1
|
Attard M, O'Kane D. Rapid response to abatacept in treatment-resistant pansclerotic morphoea. Clin Exp Dermatol 2021; 47:755-757. [PMID: 34798687 DOI: 10.1111/ced.15028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/14/2021] [Accepted: 11/16/2021] [Indexed: 11/28/2022]
Abstract
Morphoea is a spectrum of disorders characterized by inflammation and sclerosis of the skin and potentially underlying tissues. There are no specific licensed treatments for morphoea and prospective studies on commonly used therapies are lacking. We describe a case of progressive, recalcitrant pansclerotic morphoea with a rapid response to abatacept.
Collapse
Affiliation(s)
- M Attard
- Department of Dermatology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - D O'Kane
- Department of Dermatology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| |
Collapse
|
2
|
Baudin E, Goichot B, Berruti A, Hadoux J, Moalla S, Laboureau S, Noelting S, De La Fouchardière C, Kienitz T, Deutschbein T, Zovato S, Amar L, Tabarin A, Timmers H, Niccoli P, Attard M. Essai randomisé en double aveugle du Sunitinib dans les phéochromocytomes et paragangliomes malins (PPGM) : résultats de l’étude internationale FIRSTMAPPP. Annales d'Endocrinologie 2021. [DOI: 10.1016/j.ando.2021.07.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
3
|
Lamartina L, Godbert Y, Nascimento C, Do Cao C, Hescot S, Borget I, Al Ghuzlan A, Hartl D, Hadoux J, Pottier E, Attard M, Berdelou A, Terroir M, Baudin E, Schlumberger M, Leboulleux S. Locally unresectable differentiated thyroid cancer: outcomes and perspectives. Endocrine 2020; 69:133-141. [PMID: 32147774 DOI: 10.1007/s12020-020-02245-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/24/2020] [Indexed: 01/25/2023]
Abstract
PURPOSE Differentiated thyroid cancer (DTC) patients with an unresectable primary tumor cannot benefit from curative surgery, and radioiodine treatment for locoregional and distant disease is not possible with the thyroid gland still in place. Due to local invasion, these patients cannot be included in clinical trials, so that treatment options are limited. The aim of this study was to describe the characteristics and the prognosis of patients with these locally unresectable DTC. PATIENTS AND METHODS A retrospective and multicentric analysis of consecutive cases of unresectable DTC diagnosed between 2000 and 2015 was performed. RESULTS The study population consisted in 22 patients, 13 females (59%); median age: 77 years (range: 52-91). Thyroid tumors were papillary in six, follicular in seven, Hürthle cell in one and poorly differentiated in eight patients. Patients were treated with external beam radiation therapy (EBRT) (57%), locoregional therapy of distant metastases (41%), cytotoxic chemotherapy (38%) and tyrosine kinase inhibitors (TKIs) (33%). TKI treatment resulted in median disease control duration of 7 months with a grade 3-4 toxicity rate of 44%. Only one patient had a total thyroidectomy after neo-adjuvant EBRT. The 1, 3 and 5-year cumulative survival rate was 81%, 27.7% and 21.5%, respectively. The cause of death was DTC in 11 cases (local progression in 7), and to other causes in 7 cases; no patient died from treatment toxicity. CONCLUSIONS Clinical trials and approved treatments are lacking for unresectable DTC. TKI treatment may allow prolonged disease control with acceptable toxicity.
Collapse
Affiliation(s)
- L Lamartina
- Département de Médecine Nucléaire et Cancérologie Endocrinienne, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France.
| | - Y Godbert
- Département de Médecine Nucléaire, Institut Bergonié, 33076, Bordeaux, France
| | - C Nascimento
- Département de Médecine Nucléaire, Hôpital René Huguenin-Institut Curie, 92210, St Cloud, France
| | - C Do Cao
- Département d'Endocrinologie, CHRU de Lille, 5900, Lille, France
| | - S Hescot
- Département de Médecine Nucléaire, Hôpital René Huguenin-Institut Curie, 92210, St Cloud, France
| | - I Borget
- Département de Biostatistique et épidémiologie, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - A Al Ghuzlan
- Département de Biologie et pathologie médicales, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - D Hartl
- Département de Chirurgie Cervico-Faciale, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - J Hadoux
- Département de Médecine Nucléaire et Cancérologie Endocrinienne, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - E Pottier
- Département d'Imagerie médicale, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - M Attard
- Département d'Imagerie médicale, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - A Berdelou
- Département de Médecine Nucléaire et Cancérologie Endocrinienne, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - M Terroir
- Département de Médecine Nucléaire et Cancérologie Endocrinienne, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - E Baudin
- Département de Médecine Nucléaire et Cancérologie Endocrinienne, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - M Schlumberger
- Département de Médecine Nucléaire et Cancérologie Endocrinienne, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - S Leboulleux
- Département de Médecine Nucléaire et Cancérologie Endocrinienne, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| |
Collapse
|
4
|
Affiliation(s)
- Tim R. Birkhead
- Department of Animal & Plant SciencesThe University of Sheffield Sheffield UK
| | - M. Attard
- Department of Animal & Plant SciencesThe University of Sheffield Sheffield UK
| | - A. Pilastro
- Department of BiologyUniversity of Padova Padova Italy
| |
Collapse
|
5
|
Lamartina L, Durante C, Lucisano G, Grani G, Bellantone R, Lombardi CP, Pontecorvi A, Arvat E, Felicetti F, Zatelli MC, Rossi R, Puxeddu E, Morelli S, Torlontano M, Crocetti U, Montesano T, Giubbini R, Orlandi F, Aimaretti G, Monzani F, Attard M, Francese C, Antonelli A, Limone P, Rossetto R, Fugazzola L, Meringolo D, Bruno R, Tumino S, Ceresini G, Centanni M, Monti S, Salvatore D, Spiazzi G, Mian C, Persani L, Barbaro D, Nicolucci A, Filetti S. Are Evidence-Based Guidelines Reflected in Clinical Practice? An Analysis of Prospectively Collected Data of the Italian Thyroid Cancer Observatory. Thyroid 2017; 27:1490-1497. [PMID: 29020892 DOI: 10.1089/thy.2017.0299] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The goal of evidence-based practice guidelines is to optimize the management of emerging diseases, such as differentiated thyroid cancer (DTC). The aim of this study was to assess therapeutic approaches for DTC in Italy and to see how closely these practices conformed to those recommended in the 2009 American Thyroid Association (ATA) guidelines. METHODS The Italian Thyroid Cancer Observatory was established to collect data prospectively on thyroid cancers consecutively diagnosed in participating centers (uniformly distributed across the nation). Data on the initial treatment of all pathologically confirmed DTC cases present in the database from January 1, 2013 (database creation) to January 31, 2016, were analyzed. RESULTS A total of 1748 patients (77.2% females; median age 48.1 years [range 10-85 years]) were enrolled in the study. Most (n = 1640; 93.8%) were papillary carcinomas (including 84 poorly differentiated/aggressive variants); 6.2% (n = 108) were follicular and Hürthle cell carcinomas. The median tumor diameter was 11 mm (range 1-93 mm). Tumors were multifocal in 613 (35%) and presented extrathyroidal extension in 492 (28%) cases. Initial treatments included total thyroidectomy (involving one or two procedures; n = 726; 98.8%) and lobectomy (n = 22; 1.2%). A quarter of the patients who underwent total thyroidectomy had unifocal, intrathyroidal tumors ≤1 cm (n = 408; 23.6%). Neck dissection was performed in 40.4% of the patients (29.5% had central compartment dissection). Radioiodine remnant ablation (RRA) was performed in 1057 (61.2%) of the 1726 patients who underwent total thyroidectomy: 460 (41.2%) of the 983 classified by 2009 ATA guideline criteria as low-risk, 570 (87.1%) of the 655 as intermediate-risk, and 82 (93.1%) of the 88 as high-risk patients (p < 0.001). RRA was performed in 44% of the cases involving multifocal DTCs measuring ≤1 cm. CONCLUSIONS The treatment approaches for DTCs used in Italy display areas of inconsistency with those recommended by the 2009 ATA guidelines. Italian practices were characterized by underuse of thyroid lobectomy in intrathyroidal, unifocal DTCs ≤1 cm. The use of RRA was generally consistent with risk-stratified recommendations. However, its frequent use in small DTCs (≤1 cm) that are multifocal persists, despite the lack of evidence of benefit. These data provide a baseline for future assessments of the impact of international guidelines on DTC management in Italy. These findings also illustrate that the dissemination and implementation of guideline recommendations, and the change in practice patterns, require ongoing education and time.
Collapse
Affiliation(s)
- Livia Lamartina
- 1 Department of Internal Medicine and Medical Specialties, University of Rome Sapienza , Rome, Italy
| | - Cosimo Durante
- 1 Department of Internal Medicine and Medical Specialties, University of Rome Sapienza , Rome, Italy
| | - Giuseppe Lucisano
- 2 Center for Outcomes Research and Clinical Epidemiology , Pescara, Italy
| | - Giorgio Grani
- 1 Department of Internal Medicine and Medical Specialties, University of Rome Sapienza , Rome, Italy
| | - Rocco Bellantone
- 3 Division of Endocrine Surgery, Fondazione Policlinico Gemelli, Catholic University , Rome, Italy
| | - Celestino Pio Lombardi
- 3 Division of Endocrine Surgery, Fondazione Policlinico Gemelli, Catholic University , Rome, Italy
| | - Alfredo Pontecorvi
- 4 Division of Endocrinology and Metabolic Diseases, Fondazione Policlinico Gemelli, Catholic University , Rome, Italy
| | - Emanuela Arvat
- 5 Oncological Endocrinology Unit, Department of Medical Sciences, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin , Turin, Italy
| | - Francesco Felicetti
- 5 Oncological Endocrinology Unit, Department of Medical Sciences, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin , Turin, Italy
| | - Maria C Zatelli
- 6 Endocrine Unit, Azienda Ospedaliero Universitaria S. Anna , Ferrara, Italy
| | - Roberta Rossi
- 6 Endocrine Unit, Azienda Ospedaliero Universitaria S. Anna , Ferrara, Italy
| | - Efisio Puxeddu
- 7 Department of Medicine, University of Perugia , Perugia, Italy
| | - Silvia Morelli
- 7 Department of Medicine, University of Perugia , Perugia, Italy
| | - Massimo Torlontano
- 8 Department of Medical Science, Ospedale Casa Sollievo della Sofferenza-IRCCS , San Giovanni Rotondo, Italy
| | - Umberto Crocetti
- 8 Department of Medical Science, Ospedale Casa Sollievo della Sofferenza-IRCCS , San Giovanni Rotondo, Italy
| | - Teresa Montesano
- 9 Department of Nuclear Medicine, University of Rome Sapienza , Rome, Italy
| | - Raffaele Giubbini
- 10 Nuclear Medicine Unit, Spedali Civili Università degli Studi di Brescia , Brescia, Italy
| | - Fabio Orlandi
- 11 Department of Oncology, Division of Endocrinology and Metabolism, Humanitas-Gradenigo Hospital, University of Turin, Turin, Italy
| | - Gianluca Aimaretti
- 12 Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale , Novara, Italy
| | - Fabio Monzani
- 13 Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa , Pisa, Italy
| | - Marco Attard
- 14 Division of Endocrinology, Cervello Hospital , Palermo, Italy
| | - Cecilia Francese
- 15 Division of Endocrinology , Clinica Salus di Battipaglia, Salerno, Italy
| | - Alessandro Antonelli
- 16 Department of Clinical and Experimental Medicine, University of Pisa , Pisa, Italy
| | - Paolo Limone
- 17 Division of Endocrinology, Diabetology, and Metabolism, Mauriziano Umberto I Hospital , Turin, Italy
| | - Ruth Rossetto
- 18 Division of Endocrinology, Diabetology, and Metabolism, Department of Medical Sciences, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin , Turin, Italy
| | - Laura Fugazzola
- 19 Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano , Milan, Italy
- 20 Department of Pathophysiology and Transplantation, University of Milan , Milan, Italy
| | - Domenico Meringolo
- 21 Simple Operating Unit, Department of Endocrinology, Bentivoglio Hospital , Bologna, Italy
| | - Rocco Bruno
- 22 Unit of Endocrinology, Tinchi-Pisticci Hospital , Matera, Italy
| | - Salvatore Tumino
- 23 Department of Clinical and Experimental Medicine, University of Catania , Catania, Italy
| | - Graziano Ceresini
- 24 Department of Medicine and Surgery, University of Parma , Parma, Italy
| | - Marco Centanni
- 25 Department of Medical and Surgical Sciences and Biotechnology, University of Rome Sapienza , Latina, Italy
| | - Salvatore Monti
- 26 Department of Endocrinology, Ospedale S. Andrea, Sapienza Università di Roma, Rome, Italy
| | - Domenico Salvatore
- 27 Department of Clinical Medicine and Surgery, University of Naples "Federico II ," Naples, Italy
| | - Giovanna Spiazzi
- 28 Section of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Verona , Verona, Italy
| | - Caterina Mian
- 29 Endocrinology Unit, Department of Medicine-DIMED, University Hospital of Padua , Padua, Italy
| | - Luca Persani
- 19 Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano , Milan, Italy
- 30 Department of Clinical Sciences and Community Health, University of Milan , Milan, Italy
| | - Daniele Barbaro
- 31 U.O. Endocrinologia, Livorno, ASL Nord Ovest Toscana , Livorno, Italy
| | - Antonio Nicolucci
- 2 Center for Outcomes Research and Clinical Epidemiology , Pescara, Italy
| | - Sebastiano Filetti
- 1 Department of Internal Medicine and Medical Specialties, University of Rome Sapienza , Rome, Italy
| |
Collapse
|
6
|
Grani G, Bruno R, Lucisano G, Costante G, Meringolo D, Puxeddu E, Torlontano M, Tumino S, Attard M, Lamartina L, Nicolucci A, Cooper DS, Filetti S, Durante C. Temporal Changes in Thyroid Nodule Volume: Lack of Effect on Paranodular Thyroid Tissue Volume. Thyroid 2017; 27:1378-1384. [PMID: 28806880 DOI: 10.1089/thy.2017.0201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The term "nodular goiter" has long been used to refer to a nodular thyroid gland, based on the assumption that nodule growth may be associated with hyperplasia of the surrounding non-nodular tissue. The aim of this prospective, multicenter, observational study was to determine whether nodule growth is accompanied by growth in the non-nodular tissue. METHODS Eight Italian thyroid-disease referral centers enrolled 992 consecutive patients with one to four benign nodules. Nodular and non-nodular thyroid tissue volumes were assessed for five years with annual ultrasound examinations. RESULTS In participants whose nodules remained stable (n = 839), thyroid volumes did not change (baseline 15.0 mL [confidence interval (CI) 14.5-15.6]; five-year evaluation 15.1 mL [CI 14.5-15.7]). In participants with significant growth of one or more nodule (n = 153), thyroid volumes increased and by year 5 were significantly greater than those of the former group (17.4 mL [CI 16-18.7]). In 76 individuals with unilateral nodules that grew, the mean nodular lobe volume significantly exceeded that of the contralateral lobe (8.6 mL [CI 7.4-9.8] vs. 6.7 mL [CI 6-7.4]). The unaffected lobe volumes remained stable over time, while nodular lobes grew steadily and were significantly greater at the end of follow-up (10.1 mL [CI 8.9-11.3]). Excluding the volume of the largest growing nodule in these cases, the remaining volume of the affected lobe remained virtually unchanged with respect to its baseline value. Furthermore, there was no significant difference in the non-nodular tissue volume between the unaffected lobe and the affected lobe (with the largest growing nodule volume subtracted), both at baseline and at the end of follow-up. CONCLUSIONS The growth of thyroid nodules is a local process, not associated with growth of the surrounding non-nodular tissue. Therefore, a normal-sized thyroid containing nodules should be referred to as a "uni- or multinodular thyroid gland" and considered a distinct entity from "uni- or multinodular goiter."
