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Chou A, Qiu MR, Crayton H, Wang B, Ahadi MS, Turchini J, Clarkson A, Sioson L, Sheen A, Singh N, Clifton-Bligh RJ, Robinson BG, Gild ML, Tsang V, Leong D, Sidhu SB, Sywak M, Delbridge L, Aniss A, Wright D, Graf N, Kumar A, Rathi V, Benitez-Aguirre P, Glover AR, Gill AJ. A Detailed Histologic and Molecular Assessment of the Diffuse Sclerosing Variant of Papillary Thyroid Carcinoma. Mod Pathol 2023; 36:100329. [PMID: 37716505 DOI: 10.1016/j.modpat.2023.100329] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/20/2023] [Accepted: 09/07/2023] [Indexed: 09/18/2023]
Abstract
Diffuse sclerosing variant papillary thyroid carcinoma (DS-PTC) is characterized clinically by a predilection for children and young adults, bulky neck nodes, and pulmonary metastases. Previous studies have suggested infrequent BRAFV600E mutation but common RET gene rearrangements. Using strict criteria, we studied 43 DS-PTCs (1.9% of unselected PTCs in our unit). Seventy-nine percent harbored pathogenic gene rearrangements involving RET, NTRK3, NTRK1, ALK, or BRAF; with the remainder driven by BRAFV600E mutations. All 10 pediatric cases were all gene rearranged (P = .02). Compared with BRAFV600E-mutated tumors, gene rearrangement was characterized by psammoma bodies involving the entire lobe (P = .038), follicular predominant or mixed follicular architecture (P = .003), pulmonary metastases (24% vs none, P = .04), and absent classical, so-called "BRAF-like" atypia (P = .014). There was no correlation between the presence of gene rearrangement and recurrence-free survival. Features associated with persistent/recurrent disease included pediatric population (P = .030), gene-rearranged tumors (P = .020), microscopic extrathyroidal extension (P = .009), metastases at presentation (P = .007), and stage II disease (P = .015). We conclude that DS-PTC represents 1.9% of papillary thyroid carcinomas and that actionable gene rearrangements are extremely common in DS-PTC. DS-PTC can be divided into 2 distinct molecular subtypes and all BRAFV600E-negative tumors (1.5% of papillary thyroid carcinomas) are driven by potentially actionable oncogenic fusions.
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Affiliation(s)
- Angela Chou
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, New South Wales, Australia; Faculty of Medicine and Health Sciences and Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia; Cancer Diagnosis and Pathology Research Group, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia.
| | - Min Ru Qiu
- Department of Anatomical Pathology, SydPATH, St Vincent's Hospital, Darlinghurst, New South Wales, Australia; University of NSW, Randwick, New South Wales, Australia
| | - Henry Crayton
- Faculty of Medicine and Health Sciences and Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Bin Wang
- Department of Anatomical Pathology, SydPATH, St Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | - Mahsa S Ahadi
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, New South Wales, Australia; Faculty of Medicine and Health Sciences and Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia; Cancer Diagnosis and Pathology Research Group, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia
| | - John Turchini
- Department of Anatomical Pathology, Douglass Hanly Moir Pathology (A Sonic Healthcare Practice), Macquarie Park, New South Wales, Australia; Discipline of Pathology, Macquarie Medical School, Macquarie University, New South Wales, Australia
| | - Adele Clarkson
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, New South Wales, Australia; Cancer Diagnosis and Pathology Research Group, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia
| | - Loretta Sioson
- Cancer Diagnosis and Pathology Research Group, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia
| | - Amy Sheen
- Cancer Diagnosis and Pathology Research Group, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia
| | - Nisha Singh
- NSW Health Pathology, Cytogenetics Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Roderick J Clifton-Bligh
- Faculty of Medicine and Health Sciences and Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia; Department of Endocrinology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Bruce G Robinson
- Faculty of Medicine and Health Sciences and Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia; Department of Endocrinology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Matti L Gild
- Faculty of Medicine and Health Sciences and Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia; Department of Endocrinology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Venessa Tsang
- Faculty of Medicine and Health Sciences and Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia; Department of Endocrinology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - David Leong
- Endocrine Surgical Unit, Royal North Shore Hospital, St Leonards, University of Sydney, New South Wales, Australia
| | - Stanley B Sidhu
- Faculty of Medicine and Health Sciences and Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia; Endocrine Surgical Unit, Royal North Shore Hospital, St Leonards, University of Sydney, New South Wales, Australia
| | - Mark Sywak
- Faculty of Medicine and Health Sciences and Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia; Endocrine Surgical Unit, Royal North Shore Hospital, St Leonards, University of Sydney, New South Wales, Australia
| | - Leigh Delbridge
- Faculty of Medicine and Health Sciences and Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia; Endocrine Surgical Unit, Royal North Shore Hospital, St Leonards, University of Sydney, New South Wales, Australia
| | - Ahmad Aniss
- Faculty of Medicine and Health Sciences and Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia; Endocrine Surgical Unit, Royal North Shore Hospital, St Leonards, University of Sydney, New South Wales, Australia
| | - Dale Wright
- Cytogenetics Department, Sydney Genome Diagnostics, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; Specialty of Genome Medicine, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Nicole Graf
- Histopathology Department, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Amit Kumar
- Diagnostic Genomics, Monash Health Pathology, Monash Health, Clayton, Victoria, Australia
| | - Vivek Rathi
- LifeStrands Genomics, Mount Waverley, Victoria, Australia
| | - Paul Benitez-Aguirre
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Anthony R Glover
- Faculty of Medicine and Health Sciences and Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia; Endocrine Surgical Unit, Royal North Shore Hospital, St Leonards, University of Sydney, New South Wales, Australia; The Kinghorn Cancer Centre, Garvan Institute of Medical Research, St. Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Darlinghurst, New South Wales, Australia.
| | - Anthony J Gill
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, New South Wales, Australia; Faculty of Medicine and Health Sciences and Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia; Cancer Diagnosis and Pathology Research Group, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia.
