Neck Surgery for Non-Well Differentiated Thyroid Malignancies: Variations in Strategy According to Histopathology

Lymph node metastases in non-well differentiated thyroid cancer (non-WDTC) are common, both in the central compartment (levels VI and VII) and in the lateral neck (Levels II to V). Nodal metastases negatively affect prognosis and should be treated to maximize locoregional control while minimizing morbidity. In non-WDTC, the rate of nodal involvement is variable and depends on the histology of the tumor. For medullary thyroid carcinomas, poorly differentiated thyroid carcinomas, and anaplastic thyroid carcinomas, the high frequency of lymph node metastases makes central compartment dissection generally necessary. In mucoepidermoid carcinomas, malignant peripheral nerve sheath tumors, sarcomas, and malignant thyroid teratomas or thyroblastomas, central compartment dissection is less often necessary, as clinical lymphnode involvement is less common. We aim to summarize the medical literature and the opinions of several experts from different parts of the world on the current philosophy for managing the neck in less common types of thyroid cancer

Management of Recurrent Well-Differentiated Thyroid Carcinoma in the Neck: A Comprehensive Review

Surgery has been historically the preferred primary treatment for patients with well-differentiated thyroid carcinoma and for selected locoregional recurrences. Adjuvant therapy with radioactive iodine is typically recommended for patients with an intermediate to high risk of recurrence. Despite these treatments, locally advanced disease and locoregional relapses are not infrequent. These patients have a prolonged overall survival that may result in long periods of active disease and the possibility of requiring subsequent treatments. Recently, many new options have emerged as salvage therapies. This review offers a comprehensive discussion and considerations regarding surgery, active surveillance, radioactive iodine therapy, ultrasonography-guided percutaneous ablation, external beam radiotherapy, and systemic therapy for well-differentiated thyroid cancer based on relevant publications and current reference guidelines. We feel that the surgical member of the thyroid cancer management team is empowered by being aware and facile with all management options

Papillary Thyroid Cancer-Aggressive Variants and Impact on Management : A Narrative Review

Introduction Aggressive variants of papillary thyroid cancer (PTC) have been described with increasing frequency. These variants include diffuse sclerosing variant, tall cell variant, columnar cell variant, solid variant, and hobnail variant. Methods We have performed a review of the more aggressive variants of PTC with respect to main characteristics, histological and molecular features, and the consequences that the knowledge of these variants should have in the treatment of the patients. Results At the present time, we do not know the prognostic value of these aggressive PTC variants. The extent of the surgical treatment and adjuvant therapy necessary should be decided on the basis of the extent of the tumor at presentation and the opinion of experienced clinicians. Conclusion These aggressive variants should be known by clinicians, to avoid underdiagnosis, and treated according to the latest recommendations in the literature.Peer reviewe

Protective effects of curcumin against gamma radiation-induced ileal mucosal damage

The major objective of this study was to test curcumin as a potential radioprotectant for the ileum goblet cells of the rat. Wistar albino rats were used in the study. Group A was the control group and group B was the single dose radiation group. Group C was the two dose radiation group (4 days interval). The rats in groups D and E were given a daily dose of 100 mg/kg of curcumin for 14 and 18 days, respectively. During the curcumin administration period, the rats in group D were exposed to abdominal area gamma (γ)-ray dose of 5 Gy on the 10th day and group E was exposed to same dose radiation on the 10th and 14th day. Irradiation and treatment groups were decapitated on the 4th day after exposure to single or two-dose irradiation and ileum tissues were removed for light and electron microscopic investigation. Single or two dose 5 Gy γ-irradiation caused a marked intestinal mucosal injury in rats on the 4th day. Radiation produced increases in the number of goblet cells. Curcumin appears to have protective effects against radiation-induced damage, suggesting that clinical transfer is feasible

Routine inclusion of level IV in neck dissection for squamous cell carcinoma of the larynx: is it justified? Head Neck 2004;26: 309–312