Collapse
Affiliation(s)
- Giorgio Grani
- 1 Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma Sapienza , Rome, Italy
| | - Rocco Bruno
- 2 Unità di Endocrinologia , Ospedale di Tinchi-Pisticci, Matera, Italy
| | - Giuseppe Lucisano
- 3 Center for Outcomes Research and Clinical Epidemiology , Pescara, Italy
| | - Giuseppe Costante
- 4 Dipartimento di Scienze della Salute, Università di Catanzaro Magna Graecia , Catanzaro, Italy
- 5 Department of Internal Medicine, Institut Jules Bordet Comprehensive Cancer Center , Brussels, Belgium
| | - Domenico Meringolo
- 6 Unità Operativa Semplice Dipartimentale di Endocrinologia , Ospedale di Bentivoglio, Bologna, Italy
| | - Efisio Puxeddu
- 7 Dipartimento di Medicina, Università di Perugia , Perugia, Italy
| | - Massimo Torlontano
- 8 Unità Operativa di Endocrinologia, Istituto di Ricovero e Cura a Carattere Scientifico , Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Salvatore Tumino
- 9 Dipartimento di Scienze Mediche e Pediatriche, Università di Catania , Catania, Italy
| | - Marco Attard
- 10 Unità Operativa di Endocrinologia , Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Livia Lamartina
- 1 Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma Sapienza , Rome, Italy
| | - Antonio Nicolucci
- 3 Center for Outcomes Research and Clinical Epidemiology , Pescara, Italy
| | - David S Cooper
- 11 Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Sebastiano Filetti
- 1 Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma Sapienza , Rome, Italy
| | - Cosimo Durante
- 1 Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma Sapienza , Rome, Italy
| |
Collapse
|
7
|
Ghataorhe P, Rhodes CJ, Harbaum L, Attard M, Wharton J, Wilkins MR. Pulmonary arterial hypertension - progress in understanding the disease and prioritizing strategies for drug development. J Intern Med 2017; 282:129-141. [PMID: 28524624 DOI: 10.1111/joim.12623] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pulmonary arterial hypertension (PAH), at one time a largely overlooked disease, is now the subject of intense study in many academic and biotech groups. The availability of new treatments has increased awareness of the condition. This in turn has driven a change in the demographics of PAH, with an increase in the mean age at diagnosis. The diagnosis of PAH in more elderly patients has highlighted the need for careful phenotyping of patients and for further studies to understand how best to manage pulmonary hypertension associated with, for example, left heart disease. The breadth and depth of expertise focused on unravelling the molecular pathology of PAH has yielded novel insights, including the role of growth factors, inflammation and metabolic remodelling. The description of the genetic architecture of PAH is accelerating in parallel, with novel variants, such as those reported in potassium two-pore domain channel subfamily K member 3 (KCNK3), adding to the list of more established mutations in genes associated with bone morphogenetic protein receptor type 2 (BMPR2) signalling. These insights have supported a paradigm shift in treatment strategies away from simply addressing the imbalance of vasoactive mediators observed in PAH towards tackling more directly the structural remodelling of the pulmonary vasculature. Here, we summarize the changing clinical and molecular landscape of PAH. We highlight novel drug therapies that are in various stages of clinical development, targeting for example cell proliferation, metabolic, inflammatory/immune and BMPR2 dysfunction, and the challenges around developing these treatments. We argue that advances in the treatment of PAH will come through deep molecular phenotyping with the integration of clinical, genomic, transcriptomic, proteomic and metabolomic information in large populations of patients through international collaboration. This approach provides the best opportunity for identifying key signalling pathways, both as potential drug targets and as biomarkers for patient selection. The expectation is that together these will enable the prioritization of potential therapies in development and the evolution of personalized medicine for PAH.
Collapse
Affiliation(s)
- P Ghataorhe
- Department of Medicine, Imperial College London, London, UK
| | - C J Rhodes
- Department of Medicine, Imperial College London, London, UK
| | - L Harbaum
- Department of Medicine, Imperial College London, London, UK
| | - M Attard
- Department of Medicine, Imperial College London, London, UK
| | - J Wharton
- Department of Medicine, Imperial College London, London, UK
| | - M R Wilkins
- Department of Medicine, Imperial College London, London, UK
| |
Collapse
|
8
|
Lamartina L, Montesano T, Trulli F, Attard M, Torlontano M, Bruno R, Meringolo D, Monzani F, Tumino S, Ronga G, Maranghi M, Biffoni M, Filetti S, Durante C. Papillary thyroid carcinomas with biochemical incomplete or indeterminate responses to initial treatment: repeat stimulated thyroglobulin assay to identify disease-free patients. Endocrine 2016; 54:467-475. [PMID: 26668060 DOI: 10.1007/s12020-015-0823-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 11/26/2015] [Indexed: 02/01/2023]
Abstract
Papillary thyroid cancer (PTC) patients treated with thyroidectomy and radioiodine remnant ablation (RRA) often have detectable TSH-stimulated thyroglobulin (Tg) levels without localizable disease after primary treatment. To assess the value of repeat stimulated Tg assays in these patients' follow-up, we retrospectively analyzed 86 cases followed in 5 Italian thyroid-cancer referral centers. We enrolled 86 patients with PTCs treated with total/near-total thyroidectomy plus RRA between January 1,1990 and January 31, 2006. In all cases, the initial postoperative visit revealed stimulated serum Tg ≥1 ng/mL, negative Tg antibodies, and no structural evidence of disease. None received empiric radioiodine therapy. Follow-up (median: 9.6 years) included neck ultrasound and basal Tg assays (yearly) and at least 1 repeat stimulated Tg assay. Of the 86 patients analyzed (initial risk: low 63 %, intermediate 35 %, high 2 %), one (1 %) had ultrasound-detected lymph node disease and persistently elevated stimulated Tg levels at 3 years. In 17 (20 %), imaging findings were consistently negative, but the final stimulated Tg levels was still >1 ng/mL (median 2.07 ng/mL, range 1.02-4.7). The other 68 (80 %) appeared disease-free (persistently negative imaging findings with stimulated Tg levels ≤1 ng/mL). Mean intervals between first and final stimulated Tg assays were similar (5.2 and 4.8 years) in subgroups with versus without Tg normalization. Reclassification as disease-free was significantly more common when initial stimulated Tg levels were indeterminate (<10 ng/mL). In unselected PTC cohorts with incomplete/indeterminate biochemical responses to thyroidectomy and RRA, periodic remeasurement of stimulated Tg allows most patients to be classified as disease-free.
Collapse
Affiliation(s)
- Livia Lamartina
- Dipartimento di Medicina Interna e Specialità Mediche, Dipartimento di Scienze Chirurgiche, Università di Roma Sapienza, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Teresa Montesano
- Dipartimento di Medicina Interna e Specialità Mediche, Dipartimento di Scienze Chirurgiche, Università di Roma Sapienza, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Fabiana Trulli
- Dipartimento di Medicina Interna e Specialità Mediche, Dipartimento di Scienze Chirurgiche, Università di Roma Sapienza, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Marco Attard
- Unità Operativa di Endocrinologia, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, 90146, Palermo, Italy
| | - Massimo Torlontano
- Unità Operativa di Endocrinologia, Istituto di Ricovero e Cura a Carattere Scientifico, Casa Sollievo della Sofferenza, 71013, San Giovanni Rotondo, Italy
| | - Rocco Bruno
- Unità di Endocrinologia, Ospedale di Tinchi-Pisticci, 75020, Matera, Italy
| | - Domenico Meringolo
- Unità Operativa Semplice Dipartimentale di Endocrinologia, Ospedale di Bentivoglio, 40010, Bologna, Italy
| | - Fabio Monzani
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, 56126, Pisa, Italy
| | - Salvatore Tumino
- Dipartimento di Medicina Clinica e Sperimentale, Università di Catania, 95123, Catania, Italy
| | - Giuseppe Ronga
- Dipartimento di Medicina Interna e Specialità Mediche, Dipartimento di Scienze Chirurgiche, Università di Roma Sapienza, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Marianna Maranghi
- Dipartimento di Medicina Interna e Specialità Mediche, Dipartimento di Scienze Chirurgiche, Università di Roma Sapienza, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Marco Biffoni
- Dipartimento di Medicina Interna e Specialità Mediche, Dipartimento di Scienze Chirurgiche, Università di Roma Sapienza, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Sebastiano Filetti
- Dipartimento di Medicina Interna e Specialità Mediche, Dipartimento di Scienze Chirurgiche, Università di Roma Sapienza, Viale del Policlinico, 155, 00161, Rome, Italy.
| | - Cosimo Durante
- Dipartimento di Medicina Interna e Specialità Mediche, Dipartimento di Scienze Chirurgiche, Università di Roma Sapienza, Viale del Policlinico, 155, 00161, Rome, Italy
| |
Collapse
|
9
|
Scerrino G, Attard M, Lo Piccolo C, Attard A, Melfa GI, Raspanti C, Zarcone M, Bonventre S, Mazzola S, Gulotta G. The coexistence of primary hyperparathyroidism and thyroid nodules: should the preoperative work-up of the parathyroid and the thyroid diseases be specifically adjusted? G Chir 2016; 37:123-129. [PMID: 27734796 DOI: 10.11138/gchir/2016.37.3.123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES Primary hyperparathyroidism (PHPT) can be found in concomitance with thyroid disease (TD) in a high frequency of cases. In this context the diagnostic exams for localizing the enlarged parathyroid(s) gland(s) could be less reliable or nonconclusive. Moreover, the thyroid carcinoma seems to be more frequent compared to that isolated thyroid desease and, therefore, carefully investigated. The main goal of the present study is to evaluate which diagnostic tool (US, MIBI) is more reliable for localizing the site of the PTH hypersecretion and to confirm if it is always advantageous a combination of both exams. Besides, we evaluated the incidence of thyroid carcinoma in our series of patients. PATIENTS AND METHODS A review of available data of 73 patients who underwent total thyroidectomy + parathyroidectomy from 2003 and 2014 was performed. The preoperative workup included systematically US and MIBI whose results were considered true positive when at least the side (left/right) of the parathyroid affected were concordant with the surgical report, settled as the gold standard, according to the Cox nonnested model. The connection between the diagnostic results of US versus MIBI was calculated with the Cohen K index for evaluating their overlap. The average of the thyroid carcinoma were also calculated. RESULTS The difference between respectively US versus surgical report (p value=0.73) and MIBI versus surgical report (p value=0.81) were not significant. The low Cohen K index showed that both US and MIBI are complementary. In 23 patients (32,9%) a thyroid carcinoma was found. CONCLUSIONS The association of MIBI and neck US is mandatory in the first evaluation of patients undergoing thyroidectomy and parathyroid excision simultaneously. The high prevalence of thyroid carcinoma in this specific context suggests a more aggressive diagnostic and surgical behaviour.
