carcinoma medular de tiroides

37
CARCINOMA MEDULAR DE TIROIDES

Upload: mangellozano

Post on 04-Jul-2015

2.803 views

Category:

Health & Medicine


3 download

TRANSCRIPT

Page 1: Carcinoma medular de tiroides

CARCINOMA MEDULAR DE

TIROIDES

FUCS

bull MIGUEL AacuteNGEL LOZANO ARIAS

bull INFORMATICA NIVEL MEDIO

bull BOGOTA DC

bull 2011

LA GLANDULA TIROIDES

bull ldquothe thyroid is one of the largest of the endocrine organs weighing approximately 15 to 20 g The normal thyroid is made up of two lobes joined by a thin band of tissue the isthmus which is approximately 05 cm thick 2 cm wide and 1 to 2 cm high The individual lobes normally have a pointed superior pole and a poorly defined blunt inferior pole that merges medially with the isthmus Each lobe is approximately 20 to 25 cm in thickness and width at its largest diameter and it is approximately 40 cm in lengthrdquo 1

bull httpwwwnlmnihgovmedlineplusspanishencyimagesencyfullsize8966jpg

CANCER MEDULAR DE TIROIDES

bull ldquoEs un caacutencer de la glaacutendula tiroides que comienza en un tipo de ceacutelulas denominadas ceacutelulas C que liberan una hormona llamada calcitoninardquo278

httpescuelamedpucclpaginascursosterceroanatomiapatologicaimagenes_apfotos937-941941jpg

VISTA MICROSCOPICA DE NEOPLASIA EN LA GLANDULA TIROIDES

VISTA MACROSCOPICA DE NEOPLASIA EN GLANDULA TIROIDES

bull httpescuelamedpucclpublpatgeneralFotosBig133jpg

CAUSAS

bull ldquoLa causa del carcinoma medular tiroideo (CMT) se desconoce

bull A diferencia de otros tipos de caacutencer de la tiroides es menos probable que este tipo de carcinoma sea causado por radioterapia al cuello aplicada para tratar otros caacutenceres durante la infanciardquo6

CLASES DE CMT

bull ldquoHay dos formas de carcinoma medular tiroideo

bull Carcinoma medular tiroideo esporaacutedico el cual no se transmite de padres a hijos La mayoriacutea de estos carcinomas son esporaacutedicos Esta forma afecta principalmente a los adultos mayores

bull Carcinoma medular tiroideo hereditario el cual se transmite de padres a hijosrdquo2

bull httpwwwaddisonesimagbociojpg

FACTORES DE RIESGO

bull ldquoUn antecedente familiar de este tipo de carcinoma

bull Antecedentes familiares de neoplasia endocrina muacuteltiple (NEM)

bull Historia previa de feocromocitoma neuromas de la mucosa o hiperparatiroidismordquo4

httpwwwconganatorgseapdatosregionalesvcamino1jpg

Hiperparatiroidismo uno de los mas influyentes factores de riesgo

SIacuteNTOMAS

bull ldquoProblemas respiratorios debido al estrechamiento de las viacuteas respiratorias

bull Tos

bull Tos con sangre

bull Diarrea

bull Bocio (agrandamiento de la tiroides)

bull Tumor en la glaacutendula tiroidesrdquo2

BOCIO

httpgenesisuagmxsaludarticulosanterioresimagesbociojpg

SIGNOS Y EXAacuteMENES

bull ldquoEl meacutedico llevaraacute a cabo un examen fiacutesico Los ganglios linfaacuteticos en el cuello pueden presentar hinchazoacuten Las pruebas de la funcioacuten tiroidea generalmente son normales sin embargo un examen de la tiroides puede revelar noacutedulos (tumoraciones) solitarios o muacuteltiples

bull El examen fiacutesico medico es de suma importancia para detectar hiperplasias en estadios tempranos de carcinoma medular de tiroides

bull httpwwwlosmedicamentosnetconsejoswp-contentuploads201104bociojpg

bull Otros exaacutemenes que se pueden utilizar para diagnosticar el carcinoma medular tiroideo pueden ser

bull Examen de sangre para calcitonina

bull Examen de sangre para antiacutegeno carcinoembrionario (ACE)

bull Pruebas geneacuteticas

bull Biopsia de la tiroides

bull Gammagrafiacutea de la tiroides

bull Ecografiacutea de la tiroidesrdquo23httpwwwdoctorweborgstaticimagesbociojpg

OPCIONES DE TRATAMIENTO

bull ldquoCirugiacutea con frecuencia es necesario efectuar una traqueotomiacutea Si la enfermedad estaacute limitada a un aacuterea local lo cual es poco comuacuten se justifica la realizacioacuten de una tiroidectomiacutea total para reducir los siacutentomas que causa la masa tumoralrdquo39

bull httpwwwnlmnihgovmedlineplusspanishencyimagesencyfullsize14066jpg

bull Radioterapia Se puede usar la irradiacioacuten de haz externo en los pacientes que no son idoacuteneos para la cirugiacutea o cuyo tumor no puede extirparse quiruacutergicamente

bull Quimioterapia el caacutencer anaplaacutesico de la tiroides no responde al tratamiento con I131 se observa que el tratamiento con monofaacutermacosanticancerosos produce remisiones parciales en algunos pacientes Aproximadamente 30 de los pacientes logran una remisioacuten parcial con la doxorrubicina La combinacioacuten de doxorrubicina y cisplatino parece ser maacutes activa que la doxorrubicina sola y se ha observado que produce maacutes respuestas completas

bull ldquoTargeted systemic radiotherapy of pheochromocytoma and medullary thyroid cancerbull Divgi Cbull Sourcebull Columbia University New York NYbull Abstractbull Targeted systemic radiotherapy constitutes the systemic administration of a radioactive agent that

targets a molecule expressed preferentially on cancer cells The archetypal such therapy is 131-iodine ((131)I) therapy for differentiated thyroid cancers Radiotherapy typically delivers a calculated radiation-absorbed dose to tumor that takes into account (contiguous) normal tissue Systemic radiotherapy development currently uses schema more analogous to chemotherapy-a radioactivity estimate that does not cause any irreversible toxicity Historically arbitrary amounts of radioactivity shown to be effective on the basis of retrospective review were used for thyroidcancer therapy with (131)I as well as for neuroendocrine tumor therapy with (131)I-labeled meta-iodo-benzylguanidine (MIBG) Their established safety record has led to adaptations that include repeat therapies with nontoxic amounts of radioactivity There remains however a lack of clear understanding of the safety limits of systemic targeted radiotherapy This is probably most true in systemic therapy with MIBG in adult neuroendocrine tumors Bone marrow is the primary critical organ for most targeted systemic radiotherapy second organ involvement may be renal as with MIBG and targeted radiopeptide therapy or pulmonary as with radioimmunotherapy Most therapies have tended toward multiple administrations of subtoxic amounts of radioactivity Therapy with MIBG in pheochromococytoma as well as targeted radiopeptide therapy in medullarythyroid cancer has followed this model Radioimmunotherapy appears very promising a definitive Phase 2 study needs completion All therapy has shown promise in extending disease survival (as compared with historical controls) with few major structural (or biochemical) responses This review will attempt to compliment the excellent existing literature by providing an overall systemic therapeutic approach to this promising endeavorrdquo11

bull Este articulo es realmente interesante ya que plantea una mejora en el tratamiento con radioterapia para pacientes con caacutencer medular de tiroides los estudios que aquiacute presentan demuestran que la mejora del tratamiento se ve reflejada en el aumento de la expectativa de vida de los pacientes tratados con el nuevo meacutetodo frente a los tratados con el meacutetodo tradicional

bull http1bpblogspotcom_nbADpD65WD4SmDX1fuRnVIAAAAAAAAGygbXhKLyxMhAEs320tiroidesjpg

bull ldquoCurrent role of metaiodobenzylguanidine in the diagnosis of pheochromocytoma and medullary thyroid cancer

bull Ilias I Divgi C Pacak Kbull Sourcebull Department of Endocrinology E Venizelou Hospital Athens

Greecebull Abstractbull Despite early reports of excellent diagnostic characteristics of

[(131)I][(123)I]-metaiodobenzylguanidine (MIBG) in the evaluation of pheochromocytomasparagangliomas (PHEOsPGLs) or medullary thyroid cancer as experience with it was accumulated the sensitivity dropped Nevertheless this modality is still useful in the diagnostic work-up of PHEOsPGLs because it is widely available and in case of positive scans it might indicate patients who are potential candidates for [(131)I]MIBG therapy

bull Published by Elsevier Incrdquo12

bull El medicamento que referencia el articulo medico se encuentra ampliamente difundido y es esta la principal ventaja del este faacutermaco Aun faltan bastantes estudios el articulo deja muchos interrogantes

bull ldquoAnn Acad Med Singapore 2011 Jun40(6)300-2

bull Melanocytic variant of medullary thyroidcarcinoma in a previously treated papillarycarcinoma patient

bull Mohamad I Zainuddin N Zawawi N Naik VR

bull Source

bull Department of Otorhinolaryngology - Head amp Neck Surgeryrdquo13

bull Este articulo propone que los melanocitos son una variante significativa de el carcinoma medular de tiroides despueacutes de que esta haya sido exitosamente tratada

bull http4bpblogspotcom_Fnq-_ypIXdgTO6t_bKf53IAAAAAAAAAEgQLDhcalP0hks1600melanocitosjpg

bull ldquoBreast metastasis by medullary thyroid carcinoma detected by FDG positron emission tomography

bull Nofech-Mozes S Mackenzie R Kahn HJ Ehrlich L Raphael SJbull Sourcebull Department of Anatomical Pathology Sunnybrook Health Sciences Center

Toronto ON Canada M4N 3M5bull Abstractbull Medullary thyroid carcinoma (MTC) is an uncommon thyroid cancer

comprising 5 to 8 of thyroid neoplasms In contrast to common thyroid tumors this tumor originates from the calcitonin-producing C cells Regional metastases to cervical lymph nodes occur early in the disease whereas distant metastasis occurs late Common metastatic sites include the liver bone brain and adrenal medulla We present a case of MTC metastatic to the breast We report on this case for the following reasons (1) metastasis to the breast is an extremely rare occurrence and could be easily confused clinically and pathologically with a primary breast neoplasm and (2) this is the first reported case of detection of breast metastasis by an MTC using FDG ((18)F-fluoro-2-deoxy-D-glucose) positron emission tomography with an accompanying histologic descriptionrdquo14

bull El articulo trata el tema de las metaacutestasis de el carcinoma medular de tiroides haciendo especial eacutenfasis en las metaacutestasis a distancias especialmente en mama

bull http4bpblogspotcom_YmCZlFt2utMTOv2n-jvZKIAAAAAAAAABIKqnwuja7pLQs1600CancerMetastasisjpg

bull ldquoCytology of hyalinising trabecular adenoma-like variant of medullarythyroid carcinoma

bull Santosh KV Raychaudhuri S Subramanya H Naveen Kumar BJbull Sourcebull Department of Pathology Vydehi Institute of Medical Sciences and

Research Center Bangalore Indiabull Abstractbull Medullary thyroid carcinoma is a rare thyroid neoplasm that can be

either sporadic or familial It occurs in adults presenting as a solitary cold nodule on thyroid scan Most are solid firm and non-encapsulated and occur in the mid portion or upper half of the thyroid gland corresponding to areas with greater numbers of C cells We present a case of a 36-year-old female with a swelling in the front of her neck for six years Fine needle aspiration done elsewhere revealed spindle cells suggestive of a spindle cell neoplasm The histopathology of the thyroidectomyspecimen showed features of a hyalinizing trabecular adenoma-like variant of medullary carcinoma Subsequently we performed aspiration on the received specimen and studied the cytological findings The cytological diagnosis of this variant requires identification of the dual spindle and ovoid cell population and the granular neuroendocrinechromatinrdquo15

bull Este trabajo investigativo plantea la posibilidad de una variante del carcinoma medular de tiroides en forma de un adenoma hialinizante trabecular Este estudio fue hecho en una mujer de 36 antildeos es necesario hacer estudios en otros pacientes para reafirmar la tesis del articulo

BIBLIOGRAFIacuteA

bull 1) httpbibliotecafucsaludeduco2052bookspagedoeid=4-u10-B978-1-4377-0324-500011-0--s0030ampisbn=978-1-4377-0324-5ampuniqId=270438322-24-u10-B978-1-4377-0324-500011-0--f0015

bull 2)

bull httpwwwnlmnihgovmedlineplusspanishencyarticle000374htm

bull 3)bull Goldman JM Goren EN Cohen MH et al Anaplastic thyroid

carcinoma long-term survival after radical surgery J Surg Oncol 14 (4) 389-94 1980 [PUBMED Abstract]

4)bull Aldinger KA Samaan NA Ibanez M et al Anaplastic carcinoma of

the thyroid a review of 84 cases of spindle and giant cell carcinoma of the thyroid Cancer 41 (6) 2267-75 1978 [PUBMED Abstract]

5)bull Carling T Udelsman R Thyroid tumors In DeVita VT Jr Hellman

S Rosenberg SA eds Cancer Principles and Practice of Oncology Vols 1 amp 2 8th ed Philadelphia Pa Lippincott Williams amp Wilkins 2008 pp 1663-82

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 2: Carcinoma medular de tiroides

FUCS

bull MIGUEL AacuteNGEL LOZANO ARIAS

bull INFORMATICA NIVEL MEDIO

bull BOGOTA DC

bull 2011

LA GLANDULA TIROIDES

bull ldquothe thyroid is one of the largest of the endocrine organs weighing approximately 15 to 20 g The normal thyroid is made up of two lobes joined by a thin band of tissue the isthmus which is approximately 05 cm thick 2 cm wide and 1 to 2 cm high The individual lobes normally have a pointed superior pole and a poorly defined blunt inferior pole that merges medially with the isthmus Each lobe is approximately 20 to 25 cm in thickness and width at its largest diameter and it is approximately 40 cm in lengthrdquo 1

bull httpwwwnlmnihgovmedlineplusspanishencyimagesencyfullsize8966jpg

CANCER MEDULAR DE TIROIDES

bull ldquoEs un caacutencer de la glaacutendula tiroides que comienza en un tipo de ceacutelulas denominadas ceacutelulas C que liberan una hormona llamada calcitoninardquo278

httpescuelamedpucclpaginascursosterceroanatomiapatologicaimagenes_apfotos937-941941jpg

VISTA MICROSCOPICA DE NEOPLASIA EN LA GLANDULA TIROIDES

VISTA MACROSCOPICA DE NEOPLASIA EN GLANDULA TIROIDES

bull httpescuelamedpucclpublpatgeneralFotosBig133jpg

CAUSAS

bull ldquoLa causa del carcinoma medular tiroideo (CMT) se desconoce

bull A diferencia de otros tipos de caacutencer de la tiroides es menos probable que este tipo de carcinoma sea causado por radioterapia al cuello aplicada para tratar otros caacutenceres durante la infanciardquo6

CLASES DE CMT

bull ldquoHay dos formas de carcinoma medular tiroideo

bull Carcinoma medular tiroideo esporaacutedico el cual no se transmite de padres a hijos La mayoriacutea de estos carcinomas son esporaacutedicos Esta forma afecta principalmente a los adultos mayores

bull Carcinoma medular tiroideo hereditario el cual se transmite de padres a hijosrdquo2

bull httpwwwaddisonesimagbociojpg

FACTORES DE RIESGO

bull ldquoUn antecedente familiar de este tipo de carcinoma

bull Antecedentes familiares de neoplasia endocrina muacuteltiple (NEM)

bull Historia previa de feocromocitoma neuromas de la mucosa o hiperparatiroidismordquo4

httpwwwconganatorgseapdatosregionalesvcamino1jpg

Hiperparatiroidismo uno de los mas influyentes factores de riesgo

SIacuteNTOMAS

bull ldquoProblemas respiratorios debido al estrechamiento de las viacuteas respiratorias

bull Tos

bull Tos con sangre

bull Diarrea

bull Bocio (agrandamiento de la tiroides)

bull Tumor en la glaacutendula tiroidesrdquo2

BOCIO

httpgenesisuagmxsaludarticulosanterioresimagesbociojpg

SIGNOS Y EXAacuteMENES

bull ldquoEl meacutedico llevaraacute a cabo un examen fiacutesico Los ganglios linfaacuteticos en el cuello pueden presentar hinchazoacuten Las pruebas de la funcioacuten tiroidea generalmente son normales sin embargo un examen de la tiroides puede revelar noacutedulos (tumoraciones) solitarios o muacuteltiples

bull El examen fiacutesico medico es de suma importancia para detectar hiperplasias en estadios tempranos de carcinoma medular de tiroides

bull httpwwwlosmedicamentosnetconsejoswp-contentuploads201104bociojpg

bull Otros exaacutemenes que se pueden utilizar para diagnosticar el carcinoma medular tiroideo pueden ser

bull Examen de sangre para calcitonina

bull Examen de sangre para antiacutegeno carcinoembrionario (ACE)

bull Pruebas geneacuteticas

bull Biopsia de la tiroides

bull Gammagrafiacutea de la tiroides

bull Ecografiacutea de la tiroidesrdquo23httpwwwdoctorweborgstaticimagesbociojpg

OPCIONES DE TRATAMIENTO

bull ldquoCirugiacutea con frecuencia es necesario efectuar una traqueotomiacutea Si la enfermedad estaacute limitada a un aacuterea local lo cual es poco comuacuten se justifica la realizacioacuten de una tiroidectomiacutea total para reducir los siacutentomas que causa la masa tumoralrdquo39

bull httpwwwnlmnihgovmedlineplusspanishencyimagesencyfullsize14066jpg

bull Radioterapia Se puede usar la irradiacioacuten de haz externo en los pacientes que no son idoacuteneos para la cirugiacutea o cuyo tumor no puede extirparse quiruacutergicamente

bull Quimioterapia el caacutencer anaplaacutesico de la tiroides no responde al tratamiento con I131 se observa que el tratamiento con monofaacutermacosanticancerosos produce remisiones parciales en algunos pacientes Aproximadamente 30 de los pacientes logran una remisioacuten parcial con la doxorrubicina La combinacioacuten de doxorrubicina y cisplatino parece ser maacutes activa que la doxorrubicina sola y se ha observado que produce maacutes respuestas completas

bull ldquoTargeted systemic radiotherapy of pheochromocytoma and medullary thyroid cancerbull Divgi Cbull Sourcebull Columbia University New York NYbull Abstractbull Targeted systemic radiotherapy constitutes the systemic administration of a radioactive agent that

targets a molecule expressed preferentially on cancer cells The archetypal such therapy is 131-iodine ((131)I) therapy for differentiated thyroid cancers Radiotherapy typically delivers a calculated radiation-absorbed dose to tumor that takes into account (contiguous) normal tissue Systemic radiotherapy development currently uses schema more analogous to chemotherapy-a radioactivity estimate that does not cause any irreversible toxicity Historically arbitrary amounts of radioactivity shown to be effective on the basis of retrospective review were used for thyroidcancer therapy with (131)I as well as for neuroendocrine tumor therapy with (131)I-labeled meta-iodo-benzylguanidine (MIBG) Their established safety record has led to adaptations that include repeat therapies with nontoxic amounts of radioactivity There remains however a lack of clear understanding of the safety limits of systemic targeted radiotherapy This is probably most true in systemic therapy with MIBG in adult neuroendocrine tumors Bone marrow is the primary critical organ for most targeted systemic radiotherapy second organ involvement may be renal as with MIBG and targeted radiopeptide therapy or pulmonary as with radioimmunotherapy Most therapies have tended toward multiple administrations of subtoxic amounts of radioactivity Therapy with MIBG in pheochromococytoma as well as targeted radiopeptide therapy in medullarythyroid cancer has followed this model Radioimmunotherapy appears very promising a definitive Phase 2 study needs completion All therapy has shown promise in extending disease survival (as compared with historical controls) with few major structural (or biochemical) responses This review will attempt to compliment the excellent existing literature by providing an overall systemic therapeutic approach to this promising endeavorrdquo11

bull Este articulo es realmente interesante ya que plantea una mejora en el tratamiento con radioterapia para pacientes con caacutencer medular de tiroides los estudios que aquiacute presentan demuestran que la mejora del tratamiento se ve reflejada en el aumento de la expectativa de vida de los pacientes tratados con el nuevo meacutetodo frente a los tratados con el meacutetodo tradicional

bull http1bpblogspotcom_nbADpD65WD4SmDX1fuRnVIAAAAAAAAGygbXhKLyxMhAEs320tiroidesjpg

bull ldquoCurrent role of metaiodobenzylguanidine in the diagnosis of pheochromocytoma and medullary thyroid cancer

bull Ilias I Divgi C Pacak Kbull Sourcebull Department of Endocrinology E Venizelou Hospital Athens

Greecebull Abstractbull Despite early reports of excellent diagnostic characteristics of

[(131)I][(123)I]-metaiodobenzylguanidine (MIBG) in the evaluation of pheochromocytomasparagangliomas (PHEOsPGLs) or medullary thyroid cancer as experience with it was accumulated the sensitivity dropped Nevertheless this modality is still useful in the diagnostic work-up of PHEOsPGLs because it is widely available and in case of positive scans it might indicate patients who are potential candidates for [(131)I]MIBG therapy

bull Published by Elsevier Incrdquo12

bull El medicamento que referencia el articulo medico se encuentra ampliamente difundido y es esta la principal ventaja del este faacutermaco Aun faltan bastantes estudios el articulo deja muchos interrogantes

bull ldquoAnn Acad Med Singapore 2011 Jun40(6)300-2

bull Melanocytic variant of medullary thyroidcarcinoma in a previously treated papillarycarcinoma patient

bull Mohamad I Zainuddin N Zawawi N Naik VR

bull Source

bull Department of Otorhinolaryngology - Head amp Neck Surgeryrdquo13

bull Este articulo propone que los melanocitos son una variante significativa de el carcinoma medular de tiroides despueacutes de que esta haya sido exitosamente tratada

bull http4bpblogspotcom_Fnq-_ypIXdgTO6t_bKf53IAAAAAAAAAEgQLDhcalP0hks1600melanocitosjpg

bull ldquoBreast metastasis by medullary thyroid carcinoma detected by FDG positron emission tomography

bull Nofech-Mozes S Mackenzie R Kahn HJ Ehrlich L Raphael SJbull Sourcebull Department of Anatomical Pathology Sunnybrook Health Sciences Center

Toronto ON Canada M4N 3M5bull Abstractbull Medullary thyroid carcinoma (MTC) is an uncommon thyroid cancer

comprising 5 to 8 of thyroid neoplasms In contrast to common thyroid tumors this tumor originates from the calcitonin-producing C cells Regional metastases to cervical lymph nodes occur early in the disease whereas distant metastasis occurs late Common metastatic sites include the liver bone brain and adrenal medulla We present a case of MTC metastatic to the breast We report on this case for the following reasons (1) metastasis to the breast is an extremely rare occurrence and could be easily confused clinically and pathologically with a primary breast neoplasm and (2) this is the first reported case of detection of breast metastasis by an MTC using FDG ((18)F-fluoro-2-deoxy-D-glucose) positron emission tomography with an accompanying histologic descriptionrdquo14

bull El articulo trata el tema de las metaacutestasis de el carcinoma medular de tiroides haciendo especial eacutenfasis en las metaacutestasis a distancias especialmente en mama

bull http4bpblogspotcom_YmCZlFt2utMTOv2n-jvZKIAAAAAAAAABIKqnwuja7pLQs1600CancerMetastasisjpg

bull ldquoCytology of hyalinising trabecular adenoma-like variant of medullarythyroid carcinoma

bull Santosh KV Raychaudhuri S Subramanya H Naveen Kumar BJbull Sourcebull Department of Pathology Vydehi Institute of Medical Sciences and

Research Center Bangalore Indiabull Abstractbull Medullary thyroid carcinoma is a rare thyroid neoplasm that can be

either sporadic or familial It occurs in adults presenting as a solitary cold nodule on thyroid scan Most are solid firm and non-encapsulated and occur in the mid portion or upper half of the thyroid gland corresponding to areas with greater numbers of C cells We present a case of a 36-year-old female with a swelling in the front of her neck for six years Fine needle aspiration done elsewhere revealed spindle cells suggestive of a spindle cell neoplasm The histopathology of the thyroidectomyspecimen showed features of a hyalinizing trabecular adenoma-like variant of medullary carcinoma Subsequently we performed aspiration on the received specimen and studied the cytological findings The cytological diagnosis of this variant requires identification of the dual spindle and ovoid cell population and the granular neuroendocrinechromatinrdquo15

bull Este trabajo investigativo plantea la posibilidad de una variante del carcinoma medular de tiroides en forma de un adenoma hialinizante trabecular Este estudio fue hecho en una mujer de 36 antildeos es necesario hacer estudios en otros pacientes para reafirmar la tesis del articulo

BIBLIOGRAFIacuteA

bull 1) httpbibliotecafucsaludeduco2052bookspagedoeid=4-u10-B978-1-4377-0324-500011-0--s0030ampisbn=978-1-4377-0324-5ampuniqId=270438322-24-u10-B978-1-4377-0324-500011-0--f0015

bull 2)

bull httpwwwnlmnihgovmedlineplusspanishencyarticle000374htm

bull 3)bull Goldman JM Goren EN Cohen MH et al Anaplastic thyroid

carcinoma long-term survival after radical surgery J Surg Oncol 14 (4) 389-94 1980 [PUBMED Abstract]

4)bull Aldinger KA Samaan NA Ibanez M et al Anaplastic carcinoma of

the thyroid a review of 84 cases of spindle and giant cell carcinoma of the thyroid Cancer 41 (6) 2267-75 1978 [PUBMED Abstract]

5)bull Carling T Udelsman R Thyroid tumors In DeVita VT Jr Hellman

S Rosenberg SA eds Cancer Principles and Practice of Oncology Vols 1 amp 2 8th ed Philadelphia Pa Lippincott Williams amp Wilkins 2008 pp 1663-82

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 3: Carcinoma medular de tiroides

LA GLANDULA TIROIDES

bull ldquothe thyroid is one of the largest of the endocrine organs weighing approximately 15 to 20 g The normal thyroid is made up of two lobes joined by a thin band of tissue the isthmus which is approximately 05 cm thick 2 cm wide and 1 to 2 cm high The individual lobes normally have a pointed superior pole and a poorly defined blunt inferior pole that merges medially with the isthmus Each lobe is approximately 20 to 25 cm in thickness and width at its largest diameter and it is approximately 40 cm in lengthrdquo 1

bull httpwwwnlmnihgovmedlineplusspanishencyimagesencyfullsize8966jpg

CANCER MEDULAR DE TIROIDES

bull ldquoEs un caacutencer de la glaacutendula tiroides que comienza en un tipo de ceacutelulas denominadas ceacutelulas C que liberan una hormona llamada calcitoninardquo278

httpescuelamedpucclpaginascursosterceroanatomiapatologicaimagenes_apfotos937-941941jpg

