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Senghor F, Hussein Y, Ndiaye K, Slaoui O, Thiam I, Diom ES. [A thyroid pathology: The great simulator]. Ann Pathol 2024; 44:125-129. [PMID: 38326138 DOI: 10.1016/j.annpat.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/06/2024] [Accepted: 01/10/2024] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Tuberculosis remains a major public health problem in developing countries. Thyroid localization is very rare, and often the cause of misdiagnosis. Pathological anatomy plays an important role in the diagnosis of certainty. The authors report a case of primary thyroid tuberculosis in a 22-year-old patient. We highlight the epidemiological particularities of this case, and discuss diagnostic methods and the contribution of pathological anatomy. OBSERVATION A 22 year-old male patient, with no reported pathological history, was seen in the clinic for the management of an isolated anterior cervical swelling that had been evolving for two months. Clinical examination revealed only a small thyroid nodule, with no inflammatory or vascular features. Biological tests were unremarkable. Ultrasound revealed a 2.4cm hypoechoic, homogeneous, poorly vascularized tissue mass in the left lobe, classified as EU-TIRADS 3. Fine needle aspiration with cytopathological study revealed a necrotizing granulomatous lesion suggestive of tuberculosis. A lobo-isthmectomy was performed, and histopathology revealed thyroid parenchyma destroyed by tubercular granulomas. The postoperative course was straightforward, with an exeat on postoperative day 6. Anti-tuberculosis treatment was instituted for 6 months. Three- and six-month follow-up examinations were unremarkable. The evolution was favorable, with recovery after treatment. CONCLUSION Primary thyroid tuberculosis is rare. Cytology is important for orientation, and often helps to avoid misdiagnosis. The diagnosis should be considered in the presence of any thyroid mass in a patient from a tuberculosis-endemic region.
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Affiliation(s)
- Fabrice Senghor
- Service d'anatomie pathologique de l'hôpital de la Paix, Ziguinchor, Sénégal.
| | - Younes Hussein
- Service d'ORL de l'hôpital de la Paix, Ziguinchor, Sénégal
| | - Kor Ndiaye
- Service d'ORL de l'hôpital de la Paix, Ziguinchor, Sénégal
| | - Otman Slaoui
- Service d'ORL de l'hôpital régional, Ziguinchor, Sénégal
| | - Ibou Thiam
- Service d'anatomie pathologique Aristide Le Dantec, Dakar, Sénégal
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Cochand-Priollet B, Vielh P. [Bethesda 2023: A new terminology for thyroid cytopathology]. Ann Pathol 2024; 44:30-35. [PMID: 38233236 DOI: 10.1016/j.annpat.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/29/2023] [Indexed: 01/19/2024]
Abstract
A third update of The Bethesda System for Reporting Thyroid Cytopathology has been published in 2023 following the first (2010) and second (2017) versions. The main modifications are the following 1) a new co-Editor, 2) 4 associate editors, 3 of them from Europe, 3) the inclusion of 65 co-authors, 19 of them from Europe, 4) 2 new chapters: one dealing with pediatrics thyroid cytopathology and the other one describing molecular cytopathology profiling, 5) updated risks of malignancy (ROM), 6) a terminology in line with the 2022 WHO classification of thyroid tumors, 7) diagnostic categories now defined by a unique name, 8) 2 subtypes in the "Atypia of Undetermined Significance" category with corresponding ROM.
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Decaussin-Petrucci M, Cochand Priollet B, Leteurtre E, Albarel F, Borson-Chazot F. [SFE-AFCE-SFMN 2022 consensus on the management of thyroid nodules: Interest and place of thyroid cytology]. Ann Pathol 2024; 44:20-29. [PMID: 38092572 DOI: 10.1016/j.annpat.2023.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/09/2023] [Indexed: 02/07/2024]
Abstract
The SFE-AFCE-SFMN 2022 consensus deals with the management of thyroid nodules, a symptom that is a frequent reason for consultation in endocrinology. Thyroid nodules are very common and mostly benign. Thyroid ultrasound and thyroid fine-needle aspiration biopsy (FNAB) are the reference tests for the analysis of these nodules. The aim of this article is to describe for the cytopathologist the key points of the SFE-AFCE-SFMN 2022 consensus involving thyroid cytology: the indications for thyroid FNAB, the technique and analysis, and the management (treatment, follow-up) following this cytological screening examination, a key element in the management of the thyroid nodule.
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Affiliation(s)
- Myriam Decaussin-Petrucci
- Pathology department, centre hospitalier Lyon Sud, hospices civils de Lyon, Pierre Bénite, EA 3738, Lyon 1 University, Lyon, France.