Collapse
|
10
|
Malandrino P, Russo M, Ronchi A, Minoia C, Cataldo D, Regalbuto C, Giordano C, Attard M, Squatrito S, Trimarchi F, Vigneri R. Increased thyroid cancer incidence in a basaltic volcanic area is associated with non-anthropogenic pollution and biocontamination. Endocrine 2016; 53:471-9. [PMID: 26438396 DOI: 10.1007/s12020-015-0761-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 09/24/2015] [Indexed: 11/25/2022]
Abstract
The increased thyroid cancer incidence in volcanic areas suggests an environmental effect of volcanic-originated carcinogens. To address this problem, we evaluated environmental pollution and biocontamination in a volcanic area of Sicily with increased thyroid cancer incidence. Thyroid cancer epidemiology was obtained from the Sicilian Regional Registry for Thyroid Cancer. Twenty-seven trace elements were measured by quadrupole mass spectrometry in the drinking water and lichens (to characterize environmental pollution) and in the urine of residents (to identify biocontamination) in the Mt. Etna volcanic area and in adjacent control areas. Thyroid cancer incidence was 18.5 and 9.6/10(5) inhabitants in the volcanic and the control areas, respectively. The increase was exclusively due to the papillary histotype. Compared with control areas, in the volcanic area many trace elements were increased in both drinking water and lichens, indicating both water and atmospheric pollution. Differences were greater for water. Additionally, in the urine of the residents of the volcanic area, the average levels of many trace elements were significantly increased, with values higher two-fold or more than in residents of the control area: cadmium (×2.1), mercury (×2.6), manganese (×3.0), palladium (×9.0), thallium (×2.0), uranium (×2.0), vanadium (×8.0), and tungsten (×2.4). Urine concentrations were significantly correlated with values in water but not in lichens. Our findings reveal a complex non-anthropogenic biocontamination with many trace elements in residents of an active volcanic area where thyroid cancer incidence is increased. The possible carcinogenic effect of these chemicals on the thyroid and other tissues cannot be excluded and should be investigated.
Collapse
Affiliation(s)
- Pasqualino Malandrino
- Endocrinology, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, via Palermo n. 636, 95122, Catania, Italy.
| | - Marco Russo
- Endocrinology, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, via Palermo n. 636, 95122, Catania, Italy
| | - Anna Ronchi
- Laboratory of Experimental and Clinical Toxicology, Toxicology Unit, Pavia Poison Control Center and National Toxicology Information Center, IRCCS Maugeri Foundation, Pavia, Italy
| | - Claudio Minoia
- Laboratory of Experimental and Clinical Toxicology, Toxicology Unit, Pavia Poison Control Center and National Toxicology Information Center, IRCCS Maugeri Foundation, Pavia, Italy
| | - Daniela Cataldo
- Endocrinology, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, via Palermo n. 636, 95122, Catania, Italy
| | - Concetto Regalbuto
- Endocrinology, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, via Palermo n. 636, 95122, Catania, Italy
| | - Carla Giordano
- Endocrinology, Diabetology and Metabolism, Department of Internal and Specialist Biomedicine, University of Palermo, Palermo, Italy
| | - Marco Attard
- Unit of Endocrinology, Ospedali Riuniti Villa Sofia, Cervello Hospital, Palermo, Italy
| | - Sebastiano Squatrito
- Endocrinology, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, via Palermo n. 636, 95122, Catania, Italy
| | - Francesco Trimarchi
- Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Riccardo Vigneri
- Endocrinology, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, via Palermo n. 636, 95122, Catania, Italy
- Humanitas, Catania Oncoloy Center, Catania, Italy
- Institute of Biostructures and Bioimaging, CNR (National Research Council), Catania, Italy
| |
Collapse
|
11
|
Melfa GI, Raspanti C, Attard M, Cocorullo G, Attard A, Mazzola S, Salamone G, Gulotta G, Scerrino G. Comparison of minimally invasive parathyroidectomy under local anaesthesia and minimally invasive video-assisted parathyroidectomy for primary hyperparathyroidism: a cost analysis. G Chir 2016; 37:61-7. [PMID: 27381690 DOI: 10.11138/gchir/2016.37.2.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Primary hyperparathyroidism (PHPT) origins from a solitary adenoma in 70- 95% of cases. Moreover, the advances in methods for localizing an abnormal parathyroid gland made minimally invasive techniques more prominent. This study presents a micro-cost analysis of two parathyroidectomy techniques. PATIENTS AND METHODS 72 consecutive patients who underwent minimally invasive parathyroidectomy, video-assisted (MIVAP, group A, 52 patients) or "open" under local anaesthesia (OMIP, group B, 20 patients) for PHPT were reviewed. Operating room, consumable, anaesthesia, maintenance costs, equipment depreciation and surgeons/anaesthesiologists fees were evaluated. The patient's satisfaction and the rate of conversion to conventional parathyroidectomy were investigated. T-Student's, Kolmogorov-Smirnov tests and Odds Ratio were used for statistical analysis. RESULTS 1 patient of the group A and 2 of the group B were excluded from the cost analysis because of the conversion to the conventional technique. Concerning the remnant patients, the overall average costs were: for Operative Room, 1186,69 € for the MIVAP group (51 patients) and 836,11 € for the OMIP group (p<0,001); for the Team, 122,93 € (group A) and 90,02 € (group B) (p<0,001); the other operative costs were 1388,32 € (group A) and 928,23 € (group B) (p<0,001). The patient's satisfaction was very strongly in favour of the group B (Odds Ratio 20,5 with a 95% confidence interval). CONCLUSIONS MIVAP is more expensive compared to the "open" parathyroidectomy under local anaesthesia due to the costs of general anaesthesia and the longer operative time. Moreover, the patients generally prefer the local anaesthesia. Nevertheless, the rate of conversion to the conventional parathyroidectomy was relevant in the group of the local anaesthesia compared to the MIVAP, since the latter allows a four-gland exploration.
Collapse
|
12
|
Scerrino G, Attard A, Melfa GI, Raspanti C, DI Giovanni S, Attard M, Inviati A, Mazzola S, Modica G, Gulotta G, Bonventre S. Role of prophylactic central neck dissection in cN0-papillary thyroid carcinoma: results from a high-prevalence area. MINERVA CHIR 2016; 71:159-167. [PMID: 26046958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Prophylactic, compartment-oriented central neck dissection (CND) for cN0 papillary thyroid carcinoma (PTC) is not widely practiced. We examined our results with this surgical approach. METHODS A cohort of 158 patients operated on for the classical variant of PTC at a follow-up of 1-22 years (mean: 6.6) were enrolled. The patients with a preoperative diagnosis of cN0 PTC (group A, 59 patients) underwent total thyroidectomy (TT) + CND. In the patients with incidental postoperative diagnosis of malignancy (group B, 99 patients) a TT alone was performed. RESULTS Ninety-six T1, 36 T2, 26 T3/T4 PTC patients were enrolled. The overall biochemical/scintigraphic recurrence rate (15 patients, 9.49%), was significantly higher in group B. Disease-free survival and need for postoperative radioiodine ablative treatment were more favorable in group A (P<0.05; P<0.001, respectively). The median radioiodine ablative treatment in the T2 cluster alone was lower in group A (P<0.001). The morbidity rate was similar in both groups. CONCLUSION Considering the acceptable morbidity, prophylactic CND seems to be advantageous in terms of recurrence rate and need for radioiodine treatment in this variant of PTC, at least in T2 or more advanced stages. The indolent behavior of PTC does not allow for reliable prognostic evaluations.
Collapse
Affiliation(s)
- Gregorio Scerrino
- Unit of General and Emergency Surgery, Department of General, Emergency and Transplant Surgery, P. Giaccone Policlinico, Palermo, Italy -
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Garberoglio R, Aliberti C, Appetecchia M, Attard M, Boccuzzi G, Boraso F, Borretta G, Caruso G, Deandrea M, Freddi M, Gallone G, Gandini G, Gasparri G, Gazzera C, Ghigo E, Grosso M, Limone P, Maccario M, Mansi L, Mormile A, Nasi PG, Orlandi F, Pacchioni D, Pacella CM, Palestini N, Papini E, Pelizzo MR, Piotto A, Rago T, Riganti F, Rosato L, Rossetto R, Scarmozzino A, Spiezia S, Testori O, Valcavi R, Veltri A, Vitti P, Zingrillo M. Radiofrequency ablation for thyroid nodules: which indications? The first Italian opinion statement. J Ultrasound 2015; 18:423-30. [PMID: 26550079 DOI: 10.1007/s40477-015-0169-y] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 03/16/2015] [Indexed: 02/04/2023] Open
Affiliation(s)
- Roberto Garberoglio
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Camillo Aliberti
- Division of Interventional Radiology, IRCCS Istituto Oncologico Veneto, Padua, Italy
| | | | - Marco Attard
- Division of Endocrinology, Cervello Hospital, Palermo, Italy
| | - Giuseppe Boccuzzi
- Oncological Endocrinology Unit, Department of Medical Sciences, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | | | - Giorgio Borretta
- Division of Endocrinology, Diabetes and Metabolism, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Giuseppe Caruso
- Section of Radiological Sciences, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
| | - Maurilio Deandrea
- Division of Endocrinology, Diabetology and Metabolism, Mauriziano Umberto I Hospital, Turin, Italy
| | - Milena Freddi
- Endocrine Surgical Unit, Department of Surgery, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | | | - Giovanni Gandini
- Department of Radiology, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Guido Gasparri
- Endocrine Surgical Unit, Department of Surgery, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Carlo Gazzera
- Department of Radiology, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Ezio Ghigo
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Maurizio Grosso
- Department of Radiology, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Paolo Limone
- Division of Endocrinology, Diabetology and Metabolism, Mauriziano Umberto I Hospital, Turin, Italy
| | - Mauro Maccario
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Luigi Mansi
- Nuclear Medicine Unit, Department Magrassi-Lanzara, Second University of Naples, Naples, Italy
| | - Alberto Mormile
- Division of Endocrinology, Diabetology and Metabolism, Mauriziano Umberto I Hospital, Turin, Italy
| | | | - Fabio Orlandi
- Division of Internal Medicine, Department of Medical Sciences, Gradenigo Hospital, University of Turin, Turin, Italy
| | - Donatella Pacchioni
- Pathology Unit, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | | | - Nicola Palestini
- Endocrine Surgical Unit, Department of Surgery, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Enrico Papini
- Division of Endocrinology, Regina Apostolorum Hospital, Albano Laziale, Rome
| | - Maria Rosa Pelizzo
- Division of Surgical Pathology, Department of Medical and Surgical Sciences, University of Padova, Padua, Italy
| | - Andrea Piotto
- Division of Surgical Pathology, Department of Medical and Surgical Sciences, University of Padova, Padua, Italy
| | - Teresa Rago
- Department of Endocrinology, University of Pisa, Pisa, Italy
| | - Fabrizio Riganti
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Lodovico Rosato
- Endocrine Surgical Unit, Department of Surgery, Ivrea Hospital ASL TO4, School of Medicine, University of Turin, Turin, Italy
| | - Ruth Rossetto
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Antonio Scarmozzino
- Department of Health Management, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Stefano Spiezia
- Department of General and Endocrine Surgery, San Gennaro Hospital, Naples, Italy
| | - Ornella Testori
- Nuclear Medicine Unit, Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Roberto Valcavi
- Endocrinology Unit, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Andrea Veltri
- Department of Radiology, San Luigi Gonzaga Hospital, Orbassano, University of Turin, Turin, Italy
| | - Paolo Vitti
- Department of Endocrinology, University of Pisa, Pisa, Italy
| | | |
Collapse
|
14
|
Durante C, Costante G, Lucisano G, Bruno R, Meringolo D, Paciaroni A, Puxeddu E, Torlontano M, Tumino S, Attard M, Lamartina L, Nicolucci A, Filetti S. The natural history of benign thyroid nodules. JAMA 2015; 313:926-35. [PMID: 25734734 DOI: 10.1001/jama.2015.0956] [Citation(s) in RCA: 253] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Detection of asymptomatic thyroid nodules has increased. Consensus is lacking regarding the optimal follow-up of cytologically proven benign lesions and sonographically nonsuspicious nodules. Current guidelines recommend serial ultrasound examinations and reassessment of cytology if significant growth is observed. OBJECTIVE To determine the frequency, magnitude, and factors associated with changes in thyroid nodule size. DESIGN, SETTING, AND PARTICIPANTS Prospective, multicenter, observational study involving 992 consecutive patients with 1 to 4 asymptomatic, sonographically or cytologically benign thyroid nodules. Patients were recruited from 8 hospital-based thyroid-disease referral centers in Italy between 2006 and 2008. Data collected during the first 5 years of follow-up, through January 2013, were analyzed. MAIN OUTCOMES AND MEASURES Baseline nodule growth (primary end point) was assessed with yearly thyroid ultrasound examinations. Size changes were considered significant for growth if an increase of 20% or more was recorded in at least 2 nodule diameters, with a minimum increase of 2 mm. Baseline factors associated with growth were identified. Secondary end points were the sonographic detection of new nodules and the diagnosis of thyroid cancer during follow-up. RESULTS Nodule growth occurred in 153 patients (15.4% [95% CI, 14.3%-16.5%]). One hundred seventy-four of the 1567 original nodules (11.1% [95% CI, 10.3%-11.9%]) increased in size, with a mean 5-year largest diameter increase of 4.9 mm (95% CI, 4.2-5.5 mm), from 13.2 mm (95% CI, 12.1-14.2 mm) to 18.1 mm (95% CI, 16.7-19.4 mm). Nodule growth was associated with presence of multiple nodules (OR, 2.2 [95% CI 1.4-3.4] for 2 nodules; OR, 3.2 [95% CI, 1.8-5.6 for 3 nodules; and OR, 8.9 [95% CI, 4.4-18.0] for 4 nodules), main nodule volumes larger than 0.2 mL (OR, 2.9 [95% CI, 1.7-4.9] for volumes >0.2 to <1 mL and OR, 3.0 [95% CI, 1.8-5.1] for volumes ≥1 mL), and male sex (OR, 1.7 [95% CI, 1.1-2.6]), whereas an age of 60 years or older was associated with a lower risk of growth than age younger than 45 years (OR, 0.5 [95% CI 0.3-0.9]). In 184 individuals (18.5% [95% CI, 16.4%-20.9%]), nodules shrank spontaneously. Thyroid cancer was diagnosed in 5 original nodules (0.3% [95% CI, 0.0%-0.6%]). Only 2 had grown. An incidental cancer was found at thyroidectomy in a nonvisualized nodule. New nodules developed in 93 patients (9.3% [95% CI, 7.5%-11.1%]), with detection of one cancer. CONCLUSIONS AND RELEVANCE Among patients with asymptomatic, sonographically or cytologically benign thyroid nodules, the majority of nodules exhibited no significant size increase during 5 years of follow-up and thyroid cancer was rare. These findings support consideration of revision of current guideline recommendations for follow-up of asymptomatic thyroid nodules.
