Thyroid tumors include those that originate from follicular cells and those that arise from parafollicular cells (C cells). Differentiated thyroid cancer, which originates from follicular cells, includes papillary car...Thyroid tumors include those that originate from follicular cells and those that arise from parafollicular cells (C cells). Differentiated thyroid cancer, which originates from follicular cells, includes papillary carcinoma, follicular carcinoma, oncocytic cell carcinoma (Hürthle), poorly differentiated carcinoma, and anaplastic carcinoma. The incidence of thyroid cancer has been increasing significantly, with an estimated incidence in the United States of America of 53,990 cases by the year 2018. This neoplasm is listed as the most common endocrine tumor and represents approximately 3% of all malignant tumors in humans, with 75% of cases occurring in women, and two-thirds of cases occurring in people under 55 years. The increase in the prevalence/incidence of low-risk thyroid cancer over the last 10 to 20 years has required a re-appraisal of the standard one-size-fits-all approach to differentiated thyroid cancer. This adaptation to a more individualized management of the patient with thyroid cancer has led to a much more risk-adapted approach to the diagnosis, initial therapy, adjuvant therapy, and follow-up of patients with differentiated thyroid cancer. This paper with review the current understanding of the clinical presentation, diagnostic workup, and management of thyroid cancer centered on evidence-based and personalized medicine.展开更多
Thyroid nodules are a major health problem worldwide. The prevalence of palpable thyroid nodules in the general population is approximately 5% in women and 1% in men living in parts of the world with sufficient iodine...Thyroid nodules are a major health problem worldwide. The prevalence of palpable thyroid nodules in the general population is approximately 5% in women and 1% in men living in parts of the world with sufficient iodine. High resolution neck and thyroid ultrasound can detect thyroid nodules in a significant proportion of randomly selected individuals, with higher frequencies in women and the elderly population. The importance of thyroid nodules lies in the need to rule out cancer. The majority of thyroid nodules are benign, clinically irrelevant, and can be safely managed with a good surveillance program. The detection and diagnosis of differentiated thyroid cancer have evolved over the years with increased use of high resolution cervical and thyroid ultrasound, fine needle aspiration biopsy (FNAB), molecular testing, and thyroglobulin as a serum tumor marker. An algorithm that utilizes high resolution ultrasound and, when indicated, FNAB, and molecular testing for the diagnosis of thyroid nodules, facilitates a personalized, risk-based protocol that promotes high-quality care and minimizes cost and unnecessary testing. Our paper reviews the current, evidence-based management of newly diagnosed thyroid nodules.展开更多
Unregulated overproduction of parathyroid hormone (PTH) from an abnormal parathyroid gland is the origin of primary hyperparathyroidism (PHPT). Patients who have an elevated serum calcium concentration have a problem ...Unregulated overproduction of parathyroid hormone (PTH) from an abnormal parathyroid gland is the origin of primary hyperparathyroidism (PHPT). Patients who have an elevated serum calcium concentration have a problem in one or more of their parathyroid glands. To understand this disease state adequately and provide appropriate treatment, a thorough understanding of parathyroid embryology, anatomy, physiology, and pathophysiology is essential. In this manuscript, we review our current understanding of parathyroid gland embryology, anatomy, histology, physiology, and pathophysiology.展开更多
Emil Theodor Kocher and Theodor Billroth pioneered the surgical management of thyroid disease. Their surgical techniques, knowledge of thyroid anatomy, embryology, histology, physiology, and antisepsis practices trans...Emil Theodor Kocher and Theodor Billroth pioneered the surgical management of thyroid disease. Their surgical techniques, knowledge of thyroid anatomy, embryology, histology, physiology, and antisepsis practices transitioned a life-threatening operation to one with acceptable morbidity. The modern head and neck surgeon should have a meticulous surgical technique, combined with a thorough understanding of thyroid embryology and anatomy that is central to the understanding and treatment of the different disease processes of the thyroid gland and the consequences of thyroid gland surgery. In this manuscript we will be examining thyroid gland embryology, anatomy, histology, and physiology that is essential to the practicing thyroid surgeon.展开更多
