Familial papillary carcinoma of the thyroid: A report of nine first-degree relatives of four families

The authors report the occurrence of papillary carcinoma of the thyroid in nine first-degree relatives of four families among a consecutive series of 97 patients with papillary carcinoma of the thyroid who were operated on from 1991 to 1998. Total thyroidectomy was performed in all cases. All patients are alive without evidence of disease after a mean follow-up period of 43 months. Since in our series familial papillary carcinoma of the thyroid was found in 9.3% of patients, we suggest an adequate screening among first-degree relatives of all patients with papillary thyroid carcinoma. Because of reported aggressive behaviour of familial papillary carcinoma of the thyroid, aggressive surgical treatment plus post-operative thyroid remnant ablation with radio-iodine should be warranted in all patients. © 2000 Harcourt Publishers Ltd

Insular carcinoma of the thyroid. A report of 8 cases.

Insular carcinoma of the thyroid (ICT) is an uncommon malignancy with intermediate morphology and behaviour between well-differentiated and anaplastic thyroid carcinoma. Eight patients with ICT underwent total thyroidectomy. A modified neck dissection was carried out in six of them. Cervical lymph nodes metastases were detected during surgery in six patients or at scintigraphy in two patients who did not undergo neck dissection. Postoperatively, a patient developed diffuse metastases not detected by 131I whole-body scintigraphy and she died of disease 6 months later despite radio- and chemotherapy. Another patient had distant metastases detected by 131I whole-body scintigraphy and successfully treated by radioiodine ablative therapy. Unfortunately, she developed other distant metastases with no 131I uptake and died of disease 23 months later despite chemotherapy. After a mean follow-up of 5.5 years, 6 patients (75%) were alive without evidence of disease. These observations confirmed the aggressiveness of ICTs that sometimes are not responsive to current available therapies. The frequent occurrence of metastases to the regional lymph node calls on for a modified neck dissection in all patients with ICT

[Anastomosis or closure of the pancreatic stump after duodenopancreatectomy?].

From 1986 to June 1990, 10 pancreaticoduodenectomies were performed in our Department (VIII Patologia Chirurgica, Università "La Sapienza", Roma). The reconstructive sequence was based on the pancreaticojejunal anastomosis (2 end-to-end pancreaticojejunostomies after invagination, 3 end-to-side Wirsung jejunostomies) in 5 patients. The pancreatic stump was sutured using a 50mm linear stapler in the remaining 5 patients. There was a high incidence (75%) of fistulization after direct suture of the pancreatic stump, although related mortality was null. Among patients treated with pancreaticojejunal anastomosis, a fistula on the end-to-end pancreaticojejunostomy with exitus of the patient, was registered in 1 case. On principle, we believe a end-to-side Wirsung jejunostomy should be performed after pancreaticoduodenectomy. When a safe anastomosis of the pancreatic stump cannot be performed (because of the soft parenchyma, easily lacerable) the technique of the direct suture with stapler is advisable