VISTA MICROSCOPICA DE NEOPLASIA EN LA GLANDULA TIROIDES

VISTA MACROSCOPICA DE NEOPLASIA EN GLANDULA TIROIDES

bull httpescuelamedpucclpublpatgeneralFotosBig133jpg

CAUSAS

bull ldquoLa causa del carcinoma medular tiroideo (CMT) se desconoce

bull A diferencia de otros tipos de caacutencer de la tiroides es menos probable que este tipo de carcinoma sea causado por radioterapia al cuello aplicada para tratar otros caacutenceres durante la infanciardquo6

CLASES DE CMT

bull ldquoHay dos formas de carcinoma medular tiroideo

bull Carcinoma medular tiroideo esporaacutedico el cual no se transmite de padres a hijos La mayoriacutea de estos carcinomas son esporaacutedicos Esta forma afecta principalmente a los adultos mayores

bull Carcinoma medular tiroideo hereditario el cual se transmite de padres a hijosrdquo2

bull httpwwwaddisonesimagbociojpg

FACTORES DE RIESGO

bull ldquoUn antecedente familiar de este tipo de carcinoma

bull Antecedentes familiares de neoplasia endocrina muacuteltiple (NEM)

bull Historia previa de feocromocitoma neuromas de la mucosa o hiperparatiroidismordquo4

httpwwwconganatorgseapdatosregionalesvcamino1jpg

Hiperparatiroidismo uno de los mas influyentes factores de riesgo

SIacuteNTOMAS

bull ldquoProblemas respiratorios debido al estrechamiento de las viacuteas respiratorias

bull Tos

bull Tos con sangre

bull Diarrea

bull Bocio (agrandamiento de la tiroides)

bull Tumor en la glaacutendula tiroidesrdquo2

BOCIO

httpgenesisuagmxsaludarticulosanterioresimagesbociojpg

SIGNOS Y EXAacuteMENES

bull ldquoEl meacutedico llevaraacute a cabo un examen fiacutesico Los ganglios linfaacuteticos en el cuello pueden presentar hinchazoacuten Las pruebas de la funcioacuten tiroidea generalmente son normales sin embargo un examen de la tiroides puede revelar noacutedulos (tumoraciones) solitarios o muacuteltiples

bull El examen fiacutesico medico es de suma importancia para detectar hiperplasias en estadios tempranos de carcinoma medular de tiroides

bull httpwwwlosmedicamentosnetconsejoswp-contentuploads201104bociojpg

bull Otros exaacutemenes que se pueden utilizar para diagnosticar el carcinoma medular tiroideo pueden ser

bull Examen de sangre para calcitonina

bull Examen de sangre para antiacutegeno carcinoembrionario (ACE)

bull Pruebas geneacuteticas

bull Biopsia de la tiroides

bull Gammagrafiacutea de la tiroides

bull Ecografiacutea de la tiroidesrdquo23httpwwwdoctorweborgstaticimagesbociojpg

OPCIONES DE TRATAMIENTO

bull ldquoCirugiacutea con frecuencia es necesario efectuar una traqueotomiacutea Si la enfermedad estaacute limitada a un aacuterea local lo cual es poco comuacuten se justifica la realizacioacuten de una tiroidectomiacutea total para reducir los siacutentomas que causa la masa tumoralrdquo39

bull httpwwwnlmnihgovmedlineplusspanishencyimagesencyfullsize14066jpg

bull Radioterapia Se puede usar la irradiacioacuten de haz externo en los pacientes que no son idoacuteneos para la cirugiacutea o cuyo tumor no puede extirparse quiruacutergicamente

bull Quimioterapia el caacutencer anaplaacutesico de la tiroides no responde al tratamiento con I131 se observa que el tratamiento con monofaacutermacosanticancerosos produce remisiones parciales en algunos pacientes Aproximadamente 30 de los pacientes logran una remisioacuten parcial con la doxorrubicina La combinacioacuten de doxorrubicina y cisplatino parece ser maacutes activa que la doxorrubicina sola y se ha observado que produce maacutes respuestas completas

bull ldquoTargeted systemic radiotherapy of pheochromocytoma and medullary thyroid cancerbull Divgi Cbull Sourcebull Columbia University New York NYbull Abstractbull Targeted systemic radiotherapy constitutes the systemic administration of a radioactive agent that

targets a molecule expressed preferentially on cancer cells The archetypal such therapy is 131-iodine ((131)I) therapy for differentiated thyroid cancers Radiotherapy typically delivers a calculated radiation-absorbed dose to tumor that takes into account (contiguous) normal tissue Systemic radiotherapy development currently uses schema more analogous to chemotherapy-a radioactivity estimate that does not cause any irreversible toxicity Historically arbitrary amounts of radioactivity shown to be effective on the basis of retrospective review were used for thyroidcancer therapy with (131)I as well as for neuroendocrine tumor therapy with (131)I-labeled meta-iodo-benzylguanidine (MIBG) Their established safety record has led to adaptations that include repeat therapies with nontoxic amounts of radioactivity There remains however a lack of clear understanding of the safety limits of systemic targeted radiotherapy This is probably most true in systemic therapy with MIBG in adult neuroendocrine tumors Bone marrow is the primary critical organ for most targeted systemic radiotherapy second organ involvement may be renal as with MIBG and targeted radiopeptide therapy or pulmonary as with radioimmunotherapy Most therapies have tended toward multiple administrations of subtoxic amounts of radioactivity Therapy with MIBG in pheochromococytoma as well as targeted radiopeptide therapy in medullarythyroid cancer has followed this model Radioimmunotherapy appears very promising a definitive Phase 2 study needs completion All therapy has shown promise in extending disease survival (as compared with historical controls) with few major structural (or biochemical) responses This review will attempt to compliment the excellent existing literature by providing an overall systemic therapeutic approach to this promising endeavorrdquo11

bull Este articulo es realmente interesante ya que plantea una mejora en el tratamiento con radioterapia para pacientes con caacutencer medular de tiroides los estudios que aquiacute presentan demuestran que la mejora del tratamiento se ve reflejada en el aumento de la expectativa de vida de los pacientes tratados con el nuevo meacutetodo frente a los tratados con el meacutetodo tradicional

bull http1bpblogspotcom_nbADpD65WD4SmDX1fuRnVIAAAAAAAAGygbXhKLyxMhAEs320tiroidesjpg

bull ldquoCurrent role of metaiodobenzylguanidine in the diagnosis of pheochromocytoma and medullary thyroid cancer

bull Ilias I Divgi C Pacak Kbull Sourcebull Department of Endocrinology E Venizelou Hospital Athens

Greecebull Abstractbull Despite early reports of excellent diagnostic characteristics of

[(131)I][(123)I]-metaiodobenzylguanidine (MIBG) in the evaluation of pheochromocytomasparagangliomas (PHEOsPGLs) or medullary thyroid cancer as experience with it was accumulated the sensitivity dropped Nevertheless this modality is still useful in the diagnostic work-up of PHEOsPGLs because it is widely available and in case of positive scans it might indicate patients who are potential candidates for [(131)I]MIBG therapy

bull Published by Elsevier Incrdquo12

bull El medicamento que referencia el articulo medico se encuentra ampliamente difundido y es esta la principal ventaja del este faacutermaco Aun faltan bastantes estudios el articulo deja muchos interrogantes

bull ldquoAnn Acad Med Singapore 2011 Jun40(6)300-2

bull Melanocytic variant of medullary thyroidcarcinoma in a previously treated papillarycarcinoma patient

bull Mohamad I Zainuddin N Zawawi N Naik VR

bull Source

bull Department of Otorhinolaryngology - Head amp Neck Surgeryrdquo13

bull Este articulo propone que los melanocitos son una variante significativa de el carcinoma medular de tiroides despueacutes de que esta haya sido exitosamente tratada

bull http4bpblogspotcom_Fnq-_ypIXdgTO6t_bKf53IAAAAAAAAAEgQLDhcalP0hks1600melanocitosjpg

bull ldquoBreast metastasis by medullary thyroid carcinoma detected by FDG positron emission tomography

bull Nofech-Mozes S Mackenzie R Kahn HJ Ehrlich L Raphael SJbull Sourcebull Department of Anatomical Pathology Sunnybrook Health Sciences Center

Toronto ON Canada M4N 3M5bull Abstractbull Medullary thyroid carcinoma (MTC) is an uncommon thyroid cancer

comprising 5 to 8 of thyroid neoplasms In contrast to common thyroid tumors this tumor originates from the calcitonin-producing C cells Regional metastases to cervical lymph nodes occur early in the disease whereas distant metastasis occurs late Common metastatic sites include the liver bone brain and adrenal medulla We present a case of MTC metastatic to the breast We report on this case for the following reasons (1) metastasis to the breast is an extremely rare occurrence and could be easily confused clinically and pathologically with a primary breast neoplasm and (2) this is the first reported case of detection of breast metastasis by an MTC using FDG ((18)F-fluoro-2-deoxy-D-glucose) positron emission tomography with an accompanying histologic descriptionrdquo14

bull El articulo trata el tema de las metaacutestasis de el carcinoma medular de tiroides haciendo especial eacutenfasis en las metaacutestasis a distancias especialmente en mama

bull http4bpblogspotcom_YmCZlFt2utMTOv2n-jvZKIAAAAAAAAABIKqnwuja7pLQs1600CancerMetastasisjpg

bull ldquoCytology of hyalinising trabecular adenoma-like variant of medullarythyroid carcinoma

bull Santosh KV Raychaudhuri S Subramanya H Naveen Kumar BJbull Sourcebull Department of Pathology Vydehi Institute of Medical Sciences and

Research Center Bangalore Indiabull Abstractbull Medullary thyroid carcinoma is a rare thyroid neoplasm that can be

either sporadic or familial It occurs in adults presenting as a solitary cold nodule on thyroid scan Most are solid firm and non-encapsulated and occur in the mid portion or upper half of the thyroid gland corresponding to areas with greater numbers of C cells We present a case of a 36-year-old female with a swelling in the front of her neck for six years Fine needle aspiration done elsewhere revealed spindle cells suggestive of a spindle cell neoplasm The histopathology of the thyroidectomyspecimen showed features of a hyalinizing trabecular adenoma-like variant of medullary carcinoma Subsequently we performed aspiration on the received specimen and studied the cytological findings The cytological diagnosis of this variant requires identification of the dual spindle and ovoid cell population and the granular neuroendocrinechromatinrdquo15

bull Este trabajo investigativo plantea la posibilidad de una variante del carcinoma medular de tiroides en forma de un adenoma hialinizante trabecular Este estudio fue hecho en una mujer de 36 antildeos es necesario hacer estudios en otros pacientes para reafirmar la tesis del articulo

BIBLIOGRAFIacuteA

bull 1) httpbibliotecafucsaludeduco2052bookspagedoeid=4-u10-B978-1-4377-0324-500011-0--s0030ampisbn=978-1-4377-0324-5ampuniqId=270438322-24-u10-B978-1-4377-0324-500011-0--f0015

bull 2)

bull httpwwwnlmnihgovmedlineplusspanishencyarticle000374htm

bull 3)bull Goldman JM Goren EN Cohen MH et al Anaplastic thyroid

carcinoma long-term survival after radical surgery J Surg Oncol 14 (4) 389-94 1980 [PUBMED Abstract]

4)bull Aldinger KA Samaan NA Ibanez M et al Anaplastic carcinoma of

the thyroid a review of 84 cases of spindle and giant cell carcinoma of the thyroid Cancer 41 (6) 2267-75 1978 [PUBMED Abstract]

5)bull Carling T Udelsman R Thyroid tumors In DeVita VT Jr Hellman

S Rosenberg SA eds Cancer Principles and Practice of Oncology Vols 1 amp 2 8th ed Philadelphia Pa Lippincott Williams amp Wilkins 2008 pp 1663-82

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 4: Carcinoma medular de tiroides

bull httpwwwnlmnihgovmedlineplusspanishencyimagesencyfullsize8966jpg

CANCER MEDULAR DE TIROIDES

bull ldquoEs un caacutencer de la glaacutendula tiroides que comienza en un tipo de ceacutelulas denominadas ceacutelulas C que liberan una hormona llamada calcitoninardquo278

httpescuelamedpucclpaginascursosterceroanatomiapatologicaimagenes_apfotos937-941941jpg

VISTA MICROSCOPICA DE NEOPLASIA EN LA GLANDULA TIROIDES

VISTA MACROSCOPICA DE NEOPLASIA EN GLANDULA TIROIDES

bull httpescuelamedpucclpublpatgeneralFotosBig133jpg

CAUSAS

bull ldquoLa causa del carcinoma medular tiroideo (CMT) se desconoce

bull A diferencia de otros tipos de caacutencer de la tiroides es menos probable que este tipo de carcinoma sea causado por radioterapia al cuello aplicada para tratar otros caacutenceres durante la infanciardquo6

CLASES DE CMT

bull ldquoHay dos formas de carcinoma medular tiroideo

bull Carcinoma medular tiroideo esporaacutedico el cual no se transmite de padres a hijos La mayoriacutea de estos carcinomas son esporaacutedicos Esta forma afecta principalmente a los adultos mayores

bull Carcinoma medular tiroideo hereditario el cual se transmite de padres a hijosrdquo2

bull httpwwwaddisonesimagbociojpg

FACTORES DE RIESGO

bull ldquoUn antecedente familiar de este tipo de carcinoma

bull Antecedentes familiares de neoplasia endocrina muacuteltiple (NEM)

bull Historia previa de feocromocitoma neuromas de la mucosa o hiperparatiroidismordquo4

httpwwwconganatorgseapdatosregionalesvcamino1jpg

Hiperparatiroidismo uno de los mas influyentes factores de riesgo

SIacuteNTOMAS

bull ldquoProblemas respiratorios debido al estrechamiento de las viacuteas respiratorias

bull Tos

bull Tos con sangre

bull Diarrea

bull Bocio (agrandamiento de la tiroides)

bull Tumor en la glaacutendula tiroidesrdquo2

BOCIO

httpgenesisuagmxsaludarticulosanterioresimagesbociojpg

SIGNOS Y EXAacuteMENES

bull ldquoEl meacutedico llevaraacute a cabo un examen fiacutesico Los ganglios linfaacuteticos en el cuello pueden presentar hinchazoacuten Las pruebas de la funcioacuten tiroidea generalmente son normales sin embargo un examen de la tiroides puede revelar noacutedulos (tumoraciones) solitarios o muacuteltiples

bull El examen fiacutesico medico es de suma importancia para detectar hiperplasias en estadios tempranos de carcinoma medular de tiroides

bull httpwwwlosmedicamentosnetconsejoswp-contentuploads201104bociojpg

bull Otros exaacutemenes que se pueden utilizar para diagnosticar el carcinoma medular tiroideo pueden ser

bull Examen de sangre para calcitonina

bull Examen de sangre para antiacutegeno carcinoembrionario (ACE)

bull Pruebas geneacuteticas

bull Biopsia de la tiroides

bull Gammagrafiacutea de la tiroides

bull Ecografiacutea de la tiroidesrdquo23httpwwwdoctorweborgstaticimagesbociojpg

OPCIONES DE TRATAMIENTO

bull ldquoCirugiacutea con frecuencia es necesario efectuar una traqueotomiacutea Si la enfermedad estaacute limitada a un aacuterea local lo cual es poco comuacuten se justifica la realizacioacuten de una tiroidectomiacutea total para reducir los siacutentomas que causa la masa tumoralrdquo39

bull httpwwwnlmnihgovmedlineplusspanishencyimagesencyfullsize14066jpg

bull Radioterapia Se puede usar la irradiacioacuten de haz externo en los pacientes que no son idoacuteneos para la cirugiacutea o cuyo tumor no puede extirparse quiruacutergicamente

bull Quimioterapia el caacutencer anaplaacutesico de la tiroides no responde al tratamiento con I131 se observa que el tratamiento con monofaacutermacosanticancerosos produce remisiones parciales en algunos pacientes Aproximadamente 30 de los pacientes logran una remisioacuten parcial con la doxorrubicina La combinacioacuten de doxorrubicina y cisplatino parece ser maacutes activa que la doxorrubicina sola y se ha observado que produce maacutes respuestas completas

bull ldquoTargeted systemic radiotherapy of pheochromocytoma and medullary thyroid cancerbull Divgi Cbull Sourcebull Columbia University New York NYbull Abstractbull Targeted systemic radiotherapy constitutes the systemic administration of a radioactive agent that

targets a molecule expressed preferentially on cancer cells The archetypal such therapy is 131-iodine ((131)I) therapy for differentiated thyroid cancers Radiotherapy typically delivers a calculated radiation-absorbed dose to tumor that takes into account (contiguous) normal tissue Systemic radiotherapy development currently uses schema more analogous to chemotherapy-a radioactivity estimate that does not cause any irreversible toxicity Historically arbitrary amounts of radioactivity shown to be effective on the basis of retrospective review were used for thyroidcancer therapy with (131)I as well as for neuroendocrine tumor therapy with (131)I-labeled meta-iodo-benzylguanidine (MIBG) Their established safety record has led to adaptations that include repeat therapies with nontoxic amounts of radioactivity There remains however a lack of clear understanding of the safety limits of systemic targeted radiotherapy This is probably most true in systemic therapy with MIBG in adult neuroendocrine tumors Bone marrow is the primary critical organ for most targeted systemic radiotherapy second organ involvement may be renal as with MIBG and targeted radiopeptide therapy or pulmonary as with radioimmunotherapy Most therapies have tended toward multiple administrations of subtoxic amounts of radioactivity Therapy with MIBG in pheochromococytoma as well as targeted radiopeptide therapy in medullarythyroid cancer has followed this model Radioimmunotherapy appears very promising a definitive Phase 2 study needs completion All therapy has shown promise in extending disease survival (as compared with historical controls) with few major structural (or biochemical) responses This review will attempt to compliment the excellent existing literature by providing an overall systemic therapeutic approach to this promising endeavorrdquo11

bull Este articulo es realmente interesante ya que plantea una mejora en el tratamiento con radioterapia para pacientes con caacutencer medular de tiroides los estudios que aquiacute presentan demuestran que la mejora del tratamiento se ve reflejada en el aumento de la expectativa de vida de los pacientes tratados con el nuevo meacutetodo frente a los tratados con el meacutetodo tradicional

bull http1bpblogspotcom_nbADpD65WD4SmDX1fuRnVIAAAAAAAAGygbXhKLyxMhAEs320tiroidesjpg

bull ldquoCurrent role of metaiodobenzylguanidine in the diagnosis of pheochromocytoma and medullary thyroid cancer

bull Ilias I Divgi C Pacak Kbull Sourcebull Department of Endocrinology E Venizelou Hospital Athens

Greecebull Abstractbull Despite early reports of excellent diagnostic characteristics of

[(131)I][(123)I]-metaiodobenzylguanidine (MIBG) in the evaluation of pheochromocytomasparagangliomas (PHEOsPGLs) or medullary thyroid cancer as experience with it was accumulated the sensitivity dropped Nevertheless this modality is still useful in the diagnostic work-up of PHEOsPGLs because it is widely available and in case of positive scans it might indicate patients who are potential candidates for [(131)I]MIBG therapy

bull Published by Elsevier Incrdquo12

bull El medicamento que referencia el articulo medico se encuentra ampliamente difundido y es esta la principal ventaja del este faacutermaco Aun faltan bastantes estudios el articulo deja muchos interrogantes

bull ldquoAnn Acad Med Singapore 2011 Jun40(6)300-2

bull Melanocytic variant of medullary thyroidcarcinoma in a previously treated papillarycarcinoma patient

bull Mohamad I Zainuddin N Zawawi N Naik VR

bull Source

bull Department of Otorhinolaryngology - Head amp Neck Surgeryrdquo13

bull Este articulo propone que los melanocitos son una variante significativa de el carcinoma medular de tiroides despueacutes de que esta haya sido exitosamente tratada

bull http4bpblogspotcom_Fnq-_ypIXdgTO6t_bKf53IAAAAAAAAAEgQLDhcalP0hks1600melanocitosjpg

bull ldquoBreast metastasis by medullary thyroid carcinoma detected by FDG positron emission tomography

bull Nofech-Mozes S Mackenzie R Kahn HJ Ehrlich L Raphael SJbull Sourcebull Department of Anatomical Pathology Sunnybrook Health Sciences Center

Toronto ON Canada M4N 3M5bull Abstractbull Medullary thyroid carcinoma (MTC) is an uncommon thyroid cancer

comprising 5 to 8 of thyroid neoplasms In contrast to common thyroid tumors this tumor originates from the calcitonin-producing C cells Regional metastases to cervical lymph nodes occur early in the disease whereas distant metastasis occurs late Common metastatic sites include the liver bone brain and adrenal medulla We present a case of MTC metastatic to the breast We report on this case for the following reasons (1) metastasis to the breast is an extremely rare occurrence and could be easily confused clinically and pathologically with a primary breast neoplasm and (2) this is the first reported case of detection of breast metastasis by an MTC using FDG ((18)F-fluoro-2-deoxy-D-glucose) positron emission tomography with an accompanying histologic descriptionrdquo14

bull El articulo trata el tema de las metaacutestasis de el carcinoma medular de tiroides haciendo especial eacutenfasis en las metaacutestasis a distancias especialmente en mama

bull http4bpblogspotcom_YmCZlFt2utMTOv2n-jvZKIAAAAAAAAABIKqnwuja7pLQs1600CancerMetastasisjpg

bull ldquoCytology of hyalinising trabecular adenoma-like variant of medullarythyroid carcinoma

bull Santosh KV Raychaudhuri S Subramanya H Naveen Kumar BJbull Sourcebull Department of Pathology Vydehi Institute of Medical Sciences and

Research Center Bangalore Indiabull Abstractbull Medullary thyroid carcinoma is a rare thyroid neoplasm that can be

either sporadic or familial It occurs in adults presenting as a solitary cold nodule on thyroid scan Most are solid firm and non-encapsulated and occur in the mid portion or upper half of the thyroid gland corresponding to areas with greater numbers of C cells We present a case of a 36-year-old female with a swelling in the front of her neck for six years Fine needle aspiration done elsewhere revealed spindle cells suggestive of a spindle cell neoplasm The histopathology of the thyroidectomyspecimen showed features of a hyalinizing trabecular adenoma-like variant of medullary carcinoma Subsequently we performed aspiration on the received specimen and studied the cytological findings The cytological diagnosis of this variant requires identification of the dual spindle and ovoid cell population and the granular neuroendocrinechromatinrdquo15

bull Este trabajo investigativo plantea la posibilidad de una variante del carcinoma medular de tiroides en forma de un adenoma hialinizante trabecular Este estudio fue hecho en una mujer de 36 antildeos es necesario hacer estudios en otros pacientes para reafirmar la tesis del articulo

BIBLIOGRAFIacuteA

bull 1) httpbibliotecafucsaludeduco2052bookspagedoeid=4-u10-B978-1-4377-0324-500011-0--s0030ampisbn=978-1-4377-0324-5ampuniqId=270438322-24-u10-B978-1-4377-0324-500011-0--f0015

bull 2)

bull httpwwwnlmnihgovmedlineplusspanishencyarticle000374htm

bull 3)bull Goldman JM Goren EN Cohen MH et al Anaplastic thyroid

carcinoma long-term survival after radical surgery J Surg Oncol 14 (4) 389-94 1980 [PUBMED Abstract]

4)bull Aldinger KA Samaan NA Ibanez M et al Anaplastic carcinoma of

the thyroid a review of 84 cases of spindle and giant cell carcinoma of the thyroid Cancer 41 (6) 2267-75 1978 [PUBMED Abstract]

5)bull Carling T Udelsman R Thyroid tumors In DeVita VT Jr Hellman

S Rosenberg SA eds Cancer Principles and Practice of Oncology Vols 1 amp 2 8th ed Philadelphia Pa Lippincott Williams amp Wilkins 2008 pp 1663-82

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 5: Carcinoma medular de tiroides

CANCER MEDULAR DE TIROIDES

bull ldquoEs un caacutencer de la glaacutendula tiroides que comienza en un tipo de ceacutelulas denominadas ceacutelulas C que liberan una hormona llamada calcitoninardquo278

httpescuelamedpucclpaginascursosterceroanatomiapatologicaimagenes_apfotos937-941941jpg

VISTA MICROSCOPICA DE NEOPLASIA EN LA GLANDULA TIROIDES

VISTA MACROSCOPICA DE NEOPLASIA EN GLANDULA TIROIDES

bull httpescuelamedpucclpublpatgeneralFotosBig133jpg

CAUSAS

bull ldquoLa causa del carcinoma medular tiroideo (CMT) se desconoce

bull A diferencia de otros tipos de caacutencer de la tiroides es menos probable que este tipo de carcinoma sea causado por radioterapia al cuello aplicada para tratar otros caacutenceres durante la infanciardquo6