Collapse
Affiliation(s)
- Cosimo Durante
- Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma Sapienza, Roma, Italy
| | - Giuseppe Costante
- Dipartimento di Scienze della Salute, Università di Catanzaro Magna Graecia, Catanzaro, Italy
| | - Giuseppe Lucisano
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy10Dipartimento di Scienze Mediche di Base, Neuroscienze ed Organi di Senso, Università di Bari Aldo Moro, Bari, Italy
| | - Rocco Bruno
- Unità di Endocrinologia, Ospedale di Tinchi-Pisticci, Matera, Italy
| | - Domenico Meringolo
- Unità Operativa Semplice Dipartimentale di Endocrinologia, Ospedale di Bentivoglio, Bologna, Italy
| | - Alessandra Paciaroni
- Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma Sapienza, Roma, Italy
| | - Efisio Puxeddu
- Dipartimento di Medicina, Università di Perugia, Perugia, Italy
| | - Massimo Torlontano
- Unità Operativa di Endocrinologia, Istituto di Ricovero e Cura a Carattere Scientifico, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Salvatore Tumino
- Dipartimento di Medicina Clinica e Sperimentale, Università di Catania, Catania, Italy
| | - Marco Attard
- Unità Operativa di Endocrinologia, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Livia Lamartina
- Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma Sapienza, Roma, Italy
| | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Sebastiano Filetti
- Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma Sapienza, Roma, Italy
| |
Collapse
|
15
|
Durante C, Tognini S, Montesano T, Orlandi F, Torlontano M, Puxeddu E, Attard M, Costante G, Tumino S, Meringolo D, Bruno R, Trulli F, Toteda M, Redler A, Ronga G, Filetti S, Monzani F. Clinical aggressiveness and long-term outcome in patients with papillary thyroid cancer and circulating anti-thyroglobulin autoantibodies. Thyroid 2014; 24:1139-45. [PMID: 24702238 PMCID: PMC4080868 DOI: 10.1089/thy.2013.0698] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The association between papillary thyroid cancer (PTC) and Hashimoto's thyroiditis is widely recognized, but less is known about the possible link between circulating anti-thyroglobulin antibody (TgAb) titers and PTC aggressiveness. To shed light on this issue, we retrospectively examined a large series of PTC patients with and without positive TgAb. METHODS Data on 220 TgAb-positive PTC patients (study cohort) were retrospectively collected in 10 hospital-based referral centers. All the patients had undergone near-total thyroidectomy with or without radioiodine remnant ablation. Tumor characteristics and long-term outcomes (follow-up range: 2.5-24.8 years) were compared with those recently reported in 1020 TgAb-negative PTC patients with similar demographic characteristics. We also assessed the impact on clinical outcome of early titer disappearance in the TgAb-positive group. RESULTS At baseline, the study cohort (mean age 45.9 years, range 12.5-84.1 years; 85% female) had a significantly higher prevalence of high-risk patients (6.9% vs. 3.2%, p<0.05) and extrathyroidal tumor extension (28.2% vs. 24%; p<0.0001) than TgAb-negative controls. Study cohort patients were also more likely than controls to have persistent disease at the 1-year visit (13.6% vs. 7.0%, p=0.001) or recurrence during subsequent follow-up (5.8% vs. 1.4%, p=0.0001). At the final follow-up visit, the percentage of patients with either persistent or recurrent disease in the two cohorts was significantly different (6.4% of TgAb-positive patients vs. 1.7% in the TgAb-negative group, p<0.0001). At the 1-year visit, titer normalization was observed in 85 of the 220 TgAb-positive individuals. These patients had a significantly lower rate of persistent disease than those who were still TgAb positive (8.2% vs. 17.3%. p=0.05), and no relapses were observed among patients with no evidence of disease during subsequent follow-up. CONCLUSIONS PTC patients with positive serum TgAb titer during the first year after primary treatment were more likely to have persistent/recurrent disease than those who were consistently TgAb-negative. Negative titers at 1 year may be associated with more favorable outcomes.
Collapse
Affiliation(s)
- Cosimo Durante
- Department of Internal Medicine and Medical Specialties, University of Rome Sapienza, Rome, Italy
| | - Sara Tognini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Teresa Montesano
- Department of Internal Medicine and Medical Specialties, University of Rome Sapienza, Rome, Italy
| | - Fabio Orlandi
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Massimo Torlontano
- Endocrinology Unit, IRCCS, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Efisio Puxeddu
- Department of Internal Medicine, University of Perugia, Perugia, Italy
| | - Marco Attard
- Endocrinology Unit, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Giuseppe Costante
- Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
- Department of Internal Medicine, Institute Jules Bordet, Bruxelles, Belgium
| | - Salvatore Tumino
- Department of Medical and Pediatric Sciences, University of Catania, Catania, Italy
| | | | - Rocco Bruno
- Endocrinology Unit, Tinchi-Pisticci Hospital, Matera, Italy
| | - Fabiana Trulli
- Department of Internal Medicine and Medical Specialties, University of Rome Sapienza, Rome, Italy
| | - Maria Toteda
- Department of Internal Medicine and Medical Specialties, University of Rome Sapienza, Rome, Italy
| | - Adriano Redler
- Department of Surgical Sciences, University of Rome Sapienza, Rome, Italy
| | - Giuseppe Ronga
- Department of Internal Medicine and Medical Specialties, University of Rome Sapienza, Rome, Italy
| | - Sebastiano Filetti
- Department of Internal Medicine and Medical Specialties, University of Rome Sapienza, Rome, Italy
| | - Fabio Monzani
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| |
Collapse
|
16
|
Malandrino P, Pellegriti G, Attard M, Violi MA, Giordano C, Sciacca L, Regalbuto C, Squatrito S, Vigneri R. Papillary thyroid microcarcinomas: a comparative study of the characteristics and risk factors at presentation in two cancer registries. J Clin Endocrinol Metab 2013; 98:1427-34. [PMID: 23482606 DOI: 10.1210/jc.2012-3728] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
CONTEXT Papillary thyroid microcarcinoma (PTMC) is an indolent neoplasia, often asymptomatic and discovered incidentally. Some PTMCs, however, exhibit a more aggressive behavior, frequently recur, and can even cause cancer-related death. OBJECTIVE The aim of this study was to evaluate the prevalence of PTMCs and the associated risk factors at presentation in 2 thyroid cancer registries from areas with different genetic and environmental characteristics. DESIGN AND PATIENTS We conducted a retrospective, observational study of all incident cases of PTMCs recorded over a 5-year period in the Sicilian Regional Registry for Thyroid Cancer (SRRTC) and in the Surveillance Epidemiology and End Results (SEER) US registry. SETTING The study took place at an academic hospital. RESULTS The incidence of PTMCs was much higher in Sicily (1777 PTMC diagnosed in 2002-2006; age-standardized incidence rate for the world population [ASRw] = 5.8 per 100 000) than in the United States (14 423 PTMC in the period 2004-2008; ASRw = 2.9 per 100 000). Within the SRRTC, a significantly higher incidence was observed in the volcanic area (ASRw = 10.4 vs 4.6 in the rest of Sicily). In Sicily, the female to male ratio was higher, and PTMC patients were younger. In both registries, a significant inverse correlation was observed between age and tumor size. Young patients (≤45 y) exhibited a higher frequency of nodal metastases. CONCLUSIONS PTMC incidence is twice as high in Sicily compared with the United States, and within Sicily, the incidence is twice as high in the volcanic area. In young patients, PTMCs are larger at presentation and exhibit more risk factors. In both registries, more than 35% of PTMCs exhibited 2 or more risk factors, suggesting that they may require surgery and follow-up similar to that of larger carcinomas.
Collapse
Affiliation(s)
- Pasqualino Malandrino
- Endocrinology, Department of Clinical and Molecular Biomedicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Durante C, Montesano T, Torlontano M, Attard M, Monzani F, Tumino S, Costante G, Meringolo D, Bruno R, Trulli F, Massa M, Maniglia A, D'Apollo R, Giacomelli L, Ronga G, Filetti S. Papillary thyroid cancer: time course of recurrences during postsurgery surveillance. J Clin Endocrinol Metab 2013; 98:636-42. [PMID: 23293334 DOI: 10.1210/jc.2012-3401] [Citation(s) in RCA: 215] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT The current use of life-long follow-up in patients with papillary thyroid cancer (PTC) is based largely on the study of individuals diagnosed and treated in the latter half of the 20th century when recurrence rates were approximately 20% and relapses detected up to 20-30 years after surgery. Since then, however, diagnosis, treatment, and postoperative monitoring of PTC patients have evolved significantly. OBJECTIVES The objective of the study was to identify times to PTC recurrence and rates by which these relapses occurred in a more recent patient cohort. PATIENTS AND DESIGN We retrospectively analyzed follow-up data for 1020 PTC patients consecutively diagnosed in 1990-2008 in 8 Italian hospital centers for thyroid disease. Patients underwent thyroidectomy, with or without radioiodine ablation of residual thyroid tissue and were followed up with periodic serum thyroglobulin assays and neck sonography. RESULTS At the initial posttreatment (≤ 12 months) examination, 948 patients had no structural/functional evidence of disease. During follow-up (5.1-20.4 years; median 10.4 years), recurrence (cervical lymph nodes, thyroid bed) was diagnosed in 13 (1.4%) of these patients. All relapses occurred 8 or fewer years after treatment (10 within the first 5 years, 6 within the first 3 years). Recurrence was unrelated to the use/omission of postoperative radioiodine ablation. CONCLUSION In PTC patients whose initial treatment produces disease remission (no structural evidence of disease), recurrent disease is rare, and it usually occurs during the early postoperative period. The picture of recurrence timing during the follow-up provides a foundation for the design of more cost-effective surveillance protocols for PTC patients.
Collapse
Affiliation(s)
- Cosimo Durante
- Dipartimento di Medicina Interna e Specialità Medica, Università di Roma Sapienza, V.le del Policlinico, 155, 00161 Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Malandrino P, Scollo C, Marturano I, Russo M, Tavarelli M, Attard M, Richiusa P, Violi MA, Dardanoni G, Vigneri R, Pellegriti G. Descriptive epidemiology of human thyroid cancer: experience from a regional registry and the "volcanic factor". Front Endocrinol (Lausanne) 2013; 4:65. [PMID: 23761783 PMCID: PMC3671345 DOI: 10.3389/fendo.2013.00065] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 05/19/2013] [Indexed: 01/11/2023] Open
Abstract
Thyroid cancer (TC), the most common endocrine tumor, has steadily increased worldwide due to the increase of the papillary histotype. The reasons for this spread have not been established. In addition to more sensitive thyroid nodule screening, the effect of environmental factors cannot be excluded. Because high incidences of TC were found in volcanic areas (Hawaii and Iceland), a volcanic environment may play a role in the pathogenesis of TC. In January 2002, the Regional Register for TC was instituted in Sicily. With a population of approximately five million inhabitants with similar genetic and lifestyle features, the coexistence in Sicily of rural, urban, industrial, moderate-to-low iodine intake, and volcanic areas provides a conducive setting for assessing the environmental influences on the etiology of TC. In Sicily, between 2002 and 2004, 1,950 new cases of TC were identified, with an age-standardized rate (world) ASR(w) = 17.8/10(5) in females and 3.7/10(5) in males and a high female/male ratio (4.3:1.0). The incidence of TC was heterogeneous within Sicily. There were 2.3 times more cases in the Catania province (where most of the inhabitants live in the volcanic area of Mt. Etna): ASR(w) = 31.7/10(5) in females and 6.4/10(5) in males vs. 14.1 in females and 3.0 in males in the rest of Sicily. Multivariate analysis documented that residents in the volcanic area of Mt. Etna had a higher risk of TC, compared to the residents in urban, industrial, and iodine deficient areas of Sicily. An abnormally high concentration of several chemicals was found in the drinking water of the Mt. Etna aquifer, which provides water to most of the residents in the Catania province. Our data suggest that environmental carcinogen(s) of volcanic origin may promote papillary TC. Additional analyses, including cancer biological and molecular features, will allow a better understanding of risk factors and etiopathogenetic mechanisms.
