Cases reported "Thyroid Neoplasms"

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1/317. Maltoma of the thyroid in a man with Hashimoto's thyroiditis.

    We report the case of a 42-yr-old man with primary thyroid lymphoma arising from mucosa-associated lymphoid tissue (MALT-lymphoma, maltoma). The patient underwent a hemithyroidectomy for a growing mass in the right lobe of the thyroid while being treated with 1-thyroxine for Hashimoto's thyroiditis. The clinical diagnosis of Hashimoto's disease was confirmed by aspiration biopsy of the mass during the course of L-thyroxine treatment. Postoperatively, histology showed atypical lymphoproliferative infiltrates suspicious of low-grade non-Hodgkin's lymphoma of mucosa-associated lymphoid tissue-type, coexisting with a reactive process typical of chronic lymphocytic thyroiditis. immunophenotyping showed a mixed B- and T-lymphocyte population, which was nondiagnostic. However, Southern blot analysis revealed a clonal rearrangement of the Ig heavy chain gene. This case demonstrates that cytology or histology may not distinguish between reactive or low-grade lymphomatous thyroid processes. The use of molecular technique was essential to prove clonality and the presence of lymphoma.
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2/317. Successful surgical treatment of a solitary parapharyngeal metastasis from thyroid cancer, using the mandibular swing-transcervical approach: report of a case.

    A 72-year-old man presented with a right parapharyngeal mass, 4 cm in diameter, which was subsequently diagnosed as a metastasis originating from papillary carcinoma of the thyroid gland. The parapharyngeal tumor was successfully removed by the mandibular swing-transcervical approach with pharyngeal reconstruction, performed using a buccal mucosal island flap based on the facial artery. His postoperative course was uneventful, and the preoperative clinical symptoms such as dysphagia and headaches completely resolved after surgery.
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3/317. Unilateral laparoscopic adrenalectomy followed by contralateral retroperitoneoscopic partial adrenalectomy in a patient with multiple endocrine neoplasia type 2a syndrome.

    We report the first patient who had bilateral pheochromocytoma associated with multiple endocrine neoplasia type 2a syndrome (men 2a) and underwent unilateral laparoscopic adrenalectomy followed by contralateral retroperitoneoscopic partial adrenalectomy 2 years later. The postoperative course was uneventful both times, and the patient was cured of hypertension without any need for steroid replacement. Endoscopic partial adrenalectomy is a minimally invasive procedure for pheochromocytoma with mild symptoms. We believe that this procedure has considerable potential for treating bilateral pheochromocytoma, which is frequently observed in patients with men 2a.
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4/317. Follicular carcinoma in ectopic thyroid gland. A case report.

    Ectopic thyroid rest can be seen anywhere along the path of descent of the gland. The most ectopic thyroid tissue is a thyroglossal duct cyst associated with normal thyroid gland. Sublingual location is less common than a lingual ectopia. True malignant transformation in ectopic thyroid tissue is extremely rare. Such a malignancy is virtually always diagnosed only after surgical excision of the lesion at pathological examination. This report discusses a case of ectopic thyroid follicular carcinoma in the right submandibular region in the absence of orthotopic thyroid, discovered by chance after the surgical excision performed for a preoperative ultrasonically and cytologically misdiagnosed submandibular gland adenocystic carcinoma. The possible aetiology of such an unusual anatomical relationship is discussed as well as the importance of thyroid scanning, ultrasound and/or CT in neck lumps.
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5/317. radiation myelopathy with partial functional recovery: PET evidence of long-term increased metabolic activity of the spinal cord.

    Postoperative telecobalt irradiation was performed with a biologically effective extrapolated response dose of 165 Gy2 delivered to the spinal cord of a papillary thyroid cancer patient. Incomplete cervical transection developed, followed by a gradual functional improvement, which is still continuing 8 years after radiotherapy. Between the 6th and 8th years of the clinical course, positron emission tomography investigations demonstrated an increased 18F-deoxyglucose accumulation and (15)O-butanol perfusion, but negligible 11C-methionine uptake in the irradiated spinal cord segment. We suggest that the increased metabolism and perfusion, and the lack of detectable protein synthesis may be related to the increased energy demands of action potential conduction, due to the higher than normal density of sodium channels along demyelinated axons displaying restored conduction.
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6/317. Signet ring cell adenoma of the thyroid with mucin predominance.