CLASES DE CMT

bull ldquoHay dos formas de carcinoma medular tiroideo

bull Carcinoma medular tiroideo esporaacutedico el cual no se transmite de padres a hijos La mayoriacutea de estos carcinomas son esporaacutedicos Esta forma afecta principalmente a los adultos mayores

bull Carcinoma medular tiroideo hereditario el cual se transmite de padres a hijosrdquo2

bull httpwwwaddisonesimagbociojpg

FACTORES DE RIESGO

bull ldquoUn antecedente familiar de este tipo de carcinoma

bull Antecedentes familiares de neoplasia endocrina muacuteltiple (NEM)

bull Historia previa de feocromocitoma neuromas de la mucosa o hiperparatiroidismordquo4

httpwwwconganatorgseapdatosregionalesvcamino1jpg

Hiperparatiroidismo uno de los mas influyentes factores de riesgo

SIacuteNTOMAS

bull ldquoProblemas respiratorios debido al estrechamiento de las viacuteas respiratorias

bull Tos

bull Tos con sangre

bull Diarrea

bull Bocio (agrandamiento de la tiroides)

bull Tumor en la glaacutendula tiroidesrdquo2

BOCIO

httpgenesisuagmxsaludarticulosanterioresimagesbociojpg

SIGNOS Y EXAacuteMENES

bull ldquoEl meacutedico llevaraacute a cabo un examen fiacutesico Los ganglios linfaacuteticos en el cuello pueden presentar hinchazoacuten Las pruebas de la funcioacuten tiroidea generalmente son normales sin embargo un examen de la tiroides puede revelar noacutedulos (tumoraciones) solitarios o muacuteltiples

bull El examen fiacutesico medico es de suma importancia para detectar hiperplasias en estadios tempranos de carcinoma medular de tiroides

bull httpwwwlosmedicamentosnetconsejoswp-contentuploads201104bociojpg

bull Otros exaacutemenes que se pueden utilizar para diagnosticar el carcinoma medular tiroideo pueden ser

bull Examen de sangre para calcitonina

bull Examen de sangre para antiacutegeno carcinoembrionario (ACE)

bull Pruebas geneacuteticas

bull Biopsia de la tiroides

bull Gammagrafiacutea de la tiroides

bull Ecografiacutea de la tiroidesrdquo23httpwwwdoctorweborgstaticimagesbociojpg

OPCIONES DE TRATAMIENTO

bull ldquoCirugiacutea con frecuencia es necesario efectuar una traqueotomiacutea Si la enfermedad estaacute limitada a un aacuterea local lo cual es poco comuacuten se justifica la realizacioacuten de una tiroidectomiacutea total para reducir los siacutentomas que causa la masa tumoralrdquo39

bull httpwwwnlmnihgovmedlineplusspanishencyimagesencyfullsize14066jpg

bull Radioterapia Se puede usar la irradiacioacuten de haz externo en los pacientes que no son idoacuteneos para la cirugiacutea o cuyo tumor no puede extirparse quiruacutergicamente

bull Quimioterapia el caacutencer anaplaacutesico de la tiroides no responde al tratamiento con I131 se observa que el tratamiento con monofaacutermacosanticancerosos produce remisiones parciales en algunos pacientes Aproximadamente 30 de los pacientes logran una remisioacuten parcial con la doxorrubicina La combinacioacuten de doxorrubicina y cisplatino parece ser maacutes activa que la doxorrubicina sola y se ha observado que produce maacutes respuestas completas

bull ldquoTargeted systemic radiotherapy of pheochromocytoma and medullary thyroid cancerbull Divgi Cbull Sourcebull Columbia University New York NYbull Abstractbull Targeted systemic radiotherapy constitutes the systemic administration of a radioactive agent that

targets a molecule expressed preferentially on cancer cells The archetypal such therapy is 131-iodine ((131)I) therapy for differentiated thyroid cancers Radiotherapy typically delivers a calculated radiation-absorbed dose to tumor that takes into account (contiguous) normal tissue Systemic radiotherapy development currently uses schema more analogous to chemotherapy-a radioactivity estimate that does not cause any irreversible toxicity Historically arbitrary amounts of radioactivity shown to be effective on the basis of retrospective review were used for thyroidcancer therapy with (131)I as well as for neuroendocrine tumor therapy with (131)I-labeled meta-iodo-benzylguanidine (MIBG) Their established safety record has led to adaptations that include repeat therapies with nontoxic amounts of radioactivity There remains however a lack of clear understanding of the safety limits of systemic targeted radiotherapy This is probably most true in systemic therapy with MIBG in adult neuroendocrine tumors Bone marrow is the primary critical organ for most targeted systemic radiotherapy second organ involvement may be renal as with MIBG and targeted radiopeptide therapy or pulmonary as with radioimmunotherapy Most therapies have tended toward multiple administrations of subtoxic amounts of radioactivity Therapy with MIBG in pheochromococytoma as well as targeted radiopeptide therapy in medullarythyroid cancer has followed this model Radioimmunotherapy appears very promising a definitive Phase 2 study needs completion All therapy has shown promise in extending disease survival (as compared with historical controls) with few major structural (or biochemical) responses This review will attempt to compliment the excellent existing literature by providing an overall systemic therapeutic approach to this promising endeavorrdquo11

bull Este articulo es realmente interesante ya que plantea una mejora en el tratamiento con radioterapia para pacientes con caacutencer medular de tiroides los estudios que aquiacute presentan demuestran que la mejora del tratamiento se ve reflejada en el aumento de la expectativa de vida de los pacientes tratados con el nuevo meacutetodo frente a los tratados con el meacutetodo tradicional

bull http1bpblogspotcom_nbADpD65WD4SmDX1fuRnVIAAAAAAAAGygbXhKLyxMhAEs320tiroidesjpg

bull ldquoCurrent role of metaiodobenzylguanidine in the diagnosis of pheochromocytoma and medullary thyroid cancer

bull Ilias I Divgi C Pacak Kbull Sourcebull Department of Endocrinology E Venizelou Hospital Athens

Greecebull Abstractbull Despite early reports of excellent diagnostic characteristics of

[(131)I][(123)I]-metaiodobenzylguanidine (MIBG) in the evaluation of pheochromocytomasparagangliomas (PHEOsPGLs) or medullary thyroid cancer as experience with it was accumulated the sensitivity dropped Nevertheless this modality is still useful in the diagnostic work-up of PHEOsPGLs because it is widely available and in case of positive scans it might indicate patients who are potential candidates for [(131)I]MIBG therapy

bull Published by Elsevier Incrdquo12

bull El medicamento que referencia el articulo medico se encuentra ampliamente difundido y es esta la principal ventaja del este faacutermaco Aun faltan bastantes estudios el articulo deja muchos interrogantes

bull ldquoAnn Acad Med Singapore 2011 Jun40(6)300-2

bull Melanocytic variant of medullary thyroidcarcinoma in a previously treated papillarycarcinoma patient

bull Mohamad I Zainuddin N Zawawi N Naik VR

bull Source

bull Department of Otorhinolaryngology - Head amp Neck Surgeryrdquo13

bull Este articulo propone que los melanocitos son una variante significativa de el carcinoma medular de tiroides despueacutes de que esta haya sido exitosamente tratada

bull http4bpblogspotcom_Fnq-_ypIXdgTO6t_bKf53IAAAAAAAAAEgQLDhcalP0hks1600melanocitosjpg

bull ldquoBreast metastasis by medullary thyroid carcinoma detected by FDG positron emission tomography

bull Nofech-Mozes S Mackenzie R Kahn HJ Ehrlich L Raphael SJbull Sourcebull Department of Anatomical Pathology Sunnybrook Health Sciences Center

Toronto ON Canada M4N 3M5bull Abstractbull Medullary thyroid carcinoma (MTC) is an uncommon thyroid cancer

comprising 5 to 8 of thyroid neoplasms In contrast to common thyroid tumors this tumor originates from the calcitonin-producing C cells Regional metastases to cervical lymph nodes occur early in the disease whereas distant metastasis occurs late Common metastatic sites include the liver bone brain and adrenal medulla We present a case of MTC metastatic to the breast We report on this case for the following reasons (1) metastasis to the breast is an extremely rare occurrence and could be easily confused clinically and pathologically with a primary breast neoplasm and (2) this is the first reported case of detection of breast metastasis by an MTC using FDG ((18)F-fluoro-2-deoxy-D-glucose) positron emission tomography with an accompanying histologic descriptionrdquo14

bull El articulo trata el tema de las metaacutestasis de el carcinoma medular de tiroides haciendo especial eacutenfasis en las metaacutestasis a distancias especialmente en mama

bull http4bpblogspotcom_YmCZlFt2utMTOv2n-jvZKIAAAAAAAAABIKqnwuja7pLQs1600CancerMetastasisjpg

bull ldquoCytology of hyalinising trabecular adenoma-like variant of medullarythyroid carcinoma

bull Santosh KV Raychaudhuri S Subramanya H Naveen Kumar BJbull Sourcebull Department of Pathology Vydehi Institute of Medical Sciences and

Research Center Bangalore Indiabull Abstractbull Medullary thyroid carcinoma is a rare thyroid neoplasm that can be

either sporadic or familial It occurs in adults presenting as a solitary cold nodule on thyroid scan Most are solid firm and non-encapsulated and occur in the mid portion or upper half of the thyroid gland corresponding to areas with greater numbers of C cells We present a case of a 36-year-old female with a swelling in the front of her neck for six years Fine needle aspiration done elsewhere revealed spindle cells suggestive of a spindle cell neoplasm The histopathology of the thyroidectomyspecimen showed features of a hyalinizing trabecular adenoma-like variant of medullary carcinoma Subsequently we performed aspiration on the received specimen and studied the cytological findings The cytological diagnosis of this variant requires identification of the dual spindle and ovoid cell population and the granular neuroendocrinechromatinrdquo15

bull Este trabajo investigativo plantea la posibilidad de una variante del carcinoma medular de tiroides en forma de un adenoma hialinizante trabecular Este estudio fue hecho en una mujer de 36 antildeos es necesario hacer estudios en otros pacientes para reafirmar la tesis del articulo

BIBLIOGRAFIacuteA

bull 1) httpbibliotecafucsaludeduco2052bookspagedoeid=4-u10-B978-1-4377-0324-500011-0--s0030ampisbn=978-1-4377-0324-5ampuniqId=270438322-24-u10-B978-1-4377-0324-500011-0--f0015

bull 2)

bull httpwwwnlmnihgovmedlineplusspanishencyarticle000374htm

bull 3)bull Goldman JM Goren EN Cohen MH et al Anaplastic thyroid

carcinoma long-term survival after radical surgery J Surg Oncol 14 (4) 389-94 1980 [PUBMED Abstract]

4)bull Aldinger KA Samaan NA Ibanez M et al Anaplastic carcinoma of

the thyroid a review of 84 cases of spindle and giant cell carcinoma of the thyroid Cancer 41 (6) 2267-75 1978 [PUBMED Abstract]

5)bull Carling T Udelsman R Thyroid tumors In DeVita VT Jr Hellman

S Rosenberg SA eds Cancer Principles and Practice of Oncology Vols 1 amp 2 8th ed Philadelphia Pa Lippincott Williams amp Wilkins 2008 pp 1663-82

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 6: Carcinoma medular de tiroides

httpescuelamedpucclpaginascursosterceroanatomiapatologicaimagenes_apfotos937-941941jpg

VISTA MICROSCOPICA DE NEOPLASIA EN LA GLANDULA TIROIDES

VISTA MACROSCOPICA DE NEOPLASIA EN GLANDULA TIROIDES

bull httpescuelamedpucclpublpatgeneralFotosBig133jpg

CAUSAS

bull ldquoLa causa del carcinoma medular tiroideo (CMT) se desconoce

bull A diferencia de otros tipos de caacutencer de la tiroides es menos probable que este tipo de carcinoma sea causado por radioterapia al cuello aplicada para tratar otros caacutenceres durante la infanciardquo6

CLASES DE CMT

bull ldquoHay dos formas de carcinoma medular tiroideo

bull Carcinoma medular tiroideo esporaacutedico el cual no se transmite de padres a hijos La mayoriacutea de estos carcinomas son esporaacutedicos Esta forma afecta principalmente a los adultos mayores

bull Carcinoma medular tiroideo hereditario el cual se transmite de padres a hijosrdquo2

bull httpwwwaddisonesimagbociojpg

FACTORES DE RIESGO

bull ldquoUn antecedente familiar de este tipo de carcinoma

bull Antecedentes familiares de neoplasia endocrina muacuteltiple (NEM)

bull Historia previa de feocromocitoma neuromas de la mucosa o hiperparatiroidismordquo4

httpwwwconganatorgseapdatosregionalesvcamino1jpg

Hiperparatiroidismo uno de los mas influyentes factores de riesgo

SIacuteNTOMAS

bull ldquoProblemas respiratorios debido al estrechamiento de las viacuteas respiratorias

bull Tos

bull Tos con sangre

bull Diarrea

bull Bocio (agrandamiento de la tiroides)

bull Tumor en la glaacutendula tiroidesrdquo2

BOCIO

httpgenesisuagmxsaludarticulosanterioresimagesbociojpg

SIGNOS Y EXAacuteMENES

bull ldquoEl meacutedico llevaraacute a cabo un examen fiacutesico Los ganglios linfaacuteticos en el cuello pueden presentar hinchazoacuten Las pruebas de la funcioacuten tiroidea generalmente son normales sin embargo un examen de la tiroides puede revelar noacutedulos (tumoraciones) solitarios o muacuteltiples

bull El examen fiacutesico medico es de suma importancia para detectar hiperplasias en estadios tempranos de carcinoma medular de tiroides

bull httpwwwlosmedicamentosnetconsejoswp-contentuploads201104bociojpg

bull Otros exaacutemenes que se pueden utilizar para diagnosticar el carcinoma medular tiroideo pueden ser

bull Examen de sangre para calcitonina

bull Examen de sangre para antiacutegeno carcinoembrionario (ACE)

bull Pruebas geneacuteticas

bull Biopsia de la tiroides

bull Gammagrafiacutea de la tiroides

bull Ecografiacutea de la tiroidesrdquo23httpwwwdoctorweborgstaticimagesbociojpg

OPCIONES DE TRATAMIENTO

bull ldquoCirugiacutea con frecuencia es necesario efectuar una traqueotomiacutea Si la enfermedad estaacute limitada a un aacuterea local lo cual es poco comuacuten se justifica la realizacioacuten de una tiroidectomiacutea total para reducir los siacutentomas que causa la masa tumoralrdquo39

bull httpwwwnlmnihgovmedlineplusspanishencyimagesencyfullsize14066jpg

bull Radioterapia Se puede usar la irradiacioacuten de haz externo en los pacientes que no son idoacuteneos para la cirugiacutea o cuyo tumor no puede extirparse quiruacutergicamente

bull Quimioterapia el caacutencer anaplaacutesico de la tiroides no responde al tratamiento con I131 se observa que el tratamiento con monofaacutermacosanticancerosos produce remisiones parciales en algunos pacientes Aproximadamente 30 de los pacientes logran una remisioacuten parcial con la doxorrubicina La combinacioacuten de doxorrubicina y cisplatino parece ser maacutes activa que la doxorrubicina sola y se ha observado que produce maacutes respuestas completas

bull ldquoTargeted systemic radiotherapy of pheochromocytoma and medullary thyroid cancerbull Divgi Cbull Sourcebull Columbia University New York NYbull Abstractbull Targeted systemic radiotherapy constitutes the systemic administration of a radioactive agent that

targets a molecule expressed preferentially on cancer cells The archetypal such therapy is 131-iodine ((131)I) therapy for differentiated thyroid cancers Radiotherapy typically delivers a calculated radiation-absorbed dose to tumor that takes into account (contiguous) normal tissue Systemic radiotherapy development currently uses schema more analogous to chemotherapy-a radioactivity estimate that does not cause any irreversible toxicity Historically arbitrary amounts of radioactivity shown to be effective on the basis of retrospective review were used for thyroidcancer therapy with (131)I as well as for neuroendocrine tumor therapy with (131)I-labeled meta-iodo-benzylguanidine (MIBG) Their established safety record has led to adaptations that include repeat therapies with nontoxic amounts of radioactivity There remains however a lack of clear understanding of the safety limits of systemic targeted radiotherapy This is probably most true in systemic therapy with MIBG in adult neuroendocrine tumors Bone marrow is the primary critical organ for most targeted systemic radiotherapy second organ involvement may be renal as with MIBG and targeted radiopeptide therapy or pulmonary as with radioimmunotherapy Most therapies have tended toward multiple administrations of subtoxic amounts of radioactivity Therapy with MIBG in pheochromococytoma as well as targeted radiopeptide therapy in medullarythyroid cancer has followed this model Radioimmunotherapy appears very promising a definitive Phase 2 study needs completion All therapy has shown promise in extending disease survival (as compared with historical controls) with few major structural (or biochemical) responses This review will attempt to compliment the excellent existing literature by providing an overall systemic therapeutic approach to this promising endeavorrdquo11

bull Este articulo es realmente interesante ya que plantea una mejora en el tratamiento con radioterapia para pacientes con caacutencer medular de tiroides los estudios que aquiacute presentan demuestran que la mejora del tratamiento se ve reflejada en el aumento de la expectativa de vida de los pacientes tratados con el nuevo meacutetodo frente a los tratados con el meacutetodo tradicional

bull http1bpblogspotcom_nbADpD65WD4SmDX1fuRnVIAAAAAAAAGygbXhKLyxMhAEs320tiroidesjpg

bull ldquoCurrent role of metaiodobenzylguanidine in the diagnosis of pheochromocytoma and medullary thyroid cancer

bull Ilias I Divgi C Pacak Kbull Sourcebull Department of Endocrinology E Venizelou Hospital Athens

Greecebull Abstractbull Despite early reports of excellent diagnostic characteristics of

[(131)I][(123)I]-metaiodobenzylguanidine (MIBG) in the evaluation of pheochromocytomasparagangliomas (PHEOsPGLs) or medullary thyroid cancer as experience with it was accumulated the sensitivity dropped Nevertheless this modality is still useful in the diagnostic work-up of PHEOsPGLs because it is widely available and in case of positive scans it might indicate patients who are potential candidates for [(131)I]MIBG therapy

bull Published by Elsevier Incrdquo12

bull El medicamento que referencia el articulo medico se encuentra ampliamente difundido y es esta la principal ventaja del este faacutermaco Aun faltan bastantes estudios el articulo deja muchos interrogantes

bull ldquoAnn Acad Med Singapore 2011 Jun40(6)300-2

bull Melanocytic variant of medullary thyroidcarcinoma in a previously treated papillarycarcinoma patient

bull Mohamad I Zainuddin N Zawawi N Naik VR

bull Source

bull Department of Otorhinolaryngology - Head amp Neck Surgeryrdquo13

bull Este articulo propone que los melanocitos son una variante significativa de el carcinoma medular de tiroides despueacutes de que esta haya sido exitosamente tratada

bull http4bpblogspotcom_Fnq-_ypIXdgTO6t_bKf53IAAAAAAAAAEgQLDhcalP0hks1600melanocitosjpg

bull ldquoBreast metastasis by medullary thyroid carcinoma detected by FDG positron emission tomography

bull Nofech-Mozes S Mackenzie R Kahn HJ Ehrlich L Raphael SJbull Sourcebull Department of Anatomical Pathology Sunnybrook Health Sciences Center

Toronto ON Canada M4N 3M5bull Abstractbull Medullary thyroid carcinoma (MTC) is an uncommon thyroid cancer

comprising 5 to 8 of thyroid neoplasms In contrast to common thyroid tumors this tumor originates from the calcitonin-producing C cells Regional metastases to cervical lymph nodes occur early in the disease whereas distant metastasis occurs late Common metastatic sites include the liver bone brain and adrenal medulla We present a case of MTC metastatic to the breast We report on this case for the following reasons (1) metastasis to the breast is an extremely rare occurrence and could be easily confused clinically and pathologically with a primary breast neoplasm and (2) this is the first reported case of detection of breast metastasis by an MTC using FDG ((18)F-fluoro-2-deoxy-D-glucose) positron emission tomography with an accompanying histologic descriptionrdquo14

bull El articulo trata el tema de las metaacutestasis de el carcinoma medular de tiroides haciendo especial eacutenfasis en las metaacutestasis a distancias especialmente en mama

bull http4bpblogspotcom_YmCZlFt2utMTOv2n-jvZKIAAAAAAAAABIKqnwuja7pLQs1600CancerMetastasisjpg

bull ldquoCytology of hyalinising trabecular adenoma-like variant of medullarythyroid carcinoma

bull Santosh KV Raychaudhuri S Subramanya H Naveen Kumar BJbull Sourcebull Department of Pathology Vydehi Institute of Medical Sciences and

Research Center Bangalore Indiabull Abstractbull Medullary thyroid carcinoma is a rare thyroid neoplasm that can be

either sporadic or familial It occurs in adults presenting as a solitary cold nodule on thyroid scan Most are solid firm and non-encapsulated and occur in the mid portion or upper half of the thyroid gland corresponding to areas with greater numbers of C cells We present a case of a 36-year-old female with a swelling in the front of her neck for six years Fine needle aspiration done elsewhere revealed spindle cells suggestive of a spindle cell neoplasm The histopathology of the thyroidectomyspecimen showed features of a hyalinizing trabecular adenoma-like variant of medullary carcinoma Subsequently we performed aspiration on the received specimen and studied the cytological findings The cytological diagnosis of this variant requires identification of the dual spindle and ovoid cell population and the granular neuroendocrinechromatinrdquo15

bull Este trabajo investigativo plantea la posibilidad de una variante del carcinoma medular de tiroides en forma de un adenoma hialinizante trabecular Este estudio fue hecho en una mujer de 36 antildeos es necesario hacer estudios en otros pacientes para reafirmar la tesis del articulo

BIBLIOGRAFIacuteA

bull 1) httpbibliotecafucsaludeduco2052bookspagedoeid=4-u10-B978-1-4377-0324-500011-0--s0030ampisbn=978-1-4377-0324-5ampuniqId=270438322-24-u10-B978-1-4377-0324-500011-0--f0015

bull 2)

bull httpwwwnlmnihgovmedlineplusspanishencyarticle000374htm

bull 3)bull Goldman JM Goren EN Cohen MH et al Anaplastic thyroid

carcinoma long-term survival after radical surgery J Surg Oncol 14 (4) 389-94 1980 [PUBMED Abstract]

4)bull Aldinger KA Samaan NA Ibanez M et al Anaplastic carcinoma of

the thyroid a review of 84 cases of spindle and giant cell carcinoma of the thyroid Cancer 41 (6) 2267-75 1978 [PUBMED Abstract]

5)bull Carling T Udelsman R Thyroid tumors In DeVita VT Jr Hellman

S Rosenberg SA eds Cancer Principles and Practice of Oncology Vols 1 amp 2 8th ed Philadelphia Pa Lippincott Williams amp Wilkins 2008 pp 1663-82

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 7: Carcinoma medular de tiroides

VISTA MACROSCOPICA DE NEOPLASIA EN GLANDULA TIROIDES

bull httpescuelamedpucclpublpatgeneralFotosBig133jpg

CAUSAS

bull ldquoLa causa del carcinoma medular tiroideo (CMT) se desconoce

bull A diferencia de otros tipos de caacutencer de la tiroides es menos probable que este tipo de carcinoma sea causado por radioterapia al cuello aplicada para tratar otros caacutenceres durante la infanciardquo6

CLASES DE CMT

bull ldquoHay dos formas de carcinoma medular tiroideo

bull Carcinoma medular tiroideo esporaacutedico el cual no se transmite de padres a hijos La mayoriacutea de estos carcinomas son esporaacutedicos Esta forma afecta principalmente a los adultos mayores

bull Carcinoma medular tiroideo hereditario el cual se transmite de padres a hijosrdquo2

bull httpwwwaddisonesimagbociojpg

FACTORES DE RIESGO

bull ldquoUn antecedente familiar de este tipo de carcinoma

bull Antecedentes familiares de neoplasia endocrina muacuteltiple (NEM)

bull Historia previa de feocromocitoma neuromas de la mucosa o hiperparatiroidismordquo4

httpwwwconganatorgseapdatosregionalesvcamino1jpg

Hiperparatiroidismo uno de los mas influyentes factores de riesgo

SIacuteNTOMAS

bull ldquoProblemas respiratorios debido al estrechamiento de las viacuteas respiratorias

bull Tos

bull Tos con sangre

bull Diarrea

bull Bocio (agrandamiento de la tiroides)

bull Tumor en la glaacutendula tiroidesrdquo2

BOCIO

httpgenesisuagmxsaludarticulosanterioresimagesbociojpg

SIGNOS Y EXAacuteMENES

bull ldquoEl meacutedico llevaraacute a cabo un examen fiacutesico Los ganglios linfaacuteticos en el cuello pueden presentar hinchazoacuten Las pruebas de la funcioacuten tiroidea generalmente son normales sin embargo un examen de la tiroides puede revelar noacutedulos (tumoraciones) solitarios o muacuteltiples

bull El examen fiacutesico medico es de suma importancia para detectar hiperplasias en estadios tempranos de carcinoma medular de tiroides

bull httpwwwlosmedicamentosnetconsejoswp-contentuploads201104bociojpg

bull Otros exaacutemenes que se pueden utilizar para diagnosticar el carcinoma medular tiroideo pueden ser

bull Examen de sangre para calcitonina

bull Examen de sangre para antiacutegeno carcinoembrionario (ACE)

bull Pruebas geneacuteticas

bull Biopsia de la tiroides

bull Gammagrafiacutea de la tiroides

bull Ecografiacutea de la tiroidesrdquo23httpwwwdoctorweborgstaticimagesbociojpg

OPCIONES DE TRATAMIENTO

bull ldquoCirugiacutea con frecuencia es necesario efectuar una traqueotomiacutea Si la enfermedad estaacute limitada a un aacuterea local lo cual es poco comuacuten se justifica la realizacioacuten de una tiroidectomiacutea total para reducir los siacutentomas que causa la masa tumoralrdquo39

bull httpwwwnlmnihgovmedlineplusspanishencyimagesencyfullsize14066jpg

bull Radioterapia Se puede usar la irradiacioacuten de haz externo en los pacientes que no son idoacuteneos para la cirugiacutea o cuyo tumor no puede extirparse quiruacutergicamente

bull Quimioterapia el caacutencer anaplaacutesico de la tiroides no responde al tratamiento con I131 se observa que el tratamiento con monofaacutermacosanticancerosos produce remisiones parciales en algunos pacientes Aproximadamente 30 de los pacientes logran una remisioacuten parcial con la doxorrubicina La combinacioacuten de doxorrubicina y cisplatino parece ser maacutes activa que la doxorrubicina sola y se ha observado que produce maacutes respuestas completas

bull ldquoTargeted systemic radiotherapy of pheochromocytoma and medullary thyroid cancerbull Divgi Cbull Sourcebull Columbia University New York NYbull Abstractbull Targeted systemic radiotherapy constitutes the systemic administration of a radioactive agent that

targets a molecule expressed preferentially on cancer cells The archetypal such therapy is 131-iodine ((131)I) therapy for differentiated thyroid cancers Radiotherapy typically delivers a calculated radiation-absorbed dose to tumor that takes into account (contiguous) normal tissue Systemic radiotherapy development currently uses schema more analogous to chemotherapy-a radioactivity estimate that does not cause any irreversible toxicity Historically arbitrary amounts of radioactivity shown to be effective on the basis of retrospective review were used for thyroidcancer therapy with (131)I as well as for neuroendocrine tumor therapy with (131)I-labeled meta-iodo-benzylguanidine (MIBG) Their established safety record has led to adaptations that include repeat therapies with nontoxic amounts of radioactivity There remains however a lack of clear understanding of the safety limits of systemic targeted radiotherapy This is probably most true in systemic therapy with MIBG in adult neuroendocrine tumors Bone marrow is the primary critical organ for most targeted systemic radiotherapy second organ involvement may be renal as with MIBG and targeted radiopeptide therapy or pulmonary as with radioimmunotherapy Most therapies have tended toward multiple administrations of subtoxic amounts of radioactivity Therapy with MIBG in pheochromococytoma as well as targeted radiopeptide therapy in medullarythyroid cancer has followed this model Radioimmunotherapy appears very promising a definitive Phase 2 study needs completion All therapy has shown promise in extending disease survival (as compared with historical controls) with few major structural (or biochemical) responses This review will attempt to compliment the excellent existing literature by providing an overall systemic therapeutic approach to this promising endeavorrdquo11

bull Este articulo es realmente interesante ya que plantea una mejora en el tratamiento con radioterapia para pacientes con caacutencer medular de tiroides los estudios que aquiacute presentan demuestran que la mejora del tratamiento se ve reflejada en el aumento de la expectativa de vida de los pacientes tratados con el nuevo meacutetodo frente a los tratados con el meacutetodo tradicional

bull http1bpblogspotcom_nbADpD65WD4SmDX1fuRnVIAAAAAAAAGygbXhKLyxMhAEs320tiroidesjpg

bull ldquoCurrent role of metaiodobenzylguanidine in the diagnosis of pheochromocytoma and medullary thyroid cancer

bull Ilias I Divgi C Pacak Kbull Sourcebull Department of Endocrinology E Venizelou Hospital Athens

