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ABSTRACT Objective: Cervical traumatic neuromas (CTNs) may appear after lateral neck dissection for metastatic thyroid carcinoma. If they are misdiagnosed as metastatic lymph nodes (LNs) in follow-up neck ultrasound (US), unnecessary and uncomfortable fine-needle aspiration biopsy are indicated. The present study aimed to describe US features of CTNs and to assess the US performance in distinguishing CTNs from abnormal LNs. Subjects and methods: Retrospective evaluation of neck US images of 206 consecutive patients who had lateral neck dissection as a part of thyroid cancer treatment to assess CTN’s US features. Diagnostic accuracy study to evaluate US performance in distinguishing CTNs from abnormal LNs was performed. Results: Eight-six lateral neck nodules were selected for analysis: 38 CTNs and 48 abnormal LNs. CTNs with diagnostic cytology were predominantly hypoechogenic (100% vs. 45%; P = 0.008) and had shorter diameters than inconclusive cytology CTNs: short axis (0.39 cm vs. 0.50 cm; P = 0.03) and long axis (1.64 cm vs. 2.35 cm; P = 0.021). The US features with the best accuracy to distinguish CTNs from abnormal LNs were continuity with a nervous structure, hypoechogenic internal lines, short/long axis ratio ≤ 0.42, absent Doppler vascularization, fusiform morphology, and short axis ≤ 0.48 cm. Conclusion: US is a very useful method for assessing CTNs, with good performance in distinguishing CTNs from abnormal LNs. Objective (CTNs carcinoma (LNs followup follow up US, , (US) fineneedle fine needle indicated methods 20 CTN s performed Results Eightsix Eight six analysis 3 4 100% 100 (100 vs 45% 45 0.008 0008 0 008 0.39 039 39 (0.3 050 50 0.5 0.03 003 03 1.64 164 1 64 (1.6 235 2 35 2.3 0.021. 0021 0.021 . 021 0.021) structure lines shortlong 042 42 0.42 vascularization morphology 048 0.4 Conclusion (US 10 (10 0.00 000 00 0.3 (0. 05 5 0. 0.0 1.6 16 6 (1. 23 2. 002 0.02 02 04 (1 (0 1. (

https://doi.org/10.20945/2359-3997000000633

Ultrasound-guided cervical selective nerve root block in the approach to cervical traumatic neuromas: a technical note
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Marcos, Vinícius Neves

; Kulcsar, Marco Aurelio Vamondes

; Hoff, Ana Oliveira

; Chammas, Maria Cristina

; Freitas, Ricardo Miguel Costa de

Radiologia Brasileira

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aug 2022, Volume 55 N. 4 Pages 267 - 269

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/0100-3984.2021.0173

Effects of glucocorticoids on interstitial glucose concentrations in individuals with hematologic cancer and without known diagnosis of diabetes: a pilot study
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Toyoshima, Marcos Tadashi Kakitani

; Cukier, Priscilla

; Souza, Alexandre Barbosa Câmara de

; Pereira, Juliana

; Hoff, Ana Oliveira

; Nery, Marcia

einstein (São Paulo)

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2022, Volume 20 elocation eAO8031

Abstract: En | Text: En | PDF: En

ABSTRACT Objective To analyze interstitial glucose behavior during glucocorticoid use in non-diabetic patients receiving chemotherapy for hematologic malignancies. Methods Prospective pilot study carried out to assess interstitial glucose levels in 15 non-diabetic individuals with hematologic malignancies who received glucocorticoids in combination with chemotherapy. The FreeStyle Libre flash monitoring system (Abbott Diabetes Care) was used for up to 14 days to measure interstitial glucose. Results Median age and body mass index were 53 (42-61) years and 25 (23-28) kg/m2 respectively. Interstitial glucose levels >180mg/dL lasting at least one hour were detected in 60% of participants. Interstitial glucose profile parameters (median and peak interstitial glucose levels and percentage of time during which interstitial glucose levels were >180mg/dL) were significantly (p<0.01) higher during glucocorticoid use (115mg/dL, 218mg/dL and 10% respectively) than after glucocorticoid discontinuation (97mg/dL, 137mg/dL and 0% respectively). Mean interstitial glucose levels increased in the afternoon and at night during glucocorticoid use. Conclusion This pilot study was the first to evaluate interstitial glucose levels in non-diabetic individuals using glucocorticoids in treatment of hematologic cancer. Glucocorticoid use during chemotherapy significantly increases interstitial glucose levels in these patients.