Introduction: Invasive lobular carcinoma (ILC) is the second most common histologic type of breast cancer, representing 5% to 15% of invasive tumors. ILC tends to spread to bones, lungs, central nervous system, reprod...Introduction: Invasive lobular carcinoma (ILC) is the second most common histologic type of breast cancer, representing 5% to 15% of invasive tumors. ILC tends to spread to bones, lungs, central nervous system, reproductive organs, and the gastrointestinal tract (GI tract). The most commonly affected organs in the GI tract are the stomach, small intestine, followed by colon and rectum. Case presentation: A 78-year-old woman who was referred to our institution after having a bowel obstruction that required a diagnostic laparoscopy where they identified an obstructing ulcerative lesion in the distal ileum that was managed with a segmental bowel resection. Pathology report showed an invasive lobular breast carcinoma that occluded 90% of the bowel lumen. A PET/CT scan revealed a left breast tumor with increased metabolism. The patient was staged as a clinical cT4b, cN0, cM1 left breast invasive lobular carcinoma (ER/PgR positive, HER-2 negative). She was managed with endocrine therapy with Letrozole (an eight-week course). A follow-up PET/CT showed a peritoneal hypermetabolic nodule adjacent to the previous ileal anastomosis. The lesion decreased in size and metabolic activity. In a multidisciplinary fashion, the endocrine therapy was extended for another three months. Another follow-up PET/CT scan was performed three months after the identification of the peritoneal implant that showed that the nodule increased in size and in metabolism. The lesion continued to decrease significantly in size and became metabolically inactivity. Due to the good breast response and the possibility that the ileal nodule could be a granuloma, she underwent an exploratory laparoscopy with excision of the peritoneal nodule, and a modified left radical mastectomy with immediate breast reconstruction (complex wound closure). The final pathology report of the nodule was negative for malignancy. She continued on endocrine therapy and underwent whole breast irradiation four weeks after the operation. Currently, she is free of disease with no evidence of local, regional, or distant recurrence, and she is still on endocrine therapy. Discussion: The time interval between primary breast cancer and gastrointestinal involvement may range from synchronous presentation to as long as 30 years. The clinical manifestations in GI lobular breast cancer metastasis may range from non-specific complaints to acute GI symptoms, such as a bowel obstruction. There are multiple controversies in the management of ILC. Systemic treatment should be initiated as soon as possible. Indications for postmastectomy radiotherapy are also controversial, given the propensity for multifocal/multicentric tumors and late recurrences, sometimes in atypical locations. Five years of postoperative adjuvant hormonal therapy is an option for women with poor prognosis. Remissions are observed in 32% to 53% of patients. Conclusion: Metastatic lobular carcinoma of the breast has a wide range of clinical presentations. Patients with a history of breast cancer who present with new GI tumors should have these lesions evaluated for evidence of metastasis through histopathologic and immunohistochemical analysis, this will allow for appropriate management. Currently, breast cancer management involves a multidisciplinary approach including surgery, radiotherapy, and systemic medical therapy, and the treatment must be tailored to the patient’s needs.展开更多
文摘Thyroid tumors include those that originate from follicular cells and those that arise from parafollicular cells (C cells). Differentiated thyroid cancer, which originates from follicular cells, includes papillary carcinoma, follicular carcinoma, oncocytic cell carcinoma (Hürthle), poorly differentiated carcinoma, and anaplastic carcinoma. The incidence of thyroid cancer has been increasing significantly, with an estimated incidence in the United States of America of 53,990 cases by the year 2018. This neoplasm is listed as the most common endocrine tumor and represents approximately 3% of all malignant tumors in humans, with 75% of cases occurring in women, and two-thirds of cases occurring in people under 55 years. The increase in the prevalence/incidence of low-risk thyroid cancer over the last 10 to 20 years has required a re-appraisal of the standard one-size-fits-all approach to differentiated thyroid cancer. This adaptation to a more individualized management of the patient with thyroid cancer has led to a much more risk-adapted approach to the diagnosis, initial therapy, adjuvant therapy, and follow-up of patients with differentiated thyroid cancer. This paper with review the current understanding of the clinical presentation, diagnostic workup, and management of thyroid cancer centered on evidence-based and personalized medicine.
文摘Thyroid nodules are a major health problem worldwide. The prevalence of palpable thyroid nodules in the general population is approximately 5% in women and 1% in men living in parts of the world with sufficient iodine. High resolution neck and thyroid ultrasound can detect thyroid nodules in a significant proportion of randomly selected individuals, with higher frequencies in women and the elderly population. The importance of thyroid nodules lies in the need to rule out cancer. The majority of thyroid nodules are benign, clinically irrelevant, and can be safely managed with a good surveillance program. The detection and diagnosis of differentiated thyroid cancer have evolved over the years with increased use of high resolution cervical and thyroid ultrasound, fine needle aspiration biopsy (FNAB), molecular testing, and thyroglobulin as a serum tumor marker. An algorithm that utilizes high resolution ultrasound and, when indicated, FNAB, and molecular testing for the diagnosis of thyroid nodules, facilitates a personalized, risk-based protocol that promotes high-quality care and minimizes cost and unnecessary testing. Our paper reviews the current, evidence-based management of newly diagnosed thyroid nodules.