Greecebull Abstractbull Despite early reports of excellent diagnostic characteristics of

[(131)I][(123)I]-metaiodobenzylguanidine (MIBG) in the evaluation of pheochromocytomasparagangliomas (PHEOsPGLs) or medullary thyroid cancer as experience with it was accumulated the sensitivity dropped Nevertheless this modality is still useful in the diagnostic work-up of PHEOsPGLs because it is widely available and in case of positive scans it might indicate patients who are potential candidates for [(131)I]MIBG therapy

bull Published by Elsevier Incrdquo12

bull El medicamento que referencia el articulo medico se encuentra ampliamente difundido y es esta la principal ventaja del este faacutermaco Aun faltan bastantes estudios el articulo deja muchos interrogantes

bull ldquoAnn Acad Med Singapore 2011 Jun40(6)300-2

bull Melanocytic variant of medullary thyroidcarcinoma in a previously treated papillarycarcinoma patient

bull Mohamad I Zainuddin N Zawawi N Naik VR

bull Source

bull Department of Otorhinolaryngology - Head amp Neck Surgeryrdquo13

bull Este articulo propone que los melanocitos son una variante significativa de el carcinoma medular de tiroides despueacutes de que esta haya sido exitosamente tratada

bull http4bpblogspotcom_Fnq-_ypIXdgTO6t_bKf53IAAAAAAAAAEgQLDhcalP0hks1600melanocitosjpg

bull ldquoBreast metastasis by medullary thyroid carcinoma detected by FDG positron emission tomography

bull Nofech-Mozes S Mackenzie R Kahn HJ Ehrlich L Raphael SJbull Sourcebull Department of Anatomical Pathology Sunnybrook Health Sciences Center

Toronto ON Canada M4N 3M5bull Abstractbull Medullary thyroid carcinoma (MTC) is an uncommon thyroid cancer

comprising 5 to 8 of thyroid neoplasms In contrast to common thyroid tumors this tumor originates from the calcitonin-producing C cells Regional metastases to cervical lymph nodes occur early in the disease whereas distant metastasis occurs late Common metastatic sites include the liver bone brain and adrenal medulla We present a case of MTC metastatic to the breast We report on this case for the following reasons (1) metastasis to the breast is an extremely rare occurrence and could be easily confused clinically and pathologically with a primary breast neoplasm and (2) this is the first reported case of detection of breast metastasis by an MTC using FDG ((18)F-fluoro-2-deoxy-D-glucose) positron emission tomography with an accompanying histologic descriptionrdquo14

bull El articulo trata el tema de las metaacutestasis de el carcinoma medular de tiroides haciendo especial eacutenfasis en las metaacutestasis a distancias especialmente en mama

bull http4bpblogspotcom_YmCZlFt2utMTOv2n-jvZKIAAAAAAAAABIKqnwuja7pLQs1600CancerMetastasisjpg

bull ldquoCytology of hyalinising trabecular adenoma-like variant of medullarythyroid carcinoma

bull Santosh KV Raychaudhuri S Subramanya H Naveen Kumar BJbull Sourcebull Department of Pathology Vydehi Institute of Medical Sciences and

Research Center Bangalore Indiabull Abstractbull Medullary thyroid carcinoma is a rare thyroid neoplasm that can be

either sporadic or familial It occurs in adults presenting as a solitary cold nodule on thyroid scan Most are solid firm and non-encapsulated and occur in the mid portion or upper half of the thyroid gland corresponding to areas with greater numbers of C cells We present a case of a 36-year-old female with a swelling in the front of her neck for six years Fine needle aspiration done elsewhere revealed spindle cells suggestive of a spindle cell neoplasm The histopathology of the thyroidectomyspecimen showed features of a hyalinizing trabecular adenoma-like variant of medullary carcinoma Subsequently we performed aspiration on the received specimen and studied the cytological findings The cytological diagnosis of this variant requires identification of the dual spindle and ovoid cell population and the granular neuroendocrinechromatinrdquo15

bull Este trabajo investigativo plantea la posibilidad de una variante del carcinoma medular de tiroides en forma de un adenoma hialinizante trabecular Este estudio fue hecho en una mujer de 36 antildeos es necesario hacer estudios en otros pacientes para reafirmar la tesis del articulo

BIBLIOGRAFIacuteA

bull 1) httpbibliotecafucsaludeduco2052bookspagedoeid=4-u10-B978-1-4377-0324-500011-0--s0030ampisbn=978-1-4377-0324-5ampuniqId=270438322-24-u10-B978-1-4377-0324-500011-0--f0015

bull 2)

bull httpwwwnlmnihgovmedlineplusspanishencyarticle000374htm

bull 3)bull Goldman JM Goren EN Cohen MH et al Anaplastic thyroid

carcinoma long-term survival after radical surgery J Surg Oncol 14 (4) 389-94 1980 [PUBMED Abstract]

4)bull Aldinger KA Samaan NA Ibanez M et al Anaplastic carcinoma of

the thyroid a review of 84 cases of spindle and giant cell carcinoma of the thyroid Cancer 41 (6) 2267-75 1978 [PUBMED Abstract]

5)bull Carling T Udelsman R Thyroid tumors In DeVita VT Jr Hellman

S Rosenberg SA eds Cancer Principles and Practice of Oncology Vols 1 amp 2 8th ed Philadelphia Pa Lippincott Williams amp Wilkins 2008 pp 1663-82

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 8: Carcinoma medular de tiroides

CAUSAS

bull ldquoLa causa del carcinoma medular tiroideo (CMT) se desconoce

bull A diferencia de otros tipos de caacutencer de la tiroides es menos probable que este tipo de carcinoma sea causado por radioterapia al cuello aplicada para tratar otros caacutenceres durante la infanciardquo6

CLASES DE CMT

bull ldquoHay dos formas de carcinoma medular tiroideo

bull Carcinoma medular tiroideo esporaacutedico el cual no se transmite de padres a hijos La mayoriacutea de estos carcinomas son esporaacutedicos Esta forma afecta principalmente a los adultos mayores

bull Carcinoma medular tiroideo hereditario el cual se transmite de padres a hijosrdquo2

bull httpwwwaddisonesimagbociojpg

FACTORES DE RIESGO

bull ldquoUn antecedente familiar de este tipo de carcinoma

bull Antecedentes familiares de neoplasia endocrina muacuteltiple (NEM)

bull Historia previa de feocromocitoma neuromas de la mucosa o hiperparatiroidismordquo4

httpwwwconganatorgseapdatosregionalesvcamino1jpg

Hiperparatiroidismo uno de los mas influyentes factores de riesgo

SIacuteNTOMAS

bull ldquoProblemas respiratorios debido al estrechamiento de las viacuteas respiratorias

bull Tos

bull Tos con sangre

bull Diarrea

bull Bocio (agrandamiento de la tiroides)

bull Tumor en la glaacutendula tiroidesrdquo2

BOCIO

httpgenesisuagmxsaludarticulosanterioresimagesbociojpg

SIGNOS Y EXAacuteMENES

bull ldquoEl meacutedico llevaraacute a cabo un examen fiacutesico Los ganglios linfaacuteticos en el cuello pueden presentar hinchazoacuten Las pruebas de la funcioacuten tiroidea generalmente son normales sin embargo un examen de la tiroides puede revelar noacutedulos (tumoraciones) solitarios o muacuteltiples

bull El examen fiacutesico medico es de suma importancia para detectar hiperplasias en estadios tempranos de carcinoma medular de tiroides

bull httpwwwlosmedicamentosnetconsejoswp-contentuploads201104bociojpg

bull Otros exaacutemenes que se pueden utilizar para diagnosticar el carcinoma medular tiroideo pueden ser

bull Examen de sangre para calcitonina

bull Examen de sangre para antiacutegeno carcinoembrionario (ACE)

bull Pruebas geneacuteticas

bull Biopsia de la tiroides

bull Gammagrafiacutea de la tiroides

bull Ecografiacutea de la tiroidesrdquo23httpwwwdoctorweborgstaticimagesbociojpg

OPCIONES DE TRATAMIENTO

bull ldquoCirugiacutea con frecuencia es necesario efectuar una traqueotomiacutea Si la enfermedad estaacute limitada a un aacuterea local lo cual es poco comuacuten se justifica la realizacioacuten de una tiroidectomiacutea total para reducir los siacutentomas que causa la masa tumoralrdquo39

bull httpwwwnlmnihgovmedlineplusspanishencyimagesencyfullsize14066jpg

bull Radioterapia Se puede usar la irradiacioacuten de haz externo en los pacientes que no son idoacuteneos para la cirugiacutea o cuyo tumor no puede extirparse quiruacutergicamente

bull Quimioterapia el caacutencer anaplaacutesico de la tiroides no responde al tratamiento con I131 se observa que el tratamiento con monofaacutermacosanticancerosos produce remisiones parciales en algunos pacientes Aproximadamente 30 de los pacientes logran una remisioacuten parcial con la doxorrubicina La combinacioacuten de doxorrubicina y cisplatino parece ser maacutes activa que la doxorrubicina sola y se ha observado que produce maacutes respuestas completas

bull ldquoTargeted systemic radiotherapy of pheochromocytoma and medullary thyroid cancerbull Divgi Cbull Sourcebull Columbia University New York NYbull Abstractbull Targeted systemic radiotherapy constitutes the systemic administration of a radioactive agent that

targets a molecule expressed preferentially on cancer cells The archetypal such therapy is 131-iodine ((131)I) therapy for differentiated thyroid cancers Radiotherapy typically delivers a calculated radiation-absorbed dose to tumor that takes into account (contiguous) normal tissue Systemic radiotherapy development currently uses schema more analogous to chemotherapy-a radioactivity estimate that does not cause any irreversible toxicity Historically arbitrary amounts of radioactivity shown to be effective on the basis of retrospective review were used for thyroidcancer therapy with (131)I as well as for neuroendocrine tumor therapy with (131)I-labeled meta-iodo-benzylguanidine (MIBG) Their established safety record has led to adaptations that include repeat therapies with nontoxic amounts of radioactivity There remains however a lack of clear understanding of the safety limits of systemic targeted radiotherapy This is probably most true in systemic therapy with MIBG in adult neuroendocrine tumors Bone marrow is the primary critical organ for most targeted systemic radiotherapy second organ involvement may be renal as with MIBG and targeted radiopeptide therapy or pulmonary as with radioimmunotherapy Most therapies have tended toward multiple administrations of subtoxic amounts of radioactivity Therapy with MIBG in pheochromococytoma as well as targeted radiopeptide therapy in medullarythyroid cancer has followed this model Radioimmunotherapy appears very promising a definitive Phase 2 study needs completion All therapy has shown promise in extending disease survival (as compared with historical controls) with few major structural (or biochemical) responses This review will attempt to compliment the excellent existing literature by providing an overall systemic therapeutic approach to this promising endeavorrdquo11

bull Este articulo es realmente interesante ya que plantea una mejora en el tratamiento con radioterapia para pacientes con caacutencer medular de tiroides los estudios que aquiacute presentan demuestran que la mejora del tratamiento se ve reflejada en el aumento de la expectativa de vida de los pacientes tratados con el nuevo meacutetodo frente a los tratados con el meacutetodo tradicional

bull http1bpblogspotcom_nbADpD65WD4SmDX1fuRnVIAAAAAAAAGygbXhKLyxMhAEs320tiroidesjpg

bull ldquoCurrent role of metaiodobenzylguanidine in the diagnosis of pheochromocytoma and medullary thyroid cancer

bull Ilias I Divgi C Pacak Kbull Sourcebull Department of Endocrinology E Venizelou Hospital Athens

Greecebull Abstractbull Despite early reports of excellent diagnostic characteristics of

[(131)I][(123)I]-metaiodobenzylguanidine (MIBG) in the evaluation of pheochromocytomasparagangliomas (PHEOsPGLs) or medullary thyroid cancer as experience with it was accumulated the sensitivity dropped Nevertheless this modality is still useful in the diagnostic work-up of PHEOsPGLs because it is widely available and in case of positive scans it might indicate patients who are potential candidates for [(131)I]MIBG therapy

bull Published by Elsevier Incrdquo12

bull El medicamento que referencia el articulo medico se encuentra ampliamente difundido y es esta la principal ventaja del este faacutermaco Aun faltan bastantes estudios el articulo deja muchos interrogantes

bull ldquoAnn Acad Med Singapore 2011 Jun40(6)300-2

bull Melanocytic variant of medullary thyroidcarcinoma in a previously treated papillarycarcinoma patient

bull Mohamad I Zainuddin N Zawawi N Naik VR

bull Source

bull Department of Otorhinolaryngology - Head amp Neck Surgeryrdquo13

bull Este articulo propone que los melanocitos son una variante significativa de el carcinoma medular de tiroides despueacutes de que esta haya sido exitosamente tratada

bull http4bpblogspotcom_Fnq-_ypIXdgTO6t_bKf53IAAAAAAAAAEgQLDhcalP0hks1600melanocitosjpg

bull ldquoBreast metastasis by medullary thyroid carcinoma detected by FDG positron emission tomography

bull Nofech-Mozes S Mackenzie R Kahn HJ Ehrlich L Raphael SJbull Sourcebull Department of Anatomical Pathology Sunnybrook Health Sciences Center

Toronto ON Canada M4N 3M5bull Abstractbull Medullary thyroid carcinoma (MTC) is an uncommon thyroid cancer

comprising 5 to 8 of thyroid neoplasms In contrast to common thyroid tumors this tumor originates from the calcitonin-producing C cells Regional metastases to cervical lymph nodes occur early in the disease whereas distant metastasis occurs late Common metastatic sites include the liver bone brain and adrenal medulla We present a case of MTC metastatic to the breast We report on this case for the following reasons (1) metastasis to the breast is an extremely rare occurrence and could be easily confused clinically and pathologically with a primary breast neoplasm and (2) this is the first reported case of detection of breast metastasis by an MTC using FDG ((18)F-fluoro-2-deoxy-D-glucose) positron emission tomography with an accompanying histologic descriptionrdquo14

bull El articulo trata el tema de las metaacutestasis de el carcinoma medular de tiroides haciendo especial eacutenfasis en las metaacutestasis a distancias especialmente en mama

bull http4bpblogspotcom_YmCZlFt2utMTOv2n-jvZKIAAAAAAAAABIKqnwuja7pLQs1600CancerMetastasisjpg

bull ldquoCytology of hyalinising trabecular adenoma-like variant of medullarythyroid carcinoma

bull Santosh KV Raychaudhuri S Subramanya H Naveen Kumar BJbull Sourcebull Department of Pathology Vydehi Institute of Medical Sciences and

Research Center Bangalore Indiabull Abstractbull Medullary thyroid carcinoma is a rare thyroid neoplasm that can be

either sporadic or familial It occurs in adults presenting as a solitary cold nodule on thyroid scan Most are solid firm and non-encapsulated and occur in the mid portion or upper half of the thyroid gland corresponding to areas with greater numbers of C cells We present a case of a 36-year-old female with a swelling in the front of her neck for six years Fine needle aspiration done elsewhere revealed spindle cells suggestive of a spindle cell neoplasm The histopathology of the thyroidectomyspecimen showed features of a hyalinizing trabecular adenoma-like variant of medullary carcinoma Subsequently we performed aspiration on the received specimen and studied the cytological findings The cytological diagnosis of this variant requires identification of the dual spindle and ovoid cell population and the granular neuroendocrinechromatinrdquo15

bull Este trabajo investigativo plantea la posibilidad de una variante del carcinoma medular de tiroides en forma de un adenoma hialinizante trabecular Este estudio fue hecho en una mujer de 36 antildeos es necesario hacer estudios en otros pacientes para reafirmar la tesis del articulo

BIBLIOGRAFIacuteA

bull 1) httpbibliotecafucsaludeduco2052bookspagedoeid=4-u10-B978-1-4377-0324-500011-0--s0030ampisbn=978-1-4377-0324-5ampuniqId=270438322-24-u10-B978-1-4377-0324-500011-0--f0015

bull 2)

bull httpwwwnlmnihgovmedlineplusspanishencyarticle000374htm

bull 3)bull Goldman JM Goren EN Cohen MH et al Anaplastic thyroid

carcinoma long-term survival after radical surgery J Surg Oncol 14 (4) 389-94 1980 [PUBMED Abstract]

4)bull Aldinger KA Samaan NA Ibanez M et al Anaplastic carcinoma of

the thyroid a review of 84 cases of spindle and giant cell carcinoma of the thyroid Cancer 41 (6) 2267-75 1978 [PUBMED Abstract]

5)bull Carling T Udelsman R Thyroid tumors In DeVita VT Jr Hellman

S Rosenberg SA eds Cancer Principles and Practice of Oncology Vols 1 amp 2 8th ed Philadelphia Pa Lippincott Williams amp Wilkins 2008 pp 1663-82

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 9: Carcinoma medular de tiroides

CLASES DE CMT

bull ldquoHay dos formas de carcinoma medular tiroideo

bull Carcinoma medular tiroideo esporaacutedico el cual no se transmite de padres a hijos La mayoriacutea de estos carcinomas son esporaacutedicos Esta forma afecta principalmente a los adultos mayores

bull Carcinoma medular tiroideo hereditario el cual se transmite de padres a hijosrdquo2

bull httpwwwaddisonesimagbociojpg

FACTORES DE RIESGO

bull ldquoUn antecedente familiar de este tipo de carcinoma

bull Antecedentes familiares de neoplasia endocrina muacuteltiple (NEM)

bull Historia previa de feocromocitoma neuromas de la mucosa o hiperparatiroidismordquo4

httpwwwconganatorgseapdatosregionalesvcamino1jpg

Hiperparatiroidismo uno de los mas influyentes factores de riesgo

SIacuteNTOMAS

bull ldquoProblemas respiratorios debido al estrechamiento de las viacuteas respiratorias

bull Tos

bull Tos con sangre

bull Diarrea

bull Bocio (agrandamiento de la tiroides)

bull Tumor en la glaacutendula tiroidesrdquo2

BOCIO

httpgenesisuagmxsaludarticulosanterioresimagesbociojpg

SIGNOS Y EXAacuteMENES

bull ldquoEl meacutedico llevaraacute a cabo un examen fiacutesico Los ganglios linfaacuteticos en el cuello pueden presentar hinchazoacuten Las pruebas de la funcioacuten tiroidea generalmente son normales sin embargo un examen de la tiroides puede revelar noacutedulos (tumoraciones) solitarios o muacuteltiples

bull El examen fiacutesico medico es de suma importancia para detectar hiperplasias en estadios tempranos de carcinoma medular de tiroides

bull httpwwwlosmedicamentosnetconsejoswp-contentuploads201104bociojpg

bull Otros exaacutemenes que se pueden utilizar para diagnosticar el carcinoma medular tiroideo pueden ser

bull Examen de sangre para calcitonina

bull Examen de sangre para antiacutegeno carcinoembrionario (ACE)

bull Pruebas geneacuteticas

bull Biopsia de la tiroides

bull Gammagrafiacutea de la tiroides

bull Ecografiacutea de la tiroidesrdquo23httpwwwdoctorweborgstaticimagesbociojpg

OPCIONES DE TRATAMIENTO

bull ldquoCirugiacutea con frecuencia es necesario efectuar una traqueotomiacutea Si la enfermedad estaacute limitada a un aacuterea local lo cual es poco comuacuten se justifica la realizacioacuten de una tiroidectomiacutea total para reducir los siacutentomas que causa la masa tumoralrdquo39

bull httpwwwnlmnihgovmedlineplusspanishencyimagesencyfullsize14066jpg

bull Radioterapia Se puede usar la irradiacioacuten de haz externo en los pacientes que no son idoacuteneos para la cirugiacutea o cuyo tumor no puede extirparse quiruacutergicamente

bull Quimioterapia el caacutencer anaplaacutesico de la tiroides no responde al tratamiento con I131 se observa que el tratamiento con monofaacutermacosanticancerosos produce remisiones parciales en algunos pacientes Aproximadamente 30 de los pacientes logran una remisioacuten parcial con la doxorrubicina La combinacioacuten de doxorrubicina y cisplatino parece ser maacutes activa que la doxorrubicina sola y se ha observado que produce maacutes respuestas completas

bull ldquoTargeted systemic radiotherapy of pheochromocytoma and medullary thyroid cancerbull Divgi Cbull Sourcebull Columbia University New York NYbull Abstractbull Targeted systemic radiotherapy constitutes the systemic administration of a radioactive agent that

targets a molecule expressed preferentially on cancer cells The archetypal such therapy is 131-iodine ((131)I) therapy for differentiated thyroid cancers Radiotherapy typically delivers a calculated radiation-absorbed dose to tumor that takes into account (contiguous) normal tissue Systemic radiotherapy development currently uses schema more analogous to chemotherapy-a radioactivity estimate that does not cause any irreversible toxicity Historically arbitrary amounts of radioactivity shown to be effective on the basis of retrospective review were used for thyroidcancer therapy with (131)I as well as for neuroendocrine tumor therapy with (131)I-labeled meta-iodo-benzylguanidine (MIBG) Their established safety record has led to adaptations that include repeat therapies with nontoxic amounts of radioactivity There remains however a lack of clear understanding of the safety limits of systemic targeted radiotherapy This is probably most true in systemic therapy with MIBG in adult neuroendocrine tumors Bone marrow is the primary critical organ for most targeted systemic radiotherapy second organ involvement may be renal as with MIBG and targeted radiopeptide therapy or pulmonary as with radioimmunotherapy Most therapies have tended toward multiple administrations of subtoxic amounts of radioactivity Therapy with MIBG in pheochromococytoma as well as targeted radiopeptide therapy in medullarythyroid cancer has followed this model Radioimmunotherapy appears very promising a definitive Phase 2 study needs completion All therapy has shown promise in extending disease survival (as compared with historical controls) with few major structural (or biochemical) responses This review will attempt to compliment the excellent existing literature by providing an overall systemic therapeutic approach to this promising endeavorrdquo11

bull Este articulo es realmente interesante ya que plantea una mejora en el tratamiento con radioterapia para pacientes con caacutencer medular de tiroides los estudios que aquiacute presentan demuestran que la mejora del tratamiento se ve reflejada en el aumento de la expectativa de vida de los pacientes tratados con el nuevo meacutetodo frente a los tratados con el meacutetodo tradicional

bull http1bpblogspotcom_nbADpD65WD4SmDX1fuRnVIAAAAAAAAGygbXhKLyxMhAEs320tiroidesjpg

bull ldquoCurrent role of metaiodobenzylguanidine in the diagnosis of pheochromocytoma and medullary thyroid cancer

bull Ilias I Divgi C Pacak Kbull Sourcebull Department of Endocrinology E Venizelou Hospital Athens

Greecebull Abstractbull Despite early reports of excellent diagnostic characteristics of

[(131)I][(123)I]-metaiodobenzylguanidine (MIBG) in the evaluation of pheochromocytomasparagangliomas (PHEOsPGLs) or medullary thyroid cancer as experience with it was accumulated the sensitivity dropped Nevertheless this modality is still useful in the diagnostic work-up of PHEOsPGLs because it is widely available and in case of positive scans it might indicate patients who are potential candidates for [(131)I]MIBG therapy

bull Published by Elsevier Incrdquo12

bull El medicamento que referencia el articulo medico se encuentra ampliamente difundido y es esta la principal ventaja del este faacutermaco Aun faltan bastantes estudios el articulo deja muchos interrogantes

bull ldquoAnn Acad Med Singapore 2011 Jun40(6)300-2

bull Melanocytic variant of medullary thyroidcarcinoma in a previously treated papillarycarcinoma patient

bull Mohamad I Zainuddin N Zawawi N Naik VR

bull Source

bull Department of Otorhinolaryngology - Head amp Neck Surgeryrdquo13

bull Este articulo propone que los melanocitos son una variante significativa de el carcinoma medular de tiroides despueacutes de que esta haya sido exitosamente tratada

bull http4bpblogspotcom_Fnq-_ypIXdgTO6t_bKf53IAAAAAAAAAEgQLDhcalP0hks1600melanocitosjpg

bull ldquoBreast metastasis by medullary thyroid carcinoma detected by FDG positron emission tomography

bull Nofech-Mozes S Mackenzie R Kahn HJ Ehrlich L Raphael SJbull Sourcebull Department of Anatomical Pathology Sunnybrook Health Sciences Center

Toronto ON Canada M4N 3M5bull Abstractbull Medullary thyroid carcinoma (MTC) is an uncommon thyroid cancer

comprising 5 to 8 of thyroid neoplasms In contrast to common thyroid tumors this tumor originates from the calcitonin-producing C cells Regional metastases to cervical lymph nodes occur early in the disease whereas distant metastasis occurs late Common metastatic sites include the liver bone brain and adrenal medulla We present a case of MTC metastatic to the breast We report on this case for the following reasons (1) metastasis to the breast is an extremely rare occurrence and could be easily confused clinically and pathologically with a primary breast neoplasm and (2) this is the first reported case of detection of breast metastasis by an MTC using FDG ((18)F-fluoro-2-deoxy-D-glucose) positron emission tomography with an accompanying histologic descriptionrdquo14

bull El articulo trata el tema de las metaacutestasis de el carcinoma medular de tiroides haciendo especial eacutenfasis en las metaacutestasis a distancias especialmente en mama

bull http4bpblogspotcom_YmCZlFt2utMTOv2n-jvZKIAAAAAAAAABIKqnwuja7pLQs1600CancerMetastasisjpg

bull ldquoCytology of hyalinising trabecular adenoma-like variant of medullarythyroid carcinoma

bull Santosh KV Raychaudhuri S Subramanya H Naveen Kumar BJbull Sourcebull Department of Pathology Vydehi Institute of Medical Sciences and

Research Center Bangalore Indiabull Abstractbull Medullary thyroid carcinoma is a rare thyroid neoplasm that can be

either sporadic or familial It occurs in adults presenting as a solitary cold nodule on thyroid scan Most are solid firm and non-encapsulated and occur in the mid portion or upper half of the thyroid gland corresponding to areas with greater numbers of C cells We present a case of a 36-year-old female with a swelling in the front of her neck for six years Fine needle aspiration done elsewhere revealed spindle cells suggestive of a spindle cell neoplasm The histopathology of the thyroidectomyspecimen showed features of a hyalinizing trabecular adenoma-like variant of medullary carcinoma Subsequently we performed aspiration on the received specimen and studied the cytological findings The cytological diagnosis of this variant requires identification of the dual spindle and ovoid cell population and the granular neuroendocrinechromatinrdquo15

bull Este trabajo investigativo plantea la posibilidad de una variante del carcinoma medular de tiroides en forma de un adenoma hialinizante trabecular Este estudio fue hecho en una mujer de 36 antildeos es necesario hacer estudios en otros pacientes para reafirmar la tesis del articulo