Collapse
Affiliation(s)
- Pasqualino Malandrino
- Endocrinology, Department of Clinical and Molecular Biomedicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy
| | - Claudia Scollo
- Endocrinology, Department of Clinical and Molecular Biomedicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy
| | - Ilenia Marturano
- Endocrinology, Department of Clinical and Molecular Biomedicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy
| | - Marco Russo
- Endocrinology, Department of Clinical and Molecular Biomedicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy
| | - Martina Tavarelli
- Endocrinology, Department of Clinical and Molecular Biomedicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy
| | - Marco Attard
- Endocrinology, “Ospedali Riuniti Villa Sofia – Cervello” Hospital, Palermo, Italy
| | - Pierina Richiusa
- Endocrinology, Diabetology and Metabolism, Department of Internal and Specialistic Biomedicine, University of Palermo, Palermo, Italy
| | - Maria Antonia Violi
- Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Riccardo Vigneri
- Endocrinology, Department of Clinical and Molecular Biomedicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy
| | - Gabriella Pellegriti
- Endocrinology, Department of Clinical and Molecular Biomedicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy
- *Correspondence: Gabriella Pellegriti, Endocrinology Unit, Department of Clinical and Molecular Biomedicine, University of Catania, Garibaldi-Nesima Medical Center, Via Palermo 636, Catania 95122, Italy e-mail:
| |
Collapse
|
19
|
Durante C, Montesano T, Attard M, Torlontano M, Monzani F, Costante G, Meringolo D, Ferdeghini M, Tumino S, Lamartina L, Paciaroni A, Massa M, Giacomelli L, Ronga G, Filetti S. Long-term surveillance of papillary thyroid cancer patients who do not undergo postoperative radioiodine remnant ablation: is there a role for serum thyroglobulin measurement? J Clin Endocrinol Metab 2012; 97:2748-53. [PMID: 22679061 DOI: 10.1210/jc.2012-1123] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
CONTEXT Serum thyroglobulin (Tg) assays are considered fundamental in postoperative surveillance of differentiated thyroid cancer (DTC) patients. However, the postsurgical profile of Tg levels has never been specifically investigated in patients who do not undergo radioiodine remnant ablation (RRA). OBJECTIVES Our objective was to explore the evolution of Tg levels over time in DTC patients treated with total or near-total thyroidectomy without RRA. DESIGN We retrospectively analyzed 290 consecutively diagnosed cases of low-risk (American Thyroid Association criteria) DTC treated with thyroidectomy alone and followed yearly with neck ultrasonography and serum Tg assays. We compared final Tg values in this group and a matched group of 495 RRA-positive patients. Temporal trends of serial Tg levels were also analyzed in 78 of the RRA-negative patients monitored with a high-sensitivity immunoradiometric assay. RESULTS After follow-up of 2.5-22 yr (median 5 yr), final Tg levels were undetectable (<1 ng/ml) in 274 of 290 RRA-negative patients (95%) and 492 of 495 RRA-positive controls (99%). In the subset of 78 RRA-negative patients, undetectable Tg levels (<0.2 ng/ml) were recorded in 60% at the first postoperative evaluation (3-12 months) and in 79% after 5 yr. Tg levels increased in the single patient who experienced disease recurrence during the observation period. CONCLUSION In most RRA-negative patients, postoperative serum Tg values spontaneously drop to undetectable levels within 5-7 yr after thyroidectomy. Thus, in later phases, Tg assays may be a valuable tool for follow-up even in patients who do not undergo RRA.
Collapse
Affiliation(s)
- Cosimo Durante
- Dipartimento di Medicina Interna e Specialità Medica, Università di Roma Sapienza, Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Durante C, Attard M, Torlontano M, Ronga G, Monzani F, Costante G, Ferdeghini M, Tumino S, Meringolo D, Bruno R, De Toma G, Crocetti U, Montesano T, Dardano A, Lamartina L, Maniglia A, Giacomelli L, Filetti S. Identification and optimal postsurgical follow-up of patients with very low-risk papillary thyroid microcarcinomas. J Clin Endocrinol Metab 2010; 95:4882-8. [PMID: 20660054 DOI: 10.1210/jc.2010-0762] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Most papillary thyroid microcarcinomas (PTMCs; ≤ 1 cm diameter) are indolent low-risk tumors, but some cases behave more aggressively. Controversies have thus arisen over the optimum postoperative surveillance of PTMC patients. OBJECTIVES We tested the hypothesis that clinical criteria could be used to identify PTMC patients with very low mortality/recurrence risks and attempted to define the best strategy for their management and long-term surveillance. DESIGN We retrospectively analyzed data from 312 consecutively diagnosed PTMC patients with T1N0M0 stage disease, no family history of thyroid cancer, no history of head-neck irradiation, unifocal PTMC, no extracapsular involvement, and classic papillary histotypes. Additional inclusion criteria were complete follow-up data from surgery to at least 5 yr after diagnosis. All 312 had undergone (near) total thyroidectomy [with radioactive iodine (RAI) remnant ablation in 137 (44%) - RAI group] and were followed up yearly with cervical ultrasonography and serum thyroglobulin, TSH, and thyroglobulin antibody assays. RESULTS During follow-up (5-23 yr, median 6.7 yr), there were no deaths due to thyroid cancer or reoperations. The first (6-12 months after surgery) and last postoperative cervical sonograms were negative in all cases. Final serum thyroglobulin levels were undetectable (<1 ng/ml) in all RAI patients and almost all (93%) of non-RAI patients. CONCLUSION Accurate risk stratification can allow safe follow-up of most PTMC patients with a less intensive, more cost-effective protocol. Cervical ultrasonography is the mainstay of this protocol, and negative findings at the first postoperative examination are highly predictive of positive outcomes.
Collapse
Affiliation(s)
- Cosimo Durante
- Dipartimentos di Scienze Cliniche, Scienze Radiologiche, Dipartimento di Scienze Chirurgiche, and Chirurgia P. Valdoni, Università di Roma Sapienza, Roma, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Pafumi C, Gangarossa G, Lupo A, Randazzo C, Abate G, Rosa I, Palumbo M, Iemmola A, Gulino F, Attard M, Plesca A. Good Practice in Umbilical Cord Blood Collection in Order to Identify Suitable Units Before Cryopreservation. LETT DRUG DES DISCOV 2010. [DOI: 10.2174/157018010790596623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
22
|
Pafumi C, Iraci SM, Abbate G, Clemente CM, La Rosa I, Gulino FA, Iemmola A, Randazzo C, Caldaci L, Teodoro MC, Palumbo MA, Attard M, Ciotta L, Stracquadanio MG, Messina A. Protection of ovarian tissue from radiotherapy. BRATISL MED J 2010; 111:443-448. [PMID: 21033624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Advances researches in the diagnosis and treatment of childhood, adolescent and adult cancer have greatly increased the life expectancy of premenopausal women with cancer. However, one of the serious side effects of these treatments is the risk of damage to fertility. The ovaries are very sensitive to cytotoxic and radiotherapeutic treatment. The only established method of fertility preservation is embryo cryopreservation according to the Ethics Committee of the American Society for Reproductive Medicine (2005), but this option requires the patient to be of pubertal age, have a partner or use donor sperm, and be able to undergo a cycle of ovarian stimulation, which is not possible when the radiotherapy has to be initiated immediately or when stimulation is contraindicated according to the type of cancer. For patients who need immediate radiotherapy, cryopreservation of ovarian tissue is the only possible alternative. This manuscript reports the different techniques of cryopreservation and the results of transplantation of cryopreserved ovarian tissue. The current techniques allow cryopreservation of human ovarian fragments for a long time with good follicular survival rate after thawing. Numerous studies ultimately in this field have demonstrated to improve the survival rate of the oocytes and cryopreserved follicles. Moreover this manuscript includes a case of a 17-year-old girl who had to undergo pelvic irradiation for non-Hodgkin's lymphoma and the laparoscopic treatment to preserve the fertility (Fig. 2, Ref. 47).
Collapse
Affiliation(s)
- C Pafumi
- Department of Obstetrics and Gynaecology, University of Catania, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Pellegriti G, De Vathaire F, Scollo C, Attard M, Giordano C, Arena S, Dardanoni G, Frasca F, Malandrino P, Vermiglio F, Previtera DM, D'Azzò G, Trimarchi F, Vigneri R. Papillary thyroid cancer incidence in the volcanic area of Sicily. J Natl Cancer Inst 2009; 101:1575-83. [PMID: 19893009 DOI: 10.1093/jnci/djp354] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The steadily increasing incidence of thyroid cancer has been attributed mostly to more sensitive thyroid nodule screening. However, various environmental factors, such as those associated with volcanic areas, cannot be excluded as risk factors. We evaluated thyroid cancer incidence in Sicily, which has a homogenous population and a province (Catania) that includes the Mt Etna volcanic area. METHODS In a register-based epidemiological survey, we collected all incident thyroid cancers in Sicily from January 1, 2002, through December 31, 2004. The age-standardized incidence rate for the world population (ASR(w)) was calculated and expressed as the number of thyroid cancer diagnoses per 100 000 residents per year. The association of thyroid cancer incidence rate with sex, age, tumor histotype, and various environmental factors was evaluated by modeling the variation of the ASR(w). All statistical tests were two-sided. RESULTS In 2002-2004, 1950 incident thyroid cancers were identified in Sicily (among women, ASR(w) = 17.8, 95% confidence interval [CI] = 16.9 to 18.7; and among men, ASR(w) = 3.7, 95% CI = 3.3 to 4.1). Although the percentage of thyroid cancers that were microcarcinomas (ie, < or = 10 mm) and ratio of men to women with thyroid cancer were similar in all nine Sicilian provinces, thyroid cancer incidence was statistically significantly higher in the province of Catania (among women, ASR(w) = 31.7, 95% CI = 29.1 to 34.3; and among men, ASR(w) = 6.4, 95% CI = 5.2 to 7.5) than in the rest of Sicily (among women, ASR(w) = 14.1, 95% CI = 13.2 to 15.0; and among men, ASR(w) = 3.0, 95% CI = 2.6 to 3.4) (all P values < .001). Incidence of papillary, but not follicular or medullary, cancers was statistically significantly increased in Catania province, and papillary tumors from patients in Catania more frequently carried the BRAF V600E gene mutation (55 [52%] of 106 tumors) than tumors from patients elsewhere in Sicily (68 [33%] of 205 tumors) (relative risk = 1.7, 95% CI = 1.0 to 2.8, P = .02). Cancer incidence was statistically significantly lower in rural areas than in urban areas of Sicily (P = .003). No association with mild iodine deficiency or industrial installations was found. Levels of many elements (including boron, iron, manganese, and vanadium) in the drinking water of Catania province often exceeded maximum admissible concentrations, in contrast to water in the rest of Sicily. CONCLUSION Residents of Catania province with its volcanic region appear to have a higher incidence of papillary thyroid cancer than elsewhere in Sicily.
Collapse
Affiliation(s)
- Gabriella Pellegriti
- Endocrinology Division, Department of Internal and Specialistic Medicine, University of Catania Medical School, Garibaldi-Nesima Hospital, Catania, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Nucera C, Eeckhoute J, Finn S, Carroll JS, Ligon AH, Priolo C, Fadda G, Toner M, Sheils O, Attard M, Pontecorvi A, Nose V, Loda M, Brown M. FOXA1 Is a Potential Oncogene in Anaplastic Thyroid Carcinoma. Clin Cancer Res 2009; 15:3680-9. [DOI: 10.1158/1078-0432.ccr-08-3155] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
25
|
Crocetti U, Durante C, Attard M, Maniglia A, Tumino S, Bruno R, Bonfitto N, Dicembrino F, Varraso A, Meringolo D, Filetti S, Trischitta V, Torlontano M. Predictive value of recombinant human TSH stimulation and neck ultrasonography in differentiated thyroid cancer patients. Thyroid 2008; 18:1049-53. [PMID: 18816184 DOI: 10.1089/thy.2008.0160] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Serum thyroglobulin (Tg) stimulation by recombinant human TSH (rhTSH), in combination with neck ultrasonography (US), is an important tool in the first follow-up of differentiated epithelial cell thyroid carcinoma (DTC) patients. The objective of this study was to investigate if a second rhTSH stimulation, performed 2-3 years later, is of clinical utility in the follow-up of these patients. METHODS One hundred and one consecutive ambulatory DTC patients were studied. The great majority of them (89/101) were low-risk patients, being stage I or II at tumor node metastasis (TNM) staging classification. All study patients had been treated by surgery and radioiodine ablation, and exhibited, at first rhTSH follow-up, either undetectable Tg (<or=1 ng/mL) (rhTSH1-Tg-, n = 89 patients considered as free of disease) or low Tg (>1-5 ng/mL) (rhTSH1-Tg+, n = 12 patients considered with uncertain prognosis), with no US evidence of residual disease. In all patients, serum Tg measurement after a second rhTSH stimulation and neck US were performed. RESULTS At the second follow-up, all 89 rhTSH1-Tg-patients showed a negative US, and Tg became low positive only in one case, whereas it remained undetectable in the other patients. The overall negative predictive value of rhTSH1-Tg- was, then, 98.9%. Out of the remaining 12 patients (i.e., rhTSH1-Tg+ patients), 2 showed disease persistence/recurrence (with a positive predictive value of rhTSH1-Tg+ of 16.7%) and 6 became Tg-. CONCLUSIONS A second rhTSH stimulation is useless in DTC patients who were rhTSH-Tg and imaging negative at first follow-up, while it is suggested in patients with detectable, although low, rhTSH-Tg levels at first follow-up: in the absence of clinical or US evidence of disease persistence, these patients should not be retreated by radioiodine, but simply scheduled for a later rhTSH stimulation.