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Papachristos AJ, Sidhu SB. Scar-less thyroidectomy: an evolving role in the surgical armamentarium. ANZ J Surg 2023; 93:450-451. [PMID: 36939099 DOI: 10.1111/ans.18262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 12/26/2022] [Indexed: 03/21/2023]
Affiliation(s)
- Alexander J Papachristos
- Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Stanley B Sidhu
- Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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DiMarco AN, Wong MS, Jayasekara J, Cole-Clark D, Aniss A, Glover AR, Delbridge LW, Sywak MS, Sidhu SB. Risk of needing completion thyroidectomy for low-risk papillary thyroid cancers treated by lobectomy. BJS Open 2019; 3:299-304. [PMID: 31183445 PMCID: PMC6551396 DOI: 10.1002/bjs5.50137] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 11/27/2018] [Indexed: 12/30/2022] Open
Abstract
Background Low-risk differentiated thyroid cancers may, according to the American Thyroid Association (ATA) 2015 guidelines, be managed initially with lobectomy. However, definitive risk categorization requires pathological assessment of the specimen, resulting in completion thyroidectomy being recommended when discordance between preoperative and postoperative staging occurs. This study sought to establish the expected rate of completion thyroidectomy in patients with papillary thyroid cancer (PTC) treated by lobectomy. Methods Patients with PTC treated over 5 years (2013-2017 inclusive) and meeting the ATA criteria for lobectomy were identified from the prospectively developed database of a high-volume, university department of endocrine surgery. Concordance between the ATA initial and final recommendation, and the putative rate of completion thyroidectomy were calculated. Multivariable analysis was used to assess preoperative factors as predictors of the need for total thyroidectomy. Results Of 275 patients with PTC who met ATA preoperative criteria for lobectomy there was concordance between this and the final recommendation in 158 (57·5 per cent) and discordance in 117 (43·5 per cent). Most common reasons for discordance were: angioinvasion (30·8 per cent), local invasion (23·9 per cent) or both (20·5 per cent). Four patients (1·5 per cent) had permanent hypoparathyroidism. On multivariable analysis, age, sex, tumour size and family history did not independently predict the final treatment required. Conclusion Although many patients may be treated adequately with lobectomy, just under half would require completion thyroidectomy. Further work is needed on preoperative risk stratification but, before this, total thyroidectomy remains the treatment of choice for low-risk 1-4-cm PTC in the hands of high-volume thyroid surgeons who can demonstrate low complication rates.
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Affiliation(s)
- A N DiMarco
- Endocrine Surgery Unit, Faculty of Health Sciences University of Sydney Sydney New South Wales Australia.,Department of Surgery and Cancer Imperial College London London UK
| | - M S Wong
- Endocrine Surgery Unit, Faculty of Health Sciences University of Sydney Sydney New South Wales Australia
| | - J Jayasekara
- Endocrine Surgery Unit, Faculty of Health Sciences University of Sydney Sydney New South Wales Australia
| | - D Cole-Clark
- Endocrine Surgery Unit, Faculty of Health Sciences University of Sydney Sydney New South Wales Australia
| | - A Aniss
- Endocrine Surgery Unit, Faculty of Health Sciences University of Sydney Sydney New South Wales Australia
| | - A R Glover
- Endocrine Surgery Unit, Faculty of Health Sciences University of Sydney Sydney New South Wales Australia
| | - L W Delbridge
- Endocrine Surgery Unit, Faculty of Health Sciences University of Sydney Sydney New South Wales Australia
| | - M S Sywak
- Endocrine Surgery Unit, Faculty of Health Sciences University of Sydney Sydney New South Wales Australia
| | - S B Sidhu
- Endocrine Surgery Unit, Faculty of Health Sciences University of Sydney Sydney New South Wales Australia
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Engelsman AF, Warhurst S, Fraser S, Novakovic D, Sidhu SB. Influence of neural monitoring during thyroid surgery on nerve integrity and postoperative vocal function. BJS Open 2018; 2:135-141. [PMID: 29951637 PMCID: PMC5989980 DOI: 10.1002/bjs5.50] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/04/2018] [Indexed: 11/06/2022] Open
Abstract
Background Integrity of the recurrent laryngeal nerve (RLN) and the external branch of the superior laryngeal nerve (EBSLN) can be checked by intraoperative nerve monitoring (IONM) after visualization. The aim of this study was to determine the prevalence and nature of voice dysfunction following thyroid surgery with routine IONM. Methods Thyroidectomies were performed with routine division of strap muscles and nerve monitoring to confirm integrity of the RLN and EBSLN following dissection. Patients were assessed for vocal function before surgery and at 1 and 3 months after operation. Assessment included use of the Voice Handicap Index (VHI) 10, maximum phonation time, fundamental frequency, pitch range, harmonic to noise ratio, cepstral peak prominence and smoothed cepstral peak prominence. Results A total of 172 nerves at risk were analysed in 102 consecutive patients undergoing elective thyroid surgery. In 23·3 per cent of EBSLNs and 0·6 per cent of RLNs nerve identification required the assistance of IONM in addition to visualization. Nerve integrity was confirmed during surgery for 98·8 per cent of EBSLNs and 98·3 per cent of RLNs. There were no differences between preoperative and postoperative VHI-10 scores. Acoustic voice assessment showed small changes in maximum phonation time at 1 and 3 months after surgery. Conclusion Where there is routine division of strap muscles, thyroidectomy using nerve monitoring confirmation of RLN and EBSLN function following dissection results in no clinically significant voice change.
