CARCINOMA OF THE THYROID GLAND AND GARDNER'S SYNDROME

A patient known to be suffering from Gardner's syndrome who developed carcinoma of the thyroid gland is presented. A review of the literature reveals that this relationship is not fortuitous and that it has the following characteristics: female predominance (89%), youth (< 30 years in 78%), papillary form (88%), multicentricity (70%) and thyroid carcinoma preceding diagnosis of hereditary polyposis in 30%. Hereditary polyposis patients affected by familial polyposis coli are at significant risk of developing extracolonic malignant tumours, and require life-long surveillance. Palpation of the thyroid gland and possibly ultrasound examination of the neck should be part of the routine follow up of these patients.     

THE AETIOLOGY AND MANAGEMENT OF HEPATIC METASTASES

Hepatic metastases are a common event in the metastatic spread of primary tumours and indicate advanced disease. However, the presence of hepatic metastases does not necessarily imply incurability; in selected patients resection of hepatic metastases may result in 5-year survival rates of 25–35%, usually in patients with colorectal liver metastases in whom solitary metastases are more frequent than with other primary tumours. However, hepatic metastases from Wilm's tumours, adrenal tumours, renal cell carcinoma, and neuroendocrine tumours may also be resected with similar success rates. A poor prognosis after resection of hepatic metastases is likely when there are more than three metastatic deposits, involved resection margins (often as a result of ‘wedge’ resections), when there is extrahepatic disease, or nodal involvement at the primary tumour site. Cyto-reductive procedures may provide excellent palliation and possibly long-term survival in selected patients with hepatic metastases unsuitable for resection. However, further study is required to establish the appropriate role for these treatments.     

手术治疗甲状腺乳头状腺癌138例临床分析

对１９８０年１月至１９９６年１２月我院外科手术治疗的１３８例甲状腺乳头状腺癌患者的资料进行了回顾性分析。笔者认为,为了降低肿瘤复发率和并发症的发生,甲状腺叶加峡部切除是较理想的术式,为原发肿瘤直径大于１．５ｃｍ者,无论术前,术中是否摸到肿大淋巴结,以作改良颈淋上结清扫为好,对临床淋巴结阳性者,应根据具体情况实施功能或传统性颈淋巴结清扫术。     

MOLECULAR GENETICS OF THYROID AND PARATHYROID NEOPLASlA

There have been several recent advances in the understanding of the process of carcinogenesis in the thyroid and parathyroid glands. The specific abnormal molecules are, in many instances, well understood. This review provides an overview of the molecules in the cell that regulate cell growth and proliferation and identifies the molecules that have been found to be abnormal (or mutant) in various types of thyroid and parathyroid neoplasia.     

THYROID GLAND METASTASIS FROM RENAL CELL CARCINOMA MASQUERADING AS NODULAR GOITRE

Renal cell carcinoma metastasizing to the thyroid gland, in a 72 year old Japanese woman, is reported. The patient had undergone a left radical nephrectomy for renal cell carcinoma 3 months prior to the present operation. The patient noticed a nodular goitre but there was no evidence of any systemic spread of renal cell carcinoma. The histopathologic diagnosis, from a left lobectomy of the thyroid gland, was thyroid gland metastasis from renal cell carcinoma in adenomatous goitre. Clinical manifestation of thyroid gland metastasis from renal cell carcinoma, with no evidence of systemic involvement, is seen rarely. A case is reported and the condition discussed briefly.     

甲状腺滤泡性腺癌的手术治疗及术后处理：（附107例报告）

报告１９７１年～１９９３年我院外科治疗并经病理证实的１０７例甲状腺滤泡性腺癌患者的手术及随访结果，并提出进一步完善手术治疗及辅助治疗的意见，随访时间１～２２年。作者认为，手术时病变的严重程度与预后密切相关。因此，为避免术后并发症，手术范围宜适当；术后再配合１３１Ｉ治疗及促甲状腺激素（ＴＳＨ）抑制治疗可提高疗效。     

SURGICAL THYROID DISEASE IN PAPUA NEW GUINEA

A clinical and histopathological analysis was carried out on 376 thyroid specimens removed under various diagnoses from the surgical clinics of Papua New Guinea over a period of 11 years (1980–90). Solitary nodular goitre (solid and cystic) was the most common clinical diagnosis. Nineteen per cent of the solid and 35% of the cystic solitary nodular goitres were found to be malignant. Malignant goitres were confirmed histologically in 73.3% of the clinically diagnosed cases of malignancy. The presence of amyloid goitre (1.9%) posed a significant diagnostic and therapeutic problem due to its clinical features resembling that of malignant goitre. Hemithyroidectomy (lobectomy) was the most common surgical procedure employed for all unilateral thyroid lesions and partial or subtotal thyroidectomy was performed for benign and most malignant lesions.     

