Incidentally Discovered Papillary Thyroid Microcarcinoma in Patients Undergoing Thyroid Surgery for Benign Disease

IntroductionIncidence of thyroid carcinoma (TC) has grown significantly over the last few decades worldwide, partly due to the increase detection of small thyroid microcarcinoma (TMc). TMc are tumors with a maximal diameter ≤ 1 cm, identified during histopathology examination following a thyroidectomy performed for reasons not pertaining to malignancy. The aim of this study is to investigate the prevalence of papillary thyroid microcarcinoma (PTMc) according to the nature of benign pathology that submit patients to thyroid surgery and its trend evolution.MethodsRetrospective cohort analysis of 1815 patients who underwent total thyroidectomy for non-malignant disease from 2005 to 2020. ResultsThe mean age of subjects was 53.5 years, with a higher proportion of women (1481, 82.1%). A total of 167 PTMc (9.3%) were incidentally discovered. Multivariate logistic regression analysis shows no differences in prevalence according to sex or age in patients with PTMc compared to those with final benign histology. Multinodular goiter increases the risk of PTMc with an odds ratio of 2.2 (p=0.001) compared to Hashimoto's thyroiditis and Graves´ disease (GD). There is a statistically significant increase in the incidence of PTMc in the group operated between 2017-2020 vs. 2005-2008 (p=0.005)ConclusionOverall prevalence of PTMc in patients who underwent thyroid surgery for benign disease was 9.3%. Thyroid nodular hyperplasia was the most frequent benign pathology associated to this occult cancer as compared to Hashimoto or GD. Gender and age were not correlated with prevalence of TMc. Over the years, surgical findings of PTMc have grown, particularly in the 2017-2020 period.

The Diagnostic Value of the CA19-9 and Bilirubin Ratio in Patients with Pancreatic Cancer, Distal Bile Duct Cancer and Benign Periampullary Diseases, a Novel Approach

Distinction of pancreatic ductal adenocarcinoma (PDAC) in the head of the pancreas, distal cholangiocarcinoma (dCCA), and benign periampullary conditions, is complex as they often share similar clinical symptoms. However, these diseases require specific management strategies, urging improvement of non-invasive tools for accurate diagnosis. Recent evidence has shown that the ratio between CA19-9 and bilirubin levels supports diagnostic distinction of benign or malignant hepatopancreaticobiliary diseases. Here, we investigate the diagnostic value of this ratio in PDAC, dCCA and benign diseases of the periampullary region in a novel fashion. To address this aim, we enrolled 265 patients with hepatopancreaticobiliary diseases and constructed four logistic regression models on a subset of patients (n = 232) based on CA19-9, bilirubin and the ratio of both values: CA19-9/(bilirubin−1). Non-linearity was investigated using restricted cubic splines and a final model, the ‘Model Ratio’, based on these three variables was fitted using multivariable fractional polynomials. The performance of this model was consistently superior in terms of discrimination and calibration compared to models based on CA19-9 combined with bilirubin and CA19-9 or bilirubin alone. The ‘Model Ratio’ accurately distinguished between malignant and benign disease (AUC [95% CI], 0.91 [0.86–0.95]), PDAC and benign disease (AUC 0.91 [0.87–0.96]) and PDAC and dCCA (AUC 0.83 [0.74–0.92]) which was confirmed by internal validation using 1000 bootstrap replicates. These findings provide a foundation to improve minimally-invasive diagnostic procedures, ultimately ameliorating effective therapy for PDAC and dCCA.

Serum exosomal miR-451a acts as a candidate marker for pancreatic cancer

Objectives The aim of this study was to explore the diagnostic efficiency of serum exosomal miR-451a as a novel biomarker for pancreatic cancer. Methods Serum samples were collected prior to treatment. First, we analyzed microRNA (miRNA) profiles in serum exosomes from eight pancreatic cancer patients and eight healthy volunteers. We then validated the usefulness of the selected exosomal miRNAs as biomarkers in another 191 pancreatic cancer patients, 95 pancreatic benign disease (PB) patients, and 90 healthy controls. Results The expression of miR-451a in serum-derived exosomes from pancreatic cancer patients was significantly upregulated compared with those from PB patients and healthy individuals. Serum exosomal miR-451a showed excellent diagnostic power in identifying pancreatic cancer patients. In addition, exosomal miR-451a showed a significant association with clinical stage and distant metastasis in pancreatic cancer, and the expression level of serum exosomal miR-451a was sensitive to therapy and relapse. Conclusions Serum exosomal miR-451a might serve as a novel diagnostic marker for pancreatic cancer.

miR-424-5p Combined with miR-17-5p Has High Diagnostic Efficacy for Endometriosis