https://doi.org/10.31744/einstein_journal/2022ao8031

Valuable insights from real-life experiences of advanced thyroid cancer treatment with sorafenib in Latin America
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Farias, Evelin C.

; Hoff, Ana Oliveira

Archives of Endocrinology and Metabolism

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aug 2021, Volume 65 N. 4 Pages 401 - 403

Abstract: En | Text: En | PDF: En

https://doi.org/10.20945/2359-3997000000398 36 downloads

Thyroid collision tumor containing oncocytic carcinoma, classical and hobnail variants of papillary carcinoma and areas of poorly differentiated carcinoma
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Toyoshima, Marcos Tadashi Kakitani

; Domingues, Regina Barros

; Soares, Ibere Cauduro

; Danilovic, Debora Lucia Seguro

; Amorim, Larissa Costa

; Cavalcante, Edla R. C.

; Antonacio, Fernanda F.

; Roitberg, Felipe Santa Rosa

; Hoff, Ana Oliveira

Archives of Endocrinology and Metabolism

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aug 2021, Volume 65 N. 4 Pages 495 - 499

Abstract: En | Text: En | PDF: En

SUMMARY Collision tumors are rare and may comprise components with different behavior, treatments, and prognosis. We report an unprecedented case of aggressive thyroid collision tumor containing widely invasive oncocytic carcinoma (OC), classical and hobnail (HPTC) variants of papillary carcinoma, and poorly differentiated carcinoma (PDTC). The patient underwent total thyroidectomy, radioactive iodine therapy, and within months progressed with local recurrence, and pulmonary metastases requiring neck dissection, external radiotherapy and systemic treatment with sorafenib. The rapid progression, dedifferentiated metastatic lesions, and failure to treatments resulted in the patient´s death. The great variety of histological types and the evolution of this case were a challenge for the management of metastatic disease. Widely invasive OC, HPTC and PDTC are considered to have a worse prognosis. HPTC has never been reported as a component of a collision tumor. HPTC and PDTC should call attention to a possible higher-grade transformation.

https://doi.org/10.20945/2359-3997000000389 234 downloads

Diretriz Brasileira de Cardio-oncologia – 2020
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Hajjar, Ludhmila Abrahão

; Costa, Isabela Bispo Santos da Silva da

; Lopes, Marcelo Antônio Cartaxo Queiroga

; Hoff, Paulo Marcelo Gehm

; Diz, Maria Del Pilar Estevez

; Fonseca, Silvia Moulin Ribeiro

; Bittar, Cristina Salvadori

; Rehder, Marília Harumi Higuchi dos Santos

; Rizk, Stephanie Itala

; Almeida, Dirceu Rodrigues

; Fernandes, Gustavo dos Santos

; Beck-da-Silva, Luís

; Campos, Carlos Augusto Homem de Magalhães

; Montera, Marcelo Westerlund

; Alves, Sílvia Marinho Martins

; Fukushima, Júlia Tizue

; Santos, Maria Verônica Câmara dos

; Negrão, Carlos Eduardo

; Silva, Thiago Liguori Feliciano da

; Ferreira, Silvia Moreira Ayub

; Malachias, Marcus Vinicius Bolivar

; Moreira, Maria da Consolação Vieira

; Valente Neto, Manuel Maria Ramos

; Fonseca, Veronica Cristina Quiroga

; Soeiro, Maria Carolina Feres de Almeida

; Alves, Juliana Barbosa Sobral

; Silva, Carolina Maria Pinto Domingues Carvalho

; Sbano, João

; Pavanello, Ricardo

; Pinto, Ibraim Masciarelli F.