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Affiliation(s)
- A F Engelsman
- Endocrine Surgery Unit University of Sydney Sydney New South Wales Australia
| | - S Warhurst
- Voice Research Laboratory, Faculty of Health Sciences University of Sydney Sydney New South Wales Australia
| | - S Fraser
- Endocrine Surgery Unit University of Sydney Sydney New South Wales Australia
| | - D Novakovic
- Voice Research Laboratory, Faculty of Health Sciences University of Sydney Sydney New South Wales Australia
| | - S B Sidhu
- Endocrine Surgery Unit University of Sydney Sydney New South Wales Australia
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Glover AR, Zhao JT, Ip JC, Lee JC, Robinson BG, Gill AJ, Soon PSH, Sidhu SB. Long noncoding RNA profiles of adrenocortical cancer can be used to predict recurrence. Endocr Relat Cancer 2015; 22:99-109. [PMID: 25595289 DOI: 10.1530/erc-14-0457] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Adrenocortical carcinoma (ACC) is an aggressive malignancy with high rates of recurrence following surgical resection. Long noncoding RNAs (lncRNAs) play an important role in cancer development. Pathogenesis of adrenal tumours have been characterised by mRNA, microRNA and methylation expression signatures, but it is unknown if this extends to lncRNAs. This study describes lncRNA expression signatures in ACC, adrenal cortical adenoma (ACA) and normal adrenal cortex (NAC) and presents lncRNAs associated with ACC recurrence to identify novel prognostic and therapeutic targets. RNA was extracted from freshly frozen tissue with confirmation of diagnosis by histopathology. Focused lncRNA and mRNA transcriptome analysis was performed using the ArrayStar Human LncRNA V3.0 microarray. Differentially expressed lncRNAs were validated using quantitative reverse transcriptase-PCR and correlated with clinical outcomes. Microarray of 21 samples (ten ACCs, five ACAs and six NACs) showed distinct patterns of lncRNA expression between each group. A total of 956 lncRNAs were differentially expressed between ACC and NAC, including known carcinogenesis-related lncRNAs such as H19, GAS5, MALAT1 and PRINS (P≤0.05); 85 lncRNAs were differentially expressed between ACC and ACA (P≤0.05). Hierarchical clustering and heat mapping showed ACC samples correctly grouped compared with NAC and ACA. Sixty-six differentially expressed lncRNAs were found to be associated with ACC recurrence (P≤0.05), one of which, PRINS, was validated in a group of 20 ACCs and also found to be associated with metastatic disease on presentation. The pathogenesis of adrenal tumours extends to lncRNA dysregulation and low expression of the lncRNA PRINS is associated with ACC recurrence.
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Affiliation(s)
- A R Glover
- Cancer Genetics LaboratoryKolling Institute of Medical ResearchDepartments of EndocrinologyAnatomical PathologyRoyal North Shore Hospital and University of Sydney, St Leonards, New South Wales 2065, AustraliaDepartment of SurgeryBankstown Hospital and University of New South Wales, Bankstown, New South Wales 2065, AustraliaIngham Institute for Applied Medical ResearchLiverpool, New South Wales 2200, AustraliaUniversity of Sydney Endocrine Surgical UnitRoyal North Shore Hospital, St Leonards, New South Wales 2065, Australia
| | - J T Zhao
- Cancer Genetics LaboratoryKolling Institute of Medical ResearchDepartments of EndocrinologyAnatomical PathologyRoyal North Shore Hospital and University of Sydney, St Leonards, New South Wales 2065, AustraliaDepartment of SurgeryBankstown Hospital and University of New South Wales, Bankstown, New South Wales 2065, AustraliaIngham Institute for Applied Medical ResearchLiverpool, New South Wales 2200, AustraliaUniversity of Sydney Endocrine Surgical UnitRoyal North Shore Hospital, St Leonards, New South Wales 2065, Australia
| | - J C Ip
- Cancer Genetics LaboratoryKolling Institute of Medical ResearchDepartments of EndocrinologyAnatomical PathologyRoyal North Shore Hospital and University of Sydney, St Leonards, New South Wales 2065, AustraliaDepartment of SurgeryBankstown Hospital and University of New South Wales, Bankstown, New South Wales 2065, AustraliaIngham Institute for Applied Medical ResearchLiverpool, New South Wales 2200, AustraliaUniversity of Sydney Endocrine Surgical UnitRoyal North Shore Hospital, St Leonards, New South Wales 2065, Australia
| | - J C Lee
- Cancer Genetics LaboratoryKolling Institute of Medical ResearchDepartments of EndocrinologyAnatomical PathologyRoyal North Shore Hospital and University of Sydney, St Leonards, New South Wales 2065, AustraliaDepartment of SurgeryBankstown Hospital and University of New South Wales, Bankstown, New South Wales 2065, AustraliaIngham Institute for Applied Medical ResearchLiverpool, New South Wales 2200, AustraliaUniversity of Sydney Endocrine Surgical UnitRoyal North Shore Hospital, St Leonards, New South Wales 2065, Australia
| | - B G Robinson