COMPLETION TOTAL THYROIDECTOMY IN THE MANAGEMENT OF DIFFERENTIATED THYROID CARCINOMA

Background: Completion thyroidectomy is the removal of any thyroid tissue that remains after a less than total thyroidectomy. This procedure has been commonly performed when the final histopathology of the excised ipsilateral thyroid lobe reveals papillary or follicular carcinoma of the thyroid. Complete thyroidectomy carries little morbidity if performed by experienced surgeons using a lateral approach. The purpose of this study is to reinforce the usefulness of a lateral approach. Methods: A retrospective analysis over a 5 year period at the Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS) yielded 19 patients who underwent completion thyroidectomy. This group represents 23% of 82 patients who underwent total thyroidectomy for differentiated thyroid cancer (DTC) during that period. The residual thyroid tissue was excised through a lateral approach and could be resected safely, preserving the recurrent laryngeal nerve (RLN) and the parathyroid glands. Results: A lateral approach dissection could be performed with ease in a virgin area. Excision of residual thyroid tissue could be performed safely even in cases with prior partial lobectomy or bilateral subtotal resection. Tumour was found in 52% of the re-operative specimens: in three out of four of those after a previous partial lobectomy, in six out of 12 of those after a total lobectomy, and in one out of three of those after a prior bilateral (although incomplete) thyroid resection. Postoperative complications included transient RLN palsy (n = 2) and transient hypoparathyroidism (n = 4). Conclusions: Completion thyroidectomy using a lateral approach is safe in re-operative thyroid surgery.     

TUBERCULOSIS OF THE THYROID GLAND: A CLINICOPATHOLOGICAL PROFILE OF FOUR CASES AND REVIEW OF THE LITERATURE

Four cases of tuberculosis of the thyroid with different presentations including chronic sinus (following drainage of thyroid abscess), thyrotoxicosis, severe dysphagia clinically mimicking malignancy and euthyroid multinodular goitre are described. Except in the case presenting with chronic sinus (discharging acid-fast bacilli), the diagnosis was a pathological surprise (cytopathology in one and histopathology in two). Only in one case was there evidence of disease outside the cervical region. All cases showed multiple coalescing and caseating epitheloid cell granulomas along with giant cells, which are considered as diagnostic of tuberculous thyroiditis even if acid fast bacilli cannot be demonstrated. The literature is reviewed and the pathogenesis discussed.     

PAPILLARY THYROID CARCINOMA ARISING IN THYROGLOSSAL DUCT CYSTS: INCIDENCE AND MANAGEMENT

The incidence and pathological features of papillary thyroid carcinoma arising in the thyroglossal duct cysts were reviewed and compared with papillary thyroid carcinoma arising elsewhere in the thyroid gland. In the 30 year period 1964 to 1993 there were 90 thyroglossal duct nodules or cysts treated surgically at the Endocrine Surgical Unit, Royal North Shore Hospital, Sydney, Australia. There were four cases of papillary thyroid carcinoma in this group (4.4%). In the same period 2814 cases presented with clinical single thyroid nodules which were treated surgically. There were 182 cancers in this group of which 121 were papillary thyroid carcinomas (4.3% of total cases). This is identical to the incidence seen in the thyroglossal duct. We conclude that the incidence of papillary thyroid carcinoma arising in the thyroglossal duct is no different to that arising elsewhere in the gland. The difference in number of carcinomas related only to the volume of follicular thyroid tissue present in the gland proper. That being the case, there is no reason to treat these cancers differently from papillary thyroid carcinoma elsewhere in the gland.     

RECURRENT LARYNGEAL NERVE AND THE POSTERIOR FASCIAL ATTACHMENT OF THE THYROID GLAND

An investigation based on dissection of cadaveric specimens was undertaken to obtain additional data on the relationships between the recurrent laryngeal nerve and the posterior fascial attachment of the thyroid gland. Ninety-four dissections were selected for detailed study. The posterior fascial attachment on each side was found to form two bands—a vertical band described previously and a horizontal band. The horizontal band was found to be present in all cases and to be constant in position. The posterior edge of the horizontal band followed posteriorly leads to the recurrent laryngeal nerve. The nerve always had a close relationship to the horizontal band and was often adherent to it. It is suggested that the use of the horizontal band to locate the recurrent laryngeal nerve would be of particular value when the inferior thyroid artery is absent, when the nerve is non-recurrent on the right side, or when there is distortion of the normal anatomy.     

