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Cohexisting Medullary and Papillary Thyroid Cancer
Gianlorenzo Dionigi,Maria Laura Tanda,Eliana Piantanida,Silvia Uccella,Stefano La Rosa,Davide Inversini,Matteo Lavazza,Vincenzo Pappalardo,Fausto Sessa,Liu Xiaoli 대한갑상선-내분비외과학회 2017 The Koreran journal of Endocrine Surgery Vol.17 No.2
Purpose: Papillary thyroid carcinomas (PTCs) and medullary thyroid carcinomas (MTCs) have always been considered different in terms of their incidence rates, cell origins, and histopathological features. Simultaneous occurrence of both disease entities is very rare. Methods: We describe a series of cases with simultaneous MTC and PTC occurrences in the thyroid gland. Results: From 2,897 patients (mean age, 49.2±12.5; 81% women) who underwent thyroidectomy for cancer between 2000 and 2015, we reviewed 11 cases of simultaneous occurrence of MTCs and PTCs. Multifocal PTC with simultaneous MTC was detected in 5 of the 11 cases (45%). Of these PTC patients, 2 had 2 foci, 2 had 3 foci, and 1 had 4 foci. There was 1 case of multifocal MTC with solitary PTC. One patient presented with “composite thyroid carcinoma” with mixed features of MTCs and PTCs. Eight patients (72%) presented an association with diffuse lymphocytic thyroiditis. The sizes of the tumors were 1.95±0.23 cm vs. 1.20±0.20 cm for PTCs and MTCs, respectively (P=0.531). The prevalence of extrathyroidal extension was 33.1% vs. 30.2% for PTCs and MTCs, respectively (P=0.282). All patients underwent total thyroidectomy and central neck node dissection. Radio iodine was delivered to 44% of patients. Follow-up review revealed 9 disease-free patients and 1 with local neck recurrence, while 1 patient died due to non-thyroid reasons. Conclusion: There are only 30 reports describing a total of 50 cases in the English literature regarding concurrent PTC and MTC in the same gland. This study represents one of the largest case series. Whether the incidence of another cancer in these patients is coincidental, or due to the possible activation of a common tumorigenic pathway for both follicular and parafollicular thyroid cells, remains to be elucidated.
Bilateral Vocal Palsy After Total Thyroidectomy: Expert Opinion on Two Malpractice Claims
Gianlorenzo Dionigi,Hui Sun,Young Jun Chai,Antonina Catalfamo,Antonio Mangraviti,Giacomo Antonio Rizzo,Mattia Portinari,Che Wei Wu 대한갑상선-내분비외과학회 2017 The Koreran journal of Endocrine Surgery Vol.17 No.4
Two patients complained of hoarseness, respiratory distress and swallowing disorders early after total bilateral thyroidectomy for multinodular goiter and cancer, respectively. Faulty surgical techniques had caused injury to bilateral recurrent laryngeal nerves (RLNs) during thyroidectomy and the associated central lymph node dissection. The operation notes showed no statement regarding the identification, dissection, exposure and/or functional integrity of the RLN on either side of the thyroid and no mention of the first resected lobe. This report reviews the personal experience of the authors in thyroid surgery for use in 2 medical malpractice claims and for future reference.
The Consistency of Intraoperative Neural Monitoring in Thyroid Surgery
Gianlorenzo Dionigi,채영준,Francesco Freni,Özer Makay,Bruno Galletti,Francesco Galletti,김훈엽 대한갑상선-내분비외과학회 2018 The Koreran journal of Endocrine Surgery Vol.18 No.2
Numerous operating tools and technology transfers are available for thyroid surgery teams performing open, endoscopic and robotic procedures but none, or very few, of them constitutes a mandatory prerequisite. Over the past decade, the choice of intraoperative neurophysiological monitoring (IONM) of the recurrent laryngeal nerve (RLN), has been reached certain consensus, which must at least be selected on an individual basis. Identification and intraoperative assessment of the RLN seems to be more effectively performed with IONM than solely visually or endoscopically. Today, IONM has evolved sufficiently to increase the likelihood of successful functional outcomes in many patients. The transition from the concept of intermitted neural monitoring of the RLN to that of continuous functions evaluation that must be appreciate requires highly skilled knowledge of IONM. This goal will be more likely achieved in centers highly specialized in thyroid surgery.
Gianlorenzo Dionigi,Vincenzo Bartolo,Antonio Giacomo Rizzo,Massimo Marullo,Valerio Fabiano,Antonina Catalfamo,Francesca Pia Pergolizzi,Antonino Cancellieri,Giuseppinella Melita 대한갑상선-내분비외과학회 2018 The Koreran journal of Endocrine Surgery Vol.18 No.1
Literature on intraoperative neuro monitoring (IONM) during endocrine surgery have increased over recent years. A comprehensive understanding of the role of IONM for prevention of nerve injuries is critical to maximize safety during surgery of the anterior compartment of the neck. Neuromonitoring techniques are currently considered safe technique and technology; however, albeit sporadically, have been reported some complications and related side effects using such methods. The complications described can be related to the electrodes positioned at the larynx, at the obstruction of the endotracheal tube, the drugs used for anesthesia and the effects of electrical stimulation on nerve structures and systemic levels. This review will explore the safety issues of IONM to improve the outcomes among patients undergoing monitored thyroidectomy.
