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Active surveillance is a feasible and safe strategy in selected patients with papillary thyroid cancer and suspicious cervical lymph nodes detected after thyroidectomy
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Solórzano, Marlín

; Lustig, Nicole

; Mosso, Lorena

; Espinoza, Martín

; Santana, Roberto

; Gonzalez, Hernan

; Montero, Pablo H.

; Cruz, Francisco

; Solar, Antonieta

; Domínguez, José Miguel

Archives of Endocrinology and Metabolism

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2024, Volume 68 elocation e230146

Abstract: En | Text: En | PDF: En

ABSTRACT Objective: After initial treatment, up to 30% of patients with papillary thyroid cancer (PTC) have incomplete response, mainly cervical lymph node (LN) disease. Previous studies have suggested that active surveillance (AS) is a possible option for these patients. Our aim was to report the results of AS in patients with PTC and cervical LN disease. Materials and methods: In this retrospective observational study, we included adult patients treated and followed for PTC, who presented with cervical LN disease and were managed with AS. Growth was defined as an increase ≥ 3mm in either diameter. Results: We included 32 patients: 27 (84.4%) women, age of 39 ± 14 years, all initially treated with total thyroidectomy, and 22 (69%) with therapeutic neck dissection. Cervical LN disease was diagnosed 1 year (0.3-12.6) after initial management, with a diameter of 9.0 mm (6.0-19.0). After a median AS of 4.3 years (0.6-14.1), 4 (12.5%) patients had LN growth: 2 (50%) of whom were surgically removed, 1 (25%) was effectively treated with radiotherapy, and 1 (25%) had a scheduled surgery. Tg increase was the only predictive factor of LN growth evaluated as both the delta Tg (p < 0.0366) and percentage of Tg change (p < 0.0140). None of the included patients died, had local complications due to LN growth or salvage therapy, or developed distant metastases during follow-up. Conclusions: In selected patients with PTC and suspicious cervical LNs diagnosed after initial treatment, AS is a feasible and safe strategy as it allows effective identification and treatment of the minority of patients who progress. Objective 30 (PTC response (LN (AS methods study Results 3 84.4% 844 84 (84.4% women thyroidectomy 69% 69 (69% dissection 0.312.6 03126 0.3 12.6 0 12 6 (0.3-12.6 management 90 9 9. 6.019.0. 60190 6.0 19.0 . 19 (6.0-19.0) 43 4. 0.614.1, 06141 0.6 14.1 , (0.6-14.1) 12.5% 125 5 (12.5% 50% 50 (50% removed 25% 25 (25% radiotherapy surgery p 0.0366 00366 0366 0.0140. 00140 0.0140 0140 0.0140) died therapy followup. followup follow up. follow-up Conclusions progress 84.4 8 (84.4 (69 312 0.312. 0312 03 0. 126 12. (0.3-12. 019 6.019.0 6019 60 6. 190 19. (6.0-19.0 614 0.614.1 0614 06 141 14. (0.6-14.1 12.5 (12.5 (50 (25 0.036 0036 036 0014 0.014 014 84. (84. (6 31 0.312 031 (0.3-12 01 6.019. 601 (6.0-19. 61 0.614. 061 (0.6-14. (12. (5 (2 0.03 003 001 0.01 (84 ( 0.31 (0.3-1 6.019 (6.0-19 0.614 (0.6-14 (12 0.0 00 (8 (0.3- 6.01 (6.0-1 0.61 (0.6-1 (1 (0.3 (6.0- (0.6- (0. (6.0 (0.6 (0 (6.

https://doi.org/10.20945/2359-4292-2023-0146

Manifestaciones periodontales de la Granulomatosis de Wegener: Reporte de un caso clínico
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Tornel, Natalia

; Marín, Alejandro

; Solar, Antonieta

; Smith, Patricio

International journal of interdisciplinary dentistry

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aug 2023, Volume 16 N. 2 Pages 156 - 159