; Simão, Antônio Felipe

; Dracoulakis, Marianna Deway Andrade

; Hoff, Ana Oliveira

; Assunção, Bruna Morhy Borges Leal

; Novis, Yana

; Testa, Laura

; Alencar Filho, Aristóteles Comte de

; Cruz, Cecília Beatriz Bittencourt Viana

; Pereira, Juliana

; Garcia, Diego Ribeiro

; Nomura, Cesar Higa

; Rochitte, Carlos Eduardo

; Macedo, Ariane Vieira Scarlatelli

; Marcatti, Patricia Tavares Felipe

; Mathias Junior, Wilson

; Wiermann, Evanius Garcia

; Val, Renata do

; Freitas, Helano

; Coutinho, Anelisa

; Mathias, Clarissa Maria de Cerqueira

; Vieira, Fernando Meton de Alencar Camara

; Sasse, André Deeke

; Rocha, Vanderson

; Ramires, José Antônio Franchini

; Kalil Filho, Roberto

Arquivos Brasileiros de Cardiologia

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nov 2020, Volume 115 N. 5 Pages 1006 - 1043

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36660/abc.20201006 4180 downloads

Diagnostic performance of thyroid ultrasound in Hürthle cell carcinomas
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Santana, Nathalie Oliveira

; Freitas, Ricardo Miguel Costa

; Marcos, Vinicius Neves

; Chammas, Maria Cristina

; Camargo, Rosalinda Yossie Asato

; Schmerling, Cláudia Kliemann

; Vanderlei, Felipe Augusto Brasileiro

; Hoff, Ana Oliveira

; Marui, Suemi

; Danilovic, Debora Lucia Seguro

Archives of Endocrinology and Metabolism

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jun 2019, Volume 63 N. 3 Pages 300 - 305

Abstract: En | Text: En | PDF: En

ABSTRACT Objective Hürthle cell carcinomas (HCCs) of the thyroid have been recently reclassified as a separate entity due to their distinct clinical and molecular profiles. Few studies have assessed the ability of preoperative characteristics in differentiating HCCs from Hürthle cell adenomas (HCAs) due to the low prevalence of both lesions. This study aimed to compare the preoperative features of HCCs and HCAs and evaluate the diagnostic performance of ultrasound in distinguishing between both. Subjetcs and methods Retrospective study including 101 patients (52 HCCs and 49 HCAs) who underwent thyroid surgery from 2000 to 2016. Clinical, ultrasonographic, and histological data were reviewed. Diagnostic performance of suspicious sonographic features was analyzed in 51 cases (24 HCCs and 27 HCAs). Results Hürthle cell neoplasms were predominant in females. Subjects ≥ 55 years represented 58% of the cases of HCCs and 53% of those of HCAs. Carcinomas were significantly larger (p < 0.001), and a tumor size ≥ 4 cm significantly increased the risk of malignancy (odds ratio 3.67). Other clinical, cytologic, and sonographic data were similar between HCCs and HCAs. Among the HCCs, the lesions were purely solid in 54.2%, hypoechoic in 37.5%, and had coarse calcifications in 12.5%, microcalcifications in 8.3%, irregular contours in 4.2%, and a taller-than-wide shape in 16.7%. Predominantly/exclusive intranodular vascularization was observed in 52.6%. Overall, 58% of the HCCs were classified as TI-RADS 4 or 5 compared with 48% of the HCAs. TI-RADS 4 or 5 had a specificity of only 51.8% and a positive likelihood ratio of 1.21. Conclusions Apart from the lesion size, no other preoperative feature adequately distinguished HCCs from HCAs. Sonographic characteristics raising suspicion for malignancy, which are mostly present in papillary carcinomas, were infrequent in HCCs. New tools must be developed to improve preoperative diagnosis and deferral of surgery in cases of adenomas.

