Quan-Yang Duh

Medullary thyroid cancer (MTC) accounts for less than 5% of all thyroid cancers; it differs from the more common papillary thyroid cancer and follicular thyroid cancer, which collectively are called differentiated thyroid cancer. Medullary TC derives from C cells instead of follicular cells and is considered a neuroendocrine tumor. Although most MTC grows slowly, the prognosis of patients with MTC is worse than that of patients with papillary thyroid cancer or follicular thyroid cancer. A high proportion of MTC is associated with germline RET (rearranged during transfection) oncogene mutation as part of the multiple endocrine neoplasia type 2 syndrome.¹

Background The presence and location of regional lymph node metastasis affect the prognosis of patients with thyroid cancer. Lymph node classification of the current TNM system may be inadequate because it insufficiently characterizes the nature and severity of lymph node metastasis that may influence prognosis. Methods We retrospectively studied 240 patients with papillary thyroid cancer and node metastases who had undergone total thyroidectomy, lymph node dissection, and postoperative ¹³¹I treatment at the University Cancer Center between 1994 and 2004. We reviewed the status of regional lymph node metastasis, including the location, number, largest size, and extranodal tumor extension and analyzed their effect on the prognosis of the patients. Results There were 172 women and 68 men, with a median age of 38 years and median tumor size of 1.9 cm. Thirty-five percent had only central compartment (N1a) nodal metastasis and 65% had involvement of both central and lateral compartments (N1b). There were a median of 4 nodes containing metastasis with a median largest diameter of 1.2 cm. Sixty patients (25%) had extranodal extension of cancer. Multivariate analysis showed that patient age (p = .0017; hazard ratio [HR], 2.156), >3 lymph node metastasis (p = .0316; HR, 1.806), and extranodal extension (p < .0001; HR, 4.027) were independent predictors of disease recurrence. Patient age (p = .0034; HR, 22.068), vascular invasion (p = .01; HR, 8.2), and extranodal extension (p = .022; HR, 12.597) were independent predictors of disease-specific survival (DSS). The DSS and recurrence-free survival curve between patients with and without extranodal extension differ significantly (p < .0001). For those older than 45 years, the 10-year recurrence was 11 of 43 patients for those without extranodal extension and 24 of 27 patients for those with extranodal extension (p < .001). Among patients with stage 4a/4b, those with extranodal extension had a significantly worse DSS and disease-free survival (DFS; p < .001) than those without extranodal extension. The prognosis of patients with stage 4a/4b cancer who had no extranodal extension was the same as patients with stage 3 cancer. The status of extranodal extension seems to be a stronger prognostic predictor than the location of metastatic lymph nodes (N1a/1b). Conclusion Presence of extranodal extension of metastatic nodes is a significant adverse independent prognostic factor for patients with lymph node metastasis from papillary cancer. This may need to be considered in future updates of the TNM system for thyroid cancer. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1336–1343, 2015

Background: The goal of this study was to review a single institution’s experience using intraoperative ultrasound‐guided (ioUSG) methylene blue dye injection for the localization and removal of enlarged parathyroid glands in patients with primary hyperparathyroidism and a history of previous neck surgery.Methods: We performed a retrospective review of nine consecutive patients who underwent reoperative parathyroidectomy using ioUSG methylene blue dye injection.Results: All patients had successful resolution of their hyperparathyroidism, with at least a 50 % decrease in intraoperative parathyroid hormone level after resection. One patient had transient recurrent laryngeal nerve paresis. There were no permanent recurrent laryngeal nerve injuries or cases of permanent hypoparathyroidism.Conclusions: Blue dye injection is a safe and effective method of localizing diseased parathyroid glands in the reoperative neck.

Laparoscopic adrenalectomy has evolved to become the procedure of choice for most surgically treated adrenal diseases.^1-3 A safe laparoscopic adrenalectomy requires a thorough knowledge of the usual anatomy of the adrenal gland as well as its unusual anatomical variations.