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

ABSTRACT: Wegener’s granulomatosis or granulomatosis with polyangiitis (GPA) is a disease characterized by inflammation and necrosis of the blood vessel walls. It is of unknown etiology, low prevalence and high degree of aggressiveness. This disease can compromise the oral tissues, causing enlargement and inflammation of the gingival tissues. The case of a male patient who presented rapidly growing gingival tissue enlargement and inflammatory characteristics associated with the diagnosis of Wegener’s granulomatosis is reported. The lesion was removed surgically and the diagnosis was achieved by combining the serological findings of the ANCA test, periodontal manifestations and histopathological analysis of the lesion. The patient was treated with methotrexate and corticosteroids and the lesion did not reappear after 2 years of control. In this article, the periodontal manifestations associated with GPA are analyzed, highlighting the importance of an adequate diagnosis of periodontal lesions characterized by gingival enlargement and inflammation.

RESUMEN: La granulomatosis de Wegener o granulomatosis con Poliangitis (GPA) es una enfermedad caracterizada por inflamación y necrosis de las paredes de los vasos sanguíneos. Es de etiología desconocida, baja prevalencia y alta agresividad. Esta enfermedad puede comprometer los tejidos bucales causando agrandamiento e inflamación del tejido gingival. Se reporta el caso de un paciente de género masculino que manifiesta aumento de volumen de la encía e inflamación asociado al diagnóstico de granulomatosis de Wegener. La lesión fue eliminada quirúrgicamente y el diagnóstico se logró al combinar los hallazgos serológicos del test ANCA, manifestaciones periodontales y análisis histopatológico. El paciente fue tratado con metotrexato y corticoesteroides y no presenta recidiva de la lesión luego de 2 años de control. En este artículo se analizan las manifestaciones periodontales asociadas a la GPA resaltando la importancia de un adecuado diagnóstico de lesiones periodontales caracterizadas por agradamiento gingival e inflamación.

https://doi.org/10.4067/s2452-55882023000200156

Puesta al día: carcinoma paratiroideo
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Barberán, Marcela

; Campusano, Claudia

; Salman, Patricio

; Trejo, Pamela

; Silva-Figueroa, Angélica

; Rivera, Sandra

; Florenzano, Pablo

; Velasco, Soledad

; Illanes, Francisca

; Trincado, Patricio

; Canessa, José

; Solar, Antonieta

; Moreno, Marcela

; Eugenin, Daniela

; Jiménez, Beatriz

; Arroyo, Patricia

Revista médica de Chile

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mar 2021, Volume 149 N. 3 Pages 399 - 408

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Parathyroid carcinoma is a rare malignant disease that presents as a sporadic or familial primary hyperparathyroidism (PHP). The latter is associated with some genetic syndromes. It occurs with equal frequency in both sexes, unlike PHP caused by parathyroid adenoma that is more common in women. It should be suspected in cases of severe hypercalcemia, with high parathyroid hormone levels and a palpable cervical mass. Given the difficulty in distinguishing between parathyroid carcinoma and adenoma prior to the surgery, the diagnosis is often made after parathyroidectomy. The only curative treatment is complete surgical resection with oncologic block resection of the primary tumor to ensure free margins. Adjuvant therapies with chemotherapy or radiation therapy do not modify overall or disease-free survival. Recurrences are common and re-operation of resectable recurrent disease is recommended. The palliative treatment of symptomatic hypercalcemia is crucial in persistent or recurrent disease after surgery since morbidity and mortality are more associated with hypercalcemia than with tumor burden.

https://doi.org/10.4067/s0034-98872021000300399 415 downloads

Warthin-like and classic papillary thyroid cancer have similar clinical presentation and prognosis
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Olmos, Roberto

; Muñoz, Francisco

; Donoso, Francisca

; López, Jorge

; Bruera, María José

; Ruiz-Esquide, Magdalena

; Mosso, Lorena

; Lustig, Nicole

; Solar, Antonieta

; Droppelmann, Nicolás

; Montero, Pablo H.

; González, Hernán E.