https://doi.org/10.20945/2359-3997000000131 1121 downloads

Neoplasia endócrina múltipla tipo 1: diagnóstico clínico, laboratorial e molecular e tratamento das doenças associadas
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Hoff, Ana Oliveira

; Hauache, Omar Magid

Arquivos Brasileiros de Endocrinologia & Metabologia

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oct 2005, Volume 49 N. 5 Pages 735 - 746

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

As síndromes de neoplasias endócrinas múltiplas (NEM) incluem as do tipo 1 (MEN 1) e 2 (MEN 2), a síndrome de von Hippel-Lindau, neurofibromatose tipo 1 e o complexo de Carney. Estas são síndromes genéticas complexas decorrentes de ativação ou inativação de diferentes tipos de genes envolvidos na regulação da proliferação celular. Nesta revisão, discutiremos as manifestações clínicas e o acompanhamento da MEN 1, assim como o rastreamento genético de potenciais portadores de alterações no gene MEN 1. A MEN 1 inclui o desenvolvimento de hiperparatiroidismo primário multifocal, tumores de ilhotas pancreáticas e adenomas de hipófise. Além disso, alguns pacientes podem apresentar manifestações cutâneas como angiofibromas e colagenomas e ainda podem desenvolver outras neoplasias como tumores carcinóides, tumores de tiróide, adenomas de adrenal, lipomas, feocromocitomas e meningiomas. A MEN 1 é uma síndrome hereditária, transmitida de forma autossômica dominante e causada por mutação inativadora do gene MEN 1. O gene MEN 1 codifica uma proteína denominada "menin", que é um gene supressor tumoral. Vários estudos demonstraram sua importância na regulação da proliferação celular e confirmaram seu papel na patogênese da MEN 1. A identificação do gene MEN 1 e sua análise genética resultaram na possibilidade de monitoração de pacientes que ainda não apresentam manifestações clínicas associadas a esta síndrome e diagnóstico precoce e tratamento dos pacientes afetados. Tais medidas poderão implicar em sobrevida maior para estes pacientes. Estudos adicionais visando uma melhor compreensão da função e dos mecanismos de sinalização da proteína "menin" poderão propiciar alternativas terapêuticas para os pacientes que evoluem com malignização de tumores relacionados à MEN 1, podendo resultar em maior sobrevida.

Multiple endocrine neoplasia (MEN) syndromes include types 1 (MEN 1) and 2 (MEN 2), von Hippel-Lindau syndrome, neurofibromatosis type 1 and Carney complex. These are complex genetic syndromes caused by activation or inactivation of different types of genes known to be involved in the regulation of cell proliferation. In this review we will discuss the clinical manifestations and management of the MEN 1 syndrome as well as the genetic screening of potential MEN 1 gene carriers. MEN 1 is a hereditary syndrome, transmitted in an autosomic dominant fashion and caused by an inactivating mutation of the MEN 1 gene, characterized by the development of primary hyperparathyroidism, islet cell tumors and pituitary adenomas. In addition, these patients can present with cutaneous manifestations such as angiofibromas and collagenomas, and can develop other neoplastic manifestations including carcinoids, thyroid tumors, adrenal adenomas, lipomas, pheochromocytomas and meningiomas. The MEN 1 gene encodes a peptide which is a tumor suppressor gene called menin. Several studies have demonstrated its importance in regulation of cell proliferation and have confirmed its role in the pathogenesis of the MEN 1 syndrome. The discovery of the MEN 1 gene and the genetic analysis of MEN 1 patients have resulted in earlier diagnosis and treatment of asymptomatic carriers which can potentially result in a longer survival of these patients. Further investigation of the function and signaling pathways of the menin protein will hopefully offer therapeutic alternatives to patients with malignant progression of MEN 1-related tumors and also result in improved survival.

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