Investigation on the association between thyroid tumorigeneses and herpesviruses

Herpesviruses have been associated with various human malignancies and with thyroid autoimmunity. Aiming to investigate the presence of these viruses in thyroid nodules, we analyzed serum and thyroid tissue from 183 patients (83 benign and 100 malignant thyroid nodules). We also obtained 104 normal thyroid tissues extracted from the contralateral lobe of these patients. We used ELISA to screen the serology of all patients and a real-time quantitative PCR to analyze thyroid tissue viral load in antibody-positive patients. In addition, the presence of herpesviruses was tested by histological analysis in 20 EBV-positive tissues using the expression of LMP-1 by immunohistochemistry (IHC) and EBER by in situ hybridization (ISH). There was no evidence of HSV-2 or CMV DNA, but we found EBV DNA sequences in 29 (16%) thyroid tissue samples. We also found 7 positive EBV cases out of 104 normal tissues. Viral load was higher in tumors than in their respective normal tissues (p = 0.0002). ISH analysis revealed EBER expression in 11 out of 20 (52%) EBV-positive tissues, mostly in malignant cases (8/11, 73%). The presence of high EBV copy numbers in thyroid tumors and the expression of EBER only in malignant cases suggest an association between EBV and thyroid malignancies. However, we did not find any association between the presence of EBV and/or its viral load and any clinical or pathological tumor feature. Further studies aiming to clarify the mechanisms of EBV infection in thyroid cells are necessary to support a possible role in the development of thyroid cancer.

Treatment of locally aggressive well-differentiated thyroid cancer

The object of this study, conducted at Unicamp between 1988 and 1998, was to evaluate retrospectively the outcome of patients treated for locally aggressive well-differentiated thyroid carcinomas (LATC). Nineteen (42%) of 45 patients with thyroid carcinomas were considered to have LATC. The preoperative diagnosis of carcinoma was made either by fine needle aspiration biopsy (15 patients) or during surgery (4 patients). The usual prognostic factors were analyzed and classified according to risk groups. Survival was evaluated using the Kaplan-Meier method. Most of the patients were female (73%), with a mean age of 48 years. Eighteen (95%) had papillary carcinomas. Four patients were classified as high risk (21%) and the remaining 15 (79%) as intermediate risk. All patients underwent total thyroidectomy and different types of neck dissections. The structures invaded by tumors were strap muscles and trachea (four cases); recurrent nerve and larynx (three cases); manubrium, esophagus, and jugular vein (two cases); and hyoid bone and pharynx (one case). Complete tumor resection was carried out according to the extent of local invasion; no postoperative deaths resulted. Details of the procedures are provided in Table 4 and in the Discussion. Postoperative radioactive iodine treatment was used in 15 patients (79%). A mean follow-up (+/-7 years) revealed 13 (68%) patients without disease, 4 patients (21%) alive with controlled systemic disease, and 2 (11%) deaths from distant metastasis. The Kaplan-Meir survival curve was comparable with other studies in the literature. This study found that the frequency of LATC (42%) was higher than in most studies. Aggressive surgical therapy to treat these tumors is compatible with a low recurrence rate and long-term survival in a significant proportion of patients.

[Importance of upper digestive endoscopy using lugol dye solution for the diagnosis of superficial esophageal cancer and dysplasia in patients with head and neck neoplasms]

Head and neck cancer has a high incidence in Brazil, with cancer of the oral cavity being one of the five most common cancers among Brazilians. Alcohol and tobacco consumption may contribute to synchronous or metachronous head and neck cancer and esophageal cancer. A prospective study involving 60 patients with head and neck cancer was carried out at the State University of Campinas--UNICAMP, Campinas, SP, Brazil to screen for superficial esophageal cancer and dysplasia using endoscopy and a 2% lugol dye solution followed by biopsy of the suspicious areas. Five patients (8.3%) had superficial esophageal cancer, which was diagnosed as intraepithelial carcinoma in three of them (5.0%). In four patients, the superficial esophageal cancer was synchronous and in one it was metachronous to head and neck cancer. Five patients (8.3%) had dysplasias in the esophageal epithelium (three were classified as mild and two as moderate). These results demonstrate the value of endoscopic screening of the esophagus using lugol dye in patients with head and neck cancer, particularly since superficial esophageal cancer is extremely difficult to detect by conventional methods in asymptomatic patients.

