scholarly journals The Importance of Lymph Node Dissection in Medullary Thyroid Carcinoma Management

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A901-A902
Author(s):  
Camila Alejandra Villavicencio ◽  
Alberto Franco-Akel ◽  
Regina Belokovskaya
Keyword(s):  
Thyroid Carcinoma ◽  
Total Thyroidectomy ◽  
Neck Dissection ◽  
Medullary Thyroid Carcinoma ◽  
Tumor Markers ◽  
Lateral Neck ◽  
Lateral Neck Dissection ◽  
Medullary Thyroid ◽  
Preoperative Ct

Abstract Medullary thyroid carcinoma (MTC) is a rare endocrine malignancy that arises from calcitonin (Ct) parafollicular C-cells. Most cases are sporadic with frequent presentation being a solitary thyroid nodule. Total thyroidectomy with central neck dissection of lymph nodes (LN) is the standard treatment for MTC. The need for lateral neck dissection is controversial, with poor efficacy of non-surgical treatments presenting a problem. We present a case of MTC with preoperative Ct >500 pg/mL and negative imaging for metastases who underwent total thyroidectomy without LN exploration with an excellent postoperative biochemical response. This is a case of a 52-year-old female with a three-year history of anterior neck growth. The repeat fine needle aspiration (FNA) of a, previously negative for malignancy, growing nodule was consistent with MTC. Preoperative Ct and CEA levels were significantly elevated, 834.0 pg/mL and 11.2 ng/dL, respectively; a preoperative pan- CT scan did not reveal any suspicious LN or metastatic lesions and a negative RET oncogene mutation with normal plasma normetanephrines and metanephrines suggested a spontaneous rather than familial MTC. Patient underwent total thyroidectomy without LN exploration. Pathology confirmed MTC stage T1b. The one and three months postoperative follow up showed a significant downtrend with no normalization of Ct and CEA levels, 9.1 – 9.2 and 11.1 – 1.2, respectively. Reoperation for central and lateral neck dissection was considered; however, given the excellent biochemical response as well as the lack of radiographic evidence of disease, it was decided to continue monitoring of Ct and CEA levels for now. MTC response is monitored by the postoperative serum Ct and CEA levels when compared to the preoperative values. Serum Ct serves as a sensitive tumor marker, which is thought to have correlation with malignancy mass size and its cellular differentiation. The term biochemically cured, refers to the postoperative normalization of CEA and undetectable levels of Ct which carries a 5-year recurrence of 5%. It is believed that the higher the levels and the faster doubling time of these tumor markers the worse is the prognosis. In addition, it is suggested that patient’s age and extent of disease at the time of surgery are proportionally correlated with disease recurrence. However, there are reports of large MTC metastatic deposits with low serum Ct and CEA, rising up the hypothesis that levels reflect cell production potential for tumor markers rather than the number of cells. Reoperation rarely results in biochemical cure, but it may slow disease progression. Normal postoperative Ct levels predict cure; however, the clinical course of those with upper normal limit levels postoperatively is markedly variable. Careful regular biochemical and imaging follow-up will be of the utmost importance for the patient presented in this case.

The Extent of Surgery for Thyroid Medullary Cancer

1994 ◽  
Vol 80 (6) ◽  
pp. 427-432 ◽  
Author(s):  
Maria Rosa Pelizzo ◽  
Paolo Bernante ◽  
Andrea Piotto ◽  
Antonio Toniato ◽  
Maria Elisa Girelli ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Total Thyroidectomy ◽  
Neck Dissection ◽  
Medullary Thyroid Carcinoma ◽  
Radical Neck Dissection ◽  
Stage I ◽  
Stage Iii ◽  
Medullary Thyroid ◽  
The Impact