Abstract: Background. Dissection of levels II -IV as part of an elective or therapeutic neck dissection is common practice during laryngectomy for laryngeal squamous cell carcinoma (SCC). The necessity of routine dissection at level IV has recently been questioned. The purpose of this study was to find the incidence of level IV metastases in patients with transglottic and supraglottic SCC who underwent neck dissections. Methods. The charts of 71 suitable patients were reviewed. Forty-two had supraglottic primary cancers, and 29 had transglottic primary tumors. Levels II -IV had been removed in them all, and their neck specimens were marked according to the levels of the neck. The surgical specimens were pathologically diagnosed. Results. Of 43 patients who underwent elective lateral neck dissection, the only one (2.3%) with level IV metastases also showed metastases at level II. Nine (32%) of the other 28 patients with clinical adenopathy had level IV metastases. Conclusions. Dissection of level IV as part of a therapeutic neck dissection for supraglottic and transglottic SCC is recommended for patients with clinically enlarged lymph nodes, but its necessity in the absence of detectable adenopathy is challenged.

Neuromonitorización de los nervios laríngeos en cirugía de tiroides: una valoración crítica de la literatura

12 páginasOne of the most significant complication of thyroid surgery is injury of the recurrent laryngeal nerve. Injury of the external branch of the superior laryngeal nerve is a less obvious but occasionally significant problem. Recently, neuromonitoring during thyroidectomy has received considerable attention because of literature encouraging its use, but there is no consensus about its advantages and utility. A critical assessment of the literature on neuromonitoring was conducted in order to define its effectiveness, safety, cost-effectiveness and medical-legal impact. Available data does not show results superior to those obtained by traditional anatomical methods of nerve identification during thyroid surgery. Data about cost-effectiveness is scarce. The literature shows inconsistencies in methodology, patient selection and randomization in various published studies which may confound the conclusions of individual investigations. The current recommendation for use in “high risk” patients should be assessed because definition heterogeneity makes identification of these patients difficult. As routine use of neuromonitoring varies according to geography, its use should not be considered to be the standard of care.Una de las complicaciones más importantes de la cirugía de tiroides es la lesión del nervio laríngeo recurrente. La lesión de la rama externa del nervio laríngeo superior es un problema menos evidente pero en ocasiones significativo. Recientemente, la neuromonitorización durante la tiroidectomía ha recibido considerable atención debido a la literatura que fomenta su uso, pero no hay consenso sobre sus ventajas y utilidad. Se realizó una evaluación crítica de la literatura sobre neuromonitorización para definir su eficacia, seguridad, coste-efectividad e impacto médico-legal. Los datos disponibles no muestran resultados superiores a los obtenidos mediante métodos anatómicos tradicionales de identificación de nervios durante la cirugía de tiroides. Los datos sobre la rentabilidad son escasos. La literatura muestra inconsistencias en la metodología, la selección de pacientes y la aleatorización en varios estudios publicados que pueden confundir las conclusiones de las investigaciones individuales. Se debe evaluar la recomendación actual para el uso en pacientes de “alto riesgo” porque la heterogeneidad de la definición dificulta la identificación de estos pacientes. Como el uso rutinario de la neuromonitorización varía según la geografía, su uso no debe considerarse como el estándar de atención

Do pathologic and molecular analyses of neck dissection specimens justify the preservation of level IV for laryngeal squamous carcinoma with clinically negative neck?

Since the first detailed description by Franciszek Jaw-dyn ́ski in 1888,1-4there have been many variations andmodifications of the radical neck dissection procedure.These include modified radical neck dissection (alsocalled functional neck dissection) and various selectiveneck dissections.5-6Analysis of the distribution of lymph node metastasesin patients with squamous carcinoma of the larynx re-veals a marked preference for levels II, III, and IV; levelsI and V are rarely involved.7-9Based on these observa-tions, lateral neck dissection has been recommended inpatients with necks staged as N0 or N1.10This meansremoving the upper jugular lymph nodes (level II), mid-dle jugular lymph nodes (level III), and lower jugularlymph nodes (level IV). Lateral neck dissection is alsodescribed as jugular node dissection by many surgeons.The need for routine dissection at level IV has re-cently been questioned.11This article discusses whethersparing level IV lymph nodes is justified on the strengthof pathologic and molecular studies on the pattern ofnodal metastasis in patients with squamous carcinomaof the larynx. In other words, dare we perform a selectiveneck dissection involving levels IIA and III for N0 necklaryngeal cancer to avoid potential complications such aschylous fistula or phrenic nerve injury