Expressão de proteínas SMAD, mediadores da sinalização de TGF-beta/activina, em tecidos de tiroide humana

OBJECTIVE: To investigate the expression of SMAD proteins in human thyroid tissues since the inactivation of TGF-β/activin signaling components is reported in several types of cancer. Phosphorylated SMAD 2 and SMAD3 (pSMAD2/3) associated with the SMAD4 induce the signal transduction generated by TGF-β and activin, while SMAD7 inhibits this intracellular signaling. Although TGF-β and activin exert antiproliferative roles in thyroid follicular cells, thyroid tumors express high levels of these proteins. MATERIALS AND METHODS: The protein expression of SMADs was evaluated in multinodular goiter, follicular adenoma, papillary and follicular carcinomas by immunohistochemistry. RESULTS: The expression of pSMAD2/3, SMAD4 and SMAD7 was observed in both benign and malignant thyroid tumors. Although pSMAD2/3, SMAD4 and SMAD7 exhibited high cytoplasmic staining in carcinomas, the nuclear staining of pSMAD2/3 was not different between benign and malignant lesions. CONCLUSIONS: The finding of SMADs expression in thyroid cells and the presence of pSMAD2/3 and SMAD4 proteins in the nucleus of tumor cells indicates propagation of TGF-β/activin signaling. However, the high expression of the inhibitory SMAD7, mostly in malignant tumors, could contribute to the attenuation of the SMADs antiproliferative signaling in thyroid carcinomas.OBJETIVO: Investigar a expressão de proteínas SMAD em tecidos de tiroide humana desde que a inativação dos componentes da sinalização de TGF-β/activina é relatada em diversos tipos de câncer. SMAD 2 e SMAD3 fosforilados (pSMAD2/3) associados com SMAD4 induzem a transmissão do sinal gerado por TGF-β e activina, enquanto SMAD7 inibe essa sinalização intracelular. Embora TGF-β e activina exerçam efeitos antiproliferativos nas células foliculares da tiroide, tumores de tiroide expressam altos níveis dessas proteínas. MATERIAIS E MÉTODOS: A expressão proteica de SMADs foi avaliada em bócio multinodular, adenoma folicular, carcinomas papilífero e folicular por imuno-histoquímica. RESULTADOS: A expressão de pSMAD2/3, SMAD4 e SMAD7 foi observada tanto em tumores benignos como malignos da tiroide. Embora pSMAD2/3, SMAD4 e SMAD7 exibissem alta positividade citoplasmática em carcinomas, a positividade nuclear de pSMAD2/3 não foi diferente entre lesões benignas e malignas da tiroide. CONCLUSÕES: O achado da expressão de SMADs em células tiroidianas e a presença das proteínas pSMAD2/3 e SMAD4 no núcleo de células tumorais indicam propagação da sinalização TGF-β/activina. Contudo, a alta expressão de SMAD7 inibitório, principalmente em tumores malignos, poderia contribuir para atenuação da sinalização antiproliferativa de SMADs em carcinomas de tiroide.(FAPESP) São Paulo Research Foundation(CAPES) Coordination for the Improvement of Higher Education PersonnelCNPq National Counsel of Technological and Scientific Developmen

Latin American Thyroid Society Recommendations For The Management Of Thyroid Nodules [recomendações Da Sociedade Latino-americana De Tireoide No Manejo De Nódulos Tireoideos]