BIBLIOGRAFIacuteA

bull 1) httpbibliotecafucsaludeduco2052bookspagedoeid=4-u10-B978-1-4377-0324-500011-0--s0030ampisbn=978-1-4377-0324-5ampuniqId=270438322-24-u10-B978-1-4377-0324-500011-0--f0015

bull 2)

bull httpwwwnlmnihgovmedlineplusspanishencyarticle000374htm

bull 3)bull Goldman JM Goren EN Cohen MH et al Anaplastic thyroid

carcinoma long-term survival after radical surgery J Surg Oncol 14 (4) 389-94 1980 [PUBMED Abstract]

4)bull Aldinger KA Samaan NA Ibanez M et al Anaplastic carcinoma of

the thyroid a review of 84 cases of spindle and giant cell carcinoma of the thyroid Cancer 41 (6) 2267-75 1978 [PUBMED Abstract]

5)bull Carling T Udelsman R Thyroid tumors In DeVita VT Jr Hellman

S Rosenberg SA eds Cancer Principles and Practice of Oncology Vols 1 amp 2 8th ed Philadelphia Pa Lippincott Williams amp Wilkins 2008 pp 1663-82

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 10: Carcinoma medular de tiroides

bull httpwwwaddisonesimagbociojpg

FACTORES DE RIESGO

bull ldquoUn antecedente familiar de este tipo de carcinoma

bull Antecedentes familiares de neoplasia endocrina muacuteltiple (NEM)

bull Historia previa de feocromocitoma neuromas de la mucosa o hiperparatiroidismordquo4

httpwwwconganatorgseapdatosregionalesvcamino1jpg

Hiperparatiroidismo uno de los mas influyentes factores de riesgo

SIacuteNTOMAS

bull ldquoProblemas respiratorios debido al estrechamiento de las viacuteas respiratorias

bull Tos

bull Tos con sangre

bull Diarrea

bull Bocio (agrandamiento de la tiroides)

bull Tumor en la glaacutendula tiroidesrdquo2

BOCIO

httpgenesisuagmxsaludarticulosanterioresimagesbociojpg

SIGNOS Y EXAacuteMENES

bull ldquoEl meacutedico llevaraacute a cabo un examen fiacutesico Los ganglios linfaacuteticos en el cuello pueden presentar hinchazoacuten Las pruebas de la funcioacuten tiroidea generalmente son normales sin embargo un examen de la tiroides puede revelar noacutedulos (tumoraciones) solitarios o muacuteltiples

bull El examen fiacutesico medico es de suma importancia para detectar hiperplasias en estadios tempranos de carcinoma medular de tiroides

bull httpwwwlosmedicamentosnetconsejoswp-contentuploads201104bociojpg

bull Otros exaacutemenes que se pueden utilizar para diagnosticar el carcinoma medular tiroideo pueden ser

bull Examen de sangre para calcitonina

bull Examen de sangre para antiacutegeno carcinoembrionario (ACE)

bull Pruebas geneacuteticas

bull Biopsia de la tiroides

bull Gammagrafiacutea de la tiroides

bull Ecografiacutea de la tiroidesrdquo23httpwwwdoctorweborgstaticimagesbociojpg

OPCIONES DE TRATAMIENTO

bull ldquoCirugiacutea con frecuencia es necesario efectuar una traqueotomiacutea Si la enfermedad estaacute limitada a un aacuterea local lo cual es poco comuacuten se justifica la realizacioacuten de una tiroidectomiacutea total para reducir los siacutentomas que causa la masa tumoralrdquo39

bull httpwwwnlmnihgovmedlineplusspanishencyimagesencyfullsize14066jpg

bull Radioterapia Se puede usar la irradiacioacuten de haz externo en los pacientes que no son idoacuteneos para la cirugiacutea o cuyo tumor no puede extirparse quiruacutergicamente

bull Quimioterapia el caacutencer anaplaacutesico de la tiroides no responde al tratamiento con I131 se observa que el tratamiento con monofaacutermacosanticancerosos produce remisiones parciales en algunos pacientes Aproximadamente 30 de los pacientes logran una remisioacuten parcial con la doxorrubicina La combinacioacuten de doxorrubicina y cisplatino parece ser maacutes activa que la doxorrubicina sola y se ha observado que produce maacutes respuestas completas

bull ldquoTargeted systemic radiotherapy of pheochromocytoma and medullary thyroid cancerbull Divgi Cbull Sourcebull Columbia University New York NYbull Abstractbull Targeted systemic radiotherapy constitutes the systemic administration of a radioactive agent that

targets a molecule expressed preferentially on cancer cells The archetypal such therapy is 131-iodine ((131)I) therapy for differentiated thyroid cancers Radiotherapy typically delivers a calculated radiation-absorbed dose to tumor that takes into account (contiguous) normal tissue Systemic radiotherapy development currently uses schema more analogous to chemotherapy-a radioactivity estimate that does not cause any irreversible toxicity Historically arbitrary amounts of radioactivity shown to be effective on the basis of retrospective review were used for thyroidcancer therapy with (131)I as well as for neuroendocrine tumor therapy with (131)I-labeled meta-iodo-benzylguanidine (MIBG) Their established safety record has led to adaptations that include repeat therapies with nontoxic amounts of radioactivity There remains however a lack of clear understanding of the safety limits of systemic targeted radiotherapy This is probably most true in systemic therapy with MIBG in adult neuroendocrine tumors Bone marrow is the primary critical organ for most targeted systemic radiotherapy second organ involvement may be renal as with MIBG and targeted radiopeptide therapy or pulmonary as with radioimmunotherapy Most therapies have tended toward multiple administrations of subtoxic amounts of radioactivity Therapy with MIBG in pheochromococytoma as well as targeted radiopeptide therapy in medullarythyroid cancer has followed this model Radioimmunotherapy appears very promising a definitive Phase 2 study needs completion All therapy has shown promise in extending disease survival (as compared with historical controls) with few major structural (or biochemical) responses This review will attempt to compliment the excellent existing literature by providing an overall systemic therapeutic approach to this promising endeavorrdquo11

bull Este articulo es realmente interesante ya que plantea una mejora en el tratamiento con radioterapia para pacientes con caacutencer medular de tiroides los estudios que aquiacute presentan demuestran que la mejora del tratamiento se ve reflejada en el aumento de la expectativa de vida de los pacientes tratados con el nuevo meacutetodo frente a los tratados con el meacutetodo tradicional

bull http1bpblogspotcom_nbADpD65WD4SmDX1fuRnVIAAAAAAAAGygbXhKLyxMhAEs320tiroidesjpg

bull ldquoCurrent role of metaiodobenzylguanidine in the diagnosis of pheochromocytoma and medullary thyroid cancer

bull Ilias I Divgi C Pacak Kbull Sourcebull Department of Endocrinology E Venizelou Hospital Athens

Greecebull Abstractbull Despite early reports of excellent diagnostic characteristics of

[(131)I][(123)I]-metaiodobenzylguanidine (MIBG) in the evaluation of pheochromocytomasparagangliomas (PHEOsPGLs) or medullary thyroid cancer as experience with it was accumulated the sensitivity dropped Nevertheless this modality is still useful in the diagnostic work-up of PHEOsPGLs because it is widely available and in case of positive scans it might indicate patients who are potential candidates for [(131)I]MIBG therapy

bull Published by Elsevier Incrdquo12

bull El medicamento que referencia el articulo medico se encuentra ampliamente difundido y es esta la principal ventaja del este faacutermaco Aun faltan bastantes estudios el articulo deja muchos interrogantes

bull ldquoAnn Acad Med Singapore 2011 Jun40(6)300-2

bull Melanocytic variant of medullary thyroidcarcinoma in a previously treated papillarycarcinoma patient

bull Mohamad I Zainuddin N Zawawi N Naik VR

bull Source

bull Department of Otorhinolaryngology - Head amp Neck Surgeryrdquo13

bull Este articulo propone que los melanocitos son una variante significativa de el carcinoma medular de tiroides despueacutes de que esta haya sido exitosamente tratada

bull http4bpblogspotcom_Fnq-_ypIXdgTO6t_bKf53IAAAAAAAAAEgQLDhcalP0hks1600melanocitosjpg

bull ldquoBreast metastasis by medullary thyroid carcinoma detected by FDG positron emission tomography

bull Nofech-Mozes S Mackenzie R Kahn HJ Ehrlich L Raphael SJbull Sourcebull Department of Anatomical Pathology Sunnybrook Health Sciences Center

Toronto ON Canada M4N 3M5bull Abstractbull Medullary thyroid carcinoma (MTC) is an uncommon thyroid cancer

comprising 5 to 8 of thyroid neoplasms In contrast to common thyroid tumors this tumor originates from the calcitonin-producing C cells Regional metastases to cervical lymph nodes occur early in the disease whereas distant metastasis occurs late Common metastatic sites include the liver bone brain and adrenal medulla We present a case of MTC metastatic to the breast We report on this case for the following reasons (1) metastasis to the breast is an extremely rare occurrence and could be easily confused clinically and pathologically with a primary breast neoplasm and (2) this is the first reported case of detection of breast metastasis by an MTC using FDG ((18)F-fluoro-2-deoxy-D-glucose) positron emission tomography with an accompanying histologic descriptionrdquo14

bull El articulo trata el tema de las metaacutestasis de el carcinoma medular de tiroides haciendo especial eacutenfasis en las metaacutestasis a distancias especialmente en mama

bull http4bpblogspotcom_YmCZlFt2utMTOv2n-jvZKIAAAAAAAAABIKqnwuja7pLQs1600CancerMetastasisjpg

bull ldquoCytology of hyalinising trabecular adenoma-like variant of medullarythyroid carcinoma

bull Santosh KV Raychaudhuri S Subramanya H Naveen Kumar BJbull Sourcebull Department of Pathology Vydehi Institute of Medical Sciences and

Research Center Bangalore Indiabull Abstractbull Medullary thyroid carcinoma is a rare thyroid neoplasm that can be

either sporadic or familial It occurs in adults presenting as a solitary cold nodule on thyroid scan Most are solid firm and non-encapsulated and occur in the mid portion or upper half of the thyroid gland corresponding to areas with greater numbers of C cells We present a case of a 36-year-old female with a swelling in the front of her neck for six years Fine needle aspiration done elsewhere revealed spindle cells suggestive of a spindle cell neoplasm The histopathology of the thyroidectomyspecimen showed features of a hyalinizing trabecular adenoma-like variant of medullary carcinoma Subsequently we performed aspiration on the received specimen and studied the cytological findings The cytological diagnosis of this variant requires identification of the dual spindle and ovoid cell population and the granular neuroendocrinechromatinrdquo15

bull Este trabajo investigativo plantea la posibilidad de una variante del carcinoma medular de tiroides en forma de un adenoma hialinizante trabecular Este estudio fue hecho en una mujer de 36 antildeos es necesario hacer estudios en otros pacientes para reafirmar la tesis del articulo

BIBLIOGRAFIacuteA

bull 1) httpbibliotecafucsaludeduco2052bookspagedoeid=4-u10-B978-1-4377-0324-500011-0--s0030ampisbn=978-1-4377-0324-5ampuniqId=270438322-24-u10-B978-1-4377-0324-500011-0--f0015

bull 2)

bull httpwwwnlmnihgovmedlineplusspanishencyarticle000374htm

bull 3)bull Goldman JM Goren EN Cohen MH et al Anaplastic thyroid

carcinoma long-term survival after radical surgery J Surg Oncol 14 (4) 389-94 1980 [PUBMED Abstract]

4)bull Aldinger KA Samaan NA Ibanez M et al Anaplastic carcinoma of

the thyroid a review of 84 cases of spindle and giant cell carcinoma of the thyroid Cancer 41 (6) 2267-75 1978 [PUBMED Abstract]

5)bull Carling T Udelsman R Thyroid tumors In DeVita VT Jr Hellman

S Rosenberg SA eds Cancer Principles and Practice of Oncology Vols 1 amp 2 8th ed Philadelphia Pa Lippincott Williams amp Wilkins 2008 pp 1663-82

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 11: Carcinoma medular de tiroides

FACTORES DE RIESGO

bull ldquoUn antecedente familiar de este tipo de carcinoma

bull Antecedentes familiares de neoplasia endocrina muacuteltiple (NEM)

bull Historia previa de feocromocitoma neuromas de la mucosa o hiperparatiroidismordquo4

httpwwwconganatorgseapdatosregionalesvcamino1jpg

Hiperparatiroidismo uno de los mas influyentes factores de riesgo

SIacuteNTOMAS

bull ldquoProblemas respiratorios debido al estrechamiento de las viacuteas respiratorias

bull Tos

bull Tos con sangre

bull Diarrea

bull Bocio (agrandamiento de la tiroides)

bull Tumor en la glaacutendula tiroidesrdquo2

BOCIO

httpgenesisuagmxsaludarticulosanterioresimagesbociojpg

SIGNOS Y EXAacuteMENES

bull ldquoEl meacutedico llevaraacute a cabo un examen fiacutesico Los ganglios linfaacuteticos en el cuello pueden presentar hinchazoacuten Las pruebas de la funcioacuten tiroidea generalmente son normales sin embargo un examen de la tiroides puede revelar noacutedulos (tumoraciones) solitarios o muacuteltiples

bull El examen fiacutesico medico es de suma importancia para detectar hiperplasias en estadios tempranos de carcinoma medular de tiroides

bull httpwwwlosmedicamentosnetconsejoswp-contentuploads201104bociojpg

bull Otros exaacutemenes que se pueden utilizar para diagnosticar el carcinoma medular tiroideo pueden ser

bull Examen de sangre para calcitonina

bull Examen de sangre para antiacutegeno carcinoembrionario (ACE)

bull Pruebas geneacuteticas

bull Biopsia de la tiroides

bull Gammagrafiacutea de la tiroides

bull Ecografiacutea de la tiroidesrdquo23httpwwwdoctorweborgstaticimagesbociojpg

OPCIONES DE TRATAMIENTO

bull ldquoCirugiacutea con frecuencia es necesario efectuar una traqueotomiacutea Si la enfermedad estaacute limitada a un aacuterea local lo cual es poco comuacuten se justifica la realizacioacuten de una tiroidectomiacutea total para reducir los siacutentomas que causa la masa tumoralrdquo39

bull httpwwwnlmnihgovmedlineplusspanishencyimagesencyfullsize14066jpg

bull Radioterapia Se puede usar la irradiacioacuten de haz externo en los pacientes que no son idoacuteneos para la cirugiacutea o cuyo tumor no puede extirparse quiruacutergicamente

bull Quimioterapia el caacutencer anaplaacutesico de la tiroides no responde al tratamiento con I131 se observa que el tratamiento con monofaacutermacosanticancerosos produce remisiones parciales en algunos pacientes Aproximadamente 30 de los pacientes logran una remisioacuten parcial con la doxorrubicina La combinacioacuten de doxorrubicina y cisplatino parece ser maacutes activa que la doxorrubicina sola y se ha observado que produce maacutes respuestas completas

bull ldquoTargeted systemic radiotherapy of pheochromocytoma and medullary thyroid cancerbull Divgi Cbull Sourcebull Columbia University New York NYbull Abstractbull Targeted systemic radiotherapy constitutes the systemic administration of a radioactive agent that

targets a molecule expressed preferentially on cancer cells The archetypal such therapy is 131-iodine ((131)I) therapy for differentiated thyroid cancers Radiotherapy typically delivers a calculated radiation-absorbed dose to tumor that takes into account (contiguous) normal tissue Systemic radiotherapy development currently uses schema more analogous to chemotherapy-a radioactivity estimate that does not cause any irreversible toxicity Historically arbitrary amounts of radioactivity shown to be effective on the basis of retrospective review were used for thyroidcancer therapy with (131)I as well as for neuroendocrine tumor therapy with (131)I-labeled meta-iodo-benzylguanidine (MIBG) Their established safety record has led to adaptations that include repeat therapies with nontoxic amounts of radioactivity There remains however a lack of clear understanding of the safety limits of systemic targeted radiotherapy This is probably most true in systemic therapy with MIBG in adult neuroendocrine tumors Bone marrow is the primary critical organ for most targeted systemic radiotherapy second organ involvement may be renal as with MIBG and targeted radiopeptide therapy or pulmonary as with radioimmunotherapy Most therapies have tended toward multiple administrations of subtoxic amounts of radioactivity Therapy with MIBG in pheochromococytoma as well as targeted radiopeptide therapy in medullarythyroid cancer has followed this model Radioimmunotherapy appears very promising a definitive Phase 2 study needs completion All therapy has shown promise in extending disease survival (as compared with historical controls) with few major structural (or biochemical) responses This review will attempt to compliment the excellent existing literature by providing an overall systemic therapeutic approach to this promising endeavorrdquo11

bull Este articulo es realmente interesante ya que plantea una mejora en el tratamiento con radioterapia para pacientes con caacutencer medular de tiroides los estudios que aquiacute presentan demuestran que la mejora del tratamiento se ve reflejada en el aumento de la expectativa de vida de los pacientes tratados con el nuevo meacutetodo frente a los tratados con el meacutetodo tradicional

bull http1bpblogspotcom_nbADpD65WD4SmDX1fuRnVIAAAAAAAAGygbXhKLyxMhAEs320tiroidesjpg

bull ldquoCurrent role of metaiodobenzylguanidine in the diagnosis of pheochromocytoma and medullary thyroid cancer

bull Ilias I Divgi C Pacak Kbull Sourcebull Department of Endocrinology E Venizelou Hospital Athens

Greecebull Abstractbull Despite early reports of excellent diagnostic characteristics of

[(131)I][(123)I]-metaiodobenzylguanidine (MIBG) in the evaluation of pheochromocytomasparagangliomas (PHEOsPGLs) or medullary thyroid cancer as experience with it was accumulated the sensitivity dropped Nevertheless this modality is still useful in the diagnostic work-up of PHEOsPGLs because it is widely available and in case of positive scans it might indicate patients who are potential candidates for [(131)I]MIBG therapy

bull Published by Elsevier Incrdquo12

bull El medicamento que referencia el articulo medico se encuentra ampliamente difundido y es esta la principal ventaja del este faacutermaco Aun faltan bastantes estudios el articulo deja muchos interrogantes

bull ldquoAnn Acad Med Singapore 2011 Jun40(6)300-2

bull Melanocytic variant of medullary thyroidcarcinoma in a previously treated papillarycarcinoma patient

bull Mohamad I Zainuddin N Zawawi N Naik VR

bull Source

bull Department of Otorhinolaryngology - Head amp Neck Surgeryrdquo13

bull Este articulo propone que los melanocitos son una variante significativa de el carcinoma medular de tiroides despueacutes de que esta haya sido exitosamente tratada

bull http4bpblogspotcom_Fnq-_ypIXdgTO6t_bKf53IAAAAAAAAAEgQLDhcalP0hks1600melanocitosjpg

bull ldquoBreast metastasis by medullary thyroid carcinoma detected by FDG positron emission tomography

bull Nofech-Mozes S Mackenzie R Kahn HJ Ehrlich L Raphael SJbull Sourcebull Department of Anatomical Pathology Sunnybrook Health Sciences Center

Toronto ON Canada M4N 3M5bull Abstractbull Medullary thyroid carcinoma (MTC) is an uncommon thyroid cancer

comprising 5 to 8 of thyroid neoplasms In contrast to common thyroid tumors this tumor originates from the calcitonin-producing C cells Regional metastases to cervical lymph nodes occur early in the disease whereas distant metastasis occurs late Common metastatic sites include the liver bone brain and adrenal medulla We present a case of MTC metastatic to the breast We report on this case for the following reasons (1) metastasis to the breast is an extremely rare occurrence and could be easily confused clinically and pathologically with a primary breast neoplasm and (2) this is the first reported case of detection of breast metastasis by an MTC using FDG ((18)F-fluoro-2-deoxy-D-glucose) positron emission tomography with an accompanying histologic descriptionrdquo14

bull El articulo trata el tema de las metaacutestasis de el carcinoma medular de tiroides haciendo especial eacutenfasis en las metaacutestasis a distancias especialmente en mama

bull http4bpblogspotcom_YmCZlFt2utMTOv2n-jvZKIAAAAAAAAABIKqnwuja7pLQs1600CancerMetastasisjpg

bull ldquoCytology of hyalinising trabecular adenoma-like variant of medullarythyroid carcinoma

bull Santosh KV Raychaudhuri S Subramanya H Naveen Kumar BJbull Sourcebull Department of Pathology Vydehi Institute of Medical Sciences and

Research Center Bangalore Indiabull Abstractbull Medullary thyroid carcinoma is a rare thyroid neoplasm that can be

either sporadic or familial It occurs in adults presenting as a solitary cold nodule on thyroid scan Most are solid firm and non-encapsulated and occur in the mid portion or upper half of the thyroid gland corresponding to areas with greater numbers of C cells We present a case of a 36-year-old female with a swelling in the front of her neck for six years Fine needle aspiration done elsewhere revealed spindle cells suggestive of a spindle cell neoplasm The histopathology of the thyroidectomyspecimen showed features of a hyalinizing trabecular adenoma-like variant of medullary carcinoma Subsequently we performed aspiration on the received specimen and studied the cytological findings The cytological diagnosis of this variant requires identification of the dual spindle and ovoid cell population and the granular neuroendocrinechromatinrdquo15

bull Este trabajo investigativo plantea la posibilidad de una variante del carcinoma medular de tiroides en forma de un adenoma hialinizante trabecular Este estudio fue hecho en una mujer de 36 antildeos es necesario hacer estudios en otros pacientes para reafirmar la tesis del articulo

BIBLIOGRAFIacuteA

bull 1) httpbibliotecafucsaludeduco2052bookspagedoeid=4-u10-B978-1-4377-0324-500011-0--s0030ampisbn=978-1-4377-0324-5ampuniqId=270438322-24-u10-B978-1-4377-0324-500011-0--f0015

bull 2)

bull httpwwwnlmnihgovmedlineplusspanishencyarticle000374htm

bull 3)bull Goldman JM Goren EN Cohen MH et al Anaplastic thyroid

carcinoma long-term survival after radical surgery J Surg Oncol 14 (4) 389-94 1980 [PUBMED Abstract]

4)bull Aldinger KA Samaan NA Ibanez M et al Anaplastic carcinoma of

the thyroid a review of 84 cases of spindle and giant cell carcinoma of the thyroid Cancer 41 (6) 2267-75 1978 [PUBMED Abstract]

5)bull Carling T Udelsman R Thyroid tumors In DeVita VT Jr Hellman

S Rosenberg SA eds Cancer Principles and Practice of Oncology Vols 1 amp 2 8th ed Philadelphia Pa Lippincott Williams amp Wilkins 2008 pp 1663-82

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 12: Carcinoma medular de tiroides

httpwwwconganatorgseapdatosregionalesvcamino1jpg

Hiperparatiroidismo uno de los mas influyentes factores de riesgo

SIacuteNTOMAS

bull ldquoProblemas respiratorios debido al estrechamiento de las viacuteas respiratorias

bull Tos

bull Tos con sangre

bull Diarrea

bull Bocio (agrandamiento de la tiroides)

bull Tumor en la glaacutendula tiroidesrdquo2

BOCIO

httpgenesisuagmxsaludarticulosanterioresimagesbociojpg

SIGNOS Y EXAacuteMENES

bull ldquoEl meacutedico llevaraacute a cabo un examen fiacutesico Los ganglios linfaacuteticos en el cuello pueden presentar hinchazoacuten Las pruebas de la funcioacuten tiroidea generalmente son normales sin embargo un examen de la tiroides puede revelar noacutedulos (tumoraciones) solitarios o muacuteltiples

bull El examen fiacutesico medico es de suma importancia para detectar hiperplasias en estadios tempranos de carcinoma medular de tiroides

bull httpwwwlosmedicamentosnetconsejoswp-contentuploads201104bociojpg

bull Otros exaacutemenes que se pueden utilizar para diagnosticar el carcinoma medular tiroideo pueden ser

bull Examen de sangre para calcitonina

bull Examen de sangre para antiacutegeno carcinoembrionario (ACE)

bull Pruebas geneacuteticas

bull Biopsia de la tiroides

bull Gammagrafiacutea de la tiroides

bull Ecografiacutea de la tiroidesrdquo23httpwwwdoctorweborgstaticimagesbociojpg

OPCIONES DE TRATAMIENTO

bull ldquoCirugiacutea con frecuencia es necesario efectuar una traqueotomiacutea Si la enfermedad estaacute limitada a un aacuterea local lo cual es poco comuacuten se justifica la realizacioacuten de una tiroidectomiacutea total para reducir los siacutentomas que causa la masa tumoralrdquo39

bull httpwwwnlmnihgovmedlineplusspanishencyimagesencyfullsize14066jpg

bull Radioterapia Se puede usar la irradiacioacuten de haz externo en los pacientes que no son idoacuteneos para la cirugiacutea o cuyo tumor no puede extirparse quiruacutergicamente

bull Quimioterapia el caacutencer anaplaacutesico de la tiroides no responde al tratamiento con I131 se observa que el tratamiento con monofaacutermacosanticancerosos produce remisiones parciales en algunos pacientes Aproximadamente 30 de los pacientes logran una remisioacuten parcial con la doxorrubicina La combinacioacuten de doxorrubicina y cisplatino parece ser maacutes activa que la doxorrubicina sola y se ha observado que produce maacutes respuestas completas

bull ldquoTargeted systemic radiotherapy of pheochromocytoma and medullary thyroid cancerbull Divgi Cbull Sourcebull Columbia University New York NYbull Abstractbull Targeted systemic radiotherapy constitutes the systemic administration of a radioactive agent that

targets a molecule expressed preferentially on cancer cells The archetypal such therapy is 131-iodine ((131)I) therapy for differentiated thyroid cancers Radiotherapy typically delivers a calculated radiation-absorbed dose to tumor that takes into account (contiguous) normal tissue Systemic radiotherapy development currently uses schema more analogous to chemotherapy-a radioactivity estimate that does not cause any irreversible toxicity Historically arbitrary amounts of radioactivity shown to be effective on the basis of retrospective review were used for thyroidcancer therapy with (131)I as well as for neuroendocrine tumor therapy with (131)I-labeled meta-iodo-benzylguanidine (MIBG) Their established safety record has led to adaptations that include repeat therapies with nontoxic amounts of radioactivity There remains however a lack of clear understanding of the safety limits of systemic targeted radiotherapy This is probably most true in systemic therapy with MIBG in adult neuroendocrine tumors Bone marrow is the primary critical organ for most targeted systemic radiotherapy second organ involvement may be renal as with MIBG and targeted radiopeptide therapy or pulmonary as with radioimmunotherapy Most therapies have tended toward multiple administrations of subtoxic amounts of radioactivity Therapy with MIBG in pheochromococytoma as well as targeted radiopeptide therapy in medullarythyroid cancer has followed this model Radioimmunotherapy appears very promising a definitive Phase 2 study needs completion All therapy has shown promise in extending disease survival (as compared with historical controls) with few major structural (or biochemical) responses This review will attempt to compliment the excellent existing literature by providing an overall systemic therapeutic approach to this promising endeavorrdquo11

bull Este articulo es realmente interesante ya que plantea una mejora en el tratamiento con radioterapia para pacientes con caacutencer medular de tiroides los estudios que aquiacute presentan demuestran que la mejora del tratamiento se ve reflejada en el aumento de la expectativa de vida de los pacientes tratados con el nuevo meacutetodo frente a los tratados con el meacutetodo tradicional

bull http1bpblogspotcom_nbADpD65WD4SmDX1fuRnVIAAAAAAAAGygbXhKLyxMhAEs320tiroidesjpg

bull ldquoCurrent role of metaiodobenzylguanidine in the diagnosis of pheochromocytoma and medullary thyroid cancer

bull Ilias I Divgi C Pacak Kbull Sourcebull Department of Endocrinology E Venizelou Hospital Athens

