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Minimally Invasive Radiofrequency Ablation for Large Thyroid Toxic Adenoma

Abstract

Background: Most thyroid nodules are benign and do not need intervention. Toxic adenoma and toxic multinodular goiter (MNG) are common causes of hyperthyroidism, second in prevalence only to Graves’ disease. Toxic adenoma and MNG are the result of focal or diffuse hyperplasia of thyroid follicular cells whose functional capacity is independent from regulation by the thyroid stimulating hormone (TSH). When conservative treatment modalities fail to ensure an euthyroid state, surgical intervention is required, typically surgical left or right thyroid lobectomy. Radiofrequency ablation (RFA) is a new percutaneous treatment option that results in thermal tissue necrosis and fibrosis. As a result of this process, the thyroid nodules shrink.

Case presentation: We describe a case of a young woman with a large toxic thyroid adenoma who refused surgery. She was admitted to a one-day surgery unit and underwent radiofrequency ablation under total intravenous anesthesia. Using “moving shot technique” the procedure went uneventfully and the toxic adenoma displayed a significant volume reduction with resolution of the hyperthyroid symptoms. The patient also reported a significant improvement of her neck symptoms (from 7/10 to 1/10 on a Visual Analogue Scale).

Conclusions: Radiofrequency ablation is a new, well tolerated, safe and effective treatment option in selected patients with benign thyroid nodules, toxic adenomas of the thyroid gland and multinodular goiter. To the best of our knowledge, this is the first time such treatment modality is used in Bulgaria.

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Incidental uptake of 18F-fluorocholine (FCH) in the head or in the neck of patients with prostate cancer

Abstract

Background. Positron emission tomography-computed tomography (PET/CT) with 18F-fluorocholine (FCH) is routinely performed in patients with prostate cancer. In this clinical context, foci of FCH uptake in the head or in the neck were considered as incidentalomas, except for those suggestive of multiple bone metastases.

Results. In 8 patients the incidental focus corresponded to a benign tumour. The standard of truth was histology in two cases, correlative imaging with MRI in four cases, 99mTc-SestaMIBI scintigraphy, ultrasonography and biochemistry in one case and biochemistry including PTH assay in one case. The final diagnosis of benign tumours consisted in 3 pituitary adenomas, 2 meningiomas, 2 hyperfunctioning parathyroid glands and 1 thyroid adenoma. Malignancy was proven histologically in 2 other patients: 1 papillary carcinoma of the thyroid and 1 cerebellar metastasis.

Conclusions. To the best of our knowledge, FCH uptake by pituitary adenomas or hyperfunctioning parathyroid glands has never been described previously. We thus discuss whether there might be a future indication for FCH PET/ CT when one such tumour is already known or suspected: to detect a residual or recurrent pituitary adenoma after surgery, to guide surgery or radiotherapy of a meningioma or to localise a hyperfunctioning parathyroid gland. In these potential indications, comparative studies with reference PET tracers or with 99mTc-sestaMIBI in case of hyperparathyroidism could be undertaken.

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Functional polymorphisms in antioxidant genes in Hurthle cell thyroid neoplasm - an association of GPX1 polymorphism and recurrent Hurthle cell thyroid carcinoma

-related mortality. 1 - 4 A definitive way to differentiate a HCTC from a benign Hurthle cell thyroid adenoma (HCTA) is based on vascular and/or transcapsular invasion. 5 - 9 For HCTA, a lobectomy is a sufficient surgical procedure. However, if a HCTC is diagnosed on histologic sections after a lobectomy, then a complete thyroidectomy is performed as a second surgical procedure. Therefore, when a follicular neoplasm is detected with a cytological analysis of material obtained by fine-needle aspiration biopsy, the use of predictive clinical 4 , 10 or genetic markers 11 has been

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Appearance of Hürthle cell carcinoma soon after surgical extirpation of Hürthle cell adenoma and follicular adenoma of the thyroid gland

Abstract

Background. Hürthle cell neoplasms could be benign (Hürthle cell adenoma) or malignant (Hürthle cell carcinoma). Hürthle cell carcinoma is a rare tumour, representing 5% of all differentiated thyroid carcinomas. The cytological evaluation of Hürthle cell neoplasms by fine needle aspiration biopsy (FNAB) is complicated because of the presence of Hürthle cells in both Hürthle cell adenoma and Hürthle cell carcinoma. Thus, the preoperative distinction between these two entities is very difficult and possible only with pathohistological findings of the removed tumour.

Case report. A 57-year old female patient was admitted at our Department, for investigation of nodular thyroid gland. She was euthyroid and FNAB of the nodules in both thyroid lobes were consistent of Hürthle cell adenoma with cellular atypias. After thyroidectomy the histopathology revealed Hürthle cell adenoma with high cellular content and discrete cellular atypias in the left lobe and follicular thyroid adenoma without cellular atypias in the right lobe. One year after substitution therapy, a palpable tumour on the left side of the remnant tissue was found, significantly growing with time, presented as hot nodule on 99mTc-sestamibi scan and conclusive with Hürthle cell adenoma with marked cellularity on FNAB. Tumorectomy was performed and well-differentiated Hürthle cell carcinoma detected. The patient received ablative dose of 100 mCi 131I. No signs of metastatic disease are present up to date.

Conclusions. The differences between Hürthle cell adenomas and Hürthle cell carcinomas could be clearly made only by histopathological evaluation. Patients with cytological diagnosis of Hürthle cell neoplasms should proceed to total thyroidectomy, especially if tumour size is > 1cm, FNAB findings comprise cellular atypias and/or multiple bilateral nodules are detected in the thyroid gland.

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Prevalence of feline hyperthyroidism in mature cats in urban population in Warsaw

.C. Feldman. Saunders Elsevier, St. Louis, 2010, pp. 1761-1779. 13. Olczak J., Jones B.R., Pfeiffer D.U., Squires R.A., Morris R.S., Markwell P.J.: Multivariate analysis of risk factors for feline hyperthyroidism in New Zealand. N Z Vet J 2005, 53, 53-58. 14. Peterson M.: Hyperthyroidism in cats: what's causing this epidemic of thyroid disease and can we prevent it? J Feline Med Surg 2012, 14, 804-818. 15. Peeters M.E., Timmermans-Sprang E.P.M., Mol J.A.: Feline thyroid adenomas are in part associated with mutations in the Gsα

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Applicability of thyroxine measurements and ultrasound imaging in evaluations of thyroid function in turtles

snakes. Am J Vet Res 2001, 62, 1750–1754. 8. Hernandez-Divers S.J., Knott C.D., MacDonald J.: Diagnosis and surgical treatment of thyroid adenoma induced hyperthyroidism in a green iguana ( Iguana iguana ). J Zoo Wildl Med 2001, 32, 465–475. 9. https://www.idexx.com/small-animal-health/directory-tests-services.html (accessed 10.01.2018) 10. Hugenberger J.L., Licht P.: Characterization of thyroid hormone 5′- monodeiodinase activity in the turtle ( Trachemys scripta ). Gen Comp Endocrinol 1999, 113, 343–359. 11. Hulbert A.J., Williams C

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