- Cancer Genetics LaboratoryKolling Institute of Medical ResearchDepartments of EndocrinologyAnatomical PathologyRoyal North Shore Hospital and University of Sydney, St Leonards, New South Wales 2065, AustraliaDepartment of SurgeryBankstown Hospital and University of New South Wales, Bankstown, New South Wales 2065, AustraliaIngham Institute for Applied Medical ResearchLiverpool, New South Wales 2200, AustraliaUniversity of Sydney Endocrine Surgical UnitRoyal North Shore Hospital, St Leonards, New South Wales 2065, Australia Cancer Genetics LaboratoryKolling Institute of Medical ResearchDepartments of EndocrinologyAnatomical PathologyRoyal North Shore Hospital and University of Sydney, St Leonards, New South Wales 2065, AustraliaDepartment of SurgeryBankstown Hospital and University of New South Wales, Bankstown, New South Wales 2065, AustraliaIngham Institute for Applied Medical ResearchLiverpool, New South Wales 2200, AustraliaUniversity of Sydney Endocrine Surgical UnitRoyal North Shore Hospital, St Leonards, New South Wales 2065, Australia
| | - A J Gill
- Cancer Genetics LaboratoryKolling Institute of Medical ResearchDepartments of EndocrinologyAnatomical PathologyRoyal North Shore Hospital and University of Sydney, St Leonards, New South Wales 2065, AustraliaDepartment of SurgeryBankstown Hospital and University of New South Wales, Bankstown, New South Wales 2065, AustraliaIngham Institute for Applied Medical ResearchLiverpool, New South Wales 2200, AustraliaUniversity of Sydney Endocrine Surgical UnitRoyal North Shore Hospital, St Leonards, New South Wales 2065, Australia Cancer Genetics LaboratoryKolling Institute of Medical ResearchDepartments of EndocrinologyAnatomical PathologyRoyal North Shore Hospital and University of Sydney, St Leonards, New South Wales 2065, AustraliaDepartment of SurgeryBankstown Hospital and University of New South Wales, Bankstown, New South Wales 2065, AustraliaIngham Institute for Applied Medical ResearchLiverpool, New South Wales 2200, AustraliaUniversity of Sydney Endocrine Surgical UnitRoyal North Shore Hospital, St Leonards, New South Wales 2065, Australia
| | - P S H Soon
- Cancer Genetics LaboratoryKolling Institute of Medical ResearchDepartments of EndocrinologyAnatomical PathologyRoyal North Shore Hospital and University of Sydney, St Leonards, New South Wales 2065, AustraliaDepartment of SurgeryBankstown Hospital and University of New South Wales, Bankstown, New South Wales 2065, AustraliaIngham Institute for Applied Medical ResearchLiverpool, New South Wales 2200, AustraliaUniversity of Sydney Endocrine Surgical UnitRoyal North Shore Hospital, St Leonards, New South Wales 2065, Australia Cancer Genetics LaboratoryKolling Institute of Medical ResearchDepartments of EndocrinologyAnatomical PathologyRoyal North Shore Hospital and University of Sydney, St Leonards, New South Wales 2065, AustraliaDepartment of SurgeryBankstown Hospital and University of New South Wales, Bankstown, New South Wales 2065, AustraliaIngham Institute for Applied Medical ResearchLiverpool, New South Wales 2200, AustraliaUniversity of Sydney Endocrine Surgical UnitRoyal North Shore Hospital, St Leonards, New South Wales 2065, Australia
| | - S B Sidhu
- Cancer Genetics LaboratoryKolling Institute of Medical ResearchDepartments of EndocrinologyAnatomical PathologyRoyal North Shore Hospital and University of Sydney, St Leonards, New South Wales 2065, AustraliaDepartment of SurgeryBankstown Hospital and University of New South Wales, Bankstown, New South Wales 2065, AustraliaIngham Institute for Applied Medical ResearchLiverpool, New South Wales 2200, AustraliaUniversity of Sydney Endocrine Surgical UnitRoyal North Shore Hospital, St Leonards, New South Wales 2065, Australia Cancer Genetics LaboratoryKolling Institute of Medical ResearchDepartments of EndocrinologyAnatomical PathologyRoyal North Shore Hospital and University of Sydney, St Leonards, New South Wales 2065, AustraliaDepartment of SurgeryBankstown Hospital and University of New South Wales, Bankstown, New South Wales 2065, AustraliaIngham Institute for Applied Medical ResearchLiverpool, New South Wales 2200, AustraliaUniversity of Sydney Endocrine Surgical UnitRoyal North Shore Hospital, St Leonards, New South Wales 2065, Australia
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Abstract
Since its invention nearly 20 years ago, the Covidien LigaSure device along with its ForceTriad generator has dominated the Electrothermal Bipolar Vessel Sealing market. The LigaSure was used for surgical procedures, both open and laparoscopic. The purpose of this review is to provide evidence of the safety and utility of the LigaSure device compared to more traditional means of hemostasis and its ultrasonic competitor, particularly in laparoscopic applications. We will provide evidence related to electrothermal bipolar vessel sealing in general and look specifically at Covidien's newest product, the LigaSure Maryland Jaw Device.
