cristina, additional

Published
2014
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46. TIMING OF SURGICAL APPROACH ON PATIENTS WITH SOMATOTROPINOMA AND DIFFERENTIATED THYROID CANCER.

Author

Valea, Ana, Carsote, Mara, Terzea, Dana, and Ghemigian, Adina

Subjects
THYROID cancer treatment, ONCOLOGIC surgery, ACROMEGALY
Abstract

Acromegaly is a rare chronic, progressive disease caused by the increased secretion of growth hormone (GH) and subsequently insulin-like growth factor 1 (IGF-1). Benign thyroid overgrowth is a common phenomenon in this pathology, but some studies revealed that acromegaly is associated with an increase in the prevalence of malignant thyroid nodules. We present two cases of acromegaly associated with papillary thyroid carcinoma. A 69-year-old female accused at the age of 43 headache, enlarged hands and feet, secondary amenorrhea. The investigations revealed high IGF-1 and GH levels and a pituitary GH producing macroadenoma. 19 years after transsphenoidal adenomectomy, a multinodular goiter with areas of calcifications and intra and perinodular vascularization were discovered. Total thyroidectomy was performed and histopathology highlighted a papillary thyroid carcinoma. A 53-year-old male was admitted at the age of 45 with intense headache, dizziness, sexual dysfunction and a multinodular goiter. Clinical signs of acromegaly were correlated to the presence of an intra-sellar tumor with extension to the optic chiasm. Transsphenoidal adenomectomy was first decided and it was followed by conventional radiotherapy, somatostatin analogue and GH blocker afterwards. For multinodular goiter a fine needle aspiration showed the need of total thyroidectomy which was further performed and a minimally invasive papillary microcarcinoma was confirmed. The relationship between acromegaly and thyroid carcinoma could be related to the stimulatory effects of long-lasting excess of IGF-1 and GH on TSH induced thyroid cellular growth. Therefore, it is necessary to carry out effective treatment and periodic thyroid ultrasound examination in patients with acromegaly; usually thyroidectomy follows hypophysectomy to achieve GH control first. [ABSTRACT FROM AUTHOR]

Published
2016

48. FROM VASOMOTOR SYMPTOMS TO SOLID AND INSULAR PAPILLARY THYROID CANCER WITH OXYPHIL VARIANT AREAS.

Author

Carsote, Mara, Albu, Simona Elena, Iorgulescu, R., Dumitraşcu, Anda, Terzea, Dana, Goldstein, A., and Poiană, Cătălina

Subjects
HYPERTHYROIDISM, VASOMOTOR system, THYROIDECTOMY, SURGERY, CASE studies, DISEASES
Abstract

The thyroid cancer had an increasing frequency during the last decades mostly related to better and accessible detection methods. The papillary type has the major epidemiologic impact. We present a case with mixed symptoms before surgery, a rare combination of both thyrotoxicosis and thyroid malignancy and an unusual pathologic report in a 56-year-old female known with total hysterectomy at age of 42, diagnosed with toxic goiter 2 years ago and under intermittent therapy with thiamazol. She presented for unspecific hot flashes and palpitation at gynaecology and she was referred for endocrine evaluation that revealed unspecific cervical compression complains, and a large goiter. The Thyroid-Stimulating Hormone was normal under thiamazol and so were the thyroid antibodies and calcitonin. The computed tomography pointed an isthmus and left lobe nodule of maximum 7.28 cm with mass effect on trachea. Total thyroidectomy was performed without any significant complications. The patient was hospitalised for 4 days (less than 48 hours postoperatively). The pathological report showed a papillary thyroid cancer (stage III) with oxyphil variant and an insular and solid pattern component. A high proliferative index is detected by vessels invasion and a ki-67 of 15 %. She received radioiodine therapy and then she started suppression levothyroxine treatment. The insular and oxyphilic pattern as well as the large tumour size of 6 cm suggest a severe prognosis. On the other hand, it is still a matter of debate whether non-autoimmune hyperthyroidism and solid pathologic features subscribe to the hypothesis of an aggressive cancer phenotype. Lifelong follow up is needed. [ABSTRACT FROM AUTHOR]

Published
2015

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