Aims Evaluation of the impact of the extent of primary surgery and reintervention on the outcome of patients with medullary thyroid carcinoma. Methods Seventy-two patients with medullary thyroid carcinoma (MTC) were surgically treated between 1967 and 1992. Results Fifty-five cases were sporadic, 5 patients had MEN 2A, 4 MEN 2B syndrome and 8 familial non-MEN MTC; 1 patient had stage I disease, 30 patients stage II, 36 stage III and 5 stage IV. Sixty-four had their initial treatment at our center, and 8 came for subsequent treatment. At first treatment, 8 patients were subjected to partial thyroidectomy, 10 to total thyroidectomy, 53 to total thyroidectomy with neck dissection, and 1 to only radical neck dissection; postoperative serum calcitonin (Ct) levels returned to normal in 3, 6 and 27 patients, respectively. In the patient with only radical neck dissection, Ct levels remained elevated. No patient with Ct normalization after surgery became responsive to pentagastrin in the follow-up. Thirteen patients had a reoperation due to nodal relapse. At a mean follow-up of 5.7 years (6-252 months), the 10-year survival rate was 84.5% with a significant difference between patients under and over 40 years of age (96.4 vs 57%), between stage I-II (100%) and stage III, IV (83.8%, 0% respectively). At the last follow-up, 36 (50%) patients were alive and disease free and 26 were alive with disease (15 with distant metastases). Of the 10 deaths, 7 were due to tumor recurrence, 3 to 120 months after surgery. Conclusions Data suggest that an earlier diagnosis rather than more extensive surgery could improve survival and reduce recurrences. However, the least treatment required is total thyroidectomy plus central neck and upper mediastinum clearance and in addition, according to the extent of nodal involvement, mono- or bilateral neck dissection. To avoid ineffective reoperation due to distant (mainly liver) micro-metastases, persistent residual microscopic disease requires a more aggressive restaging.

scholarly journals Risk Factors for Lateral Lymph Node Metastases in Patients With Sporadic Medullary Thyroid Carcinoma

2020 ◽  
Vol 19 ◽  
pp. 153303382096208
Author(s):  
Xin Wu ◽  
Binglu Li ◽  
Chaoji Zheng ◽  
Wei Liu ◽  
Tao Hong ◽  
...  
Keyword(s):  
Lymph Node ◽  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Lymph Node Metastases ◽  
Lateral Neck ◽  
Lateral Neck Dissection ◽  
Lateral Lymph Node ◽  
Sporadic Medullary Thyroid Carcinoma ◽  
Medullary Thyroid ◽  
Node Metastases

Purpose: Medullary thyroid carcinoma is a rare endocrine malignancy; 75% of patients with this disease have sporadic medullary thyroid carcinoma. While surgery is the only curative treatment, the benefit of prophylactic lateral neck dissection is unclear. This study aimed to analyze the clinicopathological risk factors associated with lateral lymph node metastases and determine the indication for prophylactic lateral neck dissection in patients with sporadic medullary thyroid carcinoma. Methods: The medical records of patients with medullary thyroid carcinoma who were treated at our hospital between January 2002 and January 2020 were retrospectively reviewed; a database of their demographic characteristics, test results, and pathological information was constructed. The relationship between lateral lymph node metastases and clinicopathologic sporadic medullary thyroid carcinoma features were analyzed using univariate and multivariate analyses. Results: Overall, 125 patients with sporadic medullary thyroid carcinoma were included; 47.2% and 39.2% had confirmed central and lateral lymph node metastases, respectively. Univariate and multivariate analyses identified 2 independent factors associated with lateral lymph node metastases: positive central lymph node metastases (odds ratio = 9.764, 95% confidence interval: 2.610–36.523; p = 0.001) and positive lateral lymph nodes on ultrasonography (odds ratio = 101.747, 95% confidence interval: 14.666–705.869; p < 0.001). Conclusion: Medullary thyroid carcinoma is a rare endocrine malignancy. Lymph node metastases are common in patients with sporadic medullary thyroid carcinoma. Prophylactic lateral neck dissection is recommended for patients who exhibit positive central lymph node metastases and/or positive lateral lymph nodes on ultrasonography.