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Affiliation(s)
- Nisar Zaidi
- Endocrine Surgical Unit, Royal North Shore Hospital, University of Sydney, St. Leonards, New South Wales 2065, Australia
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Brown SJ, Lee JC, Christie J, Maher R, Sidhu SB, Sywak MS, Delbridge LW. Four-dimensional computed tomography for parathyroid localization: a new imaging modality. ANZ J Surg 2014; 85:483-7. [DOI: 10.1111/ans.12571] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2014] [Indexed: 12/31/2022]
Affiliation(s)
- Sebastian J. Brown
- Endocrine Surgical Unit; The University of Sydney; Sydney New South Wales Australia
| | - James C. Lee
- Endocrine Surgery Unit; Monash University; Melbourne Victoria Australia
| | - James Christie
- North Shore Radiology; North Shore Private Hospital; Sydney New South Wales Australia
| | - Richard Maher
- North Shore Radiology; North Shore Private Hospital; Sydney New South Wales Australia
| | - Stanley B. Sidhu
- Endocrine Surgical Unit; The University of Sydney; Sydney New South Wales Australia
| | - Mark S. Sywak
- Endocrine Surgical Unit; The University of Sydney; Sydney New South Wales Australia
| | - Leigh W. Delbridge
- Endocrine Surgical Unit; The University of Sydney; Sydney New South Wales Australia
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Lee JC, Zhao JT, Clifton-Bligh RJ, Gill A, Gundara JS, Ip JC, Glover A, Sywak MS, Delbridge LW, Robinson BG, Sidhu SB. MicroRNA-222 and microRNA-146b are tissue and circulating biomarkers of recurrent papillary thyroid cancer. Cancer 2013; 119:4358-65. [PMID: 24301304 DOI: 10.1002/cncr.28254] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 05/13/2013] [Accepted: 05/17/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Papillary thyroid cancer (PTC) persistence or recurrence and the need for long-term surveillance can cause significant inconvenience and morbidity in patients. Currently, recurrence risk stratification is accomplished by using clinicopathologic factors, and serum thyroglobulin is the only commercially available marker for persistent or recurrent disease. The objective of this study was to determine microRNA (miRNA) expression in PTC and determine whether 1 or more miRNAs could be measured in plasma as a biomarker for recurrence. METHODS Patients with recurrent PTC (Rc-PTC) and those without recurrence (NR-PTC) were retrospectively recruited for a comparison of their tumor miRNA profiles. Patients with either newly diagnosed PTC or multinodular goiter who were undergoing total thyroidectomy were prospectively recruited for an analysis of preoperative and postoperative circulating miRNA levels. Healthy volunteers were recruited as the control group. RESULTS MicroRNA-222 and miR-146b were over-expressed 10.8-fold and 8.9-fold, respectively, in Rc-PTC tumors compared with NR-PTC tumors (P = .014 and P = .038, respectively). In plasma from preoperative PTC patients, levels of miR-222 and miR-146b were higher compared with the levels in plasma from healthy volunteers (P < .01 for both). Reductions of 2.7-fold and 5.1-fold were observed in the plasma levels of miR-222 and miR-146b, respectively, after total thyroidectomy (P = .03 for both). CONCLUSIONS This study demonstrated that tumor levels of miR-222 and miR-146b are associated with PTC recurrence and that miR-222 and miR-146b levels in the circulation correspond to the presence of PTC. The potential of these miRNAs as tumor biomarkers to improve patient stratification according to the risk of recurrence and as circulating biomarkers for PTC surveillance warrants further study.
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Affiliation(s)
- James C Lee
- Kolling Institute of Medical Research, Cancer Genetics Laboratory, Royal North Shore Hospital and University of Sydney, St. Leonards, New South Wales, Australia; Endocrine Surgical Unit, Royal North Shore Hospital and University of Sydney, St. Leonards, New South Wales, Australia
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Wang LY, Versnick MA, Gill AJ, Lee JC, Sidhu SB, Sywak MS, Delbridge LW. Level VII is an Important Component of Central Neck Dissection for Papillary Thyroid Cancer. Ann Surg Oncol 2013; 20:2261-5. [DOI: 10.1245/s10434-012-2833-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Indexed: 11/18/2022]
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Bullock M, O'Neill C, Chou A, Clarkson A, Dodds T, Toon C, Sywak M, Sidhu SB, Delbridge LW, Robinson BG, Learoyd DL, Capper D, von Deimling A, Clifton-Bligh RJ, Gill AJ. Utilization of a MAB for BRAF(V600E) detection in papillary thyroid carcinoma. Endocr Relat Cancer 2012; 19:779-84. [PMID: 22997209 DOI: 10.1530/erc-12-0239] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Identification of BRAF(V600E) in thyroid neoplasia may be useful because it is specific for malignancy, connotes a worse prognosis, and is the target of novel therapies currently under investigation. Sanger sequencing is the 'gold standard' for mutation detection but is subject to sampling error and requires resources beyond many diagnostic pathology laboratories. In this study, we compared immunohistochemistry (IHC) using a BRAF(V600E) mutation-specific MAB to Sanger sequencing on DNA from formalin-fixed paraffin-embedded tissue, in a well-characterized cohort of 101 papillary thyroid carcinoma (PTC) patients. For all cases, an IHC result was available; however, five cases failed Sanger sequencing. Of the 96 cases with molecular data, 68 (71%) were BRAF(V600E) positive by IHC and 59 (61%) were BRAF(V600E) positive by sequencing. Eleven cases were discordant. One case was negative by IHC and initially positive by sequencing. Repeat sequencing of that sample and sequencing of a macrodissected sample were negative for BRAF(V600E). Of ten cases positive by IHC but negative by sequencing on whole sections, repeat sequencing on macrodissected tissue confirmed the IHC result in seven cases (suggesting that these were false negatives of sequencing on whole sections). In three cases, repeat sequencing on recut tissue remained negative (including using massive parallel sequencing), but these cases demonstrated relatively low neoplastic cellularity. We conclude that IHC for BRAF(V600E) is more sensitive and specific than Sanger sequencing in the routine diagnostic setting and may represent the new gold standard for detection of BRAF(V600E) mutation in PTC.
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Affiliation(s)
- M Bullock
- Hormones and Cancer Group, Cancer Genetics Laboratory, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Lee JC, Zhao JT, Clifton-Bligh RJ, Gill AJ, Gundara JS, Ip J, Sywak MS, Delbridge LW, Robinson BG, Sidhu SB. Papillary Thyroid Carcinoma in Pregnancy: A Variant of the Disease? Ann Surg Oncol 2012; 19:4210-6. [DOI: 10.1245/s10434-012-2556-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Indexed: 12/18/2022]
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13
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Abstract
BACKGROUND Permanent hypoparathyroidism is a well-recognized complication of total thyroidectomy, and a commonly reported clinical indicator of that procedure. However, a small number of patients still require ongoing calcium supplementation post-operatively in order to avoid the symptoms of hypocalcaemia, despite a normal serum parathyroid hormone level. The aim of this study was to characterize this disorder of post-operative partial hypoparathyroidism and to identify any risk factors. METHODS A retrospective study of patients undergoing a total thyroidectomy was performed. Patients with permanent hypoparathyroidism were excluded. Patients completed a telephone interview and had serum calcium and parathyroid hormone (PTH) measured. Patient demographics, operative indications and intervention, the number of parathyroid glands autotransplanted, the presence of ongoing symptoms and calcium requirements were documented. RESULTS One hundred ninety-six patients participated. The overall rate of permanent hypoparathyroidism over the duration of the study was 0.77%. An additional 10 (5%) patients were identified with a normal PTH level but who were still requiring calcium supplementation to prevent the symptoms associated with hypocalcaemia and to maintain a normal serum calcium level. Nine patients were female with a mean age of 48.5 years. A mean of 1.4 parathyroid glands were autotransplanted and the mean PTH level was 3.95 pmol/L. CONCLUSION This study demonstrates that in a small group of patients following total thyroidectomy, re-vascularization of parathyroid cells may be partial, with inadequate parathyroid reserve to avoid symptoms despite measurable PTH levels. This disorder of partial hypoparathyroidism has not been previously described and represents a small but important complication of total thyroidectomy.
