[Risk markers of follicular neoplasms in thyroid nodules]

Thyroid nodules of follicular origin include neoplastic and non neoplastic processes. No methods of diagnosis or cytological features (obtained by fine-needle aspiration, FNA) may differentiate both types, and therefore differential diagnosis still constitutes a dilemma.We analyzed the existing association between clinical variables and methods of diagnosis in thyroid nodules of follicular type with the aim of defining risk of neoplasm. Ninety two patients with nodular goiters, of follicular origin by cytology, previously submitted to surgical treatment were analyzed. The studied variables were: sex, age, size of the nodule, ultrasound characteristics, cytological diagnosis, TSH level and results of the scintigraphy. Of 92 cases, 74 were neoplastic nodules (56 adenomas and 18 differentiated thyroid cancer) and 18 were non neoplastic nodules. Markers, that were related to high risk of follicular neoplasm corresponded to the cytological diagnosis of proliferation of high follicular degree, in iso or hypoechoic, and hypofunctioning nodules with I131. The carcinomas presented cytology of follicular proliferation of high degree, in hipoechoic nodules, of irregular edges with microcalcifications and hypofunctioning, in male patients or patients younger than 20 years. The presence of macrocalcifications and hypercaptation would be in favor of nodules of benign origin.The correlation of diagnostic methods and clinical variables in thyroid nodules of follicular type would allow us to differentiate the risk of neoplasm or carcinoma, and plan surgical selective treatments.

[Non-incidental papillary microcarcinomas of the thyroid]

The clinical significance of papillary microcarcinoma of the thyroid gland keeps being controversial. Its high prevalence in autopsies and as incidental findings in thyroidectomy specimens for benign pathology indicate an indolent clinical behavior. Nevertheless some of the microcarcinomas develop lymph node metastasis and local recurrence. To determine the clinical and pathological characteristics of non-incidental papillary microcarcinomas of the thyroid (PTM -NI). 18 patients with diagnosis of non-incidental papillary microcarcinoma (tumor < or = 1 cm) with nodular expression in the thyroid gland or with lymph node metastasis have been studied. Initial diagnosis, prediction factors and evolution have been evaluated. Of 18 patients with PTM-NI, 12 demonstrated lymph node metastasis. 6 patients had positive fine needle aspiration (FNA) of palpable thyroid nodules. Multifocality and extraglandular extension were associated with lymph node metastasis. Seven of the nine metastatic lymph nodes diagnosed by FNA were cystic. Histologically 83.3% of the nodules in the thyroid were non-encapsulated and showed papillary growth pattern. Multifocality and extrathyroid infiltration were associated with lymph node metastasis at presentation. 46% of the patients with thyroid nodules > or = 4 mm and lymph node involvement (N1) showed recurrence/persistence. The non-incidental intrathyroideal papillary microcarcinoma without capsular involvement, extraglandular extension or lymph node metastasis (N0) did not demonstrate recurrence. These results suggest two groups of non- incidental papillary microcarcinoma of the thyroid (PMT-NI), one intraglandular without risk of evolution -N0- and other extraglandular at risk of recurrence -N1-.

[Idiopathic hypophysitis in elderly patients. Report of 2 cases and review of literature]

INTRODUCTION

Hypophysis inflammatory tumors are a non frequent cause for hypopituitarism. The motive of outpatient visit is headache. It is more frequent in pregnancy and immediate post-labor women. The pathology shows a lymphocytic inflammatory infiltrated or granulomas with giant cells (these can be accompanied with an infectious or autoimmune systemic disease associated).

CLINICAL CASES

We present two elderly female patients, without infectious or autoimmune pathology associated, with suggestive abnormalities of hypophysial adenoma by MRI. Both presented a suspecting clinical manifestation of intracranial expansive lesion (progressive intensive headaches, with partial compromise of the III left pair in the second one), noticing by laboratory a subclinical hormonal dysfunction. Surgery of tumoral exeresis was underwent in both patients, showing a granulomatous hypophysitis in one and a lymphocytic hypophysitis in the other.

CONCLUSION

Hypophysis inflammatory tumors must be considered as a preoperative differential diagnosis of every hypophysial tumor without important hormonal dysfunction associated, mainly in women and what is more in pregnancy or lying-in women, taking into account that surgery of tumoral resection can worsen a subclinic hypophysial dysfunction.