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Purpose Total or near-total thyroidectomy is advocated in reducing the recurrence rate and improving survival in differentiated thyroid carcinoma. However, this potential benefit could be seen in all patient groups or only in the patients who have multifocal disease. We analyzed the clinical significance of occult multifocal disease in patients with completion thyroidectomy. Patients and methods Ninety-seven patients in whom the completion thyroidectomy was performed within 6 months were included. The patients were grouped according to whether they have malignancy in the remnant thyroid tissue. The groups were examined and compared according to patients and tumor characteristics. The effect of the presence of residual tumor in remnant thyroid tissue on clinical course, disease-free survival, and overall survival were evaluated as well. Results After completion thyroidectomy, 20 (20.6%) of the 97 patients revealed additional cancer focus in the residual tissue. Median follow-up period was 104 months (range, 84–205 months). Only tumor multifocality in the resected lobe after first surgery was predictive of the presence of malignancy in the thyroid remnant ( P = .002; relative risk, 4.9; 95% confidence interval, 1.7–14.5). Detection of malignancy in the remnant thyroid tissue did not affect the disease-free survival ( P = .39). There were no deaths in patients who underwent reoperative thyroid surgery. Conclusions Only tumor multifocality in the original thyroid lobe was predictive of finding additional cancer in the contralateral lobe. However, clinical significance of occult multifocal disease was not shown.

Fine needle aspiration cytology of a thyroid nodule with Hürthle cells can be present in both benign and malignant diseases of the thyroid. The aim of this study was to identify the factors that predict malignancy in patients who underwent thyroidectomy with a preoperative fine needle aspiration cytology that contains a predominance of Hürthle cells.Retrospective data collection.Tertiary referral center.Medical records of 70 consecutive patients were reviewed between March 2005 and August 2010. Predictive factors, as well as age, gender, preoperative serum thyroid-stimulating hormone level, the microscopic findings of fine needle aspiration, ultrasonographic appearance, and size and number of nodules in the pathology report, were correlated with final histopathologic diagnosis of benign or malignant disease.Patients' final pathology showed that 21 patients (30%) had malignant disease, of whom 15 patients (71.4%) had papillary carcinoma and 6 patients (28.6%) had Hürthle cell carcinoma. Forty-nine (70%) patients had benign disease (hyperplastic/adenomatoid nodule in 24 patients, Hashimoto thyroiditis in 18 patients, Hürthle cell adenoma in 5 patients, and follicular adenoma in 2 patients). The rate of malignancy was higher in male patients (42.9% vs 28.6%), with nodules measuring ≥2 cm (36.7% vs 25.0%), the presence of a solitary nodule (34.3% vs 27.7%), and the presence of metaplasia in fine needle aspiration (36.4% vs 27.1%), although none was found to be significant (P.05).Thyroid nodules that are reported in cytology as Hürthle cell lesions require surgery to differentiate benign from malignant disease.

BackgroundLeptin has physiological roles in multiple systems, and has possible effects on several carcinogenesis steps. The aim of this study was to investigate the leptin levels in thyroid papillary carcinoma (TPC) patients.MethodsForty-three female TPC patients and 30 healthy female control subjects were recruited for the study. TPC was diagnosed by fine needle aspiration biopsy. TPC patients had a bilateral total thyroidectomy operation and their leptin levels were measured before and 20 days after the operation.ResultsSerum leptin levels of TPC patients were higher than in control group subjects (21.15 ± 14.12 ng/mL vs. 9.89 ± 0.21 ng/mL, p < 0.05). The leptin levels decreased after total thyroidectomy (13.92 ± 10.55 ng/mL) compared to prethyroidectomy levels (22.94 ± 14.67 ng/mL) in 34 patients who came to the follow-up visit (p < 0.05). However, the decreased post-thyroidectomy levels of leptin were still statistically significantly higher than the control group levels. Multivariate regression analysis showed that the leptin levels in TPC patients were not related to age, menopausal status or pathologic occult status but were directly related to the cancer group.ConclusionLeptin levels were elevated in thyroid cancer, decreased after total thyroidectomy, and might be associated with thyroid papillary carcinogenesis.

