Pendrin expression in nodular and non-nodular thyroid tissues

Introduction: Different mechanisms for the expression of pendrin which is an apical iodide transporter have been reported in nodular thyroid tissues compared to normal thyroid. The aim of the present study was to determine the alterations of pendrin expression in nodular and surrounding non-nodular thyroid tissues and clarify the role of pendrin in the functional behaviour of nodular lesions. Material and methods: Twenty-six nodular and paired non-nodular normal thyroid tissues were collected at the same centre. Patients were divided into two groups based on the function of the dominant thyroid nodule; hot nodules (n = 18) and cold nodules (n = 8). mRNA levels of pendrin were evaluated by quantitative RT-PCR. Pendrin protein expression was determined by immunohistochemical analysis. Results of dominant nodules were compared to non-nodular thyroid tissue of the same patient. Results: No statistically significant difference was found with respect to qualitative and quantitative measurements of pendrin expression between hot and cold nodules. However, percent immunohistochemical staining of pendrin was significantly higher in both hot and cold nodules compared to non-nodular thyroid tissue of the same patients. RT-PCR revealed comparable mRNA levels of pendrin gene between hot nodules and corresponding normal thyroid tissues. However, in cold nodules, significantly decreased mRNA levels of pendrin were observed compared to normal thyroid tissue. mRNA levels of pendrin showed significant positive correlation with TSH in corresponding non-nodular thyroid tissues. Conclusions: The present study demonstrates that expression of pendrin could not be influenced by TSH in thyroid nodules and expression level of pendrin seems not to have an effect on nodule function. (Endokrynol Pol 2013; 64 (3): 208–214)Wstęp: W guzkowej tkance tarczycowej opisano odmienny od pozaguzkowej tkanki tarczycowej mechanizm ekspresji pendryny — transportera jodu zlokalizowanego w części szczytowej komórki. Celem badania było ustalenie zmian w ekspresji pendryny w guzkowej tkance tarczycowej i otaczającej ją pozaguzkowej tkance tarczycowej, aby wyjaśnić rolę pendryny w zachowaniu czynnościowym zmian guzkowych. Materiał i metody: W tym samym ośrodku pobrano 26 wycinków guzkowej tkanki tarczycowej i sparowanych wycinków pozaguzkowej prawidłowej tkanki tarczycowej. Pacjentów podzielono na dwie grupy w zależności od statusu czynnościowego guzka dominującego: grupę z guzkami gorącymi (n = 18) i grupę z guzkami zimnymi (n = 8). Poziom mRNA i pendryny oznaczono ilościowo metodą RT-PCR. Ekspresję białka pendryny oznaczono metodą immunohistochemiczną. Wyniki dla guzków dominujących porównano z wynikami dla tkanki pozaguzkowej u tego samego pacjenta. Wyniki: Nie stwierdzono statystycznie znamiennych różnic pomiędzy guzkami gorącymi i zimnymi, jeżeli chodzi o wyniki oznaczenia ilościowego i jakościowego ekspresji pendryny. Procentowe barwienie immunohistochemiczne w kierunku pendryny było natomiast znamiennie większe zarówno w przypadku guzków gorących, jak i zimnych w porównaniu z tkanką pozaguzkową u tych samych pacjentów. RT-PCR wykazało porównywalne poziomy mRNA genu kodującego pendrynę w guzkach gorących i prawidłowej tkance tarczycowej u tych samych pacjentów. Z kolei w przypadku guzków zimnych stwierdzono znamiennie niższe poziomy pendryny w porównaniu z prawidłową tkanką tarczycową. Stwierdzono też korelację dodatnią poziomu mRNA pendryny i poziomu TSH w korespondujących tkankach pozaguzkowych. Wnioski: W przeprowadzonym badaniu wykazano, że na ekspresję pendryny nie może mieć wpływu TSH w guzkach tarczycy oraz że poziom ekspresji pendryny nie wydaje się wpływać na czynność guzków. (Endokrynol Pol 2013; 64 (3):208–214

An unusual finding after adrenal surgery: a case series of adrenal schwannomas

Adrenal schwannomas are rare benign tumors with no specific imaging and laboratory findings to diagnose preoperatively. Due to the limited number of cases in the literature, clinical, imaging, and pathological findings are presented in this study. Case 1 is a 61-year-old woman patient who has a 31-mm mass in the right adrenal gland. This mass was nonfunctional; in imaging studies, this mass had a cystic necrotic component, and high 18-fluorodeoxyglucose (FDG) uptake was seen. There was no metaiodobenzylguanidine (MIBG) uptake. Laparoscopic transabdominal right adrenalectomy was performed, and the pathology result was consistent with adrenal schwannomas. Case 2 is a 63-year-old man patient who presented with a 38-mm mass in the left adrenal gland. This mass was nonfunctional and similar to that in Case 1; this mass had a cystic component. Laparoscopic transabdominal left adrenalectomy was performed. The diagnosis of adrenal schwannoma with degeneration was revealed. Case 3 was a 72-year-old woman patient admitted to the hospital for a 125-mm left adrenal mass. Similar to Case 1, this mass also had a cystic necrotic component in imaging studies. High FDG uptake was seen, and the patient underwent conventional adrenalectomy due to the suspicion of malignancy. After pathological evaluation, a diagnosis of adrenal schwannoma was made. A main diagnostic challenge in adrenal schwannomas is the preoperative diagnosis. These masses have no pathognomonic finding or specific hormonal function. Imaging findings of these masses may increase the suspicion of malignancy, which may affect decisions for surgery and the surgical technique

