Occult Micro Medullary Thyroid Carcinoma: Therapeutic Strategy and Follow-up
Autor: | Petra Braun, Mansour El Khazen, Nicole Berger, Masood Saadat, Jean Louis Peix, Frédérique Mancini |
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Rok vydání: | 2000 |
Předmět: |
Adult
Male Reoperation medicine.medical_specialty Goiter Medullary cavity medicine.medical_treatment Diagnosis Differential Thyroid carcinoma medicine Humans Postoperative Period Thyroid Neoplasms Aged Aged 80 and over business.industry Biopsy Needle Thyroid Thyroidectomy Neck dissection Middle Aged medicine.disease Surgery Treatment Outcome medicine.anatomical_structure Medullary carcinoma Carcinoma Medullary Female Lymphadenectomy Tomography X-Ray Computed business Follow-Up Studies |
Zdroj: | World Journal of Surgery. 24:1373-1376 |
ISSN: | 1432-2323 0364-2313 |
Popis: | Twenty micro medullary thyroid carcinomas (MTCs) were found in histologic specimens of 19 patients in our department from 1990 to 1998. There were 14 women and 5 men, with a median age of 63 years. The indication for surgery was goiter in 12 patients and a solitary nodule in 7 patients (three differentiated cancers). Altogether, 18 patients had unifocal micro-MTCs with a median diameter of 3.6 mm. One patient had a bilateral MTC (3 and 5 mm, respectively). Surgical procedures consisted of 9 total thyroidectomies and 10 lobectomies or subtotal thyroidectomies. Of these 10 patients, 4 underwent reoperation (totalization). One was operated on 48 months after a positive pentagastrin test: There was no thyroid residual tumor but three lymph node micrometastases. Among the six patients in whom thyroid tissue was left, a 91-year-old woman died of unrelated cause and the five others remain disease-free without biologic abnormalities at follow-ups of 18 to 70 months. Considering the aggressiveness of MTCs, total thyroidectomy with central compartment dissection is theoretically indicated. However, among the nine total thyroidectomies and four secondary totalizations associated with at least central compartment dissection, no other thyroid lesion was observed and only one case of lymph node microinvasion was found. Because of the morbidity associated with reoperation and neck dissection, we propose that it is indicated only for microcarcinomas > 5 mm in diameter, in cases of an abnormal response to pentagastrin, or when it is difficult to ensure prolonged follow-up of the patient. |
Databáze: | OpenAIRE |
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