; Domínguez, José Miguel

Archives of Endocrinology and Metabolism

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oct 2020, Volume 64 N. 5 Pages 542 - 547

Abstract: En | Text: En | PDF: En

ABSTRACT Objective Warthin-like papillary thyroid cancer (WL-PTC) is an uncommon variant of PTC, usually associated with lymphocytic thyroiditis. Scarce evidence suggests that WL-PTC has similar clinical presentation to classic PTC (C-PTC), with no studies comparing risks of recurrence and response to treatment between both variants. Our objective was to describe the clinical presentation and prognosis of WL-PTC and compare it to C-PTC. Subjects and methods Retrospective analysis of a prospective cohort, including 370 (96%) patients with C-PTC and 17 (4%) with WL-PTC, consecutively treated with total thyroidectomy with or without RAI, followed for at least 6 months. We compared clinical presentation, risk of mortality and recurrence, as well as response to treatment between both variants. Results Of the total cohort: 317 (82%) female, 38 ± 13.5 years, median follow-up 4 years (0.5-28.5); most of them stage I and low/intermediate risk of recurrence. We found no differences regarding clinical-pathological data and risk of recurrence. WL-PTC was associated with a higher rate of anti-thyroglobulin antibodies (TgAb) (65% vs. 36%, p = 0.016) and lymphocytic thyroiditis (59% vs. 34%, p = 0.03). The rates of biochemical and structural incomplete responses were similar in both variants. WL-PTC had a lower rate of excellent response (23% vs. 54%, p = 0.01), which became non-significant when performing analysis by TgAb presence (50% vs. 67%, p = NS). Conclusions WL-CPT and C-CPT have similar clinical presentation and rate of recurrence. The lower rate of excellent response to treatment in WL-PTC is due to a higher frequency of TgAb. WL-PCT should not be considered an aggressive variant of PTC.

https://doi.org/10.20945/2359-3997000000270 436 downloads

Metástasis pancreática como debut de carcinoma papilar de tiroides. Caso clínico y revisión del perfil clínico patológico y molecular
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Uslar, Thomas

; Chahuán, Javier

; Olmos, Roberto

; Rodríguez, Carolina

; Astudillo, Rocio

; Zoroquiain, Pablo

; Solar, Antonieta

; Espino, Alberto

; León, Augusto

; Fardella, Carlos

; Domínguez, José Miguel

Revista médica de Chile

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jul 2020, Volume 148 N. 7 Pages 1025 - 1030

Abstract: Es | Text: Es | PDF: Es

Pancreatic metastases of papillary thyroid carcinoma (PTC) are exceptional. We report a 80-year-old man consulting for obstructive jaundice and dysphonia. Abdominal ultrasonography showed biliary dilation and abdominal magnetic resonance imaging (MRI) showed a pancreatic head mass of 36 mm. A left vocal cord paralysis was confirmed and cervical computed tomography (CT) showed multiple thyroid nodules of up to 35 mm associated with bilateral cervical lymph nodes (LN). Positron emission tomography ( 18 F-FDG PET/CT) evidenced hyper-metabolic activity in bilateral cervical LN, lungs, pancreas and left intercostal soft tissue, as well as left gluteus. Thyroid biopsy reported a tall-cell variant of PTC, and endoscopic ultrasound guided fine needle aspiration (EUS-FNA) of pancreatic mass confirmed PTC metastasis. The molecular study was positive for BRAFV600E. Pancreatic metastasis from PTC can be accurately diagnosed with 18 F-FDG PET/CT and EUS-FNA, which is consistent with a predominant expression of BRAFV600E mutation and, thus, an aggressive presentation with poor short-term survival.

991 downloads

Estudio y manejo de nódulos tiroideos por médicos no especialistas. Consenso SOCHED
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Tala, Hernán

; Díaz, René E.

; Domínguez Ruiz-Tagle, José Miguel

; Sapunar Zenteno, Jorge

; Pineda, Pedro

; Arroyo Albala, Patricia

; Barberán, Marcela

; Cabané, Patricio

; Cruz Olivos, Francisco

; Gac, Patricio E.

; Glasinovic Pizarro, Andrea

; González, Hernán E.

; Grob, Francisca

; Hidalgo Valle, Maria Soledad

; Jaimovich, Rodrigo

; Lanas, Alejandra

; Liberman, Claudio

; Lobo Guiñez, Maite

; Madrid, Arturo

; Moreno Seguel, Marcela

; Mosso, Lorena

; Munizaga, Fernando C.