| | | | - Emannuelle Leteurtre
- University of Lille, CNRS, Inserm, CHU de Lille, UMR9020-U1277 - CANTHER-Cancer Heterogeneity Plasticity and Resistance to Therapies, 59000 Lille, France
| | - Frédérique Albarel
- Service d'endocrinologie, Assistance publique-Hôpitaux de Marseille (AP-HM), hôpital de la Conception, centre de référence des maladies rares de l'hypophyse HYPO, 13005 Marseille, France
| | - Françoise Borson-Chazot
- Fédération d'endocrinologie, hospices civils de Lyon, groupement hospitalier Est, Bron, université Lyon 1, Claude-Bernard, Lyon, France
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Ettalhaoui L, Debreuve-Théresette A, Nguyen TD, Zalzali M, Antoni D, Guilbert P. [Prospective evaluation of radiation-induced thyroid disorders after breast and supraclavicular irradiation]. Cancer Radiother 2023; 27:376-386. [PMID: 37179221 DOI: 10.1016/j.canrad.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE The thyroid is an endocrine gland playing a major role in metabolism and development by the secretion of T4 and T3 thyroid hormones. Due to its anatomical position, it is often included in the target volume for the irradiation of certain tumours and thus receives significant doses (10 to 80Gy). The treatment of breast cancer requires in most cases a breast irradiation associated or not with a lymph node irradiation. The aim of our study was to investigate prospectively the frequency of thyroid disorders in patients with breast cancer treated by radiation, with or without irradiation of the supra- and subclavicular lymph nodes. MATERIAL AND METHODS This prospective multicentre study (institut Godinot, institut de cancérologie Strasbourg Europe and institut de cancérologie de Lorraine) concerned adult patients with non-metastatic breast carcinoma treated by adjuvant irradiation. They were included in a non-randomized way between February 2013 and June 2015 and divided into two groups according to treatment: (i) breast radiotherapy associated with irradiation of the supra- and subclavicular lymph nodes (group 1), or (ii) breast irradiation alone (group 2). The dose - volume histogram of the thyroid was systematically edited by the physics department. Each patient had a consultation with an endocrinologist at the beginning of the treatment and was monitored by blood analyses including TSH, T4L, antithyroglobulin and antiperoxidase antibodies every 6 months until the 60th month after the end of radiotherapy. Data were described by numbers and percentages for qualitative variables; by means, medians, standard deviation and ranges for quantitative variables. Statistical associations were tested by Chi2, Fisher's, Student's, or analysis of variance tests depending on the conditions of application. Survival analyses were performed by log rank tests and Cox models. RESULTS This study initially included 500 patients, 245 in group 1 and 252 in group 2 (three patients were later excluded for false inclusion). Thyroid abnormalities occurred in 76 patients, representing an incidence of 15.3%. The mean time of the first occurrence of thyroid disorders was 24.3 months. It was more frequent in group 1 with a prevalence of 19.2% against 11.5% in group 2 (P=0.01745). A maximal radiation dose delivered to the thyroid gland greater than 20Gy (odds ratio [OR]: 1.82; P=0.018) or 30Gy (OR: 1.89; P=0.013) was significantly associated with a higher incidence of thyroid disorders, as was a mean dose greater than 30Gy (OR: 5.69; P=0.049). A percentage of thyroid volume receiving 30Gy (V30) greater than 50% (P=0.006) or greater than 62.5% (P=0.021) was significantly associated with an increased incidence of thyroid disorder and more precisely, hypothyroidism (P=0.0007). In multivariate analysis, no factor associated with the occurrence of thyroid disorder was identified. However, in the subgroup analysis concerning group 1 (receiving supraclavicular irradiation), a maximal radiation dose greater than 30Gy appeared to be a risk factor for the occurrence of thyroid disorders (P=0.040). CONCLUSION Thyroid disorder, and in particular hypothyroidism, may be a late side effect of locoregional breast radiotherapy. Patients receiving this treatment should have a biological monitoring of thyroid function.
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Affiliation(s)
- L Ettalhaoui
- Département de radiothérapie, institut Godinot, 1, rue du Général-Koenig, 51100 Reims, France.
| | - A Debreuve-Théresette
- Département d'information médicale, institut Godinot, 1, rue du Général-Koenig, 51100 Reims, France
| | - T D Nguyen
- Département de radiothérapie, institut Godinot, 1, rue du Général-Koenig, 51100 Reims, France
| | - M Zalzali
- Unité thyroïde, institut Godinot, 1, rue du Général-Koenig, 51100 Reims, France
| | - D Antoni
- Service de radiothérapie-curiethérapie, Institut de cancérologie Strasbourg Europe (Icans), 17, rue Albert-Calmette, 67200 Strasbourg, France
| | - P Guilbert
- Département de radiothérapie, institut Godinot, 1, rue du Général-Koenig, 51100 Reims, France
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Tran L, Klainguti G, Hoeckele N, Kaeser PF. Torsional strabismus and vertical rectus muscle surgery in thyroid eye disease. J Fr Ophtalmol 2023; 46:49-56. [PMID: 36496294 DOI: 10.1016/j.jfo.2022.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/21/2022] [Accepted: 05/30/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE To assess the torsional component in patients with vertical strabismus due to thyroid eye disease (TED) and its course after vertical rectus muscle surgery. PATIENTS AND METHODS Retrospective chart review of patients undergoing vertical strabismus surgery for TED between 1998 and 2017, having undergone pre- and postoperative Harms tangent screen examination. RESULTS Forty patients (27 women) were identified. A torsional component was present in all patients. Thirty-three patients had a mean excyclotorsion of 4.5° in primary position, increasing to 8.2° in upgaze, associated with restricted elevation. Inferior rectus muscle recession (n=29) reduced the excyclotorsion in all cases. A 4.4° mean incyclotorsion was present in primary position in 7 cases, increasing to 7.1° in downgaze. Superior rectus muscle recession reduced the incyclotorsion in 5/6 cases. The torsional surgical dose-effect relationship was correlated with the amount of preoperative torsion. The field of binocular single vision improved from 6.5% preoperatively to 71.1% after surgery. CONCLUSIONS Ocular torsion is common in vertical strabismus secondary to TED and is significantly improved by vertical rectus muscle surgery alone. Surgery should be planned according to vertical deviation and motility limitation, and vertical rectus muscles surgery should be considered the first line of treatment, with selective oblique muscle surgery as a second-line option, which was unnecessary in our series.
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Affiliation(s)
- L Tran
- Hôpital ophtalmique Jules-Gonin, service d'ophtalmologie de l'université de Lausanne, 15, avenue de France, 1004 Lausanne, Switzerland
| | - G Klainguti
- Hôpital ophtalmique Jules-Gonin, service d'ophtalmologie de l'université de Lausanne, 15, avenue de France, 1004 Lausanne, Switzerland
| | - N Hoeckele
- Hôpital ophtalmique Jules-Gonin, service d'ophtalmologie de l'université de Lausanne, 15, avenue de France, 1004 Lausanne, Switzerland
| | - P-F Kaeser
- Hôpital ophtalmique Jules-Gonin, service d'ophtalmologie de l'université de Lausanne, 15, avenue de France, 1004 Lausanne, Switzerland.
