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   2016| July-December  | Volume 4 | Issue 2  
    Online since December 20, 2016

 
 
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CASE REPORT
Medullary carcinoma of thyroid: Case report and a review of literature
Ratna Priya, Nitish Virmani, Jyoti P Dabholkar
July-December 2016, 4(2):80-84
DOI:10.4103/2347-8128.196232  
Medullary thyroid carcinoma (MTC) constitutes around 5% of all thyroid cancers. It accounts for as much as 13% of all thyroid cancer-related deaths. MTC usually arises from parafollicular C-cells that normally secrete a number of peptide hormones such as calcitonin, serotonin, and vasoactive intestinal peptide; thus, it is widely accepted as a neuroendocrine tumor. Both sporadic and familial forms are seen, the sporadic form being responsible for 70% of the cases and familial form for 10-20% of the cases. Here, we present a case report of two patients with sporadic MTC. The first patient underwent total thyroidectomy with central compartment neck dissection and right lateral neck dissection, and also in the second patient, total thyroidectomy with central compartment neck dissection was done. Final histopathology came out to be medullary carcinoma of the thyroid. Postoperative serum calcitonin at 2 months following the surgery came out to be normal. Both the patients are on regular follow-up, and there has been no recurrence. Genetic screening and the evaluation of familial syndromes should always be considered in preoperative work-up in MTC patients. Early diagnosis offers a higher likelihood of cure and long-term survival. Total thyroidectomy plus central compartment neck dissection is the mainstay of treatment. All patients must be kept on regular follow-up to avoid recurrence.
  6,454 469 -
KEYNOTE ADDRESS
A century of progress in head and neck cancer
Jatin P Shah
July-December 2016, 4(2):50-58
DOI:10.4103/2347-8128.196181  
  4,792 763 2
ORIGINAL ARTICLES
A retrospective analysis of 200 axillary route thyroidectomy cases
Padmakumar Ramakrishnapillai, Madhukara Pai, Mary Varghese, Farish Shams, PG Shaji, TS Anithadevi, Subin Thomas
July-December 2016, 4(2):75-79
DOI:10.4103/2347-8128.196231  
Background: Thyroid disorders are common in women. The surgical solution available in most places is open thyroidectomy, which can ultimately lead to unsightly scar formation. This can be cosmetically unappealing, especially for women. The endoscopic thyroidectomy is a very good alternative to the traditional open thyroidectomy. It gives excellent cosmetic outcomes, especially when done with an axillary approach, without compromising safety. Methodology: This is a retrospective study conducted on 200 patients who underwent endoscopic thyroidectomy at Sunrise Group of Hospitals, Kochi and Dubai, from July 2013 to March 2016. The procedures performed were total thyroidectomy and hemithyroidectomy. The operation time, thyroid gland/nodule size, duration of hospital stay, and complications were considered for the outcome assessment. Results: A total of 200 endoscopic thyroidectomies were done. The mean age was 38 years, and the mean size of the thyroid was 9.19 ± 3.45 cm. The average time for hemithyroidectomy was 90 ± 12 min, and average time for total thyroidectomy was 150 ± 10 min. Forty-two patients underwent endoscopic hemithyroidectomy, whereas 158 patients underwent endoscopic total thyroidectomy. The histopathological reports revealed that there were 70 adenomas, 41 colloid nodules, 30 thyrotoxicosis, 27 thyroiditis, 26 carcinoma, and 6 Hurthle cell neoplasm cases. Complications, such as permanent hypoparathyroidism, nerve injury, and mortality, were not seen in the study population. Conclusion: Endoscopic thyroidectomy offers excellent cosmetic outcomes with no additional untoward effects. This procedure can be utilized for thyroids as large as 12 cm. All pathologies, including malignancies, can be safely dealt by expert endoscopic surgeon.
  4,461 369 -
Evaluation of distant metastasis in treated thyroid cancers: Study of radioiodine scans in a tertiary care center
US Vishal Rao, Srinidhi Koya, Sataksi Chatterjee, Ashutosh A Patil, Ravi C Nayar, KG Kallur
July-December 2016, 4(2):59-62
DOI:10.4103/2347-8128.196222  
The presence of distant metastases is one of the most important predictive factors of poor outcomes in thyroid cancer patients. Apart from distant metastasis, sex, age, histopathological subtypes, and completeness of surgical resection are the other prognostic indicators of survival. Our attempt in this study is to analyze the presence of distant metastasis in operated patients of thyroid malignancy and evaluate these prognostic indicators in the metastatic subgroup. Objective: The objective of this study was to retrospectively analyze the presence and extent of distant metastasis among treated thyroid cancer patients. Materials and Methods: The postoperative radioiodine scan reports of the patients who presented to Health Care Global Enterprises Ltd., Bengaluru over a period of 8 years (January 2008 to December 2015) were analyzed. Results: Sixty-six patients out of the 499 patients evaluated (13.22%) had distant metastasis. Most of the patients with distant metastasis were females, aged 45 years and above and had papillary carcinoma of thyroid. Percentage of skeletal and pulmonary metastasis was almost equal in the study group. Conclusion: The patterns of distant metastasis were similar to the trends in literature, except for increased incidence of skeletal metastasis, more so in a follicular subtype of papillary carcinomas.