Pitfalls in the 2017 TNM Classification of Thyroid Carcinoma
Gianlorenzo Dionigi,Antonio Ieni,Francesco Ferraù,Hui Sun,Salvatore Cannavò,Giovanni Tuccari 대한갑상선-내분비외과학회 2018 The Koreran journal of Endocrine Surgery Vol.18 No.2
The objective of this article is to detail the 2017 tumor-node-metastasis (TNM) staging criteria for thyroid cancer. The literature presents only few contributions, with controversial results, about comparison between previous and the new TNM systems. The 2017 TNM classification categorizes either thyroid carcinomas only limited to the gland either carcinomas macroscopically infiltrating into defined anatomical structures. The “minimal extrathyroid spread” into the perithyroidal adipose tissue no longer appears as a classification parameter in the new TNM. In the present paper is discussed for the pT categories pT1a, pT1b, pT2, and pT3a. In detail, the T-categories pT1a, pT1b, pT2, and pT3a are each subdivided into true thyroid-restricted carcinomas (pT1a1, pT1b1, pT2a1, and pT3a1) and “minimal extrathyroid proliferation” carcinomas (pT1a2, pT1b2, pT2b, and pT3a2). As a basis, a strict definition of the “minimal extrathyroid propagation” of thyroid carcinomas is essential. Although the suggestion made with the additional substrate characterization makes the work of the pathologist more intricate in daily use, standardized fundamentals for demonstrating or excluding the prognostic and therapeutic relevance concerning a “minimal extrathyroid extension” in thyroid carcinoma appear to be necessary.
A Historical Account for Thyroid Surgery
Christos Christoforides,Gianlorenzo Dionigi,Ioanna Vasileiou,Kyriakos Vamvakidis 대한갑상선-내분비외과학회 2018 The Koreran journal of Endocrine Surgery Vol.18 No.1
Thyroid surgery is nowadays considered one of the most common surgical procedures globally. For nearly 4,000 years, thyroid gland pathology and surgery have been a field of observation, research, and interventions. From ancient references or drawings regarding thyroid shape or enlargement (goiter), to more recent years when the first surgical approaches to thyroid pathology were established, until today when evolution in imaging, biochemical methods, surgical instruments and adjuncts is in everyday thyroid clinical practice, many prominent individuals add information to the current knowledge on the field. Europe, America, and Asia provide a rich historical background where outstanding scientists have devoted their entire life to thyroid surgical pathology and treatment. A brief tribute to all these distinguished pioneers - by looking into this evolutionary progress throughout the years - is attempted in this work.
Alessandro Pontin,Ettore Gagliano,Gianlorenzo Dionigi 대한갑상선-내분비외과학회 2019 The Koreran journal of Endocrine Surgery Vol.19 No.4
Papillary thyroid carcinoma (PTC) is a heterogeneous tumor group with differing pathogenesis and prognosis of the individual subtypes. In addition, a tumor entity has been spun off, now referred to as “noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP). A recent study, based on a comprehensive evaluation of a prospective multicenter NIFTP-based retrospective study, was intended to clarify whether NIFTP can metastasize and thus justify a reduced resection rate compared to classical PTC. For 3 reasons, Authors nicely recommend caution regarding a limited thyroid procedure (i.e. lobectomy vs. completion thyroidectomy): i) In the current literature, lymph node metastases have been described in 10 patients with NIFTP, and in 1 patient lung metastases. ii) As reported for the first time in this study, nearly one-fifth of patients have NIFTP-associated PTMC with unclear potential for metastasis. iii) Observation periods are still relatively short and so far, there are no agreed follow-up standards.
Efficacy of Percutaneous Thermal Ablation of Papillary Thyroid Carcinoma
Ettore Caruso,Ettore Gagliano,Gianlorenzo Dionigi 대한갑상선-내분비외과학회 2019 The Koreran journal of Endocrine Surgery Vol.19 No.4
Percutaneous thermoablation (PTA) has become an increasingly used option in the interventional treatment of symptomatic, cytologic and sonographic benign solid thyroid gland disease. Currently, there is no high-level evidence of treatment for differentiated thyroid cancer by means of PTA. Surgery is a standard treatment for primary and also for recurrent thyroid cancer, followed by radioactive iodine and thyroid hormone therapy. PTA, however, can be used in patients at high-risk and in patients who refuse to undergo repeated surgery. The Task Force Committee of the Korean Society of Thyroid Radiology has developed recommendations for the optimal use of PTA for thyroid nodules. However, there are still several questions on safe distance to the laryngeal nerves, no data on duration of PTA application around the nerves, no intra-procedure assessment of laryngeal nerves function and position. Future experimental studies are required.