Collapse
Affiliation(s)
- Umberto Crocetti
- Unit of Endocrinology, Scientific Institute Casa Sollievo della Sofferenza, S Giovanni Rotondo, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Gebbia V, Di Gregorio C, Attard M. Thyroglossal duct cyst carcinoma with concurrent thyroid carcinoma: a case report. J Med Case Rep 2008; 2:132. [PMID: 18445281 PMCID: PMC2387158 DOI: 10.1186/1752-1947-2-132] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2007] [Accepted: 04/29/2008] [Indexed: 11/22/2022] Open
Abstract
Introduction Thyroglossal duct carcinoma is a very rare finding and its presentation is similar to that of a benign cyst, which is a relatively common developmental abnormality that may manifest as a midline, neck mass. In general the diagnosis of thyroglossal duct carcinoma is based on the pathologic examination of the mass, but needle aspiration cytology, ultrasound and computed tomography play a role in the differential diagnosis of malignancy. Case presentation A further case of thyroglossal duct carcinoma and concurrent thyroid carcinoma with locoregional lymph node metastases affecting a 40-year-old woman followed up for 4 years is presented and discussed. Conclusion Sistrunk's surgical technique must always be the initial treatment, but in case of carcinoma further surgery, that is, thyroidectomy with or without lymph node dissection, and treatment with radioactive iodine have to be considered according to the microscopic and clinical findings. Accurate pre-operative clinical and radiological evaluation should be performed in order to plan surgical strategy.
Collapse
Affiliation(s)
- Vittorio Gebbia
- Department of Experimental Oncology and Clinical Applications, University of Palermo, Italy.
| | | | | |
Collapse
|
27
|
Frasca F, Nucera C, Pellegriti G, Gangemi P, Attard M, Stella M, Loda M, Vella V, Giordano C, Trimarchi F, Mazzon E, Belfiore A, Vigneri R. BRAF(V600E) mutation and the biology of papillary thyroid cancer. Endocr Relat Cancer 2008; 15:191-205. [PMID: 18310287 DOI: 10.1677/erc-07-0212] [Citation(s) in RCA: 180] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BRAF((V600E)) mutation is the most frequent genetic alteration in papillary thyroid carcinomas (PTCs) that are 80-90% of all thyroid cancers. We evaluated the relationship between BRAF((V600E)) and tumor, host, and environmental factors in PTCs from all geographical areas of Sicily. By PCR, BRAF((V600E)) was investigated in a series of 323 PTCs diagnosed in 2002-2005. The correlation between clinicopathological tumor, host, and environmental characteristics and the presence of BRAF((V600E)) were evaluated by both univariate and multivariate analyses. BRAF((V600E)) was found in 38.6% PTCs, with a 52% frequency in the classical PTCs and 26.4% in the tall cell variant. Univariate analysis indicated that BRAF((V600E)) was associated with greater tumor size (P=0.0048), extra-thyroid invasion (P<0.0001), and cervical lymph nodal metastases (P=0.0001). Multivariate logistic regression analysis confirmed that BRAF((V600E)) was an independent predictor of extra-thyroid invasion (P=0.0001) and cervical lymph nodal metastasis (P=0.0005). The association between BRAF((V600E)) and extra-thyroid invasion was also found in micro-PTCs (P=0.006). In 60 classical PTCs, BRAF((V600E)) was positively correlated with matrix metalloproteinase-9 expression (P=0.0047), suggesting a possible mechanism for BRAF((V600E)) effect on PTC invasiveness. No association was found between BRAF((V600E)) and patient age, gender, or iodine intake. In contrast, a strong association was found with residency in Eastern Sicily (P<0.0001 compared with Western Sicily). These results indicate that BRAF((V600E)) mutation is a marker of aggressive disease in both micro- and macro-PTCs. Moreover, for the first time, a possible link between BRAF((V600E)) mutation and environmental carcinogens is suggested.
Collapse
Affiliation(s)
- F Frasca
- Endocrinologia, Dipartimento di Medicina Interna e Medicina Specialistica, University of Catania, PO Garibaldi Nesima, Via Palermo 636, Catania, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Montesano T, Durante C, Attard M, Crocetti U, Meringolo D, Bruno R, Tumino S, Rubello D, Al-Nahhas A, Colandrea M, Maranghi M, Travascio L, Ronga G, Torlontano M. Age influences TSH serum levels after withdrawal of l-thyroxine or rhTSH stimulation in patients affected by differentiated thyroid cancer. Biomed Pharmacother 2007; 61:468-71. [PMID: 17553654 DOI: 10.1016/j.biopha.2007.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Accepted: 04/20/2007] [Indexed: 10/23/2022] Open
Abstract
Recombinant human TSH (rhTSH) has been recently suggested for radioiodine ablation in patients with differentiated thyroid cancer (DTC). To date, studies are still not available about the effectiveness of rhTSH stimulation depending on the age, since serum TSH clearance may be different in younger and in older patients. The aim of this study was to investigate the influence of age to serum TSH levels after rhTSH stimulation and thyroid hormone withdrawal (THW). We retrospectively evaluated two groups of consecutive DTC patients: group 1 (311 patients, age 49.0+/-13.6 years, ranging 15-86) underwent rhTSH stimulation 6-12 months after thyroid ablation (rhTSH-group); group 2 (84 patients, age 46.9+/-13.5 years, ranging 20-77) was followed by THW (THW-group). The influence of age, gender, body mass index and body surface area to serum TSH levels were evaluated in both groups. RhTSH-group: on day 5 (d5), TSH levels were 32.7+/-21.4 microU/ml (range 0.8-136.6). By univariate analysis, d5-TSH was positively related to age (r=0.27, p=0.0001) and no correlations were found with the other parameters. At multivariate analysis, both age and gender (female) were independently associated with d5-TSH levels. THW-group: after thyroid hormone withdrawal, TSH levels were 71.1+/-36.4 microU/ml (range 8.5-200). At univariate analysis, only age was significantly and negatively related to serum TSH levels (r=-0.31, p=0.004). Our data indicate that age and gender seem to positively influence serum TSH levels after rhTSH stimulation. An opposite effect of age on serum TSH levels has been observed after THW. Therapeutic implications ((131)I-treatment) of these findings have to be better investigated in prospective studies.
Collapse
Affiliation(s)
- Teresa Montesano
- Dipartimento di Scienze Cliniche, Università "La Sapienza", Viale del Policlinico, 155, 00161 Roma, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Costante G, Meringolo D, Durante C, Bianchi D, Nocera M, Tumino S, Crocetti U, Attard M, Maranghi M, Torlontano M, Filetti S. Predictive value of serum calcitonin levels for preoperative diagnosis of medullary thyroid carcinoma in a cohort of 5817 consecutive patients with thyroid nodules. J Clin Endocrinol Metab 2007; 92:450-5. [PMID: 17119000 DOI: 10.1210/jc.2006-1590] [Citation(s) in RCA: 196] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
CONTEXT Routine serum calcitonin (CT) measurement in patients with thyroid nodules for diagnosis of medullary thyroid carcinoma (MTC) is controversial. OBJECTIVE The objective of this study was to evaluate the diagnostic accuracy of systematic CT measurement in non-multiple endocrine neoplasia type 2 patients with nodular thyroid disease. SETTINGS This study was conducted at a national healthcare system hospital (outpatient and inpatient sectors). SUBJECTS Consecutive patients with nodular thyroid disease (n = 5817) were studied. MAIN OUTCOME MEASURES Serum CT levels were measured under basal conditions, and when basal values were more than or equal to 20 and less than 100 pg/ml, testing was repeated after pentagastrin stimulation. Basal or stimulated levels more than 100 pg/ml were indication for surgery. RESULTS Fifteen cases of MTC and seven of C cell hyperplasia (CCH) were identified. MTCs were diagnosed in all patients with basal CT more than 100 pg/ml. The four patients with basal CT more than or equal to 50 and less than 100 pg/ml included two diagnosed with MTC and two with CCH. In 10 patients with basal levels more than or equal to 20 and less than 50 pg/ml, histology confirmed the presence of MTC in four, four others had CCH, and the remaining two were negative for thyroid malignancy. Positive predictive values for basal CT levels in the preoperative diagnosis of MTC were: 23.1% for values more than or equal to 20 pg/ml, 100% for values more than 100 pg/ml, 25% for levels more than or equal to 50 and less than 100 pg/ml, and 8.3% for values more than or equal to 20 and less than 50 pg/ml. Positive predictive values for the pentagastrin test (>100 pg/ml) were 40% in the entire series. CONCLUSIONS CT screening of thyroid nodules is a highly sensitive test for early diagnosis of MTC, but confirmatory stimulation testing is necessary in most cases to identify true positive increases.
Collapse
Affiliation(s)
- Giuseppe Costante
- Dipartimento di Medicina Sperimentale e Clinica, Università Magna Graecia, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Bartolotta TV, Midiri M, Galia M, Runza G, Attard M, Savoia G, Lagalla R, Cardinale AE. Qualitative and quantitative evaluation of solitary thyroid nodules with contrast-enhanced ultrasound: initial results. Eur Radiol 2006; 16:2234-41. [PMID: 16670868 DOI: 10.1007/s00330-006-0229-y] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2005] [Revised: 01/23/2006] [Accepted: 02/24/2006] [Indexed: 12/27/2022]
Abstract
To assess the feasibility of contrast-enhanced ultrasound (CEUS) of the thyroid gland and to evaluate the potential of this method for characterising solitary thyroid nodules.18 patients affected by solitary thyroid nodules (size range: 0.6 to 3.6 cm; mean: 1.8 cm) confirmed by surgery (nine papillary carcinomas, four follicular carcinomas, three hyperplasias, one follicular adenoma and one Plummer's adenoma) underwent pulse inversion US at low M.I. (0.06 to 0.08) after i.v. injection of a 2.4-mL bolus of SonoVue. Baseline echogenicity and the dynamic enhancement pattern of each nodule, in comparison with adjacent thyroid parenchyma, were assessed. Signal intensity values on grey-scale images were also calculated at baseline, 30 s, 60 s and 120 s after SonoVue administration. Following administration of SonoVue, malignant nodules showed absent (4 out of 13), faint dotted (4 out of 13) and diffuse (5 out of 13) contrast enhancement, in this last case inhomogeneous (4 out of 5 cases) or homogeneous (1 out of 5). Benign nodules showed diffuse contrast enhancement, both homogeneous (3 out of 5) and heterogeneous (2 out of 5). Quantitative data have confirmed subjective findings, but CEUS never modified precontrast analysis. CEUS of thyroid gland is a feasible technique, but overlapping findings seem to limit the potential of this technique in the characterization of thyroid nodules.
Collapse
|
31
|
Torlontano M, Attard M, Crocetti U, Tumino S, Bruno R, Costante G, D'Azzò G, Meringolo D, Ferretti E, Sacco R, Arturi F, Filetti S. Follow-up of low risk patients with papillary thyroid cancer: role of neck ultrasonography in detecting lymph node metastases. J Clin Endocrinol Metab 2004; 89:3402-7. [PMID: 15240622 DOI: 10.1210/jc.2003-031521] [Citation(s) in RCA: 182] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Persistent or recurrent disease is rare in low risk patients with papillary thyroid cancer, and follow-up of these patients is a matter of debate. Neck ultrasonography (US), serum thyroglobulin (Tg), and whole body scan (WBS) after T(4) withdrawal were performed in 456 patients, followed up to 5 yr. At the end of the first year, 335 patients were Tg negative, and 121 were Tg positive; 65 of 96 patients with Tg levels between 1 and 10 ng/ml became spontaneously Tg negative after 2 yr. During follow-up, WBS discovered node metastases in 13 subjects, and US discovered node metastases in 38 subjects (31 Tg positive and 7 Tg negative). WBS did not add any information, because all WBS-positive patients were also US and Tg positive. Fifty percent of metastases were less than 1 cm and not palpable. Finally, the negative predictive value of both negative Tg and US at first follow-up was 98.8%. We suggest a first follow-up based upon US assessment and stimulated (after T(4) withdrawal or recombinant human TSH) serum Tg determination; subsequently, 1) US should not be mandatory at each examination in initially Tg- and US-negative subjects, but is strongly suggested in all other cases; 2) Tg determination should be repeated 1 yr later, after exogenous or endogenous TSH stimulation only in initially Tg-positive patients without any other evidence of residual disease; and 3) Tg measurement during therapy should be sufficient in all other cases.
