Proteomic approach used in the diagnosis of Riedel's thyroiditis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Riedel's thyroiditis, a rare thyroid disease, can be difficult to diagnose prior to surgical removal and can be confused with malignancy both clinically and cytologically.</p> <p>Case presentation</p> <p>We report the case of a 72-year-old Caucasian woman who presented with a goiter, which showed a rapid increase in size at ultrasound check, suggesting malignancy. Because of inconclusive cytology, a total thyroidectomy was performed. Fine-needle aspiration of the removed thyroid was processed by two-dimensional electrophoresis, and the proteome was compared with both anaplastic cancer and control samples. Significant differentially expressed protein spots were identified by Western blot analysis by using specific antibodies.</p> <p>Conclusions</p> <p>The protein pattern of Riedel's fine-needle aspiration revealed a superimposition with that of the control samples. The comparison of the protein pattern of Riedel's thyroiditis fine-needle aspiration with that of anaplastic cancer showed evidence of a different expression of ferritin heavy chains, ferritin light chains, and haptoglobins, as previously reported in thyroid cancers. Therefore, we performed Western blot analysis of these proteins and validated that their expression levels were low or absent in Riedel's thyroiditis and control samples despite the high concentrations present in fine-needle aspiration anaplastic samples. The concurrent absent or low expression levels of haptoglobin, ferritin light chain, and ferritin heavy chain in Riedel's thyroiditis fine-needle aspiration samples strongly indicate the benign nature of the thyroid lesion. These results suggest the potential applicability of fine-needle aspiration proteome analysis for Riedel's thyroiditis diagnosis.</p

Inferior vena cava duplication

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Thyroid surgery complications

Thyroidectomy is a well standardized procedure. Currently mortality rate is reduced close to zero and its complications are not worrisome. Technical progress and wide attention to the cosmetic results have pushed the development of new surgical techniques, namely Minimal Invasive Video Assisted thyroidectomy (MIVAT) and transaxillary robotic thyroidectomy. MIVAT can be considered a miniaturization of traditional cervicotomic approach with a similar spectrum of complications. In the literature have been described a subcutaneous reimplant from a benign goiter. With the transaxillary approach the spectrum of complications have been broadened with tunnel associated problems and the position of the arm. One of the authors (MP) have observed a neoplastic reimplant in the tunnel. The main complications of the classic thyroidectomy are: • Acute post-operative hemorrage with compressive hematoma: this causes asphyxia, that requests emergency decompression. When bleeding is less dramatic we observe a subcutaneous hematoma, which determines a visible lump without respiratory problems • Hypocalcemia is routinely checked and can be symptomatic or a laboratory diagnosis, associated with overt symptoms or not. The asymptomatic one can be a mild form of hypoparathyroidism, deserving some forms of treatment or can reflect a low protein level: this does not deserve any treatment. • Recurrent laryngeal nerve injury can be transient or permanent, unilateral or bilateral: the last is one of the most dramatic acute event in thyroid surgery. In the recent years many surgeons have suggested the use of neuromonitoring (NIM) to reduce the incidence of nerve palsy and more to avoid bilateral palsy with a staged thyroidectomy. Other complication of thyroid surgery are: • wound problems, like seroma, infection, cutaneous sensitive neck problems and a bad scar • swallowing disorders • chilous fistula • Horner syndrome • tracheal or esophageal injury Further peculiar complications are associated to the dissection of lateral compartment of the neck

Neck lesions mimicking thyroid pathology

Abstract INTRODUCTION: Nodular lesions within the neck may origin from several structures. A misdiagnosed origin may expose the surgeon to inappropriate procedures. These lesions are paradoxically frequent in high specialised centre for endocrine surgery. PATIENTS AND METHODS: In the year 2006, three patients were first admitted to our department with a diagnosis of thyroid nodule (1) or lymphatic metastases of thyroid carcinoma (2). The first patient had ultrasound (US) and Tc-99-m scan orienting for thyroid nodule. The two other patients, presented with lateral neck lesion in ipsilateral sincronous and previous diagnosis of papillary thyroid carcinoma, respectively, with US and computed tomography scan confirmed lesion but with a FNA cytology negative for tumoural cells. RESULTS: All three patients underwent surgical exploration. In the first two cases, a whitish tender nodule (4 and 4.5cm), cleavable from surrounding structures, was removed with final histology of Schwannoma and Paraganglioma, respectively. Both patients experienced Bernard Horner Syndrome. In the last patients, a firm grey nodule of 5cm strictly adherent to muscular planes was removed with diagnosis of Castleman's Disease. CONCLUSIONS: Nodular neck lesions mimicking a thyroid pathology (thyroid nodules or metastatic lymph nodes) are rare but can represent a tough challenge for surgeons who might fall into incorrect surgical approaches, resulting in high morbidity. Pre-operative work-up would help the surgeon to obtain the correct diagnosis, thus, to follow the better surgical approach. Nevertheless, a careful approach would be used for that neurogenic tumour amenable of resection without jeopardising nervous structure

The Halsted operation versus modified radical mastectomy: usefulness of patient selection as a function of the type and site of the tumor.

Abstract ystematic analysis of the pectoral muscle and fascia disclosed neoplastic infiltration in 6.2% of our stage T2a cases. Accordingly the authors propose a Halsted type resection in all cases staged T3, T2b and T2a when the tumor is located deep in the gland

Small bowel angiodysplasia: usefulness of peroperative enteroscopy

Abstract In this report the Authors present the case of an old patient treated for chronic recurrent bleeding from small bowel angiodysplasia. The diagnosis was missed by the conventional methods: angiography and scintiscan with marked erythrocytes. Diagnosis was instead possible by using intraoperative enteroscopy. The Authors stress the usefulness of this technique that permits the exploration of the mucosal by trans-illumination to discover bleeding and vascular anomalies of the bowel

Thyroid carcinoma in intrathoracic goiter Langenbeck's

Abstract INTRODUCTION: Most cases of intrathoracic goiter can be managed by cervical incision alone. A thoracic approach may be needed when adhesions or an anomalous blood supply are present or carcinoma is suspected. PATIENTS AND METHODS: Only 44 patients out of 5263 operated on for goiter needed a thoracic incision. A sternotomy was performed in 29 cases and a thoracotomy in 15; a malignancy was present in 9 cases. Symptoms, surgical approach, histology, survival and pTN staging of these 9 patients were reviewed and discussed; no perioperative mortality was observed. DISCUSSION: A thoracic approach is more frequently needed for treatment of intrathoracic thyroid carcinoma as it offers a greater chance of radical excision and better control of intraoperative bleeding. Histologically, thyroid carcinoma in intrathoracic goiter is often anaplastic or rare and has a poor long-term survival rate when compared to cervical forms