文摘Unregulated overproduction of parathyroid hormone (PTH) from an abnormal parathyroid gland is the origin of primary hyperparathyroidism (PHPT). Patients who have an elevated serum calcium concentration have a problem in one or more of their parathyroid glands. To understand this disease state adequately and provide appropriate treatment, a thorough understanding of parathyroid embryology, anatomy, physiology, and pathophysiology is essential. In this manuscript, we review our current understanding of parathyroid gland embryology, anatomy, histology, physiology, and pathophysiology.
文摘Emil Theodor Kocher and Theodor Billroth pioneered the surgical management of thyroid disease. Their surgical techniques, knowledge of thyroid anatomy, embryology, histology, physiology, and antisepsis practices transitioned a life-threatening operation to one with acceptable morbidity. The modern head and neck surgeon should have a meticulous surgical technique, combined with a thorough understanding of thyroid embryology and anatomy that is central to the understanding and treatment of the different disease processes of the thyroid gland and the consequences of thyroid gland surgery. In this manuscript we will be examining thyroid gland embryology, anatomy, histology, and physiology that is essential to the practicing thyroid surgeon.
文摘Introduction: Invasive lobular carcinoma (ILC) is the second most common histologic type of breast cancer, representing 5% to 15% of invasive tumors. ILC tends to spread to bones, lungs, central nervous system, reproductive organs, and the gastrointestinal tract (GI tract). The most commonly affected organs in the GI tract are the stomach, small intestine, followed by colon and rectum. Case presentation: A 78-year-old woman who was referred to our institution after having a bowel obstruction that required a diagnostic laparoscopy where they identified an obstructing ulcerative lesion in the distal ileum that was managed with a segmental bowel resection. Pathology report showed an invasive lobular breast carcinoma that occluded 90% of the bowel lumen. A PET/CT scan revealed a left breast tumor with increased metabolism. The patient was staged as a clinical cT4b, cN0, cM1 left breast invasive lobular carcinoma (ER/PgR positive, HER-2 negative). She was managed with endocrine therapy with Letrozole (an eight-week course). A follow-up PET/CT showed a peritoneal hypermetabolic nodule adjacent to the previous ileal anastomosis. The lesion decreased in size and metabolic activity. In a multidisciplinary fashion, the endocrine therapy was extended for another three months. Another follow-up PET/CT scan was performed three months after the identification of the peritoneal implant that showed that the nodule increased in size and in metabolism. The lesion continued to decrease significantly in size and became metabolically inactivity. Due to the good breast response and the possibility that the ileal nodule could be a granuloma, she underwent an exploratory laparoscopy with excision of the peritoneal nodule, and a modified left radical mastectomy with immediate breast reconstruction (complex wound closure). The final pathology report of the nodule was negative for malignancy. She continued on endocrine therapy and underwent whole breast irradiation four weeks after the operation. Currently, she is free of disease with no evidence of local, regional, or distant recurrence, and she is still on endocrine therapy. Discussion: The time interval between primary breast cancer and gastrointestinal involvement may range from synchronous presentation to as long as 30 years. The clinical manifestations in GI lobular breast cancer metastasis may range from non-specific complaints to acute GI symptoms, such as a bowel obstruction. There are multiple controversies in the management of ILC. Systemic treatment should be initiated as soon as possible. Indications for postmastectomy radiotherapy are also controversial, given the propensity for multifocal/multicentric tumors and late recurrences, sometimes in atypical locations. Five years of postoperative adjuvant hormonal therapy is an option for women with poor prognosis. Remissions are observed in 32% to 53% of patients. Conclusion: Metastatic lobular carcinoma of the breast has a wide range of clinical presentations. Patients with a history of breast cancer who present with new GI tumors should have these lesions evaluated for evidence of metastasis through histopathologic and immunohistochemical analysis, this will allow for appropriate management. Currently, breast cancer management involves a multidisciplinary approach including surgery, radiotherapy, and systemic medical therapy, and the treatment must be tailored to the patient’s needs.
