Evaluation of lymph node reactivity in differentiated thyroid carcinoma

Autor: Marilene Paladino Rosas, Ali Amar, Abrão Rapoport
Rok vydání: 1999
Předmět:
Zdroj: Sao Paulo Medical Journal, Volume: 117, Issue: 3, Pages: 125-128, Published: 06 MAY 1999
São Paulo Medical Journal, Vol 117, Iss 3, Pp 125-128 (1999)
Sao Paulo Medical Journal v.117 n.3 1999
São Paulo medical journal
Associação Paulista de Medicina
instacron:APM
ISSN: 1516-3180
DOI: 10.1590/s1516-31801999000300006
Popis: CONTEXT: The development of metastases is the most notable characteristic of malignant neoplasias. The filter function of lymph nodes, which led to the idea of including lymphatic treatment in surgical management of metastases. OBJECTIVES: To evaluate morphological alterations in neck nodes in the presence of differentiated thyroid carcinoma (DTC): hyperplasia, histiocytosis, desmoplasia, capsular rupture, necrosis and their relation to the biological behavior of these neoplasias. DESIGN: Retrospective study. SETTING: University referral unit. PARTICIPANTS: 98 DTC patients, from 1977 to 1992, 18 cases were selected for histological analyses, of which 14 were female and 4 males, with an average age of 50.2 years. From these cases, 290 lymph nodes were analyzed (81 with metastasis), with an average of 16 lymph nodes/patient. MAIN MEASUREMENTS: Morphological evaluation of paraffin cuts stained by HE was done using an optical microscope, looking for presence of the abovementioned neoplasias and their UICC-TNM (1997) staging. RESULTS: Sinus histiocytosis was 2.4 times more frequent in the absence of lymph node metastasis (pNo). Disease recurrence occurred in 5 patients, all of whom were more than 40 years old (p= 0.24) and 4 of whom had necrosis (p= 0.02). Six patients with predominance of paracortical hyperplasia (p= 0.02) did not show as much relapse into disease as those with less than 6 metastasis lymph nodes (p= 0.009). CONCLUSIONS: The presence of paracortical hyperplasia is associated with a better prognosis. The existence of necrosis or metastasis in more than 6 lymph nodes in patients over 40 years of age is related to higher risk of relapse of disease in DTC. OBJETIVOS: Verificar as alterações morfológicas desencadeadas nos linfonodos cervicais na presença de carcinoma diferenciado da tireóide (CDT), estabelecendo a relação entre os achados: hiperplasia (folicular, paracortical, sinusal e mista), histiocitose, desmoplasia, ruptura capsular, necrose, calcificação e o comportamento biológico destas neoplasias.LOCAL: Serviço de cirurgia de cabeça e pescoço do Hospital Heliópolis. MÉTODO: 18 pacientes com CDT foram submetidos a esvaziamento cervical (recurrencial ou modificado) de 1977 à 1988. VARIÁVEIS ESTUDADAS: Foram analisados 290 linfonodos, sendo 81 metastáticos (24,4%) - média de 16 linfonodos por paciente. Foram analisados pela coloração HE e avaliados parâmetros como hiperplasia (folicular, paracortical, sinusal e mista), desmoplasia, histiocitose, ruptura capsular, necrose e calcificação) e estadiados pelo TNM do UICC de 1997. RESULTADOS: a histiocitose sinusal foi 2,4 vezes mais freqüente nos linfonodos sem metástases (pNo). A recidiva da doença ocorreu em 5 pacientes, todos com idade maior ou igual a 40 anos (p=0,24), dos quais 4 apresentavam necrose linfonodal (p=0,02). Os pacientes com hiperplasia paracortical não desenvolveram recidiva da doença (p=0,02), da mesma forma como aqueles com 6 linfonodos metastáticos (p=0,009). CONCLUSÕES: a presença de histiocitose tem relação inversa com a presença de metástase no linfonodo, e a hiperplasia paracortical associa-se a um melhor prognóstico. A existência de necrose ou metástase em 6 ou + linfonodos, em pacientes com idade acima de 40 anos, associa-se à recidiva da doença.
Databáze: OpenAIRE
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