Endothelin-1 [ET-1] acts as a growth factor in various malignancies. Big endothelin-1 (big ET-1) is the precursor of ET-1. The aim of this study was to determine the importance of serum big ET-1 levels as a novel marker of disease in female patients with breast cancer of various clinical stages. The study consisted of 75 female patients with breast cancer who were diagnosed and treated at the Gazi University Department of Medical Oncology and 20 controls. The patients were classified as follows: group A [n=26], patients with newly diagnosed primary breast cancer but without metastasis; group B [n=33], patients with metastatic breast cancer who had undergone treatment for their diseases and in whom metastasis was detected during follow-up; group C [n=16], off-therapy patients whose cancer had been in remission for at least 5 years; and group D [n=20] healthy controls. Serum big ET-1 level were measured with an enzyme immunoassay kit. The median serum big ET-1 levels of the 75 patients with breast cancer [10.96 +/- 1.36 ng/ml] were statistically significantly higher than those of controls [8.97 +/- 1.55 ng/ml]. The median serum big ET-1 levels of the patients with primary breast cancer patients [group A] were statistically significantly different from those in the controls, the off-therapy patients and the patients with metastatic disease [11.56 +/- 0.78 ng/ml, 8.97 1.55 ng/ml, 9.76 +/- 1.52 ng/ml, and 10.83 +/- 1.18 ng/ml respectively, P=.001]. There was no statistically significant difference in the serum big ET-1 levels of patients in group A in terms of tumor stage, hormone receptor status or lymph node status. Serum big ET-1 levels were statistically significantly higher in patients with metastatic disease than in controls or off-therapy patients (P=.001). The serum big ET-1 levels of off-therapy patients whose disease was in remission were not statistically significantly different from those in controls (P>.05). Serum big ET-1 levels seemed to represent the activation of ET-1 in female patients with breast cancer. Serum big ET-1 levels can be an indicator of the breast cancer. Further studies are needed to demonstrate the prognostic importance of serum big ET-1 in patients with breast cancer. (C) 2008 Elsevier B.V. All rights reserved.

The aim of this study was to determine the importance of serum neopterin level in female patients with breast cancer of various clinical stages. The study consisted of 75 female patients with breast cancer who were diagnosed and treated at the Gazi University Department of Medical Oncology. The patients were classified into three representative groups and a control group: group A (n = 26), patients with newly diagnosed primary breast cancer and without metastasis; group B (n = 33), patients with metastatic breast cancer who had undergone treatment for their diseases and on whom metastasis was detected during their follow-up; group C (n = 16), off-therapy patient whose cancer had been in remission for at least 5 years; group D (n = 20) healthy controls. The median serum neopterin levels of the 75 patients with breast cancer 11.0 (range, 0-23.6) nmol/L were significantly higher than those of controls (8.3 (range, 1.2-12.0) nmol/L). In group B patients, neopterin levels (12.6 (range, 0-23.6) nmol/L) were statistically significantly higher than those of controls, primary breast cancer patients, and off-therapy patients (P < .05). In group B, patients with visceral metastases had higher neopterin levels than did those with bone or local metastases; however, that difference was not statistically significant. The median serum neopterin levels of the primary breast cancer patients in group A (8.8 (range, 0-20) nmol/l) were not statistically significantly different from those in controls and off-therapy patients. Serum neopterin levels were significantly elevated in patients with metastatic breast cancer. Neopterin seems to be an indicator of metastatic cancer rather than a marker for local cancer. In patients with metastatic breast cancer, determining the serum neopterin levels may be useful in estimating survival; however, additional long-term follow-up will be needed.

The oxidation of protein plays an essential role in the pathogenesis of an important number of degenerative and cancer diseases, which is now widely recognized. The aim is to examine advanced oxidation protein products (AOPPs), lipid peroxidation products malondialdehyde (MDA), and ferrous oxidation in xylenol orange (FOX) in blood samples of papillary thyroid cancer patients compared with healthy controls to determine the oxidation status and the change after thyroidectomy.Thirty-five female thyroid cancer patients who underwent total thyroidectomy and 39 female control subjects were included into this study. Prethyroidectomy and postthyroidectomy, AOPP, FOX, and MDA levels were studied.Prethyroidectomy AOPP, FOX, and MDA levels were significantly higher compared to control (P.05). In postthyroidectomy AOPP, FOX, and MDA levels were significantly decreased compared with prethyroidectomy levels (P.05). However, postthyroidectomy levels on the 20th day were still significantly higher, compared to control subjects (P.05).In conclusion, all of AOPP, FOX, and MDA levels that are markers of protein oxidation and lipid hyperoxidation may induce thyroid cancer development and begin to decrease after thyroidectomy.

Hydatid disease is a parasitic infestation caused by the larval form of the cestode worm Echinococcus. The most commonly encountered form of the disease is visceral hydatid cyst caused by Echinococcus granulosus or dog tapeworm. We hereby represent an unusual case of hydatid disease located in the neck region in a 22-year-old female patient.