Bilateral patterns and motor function of the extralaryngeal branching of the recurrent laryngeal nerve

Purpose To evaluate the bilateral patterns and motor function of the extralaryngeal branches (ELB) of the recurrent laryngeal nerve(RLN)

Multicentricity Is More Common in Thyroid Papillary Microcancer with a Preoperative Diagnosis Compared to Incidental Microcancer.

Objective: Although multicentricity is a common feature of thyroid papillary microcancer, it might be difficult to predict this histopathological feature preoperatively. Methods: The records of 306 papillary microcancer patients who underwent thyroidectomy were evaluated. Papillary microcancer was diagnosed as an incidental histopathological finding in 242 (group 1), and by preoperative fine-needle aspiration biopsy in 64 (group 2). Demographic data and histopathological features were compared between the two groups. Results: Age (44 +/- 11.4 vs. 43 +/- 14 years) and male/female ratio (44/193 vs. 12/52) showed no significant difference between groups 1 and 2 (p > 0.05). Mean tumor size was significantly larger in group 2 (5.2 +/- 2.8 mm) compared to group 1 (3.7 +/- 2.4 mm) (p = 0.004). The frequency of thyroid capsule invasion (44 vs. 19%, p = 0.0001), microscopic extrathyroidal invasion (25 vs. 10%, p = 0.004) and multicentricity (44 vs. 29%, p = 0.04), and bilateral lobar involvement (22 vs. 10%, p = 0.0001) was significantly higher in group 2 compared to group 1. Conclusion: Multicentricity with bilateral lobar involvement and aggressive histopathological features are more frequent in papillary microcancer patients diagnosed with preoperative fine-needle aspiration biopsy compared to papillary microcancer diagnosed as postoperative incidental histopathological finding

Preoperative adrenal artery embolization followed by surgical excision of giant hypervascular adrenal masses: report of three cases

Background: Transcatheter arterial embolization (TAE) is an effective minimally invasive adjunct to surgery for the management and/or palliation of adrenal tumors

Surgical Treatment in Papillary Thyroid Microcarcinom

Despite the notable increasing incidence of papillary thyroid microcarcinoma (PTMC), the optimal treatment of the patients with PTMC remains controversial. Because of no consensus about its treatment, the suggested treatment varies from active surveillance alone to total thyroidectomy. Although the 2015 revised American Thyroid Association guideline recommends hemithyroidectomy as the first-line treatment, active surveillance has also been discussed and accepted as another approach for the patients with PTMC. However, the same guideline does not recommend fine needle aspiration biopsy for nodules sized <1 cm, even it is suspicious. In such situation, neither active surveillance nor hemithyroidectomy could be discussed, with a lack of objective cytologic data about the nodules sized <1 cm. In this situation, the decision to perform FNAB to the nodules <1 cm in size depends on the performer of the thyroid ultrasonography

The Change in Surgical Practice from Subtotal to Near-Total or Total Thyroidectomy in the Treatment of Patients with Benign Multinodular Goiter

Although total thyroidectomy is the procedure of choice in patients with thyroid carcinoma, this surgical approach has emerged as a surgical option to treat patients with benign multinodular goiter (BMNG), especially in endemically iodine-deficient regions. The aim of this study was to review our experience with patients with BMNG in an endemically iodine-deficient region treated by either subtotal or total/near-total thyroidectomy, and to document whether total or near-total thyroidectomy decreased the rate of completion thyroidectomy for incidentally diagnosed thyroid carcinoma in comparison to the patients with BMNG treated initially by subtotal thyroidectomy

The mechanisms of recurrent laryngeal nerve injury during thyroidectomy and the impact of continuous intraoperative nerve monitoring on surgical strategy

Objective: To evaluate the mechanisms of recurrent laryngeal nerve (RLN) injury during thyroidectomy and the impact of continuous intraoperative nerve monitoring (C-IONM) on surgical strategy

Single-incision laparoscopic adrenalectomy.

Background The aim of this study was to compare outcome measures between conventional transabdominal laparoscopic adrenalectomy and single-incision laparoscopic adrenalectomy (SILA)