; Ortiz Parada, Eugenia

; Osorio Gonnet, Fernando

; Slater Morales, Jeannie

; Solar, Antonieta

; Stehr, Carlos

; Vásquez Rodríguez, Félix

; Véliz, Jesús

; Villaseca Najarian, Roberto

; Wohllk, Nelson

Revista médica de Chile

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aug 2017, Volume 145 N. 8 Pages 1028 - 1037

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

The thyroid nodule is a frequent cause of primary care consultation. The prevalence of a palpable thyroid nodule is approximately 4-7%, increasing up to 67% by the incidental detection of nodules on ultrasound. The vast majority are benign and asymptomatic, staying stable over time. The clinical importance of studying a thyroid nodule is to exclude thyroid cancer, which occurs in 5 to 10% of the nodules. The Board of SOCHED (Chilean Society of Endocrinology and Diabetes) asked the Thyroid Study Group to develop a consensus regarding the diagnostic management of the thyroid nodule in Chile, aimed at non-specialist physicians and adapted to the national reality. To this end, a multidisciplinary group of 31 experts was established among university academics, active researchers with publications on the subject and prominent members of scientific societies of endocrinology, head and neck surgery, pathology and radiology. A total of 14 questions were developed with key aspects for the diagnosis and subsequent referral of patients with thyroid nodules, which were addressed by the participants. In those areas where the evidence was insufficient or the national reality had to be considered, the consensus opinion of the experts was used through the Delphi methodology. The consensus was approved by the SOCHED board for publication.

https://doi.org/10.4067/s0034-98872017000801028 28478 downloads

Concordancia de la citología por punción con aguja fina para la detección de cáncer de tiroides en pediatría
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Grob, Francisca

; Carrillo, Diego

; Martínez-Aguayo, Alejandro

; Zoroquain, Pablo

; Solar, Antonieta

; Nicolaides, Irini

; González, Hernán

Revista médica de Chile

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mar 2014, Volume 142 N. 3 Pages 330 - 335

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Background: Despite the low frequency of thyroid nodules (TN) in children, one of every four is malignant. Fine-needle aspiration cytology (FNAC) has a high accuracy detecting thyroid cancer. Aim: To evaluate the performance of FNAC in TN in Chilean children to detect thyroid cancer. Patients and Methods: The pathological reports of 77 thyroidectomies and 103 FNAC carried out in patients aged less than 18 years, between 2002 and 2013 were reviewed. In 36 patients aged 15 ± 2 years (77% women), both the reports of the thyroidectomy and FNAC were available. The cytological specimens were reclassified based on Bethesda 2010. The histology was classified as benign (nodular hyperplasia and follicular adenoma, n = 18), or malignant (papillary, follicular and medullar carcinoma, n = 18). The concordance of the cytology with the final biopsy report was calculated. Results: FNAC classified 13 specimens as definitively benign and 13 as definitively malignant. Among these, these concordances with the pathological study of the biopsy was 100%. Of six cytology tests considered "suspicious for follicular neoplasm" by FNAC, four were benign (67%), and two malignant (33%). Of four cytology tests considered "suggestive of carcinoma" by FNAC, one was benign (25%), and three malignant (75%). Conclusions: Among the studied children, there was a good concordance between FNAC and surgical biopsies. Therefore a FNAC should be carried out when malignancy is suspected in pediatric patients with a TN.

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Del macro al microcarcinoma tiroideo: cambios en las características de presentación del cáncer de tiroides en un centro universitario chileno en 20 años
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Mosso, Lorena

; Campusano, Claudia

; González, Hernán

; Domínguez, José Miguel

; Salman, Patricio

; Suazo, Valeria

; Solar, Antonieta

; Cerda, Jaime

Revista médica de Chile

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apr 2013, Volume 141 N. 4 Pages 442 - 448