Serum Calcitonin-Negative Medullary Thyroid Carcinoma: Role of CgA and CEA as Complementary Markers

2008 ◽  
Vol 23 (2) ◽  
pp. 129-131 ◽  
Author(s):  
L. Giovanella ◽  
S. Crippa ◽  
L. Ceriani
Keyword(s):  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Needle Aspiration ◽  
Radical Cure ◽  
Serum Calcitonin ◽  
Medullary Thyroid ◽  
Preoperative Ct ◽  
Serum Cea

The biochemical activity of medullary thyroid carcinoma (MTC) includes production of calcitonin (CT), chromogranin A (CgA) and carcinoembryonic antigen (CEA). Routine CT measurement has been proposed as part of the initial evaluation of thyroid nodules and its use could ultimately decrease the morbidity and mortality of MTC. We report on a 43-year-old female patient with a large MTC expressing CT, CgA and CEA on immunostains but with negative preoperative CT and CgA results. Serum CEA was slightly increased and its rapid disappearance predicted radical cure by surgery as confirmed by 2-year follow-up. Our report illustrates that a diagnosis of MTC cannot always be excluded by negative preoperative CT. Fine-needle aspiration with cytomorphological analysis and complementary immunocytochemistry remains an essential diagnostic tool. Finally, serum aliquots must be stored before thyroid surgery in order to measure circulating forms of complementary markers found by tissue immunostaining (CEA and CgA)

Outcome of Thyroid Surgeries at Patan Hospital

2018 ◽  
Vol 6 (1) ◽  
pp. 11-14
Author(s):  
Deepak Yadav ◽  
Bhawana Dangol ◽  
Anita GC ◽  
Namita Shrestha ◽  
Ishwor Raj Devkota ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Neck Dissection ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Central Compartment ◽  
Neck Surgery ◽  
Laryngeal Nerve ◽  
Completion Thyroidectomy ◽  
Lateral Neck ◽  
Lateral Neck Dissection

Objective: To assess the outcome of thyroid surgeries at Patan HospitalMaterials and Methods: It is a retrospective study of in-patient records of patients undergoing thyroid surgeries for various indications from April 2013 to January 2015 at Patan Hospital, Lalitpur.Results: During the period of 21 months, 75 patients underwent thyroid surgeries. Majority of patients underwent hemithyroidectomy (35) followed by total thyroidectomy (28), subtotal thyroidectomy (7) and completion thyroidectomy (5). Out of 28 patients undergoing total thyroidectomy (TT), 11 underwent central compartment clearance (CCC), 5 underwent CCC and lateral neck dissection. Among 5 patients undergoing completion thyroidectomy, CCC was performed in all cases and in one patient lateral neck dissection was also performed.  A total of 13 patients developed unilateral recurrent laryngeal nerve palsy (RLN), among them 5 had permanent palsy. Tracheostomy had to be done in immediate postoperative period for stridor following total thyroidectomy (TT) in one case. Temporary hypocalcaemia was observed in 10 (10/28) cases following TT, out of which 8 had undergone CCC. Permanent hypocalcaemia was observed in 7 (7/28) cases following TT out of which 3 had undergone CCC. Chylous leak occurred in one of the patient undergoing left level II-IV neck dissection which was managed conservatively. None of the patient had to be transfused postoperatively.Conclusion: Complications to thyroid surgery are not uncommon. Visualization of recurrent laryngeal nerve alone in our context is adequate in experienced hands. Identification of parathyroid during thyroidectomy is recommended to avoid hypocalcaemia. Meticulous dissection can reduce the complications.Nepalese Journal of ENT Head and Neck Surgery, Vol. 6, No. 1, 2015

Prophylactic Lymph Node Dissection in Papillary Thyroid Carcinoma: Is There a Place for Lateral Neck Dissection?

