The overall prognosis of MTC is favourable, even if the rate of biochemical cure is lower in MTC than in differentiated types of thyroid cancer. This is also true for patients with biochemically persistent disease. Whether the identification of further tumour sites by advanced imaging procedures such as PET/CT translates into a better prognosis in patients with persistently elevated calcitonin levels remains to be investigated.
The combination of ERCP and laparoscopic cholecystectomy offers a safe and effective option for the definitive treatment of complicated gallstone disease and intractable pain during pregnancy, and there is sufficient access for the combined treatment to be employed.
The aim of this study was to evaluate sentinel lymph node mapping in patients with differentiated thyroid carcinoma. Nine patients with suspected thyroid carcinoma who were scheduled to undergo thyroidectomy underwent scintigraphic localization of sentinel lymph nodes (SLNs). On the day of surgery we injected 37 MBq technetium-99m nanocolloid intratumourally. Dynamic data up to 10 min followed by planar anterior and lateral oblique images up to 1 h after tracer administration were recorded. At surgery the primary tumour was excised first, then the SLNs were removed using a gamma probe. Four patients had papillary carcinoma, two follicular carcinoma, one an oncocytic tumour and two benign tumours. An SLN was identified in all four patients with papillary carcinoma. In the two patients with follicular carcinoma, SLN detection failed. Five patients had one radioactive node, one had three and one had four. In one patient, no SLN was visible with scintigraphic imaging but at surgery three SLNs could be clearly identified using the gamma probe after removal of the primary tumour. There were no false-negative findings. This initial study indicates that in patients with papillary thyroid carcinoma detection of the SLN is possible, whereas the technique failed in two patients with follicular carcinoma. A study on a larger patient sample is now warranted.
We report a case of a doubled gallbladder missed in preoperative ultrasound and laparoscopic cholecystectomy but demonstrated by endoscopic retrograde cholangiography (ERC) postoperatively.
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