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Kouassi KPB, Kouakou BDM, Tanoh Kessé E, Bravo-Tsri AB, Marius VK, Kouadio AF, Yao BL, Sanogo SC, Soro M, Ede F, Konaté I. [Ultrasound Profile Of Thyroid Spheres At The University Hospital Of Bouaké (Côte d'Ivoire)]. Mali Med 2023; 38:27-32. [PMID: 38514942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Ultrasound is the first-line examination in the morphological exploration of the thyroid. It is an excellent diagnostic and prognostic tool in nodular thyropathy. OBJECTIVE to determine the profile of thyroid nodules on ultrasound according to the EU-TIRADS classification. MATERIAL AND METHODS descriptive cross-sectional study carried out in the radiology department of the University Hospital of Bouaké during one year. We included all thyroid ultrasound reports of patients with thyroid nodules. Data were analysed using Epi Info 7 software. RESULTS A total of 60 patients had nodules out of 97 referred for thyropathy (60.8%). The mean age was 45.6 years [13-82 years]. Females predominated with 82.7%. Anterior cervical swelling was the main indication in 72%. Thyroid volume was increased in 63% of patients with a mean volume of 71 cm3. Solitary nodules were present in 46.55%. Spongiform nodules were predominant in 32%. The nodules were solid in 29.8% and mixed in 16.5%. Hypoechogenicity was found in 44.8% of solid nodules. Lesions were classified as EU-TIRADS 2 in 58.8%, EU-TIRADS 3 in 23.5%, EU-TIRADS 4 in 14.7% and EU-TIRADS 5 in 2.9%. CONCLUSION The characterisation and classification of thyroid nodules is an important step in the management of patients. In our study, these nodules are essentially benign (EU-TIRADS 2 and 3) with a female predominance. A decision tree taking into account the clinical and cytopathological elements would be more useful for possible surgery.
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Affiliation(s)
- Kouamé Paul Bonfils Kouassi
- Service d'Imagerie Médicale et Radiodiagnostic du Centre Hospitalier Universitaire de Bouaké (Côte d'Ivoire)
| | | | - Emile Tanoh Kessé
- Service d'Imagerie Médicale et Radiodiagnostic du Centre Hospitalier Universitaire de Bouaké (Côte d'Ivoire)
| | - Akoli Baudouin Bravo-Tsri
- Service d'Imagerie Médicale et Radiodiagnostic du Centre Hospitalier Universitaire de Bouaké (Côte d'Ivoire)
| | - Vanga K Marius
- Service d'Imagerie Médicale et Radiodiagnostic du Centre Hospitalier Universitaire de Bouaké (Côte d'Ivoire)
| | - Allou Florent Kouadio
- Service d'Imagerie Médicale et Radiodiagnostic du Centre Hospitalier Universitaire de Bouaké (Côte d'Ivoire)
| | - Brou Lambert Yao
- Service d'Imagerie Médicale et Radiodiagnostic du Centre Hospitalier Universitaire de Bouaké (Côte d'Ivoire)
| | - Sara Carole Sanogo
- Service d'Imagerie Médicale et Radiodiagnostic du Centre Hospitalier Universitaire de Bouaké (Côte d'Ivoire)
| | - Malick Soro
- Service d'Imagerie Médicale et Radiodiagnostic du Centre Hospitalier Universitaire de Bouaké (Côte d'Ivoire)
| | - Fabrice Ede
- Service d'Imagerie Médicale et Radiodiagnostic du Centre Hospitalier Universitaire de Bouaké (Côte d'Ivoire)
| | - Issa Konaté
- Service d'Imagerie Médicale et Radiodiagnostic du Centre Hospitalier Universitaire de Bouaké (Côte d'Ivoire)
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Hartl DM, Hadoux J, Garcia C, Ghuzlan AA, Guerlain J, Breuskin I, Baudin E, Lamartina L. [De-escalation strategies in differentiated thyroid cancer]. Bull Cancer 2021; 108:1132-1144. [PMID: 34649722 DOI: 10.1016/j.bulcan.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/26/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
Thyroid cancer runs the gamut from indolent micropapillary carcinoma to highly aggressive metastatic disease. Today, using prognostic algorithms, treatment and follow-up can be tailored to each patient in order to decrease overtreatment and over-medicalization of indolent disease. Active surveillance of papillary thyroid carcinoma less than 1cm avoids surgery and thyroid hormone replacement in a large proportion of patient whose tumors remain stable for years. Total thyroidectomy, once a dogma in the treatment of all thyroid cancer, is being supplanted by thyroid lobectomy for low-risk cancers, thereby decreasing the surgical risks involved and improving patients' quality of life. Indications for prophylactic central neck dissection, once mandatory, are now being adapted to the risk of cancer recurrence. Radioactive iodine therapy, also previously mandatory for all, is now only employed according to risk factors and expected outcomes. Follow-up is also being tailored to risk factors for recurrence, with less frequent visits and less use of ultrasound and scintigraphy. For more advanced disease, molecular therapies tailored to somatic mutations are opening opportunities for redifferentiation of aggressive tumors which become amenable to radioactive iodine therapy which carries fewer side effects than other systemic therapies. These advances in the management of thyroid cancer with a personalized approach and de-escalation of treatment and follow-up are improving the way we treat thyroid cancer, avoiding overtreatment and improving patients' quality of life.
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Affiliation(s)
- Dana M Hartl
- Gustave-Roussy Cancer Campus and Université Paris-Saclay, département de chirurgie, service de cancérologie cervico-faciale, 114, rue Edouard-Vaillant, 94805 Villejuif, France.
| | - Julien Hadoux
- Gustave-Roussy Cancer Campus and Université Paris-Saclay, département de médecine nucléaire et d'oncologie endocrinienne, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - Camilo Garcia
- Gustave-Roussy Cancer Campus and Université Paris-Saclay, département de médecine nucléaire et d'oncologie endocrinienne, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - Abir Al Ghuzlan
- Gustave-Roussy Cancer Campus and Université Paris-Saclay, département de biologie et de pathologie, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - Joanne Guerlain
- Gustave-Roussy Cancer Campus and Université Paris-Saclay, département de chirurgie, service de cancérologie cervico-faciale, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - Ingrid Breuskin
- Gustave-Roussy Cancer Campus and Université Paris-Saclay, département de chirurgie, service de cancérologie cervico-faciale, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - Eric Baudin
- Gustave-Roussy Cancer Campus and Université Paris-Saclay, département de médecine nucléaire et d'oncologie endocrinienne, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - Livia Lamartina
- Gustave-Roussy Cancer Campus and Université Paris-Saclay, département de médecine nucléaire et d'oncologie endocrinienne, 114, rue Edouard-Vaillant, 94805 Villejuif, France
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Scheller B, Santini J, Anota A, Poissonnet G, Chateau Y, Schiappa R, Benisvy D, Dassonville O, Bozec A, Chamorey E. [Cross-cultural adaptation of the French version of the thyroid cancer-specific quality of life questionnaire: THYCA-QoL]. Bull Cancer 2021; 108:696-704. [PMID: 33896584 DOI: 10.1016/j.bulcan.2021.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 12/24/2020] [Accepted: 01/04/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The aim of this study was to translate into French the 24 items of the THYCA-QoL questionnaire used in thyroid cancers and then to study its psychometric properties. MATERIALS AND METHODS The THYCA-QoL is a specific questionnaire for evaluating the quality of life of patients undergoing thyroid cancer surgery. It consists of 24 items and is divided into seven dimensions and six isolated questions. The translation has been carried out according to the recommendations of the EORTC. Validation of the translated version was obtained by finding a consensus of experts for each of the items. RESULTS All the original questions of the questionnaire have been adapted into French. The translated questionnaire, named THYCA-CoL-fr, was tested on 60 patients (65 % female), mean age 54.5 years. All questions were well accepted and understood and no missing data were reported. Eight patients (13 %) proposed an item correction to the questionnaire. No attenuation effects (floor or ceiling) were detected. The internal structure was comparable to the original questionnaire: Cronbach α coefficients varied from 0.53 for the oropharyngeal dimension to 0.88 for the voice dimension. The scree-plot highlighted the seven dimensions of the English version. CONCLUSION THYCA-QoL-fr is the first specific French language questionnaire to evaluate the quality of life in thyroid cancer patients undergoing surgery. These first exploratory psychometric results confirmed the conceptual similarity of the French translation and the English version.