Diagnosis of superficial esophageal cancer and dysplasia using endoscopic screening with a 2% lugol dye solution in patients with head and neck cancer

BACKGROUND

Head and neck cancer (HNC) has a high incidence in Brazil, with cancer of the oral cavity being one of the five most common cancers among Brazilians. Alcohol and tobacco consumption may contribute to synchronous or metachronous HNC and esophageal cancer. The early detection of superficial esophageal cancer and dysplasia in asymptomatic patients with HNC, after successfully treating the primary cancer, may provide an effective cure.

METHODS

A prospective study involving 60 patients with HNC was carried out at the State University of Campinas (UNICAMP) to screen for superficial esophageal cancer and dysplasia using endoscopy and a 2% lugol dye solution followed by biopsy of the suspicious areas.

RESULTS

Five patients (8.3%) had superficial esophageal cancer, which was diagnosed as intraepithelial carcinoma in three of them (5.0%). In four patients, the superficial esophageal cancer was synchronous, and in one it was metachronous to HNC. Five patients (8.3%) had dysplasias in the esophageal epithelium (three were classified as mild and two as moderate).

CONCLUSION

These results demonstrate the value of endoscopic screening of the esophagus using lugol dye in patients with HNC, particularly because superficial esophageal cancer is extremely difficult to detect by conventional methods in asymptomatic patients.

Diagnosis of superficial esophageal cancer and dysplasia using endoscopic screening with a 2% lugol dye solution in patients with head and neck cancer

BACKGROUND

Head and neck cancer (HNC) has a high incidence in Brazil, with cancer of the oral cavity being one of the five most common cancers among Brazilians. Alcohol and tobacco consumption may contribute to synchronous or metachronous HNC and esophageal cancer. The early detection of superficial esophageal cancer and dysplasia in asymptomatic patients with HNC, after successfully treating the primary cancer, may provide an effective cure.

METHODS

A prospective study involving 60 patients with HNC was carried out at the State University of Campinas (UNICAMP) to screen for superficial esophageal cancer and dysplasia using endoscopy and a 2% lugol dye solution followed by biopsy of the suspicious areas.

RESULTS

Five patients (8.3%) had superficial esophageal cancer, which was diagnosed as intraepithelial carcinoma in three of them (5.0%). In four patients, the superficial esophageal cancer was synchronous, and in one it was metachronous to HNC. Five patients (8.3%) had dysplasias in the esophageal epithelium (three were classified as mild and two as moderate).

CONCLUSION

These results demonstrate the value of endoscopic screening of the esophagus using lugol dye in patients with HNC, particularly because superficial esophageal cancer is extremely difficult to detect by conventional methods in asymptomatic patients.

Diagnosis of superficial esophageal cancer and dysplasia using endoscopic screening with a 2% lugol dye solution in patients with head and neck cancer

BACKGROUND

Head and neck cancer (HNC) has a high incidence in Brazil, with cancer of the oral cavity being one of the five most common cancers among Brazilians. Alcohol and tobacco consumption may contribute to synchronous or metachronous HNC and esophageal cancer. The early detection of superficial esophageal cancer and dysplasia in asymptomatic patients with HNC, after successfully treating the primary cancer, may provide an effective cure.

METHODS

A prospective study involving 60 patients with HNC was carried out at the State University of Campinas (UNICAMP) to screen for superficial esophageal cancer and dysplasia using endoscopy and a 2% lugol dye solution followed by biopsy of the suspicious areas.

RESULTS

Five patients (8.3%) had superficial esophageal cancer, which was diagnosed as intraepithelial carcinoma in three of them (5.0%). In four patients, the superficial esophageal cancer was synchronous, and in one it was metachronous to HNC. Five patients (8.3%) had dysplasias in the esophageal epithelium (three were classified as mild and two as moderate).