Greecebull Abstractbull Despite early reports of excellent diagnostic characteristics of

[(131)I][(123)I]-metaiodobenzylguanidine (MIBG) in the evaluation of pheochromocytomasparagangliomas (PHEOsPGLs) or medullary thyroid cancer as experience with it was accumulated the sensitivity dropped Nevertheless this modality is still useful in the diagnostic work-up of PHEOsPGLs because it is widely available and in case of positive scans it might indicate patients who are potential candidates for [(131)I]MIBG therapy

bull Published by Elsevier Incrdquo12

bull El medicamento que referencia el articulo medico se encuentra ampliamente difundido y es esta la principal ventaja del este faacutermaco Aun faltan bastantes estudios el articulo deja muchos interrogantes

bull ldquoAnn Acad Med Singapore 2011 Jun40(6)300-2

bull Melanocytic variant of medullary thyroidcarcinoma in a previously treated papillarycarcinoma patient

bull Mohamad I Zainuddin N Zawawi N Naik VR

bull Source

bull Department of Otorhinolaryngology - Head amp Neck Surgeryrdquo13

bull Este articulo propone que los melanocitos son una variante significativa de el carcinoma medular de tiroides despueacutes de que esta haya sido exitosamente tratada

bull http4bpblogspotcom_Fnq-_ypIXdgTO6t_bKf53IAAAAAAAAAEgQLDhcalP0hks1600melanocitosjpg

bull ldquoBreast metastasis by medullary thyroid carcinoma detected by FDG positron emission tomography

bull Nofech-Mozes S Mackenzie R Kahn HJ Ehrlich L Raphael SJbull Sourcebull Department of Anatomical Pathology Sunnybrook Health Sciences Center

Toronto ON Canada M4N 3M5bull Abstractbull Medullary thyroid carcinoma (MTC) is an uncommon thyroid cancer

comprising 5 to 8 of thyroid neoplasms In contrast to common thyroid tumors this tumor originates from the calcitonin-producing C cells Regional metastases to cervical lymph nodes occur early in the disease whereas distant metastasis occurs late Common metastatic sites include the liver bone brain and adrenal medulla We present a case of MTC metastatic to the breast We report on this case for the following reasons (1) metastasis to the breast is an extremely rare occurrence and could be easily confused clinically and pathologically with a primary breast neoplasm and (2) this is the first reported case of detection of breast metastasis by an MTC using FDG ((18)F-fluoro-2-deoxy-D-glucose) positron emission tomography with an accompanying histologic descriptionrdquo14

bull El articulo trata el tema de las metaacutestasis de el carcinoma medular de tiroides haciendo especial eacutenfasis en las metaacutestasis a distancias especialmente en mama

bull http4bpblogspotcom_YmCZlFt2utMTOv2n-jvZKIAAAAAAAAABIKqnwuja7pLQs1600CancerMetastasisjpg

bull ldquoCytology of hyalinising trabecular adenoma-like variant of medullarythyroid carcinoma

bull Santosh KV Raychaudhuri S Subramanya H Naveen Kumar BJbull Sourcebull Department of Pathology Vydehi Institute of Medical Sciences and

Research Center Bangalore Indiabull Abstractbull Medullary thyroid carcinoma is a rare thyroid neoplasm that can be

either sporadic or familial It occurs in adults presenting as a solitary cold nodule on thyroid scan Most are solid firm and non-encapsulated and occur in the mid portion or upper half of the thyroid gland corresponding to areas with greater numbers of C cells We present a case of a 36-year-old female with a swelling in the front of her neck for six years Fine needle aspiration done elsewhere revealed spindle cells suggestive of a spindle cell neoplasm The histopathology of the thyroidectomyspecimen showed features of a hyalinizing trabecular adenoma-like variant of medullary carcinoma Subsequently we performed aspiration on the received specimen and studied the cytological findings The cytological diagnosis of this variant requires identification of the dual spindle and ovoid cell population and the granular neuroendocrinechromatinrdquo15

bull Este trabajo investigativo plantea la posibilidad de una variante del carcinoma medular de tiroides en forma de un adenoma hialinizante trabecular Este estudio fue hecho en una mujer de 36 antildeos es necesario hacer estudios en otros pacientes para reafirmar la tesis del articulo

BIBLIOGRAFIacuteA

bull 1) httpbibliotecafucsaludeduco2052bookspagedoeid=4-u10-B978-1-4377-0324-500011-0--s0030ampisbn=978-1-4377-0324-5ampuniqId=270438322-24-u10-B978-1-4377-0324-500011-0--f0015

bull 2)

bull httpwwwnlmnihgovmedlineplusspanishencyarticle000374htm

bull 3)bull Goldman JM Goren EN Cohen MH et al Anaplastic thyroid

carcinoma long-term survival after radical surgery J Surg Oncol 14 (4) 389-94 1980 [PUBMED Abstract]

4)bull Aldinger KA Samaan NA Ibanez M et al Anaplastic carcinoma of

the thyroid a review of 84 cases of spindle and giant cell carcinoma of the thyroid Cancer 41 (6) 2267-75 1978 [PUBMED Abstract]

5)bull Carling T Udelsman R Thyroid tumors In DeVita VT Jr Hellman

S Rosenberg SA eds Cancer Principles and Practice of Oncology Vols 1 amp 2 8th ed Philadelphia Pa Lippincott Williams amp Wilkins 2008 pp 1663-82

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 13: Carcinoma medular de tiroides

SIacuteNTOMAS

bull ldquoProblemas respiratorios debido al estrechamiento de las viacuteas respiratorias

bull Tos

bull Tos con sangre

bull Diarrea

bull Bocio (agrandamiento de la tiroides)

bull Tumor en la glaacutendula tiroidesrdquo2

BOCIO

httpgenesisuagmxsaludarticulosanterioresimagesbociojpg

SIGNOS Y EXAacuteMENES

bull ldquoEl meacutedico llevaraacute a cabo un examen fiacutesico Los ganglios linfaacuteticos en el cuello pueden presentar hinchazoacuten Las pruebas de la funcioacuten tiroidea generalmente son normales sin embargo un examen de la tiroides puede revelar noacutedulos (tumoraciones) solitarios o muacuteltiples

bull El examen fiacutesico medico es de suma importancia para detectar hiperplasias en estadios tempranos de carcinoma medular de tiroides

bull httpwwwlosmedicamentosnetconsejoswp-contentuploads201104bociojpg

bull Otros exaacutemenes que se pueden utilizar para diagnosticar el carcinoma medular tiroideo pueden ser

bull Examen de sangre para calcitonina

bull Examen de sangre para antiacutegeno carcinoembrionario (ACE)

bull Pruebas geneacuteticas

bull Biopsia de la tiroides

bull Gammagrafiacutea de la tiroides

bull Ecografiacutea de la tiroidesrdquo23httpwwwdoctorweborgstaticimagesbociojpg

OPCIONES DE TRATAMIENTO

bull ldquoCirugiacutea con frecuencia es necesario efectuar una traqueotomiacutea Si la enfermedad estaacute limitada a un aacuterea local lo cual es poco comuacuten se justifica la realizacioacuten de una tiroidectomiacutea total para reducir los siacutentomas que causa la masa tumoralrdquo39

bull httpwwwnlmnihgovmedlineplusspanishencyimagesencyfullsize14066jpg

bull Radioterapia Se puede usar la irradiacioacuten de haz externo en los pacientes que no son idoacuteneos para la cirugiacutea o cuyo tumor no puede extirparse quiruacutergicamente

bull Quimioterapia el caacutencer anaplaacutesico de la tiroides no responde al tratamiento con I131 se observa que el tratamiento con monofaacutermacosanticancerosos produce remisiones parciales en algunos pacientes Aproximadamente 30 de los pacientes logran una remisioacuten parcial con la doxorrubicina La combinacioacuten de doxorrubicina y cisplatino parece ser maacutes activa que la doxorrubicina sola y se ha observado que produce maacutes respuestas completas

bull ldquoTargeted systemic radiotherapy of pheochromocytoma and medullary thyroid cancerbull Divgi Cbull Sourcebull Columbia University New York NYbull Abstractbull Targeted systemic radiotherapy constitutes the systemic administration of a radioactive agent that

targets a molecule expressed preferentially on cancer cells The archetypal such therapy is 131-iodine ((131)I) therapy for differentiated thyroid cancers Radiotherapy typically delivers a calculated radiation-absorbed dose to tumor that takes into account (contiguous) normal tissue Systemic radiotherapy development currently uses schema more analogous to chemotherapy-a radioactivity estimate that does not cause any irreversible toxicity Historically arbitrary amounts of radioactivity shown to be effective on the basis of retrospective review were used for thyroidcancer therapy with (131)I as well as for neuroendocrine tumor therapy with (131)I-labeled meta-iodo-benzylguanidine (MIBG) Their established safety record has led to adaptations that include repeat therapies with nontoxic amounts of radioactivity There remains however a lack of clear understanding of the safety limits of systemic targeted radiotherapy This is probably most true in systemic therapy with MIBG in adult neuroendocrine tumors Bone marrow is the primary critical organ for most targeted systemic radiotherapy second organ involvement may be renal as with MIBG and targeted radiopeptide therapy or pulmonary as with radioimmunotherapy Most therapies have tended toward multiple administrations of subtoxic amounts of radioactivity Therapy with MIBG in pheochromococytoma as well as targeted radiopeptide therapy in medullarythyroid cancer has followed this model Radioimmunotherapy appears very promising a definitive Phase 2 study needs completion All therapy has shown promise in extending disease survival (as compared with historical controls) with few major structural (or biochemical) responses This review will attempt to compliment the excellent existing literature by providing an overall systemic therapeutic approach to this promising endeavorrdquo11

bull Este articulo es realmente interesante ya que plantea una mejora en el tratamiento con radioterapia para pacientes con caacutencer medular de tiroides los estudios que aquiacute presentan demuestran que la mejora del tratamiento se ve reflejada en el aumento de la expectativa de vida de los pacientes tratados con el nuevo meacutetodo frente a los tratados con el meacutetodo tradicional

bull http1bpblogspotcom_nbADpD65WD4SmDX1fuRnVIAAAAAAAAGygbXhKLyxMhAEs320tiroidesjpg

bull ldquoCurrent role of metaiodobenzylguanidine in the diagnosis of pheochromocytoma and medullary thyroid cancer

bull Ilias I Divgi C Pacak Kbull Sourcebull Department of Endocrinology E Venizelou Hospital Athens

Greecebull Abstractbull Despite early reports of excellent diagnostic characteristics of

[(131)I][(123)I]-metaiodobenzylguanidine (MIBG) in the evaluation of pheochromocytomasparagangliomas (PHEOsPGLs) or medullary thyroid cancer as experience with it was accumulated the sensitivity dropped Nevertheless this modality is still useful in the diagnostic work-up of PHEOsPGLs because it is widely available and in case of positive scans it might indicate patients who are potential candidates for [(131)I]MIBG therapy

bull Published by Elsevier Incrdquo12

bull El medicamento que referencia el articulo medico se encuentra ampliamente difundido y es esta la principal ventaja del este faacutermaco Aun faltan bastantes estudios el articulo deja muchos interrogantes

bull ldquoAnn Acad Med Singapore 2011 Jun40(6)300-2

bull Melanocytic variant of medullary thyroidcarcinoma in a previously treated papillarycarcinoma patient

bull Mohamad I Zainuddin N Zawawi N Naik VR

bull Source

bull Department of Otorhinolaryngology - Head amp Neck Surgeryrdquo13

bull Este articulo propone que los melanocitos son una variante significativa de el carcinoma medular de tiroides despueacutes de que esta haya sido exitosamente tratada

bull http4bpblogspotcom_Fnq-_ypIXdgTO6t_bKf53IAAAAAAAAAEgQLDhcalP0hks1600melanocitosjpg

bull ldquoBreast metastasis by medullary thyroid carcinoma detected by FDG positron emission tomography

bull Nofech-Mozes S Mackenzie R Kahn HJ Ehrlich L Raphael SJbull Sourcebull Department of Anatomical Pathology Sunnybrook Health Sciences Center

Toronto ON Canada M4N 3M5bull Abstractbull Medullary thyroid carcinoma (MTC) is an uncommon thyroid cancer

comprising 5 to 8 of thyroid neoplasms In contrast to common thyroid tumors this tumor originates from the calcitonin-producing C cells Regional metastases to cervical lymph nodes occur early in the disease whereas distant metastasis occurs late Common metastatic sites include the liver bone brain and adrenal medulla We present a case of MTC metastatic to the breast We report on this case for the following reasons (1) metastasis to the breast is an extremely rare occurrence and could be easily confused clinically and pathologically with a primary breast neoplasm and (2) this is the first reported case of detection of breast metastasis by an MTC using FDG ((18)F-fluoro-2-deoxy-D-glucose) positron emission tomography with an accompanying histologic descriptionrdquo14

bull El articulo trata el tema de las metaacutestasis de el carcinoma medular de tiroides haciendo especial eacutenfasis en las metaacutestasis a distancias especialmente en mama

bull http4bpblogspotcom_YmCZlFt2utMTOv2n-jvZKIAAAAAAAAABIKqnwuja7pLQs1600CancerMetastasisjpg

bull ldquoCytology of hyalinising trabecular adenoma-like variant of medullarythyroid carcinoma

bull Santosh KV Raychaudhuri S Subramanya H Naveen Kumar BJbull Sourcebull Department of Pathology Vydehi Institute of Medical Sciences and

Research Center Bangalore Indiabull Abstractbull Medullary thyroid carcinoma is a rare thyroid neoplasm that can be

either sporadic or familial It occurs in adults presenting as a solitary cold nodule on thyroid scan Most are solid firm and non-encapsulated and occur in the mid portion or upper half of the thyroid gland corresponding to areas with greater numbers of C cells We present a case of a 36-year-old female with a swelling in the front of her neck for six years Fine needle aspiration done elsewhere revealed spindle cells suggestive of a spindle cell neoplasm The histopathology of the thyroidectomyspecimen showed features of a hyalinizing trabecular adenoma-like variant of medullary carcinoma Subsequently we performed aspiration on the received specimen and studied the cytological findings The cytological diagnosis of this variant requires identification of the dual spindle and ovoid cell population and the granular neuroendocrinechromatinrdquo15

bull Este trabajo investigativo plantea la posibilidad de una variante del carcinoma medular de tiroides en forma de un adenoma hialinizante trabecular Este estudio fue hecho en una mujer de 36 antildeos es necesario hacer estudios en otros pacientes para reafirmar la tesis del articulo

BIBLIOGRAFIacuteA

bull 1) httpbibliotecafucsaludeduco2052bookspagedoeid=4-u10-B978-1-4377-0324-500011-0--s0030ampisbn=978-1-4377-0324-5ampuniqId=270438322-24-u10-B978-1-4377-0324-500011-0--f0015

bull 2)

bull httpwwwnlmnihgovmedlineplusspanishencyarticle000374htm

bull 3)bull Goldman JM Goren EN Cohen MH et al Anaplastic thyroid

carcinoma long-term survival after radical surgery J Surg Oncol 14 (4) 389-94 1980 [PUBMED Abstract]

4)bull Aldinger KA Samaan NA Ibanez M et al Anaplastic carcinoma of

the thyroid a review of 84 cases of spindle and giant cell carcinoma of the thyroid Cancer 41 (6) 2267-75 1978 [PUBMED Abstract]

5)bull Carling T Udelsman R Thyroid tumors In DeVita VT Jr Hellman

S Rosenberg SA eds Cancer Principles and Practice of Oncology Vols 1 amp 2 8th ed Philadelphia Pa Lippincott Williams amp Wilkins 2008 pp 1663-82

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 14: Carcinoma medular de tiroides

BOCIO

httpgenesisuagmxsaludarticulosanterioresimagesbociojpg

SIGNOS Y EXAacuteMENES

bull ldquoEl meacutedico llevaraacute a cabo un examen fiacutesico Los ganglios linfaacuteticos en el cuello pueden presentar hinchazoacuten Las pruebas de la funcioacuten tiroidea generalmente son normales sin embargo un examen de la tiroides puede revelar noacutedulos (tumoraciones) solitarios o muacuteltiples

bull El examen fiacutesico medico es de suma importancia para detectar hiperplasias en estadios tempranos de carcinoma medular de tiroides

bull httpwwwlosmedicamentosnetconsejoswp-contentuploads201104bociojpg

bull Otros exaacutemenes que se pueden utilizar para diagnosticar el carcinoma medular tiroideo pueden ser

bull Examen de sangre para calcitonina

bull Examen de sangre para antiacutegeno carcinoembrionario (ACE)

bull Pruebas geneacuteticas

bull Biopsia de la tiroides

bull Gammagrafiacutea de la tiroides

bull Ecografiacutea de la tiroidesrdquo23httpwwwdoctorweborgstaticimagesbociojpg

OPCIONES DE TRATAMIENTO

bull ldquoCirugiacutea con frecuencia es necesario efectuar una traqueotomiacutea Si la enfermedad estaacute limitada a un aacuterea local lo cual es poco comuacuten se justifica la realizacioacuten de una tiroidectomiacutea total para reducir los siacutentomas que causa la masa tumoralrdquo39

bull httpwwwnlmnihgovmedlineplusspanishencyimagesencyfullsize14066jpg

bull Radioterapia Se puede usar la irradiacioacuten de haz externo en los pacientes que no son idoacuteneos para la cirugiacutea o cuyo tumor no puede extirparse quiruacutergicamente

bull Quimioterapia el caacutencer anaplaacutesico de la tiroides no responde al tratamiento con I131 se observa que el tratamiento con monofaacutermacosanticancerosos produce remisiones parciales en algunos pacientes Aproximadamente 30 de los pacientes logran una remisioacuten parcial con la doxorrubicina La combinacioacuten de doxorrubicina y cisplatino parece ser maacutes activa que la doxorrubicina sola y se ha observado que produce maacutes respuestas completas

bull ldquoTargeted systemic radiotherapy of pheochromocytoma and medullary thyroid cancerbull Divgi Cbull Sourcebull Columbia University New York NYbull Abstractbull Targeted systemic radiotherapy constitutes the systemic administration of a radioactive agent that

targets a molecule expressed preferentially on cancer cells The archetypal such therapy is 131-iodine ((131)I) therapy for differentiated thyroid cancers Radiotherapy typically delivers a calculated radiation-absorbed dose to tumor that takes into account (contiguous) normal tissue Systemic radiotherapy development currently uses schema more analogous to chemotherapy-a radioactivity estimate that does not cause any irreversible toxicity Historically arbitrary amounts of radioactivity shown to be effective on the basis of retrospective review were used for thyroidcancer therapy with (131)I as well as for neuroendocrine tumor therapy with (131)I-labeled meta-iodo-benzylguanidine (MIBG) Their established safety record has led to adaptations that include repeat therapies with nontoxic amounts of radioactivity There remains however a lack of clear understanding of the safety limits of systemic targeted radiotherapy This is probably most true in systemic therapy with MIBG in adult neuroendocrine tumors Bone marrow is the primary critical organ for most targeted systemic radiotherapy second organ involvement may be renal as with MIBG and targeted radiopeptide therapy or pulmonary as with radioimmunotherapy Most therapies have tended toward multiple administrations of subtoxic amounts of radioactivity Therapy with MIBG in pheochromococytoma as well as targeted radiopeptide therapy in medullarythyroid cancer has followed this model Radioimmunotherapy appears very promising a definitive Phase 2 study needs completion All therapy has shown promise in extending disease survival (as compared with historical controls) with few major structural (or biochemical) responses This review will attempt to compliment the excellent existing literature by providing an overall systemic therapeutic approach to this promising endeavorrdquo11

bull Este articulo es realmente interesante ya que plantea una mejora en el tratamiento con radioterapia para pacientes con caacutencer medular de tiroides los estudios que aquiacute presentan demuestran que la mejora del tratamiento se ve reflejada en el aumento de la expectativa de vida de los pacientes tratados con el nuevo meacutetodo frente a los tratados con el meacutetodo tradicional

bull http1bpblogspotcom_nbADpD65WD4SmDX1fuRnVIAAAAAAAAGygbXhKLyxMhAEs320tiroidesjpg

bull ldquoCurrent role of metaiodobenzylguanidine in the diagnosis of pheochromocytoma and medullary thyroid cancer

bull Ilias I Divgi C Pacak Kbull Sourcebull Department of Endocrinology E Venizelou Hospital Athens

Greecebull Abstractbull Despite early reports of excellent diagnostic characteristics of

[(131)I][(123)I]-metaiodobenzylguanidine (MIBG) in the evaluation of pheochromocytomasparagangliomas (PHEOsPGLs) or medullary thyroid cancer as experience with it was accumulated the sensitivity dropped Nevertheless this modality is still useful in the diagnostic work-up of PHEOsPGLs because it is widely available and in case of positive scans it might indicate patients who are potential candidates for [(131)I]MIBG therapy

bull Published by Elsevier Incrdquo12

bull El medicamento que referencia el articulo medico se encuentra ampliamente difundido y es esta la principal ventaja del este faacutermaco Aun faltan bastantes estudios el articulo deja muchos interrogantes

bull ldquoAnn Acad Med Singapore 2011 Jun40(6)300-2

bull Melanocytic variant of medullary thyroidcarcinoma in a previously treated papillarycarcinoma patient

bull Mohamad I Zainuddin N Zawawi N Naik VR

bull Source

bull Department of Otorhinolaryngology - Head amp Neck Surgeryrdquo13

bull Este articulo propone que los melanocitos son una variante significativa de el carcinoma medular de tiroides despueacutes de que esta haya sido exitosamente tratada

bull http4bpblogspotcom_Fnq-_ypIXdgTO6t_bKf53IAAAAAAAAAEgQLDhcalP0hks1600melanocitosjpg

bull ldquoBreast metastasis by medullary thyroid carcinoma detected by FDG positron emission tomography

bull Nofech-Mozes S Mackenzie R Kahn HJ Ehrlich L Raphael SJbull Sourcebull Department of Anatomical Pathology Sunnybrook Health Sciences Center

Toronto ON Canada M4N 3M5bull Abstractbull Medullary thyroid carcinoma (MTC) is an uncommon thyroid cancer

comprising 5 to 8 of thyroid neoplasms In contrast to common thyroid tumors this tumor originates from the calcitonin-producing C cells Regional metastases to cervical lymph nodes occur early in the disease whereas distant metastasis occurs late Common metastatic sites include the liver bone brain and adrenal medulla We present a case of MTC metastatic to the breast We report on this case for the following reasons (1) metastasis to the breast is an extremely rare occurrence and could be easily confused clinically and pathologically with a primary breast neoplasm and (2) this is the first reported case of detection of breast metastasis by an MTC using FDG ((18)F-fluoro-2-deoxy-D-glucose) positron emission tomography with an accompanying histologic descriptionrdquo14

bull El articulo trata el tema de las metaacutestasis de el carcinoma medular de tiroides haciendo especial eacutenfasis en las metaacutestasis a distancias especialmente en mama

bull http4bpblogspotcom_YmCZlFt2utMTOv2n-jvZKIAAAAAAAAABIKqnwuja7pLQs1600CancerMetastasisjpg

bull ldquoCytology of hyalinising trabecular adenoma-like variant of medullarythyroid carcinoma

bull Santosh KV Raychaudhuri S Subramanya H Naveen Kumar BJbull Sourcebull Department of Pathology Vydehi Institute of Medical Sciences and

Research Center Bangalore Indiabull Abstractbull Medullary thyroid carcinoma is a rare thyroid neoplasm that can be

either sporadic or familial It occurs in adults presenting as a solitary cold nodule on thyroid scan Most are solid firm and non-encapsulated and occur in the mid portion or upper half of the thyroid gland corresponding to areas with greater numbers of C cells We present a case of a 36-year-old female with a swelling in the front of her neck for six years Fine needle aspiration done elsewhere revealed spindle cells suggestive of a spindle cell neoplasm The histopathology of the thyroidectomyspecimen showed features of a hyalinizing trabecular adenoma-like variant of medullary carcinoma Subsequently we performed aspiration on the received specimen and studied the cytological findings The cytological diagnosis of this variant requires identification of the dual spindle and ovoid cell population and the granular neuroendocrinechromatinrdquo15

bull Este trabajo investigativo plantea la posibilidad de una variante del carcinoma medular de tiroides en forma de un adenoma hialinizante trabecular Este estudio fue hecho en una mujer de 36 antildeos es necesario hacer estudios en otros pacientes para reafirmar la tesis del articulo

BIBLIOGRAFIacuteA

bull 1) httpbibliotecafucsaludeduco2052bookspagedoeid=4-u10-B978-1-4377-0324-500011-0--s0030ampisbn=978-1-4377-0324-5ampuniqId=270438322-24-u10-B978-1-4377-0324-500011-0--f0015

bull 2)

bull httpwwwnlmnihgovmedlineplusspanishencyarticle000374htm

bull 3)bull Goldman JM Goren EN Cohen MH et al Anaplastic thyroid

carcinoma long-term survival after radical surgery J Surg Oncol 14 (4) 389-94 1980 [PUBMED Abstract]

4)bull Aldinger KA Samaan NA Ibanez M et al Anaplastic carcinoma of

the thyroid a review of 84 cases of spindle and giant cell carcinoma of the thyroid Cancer 41 (6) 2267-75 1978 [PUBMED Abstract]

5)bull Carling T Udelsman R Thyroid tumors In DeVita VT Jr Hellman

S Rosenberg SA eds Cancer Principles and Practice of Oncology Vols 1 amp 2 8th ed Philadelphia Pa Lippincott Williams amp Wilkins 2008 pp 1663-82

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 15: Carcinoma medular de tiroides