甲状腺癌外科治疗的历史与现况

甲状腺癌 (ＴＣ)占人体全部恶性肿瘤的 1%左右 ,年发病率为 1.5 /10万。ＴＣ具有广泛的恶性病病谱 ,从恶性程度较低的乳头状癌到死亡率很高的未分化癌 ,每一类型的ＴＣ其生物特性不同 ,外科治疗的对策也不同。回顾历史 ,分析促进ＴＣ外科治疗发展的因素 ,根据不同类型的ＴＣ采取不同治疗方案 ,对提高ＴＣ外科治疗的效果有积极意义。1　历史回顾早在公元 95 0年 ,西班牙的ＭｏｏｒＡｌｂｕｃａｓｉｓ即成功地切除过甲状腺。 1786年Ｐａｒｒｙ最早描述过甲状腺机能亢进症的临床征象 ,随即 1835年Ｇｒａｖｅｓ和 1840年ＶｏｎＢａｓｅｄｏｗ相…     

HURTHLE CELL NEOPLASMS OF THE THYROID GLAND REVISITED

Hurthle cell tumours (benign and malignant) have been regarded as lesions with uncertain biological behaviour. However recent clinico-pathological studies have shown that they should be categorized as benign or malignant on the basis of capsular and/or vascular invasion, like other differentiated thyroid neoplasms. The fact that the tumours are composed of Hurthle cells is irrelevant. Currently, histological parameters do not seem to predict biological behaviour of Hurthle cell carcinomas.     

SURGICAL MANAGEMENT OF ARTHRITIS OF THE CARPO-METACARPAL JOINT OF THE THUMB

In the years 1970–90, 118 procedures were performed on 100 patients with arthritis (osteoarthritis in all but 13) of the carpo-metacarpal joint of the thumb. The patients were aged 17 to 83 years (mean 54.5 years); 75 were females and 25 males; there were 73 right and 45 left hands; 18 patients had bilateral procedures. The average follow up period was 4.3 years, with a range of 1 to 20 years. Sixteen of the 118 procedures were arthrodeses; all these patients had isolated trapezio-metacarpal joint arthritis. Fifteen procedures were trapeziectomies and soft tissue arthroplasties; they were performed for pan-trapezial arthritis in the older age group, or as a secondary procedure for failed previous operations. Eighty-seven of the 118 procedures were silicone partial or total arthroplasties either for pan-trapezial arthritis or isolated trapezio-metacarpal joint arthritis (53 trapezium, 32 metatarso-phalangeal and 2 condyle implants). The overall results were: arthrodesis (68.7% good, 18.8% fair, 12.5% poor); soft tissue arthroplasty (80% good, 6.7% fair, 13.3% poor); silicone total arthroplasty (73.5% good, 15.1% fair, 11.3% poor); silicone hemiarthroplasty (68.8% good, 15.6% fair, 15.6% poor). No silicone synovitis was found in any of the 87 cases of silicone arthroplasties.     

乳腺积乳囊肿的病因及诊治

本文报告乳腺积乳囊肿56例。年龄23～52岁,平均27.5岁。术前50例诊断正确,误诊6例。特别提出局部肿块波动感试验阳性,A超显示液平段,B起显示无回声,试穿抽出乳汁,对诊断有一定价值。治疗以手术切除为主;仅有7例穿刺抽吸乳汁得以治愈。     

THE MANAGEMENT OF COLORECTAL PERFORATION AND PERITONITIS

Background : Surgical outcomes in patients presenting with colonic perforation or peritonitis tend to be poor. This study was undertaken to determine outcomes in such patients at a time before multiple re-laparotomies were performed. Methods : Retrospective analysis of computer records of all patients presenting acutely to the University Surgical Unit (Wellington School of Medicine) with colonic perforation or peritonitis over a 15-year period. Results : Seventy-three patients, 33 males and 40 females were admitted with either perforation or localized peritonitis of colorectal origin. Of these, 78% were managed as emergencies, but six were admitted electively and found incidentally. Consultant surgeons performed surgery slightly more frequently than registrars. Two patients were managed non-operatively. Forty-one percent received peri-operative blood transfusion and 22% peri-operative total parenteral nutrition. The majority of patients presented with either peritonitis or free perforation in association with diverticular disease. The site of perforation was either ileocolic or sigmoid colonic in the majority of patients. Hartmann'operation was the most commonly performed resection. Respiratory, urinary and wound infections were the most commonly observed postoperative complications. Two patients developed anastomotic leaks (6.3%). The overall persistent intra-abdominal infection rate was 5.5%. Seven patients died following surgery. Conclusions : Resection of the perforated bowel is mandatory and this should be followed by anastomoses in the case of right-sided lesions and a Hartmann'operation or resection, colostomy and mucous fistula in distally situated lesions.