Collapse
Affiliation(s)
- Massimo Torlontano
- Unit of Endocrinology, Scientific Institute Casa Sollievo della Sofferanza, 71013 S. Giovanni Rotondo, Foggia, Italy
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Pellegriti G, Scollo C, Regalbuto C, Attard M, Marozzi P, Vermiglio F, Violi MA, Cianci M, Vigneri R, Pezzino V, Squatrito S. The diagnostic use of the rhTSH/thyroglobulin test in differentiated thyroid cancer patients with persistent disease and low thyroglobulin levels. Clin Endocrinol (Oxf) 2003; 58:556-61. [PMID: 12699436 DOI: 10.1046/j.1365-2265.2003.01744.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Serum thyroglobulin (Tg) measurement after TSH stimulation, by either thyroid hormone withdrawal or recombinant human TSH (rhTSH) administration, is the most sensitive method for early detection of patients with persistent or recurrent differentiated thyroid cancer (DTC) after total thyroidectomy and 131I ablation. The use of rhTSH is now increasing because it avoids thyroid hormone suppressive therapy (THST) withdrawal and the consequent symptoms of severe hypothyroidism. Current guidelines suggest measurement of serum Tg 4 days after starting a 2-day course of rhTSH injections, and assumes that Tg reaches maximum serum levels at that time. OBJECTIVE The present study was carried out to evaluate the accuracy of rhTSH/thyroglobulin test in DTC patients with persistent disease and low thyroglobulin levels. PATIENTS AND MEASUREMENTS A series of 13 DTC patients was selected because they had proven persistent disease associated with low Tg levels (< 2.0 micro g/l) under l-thyroxine treatment. In all of them, serum Tg was > 5.0 micro g/l at the last THST withdrawal. We measured serum Tg and TSH levels on days 0.5, 1, 1.5, 2, 4, 7, 10 and 15 after the first of a 2-day course of intramuscular rhTSH injections. RESULTS Serum Tg values were variable in terms of both peak and time-course. Detectable serum Tg levels were recorded on day 4 in all patients. However, among these 13 patients, the peak Tg value was reached earlier than day 4 in three patients and later in two others. In one patient, Tg level at day 2 was higher (3.0 micro g/l) than at day 4 (1.8 micro g/l). In six of the 13 patients studied we compared Tg values after rhTSH to those subsequently obtained after THST withdrawal: in five of them Tg values were two to three times higher after the latter stimulation. Serum Tg value variability after rhTSH was partially accounted for by variability of serum TSH levels, which were inversely related to patient body surface. CONCLUSIONS In DTC patients with persistent disease and low Tg levels, optimization of the diagnostic use of Tg measurement after rhTSH may require rhTSH dose adjustment to the patient body surface area and repeated blood sampling, in order to improve diagnostic accuracy. In these patients not even a TSH-stimulated serum Tg cut-off of 2.0 micro g/l on day 4 provides 100% accuracy, whereas a cut-off of 1.0 micro g/l seems more appropriate. Therefore, in this subset of patients, if any detectable Tg level >or= 1.0 micro g/l is found after rhTSH, re-evaluation after THST should be advised.
Collapse
MESH Headings
- Adult
- Biomarkers, Tumor/blood
- Carcinoma, Papillary/blood
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/therapy
- Carcinoma, Papillary, Follicular/blood
- Carcinoma, Papillary, Follicular/diagnosis
- Carcinoma, Papillary, Follicular/therapy
- Female
- Humans
- Male
- Middle Aged
- Neoplasm, Residual
- Recombinant Proteins/blood
- Thyroglobulin/blood
- Thyroid Function Tests/methods
- Thyroid Hormones/therapeutic use
- Thyroid Neoplasms/blood
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/therapy
- Thyroidectomy
- Thyrotropin/blood
- Whole-Body Counting
Collapse
Affiliation(s)
- Gabriella Pellegriti
- Dipartimento di Medicina Interna e Medicina Specialistica, University of Catania Medical School, Catania, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Ruggeri RM, Villari D, Simone A, Scarfi R, Attard M, Orlandi F, Barresi G, Trimarchi F, Trovato M, Benvenga S. Co-expression of interleukin-6 (IL-6) and interleukin-6 receptor (IL-6R) in thyroid nodules is associated with co-expression of CD30 ligand/CD30 receptor. J Endocrinol Invest 2002; 25:959-66. [PMID: 12553555 DOI: 10.1007/bf03344068] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Data on the expression of interleukin 6 (IL-6)/interleukin 6 receptor (IL-6R) in thyroid nodules is scarce. Based on our recent data of CD30 ligand (CD30L)/CD30 receptor (CD30) in these nodules and on the knowledge that this signal stimulates IL-6 production in non-thyroid neoplasms, we wanted to evaluate the immunocytochemical expression of these 2 ligand/receptor systems in a large archival series of paraffin-embedded specimens. These specimens included 6 normal thyroids and 130 thyroid nodules. Co-expression of IL-6 and IL-6R in the epithelial (follicular) cells was observed solely in CD30L/CD30 positive nodules: 5/15 (33%) oncocytic adenomas; 6/30 (20%) follicular adenomas which belonged to 2 variants (4/4 microfollicular toxic and 2/2 hyalinizing trabecular); 9/30 (30%) papillary thyroid cancers (PTC), all belonging to the conventional variant. In PTC the proportion of tumor epithelial cells that were IL6 positive was inversely correlated with the pTNM staging (r=-0.549, p=0.01). All 15 follicular cancers (FTC), all 6 anaplastic cancers (ATC) were IL-6/lL-6R negative; 14/15 FTC and 5/6 ATC were CD30L/CD30 negative. In another oncocytic adenoma, another 4 conventional PTC and another 7 non-conventional PTC CD30L/CD30 expression was associated to expression of IL-6 only. IL-6 staining associated to absent expression of CD30L and CD30 was observed in 7 follicular adenomas (all belonging to variants different from toxic and hyalinizing trabecular), 2 oncocytic adenomas, 5 of the 30 colloid nodules and 2 normal thyroids. Of the 6 tumors arising from the parafollicular C cells (medullary thyroid cancer, MTC), all 3 that had metastasized were CD30L/CD30/IL-6 positive and IL-6R negative; only IL-6 expression was lost in both the local and distant metastases. This finding matched the loss of IL-6 expression in one PTC metastasis. All 3 non-metastasized MTC were IL-6/IL-6R negative, and 1/3 was CD30L positive/CD30 negative. We conclude that only in a subset of both benign and malignant thyroid nodules the IL-6/IL-6R signal could be induced by the CD30L/CD30. IL-6 expression is related with aggressiveness in both PTC and MTC. In the normal thyroid tissue, colloid nodules, and another subset of benign and malignant thyroid nodules, IL-6 expression is under control of signals other than CD30L/CD30.
Collapse
Affiliation(s)
- R M Ruggeri
- Section of Endocrinology, Clinical/Experimental Department of Medicine and Pharmacology, University of Messina School of Medicine, Messina, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Attard M, Marozzi P, Gambino L, Janní F, Salice P, Ficola U, Giuffrida D. False-positive results of an iodine-131 whole-body scan caused by an ectopic kidney. Clin Nucl Med 2001; 26:271-3. [PMID: 11245137 DOI: 10.1097/00003072-200103000-00031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- M Attard
- Division of Endocrinology, V. Cervello Hospital, Palermo, Italy
| | | | | | | | | | | | | |
Collapse
|
35
|
Giuffrida D, Attard M, Marasà L, Ferraù F, Marletta F, Restuccia N, Gambino L, Janni F, Failla G. Thyroid carcinosarcoma, a rare and aggressive histotype: a case report. Ann Oncol 2000; 11:1497-9. [PMID: 11142492 DOI: 10.1023/a:1026538410510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Thyroid carcinosarcoma is a rare and aggressive thyroid tumor. Histological examination of a tumor showed the characteristic of epithelial carcinoma and mesenchymal differentiation. We retrospectively analyzed the course of the patient and reviewed the literature in which only 19 other cases are described. Carcinosarcoma of the thyroid is a very aggressive tumor with a clinical course similar to anaplastic thyroid carcinoma. Survival is very short despite aggressive multimodal treatment.
Collapse
Affiliation(s)
- D Giuffrida
- Department of Oncology, Ospedale S. Luigi-S. Currò, Catania, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Caruso G, Attard M, Caronia A, Lagalla R. Color Doppler measurement of blood flow in the inferior thyroid artery in patients with autoimmune thyroid diseases. Eur J Radiol 2000; 36:5-10. [PMID: 10996751 DOI: 10.1016/s0720-048x(00)00147-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of the study is to find out whether the measurement of peak systolic velocity in the inferior thyroid artery (ITA) is a valuable parameter to differentiate autoimmune thyroid diseases (hyper-, normo- or hypofunctional) and to evaluate the efficacy of medical treatment. MATERIAL AND METHODS The ITA of 31 patients (eight with Graves' disease, 23 with subclinical hypothyroidism) was examined with color Doppler and pulsed Doppler. The final diagnosis was obtained by cytology and by hormonal and antibodies assays. The patients were monitorized by ultrasound for a period of 8 months. RESULTS In all the patients with Graves' disease the peak systolic velocity was always over 150 cm/s, while in other autoimmune thyroiditis the peak systolic velocity was within the normal range, and never exceeding 65 cm/s. In the first group, the measurement taken in the ITA showed also the efficacy of the pharmacological treatment earlier and more reliably than the color Doppler pattern obtained in the parenchyma. CONCLUSIONS The color Doppler measurement of the ITA seems to be a promising technique with low-cost and easy approach. In our experience, the color Doppler of the ITA could have a clinical role in the differential diagnosis of diffuse thyroid diseases and in the follow-up of the Graves' disease during medical treatment.
Collapse
Affiliation(s)
- G Caruso
- Department of Radiology, University 'P. Giaccone', Palermo, Italy
| | | | | | | |
Collapse
|
37
|
Attard M, Jean G, Forestier L, Cherqui S, van't Hoff W, Broyer M, Antignac C, Town M. Severity of phenotype in cystinosis varies with mutations in the CTNS gene: predicted effect on the model of cystinosin. Hum Mol Genet 1999; 8:2507-14. [PMID: 10556299 DOI: 10.1093/hmg/8.13.2507] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Infantile nephropathic cystinosis is a rare, autosomal recessive disease caused by a defect in the transport of cystine across the lysosomal membrane and characterized by early onset of renal proximal tubular dysfunction. Late-onset cystinosis, a rarer form of the disorder, is characterized by onset of symptoms between 12 and 15 years of age. We previously characterized the cystinosis gene, CTNS, and identified pathogenic mutations in patients with infantile nephropathic cystinosis, including a common, approximately 65 kb deletion which encompasses exons 1-10. Structure predictions suggested that the gene product, cystinosin, is a novel integral lysosomal membrane protein. We now examine the predicted effect of mutations on this model of cystinosin. In this study, we screened patients with infantile nephropathic cystinosis, those with late-onset cystinosis and patients whose phenotype does not fit the classical definitions. We found 23 different mutations in CTNS; 14 are novel mutations. Out of 25 patients with infantile nephropathic cystinosis, 12 have two severely truncating mutations, which is consistent with a loss of functional protein, and 13 have missense or in-frame deletions, which would result in disruption of transmembrane domains and loss of protein function. Mutations found in two late-onset patients affect functionally unimportant regions of cystinosin, which accounts for their milder phenotype. For three patients, the age of onset of cystinosis was <7 years but the course of the disease was milder than the infantile nephropathic form. This suggests that the missense mutations found in these individuals allow production of functional protein and may also indicate regions of cystinosin which are not functionally important.
Collapse
Affiliation(s)
- M Attard
- Nephrourology Unit, Institute of Child Health, University College London Medical School, 30 Guilford Street, London WC1N 1EH, UK
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Forestier L, Jean G, Attard M, Cherqui S, Lewis C, van't Hoff W, Broyer M, Town M, Antignac C. Molecular characterization of CTNS deletions in nephropathic cystinosis: development of a PCR-based detection assay. Am J Hum Genet 1999; 65:353-9. [PMID: 10417278 PMCID: PMC1377934 DOI: 10.1086/302509] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Nephropathic cystinosis is an autosomal recessive disorder that is characterized by accumulation of intralysosomal cystine and is caused by a defect in the transport of cystine across the lysosomal membrane. Using a positional cloning strategy, we recently cloned the causative gene, CTNS, and identified pathogenic mutations, including deletions, that span the cystinosis locus. Two types of deletions were detected-one of 9.5-16 kb, which was seen in a single family, and one of approximately 65 kb, which is the most frequent mutation found in the homozygous state in nearly one-third of cystinotic individuals. We present here characterization of the deletion breakpoints and demonstrate that, although both deletions occur in regions of repetitive sequences, they are the result of nonhomologous recombination. This type of mechanism suggests that the approximately 65-kb deletion is not a recurrent mutation, and our results confirm that it is identical in all patients. Haplotype analysis shows that this large deletion is due to a founder effect that occurred in a white individual and that probably arose in the middle of the first millenium. We also describe a rapid PCR-based assay that will accurately detect both homozygous and heterozygous deletions, and we use it to show that the approximately 65-kb deletion is present in either the homozygous or the heterozygous state in 76% of cystinotic patients of European origin.