CONCLUSION

These results demonstrate the value of endoscopic screening of the esophagus using lugol dye in patients with HNC, particularly because superficial esophageal cancer is extremely difficult to detect by conventional methods in asymptomatic patients.

Papillary carcinoma in a thyroglossal duct: case report

CONTEXT

Thyroglossal duct cysts are the most common congenital cervical abnormality in childhood. Malignant lesions are rare in thyroglossal duct cysts (about 1%).

OBJECTIVE

To report a case of papillary carcinoma in thyroglossal duct cysts.

DESIGN

Case report.

CASE REPORT

The patient was a 21-year-old female with a four-month history of an anterior midline neck mass but without other symptoms. The physical examination revealed a 4.0 cm diameter, smooth, painless, cystic nodule at the level of the hyoid bone. The thyroid gland was normal by palpation and no neck lymph nodes were found. Indirect laryngoscopy, fine-needle biopsy aspiration and cervical ultrasound were normal and compatible with the physical findings of a thyroglossal duct cyst. The patient underwent surgery with this diagnosis, under general anesthesia, and the mass was resected by the usual Sistrunk procedure. There were no local signs of invasion of the tissue surrounding the cyst or duct at surgery. The patient was discharged within 24 hours. Histopathological examination of the specimen showed a 3.5 x 3.0 x 3.0 cm thyroglossal cyst, partially filled by a solid 1.0 x 0.5 cm brownish tissue. Histological sections showed a papillary carcinoma in the thyroid tissue of a thyroglossal cyst, with normal thyroid tissue at the boundary of the carcinoma. There was no capsule invasion and the margins were negative. The follow-up of the patient consisted of head and neck examinations, ultrasonography of the surgical region and thyroid, and total body scintigraphy. The patient has been followed up for two years with no further evidence of disease.

Parapharyngeal space tumors: considerations in 26 cases

CONTEXT

Parapharyngeal space tumors comprise less than 0.5% of all head and neck neoplasms. The majority of these tumors are benign, but surgery is usually required to establish the diagnosis and treat the patients. We present 26 patients treated surgically for tumors arising in the parapharyngeal space (PPS) at the State University of Campinas Hospital--UNICAMP.

CASES SERIES

Of these, 17 (65.5%) had benign and 9 (34.6%) malignant neoplasms. The surgical and pathological data relevant to these cases are highlighted, observing any local recurrence, surgical complications and the five-year survival. Neurogenic tumors and soft tissue sarcomas were, respectively, the most frequent benign (35.3%) and malignant neoplasms (44.5%). Benign tumors accounted for the majority of the cases and involved minimal surgical morbidity with no recurrence during a median follow-up of five years. Malignant tumors had a high rate of recurrence and mortality. Surgery is the treatment of choice for PPS tumors. A knowledge of the anatomy of this site is essential for the safe performance of surgical procedures. Malignant neoplasms have a poor prognosis. Fine needle aspiration was helpful in diagnosis of all tumors.

Melanoma ganglionic metastasis 30 years after treatment of the primary tumor--a case report

The recurrence of melanoma in patients is well-documented, and is dependent on a number of factors. We report a case in which a patient had a case of ganglionar metastasis in the neck after a 30-year disease-free interval following primary treatment.

[Benign tumors of the bile ducts]

Benign neoplasms are rare events in the extrahepatic biliary ducts, and scanty literary references on the subject are available. Four cases of obstructive jaundice caused by benign tumours of the extrahepatic biliary ducts have been reviewed. Two of them have also displayed lithiasis of the gallbladder and common bile duct. In three cases histopathologic confirmation was obtained, in contrast to the remaining case in which only a gross pathologic presumptive diagnosis was possible. Three patients underwent surgical resection, and in one of them hepatojejunostomy was performed. The patient with a presumptive diagnosis of "inflammatory polyp" was not submitted to surgery, due to the special circumstances of the case. The undisturbed follow-up of the four cases attested to the worthiness of the surgical procedures.