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Background: The prevalence of thyroid cancer has increased, particularly in nodules smaller than 10 mm, probably due to the growing use of routine thyroid ultrasound. There is controversy about the biological behavior of micro carcinomas and the relevance of their early detection. Aim: To characterize the clinical presentation of thyroid cancer over 20 years in an University medical center and to evaluate the differences between macro and micro carcinomas. Patients and Methods: We reviewed 1547 surgical biopsy records of thyroid cancer in our institution obtained between 1991 and 2010. Results: We observed a sustained increase in the rate of thyroidectomies for thyroid cancer (per 1000 surgical procedures) in the study period. Papillary, follicular, mixed, medullary and anaplastic carcinomas were observed in 95, 3, 2, 0.5 and 0.1% of biopsies, respectively. The incidence of tumors of less than 10 mm (micro carcinoma) also increased. Those findings were associated with a significant decrease in tumor aggressiveness, determined by a low frequency of surgical margin involvement of thyroid capsule, perithyroid tissue invasion, vascular permeation and lymph node metastases. Conclusions: The increased prevalence of thyroid cancer, especially of micro carcinomas, may reflect the greater use of diagnostic ultrasound or represent a real change in the biological behavior of this disease and our data suggest that further studies are needed to know the impact of early treatment in the outcome of those patients because of the real less histologic agressiveness of micro carcinomas.

4518 downloads Cited 2 times in SciELO

Hallazgos anatomopatológicos definitivos en pacientes tiroidectomizados con diagnóstico preoperatorio de neoplasia folicular
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Goñi E, Ignacio

; Krsulovic R, Claudio

; León R, Augusto

; González D, Hernán

; Solar, Antonieta

; Campusano M, Claudia

; Ruiz A, Catalina

Revista chilena de cirugía

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apr 2012, Volume 64 N. 2 Pages 128 - 132

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Background: The finding of follicular neoplasm, using a FNAP, is an indication for partial or total thyroidectomy, to obtain the definitive malignant or benign histology. Frequently, it is possible to identify significant additional histological diagnosis. Aim: To obtain the definitive histological findings in patients with follicular neoplasm by FNAP. Patients and Method: Transversal analysis of 133 patients that underwent to total thyroidectomy between 2003 and 2009, that filled de requirements for adequate histological assessment. Results: In 33.1% of the treated patients the final diagnosis was indeed a follicular neoplasm (adenoma in 26.3% and cancer in 6.8%). In the 51.9% the finding was follicular colloidal hyperplasia and other thyroid cancer in 8.3%. The total malignant prevalence in the whole gland was 29.3%. Conclusions: The thyroidec-tomy is the treatment of choice and the final diagnostic procedure for these patients. The histological findings of cancer different from follicular not only in the punctioned nodule are a secondary and an additional argument for reinforcing the surgical indication.

Introducción: El hallazgo de una neoplasia folicular por PAAF, obliga a realizar una tiroidectomía parcial o total, para definir la naturaleza maligna o benigna definitiva de la lesión tiroidea. Junto a este diagnóstico preoperatorio se identifican finalmente con alta frecuencia lesiones histológicas adicionales. Objetivo: Conocer y describir los hallazgos anatomopatológicos definitivos que se encuentran en tiroidectomías por neoplasias foliculares diagnosticadas por PAAF. Materiales y Métodos: Revisión transversal de las biopsias definitivas de 133 pacientes sometidos a tiroidectomía total entre 2003 y 2009, que cumplieron los requisitos establecidos para evaluar la histología definitiva del nódulo puncionado y de la glándula tiroides completa. Resultados: En el 33,1% de los pacientes el diagnóstico definitivo del nódulo puncionado fue efectivamente una neoplasia folicular (adenoma en el 26,3% y cáncer en el 6,8%). El 51,9% correspondió a hiperplasia folicular y el 8,3% otro cáncer. La prevalencia de malignidad final en la glándula completa fue de un 29,3%. Conclusiones: Siendo la indicación de tiroidectomía en estos pacientes un tratamiento y procedimiento diagnóstico aceptado y necesario, se concluye que la alta prevalencia de lesiones malignas (29,3%) tanto en el nódulo puncionado como, adicionalmente, en el resto de la glándula, reforzaría la necesidad de este tratamiento quirúrgico.

5144 downloads

10.