2013 ◽  
Vol 37 (7) ◽  
pp. 1584-1591 ◽  
Author(s):  
Romain Ducoudray ◽  
Christophe Trésallet ◽  
Gaelle Godiris-Petit ◽  
Frédérique Tissier ◽  
Laurence Leenhardt ◽  
...  
Keyword(s):  
Lymph Node ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Neck Dissection ◽  
Lymph Node Dissection ◽  
Lateral Neck ◽  
Papillary Thyroid ◽  
Node Dissection ◽  
Lateral Neck Dissection ◽  
Prophylactic Lymph Node Dissection

Risk factors for local recurrence following lateral neck dissection for papillary thyroid carcinoma

Endocrine ◽  
2018 ◽  
Vol 63 (2) ◽  
pp. 310-315 ◽  
Author(s):  
Marco Raffaelli ◽  
Carmela De Crea ◽  
Luca Sessa ◽  
Serena Elisa Tempera ◽  
Amanda Belluzzi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Papillary Thyroid Carcinoma ◽  
Local Recurrence ◽  
Thyroid Carcinoma ◽  
Neck Dissection ◽  
Lateral Neck ◽  
Papillary Thyroid ◽  
Lateral Neck Dissection

scholarly journals Management of Advanced Medullary Thyroid Carcinoma with Vandetanib: Case Series

2021 ◽  
Vol 5 (1) ◽  
pp. 01-07
Author(s):  
Andrés Flórez R
Keyword(s):  
Partial Response ◽  
Adverse Events ◽  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Stable Disease ◽  
Case Series ◽  
Medullary Thyroid ◽  
The Mean ◽  
Grade 3

Objective: To describe the tumor response and adverse events in patients with advanced medullary thyroid carcinoma (MTC) treated with vandetanib at the National Cancer Institute in Bogotá, Colombia. Materials and Methods: Case series including five patients with advanced MTC treated with vandetanib from April 2011 to August 2018 and a minimum follow-up of 6 months. Results: 5 patients met the inclusion criteria, including 3 women. The mean age was 49 years. A total of 4 patients underwent total thyroidectomy prior to starting vandetanib. The main indication for vandetanib was progression of liver metastasis (4 patients). Regarding treatment response, 3 patients presented stable disease, 1 patient showed partial response, and 1 had disease progression. The mean treatment duration was 16.5 months. Grade 3 or 4 adverse events were observed in three patients, 1 with diarrhea, 1 with hypertension, and 1 with rash. All symptoms improved with dose reduction or temporary suspension of vandetanib. Conclusions: The management of advanced MTC with vandetanib allows for prolonged disease control (stable disease or partial response). Although adverse events are frequent, most are mild and severe cases are manageable.

Circulating Neuron-Specific Enolase in Medullary Thyroid Cancer

1986 ◽  
Vol 1 (2) ◽  
pp. 85-88 ◽  
Author(s):  
Furio Pacini ◽  
Rossella Elisei ◽  
Stefano Anelli ◽  
Lucia Gasperini ◽  
Ernestina Schipani ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Time Course ◽  
Neuron Specific Enolase ◽  
High Serum ◽  
Large Tumor ◽  
Medullary Thyroid ◽  
The Mean ◽  
Metastatic Involvement

The utility of determining circulating neuron-specific enolase (NSE) in medullary thyroid carcinoma was assessed in 25 patients followed up for a mean period of 45.6 months. In 5 patients tested before any treatment serum NSE concentrations were in the normal range. After total thyroidectomy abnormally high serum NSE concentrations (more than 9.8 ng/ml) were found in 1/3 patients with normal calcitonin (CT) in remission, in 2/10 with elevated CT levels but no evidence of disease and in 9/12 with elevated CT levels and documented metastases. The mean (± SD) NSE value in this last group was 12.0 ± 12.6 ng/ml, significantly higher than in the other groups (p < 0.005). The time course of serum NSE in patients with long follow-up seems to indicate that serum NSE rises when a large tumor mass is present and usually parallels the pattern of circulating CT. Effective treatment of the metastases is usually followed by reduction of serum NSE. Thus, serum NSE can serve as an additional humoral marker for medullary thyroid carcinoma, its elevation being associated with important metastatic involvement and with a poor prognosis of the tumor.

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