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Affiliation(s)
- Boris Scheller
- Institut universitaire de la Face et du Cou, Université Côté d'Azur, 31, avenue de Valombrose, 06100 Nice, France.
| | - Joseph Santini
- Polyclinique Saint Georges, 2, avenue de Rimiez, 06100 Nice, France
| | - Amélie Anota
- Unité de méthodologie et de qualité de vie en oncologie, CHU Jean Minjoz, boulevard Fleming, 25030 Besançon, France
| | - Gilles Poissonnet
- Institut universitaire de la Face et du Cou, Université Côté d'Azur, 31, avenue de Valombrose, 06100 Nice, France
| | - Y Chateau
- Département de biostatistiques, Centre Antoine-Lacassagne, Université Côté d'Azur, 33, avenue de Valombrose, 06189 Nice, France
| | - Renaud Schiappa
- Département de biostatistiques, Centre Antoine-Lacassagne, Université Côté d'Azur, 33, avenue de Valombrose, 06189 Nice, France
| | - Danielle Benisvy
- Pôle d'imagerie médecine nucléaire, Centre Antoine-Lacassagne, Université Côté d'Azur, 33, avenue de Valombrose, 06189 Nice, France
| | - Olivier Dassonville
- Institut universitaire de la Face et du Cou, Université Côté d'Azur, 31, avenue de Valombrose, 06100 Nice, France
| | - Alexandre Bozec
- Institut universitaire de la Face et du Cou, Université Côté d'Azur, 31, avenue de Valombrose, 06100 Nice, France
| | - Emmanuel Chamorey
- Département de biostatistiques, Centre Antoine-Lacassagne, Université Côté d'Azur, 33, avenue de Valombrose, 06189 Nice, France
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Da Cruz V, Lopez J, Lifante JC, Decaussin-Petrucci M. [Hobnail variant of papillary thyroid carcinoma]. Ann Pathol 2021; 41:201-6. [PMID: 33272718 DOI: 10.1016/j.annpat.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 09/01/2020] [Accepted: 10/25/2020] [Indexed: 11/24/2022]
Abstract
We report the case of a hobnail variant of papillary thyroid carcinoma revealed by a cervical mass in a 67 years-old patient. This new entity in the 2017 WHO classification is rare. Histopathological diagnosis is based on four main criteria, present in≥30% of tumor cells: a discohesive tumor, micropapillary structures and loss of cell polarity and hobnail cells. This tumor expresses markers of thyroid differentiation. The most widely described molecular alteration is BRAF V600E mutation associated with other alterations, especially p53 mutations. This reflects the agressivness of this variant. It is important to recognize the hobnail variant of papillary thyroid carcinoma and to specify it in the pathological report because of its more pejorative prognosis, with local invasion, lymph node and distant metastasis, and deacreased survival. No specific management is recommended, but a close follow up seems necessary.
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Abou-Jaoudé R, El Naderi S, Sader Ghorra C. [Unusual pattern of metastatic dissemination to the thyroid gland]. Ann Pathol 2020; 40:421-424. [PMID: 32291116 DOI: 10.1016/j.annpat.2020.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 09/12/2019] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Rosy Abou-Jaoudé
- Service d'anatomie et cytologie pathologiques, université Saint-Joseph, centre hospitalier universitaire Hôtel-Dieu de France, Beyrouth, Liban
| | - Samah El Naderi
- Service d'anatomie et cytologie pathologiques, université Saint-Joseph, centre hospitalier universitaire Hôtel-Dieu de France, Beyrouth, Liban
| | - Claude Sader Ghorra
- Service d'anatomie et cytologie pathologiques, université Saint-Joseph, centre hospitalier universitaire Hôtel-Dieu de France, Beyrouth, Liban.
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Boursier L, Clerc Urmes I, Garon J, Klein M, Demarquet L. Ultrasound and cytological characteristics of non-invasive follicular thyroid neoplasm with papillary-like nuclear features compared to papillary carcinomas. Ann Endocrinol (Paris) 2020; 81:28-33. [PMID: 32081363 DOI: 10.1016/j.ando.2019.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 10/15/2019] [Accepted: 10/28/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION NIFTP (non-invasive follicular thyroid neoplasm with papillary-like nuclear features, formerly non-invasive encapsulated follicular variant of papillary thyroid carcinoma) has been removed from the carcinoma category because of its indolent character and good prognosis. This change impacts clinical and surgical management, since these tumors no longer require total thyroidectomy, or complementary radioactive iodine therapy for <4cm tumor. The aim of the present study was to identify preoperative ultrasound and cytological differences between NIFTP and papillary thyroid carcinoma (PTC). MATERIALS AND METHODS A retrospective study included 81 patients who underwent total thyroidectomy or thyroid lobectomy with histologic diagnosis of PTC, NIFTP or invasive follicular variant of PTC (IFVPTC) between January 1st, 2016 and May 31st, 2018. Ultrasound and cytological data were analyzed and compared between NIFTP and non-NIFTP (PTC and invasive follicular variant of PTC). RESULTS Fourteen NIFTPs, 67 PTCs, including 20 IFVPTCs, were included. In comparison with non-NIFTP PTC, nodules in NIFTP were more often isoechoic (69.2% vs. 17.4%; P=0.0007), with smooth borders (92.3% vs. 31.1%; P=0.0001) and TI-RADS score 2, 3 or 4a. Cytologically, NIFTPs were mainly in categories AUS/FLUS, FN and SusM of the Bethesda System for Reporting Thyroid Cytopathology. Only nuclear pseudo-inclusions were significantly associated with non-NIFTP (P=0.0031). CONCLUSION NIFTP appears non-suspect on preoperative ultrasound and indeterminate on cytology. These differences with respect to PTC can guide diagnosis and surgical treatment.