Diseño de una escala ecográfica predictora de malignidad en nódulos tiroideos: Comunicación preliminar
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Domínguez, José Miguel

; Baudrand, René

; Arteaga, Eugenio

; Campusano, Claudia

; González, Gilberto

; Mosso, Lorena

; Cavada, Gabriel

; Cruz, Francisco

; Torres, Javiera

; Solar, Antonieta

; Arias, Tatiana

; Pizarro, Alejandra

; Gómez, Marcelo

; Fardella, Carlos

Revista médica de Chile

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aug 2009, Volume 137 N. 8 Pages 1031 - 1036

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Background: Thyroid nodules are common and associated to a low risk of malignancy. Their clinical assessment usually includes a fine neddle aspiration biopsy (FNAB). Aim To identify ultrasonographic characteristics associated to papillary thyroid carcinoma (PTC) and generate a score that predicts the risk of PTC. Material and methods: Retrospective review of all fine needle aspiration biopsies of the thyroid performed in a lapse of two years. Biopsies that were conclusive for PTC were selected and compared with an equal amount of randomly selected biopsies that disclosed a benign diagnosis. Results: One hundred twenty two biopsies of a total of 1,498 were conclusive for PTC. Univariate analysis showed associations with PTC for the presence of micro-calcifications (Odds ratio (OR) 49.2: 95% confidence intervals (CI) 18.7-140.9), solid predominance (OR 25.1; 95% CI 6-220), hypoechogenicity (OR 23.5, 95% CI 6.5-122.6), irregular borders (OR 17, 95% CI 7.2-42.9), lymph node involvement (OR 12.3, 95% CI2.7-112), central vascularization (OR 12.2, 95% CI 4.8-33.3), local invasion and hyperechogenicity (OR 0.2; CI95% CI 0.03-0.6). Multivariate analysis disclosed microcalcifications (OR 28.1; CI 95% 8.9-89), hypoechogenicity (OR 9.4; 95% CI 1.5-59.5) and irregular borders (OR 4.7; CI 95% 1.5-15) as the variables independently associated with the presence of PTC. The prevalence of PTC in the presence of the three variables was 97.6% (Likelihood ratio (LR) 45) and 5.4% in their absence (LR 0.06). Conclusions: This scale predicts the presence or absence of PTC using simple ultrasound characteristics.

5140 downloads

11.

Carcinoma familiar del tiroides no medular (CFTNM): características de presentación en 17 casos
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Mosso, Lorena

; Velasco, Soledad

; Salazar, Iván

; Solar, Antonieta

; González, Hernán

; Cardona, Belinda

; Fardella, Carlos

; González, Gilberto

; López, José Manuel

; Rodríguez, José Adolfo

; Cruz, Francisco

; Arteaga, Eugenio

Revista médica de Chile

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jun 2007, Volume 135 N. 6 Pages 718 - 724

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Background: Papillary thyroid carcinoma can have familial aggregation. Aim: To compare retrospectively familial non medullary thyroid carcinoma (FNMTC) with sporadic papillary thyroid carcinoma (PTC). Material and methods: Retrospective analysis of medical records of patients with thyroid carcinoma. An index case was defined as a subject with the diagnosis of differentiated thyroid carcinoma with one or more first degree relatives with the same type of cancer. Seventeen such patients were identified and were compared with 352 subjects with PTC. Results: The most common affected relatives were sisters. Patients with FNMTC were younger than those with PTC. No differences were observed in gender, single or multiple foci, thyroid capsule involvement, surgical border involvement, number of affected lymph nodes and coexistence of follicular hyperplasia. Patients with FNMTC had smaller tumors and had a nine times more common association with lymphocytic thyroiditis. Five patients with FNMTC had local recurrence during 4.8 years of follow up. Conclusions: Patients with FNMTC commonly have an associated chronic thyroiditis, are younger and have smaller tumors than patients with PTC

4929 downloads Cited 1 time in SciELO

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ta	journal short title (e.g. Cad. Saúde Pública)
journal_title	journal full title (e.g. Cadernos de Saúde Pública)
la	publication language code (e.g. pt - Portuguese, es - Spanish)
type	document type
pid	publication identifier
publication_year	publication year of publication
sponsor	sponsor
aff_country	country code of the author's affiliation
aff_institution	author affiliation institution
volume	article volume
issue	article issue
elocation	elocation
doi	DOI number
issn	journal ISSN
in	SciELO colection code (e.g. scl - Brasil, col - Colômbia)
use_license	article usage license code

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