Collapse
Affiliation(s)
- L Forestier
- INSERM U423, Tour Lavoisier 6e étage, Hôpital Necker-Enfants Malades 149, Paris, France
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Giordano A, Marozzi P, Meduri G, Ficola U, Calcagni ML, Vaccaro A, Rubini G, Attard M, Li Puma M, Ricci R, Corsello S. Quantitative comparison of technetium-99m tetrofosmin and thallium-201 images of the thyroid and abnormal parathyroid glands. Eur J Nucl Med 1999; 26:907-11. [PMID: 10436206 DOI: 10.1007/s002590050467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of the study was to quantitatively compare the scintigraphic images of the thyroid and abnormal parathyroid glands obtained with technetium-99m tetrofosmin and thallium-201 in patients with hyperparathyroidism. Forty-six patients with hyperparathyroidism underwent (201)Tl (74 MBq), (99m)Tc-pertechnetate (74 MBq) and (99m)Tc-tetrofosmin (555-740 MBq) scintigraphy in a single session. Image analysis included the computation of the thyroid/background ratio in the whole study population and the parathyroid/background ratio, parathyroid/thyroid ratio and diagnostic sensitivity in 17 patients who underwent parathyroid surgery. The pertechnetate subtraction technique was used. (201)Tl and (99m)Tc-tetrofosmin showed a similar thyroid/background ratio (1.79+/-0.41 and 1.81+/-0. 47, respectively, P=NS); however, (99m)Tc-tetrofosmin showed a higher parathyroid/background ratio than (201)Tl (2.06+/-0.54 vs 1. 79+/- 0.50, P=0.007). Despite the superior quality of (99m)Tc-tetrofosmin images, both tracers showed identical sensitivity in detecting enlarged parathyroid glands in patients with primary hyperparathyroidism (89%) and in those with secondary hyperparathyroidism (50%).
Collapse
Affiliation(s)
- A Giordano
- Catholic University of the Sacred Heart, Department of Nuclear Medicine, Largo A. Gemelli 8, I-00168 Roma, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Chiefari E, Russo D, Giuffrida D, Zampa GA, Meringolo D, Arturi F, Chiodini I, Bianchi D, Attard M, Trischitta V, Bruno R, Giannasio P, Pontecorvi A, Filetti S. Analysis of RET proto-oncogene abnormalities in patients with MEN 2A, MEN 2B, familial or sporadic medullary thyroid carcinoma. J Endocrinol Invest 1998; 21:358-64. [PMID: 9699127 DOI: 10.1007/bf03350771] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Medullary thyroid carcinoma (MTC) may occur either as a sporadic or familial (FMTC) disease. Multiple endocrine neoplasia (MEN) type 2, inherited as an autosomal dominant disease, is characterized by coexistence of MTC with other endocrine neoplasia. Activating mutations of the RET proto-oncogene, involving the somatic or the germinal cell lineage, are found in both inherited and acquired forms. In this study, RET mutations were screened in 47 individuals either affected by MTC or belonging to families with hereditary MTC. Exons 10, 11, 13, 14, 15 and 16 of the RET gene were amplified by polymerase chain reaction and examined by DNA sequence and/or restriction enzyme analysis to detect mutations in purified amplicons. Six MEN 2A families with a germline mutation at codon 634, one FMTC family carrying a mutation at codon 618 and two MEN 2B families with a mutation at codon 918 were identified. In affected members of a MEN 2A family no known RET mutations were observed. Besides, we identified a germline mutation in a patient with apparently sporadic MTC and in two out of three sons, indicating the presence of a sporadic misclassified familial disease. In all of the families examined we were able to distinguish the affected vs unaffected (not at risk) members. A somatic mutation of codon 918 was detected in three out of ten patients with apparently sporadic MTC.
Collapse
Affiliation(s)
- E Chiefari
- Dipartimento di Medicina Sperimentale e Clinica, Facoltà di Farmacia, Università di Catanzaro, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Dode L, De Greef C, Mountian I, Attard M, Town MM, Casteels R, Wuytack F. Structure of the human sarco/endoplasmic reticulum Ca2+-ATPase 3 gene. Promoter analysis and alternative splicing of the SERCA3 pre-mRNA. J Biol Chem 1998; 273:13982-94. [PMID: 9593748 DOI: 10.1074/jbc.273.22.13982] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Human chromosome 17-specific genomic clones extending over 90 kilobases (kb) of DNA and coding for sarco/endoplasmic reticulum Ca2+-ATPase 3 (SERCA3) were isolated. The presence of the D17S1828 genetic marker in the cosmid contig enabled us to map the SERCA3 gene (ATP2A3) 11 centimorgans from the top of the short arm p of chromosome 17, in the vicinity of the cystinosis gene locus. The SERCA3 gene contains 22 exons spread over 50 kb of genomic DNA. The exon/intron boundaries are well conserved between human SERCA3 and SERCA1 genes, except for the junction between exons 8 and 9 which is found in the SERCA1 gene but not in SERCA3 and SERCA2 genes. The transcription start site (+1) is located 152 nucleotides (nt) upstream of the AUG codon. The 5'-flanking region, including exon 1, is embedded in a 1.5-kb CpG island and is characterized by the absence of a TATA box and by the presence of 14 putative Sp1 sites, 11 CACCC boxes, 5 AP-2-binding motifs, 3 GGCTGGGG motifs, 3 CANNTG boxes, a GATA motif, as well as single sites for Ets-1, c-Myc, and TFIIIc. Functional promoter analysis indicated that the GC-rich region (87% G + C) from -135 to -31 is of critical importance in initiating SERCA3 gene transcription in Jurkat cells. Exon 21 (human, 101 base pairs; mouse, 86 base pairs) can be alternatively excluded, partially included, or totally included, thus generating, respectively, SERCA3a (human and mouse, 999 amino acids (aa)), SERCA3b (human, 1043 aa; mouse, 1038 aa), or SERCA3c (human, 1024 aa; mouse, 1021 aa) isoforms with different C termini. Expression of the mouse SERCA3 isoforms in COS-1 cells demonstrated their ability to function as active pumps, although with different apparent affinities for Ca2+.
Collapse
Affiliation(s)
- L Dode
- Laboratorium voor Fysiologie, Katholieke Universiteit Leuven, Campus Gasthuisberg, Herestraat 49, B-3000, Leuven, Belgium.
| | | | | | | | | | | | | |
Collapse
|
42
|
Town M, Jean G, Cherqui S, Attard M, Forestier L, Whitmore SA, Callen DF, Gribouval O, Broyer M, Bates GP, van't Hoff W, Antignac C. A novel gene encoding an integral membrane protein is mutated in nephropathic cystinosis. Nat Genet 1998; 18:319-24. [PMID: 9537412 DOI: 10.1038/ng0498-319] [Citation(s) in RCA: 397] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Nephropathic cystinosis, an autosomal recessive disorder resulting from defective lysosomal transport of cystine, is the most common inherited cause of renal Fanconi syndrome. The cystinosis gene has been mapped to chromosome 17p13. We found that the locus D17S829 was homozygously deleted in 23 out of 70 patients, and identified a novel gene, CTNS, which mapped to the deletion interval. CTNS encodes an integral membrane protein, cystinosin, with features of a lysosomal membrane protein. Eleven different mutations, all predicted to cause loss of function of the protein, were found to segregate with the disorder.
Collapse
Affiliation(s)
- M Town
- Division of Medical and Molecular Genetics, United Medical and Dental Schools, Guy's Hospital, London, UK.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Coyle LA, Papaioannou M, Yaxley JC, Chim JS, Attard M, Hoffbrand AV, Foroni L. Molecular analysis of the leukaemic B cell in adult and childhood acute lymphoblastic leukaemia. Br J Haematol 1996; 94:685-93. [PMID: 8826893 DOI: 10.1046/j.1365-2141.1996.d01-1851.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Immunoglobulin heavy chain gene (IgH gene) rearrangements are found in the majority of cases of B-lineage acute lymphoblastic leukaemia (ALL). We have examined bone marrow samples taken at presentation or relapse from 109 patients (79 adults and 30 children) and have performed sequence analysis of the complementarity determining region 3 (CDR3) on 65 alleles from 54 patients. We aimed to define immunoglobulin heavy chain (IgH) variable segment family use and investigate biological and structural features of the B cell in adult and childhood ALL. Using the FR1 fingerprinting method, a rearranged band was identified in 70 (89%) of 79 adult ALL and in 29 (97%) of 30 childhood ALL. This study found no preferential use or selection of IgH VH genes and no statistically significant structural differences between normal and leukaemic B cells in either adult and childhood ALL. An equal proportion of amplifiable cases of adult and childhood ALL uses more than one VH family gene (24/70, 34%, and 8/29, 27.5%, respectively). There were no significant differences in the structure or size of the CDR3 region and the variable (V) or joining (J) segment use in ALL patients compared to normal B cells. We observed that the N2 region was shorter than N1 in children whereas the opposite was observed in adults (not statistically significant). The J4 segment was a more common rearrangement in children than in adults, and in both groups J4 was more frequently associated with multiple D segment VDJ rearrangements. An increase in VH6 use in leukaemic alleles compared to normal B lymphocytes (2%) was observed but it was not statistically significant in our group of patients. Amongst children and adults, in-frame CDR3 junctions occurred in 78% and 64% of rearranged alleles, respectively, compared to 75% of in-frame sequences reported by others to occur among normal B cells.
Collapse
Affiliation(s)
- L A Coyle
- Department of Haematology, Royal Free Hospital School of Medicine, London
| | | | | | | | | | | | | |
Collapse
|
44
|
Abstract
The aim of the present study was to calculate the age-and sex-specific standardized mortality ratios (SMRs) in two populations of people with learning disability (LD). These populations included people living in institutions and community settings. It was found that SMRs tended to be raised for both males and females in each population, but SMRs do not always significantly differ from unity. For the combined Register populations, SMRs are generally significantly greater than unity. We conclude that these data provide evidence that death rates for people with LD are often higher than in the general population.
Collapse
Affiliation(s)
- S M McGuigan
- Department of Mental Health Sciences, St George's Hospital Medical School, London, England
| | | | | |
Collapse
|
45
|
Cannell PK, Amlot P, Attard M, Hoffbrand AV, Foroni L. Variable kappa gene rearrangement in lymphoproliferative disorders: an analysis of V kappa gene usage, VJ joining and somatic mutation. Leukemia 1994; 8:1139-45. [PMID: 8035605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We have studied a diverse group of lymphoproliferative disorders (acute lymphoblastic leukaemia (ALL), chronic lymphocytic leukaemia (CLL), non-Hodgkin lymphoma (NHL) and myeloma) to determine if V kappa gene use is random or disease-specific and whether somatic mutations (a late event in B-cell differentiation) can provide additional information on the type of B cell involved in the neoplastic clone. In this group of disorders V kappa gene selection is not random and some members of each V kappa family are preferentially rearranged. V kappa genes from the distal portion of the locus are seldom used, possibly because rearrangement of the proximal locus by deletion is more efficient than rearrangement of the distal locus by inversion. Although pseudogenes account for 46% of the V genes in the kappa locus none were ever rearranged, even in non-functional rearrangements of lambda-producing leukemias, suggesting the existence of a mechanism which down-regulates the rearrangement of pseudogenes. N regions were noted at the VJ junction in 20% of alleles (in six CLL, three NHL, two ALL and one myeloma) possibly the result of kappa-chain recombination during the early period of B-cell maturation in which TdT is expressed. Nucleotide addition or imprecise joining at the VJ junction, resulting in a shift in the reading frame, were the commonest causes of non-functional rearrangement. The occurrence of somatic mutation broadly correlated with the stage of B-cell maturation from which the different disorders are thought to arise. However, there was no strict association and somatic mutations were demonstrated in 'typical CLL' while V kappa genes were germline in some follicular lymphomas; these findings suggest either heterogeneity in the stage of B-cell maturation at which these disorders arise or some variability in the process of somatic mutation.
Collapse
Affiliation(s)
- P K Cannell
- Department of Haematology, Royal Free Hospital School of Medicine, London, UK
| | | | | | | | | |
Collapse
|
46
|
Smal MA, Dziadek M, Cooney SJ, Attard M, Baldo BA. Examination for platelet-activating factor production by preimplantation mouse embryos using a specific radioimmunoassay. J Reprod Fertil 1990; 90:419-25. [PMID: 2250241 DOI: 10.1530/jrf.0.0900419] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A specific and highly sensitive radioimmunoassay was used to measure platelet-activating factor (PAF) production by preimplantation mouse embryos in vitro. Levels of PAF greater than 1 pg per embryo were not observed in 24-h culture medium from 2-cell embryos, compacted morulae or blastocysts, or in extracts from these embryos. Synthetic PAF added to embryos at the start of culture could be almost totally recovered after the incubation period, indicating negligible degradation of PAF during culture. PAF was also not detected in embryo samples using a washed rabbit-platelet aggregation assay. It can be concluded that mouse embryos do not produce substantial levels of PAF, or any of the biologically active analogues of PAF detected by the assay.
Collapse
Affiliation(s)
- M A Smal
- Kolling Institute of Medical Research, Royal North Shore Hospital, St. Leonards, NSW, Australia
| | | | | | | | | |
Collapse
|
47
|
Woodside B, Leon M, Attard M, Feder HH, Siegel HI, Fischette C. Prolactin-steroid influences on the thermal basis for mother-young contact in Norway rats. J Comp Physiol Psychol 1981; 95:771-80. [PMID: 7309929 DOI: 10.1037/h0077822] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Norway rat dams have a chronic elevation in core temperature throughout the first 2 wk postpartum, a situation that makes them vulnerable to a further, acute rise in body temperature during contact with their young. Prolactin appears to contribute to the chronic elevation of maternal temperature, probably by stimulating the secretion of progesterone, which then elevates the maternal thermal set point.
Collapse
|