  2,981 313 -
Transoral micro-endoscopic KTP-532 Laser-assisted excision of hypopharyngeal cancers: Our experience
Dipak Ranjan Nayak, Suraj Nair, Ramaswamy Balakrishnan, Apoorva Reddy
July-December 2016, 4(2):69-74
DOI:10.4103/2347-8128.196228  
Aim: To evaluate the overall and disease specific survival rate in patients with hypopharyngeal cancers treated with KTP - 532 LASER. Materials and Methods: We present a retrospective observational study conducted between January 2000 and December 2012 on a total of 28 patients of biopsy-proven cases of squamous cell carcinoma of hypopharynx in Stages I-IV including eight radio-residual cases who underwent trans-oral micro-endoscopic KTP-532 laser-assisted excision of the primary lesion. All patients with clinically and radiologically positive N status underwent modified neck dissection within 10 days. Average follow-up period was 15 months. All the cases received adjuvant radiotherapy except for the radio-residual ones which were managed with salvage surgery alone. Observation and Results: 25/ 28 patients had no disease on their last follow-up with 3 locoregional recurrences. Nineteen patients were followed up for 2 years or more and we found two loco-regional recurrences within 2 years. Overall survival rate was found to be 89.2% and 2-year specific disease-free survival rate 89.4% as calculated using Kaplan-Meier scale. Conclusion: This study evaluates the efficacy and survival rate of patients who underwent trans-oral micro-endoscopic KTP-532 laser-assisted excision for hypopharyngealcancers in various stages as an alternative to conventional open surgeries.
  2,675 357 -
Patterns of failure and prognostic factors for radically treated patients of oropharyngeal cancers planned by two-dimensional radiotherapy: An audit from a regional cancer center
Pragyat Thakur, Bhavana Rai, Raviteja Miriyala, Sushmita Ghoshal
July-December 2016, 4(2):63-68
DOI:10.4103/2347-8128.196226  
Objectives: To review the patterns of failure and analyze various prognostic factors influencing the outcomes of radically treated patients of oropharyngeal squamous cell cancer treated at our institute with two-dimensional planning (2D). Materials and Methods: Case records of 100 oropharyngeal squamous cell cancers, which were treated radically with radiation or concurrent chemoradiation to an equivalent dose of 66 Gy in conventional fractionation, in our department between 2011 and 2013 were retrospectively analyzed for locoregional control (LRC), progression-free survival (PFS), patterns of failure, and various prognostic factors. Results: Median age of presentation was 53 years, 95% being males. Ninety-three percent had a history of tobacco use. Base of tongue was the most common site in 63% of patients followed by tonsil in 26%. All patients were of Stage III and IV. Among these patients, 27% received concurrent chemoradiation while others received radical radiation. At a median follow-up of 28 months, 57% of the patients were disease free and the LRC was 60%. Among the recurrences, 17% had local failures while 23% had nodal failures as the first site of recurrence. There were no marginal failures. On multivariate analysis, stage of the disease was the single most important prognostic factor determining the PFS and LRC. Conclusion: Stage appears to be the most important prognostic factor affecting LRC and PFS. Absence of marginal failures in our study implies adequacy of coverage with 2D treatment planning while in-field failures mandate attempts to use increased dose, chemosensitizers or nodal dissection postradical radiation.
  2,578 292 -
EDITORIAL
Editor's message
Jyoti Dabholkar
July-December 2016, 4(2):49-49
DOI:10.4103/2347-8128.196178  
  2,251 305 -
LETTERS TO EDITOR
Human epidermal growth factor receptor-2 expression in head and neck squamous cell carcinoma: A potential for targeted therapy?
Ravi C Nayar, Vijay Agarwal, Vishal Rao, ML Sheela, Naveen Krishnamurthy, Mithua Ghosh
July-December 2016, 4(2):85-86
DOI:10.4103/2347-8128.196233  
  2,010 225 -
Robotic surgery in oropharyngeal cancers: A brief narrative
Manigreeva Krishnatreya
July-December 2016, 4(2):86-88
DOI:10.4103/2347-8128.196234  
  1,790 206 -