Purpose: Endometriosis (EMT) is a chronic benign disease with high prevalence. This study investigated the diagnostic value of serum miR-17-5p, miR-424-5p, and their combined expressions for EMT.Methods: A total of 80 EMT patients of reproductive age were included as the study subjects, and another 80 healthy women of reproductive age were selected as the control group. The whole blood samples of enrolled subjects were collected and clinical characteristics were recorded. The miR-17-5p, miR-424-5p, VEGFA, IL-4, and IL-6 levels in the serum were measured. ROC curve was used to evaluate the diagnostic efficacy of miR-17-5p and miR-424-5p expressions for EMT. Pearson correlation was performed to analyze the correlation of miR-17-5p and miR-424-5p with clinical indexes in EMT patients.Results: miR-17-5p and miR-424-5p were significantly downregulated in EMT patients. For the diagnosis of EMT, the AUC of miR-17-5p was 0.865 and cutoff value was 0.890 (91.3% sensitivity and 85% specificity), the AUC of miR-424-5p was 0.737 and cutoff value was 0.915 (98.8% sensitivity and 61.2% specificity), the AUC of miR-424-5p combined with miR-17-5p was 0.938 and cutoff value was 2.205 (93.8% sensitivity and 88.7% specificity), with the diagnostic efficacy higher than miR-424-5p or miR-17-5p alone. The expressions of miR-17-5p and miR-424-5p were negatively correlated with dysmenorrhea, infertility, pelvic pain, and rASRM stage, but not with age, BMI, menstrual disorder, and nulliparity. VEGFA, IL-4, and IL-6 were remarkably increased in EMT patients, and both were inversely associated with miR-17-5p and miR-424-5p.Conclusion: miR-424-5p combined with miR-17-5p has high diagnostic efficacy for EMT.

Effective Initial Treatment of Diffuse Pulmonary Lymphangiomatosis with Sirolimus and Propranolol: A Case Report

Diffuse pulmonary lymphangiomatosis (DPL), an exceptionally rare disease, mainly occurs in children and young adults of both sexes. Even though DPL is considered to be a benign disease, its prognosis is relatively poor. Because of its rarity, little guidance on diagnosis and treatment is available, which makes working with patients with DPL challenging for clinicians. We present here a case of a young man with DPL in whom treatment with sirolimus and propranolol rapidly achieved positive radiological and clinical effects.

Oropharynx microbiota transitions in hypopharyngeal carcinoma treatment of induced chemotherapy followed by surgery

Aims To analyze changes in oropharynx microbiota composition after receiving induced chemotherapy followed by surgery for hypopharyngeal squamous cell carcinoma (HPSCC) patients. Methods Clinical data and swab samples of 38 HPSCC patients (HPSCC group) and 30 patients with benign disease (control group, CG) were enrolled in the study. HPSCC group was stratified into two groups: induced chemotherapy group (IC) of 10 patients and non-induced chemotherapy group (nIC) of 28 patients. The microbiota from oropharyngeal membrane was analyzed through 16S rRNA sequencing. Results Alpha-diversity (Shannon and Ace indexes) and weighted UniFrac based beta-diversity severely decreased in the HPSCC group when compared with CG. In pre-operative comparisons, PCoA and NMDS analyses showed microbial structures in the IC group were more similar to CG than nIC. Both IC group and nIC group yielded significantly diverse post-operative communities in contrast to their pre-operative counterparts, evident by the decrease in genera Veillonella and Fusobacterium and increase in genera Streptococcus and Gemella. Given that post-operative oropharynx microbiota showed no difference between IC and nIC groups, the IC group showed less accumulation in anaerobic communities. The abundance of genera Fusobacterium, Parvimonas, Actinomyces were enhanced in the advanced stages (III/IV). Conclusions Oropharynx microbiota in the HPSCC group presents dysbiosis with low diversity and abundance. Induced chemotherapy is beneficial in adjusting the oropharynx microbial environment leading to fewer amounts of anaerobe accumulation after operation. Higher amounts of Fusobacterium in advanced stages (III/IV) may influence the progression of HPSCC.

Multi-Nodule of Large Airway: Tracheobronchopathia Osteochondroplastica, Two Cases Report and Literature Review

We report two subjects with tracheobronchopathia osteochondroplastica (TO), including the clinical manifestations, histological findings, and clinical treatments, which were analyzed retrospectively. One patient with TO was a 60-year-old woman, and the other was a 47-year-old man. The main clinical manifestations were cough, chest pain, and dyspnea. Computed tomography (CT) images showed that TO mainly occurred in the trachea and main bronchus. Histological analysis showed inflammatory exudation, squamous metaplasia, submucosal cartilaginous, and ossification. We present the two cases to increase physician and patient awareness of this benign disease and to improve their understanding of the disease manifestations and potential complications.