Several guidelines on diagnosis and treatment of thyroid nodules and cancer have recently been published. However, recommended practices are not always appropriate to different settings or countries. The aim of this consensus was to develop Clinical Guidelines for evaluation and management of patients with thyroid nodules applicable to Latin American countries. The panel was composed by 13 members of the Latin American Thyroid Society involved with research and management of thyroid nodules and cancer from different medical centers in Latin America. The consensus was produced based on the expert opinion of the panel with use of principles of evidence-based medicine. Following a group meeting, a first draft based on the expert opinion of the panel was elaborated and later circulated among panel members for further revision. After revision, this document was submitted to all LATS members for commentaries and considerations and finally revised and refined by the authors. The final recommendations represent state of the art on management of thyroid nodules applied to all Latin American countries. © ABE&M todos os direitos reservados.53911671175Villena, J., Pretell, E., Bocio nodular tóxico en pacientes de zonas yodo deficientes y de la costa (1991) Rev Méd Hered, 2 (4), pp. 149-155Villena, J., Ferrufino, J.C., Klinge, G., Nódulo tireoideo frio. Características clínicas y anatomopatológicas en pacientes migrantes de zonas con deficiencia de yodo y de la costa (1993) Rev Méd Hered, 4 (4), pp. 188-193Harach, H.R., Ceballos, G.A., Thyroid cancer, thyroiditis and dietary iodine: A review based on the Salta, Argentina model (2008) Endocr Pathol, 19 (4), pp. 209-220Pretell, E.A., Delange, F., Hostalek, U., Corigliano, S., Barreda, L., Higa, A.M., Iodine nutrition improves in Latin America (2004) Thyroid, 14 (8), pp. 595-604Harach, H.R., Franssila, K.O., Wasenius, V.M., Occult papillary carcinoma of the thyroid. A "normal" finding in Finland. A systematic autopsy study (1985) Cancer, 56 (3), pp. 531-538Rosai, J., Livolsi, V.A., Sobrinho-Simoes, M., Williams, E.D., Renaming papillary microcarcinoma of the thyroid gland: The Porto proposal (2003) Int J Surg Pathol, 11 (4), pp. 249-251Hay, I.D., Grant, C.S., van Heerden, J.A., Goellner, J.R., Ebersold, J.R., Bergstralh, E.J., Papillary thyroid microcarcinoma: A study of 535 cases observed in a 50-year period (1992) Surgery, 112 (6), pp. 1139-1146Jukkola, A., Bloigu, R., Ebeling, T., Salmela, P., Blanco, G., Prognostic factors in differentiated thyroid carcinomas and their implications for current staging classifications (2004) Endocr Relat Cancer, 11 (3), pp. 571-579Passler, C., Scheuba, C., Prager, G., Kaczirek, K., Kaserer, K., Zettinig, G., Prognostic factors of papillary and follicular thyroid cancer: Differences in an iodine-replete endemic goiter region (2004) Endocr Relat Cancer, 11 (1), pp. 131-139Rossi, R., Roti, E., Trasforini, G., Pansini, G., Cavazzini, L., Zatelli, M.C., Differentiated thyroid cancers 11-20 mm in diameter have clinical and histopathologic characteristics suggesting higher aggressiveness than those ≤ 10 mm (2008) Thyroid, 18 (3), pp. 309-315Curtis, R.E., Rowlings, P.A., Deeg, H.J., Shriner, D.A., Socie, G., Travis, L.B., Solid cancers after bone marrow transplantation (1997) N Engl J Med, 336 (13), pp. 897-904Sippel, R.S., Caron, N.R., Clark, O.H., An evidence-based approach to familial nonmedullary thyroid cancer: Screening, clinical management, and follow-up (2007) World J Surg, 31 (5), pp. 924-933Pacini, F., Pinchera, A., Giani, C., Grasso, L., Doveri, F., Baschieri, L., Serum thyroglobulin in thyroid carcinoma and other thyroid disorders (1980) J Endocrinol Invest, 3 (3), pp. 283-292Niccoli, P., Wion-Barbot, N., Caron, P., Henry, J.F., de Micco, C., Saint Andre, J.P., Interest of routine measurement of serum calcitonin: Study in a large series of thyroidectomized patients. The French Medullary Study Group (1997) J Clin Endocrinol Metab, 82 (2), pp. 338-341Gagel, R.F., Hoff, A.O., Cote, G.J., Medullary thyroid carcinoma (2005) Werner and Ingbar's the Thyroid: A Fundamental and Clinical Text, pp. 967-988. , In: Lewis E, Robert D, Sidney H, Sidney C, (Eds)., Philadelphia: Lippincott Williams and WilkinsPapini, E., Guglielmi, R., Bianchini, A., Crescenzi, A., Taccogna, S., Nardi, F., Risk of malignancy in nonpalpable thyroid nodules: Predictive value of ultrasound and color-Doppler features (2002) J Clin Endocrinol Metab, 87 (5), pp. 1941-1946Camargo, R.Y., Tomimori, E.K., Knobel, M., Medeiros-Neto, G., Preoperative assessment of thyroid nodules: Role of ultrasonography and fine needle aspiration biopsy followed by cytology (2007) Clinics, 62 (4), pp. 411-418Kang, H.W., No, J.H., Chung, J.H., Min, Y.K., Lee, M.S., Lee, M.K., Prevalence, clinical and ultrasonographic characteristics of thyroid incidentalomas (2004) Thyroid, 14 (1), pp. 29-33Shimura, H., Haraguchi, K., Hiejima, Y., Fukunari, N., Fujimoto, Y., Katagiri, M., Distinct diagnostic criteria for ultrasonographic examination of papillary thyroid carcinoma: A multicenter study (2005) Thyroid, 15 (3), pp. 251-258Cappelli, C., Castellano, M., Pirola, I., Cumetti, D., Agosti, B., Gandossi, E., The predictive value of ultrasound findings in the management of thyroid nodules (2007) Qjm, 100 (1), pp. 29-35Holden, A., The role of colour and duplex Doppler ultrasound in the assessment of thyroid nodules (1995) Australas Radiol, 39 (4), pp. 343-349Papini, E., Guglielmi, R., Bianchini, A., Crescenzi, A., Taccogna, S., Nardi, F., Risk of malignancy in nonpalpable thyroid nodules: Predictive value of ultrasound and color-Doppler features (2002) J Clin Endocrinol Metab, 87 (5), pp. 1941-1946Chammas, M.C., Gerhard, R., de Oliveira, I.R., Widman, A., de Barros, N., Durazzo, M., Thyroid nodules: Evaluation with power Doppler and duplex Doppler ultrasound (2005) Otolaryngol Head Neck Surg, 132 (6), pp. 874-882Frates, M.C., Benson, C.B., Doubilet, P.M., Cibas, E.S., Marqusee, E., Can color Doppler sonography aid in the prediction of malignancy of thyroid nodules? 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Anatomic Landmarks for Localization of the Spinal Accessory Nerve