SIGNOS Y EXAacuteMENES

bull ldquoEl meacutedico llevaraacute a cabo un examen fiacutesico Los ganglios linfaacuteticos en el cuello pueden presentar hinchazoacuten Las pruebas de la funcioacuten tiroidea generalmente son normales sin embargo un examen de la tiroides puede revelar noacutedulos (tumoraciones) solitarios o muacuteltiples

bull El examen fiacutesico medico es de suma importancia para detectar hiperplasias en estadios tempranos de carcinoma medular de tiroides

bull httpwwwlosmedicamentosnetconsejoswp-contentuploads201104bociojpg

bull Otros exaacutemenes que se pueden utilizar para diagnosticar el carcinoma medular tiroideo pueden ser

bull Examen de sangre para calcitonina

bull Examen de sangre para antiacutegeno carcinoembrionario (ACE)

bull Pruebas geneacuteticas

bull Biopsia de la tiroides

bull Gammagrafiacutea de la tiroides

bull Ecografiacutea de la tiroidesrdquo23httpwwwdoctorweborgstaticimagesbociojpg

OPCIONES DE TRATAMIENTO

bull ldquoCirugiacutea con frecuencia es necesario efectuar una traqueotomiacutea Si la enfermedad estaacute limitada a un aacuterea local lo cual es poco comuacuten se justifica la realizacioacuten de una tiroidectomiacutea total para reducir los siacutentomas que causa la masa tumoralrdquo39

bull httpwwwnlmnihgovmedlineplusspanishencyimagesencyfullsize14066jpg

bull Radioterapia Se puede usar la irradiacioacuten de haz externo en los pacientes que no son idoacuteneos para la cirugiacutea o cuyo tumor no puede extirparse quiruacutergicamente

bull Quimioterapia el caacutencer anaplaacutesico de la tiroides no responde al tratamiento con I131 se observa que el tratamiento con monofaacutermacosanticancerosos produce remisiones parciales en algunos pacientes Aproximadamente 30 de los pacientes logran una remisioacuten parcial con la doxorrubicina La combinacioacuten de doxorrubicina y cisplatino parece ser maacutes activa que la doxorrubicina sola y se ha observado que produce maacutes respuestas completas

bull ldquoTargeted systemic radiotherapy of pheochromocytoma and medullary thyroid cancerbull Divgi Cbull Sourcebull Columbia University New York NYbull Abstractbull Targeted systemic radiotherapy constitutes the systemic administration of a radioactive agent that

targets a molecule expressed preferentially on cancer cells The archetypal such therapy is 131-iodine ((131)I) therapy for differentiated thyroid cancers Radiotherapy typically delivers a calculated radiation-absorbed dose to tumor that takes into account (contiguous) normal tissue Systemic radiotherapy development currently uses schema more analogous to chemotherapy-a radioactivity estimate that does not cause any irreversible toxicity Historically arbitrary amounts of radioactivity shown to be effective on the basis of retrospective review were used for thyroidcancer therapy with (131)I as well as for neuroendocrine tumor therapy with (131)I-labeled meta-iodo-benzylguanidine (MIBG) Their established safety record has led to adaptations that include repeat therapies with nontoxic amounts of radioactivity There remains however a lack of clear understanding of the safety limits of systemic targeted radiotherapy This is probably most true in systemic therapy with MIBG in adult neuroendocrine tumors Bone marrow is the primary critical organ for most targeted systemic radiotherapy second organ involvement may be renal as with MIBG and targeted radiopeptide therapy or pulmonary as with radioimmunotherapy Most therapies have tended toward multiple administrations of subtoxic amounts of radioactivity Therapy with MIBG in pheochromococytoma as well as targeted radiopeptide therapy in medullarythyroid cancer has followed this model Radioimmunotherapy appears very promising a definitive Phase 2 study needs completion All therapy has shown promise in extending disease survival (as compared with historical controls) with few major structural (or biochemical) responses This review will attempt to compliment the excellent existing literature by providing an overall systemic therapeutic approach to this promising endeavorrdquo11

bull Este articulo es realmente interesante ya que plantea una mejora en el tratamiento con radioterapia para pacientes con caacutencer medular de tiroides los estudios que aquiacute presentan demuestran que la mejora del tratamiento se ve reflejada en el aumento de la expectativa de vida de los pacientes tratados con el nuevo meacutetodo frente a los tratados con el meacutetodo tradicional

bull http1bpblogspotcom_nbADpD65WD4SmDX1fuRnVIAAAAAAAAGygbXhKLyxMhAEs320tiroidesjpg

bull ldquoCurrent role of metaiodobenzylguanidine in the diagnosis of pheochromocytoma and medullary thyroid cancer

bull Ilias I Divgi C Pacak Kbull Sourcebull Department of Endocrinology E Venizelou Hospital Athens

Greecebull Abstractbull Despite early reports of excellent diagnostic characteristics of

[(131)I][(123)I]-metaiodobenzylguanidine (MIBG) in the evaluation of pheochromocytomasparagangliomas (PHEOsPGLs) or medullary thyroid cancer as experience with it was accumulated the sensitivity dropped Nevertheless this modality is still useful in the diagnostic work-up of PHEOsPGLs because it is widely available and in case of positive scans it might indicate patients who are potential candidates for [(131)I]MIBG therapy

bull Published by Elsevier Incrdquo12

bull El medicamento que referencia el articulo medico se encuentra ampliamente difundido y es esta la principal ventaja del este faacutermaco Aun faltan bastantes estudios el articulo deja muchos interrogantes

bull ldquoAnn Acad Med Singapore 2011 Jun40(6)300-2

bull Melanocytic variant of medullary thyroidcarcinoma in a previously treated papillarycarcinoma patient

bull Mohamad I Zainuddin N Zawawi N Naik VR

bull Source

bull Department of Otorhinolaryngology - Head amp Neck Surgeryrdquo13

bull Este articulo propone que los melanocitos son una variante significativa de el carcinoma medular de tiroides despueacutes de que esta haya sido exitosamente tratada

bull http4bpblogspotcom_Fnq-_ypIXdgTO6t_bKf53IAAAAAAAAAEgQLDhcalP0hks1600melanocitosjpg

bull ldquoBreast metastasis by medullary thyroid carcinoma detected by FDG positron emission tomography

bull Nofech-Mozes S Mackenzie R Kahn HJ Ehrlich L Raphael SJbull Sourcebull Department of Anatomical Pathology Sunnybrook Health Sciences Center

Toronto ON Canada M4N 3M5bull Abstractbull Medullary thyroid carcinoma (MTC) is an uncommon thyroid cancer

comprising 5 to 8 of thyroid neoplasms In contrast to common thyroid tumors this tumor originates from the calcitonin-producing C cells Regional metastases to cervical lymph nodes occur early in the disease whereas distant metastasis occurs late Common metastatic sites include the liver bone brain and adrenal medulla We present a case of MTC metastatic to the breast We report on this case for the following reasons (1) metastasis to the breast is an extremely rare occurrence and could be easily confused clinically and pathologically with a primary breast neoplasm and (2) this is the first reported case of detection of breast metastasis by an MTC using FDG ((18)F-fluoro-2-deoxy-D-glucose) positron emission tomography with an accompanying histologic descriptionrdquo14

bull El articulo trata el tema de las metaacutestasis de el carcinoma medular de tiroides haciendo especial eacutenfasis en las metaacutestasis a distancias especialmente en mama

bull http4bpblogspotcom_YmCZlFt2utMTOv2n-jvZKIAAAAAAAAABIKqnwuja7pLQs1600CancerMetastasisjpg

bull ldquoCytology of hyalinising trabecular adenoma-like variant of medullarythyroid carcinoma

bull Santosh KV Raychaudhuri S Subramanya H Naveen Kumar BJbull Sourcebull Department of Pathology Vydehi Institute of Medical Sciences and

Research Center Bangalore Indiabull Abstractbull Medullary thyroid carcinoma is a rare thyroid neoplasm that can be

either sporadic or familial It occurs in adults presenting as a solitary cold nodule on thyroid scan Most are solid firm and non-encapsulated and occur in the mid portion or upper half of the thyroid gland corresponding to areas with greater numbers of C cells We present a case of a 36-year-old female with a swelling in the front of her neck for six years Fine needle aspiration done elsewhere revealed spindle cells suggestive of a spindle cell neoplasm The histopathology of the thyroidectomyspecimen showed features of a hyalinizing trabecular adenoma-like variant of medullary carcinoma Subsequently we performed aspiration on the received specimen and studied the cytological findings The cytological diagnosis of this variant requires identification of the dual spindle and ovoid cell population and the granular neuroendocrinechromatinrdquo15

bull Este trabajo investigativo plantea la posibilidad de una variante del carcinoma medular de tiroides en forma de un adenoma hialinizante trabecular Este estudio fue hecho en una mujer de 36 antildeos es necesario hacer estudios en otros pacientes para reafirmar la tesis del articulo

BIBLIOGRAFIacuteA

bull 1) httpbibliotecafucsaludeduco2052bookspagedoeid=4-u10-B978-1-4377-0324-500011-0--s0030ampisbn=978-1-4377-0324-5ampuniqId=270438322-24-u10-B978-1-4377-0324-500011-0--f0015

bull 2)

bull httpwwwnlmnihgovmedlineplusspanishencyarticle000374htm

bull 3)bull Goldman JM Goren EN Cohen MH et al Anaplastic thyroid

carcinoma long-term survival after radical surgery J Surg Oncol 14 (4) 389-94 1980 [PUBMED Abstract]

4)bull Aldinger KA Samaan NA Ibanez M et al Anaplastic carcinoma of

the thyroid a review of 84 cases of spindle and giant cell carcinoma of the thyroid Cancer 41 (6) 2267-75 1978 [PUBMED Abstract]

5)bull Carling T Udelsman R Thyroid tumors In DeVita VT Jr Hellman

S Rosenberg SA eds Cancer Principles and Practice of Oncology Vols 1 amp 2 8th ed Philadelphia Pa Lippincott Williams amp Wilkins 2008 pp 1663-82

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 16: Carcinoma medular de tiroides

bull El examen fiacutesico medico es de suma importancia para detectar hiperplasias en estadios tempranos de carcinoma medular de tiroides

bull httpwwwlosmedicamentosnetconsejoswp-contentuploads201104bociojpg

bull Otros exaacutemenes que se pueden utilizar para diagnosticar el carcinoma medular tiroideo pueden ser

bull Examen de sangre para calcitonina

bull Examen de sangre para antiacutegeno carcinoembrionario (ACE)

bull Pruebas geneacuteticas

bull Biopsia de la tiroides

bull Gammagrafiacutea de la tiroides

bull Ecografiacutea de la tiroidesrdquo23httpwwwdoctorweborgstaticimagesbociojpg

OPCIONES DE TRATAMIENTO

bull ldquoCirugiacutea con frecuencia es necesario efectuar una traqueotomiacutea Si la enfermedad estaacute limitada a un aacuterea local lo cual es poco comuacuten se justifica la realizacioacuten de una tiroidectomiacutea total para reducir los siacutentomas que causa la masa tumoralrdquo39

bull httpwwwnlmnihgovmedlineplusspanishencyimagesencyfullsize14066jpg

bull Radioterapia Se puede usar la irradiacioacuten de haz externo en los pacientes que no son idoacuteneos para la cirugiacutea o cuyo tumor no puede extirparse quiruacutergicamente

bull Quimioterapia el caacutencer anaplaacutesico de la tiroides no responde al tratamiento con I131 se observa que el tratamiento con monofaacutermacosanticancerosos produce remisiones parciales en algunos pacientes Aproximadamente 30 de los pacientes logran una remisioacuten parcial con la doxorrubicina La combinacioacuten de doxorrubicina y cisplatino parece ser maacutes activa que la doxorrubicina sola y se ha observado que produce maacutes respuestas completas

bull ldquoTargeted systemic radiotherapy of pheochromocytoma and medullary thyroid cancerbull Divgi Cbull Sourcebull Columbia University New York NYbull Abstractbull Targeted systemic radiotherapy constitutes the systemic administration of a radioactive agent that

targets a molecule expressed preferentially on cancer cells The archetypal such therapy is 131-iodine ((131)I) therapy for differentiated thyroid cancers Radiotherapy typically delivers a calculated radiation-absorbed dose to tumor that takes into account (contiguous) normal tissue Systemic radiotherapy development currently uses schema more analogous to chemotherapy-a radioactivity estimate that does not cause any irreversible toxicity Historically arbitrary amounts of radioactivity shown to be effective on the basis of retrospective review were used for thyroidcancer therapy with (131)I as well as for neuroendocrine tumor therapy with (131)I-labeled meta-iodo-benzylguanidine (MIBG) Their established safety record has led to adaptations that include repeat therapies with nontoxic amounts of radioactivity There remains however a lack of clear understanding of the safety limits of systemic targeted radiotherapy This is probably most true in systemic therapy with MIBG in adult neuroendocrine tumors Bone marrow is the primary critical organ for most targeted systemic radiotherapy second organ involvement may be renal as with MIBG and targeted radiopeptide therapy or pulmonary as with radioimmunotherapy Most therapies have tended toward multiple administrations of subtoxic amounts of radioactivity Therapy with MIBG in pheochromococytoma as well as targeted radiopeptide therapy in medullarythyroid cancer has followed this model Radioimmunotherapy appears very promising a definitive Phase 2 study needs completion All therapy has shown promise in extending disease survival (as compared with historical controls) with few major structural (or biochemical) responses This review will attempt to compliment the excellent existing literature by providing an overall systemic therapeutic approach to this promising endeavorrdquo11

bull Este articulo es realmente interesante ya que plantea una mejora en el tratamiento con radioterapia para pacientes con caacutencer medular de tiroides los estudios que aquiacute presentan demuestran que la mejora del tratamiento se ve reflejada en el aumento de la expectativa de vida de los pacientes tratados con el nuevo meacutetodo frente a los tratados con el meacutetodo tradicional

bull http1bpblogspotcom_nbADpD65WD4SmDX1fuRnVIAAAAAAAAGygbXhKLyxMhAEs320tiroidesjpg

bull ldquoCurrent role of metaiodobenzylguanidine in the diagnosis of pheochromocytoma and medullary thyroid cancer

bull Ilias I Divgi C Pacak Kbull Sourcebull Department of Endocrinology E Venizelou Hospital Athens

Greecebull Abstractbull Despite early reports of excellent diagnostic characteristics of

[(131)I][(123)I]-metaiodobenzylguanidine (MIBG) in the evaluation of pheochromocytomasparagangliomas (PHEOsPGLs) or medullary thyroid cancer as experience with it was accumulated the sensitivity dropped Nevertheless this modality is still useful in the diagnostic work-up of PHEOsPGLs because it is widely available and in case of positive scans it might indicate patients who are potential candidates for [(131)I]MIBG therapy

bull Published by Elsevier Incrdquo12

bull El medicamento que referencia el articulo medico se encuentra ampliamente difundido y es esta la principal ventaja del este faacutermaco Aun faltan bastantes estudios el articulo deja muchos interrogantes

bull ldquoAnn Acad Med Singapore 2011 Jun40(6)300-2

bull Melanocytic variant of medullary thyroidcarcinoma in a previously treated papillarycarcinoma patient

bull Mohamad I Zainuddin N Zawawi N Naik VR

bull Source

bull Department of Otorhinolaryngology - Head amp Neck Surgeryrdquo13

bull Este articulo propone que los melanocitos son una variante significativa de el carcinoma medular de tiroides despueacutes de que esta haya sido exitosamente tratada

bull http4bpblogspotcom_Fnq-_ypIXdgTO6t_bKf53IAAAAAAAAAEgQLDhcalP0hks1600melanocitosjpg

bull ldquoBreast metastasis by medullary thyroid carcinoma detected by FDG positron emission tomography

bull Nofech-Mozes S Mackenzie R Kahn HJ Ehrlich L Raphael SJbull Sourcebull Department of Anatomical Pathology Sunnybrook Health Sciences Center

Toronto ON Canada M4N 3M5bull Abstractbull Medullary thyroid carcinoma (MTC) is an uncommon thyroid cancer

comprising 5 to 8 of thyroid neoplasms In contrast to common thyroid tumors this tumor originates from the calcitonin-producing C cells Regional metastases to cervical lymph nodes occur early in the disease whereas distant metastasis occurs late Common metastatic sites include the liver bone brain and adrenal medulla We present a case of MTC metastatic to the breast We report on this case for the following reasons (1) metastasis to the breast is an extremely rare occurrence and could be easily confused clinically and pathologically with a primary breast neoplasm and (2) this is the first reported case of detection of breast metastasis by an MTC using FDG ((18)F-fluoro-2-deoxy-D-glucose) positron emission tomography with an accompanying histologic descriptionrdquo14

bull El articulo trata el tema de las metaacutestasis de el carcinoma medular de tiroides haciendo especial eacutenfasis en las metaacutestasis a distancias especialmente en mama

bull http4bpblogspotcom_YmCZlFt2utMTOv2n-jvZKIAAAAAAAAABIKqnwuja7pLQs1600CancerMetastasisjpg

bull ldquoCytology of hyalinising trabecular adenoma-like variant of medullarythyroid carcinoma

bull Santosh KV Raychaudhuri S Subramanya H Naveen Kumar BJbull Sourcebull Department of Pathology Vydehi Institute of Medical Sciences and

Research Center Bangalore Indiabull Abstractbull Medullary thyroid carcinoma is a rare thyroid neoplasm that can be

either sporadic or familial It occurs in adults presenting as a solitary cold nodule on thyroid scan Most are solid firm and non-encapsulated and occur in the mid portion or upper half of the thyroid gland corresponding to areas with greater numbers of C cells We present a case of a 36-year-old female with a swelling in the front of her neck for six years Fine needle aspiration done elsewhere revealed spindle cells suggestive of a spindle cell neoplasm The histopathology of the thyroidectomyspecimen showed features of a hyalinizing trabecular adenoma-like variant of medullary carcinoma Subsequently we performed aspiration on the received specimen and studied the cytological findings The cytological diagnosis of this variant requires identification of the dual spindle and ovoid cell population and the granular neuroendocrinechromatinrdquo15

bull Este trabajo investigativo plantea la posibilidad de una variante del carcinoma medular de tiroides en forma de un adenoma hialinizante trabecular Este estudio fue hecho en una mujer de 36 antildeos es necesario hacer estudios en otros pacientes para reafirmar la tesis del articulo

BIBLIOGRAFIacuteA

bull 1) httpbibliotecafucsaludeduco2052bookspagedoeid=4-u10-B978-1-4377-0324-500011-0--s0030ampisbn=978-1-4377-0324-5ampuniqId=270438322-24-u10-B978-1-4377-0324-500011-0--f0015

bull 2)

bull httpwwwnlmnihgovmedlineplusspanishencyarticle000374htm

bull 3)bull Goldman JM Goren EN Cohen MH et al Anaplastic thyroid

carcinoma long-term survival after radical surgery J Surg Oncol 14 (4) 389-94 1980 [PUBMED Abstract]

4)bull Aldinger KA Samaan NA Ibanez M et al Anaplastic carcinoma of

the thyroid a review of 84 cases of spindle and giant cell carcinoma of the thyroid Cancer 41 (6) 2267-75 1978 [PUBMED Abstract]

5)bull Carling T Udelsman R Thyroid tumors In DeVita VT Jr Hellman

S Rosenberg SA eds Cancer Principles and Practice of Oncology Vols 1 amp 2 8th ed Philadelphia Pa Lippincott Williams amp Wilkins 2008 pp 1663-82

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 17: Carcinoma medular de tiroides

bull Otros exaacutemenes que se pueden utilizar para diagnosticar el carcinoma medular tiroideo pueden ser

bull Examen de sangre para calcitonina

bull Examen de sangre para antiacutegeno carcinoembrionario (ACE)

bull Pruebas geneacuteticas

bull Biopsia de la tiroides

bull Gammagrafiacutea de la tiroides

bull Ecografiacutea de la tiroidesrdquo23httpwwwdoctorweborgstaticimagesbociojpg

OPCIONES DE TRATAMIENTO

bull ldquoCirugiacutea con frecuencia es necesario efectuar una traqueotomiacutea Si la enfermedad estaacute limitada a un aacuterea local lo cual es poco comuacuten se justifica la realizacioacuten de una tiroidectomiacutea total para reducir los siacutentomas que causa la masa tumoralrdquo39

bull httpwwwnlmnihgovmedlineplusspanishencyimagesencyfullsize14066jpg

bull Radioterapia Se puede usar la irradiacioacuten de haz externo en los pacientes que no son idoacuteneos para la cirugiacutea o cuyo tumor no puede extirparse quiruacutergicamente

bull Quimioterapia el caacutencer anaplaacutesico de la tiroides no responde al tratamiento con I131 se observa que el tratamiento con monofaacutermacosanticancerosos produce remisiones parciales en algunos pacientes Aproximadamente 30 de los pacientes logran una remisioacuten parcial con la doxorrubicina La combinacioacuten de doxorrubicina y cisplatino parece ser maacutes activa que la doxorrubicina sola y se ha observado que produce maacutes respuestas completas

bull ldquoTargeted systemic radiotherapy of pheochromocytoma and medullary thyroid cancerbull Divgi Cbull Sourcebull Columbia University New York NYbull Abstractbull Targeted systemic radiotherapy constitutes the systemic administration of a radioactive agent that

targets a molecule expressed preferentially on cancer cells The archetypal such therapy is 131-iodine ((131)I) therapy for differentiated thyroid cancers Radiotherapy typically delivers a calculated radiation-absorbed dose to tumor that takes into account (contiguous) normal tissue Systemic radiotherapy development currently uses schema more analogous to chemotherapy-a radioactivity estimate that does not cause any irreversible toxicity Historically arbitrary amounts of radioactivity shown to be effective on the basis of retrospective review were used for thyroidcancer therapy with (131)I as well as for neuroendocrine tumor therapy with (131)I-labeled meta-iodo-benzylguanidine (MIBG) Their established safety record has led to adaptations that include repeat therapies with nontoxic amounts of radioactivity There remains however a lack of clear understanding of the safety limits of systemic targeted radiotherapy This is probably most true in systemic therapy with MIBG in adult neuroendocrine tumors Bone marrow is the primary critical organ for most targeted systemic radiotherapy second organ involvement may be renal as with MIBG and targeted radiopeptide therapy or pulmonary as with radioimmunotherapy Most therapies have tended toward multiple administrations of subtoxic amounts of radioactivity Therapy with MIBG in pheochromococytoma as well as targeted radiopeptide therapy in medullarythyroid cancer has followed this model Radioimmunotherapy appears very promising a definitive Phase 2 study needs completion All therapy has shown promise in extending disease survival (as compared with historical controls) with few major structural (or biochemical) responses This review will attempt to compliment the excellent existing literature by providing an overall systemic therapeutic approach to this promising endeavorrdquo11

bull Este articulo es realmente interesante ya que plantea una mejora en el tratamiento con radioterapia para pacientes con caacutencer medular de tiroides los estudios que aquiacute presentan demuestran que la mejora del tratamiento se ve reflejada en el aumento de la expectativa de vida de los pacientes tratados con el nuevo meacutetodo frente a los tratados con el meacutetodo tradicional

bull http1bpblogspotcom_nbADpD65WD4SmDX1fuRnVIAAAAAAAAGygbXhKLyxMhAEs320tiroidesjpg

bull ldquoCurrent role of metaiodobenzylguanidine in the diagnosis of pheochromocytoma and medullary thyroid cancer

bull Ilias I Divgi C Pacak Kbull Sourcebull Department of Endocrinology E Venizelou Hospital Athens

Greecebull Abstractbull Despite early reports of excellent diagnostic characteristics of

[(131)I][(123)I]-metaiodobenzylguanidine (MIBG) in the evaluation of pheochromocytomasparagangliomas (PHEOsPGLs) or medullary thyroid cancer as experience with it was accumulated the sensitivity dropped Nevertheless this modality is still useful in the diagnostic work-up of PHEOsPGLs because it is widely available and in case of positive scans it might indicate patients who are potential candidates for [(131)I]MIBG therapy

bull Published by Elsevier Incrdquo12

bull El medicamento que referencia el articulo medico se encuentra ampliamente difundido y es esta la principal ventaja del este faacutermaco Aun faltan bastantes estudios el articulo deja muchos interrogantes

bull ldquoAnn Acad Med Singapore 2011 Jun40(6)300-2

bull Melanocytic variant of medullary thyroidcarcinoma in a previously treated papillarycarcinoma patient

bull Mohamad I Zainuddin N Zawawi N Naik VR

bull Source

bull Department of Otorhinolaryngology - Head amp Neck Surgeryrdquo13

bull Este articulo propone que los melanocitos son una variante significativa de el carcinoma medular de tiroides despueacutes de que esta haya sido exitosamente tratada

bull http4bpblogspotcom_Fnq-_ypIXdgTO6t_bKf53IAAAAAAAAAEgQLDhcalP0hks1600melanocitosjpg

bull ldquoBreast metastasis by medullary thyroid carcinoma detected by FDG positron emission tomography

bull Nofech-Mozes S Mackenzie R Kahn HJ Ehrlich L Raphael SJbull Sourcebull Department of Anatomical Pathology Sunnybrook Health Sciences Center

Toronto ON Canada M4N 3M5bull Abstractbull Medullary thyroid carcinoma (MTC) is an uncommon thyroid cancer

comprising 5 to 8 of thyroid neoplasms In contrast to common thyroid tumors this tumor originates from the calcitonin-producing C cells Regional metastases to cervical lymph nodes occur early in the disease whereas distant metastasis occurs late Common metastatic sites include the liver bone brain and adrenal medulla We present a case of MTC metastatic to the breast We report on this case for the following reasons (1) metastasis to the breast is an extremely rare occurrence and could be easily confused clinically and pathologically with a primary breast neoplasm and (2) this is the first reported case of detection of breast metastasis by an MTC using FDG ((18)F-fluoro-2-deoxy-D-glucose) positron emission tomography with an accompanying histologic descriptionrdquo14

bull El articulo trata el tema de las metaacutestasis de el carcinoma medular de tiroides haciendo especial eacutenfasis en las metaacutestasis a distancias especialmente en mama

bull http4bpblogspotcom_YmCZlFt2utMTOv2n-jvZKIAAAAAAAAABIKqnwuja7pLQs1600CancerMetastasisjpg

bull ldquoCytology of hyalinising trabecular adenoma-like variant of medullarythyroid carcinoma

bull Santosh KV Raychaudhuri S Subramanya H Naveen Kumar BJbull Sourcebull Department of Pathology Vydehi Institute of Medical Sciences and

Research Center Bangalore Indiabull Abstractbull Medullary thyroid carcinoma is a rare thyroid neoplasm that can be

either sporadic or familial It occurs in adults presenting as a solitary cold nodule on thyroid scan Most are solid firm and non-encapsulated and occur in the mid portion or upper half of the thyroid gland corresponding to areas with greater numbers of C cells We present a case of a 36-year-old female with a swelling in the front of her neck for six years Fine needle aspiration done elsewhere revealed spindle cells suggestive of a spindle cell neoplasm The histopathology of the thyroidectomyspecimen showed features of a hyalinizing trabecular adenoma-like variant of medullary carcinoma Subsequently we performed aspiration on the received specimen and studied the cytological findings The cytological diagnosis of this variant requires identification of the dual spindle and ovoid cell population and the granular neuroendocrinechromatinrdquo15

bull Este trabajo investigativo plantea la posibilidad de una variante del carcinoma medular de tiroides en forma de un adenoma hialinizante trabecular Este estudio fue hecho en una mujer de 36 antildeos es necesario hacer estudios en otros pacientes para reafirmar la tesis del articulo