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Bel Lassen P, Kyrilli A, Lytrivi M, Corvilain B. Graves' disease, multinodular goiter and subclinical hyperthyroidism. Ann Endocrinol (Paris) 2019; 80:240-249. [PMID: 31427038 DOI: 10.1016/j.ando.2018.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 06/27/2018] [Accepted: 09/04/2018] [Indexed: 12/17/2022]
Abstract
Subclinical hyperthyroidism is a common clinical entity, defined by serum TSH below the reference range, with normal FT4 and FT3 levels in an asymptomatic patient. Whether or not subclinical hyperthyroidism should be treated remains a matter of debate. Cross-sectional and longitudinal population-based studies demonstrate association of subclinical hyperthyroidism with risk of atrial fibrillation and osteoporosis, and with cardiovascular and all-cause mortality. However, there are no randomized clinical trials addressing whether long-term health outcomes are improved by treating subclinical hyperthyroidism; in the absence of evidence one way or the other, it seems appropriate to use decision trees taking account of TSH concentration and presence of risk factors (age>65 years or post-menopause, osteoporosis and cardiac disease).
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Affiliation(s)
- Pierre Bel Lassen
- Department of endocrinology, université Libre de Bruxelles, Erasme University Hospital, route de Lennik 808, 1070 Brussels, Belgium; UMRS 1166 (Inserm), 91, boulevard de l'Hôpital, 75013 Paris, France.
| | - Aglaia Kyrilli
- Department of endocrinology, université Libre de Bruxelles, Erasme University Hospital, route de Lennik 808, 1070 Brussels, Belgium
| | - Maria Lytrivi
- Department of endocrinology, université Libre de Bruxelles, Erasme University Hospital, route de Lennik 808, 1070 Brussels, Belgium
| | - Bernard Corvilain
- Department of endocrinology, université Libre de Bruxelles, Erasme University Hospital, route de Lennik 808, 1070 Brussels, Belgium
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Schaut A, Cloché V, Mouna A, Angioi K, Berrod JP, Conart JB, Maalouf T. [Evaluation by quality of life questionnaires in patients undergoing strabismus surgery in Graves' disease]. J Fr Ophtalmol 2018; 41:814-22. [PMID: 30217613 DOI: 10.1016/j.jfo.2017.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 12/20/2017] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate the improvement in quality of life of patients operated within 6 months for strabismus in Graves' disease using a questionnaire. MATERIALS AND METHODS A retrospective study was based on a cohort of patients undergoing strabismus surgery for Graves' disease at the Nancy university medical center between June 2015 and January 2017. A quality-of-life questionnaire composed of the functional GO QOL questionnaire plus 10 additional questions was given to patients. The questionnaires were completed by patients in consultation before surgery and then at six months postoperatively. A subgroup analysis was conducted to identify potential risk factors such as smoking, orbital decompression, duration of disease progression, number of surgeries, previous treatments or gender influences on the progression of the postoperative score. RESULTS Thirty-three patients (15 men/18 women) underwent surgery, with mean age 56 years; 16 (48 %) were smokers, 24 (70 %) were operated for the first time for strabismus. 8 patients (24 %) had a history of surgical orbital decompression. The mean preoperative GO QOLf was 30 (±23.8), which increased to 72 (±29.6) postoperatively (P=0.004). All the answers to the questions proposed were improved by surgery. The most improved items were difficulty in extreme gaze+6.82 points (P=0.001) and going down stairs +6.81 (P=0.002). Smokers had a lower preoperative GO QOLf than non-smokers (25±22.84 vs. 34±24.55); the same was true for their postoperative improvement (35±34.5 points vs. 50±18.8, P=0.002). History of orbital decompression did not appear to influence quality of life (21±25.39 vs. 65±33.98); the same was true for previous corticosteroid or immunosuppressant treatment (28±23.52 vs. 67±28.24), respectively P=0.42; P=0.73. Gender did not appear to influence the results P=0.17. First-time strabismus surgery patients showed a tendency which was not significant toward better improvement after 2 or 3 surgeries (respectively 45 vs. 39 vs. 33) P=0.056. There was no correlation between the duration of the disease and the change in the GO QOLf (R=0.04). CONCLUSION This study confirms that strabismus surgery significantly improves the quality of life of patients with Graves' ophthalmopathy. The GO QOLf demonstrates its effectiveness in highlighting this progression. Our ten additional questions proved to be very good tools for assessing this condition.
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Brandone N, Okhremchuk I, Rojat-Habib MC, Blanc AL, Essamet W, Agostini A, Macagno N. [An ovarian tumor can hide another one]. Ann Pathol 2017; 37:479-483. [PMID: 29169834 DOI: 10.1016/j.annpat.2017.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 10/08/2017] [Indexed: 10/18/2022]
Abstract
We report the case of a 33-year-old woman who went under surgery for a cystic mature teratoma. The histological exam found two cysts, one was a mature teratoma and the other was a struma ovarii with a papillary carcinomatous element. Struma ovarii cancerization is seen in 5 to 10% of the cases usually under a papillary carcinoma type. Diagnosis is rarely made before surgery, the patients exceptionally show thyroid symptoms. Histologically, the tumour presents the same way as the one seen in the thyroid gland and BRAF mutations have been reported. The problem concerns ovarian metastases of a thyroid cancer. A normal thyroid check up and normal thyroid tissue close to the tumor in the ovary are in favor for a cancerize struma ovarii. The therapeutic care is not consensual, going from an annexectomy to hysterectomy and bilateral annexectomy. The patients must be followed on long-term with thyroglobulin quantitative analysis for at least 10 years and whole body scintigraphy with iodine 123 to detect relapse or metastases. The prognosis is usually good but precise criteria are still to define.