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Affiliation(s)
- Ruth S Prichard
- University of Sydney Endocrine Surgical Unit, Sydney, Australia
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Prichard RS, Lee JC, Gill AJ, Sywak MS, Fingleton L, Robinson BG, Sidhu SB, Delbridge LW. Mucoepidermoid carcinoma of the thyroid: a report of three cases and postulated histogenesis. Thyroid 2012; 22:205-9. [PMID: 22224821 DOI: 10.1089/thy.2011.0276] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Primary mucoepidermoid carcinoma (MEC) of the thyroid is a rare clinical and pathological entity that accounts for <0.5% of all thyroid malignancies. Although the histogenesis has been controversial, most investigators now favor it as arising from either metaplasia of thyroid follicular epithelium or heterologous de-differentiation from papillary thyroid carcinoma (PTC). We report three cases of thyroid MEC found in continuity with, and clearly arising from de-differentiation of, well-differentiated thyroid carcinomas (WDTCs). PATIENT FINDINGS AND SUMMARY The cases presented here included two women (aged 22 and 52) and one man (aged 58). One of these cases arose in conjunction with PTC, one with follicular thyroid carcinoma (FTC), and one with Hurthle cell carcinoma (HCC). In all three cases, there was a gradual transition in morphology between the areas of typical WDTC and the areas showing MEC differentiation. In addition, immunohistochemistry demonstrated a gradual loss of thyroid specific markers (thyroid transcription factor-1, thyroglobulin) mirroring the change in morphology. CONCLUSION We conclude that thyroid MEC can arise from metaplastic de-differentiation of WDTC, including FTC or HCC in addition to PTC. Currently, we recommend that after excision, each of the WDTC and MEC components of these tumors be treated with targeted adjuvant therapies, which may involve radioactive-iodine ablation, thyrotropin suppression, and external beam radiotherapy.
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Affiliation(s)
- Ruth S Prichard
- Department of Endocrine and Oncology Surgery, Royal North Shore Hospital, Sydney, Australia
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15
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Vasica G, O'Neill CJ, Sidhu SB, Sywak MS, Reeve TS, Delbridge LW. Reoperative surgery for bilateral multinodular goitre in the era of total thyroidectomy. Br J Surg 2012; 99:688-92. [DOI: 10.1002/bjs.8684] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2011] [Indexed: 11/08/2022]
Abstract
Abstract
Background
Total thyroidectomy, rather than bilateral subtotal thyroidectomy, is now accepted as the preferred management for bilateral benign multinodular goitre (BMNG) in order to reduce the need for reoperative surgery. The aim of this study was to examine whether this approach has had an impact on presentation for bilateral reoperative thyroid surgery.
Methods
This was a retrospective cohort study. The study group comprised patients presenting with recurrent BMNG who underwent bilateral reoperative thyroid surgery following previous bilateral subtotal or partial thyroidectomy. They were compared with patients undergoing unilateral reoperative thyroid surgery following previous lobectomy, and those undergoing primary total thyroidectomy for BMNG.
Results
Between 1 January 1987 and 31 December 2009, 12 354 consecutive thyroid procedures were undertaken. Among those with BMNG, primary total thyroidectomy was undertaken in 3298 patients, unilateral reoperative thyroidectomy in 337 and bilateral reoperative thyroidectomy in 191. Presentations of patients with recurrent BMNG declined gradually over the study period following the change in policy from subtotal to total thyroidectomy; only five patients (representing less than 0·5 per cent of all thyroid surgery) underwent bilateral reoperative surgery for BMNG in the last year of the study. Four of these patients had their initial operation before 1987 and in another unit, whereas the remaining patient initially had surgery overseas.
Conclusion
The introduction of a policy of initial total thyroidectomy for bilateral BMNG has essentially eliminated the need for bilateral reoperative surgery for recurrent goitre.
