We present a case of a 32-year-old woman with hyperparathyroidism, treated with ultrasound-guided percutaneous radiofrequency ablation (RFA). RFA, assisted by saline injection inferomedial to the parathyroid, is a safe technique that prevents burn injury to the nerve. The saline injection technique shifted the parathyroid gland laterally, so that the distance between the nerve and the parathyroid gland was sufficient to prevent burn injury. The completeness of tissue ablation was evaluated based on Doppler ultrasound imaging and serum intact parathyroid hormone (iPTH) level immediately after RFA. There were no complications associated with RFA. Serum iPTH levels normalized during follow-up for 20 months. It was possible to perform RFA for primary parathyroid adenoma safely using a saline injection technique.
Primary squamous cell carcinoma of the thyroid gland is very rare and its histogenesis is poorly defined so far. Although there have been some cases of squamous cell carcinoma with variant types of papillary thyroid carcinoma (PTC), the present case is the first primary squamous cell carcinoma with classic PTC to be reported. A 43-year-old woman presented with a 20 year history of neck mass. Neck ultrasound indicated a 6x4x3 cm large mass. The patient underwent total thyroidectomy. Histopathology indicated a well-differentiated squamous cell carcinoma and squamous metaplasia in conjunction with classic PTC. On immunohistochemistry cytokeratin 7 was positive in papillary carcinoma and squamous metaplasia, thyroglobulin was positive only in papillary carcinoma, and p63 was positive in squamous metaplasia and squamous cell carcinoma. Postoperatively, the patient received 59.4 Gy adjuvant radiotherapy, hormonal therapy and radioactive iodine therapy. At 8 months after surgery the patient remained disease free.
Purpose: This study was performed to find the adequate number of removed lymph nodes to achieve an acceptable false-negative rate when performing sentinel lymph node biopsy for breast cancer. Methods: A total of 179 sentinel node biopsies combined with conventional axillary lymph node dissection for breast cancer were performed between November 2003 and June 2007. Results: The overall identification rate of sentinel lymph node and the false negative rate of the biopsy were 95.0% and 8.1%, respectively. Yet the false negative rate of the biopsy was lowered as the number of the removed nodes was increased. Especially, the false negative rate was 0% when more than 4 lymph nodes were removed. Conclusion: We recommend that four lymph nodes should be removed to obtain accurate results in sentinel node biopsy for breast cancer.
This study estimated the changes in distance between a thyroid nodule and the surrounding structures after tumescent anesthesia in radiofrequency ablation (RFA) for a benign thyroid nodule. Methods: Between January 2015 and December 2017, the sonogram images in patients treated with thyroid RFA were reviewed retrospectively. Patients without images immediately after tumescent anesthesia or treated with RFA for carcinoma were excluded. The 0.2% saline mixed lidocaine as a tumescent solution was injected into the anterior, posterior, and lateral capsules of the thyroid and thyroid-trachea junction. In a sonogram image, the distances between the posterior margin of the nodule and above the longus colli muscle, between the medial margin of the nodule and trachea, and between the lateral margin of the nodule and common carotid artery (CCA) were measured before and after tumescent anesthesia. Results: Tumescent anesthesia was technically successful in all 133 patients (100%) and the analgesic effect was also obtained successfully. No complications related to tumescent anesthesia were observed. The average distance between the posterior margin of the nodule and the longus colli muscle increased by 4.2 ± 2.4 mm. The average distance between the medial margin of the nodule and trachea increased by 2.2 ± 1.9 mm. The average distance between the lateral margin of the nodule and CCA increased by 4.6 ± 3.0 mm. Conclusion: Tumescent anesthesia is a safe and useful method for secure a safe distance (over 2 mm) in RFA for thyroid nodules close to the surrounding structure.
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