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Affiliation(s)
- Nicolas Brandone
- Service d'anatomie et cytologie pathologiques, hôpital de la Timone, 254, rue Saint-Pierre, 13005 Marseille, France.
| | - Ilona Okhremchuk
- Service d'anatomie et cytologie pathologiques, hôpital de la Timone, 254, rue Saint-Pierre, 13005 Marseille, France
| | - Marie-Christine Rojat-Habib
- Service d'anatomie et cytologie pathologiques, hôpital de la Timone, 254, rue Saint-Pierre, 13005 Marseille, France
| | - Anne-Laroque Blanc
- Service d'anatomie et cytologie pathologiques, hôpital de la Timone, 254, rue Saint-Pierre, 13005 Marseille, France
| | - Wassim Essamet
- Service d'anatomie et cytologie pathologiques, hôpital de la Timone, 254, rue Saint-Pierre, 13005 Marseille, France
| | - Aubert Agostini
- Service de gynécologie, hôpital La-Conception, 147, boulevard Baille, 13005 Marseille, France
| | - Nicolas Macagno
- Service d'anatomie et cytologie pathologiques, hôpital de la Timone, 254, rue Saint-Pierre, 13005 Marseille, France
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de la Fouchardiere C. [Lenvatinib in radioiodine refractory thyroid carcinomas]. Bull Cancer 2016; 103:905-910. [PMID: 27817859 DOI: 10.1016/j.bulcan.2016.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 10/06/2016] [Accepted: 10/06/2016] [Indexed: 10/20/2022]
Abstract
Differentiated thyroid cancers are usually cured by an appropriate surgery and a radioiodine remnant ablation. If metastases occur, successive radioiodine administrations and/or local treatments can be provided. Nevertheless, some patients will be, or become refractory to radioiodine. In case of significant and rapid progression of metastatic lesions, they will be candidate to kinase inhibitor treatments. Two agents are now approved in this situation: sorafenib and lenvatinib. Lenvatinib (Lenvima®) is a tyrosine kinase inhibitor (TKI) targeting the VEGFR1-3, FGFR 1-4, PDGFR-α, RET and c-kit. It received an FDA and EMA approval in February and March 2015 for the treatment of radioiodine refractory thyroid cancers following the SELECT study's results. In this study, patients treated with lenvatinib had a significant increase in progression-free survival (18.3 months vs. 3.6 months; HR=0.21; CI=0.14-0.31, P < 0.001) and response rate (64.8% vs. 1.5% with placebo). The median overall survival was not reached in both groups at the time of data cutoff. In France, lenvatinib was first available within a compassionate use program (ATU) and is now dispended by hospitals because not yet marketed.
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Lamblin G, Gallice C, Bournaud C, Nadaud B, Lebail-Carval K, Chene G. [Benign struma ovarii: Report of 7 cases and review of the literature]. ACTA ACUST UNITED AC 2016; 44:263-8. [PMID: 26997461 DOI: 10.1016/j.gyobfe.2016.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 02/04/2016] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Struma ovarii is a monodermal teratoma composed of thyroid tissue, representing 0.85 to 1.3% of ovarian tumors. The objective of the present study is to report a continuous series of struma ovarii, with a comprehensive analysis of the literature. METHODS A retrospective study in the gynecological surgery department of Hôpital Femme-Mère-Enfant (Hospices Civils de Lyon, Lyon, France) assessed a continuous series of struma ovarii from the Lyon East Pathology Center database. Clinical and biological, imaging and pathological aspects were analyzed and the various forms of treatment described. RESULTS We identified 7 patients with struma ovarii from March 2008 to April 2015. Mean patient age was 49.7 years (28-70years). Three patients had a history of thyroid disease. CA-125 was elevated (51IU/mL) in only 1 patient. MRI and ultrasound imaging did not enable diagnosis of struma ovarii, which depended on pathologic examination. Conservative surgery for cystectomy or oophorectomy was performed for patients wishing to become pregnant (71%); nonconservative hysterectomy was performed in postmenopausal women (29%). CONCLUSIONS Struma ovarii is a rare, often asymptomatic condition in which diagnosis is difficult. Few series are described in the literature. Here we propose a management model for struma ovarii. Revision surgery and adjuvant therapy is indicated in case of malignant struma ovarii.
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Affiliation(s)
- G Lamblin
- Service de chirurgie gynécologique, université Claude Bernard-Lyon 1, hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69677 Lyon-Bron, France.
| | - C Gallice
- Service de chirurgie gynécologique, université Claude Bernard-Lyon 1, hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69677 Lyon-Bron, France
| | - C Bournaud
- Service de médecine nucléaire, groupement hospitalier Est, 59, boulevard Pinel, 69677 Lyon-Bron, France
| | - B Nadaud
- Service de pathologie Est (CPE), groupement hospitalier Est, 59, boulevard Pinel, 69677 Lyon-Bron, France
| | - K Lebail-Carval
- Service de chirurgie gynécologique, université Claude Bernard-Lyon 1, hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69677 Lyon-Bron, France
| | - G Chene
- Service de chirurgie gynécologique, université Claude Bernard-Lyon 1, hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69677 Lyon-Bron, France
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Agopiantz M, Elhanbali O, Demore B, Cuny T, Demarquet L, Ndiaye C, Barbe F, Brunaud L, Weryha G, Klein M. Thyroid side effects prophylaxis in front of nuclear power plant accidents. Ann Endocrinol (Paris) 2016; 77:1-6. [PMID: 26830953 DOI: 10.1016/j.ando.2015.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 12/16/2015] [Accepted: 12/20/2015] [Indexed: 11/21/2022]
Abstract
The better knowledge of the mechanisms of nuclear incidents and lessons learned from accidents in the recent past to improve the effectiveness of measures taken following a nuclear accident exposure to fallout of radioactive iodine isotopes. Thus, immediate, passive measures, such as containment, and stopping consumption of contaminated products are paramount. The earliest possible administration of stable iodine as potassium iodide (KI) reduces significantly (up to 90% if taken at the same time of the accident) thyroid radioactive contamination. These tablets should be given in priority to children and pregnant women. The side effects are minor. KI is not recommended for persons aged over 60 years, or for adults suffering from cardiovascular disorders.