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Affiliation(s)
- G Vasica
- University of Sydney Endocrine Surgical Unit, Sydney, New South Wales, Australia
| | - C J O'Neill
- University of Sydney Endocrine Surgical Unit, Sydney, New South Wales, Australia
| | - S B Sidhu
- University of Sydney Endocrine Surgical Unit, Sydney, New South Wales, Australia
| | - M S Sywak
- University of Sydney Endocrine Surgical Unit, Sydney, New South Wales, Australia
| | - T S Reeve
- University of Sydney Endocrine Surgical Unit, Sydney, New South Wales, Australia
| | - L W Delbridge
- University of Sydney Endocrine Surgical Unit, Sydney, New South Wales, Australia
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Prichard RS, O’Neill CJ, Oucharek JJ, Sippel RS, Delbridge LW, Sidhu SB, Chen H. Is Focused Minimally Invasive Parathyroidectomy Appropriate for Patients With Familial Primary Hyperparathyroidism? Ann Surg Oncol 2011; 19:1264-8. [DOI: 10.1245/s10434-011-2092-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Indexed: 11/18/2022]
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Tacon LJ, Soon PS, Gill AJ, Chou AS, Clarkson A, Botling J, Stalberg PLH, Skogseid BM, Robinson BG, Sidhu SB, Clifton-Bligh RJ. The glucocorticoid receptor is overexpressed in malignant adrenocortical tumors. J Clin Endocrinol Metab 2009; 94:4591-9. [PMID: 19820023 DOI: 10.1210/jc.2009-0546] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
CONTEXT Adrenocortical carcinoma (ACC) is a rare tumor with a poor prognosis. The Weiss score is the most widely accepted method for distinguishing an ACC from an adrenocortical adenoma (ACA); however, in borderline cases, accurate diagnosis remains problematic. We recently discovered that the glucocorticoid receptor (GR) gene NR3C1 is significantly up-regulated in ACCs compared with ACAs in global gene expression studies. OBJECTIVE Our objective was to study GR expression in adrenocortical tumors (ACTs) and to assess its utility as an adjunct to the Weiss score. DESIGN Microarray analysis, real-time quantitative RT-PCR (qPCR), immunohistochemistry, Western blot, and direct sequencing were performed. RESULTS Analysis of 28 ACTs by microarray and 49 ACTs by qPCR found NR3C1 expression to be up-regulated in ACCs compared with ACAs (P < 0.001). Western blotting and RT-PCR confirmed the presence of the GRalpha isoform in ACCs, and no mutations were detected on direct sequencing. Immunohistochemistry for GR in an overlapping cohort of ACTs demonstrated strongly positive nuclear staining in 31 of 33 ACCs (94%), with negative staining in 40 of 41 ACAs (98%) (P < 0.001). This finding was validated in an external cohort of ACTs, such that 14 of 18 ACCs (78%) demonstrated positive nuclear staining whereas 32 of 33 ACAs (94%) were negative (P < 0.001). CONCLUSIONS The immunohistochemical finding of nuclear GR staining identified ACCs with high diagnostic accuracy. We propose that GR immunohistochemistry may complement the Weiss score in the diagnosis of ACC in cases that display borderline histology. The possibility that GR is transcriptionally active in these tumors, and may therefore be a therapeutic target, requires further study.
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Affiliation(s)
- Lyndal J Tacon
- Cancer Genetics Unit, Hormones and Cancer Group, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW 2006, Australia.
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Tacon LJ, Soon PS, Gill AJ, Chou AS, Clarkson A, Botling J, Stalberg PLH, Skogseid BM, Robinson BG, Sidhu SB, Clifton-Bligh RJ. The Glucocorticoid Receptor Is Overexpressed in Malignant Adrenocortical Tumors. Mol Endocrinol 2009. [DOI: 10.1210/mend.23.10.9997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Soon PSH, Gill AJ, Benn DE, Clarkson A, Robinson BG, McDonald KL, Sidhu SB. Microarray gene expression and immunohistochemistry analyses of adrenocortical tumors identify IGF2 and Ki-67 as useful in differentiating carcinomas from adenomas. Endocr Relat Cancer 2009; 16:573-83. [PMID: 19218281 DOI: 10.1677/erc-08-0237] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The management of adrenocortical tumors (ACTs) is complex. The Weiss score is the present most widely used system for ACT diagnosis. An ACT is scored from 0 to 9, with a higher score correlating with increased malignancy. However, ACTs with a score of 3 can be phenotypically benign or malignant. Our objective is to use microarray profiling of a cohort of adrenocortical carcinomas (ACCs) and adrenocortical adenomas (ACAs) to identify discriminatory genes that could be used as an adjunct to the Weiss score. A cohort of Weiss score defined ACCs and ACAs were profiled using Affymetrix HGU133plus2.0 genechips. Genes with high-discriminatory power were identified by univariate and multivariate analyses and confirmed by quantitative real-time reverse transcription PCR and immunohistochemistry (IHC). The expression of IGF2, MAD2L1, and CCNB1 were significantly higher in ACCs compared with ACAs while ABLIM1, NAV3, SEPT4, and RPRM were significantly lower. Several proteins, including IGF2, MAD2L1, CCNB1, and Ki-67 had high-diagnostic accuracy in differentiating ACCs from ACAs. The best results, however, were obtained with a combination of IGF2 and Ki-67, with 96% sensitivity and 100% specificity in diagnosing ACCs. Microarray gene expression profiling accurately differentiates ACCs from ACAs. The combination of IGF2 and Ki-67 IHC is also highly accurate in distinguishing between the two groups and is particularly helpful in ACTs with Weiss score of 3.
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Affiliation(s)
- P S H Soon
- Cancer Genetics, Kolling Institute of Medical Research, Royal North Shore Hospital, University of Sydney, St Leonards, Sydney, New South Wales 2065, Australia.
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Soon PSH, Sidhu SB. Molecular basis of adrenocortical carcinomas. MINERVA ENDOCRINOL 2009; 34:137-147. [PMID: 19471238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Adrenocortical carcinomas (ACCs) are rare tumors associated with poor prognosis. Although surgery is the mainstay of treatment for this cancer, most patients will experience a recurrence of their tumor. Adjuvant therapies currently include mitotane, radiotherapy and chemotherapy, but responses to these therapies, however, are poor. A better understanding of the molecular basis of this cancer is crucial to the development of newer and better treatment options. This review summarizes the current knowledge of the molecular basis of ACCs.
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Affiliation(s)
- P S H Soon
- Department of Surgery, Bankstown Hospital and South West Clinical School, University of New South Wales, Sydney, Australia.