This anatomical study examines the anatomic topography and landmarks for localization of the spinal accessory nerve (SAN) during surgical dissections in 40 fresh human cadavers (2 females and 38 males; ages from 22 to 89 years with a mean of 60 years). In the submandibular region, the SAN was found anteriorly to the transverse process of the atlas in 77.5% of the dissections. When the SAN crossed the posterior belly of the digastric muscle, the mean distance from the point of crossing to the tendon of the muscle was 1.75 +/- 0.54 cm. Distally, the SAN crossed between the two heads of the SCM muscle in 45% of the dissections and deep to the muscle in 55%. The SAN exited the posterior border of the sternocleidomastoid muscle in a point superior to the nerve point with a mean distance between these two anatomic parameters of 0.97 +/- 0.46 cm. The mean overall extracranial length of the SAN was 12.02 +/- 2.32 cm, whereas the mean length of the SAN in the posterior triangle was 5.27 +/- 1.52 cm. There were 2-10 lymph nodes in the SAN chain. In conclusion, the nerve point is one of the most reliable anatomic landmarks for localization of the SAN in surgical neck dissections. Although other anatomic parameters including the transverse process of the atlas and the digastric muscle can also be used to localize the SAN, the surgeon should be aware of the possibility of anatomic variations of those parameters. Similar to previous investigations, our results suggest that the number of lymph nodes of the SAN chain greatly varies. Clin. Anat. 22:471-475, 2009. (c) 2009 Wiley-Liss, Inc

Recommendations Of The Latin American Thyroid Society On Diagnosis And Management Of Differentiated Thyroid Cancer [recomendações Da Sociedade Latino-americana De Tireoide Para Diagnóstico E Manejo Do Carcinoma Diferenciado De Tireoide]

The aims of these recommendations were to develop clinical guidelines for evaluation and mana-gement of patients with differentiated thyroid cancer applicable to Latin American countries. The panel was composed by 13 members of the Latin American Thyroid Society (LATS) involved with research and management of thyroid cancer from different medical centers in Latin America. The recommendations were produced on the basis of the expert opinion of the panel with use of prin-ciples of Evidence-Based Medicine. Following a group meeting, a first draft based on evidences and the expert opinions of the panel was elaborated and, later, circulated among panel members, for further revision. After, this document was submitted to the LATS members, for commentaries and considerations, and, finally, revised and refined by the authors. The final recommendations presented in this paper represent the state of the art on management of differentiated thyroid cancer applied to all Latin American countries.537884897Harach, H.R., Ceballos, G.A., Thyroid cancer, thyroiditis and dietary iodine: A review based on the Salta, Argentina model (2008) Endocr Pathol, 19 (4), pp. 209-20Pretell, E.A., Delange, F., Hostalek, U., Corigliano, S., Barreda, L., Higa, A.M., Iodine nutrition improves in Latin America (2004) Thyroid, 14 (8), pp. 595-604Davies, L., Welch, H.G., Increasing incidence of thyroid cancer in the United States, 1973-2002 (2006) JAMA, 295 (18), pp. 2164-7Harach, H.R., Franssila, K.O., Wasenius, V.M., Occult papillary carcinoma of the thyroid. A "normal" finding in Finland. 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Retrospective study from 1953 to 1994. 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