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Demoor-Goldschmidt C, Fayech C, Girard P, Plantaz D. [Secondary cancers: Incidence, risk factors and recommendations]. Bull Cancer 2015; 102:656-64. [PMID: 25911942 DOI: 10.1016/j.bulcan.2015.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 03/23/2015] [Indexed: 01/22/2023]
Abstract
Cure rates for most childhood cancers and adolescents have made remarkable progress over the last thirty to forty years. The development of secondary malignancies has become an important question for these patients. The frequency is low, but the risk is significantly higher (between 3 and 10 times) and it is the leading cause of long-term mortality off relapse. In this literature review, we discuss the epidemiological aspect and the risk factors contributing to this increased risk, and conclude with a summary of current recommendations for screening and surveillance. We also discuss briefly the constitutional predisposing genetic contributions to other cancers.
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Affiliation(s)
- Charlotte Demoor-Goldschmidt
- Institut de cancérologie de l'Ouest, ICO-René Gauducheau, service de radiothérapie, boulevard J-Monod, 44800 Saint-Herblain, France; Faculté de médecine de Nantes, 44000 Nantes, France.
| | - Chiraz Fayech
- Institut Gustave-Roussy, service d'oncologie pédiatrique, rue Camille-Des-Moulins, 94805 Villejuif, France
| | - Pauline Girard
- CHU de Grenoble, hôpital Couple Enfant, clinique universitaire de pédiatrie, CS10217, 38043 Grenoble cedex, France
| | - Dominique Plantaz
- CHU de Grenoble, hôpital Couple Enfant, clinique universitaire de pédiatrie, CS10217, 38043 Grenoble cedex, France
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Abstract
Links between affective and endocrine-metabolic disorders are numerous and complex. In this review, we explore most frequent endocrine-metabolic comorbidities. On the one hand, these comorbidities imply numerous iatrogenic effects from antipsychotics (metabolic side-effects) or from lithium (endocrine side-effects). On the other hand, these comorbidities are also associated with affective disorders independently from medication. We will successively examine metabolic syndrome, glycemic disturbances, obesity and thyroid disorders among patients with affective disorders. Endocrinemetabolic comorbidities can be individually encountered, but can also be associated. Therefore, they substantially impact morbidity and mortality by increasing cardiovascular risk factors. Two distinct approaches give an account of processes involved in these comorbidities: common environmental factors (iatrogenic effects, lifestyle), and/or shared physiological vulnerabilities. In conclusion, we provide a synthesis of important results and recommendations related to endocrine-metabolic comorbidities in affective disorders : heavy influence on morbidity and mortality, undertreatment of somatic diseases, importance of endocrine and metabolic side effects from main mood stabilizers, impact from sex and age on the prevalence of comorbidities, influence from previous depressive episodes in bipolar disorders, and relevance of systematic screening for subclinical (biological) disturbances.
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Affiliation(s)
- M Cermolacce
- Pôle universitaire de psychiatrie, CHU Sainte-Marguerite, 13274 Marseille cedex 9, France; Laboratoire de Neurosciences Cognitives, UMR CNRS 6155 & Aix-Marseille Université, Fédération 3C, Marseille, France.
| | - R Belzeaux
- Pôle universitaire de psychiatrie, CHU Sainte-Marguerite, 13274 Marseille cedex 9, France
| | - M Adida
- Pôle universitaire de psychiatrie, CHU Sainte-Marguerite, 13274 Marseille cedex 9, France
| | - J-M Azorin
- Pôle universitaire de psychiatrie, CHU Sainte-Marguerite, 13274 Marseille cedex 9, France
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Razafimanjato NNM, Rakotonaivo MJ, Hunald FA, Samison LH, Rakotovao HJL, Rakototiana AF. [Pseudosyndrome of Meigs revealer of an ovarian goiter]. ACTA ACUST UNITED AC 2014; 42:810-2. [PMID: 25444703 DOI: 10.1016/j.gyobfe.2014.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 09/03/2014] [Indexed: 11/29/2022]
Abstract
The pseudosyndrome of Meigs is caracterised by a triad, which associates a solid benign tumor of the ovary, an ascitis and a pleural effusion. Surgical extraction of the tumor entails disappearance of the symptomatology. The authors report in this study a case of an ovarian goitre revealed by this syndrom.
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Affiliation(s)
- N N M Razafimanjato
- Service de chirurgie thoracique CHU/JRA, 4150 CP, 101, Antananarivo, Madagascar.
| | - M J Rakotonaivo
- Service de chirurgie viscérale CHU/JRA, 4150 CP, 101, Antananarivo, Madagascar
| | - F A Hunald
- Service d'urologie CHU/JRA, 4150 CP, 101, Antananarivo, Madagascar
| | - L H Samison
- Service de chirurgie viscérale CHU/JRA, 4150 CP, 101, Antananarivo, Madagascar
| | - H J L Rakotovao
- Service de chirurgie thoracique CHU/JRA, 4150 CP, 101, Antananarivo, Madagascar
| | - A F Rakototiana
- Service d'urologie CHU/JRA, 4150 CP, 101, Antananarivo, Madagascar
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James YE, Doleagbenou A, Kassegne I, Biramah BT, Keke K, Dosseh ED, Ayite AE, James K. [Zuckerkandl's tubercle: incidence and relationship with the inferior laryngeal nerve]. Morphologie 2014; 98:171-175. [PMID: 25443782 DOI: 10.1016/j.morpho.2014.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 07/03/2014] [Accepted: 07/16/2014] [Indexed: 06/04/2023]
Abstract
UNLABELLED The iatrogenal lesion of the inferior laryngeal nerve (ILN) during thyroid surgery is an incident, which can have greatest functional after-effects. Its research is recommended during cervicotomy for thyroidectomy and it can be easily found by the presence of Zuckerkandl tubercle, which is a postero-lateral excrescence of the thyroid gland. OBJECTIVES The main objective of our study was the researching of the presence of this Zuckerkandl tubercle and appreciating the reports with the ILN. PATIENTS AND METHODS From 1st October 2010 to 30th September 2012, we realized a continuous prospective study on a mono-operator series of 48 patients operated on for thyroidectomy. The Zuckerkandl tubercle has been researched from all the patients and classified according to the classification of Pelizzo et al. RESULTS From 21 patients (43.75%), the Zuckerkandl tubercle has been well identified and it was grade 3 and grade 2. In those cases, the ILN was very closed to the tubercle. For the 27 other patients (56.25%), the tubercle was practically undetectable or reduced to a small glandular mound (grades 0 and 1). The connections with the nerve in this case were less evident. CONCLUSION The zuckerkandl tubercle is comparatively frequent and is refound more than one time over 3 in our study. Its presence makes easier the identification of the ILN, which entertains a dangerous connection with the thyroid gland.