Peritoneal recurrence is not an uncommon cause of death after surgery for gastric cancer, even after surgery with curative intent. This indicates that there is undetected residual disease in the peritoneal cavity. We conducted this study to determine the value of peritoneal and serum carcinoembryonic antigen (CEA) levels and peritoneal washing cytology in predicting the locoregional and distant spread of gastric cancer.We prospectively evaluated 70 consecutive patients with gastric cancer by measuring peritoneal CEA (pCEA) and serum CEA (sCEA) levels and peritoneal washing cytology results, and studying their effect on the histopathologic properties. The effect of the pCEA level on disease-free survival (DFS) and overall survival (OS) was also evaluated in patients treated with curative intent.Twenty-one (30%) patients had sCEA levels10 ng/ml, whereas 25 patients (35.7%) had pCEA levels10 ng/g protein and 26 patients (37.1%) had positive cytology. The pCEA levels were significantly higher in patients with hepatic metastases (P = 0.034), or serosal (P = 0.028), and peritoneal (P = 0.026) involvement, whereas the sCEA levels were significantly higher only in patients with hepatic metastases (P = 0.04). Similarly, positive cytology was mainly detected in patients with hepatic metastases (P = 0.004). The pCEA levels significantly affected DFS (P = 0.002) and OS (P = 0.01) in 34 patients treated with curative intent.Since pCEA levels are more useful for predicting locoregional recurrence, their measurement during surgery may help plan the most appropriate surgical strategy and adjuvant therapy.

WOS: 000339966100003 PubMed: 25216094 Background. Lymphoedema resulting from axillary lymph node dissection remains a challenging complication after modified radical mastectomy. Objective. To examine the effects of supportive therapy such as rehabilitation and medical and physical treatment on the development of lymphoedema, in an attempt to establish non-surgical ways to help prevent or reduce it. Methods. Patients (N= 5 064) who underwent breast cancer surgery in the Department of General Surgery, Ankara Oncology Research and Training Hospital, Turkey, between 1995 and 2010 were included. Data were collected by retrospectively examining all the patients' files and the pre- and postoperative breast cancer follow-up forms. Results. Of the patients in the study, 19.9% developed lymphoedema. It was significantly less common in patients who participated in physiotherapy than in those who did not, and it was more common in patients with a body mass index (BMI, kg/m(2)) between 30 and 34.9 than in those with lower BMIs. Postoperative axillary radiotherapy did not affect the occurrence of lymphoedema. Conclusion. It is clear that the most successful method to reduce the impact of lymphoedema is to prevent it. We believe that educating patients about the risk factors for developing lymphoedema and referring them to postoperative physical therapy and rehabilitation clinics are the most important ways to avoid this distressing condition.

WOS: 000338835600016 PubMed: 24353138 Background: Thyroid carcinoma in pediatric patients continues to be a rare albeit significant condition because local recurrence or distant metastases may be revealed during its diagnosis, or even years after completion of treatment. Methods: This study was prepared by retrospective analysis of patient files to focus on the clinical presentation of thyroid carcinoma in pediatric patients, and proposes to investigate the clinical parameters that differ from, or that correspond to, those in adult patients. Subjects: A total of 108 patients, of whom 22 were children and adolescents and 86 were adults, and who were operated on for differentiated thyroid carcinoma during the period 2001-2009, were included in the study. Results: The rate of large thyroid, multinodular goiter, or tumor >1 cm was significantly higher in the adult group than in the pediatric group. Our analysis also revealed that that the frequency of lymph node metastasis was significantly higher in the pediatric group than in the adult group. Moreover, the frequencies of total lymph node and positive lymph node presentations were significantly higher in the pediatric group than in the adult group. Conclusion: Although thyroid carcinoma has a good prognosis in young patients, one must stress that late diagnosis and ineffective treatment are the main criteria for poor prognosis and, most important, that it is advisable to keep the management of thyroid carcinoma on a path that differs from the management of adult thyroid carcinomas, in nearly all aspects from presentation to treatment.

Secretory breast carcinoma is a rare entity. It was first reported in pediatric patients in 1966, and was named juvenile breast carcinoma. Incidences of pediatric and adult patients are similar. Prognosis is favorable in both groups, but distant metastases have been reported. The authors describe a case of secretory breast carcinoma with extensive intraductal component.

Purpose: To compare the antioxidant enzyme activities of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and the levels of lipid peroxidation product malondialdehyde (MDA) in blood samples of thyroid cancer patients compared to healthy controls. Methods: 43 control subjects (mean age 44 +/- 13 years) and 43 patients (43 +/- 13 years) presented with multinodular goiter whose fine needle aspiration revealed malignant cytology were included into this study. The SOD, MDA and GSH-Px activities were measured in control subjects, and before/20 days after thyroidectomy in thyroid cancer patients. Results: SOD activities of pre-thyroidectomy, post-thyroidectomy and control groups were not different (p>0.05). Before thyroidectomy GSH-Px activities were lower (p

The authors report a case of scalp meningioma. The mass was removed totally, and all of the following neuroradiological studies proved the absence of an intracranial meningioma.