    A 22-year-old male presented with a 1-year history of a right anterior neck mass. He did not have gastrointestinal cancer. Laboratory examination revealed an elevated serum thyroglobulin level of 120 ng/mL. The neck lesion showed poor uptake on 99mTc scan, but enhanced uptake on 201T1 scan. The patient underwent a hemithyroidectomy; the cut surface of the 7 x 3.5 cm lesion was solid and tanned orange. Postoperatively the serum thyroglobulin level decreased to 26 ng/mL. microscopy of the tumor showed signet ring cells and microfollides, both of which were positive for mucicarmin and alcian blue. A small percentage of the follicles were positive for thyroglobulin and periodic acid-Schiff. Our literature search detected 18 patients with signet ring cell lesions positive for thyroglobulin, but none had characteristics similar to ours showing predominance of mucin and poor staining for thyroglobulin.
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7/317. Lymphoepithelioma-like esophageal carcinoma: report of a case.

    We herein report the rare case of a patient suffering from lymphoepithelioma-like poorly differentiated squamous cell carcinoma of the esophagus. The patient was a 74-year-old woman in whom an esophageal tumor was found during an operation for thyroid cancer. After performing a subtotal thyroidectomy and cervical esophagectomy, esophageal reconstruction was performed using a free jejunal graft. Based on the results of the pathological examination, the esophageal tumor was diagnosed to be primary lymphoepithelioma-like esophageal cancer, not metastasis of either unknown nasopharyngeal cancer or thyroid cancer. Since surgery, she has survived postoperatively for more than 4 years with no evidence of recurrent disease.
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8/317. hyperthyroidism due to papillary carcinoma of the thyroid--a case report.

    A rare case of papillary carcinoma of the thyroid producing hyperthyroidism is presented. A young patients presented seven years after a thyroid operation with metastatic disease in the cervical lymph nodes and a history of deteriorating vision in the left eye. He also had a lesion in the base of the skull which could not be established to be metastasis from the thyroid cancer. There was clinical and biochemical evidence of hyperthyroidism. Radionuclide scan revealed uptake in the residual thyroid tissue and patchy uptake by the cervical lymph nodes. The patient underwent a complete thyroidectomy and radical neck dissection of the left side and 'berry-picking' of the lymph nodes on the right side. Although the patient became euthyroid post-operatively, his general condition deteriorated and he rapidly lost vision in both eyes before any ablative therapy could be instituted for the tumour in the base of the skull. The patient was lost to follow-up.
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9/317. Mediastinal lymph node involvement as the initial manifestation of occult thyroid cancer in the surgical treatment of lung cancer: report of a case.

    A 63-year-old man was referred to our institute for the treatment of squamous cell carcinoma of the upper lobe of his right lung. A right upper lobectomy of the lung was performed with a mediastinal lymph node dissection. The postoperative pathological examination of the dissected specimens revealed one of the superior mediastinal lymph nodes to be morbid with micrometastasis of occult thyroid cancer, while no node involvement was seen due to lung cancer. A right lobectomy of the thyroid gland with a modified radical neck dissection was done 4 years later after the confirmation of the absence of any recurrent sign of lung cancer. In the resected specimen, papillary thyroid microcarcinoma was observed with several intraglandular metastases and right regional lymph node involvement. Eight months later, a new primary lung cancer developed in the left lung, and a left upper lobectomy of the lung with a mediastinal lymph node dissection was performed. At that time, the absence of mediastinal lymph node metastasis from lung cancer or thyroid cancer was confirmed. Mediastinal lymph node involvement as the initial manifestation of occult thyroid cancer in surgical treatment for lung cancer is rare, but it is important to be aware of the possibility of incidentally detecting occult thyroid cancer in surgical dissections in this area for lung cancer. The appropriate surgical treatment should be determined while carefully considering the prognosis of the lung cancer as well as that of any coexisting malignancy.
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10/317. Thyroid carcinoma with isolated spinal metastasis: case history and review of the literature.

    An unusual case of metastatic follicular thyroid cancer presenting with symptoms of a radiculopathy at C6 is presented. The patient underwent a laminectomy and removal of tumor with resolution of his symptoms. He was found to have a well differentiated follicular thyroid carcinoma and subsequently had total thyroidectomy and 131I treatment. This patient's presentation raised questions about appropriate preoperative evaluation in this clinical scenario. This case highlights the importance of a thorough pre-operative work up for metastatic spine tumors. This should include evaluation of the thyroid consisting of thorough clinical history with particular attention to prior radiation exposure. palpation of the thyroid also should be included as part of a routine pre-operative physical in cases of metastatic lesions of unknown origin. Thyroid function studies should not be utilized unless a clinical suspicion for thyroid cancer is raised during the examination.
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