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Affiliation(s)
- Y E James
- Laboratoire d'anatomie, faculté des sciences de la santé, BP 1515, 08 BP 81574, Lomé, Togo; Service de chirurgie orthopédique, CHU Sylvanus-Olympio, BP 57, Lomé, Togo.
| | - A Doleagbenou
- Laboratoire d'anatomie, faculté des sciences de la santé, BP 1515, 08 BP 81574, Lomé, Togo
| | - I Kassegne
- Service de chirurgie générale et digestive, CHU Sylvanus-Olympio, BP 57, Lomé, Togo
| | - B T Biramah
- Laboratoire d'anatomie, faculté des sciences de la santé, BP 1515, 08 BP 81574, Lomé, Togo; Service de chirurgie orthopédique, CHU Sylvanus-Olympio, BP 57, Lomé, Togo
| | - K Keke
- Laboratoire d'anatomie, faculté des sciences de la santé, BP 1515, 08 BP 81574, Lomé, Togo
| | - E D Dosseh
- Service de chirurgie générale et digestive, CHU Sylvanus-Olympio, BP 57, Lomé, Togo
| | - A E Ayite
- Service de chirurgie générale et digestive, CHU Sylvanus-Olympio, BP 57, Lomé, Togo
| | - K James
- Laboratoire d'anatomie, faculté des sciences de la santé, BP 1515, 08 BP 81574, Lomé, Togo; Service de chirurgie générale et digestive, CHU Sylvanus-Olympio, BP 57, Lomé, Togo
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Khonsari RH, Bertolus C, Corre P, Chaine A, Guerre A, Ménégaud F, Goudot P. [Submandibular swelling four years after total thyroidectomy]. ACTA ACUST UNITED AC 2014; 115:118-20. [PMID: 24456910 DOI: 10.1016/j.revsto.2013.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 12/12/2013] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Submandibular swelling most frequently involves the submandibular gland. It is often due to lithiasis or to tumor. Some rare cases of submandibular swelling have been reported such as submandibular localizations of thyroid lesions. Our case study concerns one of these rare occurrences. OBSERVATION A 47-year-old female patient consulted for a right-sided submandibular mass progressively increasing in size during the previous 2 years. The patient had undergone a total thyroidectomy, 4 years before consulting, for a toxic multinodular goiter THAT had been treated by L-thyroxin replacement therapy per os since the surgery. TSH and LT4 levels were normal. A CT scan revealed a large tumor in the right submandibular space with heterogeneous contrast. Fine needle cytopuncture allowed observing follicular cellules suggesting thyroid origin. The cervicotomy confirmed the diagnosis of an ectopic goiter. DISCUSSION Thyroid disorders may in rare cases concern the submandibular space. A history of thyroid disorders should be taken into account for the etiological diagnosis of unusual submandibular masses in maxillo-facial surgery.
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Affiliation(s)
- R-H Khonsari
- Service de chirurgie maxillo-faciale et stomatologie, CHU Pitié-Salpêtrière, université Pierre-et-Marie-Curie Paris 06, 75006 Paris, France.
| | - C Bertolus
- Service de chirurgie maxillo-faciale et stomatologie, CHU Pitié-Salpêtrière, université Pierre-et-Marie-Curie Paris 06, 75006 Paris, France
| | - P Corre
- Service de chirurgie maxillo-faciale et stomatologie, centre hospitalier universitaire Hôtel-Dieu, Nantes, France
| | - A Chaine
- Service de chirurgie maxillo-faciale et stomatologie, CHU Pitié-Salpêtrière, université Pierre-et-Marie-Curie Paris 06, 75006 Paris, France
| | - A Guerre
- Service de chirurgie maxillo-faciale et stomatologie, CHU Pitié-Salpêtrière, université Pierre-et-Marie-Curie Paris 06, 75006 Paris, France
| | - F Ménégaud
- Service de chirurgie générale, CHU Pitié-Salpêtrière, Paris, France
| | - P Goudot
- Service de chirurgie maxillo-faciale et stomatologie, CHU Pitié-Salpêtrière, université Pierre-et-Marie-Curie Paris 06, 75006 Paris, France
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Retornaz F, Castinetti F, Molines C, Oliver C. [Thyroid in the elderly (Part 1)]. Rev Med Interne 2013; 34:623-7. [PMID: 23352291 DOI: 10.1016/j.revmed.2012.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 10/30/2012] [Accepted: 11/26/2012] [Indexed: 10/27/2022]
Abstract
Aging is associated with changes in thyroid function at several levels of regulation. Thyroid hormones levels are usually within the lower part of normal values reported in the general population. Two changes in aging are of clinical importance: a shift in the distribution of TSH levels, the 97.5th percentile of the TSH distribution being within 6 μUI/ml after 70 years and within 7.5 μUI/ml in subjects older than 80 instead of 4.5 μU/ml in the general population, and an increased prevalence of thyroid nodularity, requiring reliable and non-invasive methods of investigation in older people. Lastly, aging may be associated with comorbidities, high risk of drug interactions and under nutrition, which may make difficult the interpretation of laboratory data and in some cases induce iatrogenic thyroid diseases. Considering the high prevalence of the thyroid diseases in older patients and a better understanding of the physiopathological hormonal variations with the ageing, it seemed useful to propose a review to help the clinician in the care of these situations.
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Affiliation(s)
- F Retornaz
- Pôle gériatrique, centre gérontologique départemental, 176, avenue de Montolivet, 13012 Marseille, France; EA3279, évaluation des systèmes de soins - santé perçue, université de la Méditerranée, 27, boulevard Jean-Moulin, 13006 Marseille, France.
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