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Soon PSH, Yeh MW, Delbridge LW, Bambach CP, Sywak MS, Robinson BG, Sidhu SB. Laparoscopic surgery is safe for large adrenal lesions. Eur J Surg Oncol 2008; 34:67-70. [PMID: 17532597 DOI: 10.1016/j.ejso.2007.03.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2006] [Accepted: 03/07/2007] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Laparoscopic adrenalectomy has surpassed open adrenalectomy as the gold standard for excision of benign adrenal lesions. The size threshold for offering laparoscopic adrenalectomy is controversial as the prevalence of adrenocortical carcinoma increases with increasing tumour size. The aim of this paper was to assess the safety of laparoscopic adrenalectomy for large adrenal tumours (tumours > or = 60 mm). METHODS A retrospective cohort study of patients who underwent adrenalectomy in a single unit during the period 1995-2005 was undertaken. RESULTS One hundred and seventy patients with 173 tumours were included in this study. Of these, 29 were > or = 60 mm in size, and 16 of these patients underwent laparoscopic adrenalectomy. There were 8 adrenocortical carcinomas in the group with tumours > or = 60 mm in size. Five of these patients underwent an open adrenalectomy, while 2 and 1 patients had laparoscopic and laparoscopic converted to open adrenalectomy respectively. Four of the patients undergoing open adrenalectomy died of their disease while 1 is alive with recurrence 3 years later. The 3 patients who underwent either laparoscopic or laparoscopic converted to open adrenalectomy are alive without evidence of disease after 18 months follow up. CONCLUSION Our data show that patients with tumours > or = 60 mm with no preoperative or intraoperative evidence of malignancy can undergo laparoscopic adrenalectomy without evidence of recurrence on short term follow up. These findings are concordant with the growing body of literature supporting laparoscopic adrenalectomy for potentially malignant tumours > or = 60 mm in size without preoperative or intraoperative features of malignancy.
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Affiliation(s)
- P S H Soon
- University of Sydney Endocrine Surgical Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Meyer-Rochow GY, Alvarado R, Sywak MS, Sidhu SB, Delbridge LW, Gill AJ. Letter 2: Intraoperative diagnosis and treatment of parathyroid cancer and atypical parathyroid adenoma (Br J Surg 2007; 94: 566-570). Br J Surg 2007; 94:1043; author reply 1043-4. [PMID: 17636522 DOI: 10.1002/bjs.5974] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Meyer-Rochow GY, Sywak MS, Reeve TS, Delbridge LW, Sidhu SB. Surgical trends in the management of thyroid lymphoma. Eur J Surg Oncol 2007; 34:576-80. [PMID: 17604588 DOI: 10.1016/j.ejso.2007.04.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2006] [Accepted: 04/28/2007] [Indexed: 02/08/2023] Open
Abstract
AIMS To determine the changing trends and current role of surgery for the management of thyroid lymphoma. METHODS A retrospective review of 50 surgical patients with a final diagnosis of thyroid lymphoma over a 35-year period. RESULTS All patients presented with an enlarging mass, with half having compressive symptoms on presentation. Two-thirds of patients had co-existent histological features of Hashimoto's thyroiditis. Surgery for patients with thyroid lymphoma peaked in the late 1970s (0.79% of all thyroid operations performed) followed by a significant decline in the 1980s with a current frequency of only 0.16% (p=0.009). A larger number of thyroid resections intended as a curative procedure was performed during the first half of this series compared to the latter half (p=0.05). There was no difference in disease-free survival between patients treated by thyroid resection when compared with an open biopsy (p=0.4875). CONCLUSION The surgical management of thyroid lymphoma has changed with time. Currently a larger proportion of patients are undergoing surgery in order to achieve a histological diagnosis rather than with therapeutic intent, however, an important role for surgery still exists in the management of a patient with severe airways obstruction.
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Affiliation(s)
- G Y Meyer-Rochow
- University of Sydney Endocrine Surgical Unit, Royal North Shore Hospital, Sydney, Australia
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Palazzo FF, Gosnell J, Savio R, Reeve TS, Sidhu SB, Sywak MS, Robinson B, Delbridge LW. Lymphadenectomy for papillary thyroid cancer: Changes in practice over four decades. Eur J Surg Oncol 2006; 32:340-4. [PMID: 16478655 DOI: 10.1016/j.ejso.2005.12.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2004] [Revised: 11/29/2005] [Accepted: 12/07/2005] [Indexed: 11/17/2022] Open
Abstract
AIMS Lymphadenectomy in the management of papillary thyroid cancer (PTC) has evolved. The aim of this study was to examine the changing role of neck dissection as reflected in the practice of a large thyroid unit over four decades. METHODS A retrospective cohort study of patients that underwent primary thyroid surgery for papillary cancer in a single unit in the period 1958-2002. Nine 5-year periods were considered and the data relevant to the treatment of the regional lymph nodes reviewed. RESULTS Nine hundred patients with PTC underwent surgery between 1958 and 2002 of whom 32.7% underwent lymph node dissection (LND). The use of lymphadenectomy increased from 21.4% in 1958-1962 to 48.1% in 1998-2002 of which 84% underwent a selective lymph node dissection (SLND)-a dissection where the LND is determined by the extent of the disease encountered. The mean number of nodes removed during SLND was 12.6 (range 1-56) of which a mean of 3.1 (24.8%) (0-19) were involved by the disease. Cervical levels 6 and level 4 were those most frequently dissected. There was no statistically significant difference in the complication rates in patients undergoing neck dissection and those not. CONCLUSION The four decade experience reflects a move away from modified radical neck dissection and cherry picking towards SLND. Growing evidence suggests that lymphadenopathy in adult PTC is an adverse prognostic factor. SLND, a lymphadenectomy tailored to the extent of the disease process, is the coherent treatment for PTC since it serves the dual purpose of staging as well as control of local disease. This can be achieved with little morbidity when performed in a specialist centre.
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Affiliation(s)
- F F Palazzo
- Endocrine Surgical Unit, Department of Surgery, Royal North Shore Hospital, University of Sydney, St Leonards, Sydney, NSW 2065, Australia
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