BIBLIOGRAFIacuteA

bull 1) httpbibliotecafucsaludeduco2052bookspagedoeid=4-u10-B978-1-4377-0324-500011-0--s0030ampisbn=978-1-4377-0324-5ampuniqId=270438322-24-u10-B978-1-4377-0324-500011-0--f0015

bull 2)

bull httpwwwnlmnihgovmedlineplusspanishencyarticle000374htm

bull 3)bull Goldman JM Goren EN Cohen MH et al Anaplastic thyroid

carcinoma long-term survival after radical surgery J Surg Oncol 14 (4) 389-94 1980 [PUBMED Abstract]

4)bull Aldinger KA Samaan NA Ibanez M et al Anaplastic carcinoma of

the thyroid a review of 84 cases of spindle and giant cell carcinoma of the thyroid Cancer 41 (6) 2267-75 1978 [PUBMED Abstract]

5)bull Carling T Udelsman R Thyroid tumors In DeVita VT Jr Hellman

S Rosenberg SA eds Cancer Principles and Practice of Oncology Vols 1 amp 2 8th ed Philadelphia Pa Lippincott Williams amp Wilkins 2008 pp 1663-82

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 18: Carcinoma medular de tiroides

OPCIONES DE TRATAMIENTO

bull ldquoCirugiacutea con frecuencia es necesario efectuar una traqueotomiacutea Si la enfermedad estaacute limitada a un aacuterea local lo cual es poco comuacuten se justifica la realizacioacuten de una tiroidectomiacutea total para reducir los siacutentomas que causa la masa tumoralrdquo39

bull httpwwwnlmnihgovmedlineplusspanishencyimagesencyfullsize14066jpg

bull Radioterapia Se puede usar la irradiacioacuten de haz externo en los pacientes que no son idoacuteneos para la cirugiacutea o cuyo tumor no puede extirparse quiruacutergicamente

bull Quimioterapia el caacutencer anaplaacutesico de la tiroides no responde al tratamiento con I131 se observa que el tratamiento con monofaacutermacosanticancerosos produce remisiones parciales en algunos pacientes Aproximadamente 30 de los pacientes logran una remisioacuten parcial con la doxorrubicina La combinacioacuten de doxorrubicina y cisplatino parece ser maacutes activa que la doxorrubicina sola y se ha observado que produce maacutes respuestas completas

bull ldquoTargeted systemic radiotherapy of pheochromocytoma and medullary thyroid cancerbull Divgi Cbull Sourcebull Columbia University New York NYbull Abstractbull Targeted systemic radiotherapy constitutes the systemic administration of a radioactive agent that

targets a molecule expressed preferentially on cancer cells The archetypal such therapy is 131-iodine ((131)I) therapy for differentiated thyroid cancers Radiotherapy typically delivers a calculated radiation-absorbed dose to tumor that takes into account (contiguous) normal tissue Systemic radiotherapy development currently uses schema more analogous to chemotherapy-a radioactivity estimate that does not cause any irreversible toxicity Historically arbitrary amounts of radioactivity shown to be effective on the basis of retrospective review were used for thyroidcancer therapy with (131)I as well as for neuroendocrine tumor therapy with (131)I-labeled meta-iodo-benzylguanidine (MIBG) Their established safety record has led to adaptations that include repeat therapies with nontoxic amounts of radioactivity There remains however a lack of clear understanding of the safety limits of systemic targeted radiotherapy This is probably most true in systemic therapy with MIBG in adult neuroendocrine tumors Bone marrow is the primary critical organ for most targeted systemic radiotherapy second organ involvement may be renal as with MIBG and targeted radiopeptide therapy or pulmonary as with radioimmunotherapy Most therapies have tended toward multiple administrations of subtoxic amounts of radioactivity Therapy with MIBG in pheochromococytoma as well as targeted radiopeptide therapy in medullarythyroid cancer has followed this model Radioimmunotherapy appears very promising a definitive Phase 2 study needs completion All therapy has shown promise in extending disease survival (as compared with historical controls) with few major structural (or biochemical) responses This review will attempt to compliment the excellent existing literature by providing an overall systemic therapeutic approach to this promising endeavorrdquo11

bull Este articulo es realmente interesante ya que plantea una mejora en el tratamiento con radioterapia para pacientes con caacutencer medular de tiroides los estudios que aquiacute presentan demuestran que la mejora del tratamiento se ve reflejada en el aumento de la expectativa de vida de los pacientes tratados con el nuevo meacutetodo frente a los tratados con el meacutetodo tradicional

bull http1bpblogspotcom_nbADpD65WD4SmDX1fuRnVIAAAAAAAAGygbXhKLyxMhAEs320tiroidesjpg

bull ldquoCurrent role of metaiodobenzylguanidine in the diagnosis of pheochromocytoma and medullary thyroid cancer

bull Ilias I Divgi C Pacak Kbull Sourcebull Department of Endocrinology E Venizelou Hospital Athens

Greecebull Abstractbull Despite early reports of excellent diagnostic characteristics of

[(131)I][(123)I]-metaiodobenzylguanidine (MIBG) in the evaluation of pheochromocytomasparagangliomas (PHEOsPGLs) or medullary thyroid cancer as experience with it was accumulated the sensitivity dropped Nevertheless this modality is still useful in the diagnostic work-up of PHEOsPGLs because it is widely available and in case of positive scans it might indicate patients who are potential candidates for [(131)I]MIBG therapy

bull Published by Elsevier Incrdquo12

bull El medicamento que referencia el articulo medico se encuentra ampliamente difundido y es esta la principal ventaja del este faacutermaco Aun faltan bastantes estudios el articulo deja muchos interrogantes

bull ldquoAnn Acad Med Singapore 2011 Jun40(6)300-2

bull Melanocytic variant of medullary thyroidcarcinoma in a previously treated papillarycarcinoma patient

bull Mohamad I Zainuddin N Zawawi N Naik VR

bull Source

bull Department of Otorhinolaryngology - Head amp Neck Surgeryrdquo13

bull Este articulo propone que los melanocitos son una variante significativa de el carcinoma medular de tiroides despueacutes de que esta haya sido exitosamente tratada

bull http4bpblogspotcom_Fnq-_ypIXdgTO6t_bKf53IAAAAAAAAAEgQLDhcalP0hks1600melanocitosjpg

bull ldquoBreast metastasis by medullary thyroid carcinoma detected by FDG positron emission tomography

bull Nofech-Mozes S Mackenzie R Kahn HJ Ehrlich L Raphael SJbull Sourcebull Department of Anatomical Pathology Sunnybrook Health Sciences Center

Toronto ON Canada M4N 3M5bull Abstractbull Medullary thyroid carcinoma (MTC) is an uncommon thyroid cancer

comprising 5 to 8 of thyroid neoplasms In contrast to common thyroid tumors this tumor originates from the calcitonin-producing C cells Regional metastases to cervical lymph nodes occur early in the disease whereas distant metastasis occurs late Common metastatic sites include the liver bone brain and adrenal medulla We present a case of MTC metastatic to the breast We report on this case for the following reasons (1) metastasis to the breast is an extremely rare occurrence and could be easily confused clinically and pathologically with a primary breast neoplasm and (2) this is the first reported case of detection of breast metastasis by an MTC using FDG ((18)F-fluoro-2-deoxy-D-glucose) positron emission tomography with an accompanying histologic descriptionrdquo14

bull El articulo trata el tema de las metaacutestasis de el carcinoma medular de tiroides haciendo especial eacutenfasis en las metaacutestasis a distancias especialmente en mama

bull http4bpblogspotcom_YmCZlFt2utMTOv2n-jvZKIAAAAAAAAABIKqnwuja7pLQs1600CancerMetastasisjpg

bull ldquoCytology of hyalinising trabecular adenoma-like variant of medullarythyroid carcinoma

bull Santosh KV Raychaudhuri S Subramanya H Naveen Kumar BJbull Sourcebull Department of Pathology Vydehi Institute of Medical Sciences and

Research Center Bangalore Indiabull Abstractbull Medullary thyroid carcinoma is a rare thyroid neoplasm that can be

either sporadic or familial It occurs in adults presenting as a solitary cold nodule on thyroid scan Most are solid firm and non-encapsulated and occur in the mid portion or upper half of the thyroid gland corresponding to areas with greater numbers of C cells We present a case of a 36-year-old female with a swelling in the front of her neck for six years Fine needle aspiration done elsewhere revealed spindle cells suggestive of a spindle cell neoplasm The histopathology of the thyroidectomyspecimen showed features of a hyalinizing trabecular adenoma-like variant of medullary carcinoma Subsequently we performed aspiration on the received specimen and studied the cytological findings The cytological diagnosis of this variant requires identification of the dual spindle and ovoid cell population and the granular neuroendocrinechromatinrdquo15

bull Este trabajo investigativo plantea la posibilidad de una variante del carcinoma medular de tiroides en forma de un adenoma hialinizante trabecular Este estudio fue hecho en una mujer de 36 antildeos es necesario hacer estudios en otros pacientes para reafirmar la tesis del articulo

BIBLIOGRAFIacuteA

bull 1) httpbibliotecafucsaludeduco2052bookspagedoeid=4-u10-B978-1-4377-0324-500011-0--s0030ampisbn=978-1-4377-0324-5ampuniqId=270438322-24-u10-B978-1-4377-0324-500011-0--f0015

bull 2)

bull httpwwwnlmnihgovmedlineplusspanishencyarticle000374htm

bull 3)bull Goldman JM Goren EN Cohen MH et al Anaplastic thyroid

carcinoma long-term survival after radical surgery J Surg Oncol 14 (4) 389-94 1980 [PUBMED Abstract]

4)bull Aldinger KA Samaan NA Ibanez M et al Anaplastic carcinoma of

the thyroid a review of 84 cases of spindle and giant cell carcinoma of the thyroid Cancer 41 (6) 2267-75 1978 [PUBMED Abstract]

5)bull Carling T Udelsman R Thyroid tumors In DeVita VT Jr Hellman

S Rosenberg SA eds Cancer Principles and Practice of Oncology Vols 1 amp 2 8th ed Philadelphia Pa Lippincott Williams amp Wilkins 2008 pp 1663-82

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 19: Carcinoma medular de tiroides

bull httpwwwnlmnihgovmedlineplusspanishencyimagesencyfullsize14066jpg

bull Radioterapia Se puede usar la irradiacioacuten de haz externo en los pacientes que no son idoacuteneos para la cirugiacutea o cuyo tumor no puede extirparse quiruacutergicamente

bull Quimioterapia el caacutencer anaplaacutesico de la tiroides no responde al tratamiento con I131 se observa que el tratamiento con monofaacutermacosanticancerosos produce remisiones parciales en algunos pacientes Aproximadamente 30 de los pacientes logran una remisioacuten parcial con la doxorrubicina La combinacioacuten de doxorrubicina y cisplatino parece ser maacutes activa que la doxorrubicina sola y se ha observado que produce maacutes respuestas completas

bull ldquoTargeted systemic radiotherapy of pheochromocytoma and medullary thyroid cancerbull Divgi Cbull Sourcebull Columbia University New York NYbull Abstractbull Targeted systemic radiotherapy constitutes the systemic administration of a radioactive agent that

targets a molecule expressed preferentially on cancer cells The archetypal such therapy is 131-iodine ((131)I) therapy for differentiated thyroid cancers Radiotherapy typically delivers a calculated radiation-absorbed dose to tumor that takes into account (contiguous) normal tissue Systemic radiotherapy development currently uses schema more analogous to chemotherapy-a radioactivity estimate that does not cause any irreversible toxicity Historically arbitrary amounts of radioactivity shown to be effective on the basis of retrospective review were used for thyroidcancer therapy with (131)I as well as for neuroendocrine tumor therapy with (131)I-labeled meta-iodo-benzylguanidine (MIBG) Their established safety record has led to adaptations that include repeat therapies with nontoxic amounts of radioactivity There remains however a lack of clear understanding of the safety limits of systemic targeted radiotherapy This is probably most true in systemic therapy with MIBG in adult neuroendocrine tumors Bone marrow is the primary critical organ for most targeted systemic radiotherapy second organ involvement may be renal as with MIBG and targeted radiopeptide therapy or pulmonary as with radioimmunotherapy Most therapies have tended toward multiple administrations of subtoxic amounts of radioactivity Therapy with MIBG in pheochromococytoma as well as targeted radiopeptide therapy in medullarythyroid cancer has followed this model Radioimmunotherapy appears very promising a definitive Phase 2 study needs completion All therapy has shown promise in extending disease survival (as compared with historical controls) with few major structural (or biochemical) responses This review will attempt to compliment the excellent existing literature by providing an overall systemic therapeutic approach to this promising endeavorrdquo11

bull Este articulo es realmente interesante ya que plantea una mejora en el tratamiento con radioterapia para pacientes con caacutencer medular de tiroides los estudios que aquiacute presentan demuestran que la mejora del tratamiento se ve reflejada en el aumento de la expectativa de vida de los pacientes tratados con el nuevo meacutetodo frente a los tratados con el meacutetodo tradicional

bull http1bpblogspotcom_nbADpD65WD4SmDX1fuRnVIAAAAAAAAGygbXhKLyxMhAEs320tiroidesjpg

bull ldquoCurrent role of metaiodobenzylguanidine in the diagnosis of pheochromocytoma and medullary thyroid cancer

bull Ilias I Divgi C Pacak Kbull Sourcebull Department of Endocrinology E Venizelou Hospital Athens

Greecebull Abstractbull Despite early reports of excellent diagnostic characteristics of

[(131)I][(123)I]-metaiodobenzylguanidine (MIBG) in the evaluation of pheochromocytomasparagangliomas (PHEOsPGLs) or medullary thyroid cancer as experience with it was accumulated the sensitivity dropped Nevertheless this modality is still useful in the diagnostic work-up of PHEOsPGLs because it is widely available and in case of positive scans it might indicate patients who are potential candidates for [(131)I]MIBG therapy

bull Published by Elsevier Incrdquo12

bull El medicamento que referencia el articulo medico se encuentra ampliamente difundido y es esta la principal ventaja del este faacutermaco Aun faltan bastantes estudios el articulo deja muchos interrogantes

bull ldquoAnn Acad Med Singapore 2011 Jun40(6)300-2

bull Melanocytic variant of medullary thyroidcarcinoma in a previously treated papillarycarcinoma patient

bull Mohamad I Zainuddin N Zawawi N Naik VR

bull Source

bull Department of Otorhinolaryngology - Head amp Neck Surgeryrdquo13

bull Este articulo propone que los melanocitos son una variante significativa de el carcinoma medular de tiroides despueacutes de que esta haya sido exitosamente tratada

bull http4bpblogspotcom_Fnq-_ypIXdgTO6t_bKf53IAAAAAAAAAEgQLDhcalP0hks1600melanocitosjpg

bull ldquoBreast metastasis by medullary thyroid carcinoma detected by FDG positron emission tomography

bull Nofech-Mozes S Mackenzie R Kahn HJ Ehrlich L Raphael SJbull Sourcebull Department of Anatomical Pathology Sunnybrook Health Sciences Center

Toronto ON Canada M4N 3M5bull Abstractbull Medullary thyroid carcinoma (MTC) is an uncommon thyroid cancer

comprising 5 to 8 of thyroid neoplasms In contrast to common thyroid tumors this tumor originates from the calcitonin-producing C cells Regional metastases to cervical lymph nodes occur early in the disease whereas distant metastasis occurs late Common metastatic sites include the liver bone brain and adrenal medulla We present a case of MTC metastatic to the breast We report on this case for the following reasons (1) metastasis to the breast is an extremely rare occurrence and could be easily confused clinically and pathologically with a primary breast neoplasm and (2) this is the first reported case of detection of breast metastasis by an MTC using FDG ((18)F-fluoro-2-deoxy-D-glucose) positron emission tomography with an accompanying histologic descriptionrdquo14

bull El articulo trata el tema de las metaacutestasis de el carcinoma medular de tiroides haciendo especial eacutenfasis en las metaacutestasis a distancias especialmente en mama

bull http4bpblogspotcom_YmCZlFt2utMTOv2n-jvZKIAAAAAAAAABIKqnwuja7pLQs1600CancerMetastasisjpg

bull ldquoCytology of hyalinising trabecular adenoma-like variant of medullarythyroid carcinoma

bull Santosh KV Raychaudhuri S Subramanya H Naveen Kumar BJbull Sourcebull Department of Pathology Vydehi Institute of Medical Sciences and

Research Center Bangalore Indiabull Abstractbull Medullary thyroid carcinoma is a rare thyroid neoplasm that can be

either sporadic or familial It occurs in adults presenting as a solitary cold nodule on thyroid scan Most are solid firm and non-encapsulated and occur in the mid portion or upper half of the thyroid gland corresponding to areas with greater numbers of C cells We present a case of a 36-year-old female with a swelling in the front of her neck for six years Fine needle aspiration done elsewhere revealed spindle cells suggestive of a spindle cell neoplasm The histopathology of the thyroidectomyspecimen showed features of a hyalinizing trabecular adenoma-like variant of medullary carcinoma Subsequently we performed aspiration on the received specimen and studied the cytological findings The cytological diagnosis of this variant requires identification of the dual spindle and ovoid cell population and the granular neuroendocrinechromatinrdquo15

bull Este trabajo investigativo plantea la posibilidad de una variante del carcinoma medular de tiroides en forma de un adenoma hialinizante trabecular Este estudio fue hecho en una mujer de 36 antildeos es necesario hacer estudios en otros pacientes para reafirmar la tesis del articulo

BIBLIOGRAFIacuteA

bull 1) httpbibliotecafucsaludeduco2052bookspagedoeid=4-u10-B978-1-4377-0324-500011-0--s0030ampisbn=978-1-4377-0324-5ampuniqId=270438322-24-u10-B978-1-4377-0324-500011-0--f0015

bull 2)

bull httpwwwnlmnihgovmedlineplusspanishencyarticle000374htm

bull 3)bull Goldman JM Goren EN Cohen MH et al Anaplastic thyroid

carcinoma long-term survival after radical surgery J Surg Oncol 14 (4) 389-94 1980 [PUBMED Abstract]

4)bull Aldinger KA Samaan NA Ibanez M et al Anaplastic carcinoma of

the thyroid a review of 84 cases of spindle and giant cell carcinoma of the thyroid Cancer 41 (6) 2267-75 1978 [PUBMED Abstract]

5)bull Carling T Udelsman R Thyroid tumors In DeVita VT Jr Hellman

S Rosenberg SA eds Cancer Principles and Practice of Oncology Vols 1 amp 2 8th ed Philadelphia Pa Lippincott Williams amp Wilkins 2008 pp 1663-82

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 20: Carcinoma medular de tiroides

bull Radioterapia Se puede usar la irradiacioacuten de haz externo en los pacientes que no son idoacuteneos para la cirugiacutea o cuyo tumor no puede extirparse quiruacutergicamente

bull Quimioterapia el caacutencer anaplaacutesico de la tiroides no responde al tratamiento con I131 se observa que el tratamiento con monofaacutermacosanticancerosos produce remisiones parciales en algunos pacientes Aproximadamente 30 de los pacientes logran una remisioacuten parcial con la doxorrubicina La combinacioacuten de doxorrubicina y cisplatino parece ser maacutes activa que la doxorrubicina sola y se ha observado que produce maacutes respuestas completas

bull ldquoTargeted systemic radiotherapy of pheochromocytoma and medullary thyroid cancerbull Divgi Cbull Sourcebull Columbia University New York NYbull Abstractbull Targeted systemic radiotherapy constitutes the systemic administration of a radioactive agent that

targets a molecule expressed preferentially on cancer cells The archetypal such therapy is 131-iodine ((131)I) therapy for differentiated thyroid cancers Radiotherapy typically delivers a calculated radiation-absorbed dose to tumor that takes into account (contiguous) normal tissue Systemic radiotherapy development currently uses schema more analogous to chemotherapy-a radioactivity estimate that does not cause any irreversible toxicity Historically arbitrary amounts of radioactivity shown to be effective on the basis of retrospective review were used for thyroidcancer therapy with (131)I as well as for neuroendocrine tumor therapy with (131)I-labeled meta-iodo-benzylguanidine (MIBG) Their established safety record has led to adaptations that include repeat therapies with nontoxic amounts of radioactivity There remains however a lack of clear understanding of the safety limits of systemic targeted radiotherapy This is probably most true in systemic therapy with MIBG in adult neuroendocrine tumors Bone marrow is the primary critical organ for most targeted systemic radiotherapy second organ involvement may be renal as with MIBG and targeted radiopeptide therapy or pulmonary as with radioimmunotherapy Most therapies have tended toward multiple administrations of subtoxic amounts of radioactivity Therapy with MIBG in pheochromococytoma as well as targeted radiopeptide therapy in medullarythyroid cancer has followed this model Radioimmunotherapy appears very promising a definitive Phase 2 study needs completion All therapy has shown promise in extending disease survival (as compared with historical controls) with few major structural (or biochemical) responses This review will attempt to compliment the excellent existing literature by providing an overall systemic therapeutic approach to this promising endeavorrdquo11

bull Este articulo es realmente interesante ya que plantea una mejora en el tratamiento con radioterapia para pacientes con caacutencer medular de tiroides los estudios que aquiacute presentan demuestran que la mejora del tratamiento se ve reflejada en el aumento de la expectativa de vida de los pacientes tratados con el nuevo meacutetodo frente a los tratados con el meacutetodo tradicional

bull http1bpblogspotcom_nbADpD65WD4SmDX1fuRnVIAAAAAAAAGygbXhKLyxMhAEs320tiroidesjpg

bull ldquoCurrent role of metaiodobenzylguanidine in the diagnosis of pheochromocytoma and medullary thyroid cancer

bull Ilias I Divgi C Pacak Kbull Sourcebull Department of Endocrinology E Venizelou Hospital Athens

Greecebull Abstractbull Despite early reports of excellent diagnostic characteristics of

[(131)I][(123)I]-metaiodobenzylguanidine (MIBG) in the evaluation of pheochromocytomasparagangliomas (PHEOsPGLs) or medullary thyroid cancer as experience with it was accumulated the sensitivity dropped Nevertheless this modality is still useful in the diagnostic work-up of PHEOsPGLs because it is widely available and in case of positive scans it might indicate patients who are potential candidates for [(131)I]MIBG therapy

bull Published by Elsevier Incrdquo12

bull El medicamento que referencia el articulo medico se encuentra ampliamente difundido y es esta la principal ventaja del este faacutermaco Aun faltan bastantes estudios el articulo deja muchos interrogantes

bull ldquoAnn Acad Med Singapore 2011 Jun40(6)300-2

bull Melanocytic variant of medullary thyroidcarcinoma in a previously treated papillarycarcinoma patient

bull Mohamad I Zainuddin N Zawawi N Naik VR

bull Source

bull Department of Otorhinolaryngology - Head amp Neck Surgeryrdquo13

bull Este articulo propone que los melanocitos son una variante significativa de el carcinoma medular de tiroides despueacutes de que esta haya sido exitosamente tratada

bull http4bpblogspotcom_Fnq-_ypIXdgTO6t_bKf53IAAAAAAAAAEgQLDhcalP0hks1600melanocitosjpg

bull ldquoBreast metastasis by medullary thyroid carcinoma detected by FDG positron emission tomography

bull Nofech-Mozes S Mackenzie R Kahn HJ Ehrlich L Raphael SJbull Sourcebull Department of Anatomical Pathology Sunnybrook Health Sciences Center

Toronto ON Canada M4N 3M5bull Abstractbull Medullary thyroid carcinoma (MTC) is an uncommon thyroid cancer

comprising 5 to 8 of thyroid neoplasms In contrast to common thyroid tumors this tumor originates from the calcitonin-producing C cells Regional metastases to cervical lymph nodes occur early in the disease whereas distant metastasis occurs late Common metastatic sites include the liver bone brain and adrenal medulla We present a case of MTC metastatic to the breast We report on this case for the following reasons (1) metastasis to the breast is an extremely rare occurrence and could be easily confused clinically and pathologically with a primary breast neoplasm and (2) this is the first reported case of detection of breast metastasis by an MTC using FDG ((18)F-fluoro-2-deoxy-D-glucose) positron emission tomography with an accompanying histologic descriptionrdquo14

bull El articulo trata el tema de las metaacutestasis de el carcinoma medular de tiroides haciendo especial eacutenfasis en las metaacutestasis a distancias especialmente en mama

bull http4bpblogspotcom_YmCZlFt2utMTOv2n-jvZKIAAAAAAAAABIKqnwuja7pLQs1600CancerMetastasisjpg

bull ldquoCytology of hyalinising trabecular adenoma-like variant of medullarythyroid carcinoma

bull Santosh KV Raychaudhuri S Subramanya H Naveen Kumar BJbull Sourcebull Department of Pathology Vydehi Institute of Medical Sciences and

Research Center Bangalore Indiabull Abstractbull Medullary thyroid carcinoma is a rare thyroid neoplasm that can be

either sporadic or familial It occurs in adults presenting as a solitary cold nodule on thyroid scan Most are solid firm and non-encapsulated and occur in the mid portion or upper half of the thyroid gland corresponding to areas with greater numbers of C cells We present a case of a 36-year-old female with a swelling in the front of her neck for six years Fine needle aspiration done elsewhere revealed spindle cells suggestive of a spindle cell neoplasm The histopathology of the thyroidectomyspecimen showed features of a hyalinizing trabecular adenoma-like variant of medullary carcinoma Subsequently we performed aspiration on the received specimen and studied the cytological findings The cytological diagnosis of this variant requires identification of the dual spindle and ovoid cell population and the granular neuroendocrinechromatinrdquo15

bull Este trabajo investigativo plantea la posibilidad de una variante del carcinoma medular de tiroides en forma de un adenoma hialinizante trabecular Este estudio fue hecho en una mujer de 36 antildeos es necesario hacer estudios en otros pacientes para reafirmar la tesis del articulo

BIBLIOGRAFIacuteA

bull 1) httpbibliotecafucsaludeduco2052bookspagedoeid=4-u10-B978-1-4377-0324-500011-0--s0030ampisbn=978-1-4377-0324-5ampuniqId=270438322-24-u10-B978-1-4377-0324-500011-0--f0015

bull 2)

bull httpwwwnlmnihgovmedlineplusspanishencyarticle000374htm

bull 3)bull Goldman JM Goren EN Cohen MH et al Anaplastic thyroid

carcinoma long-term survival after radical surgery J Surg Oncol 14 (4) 389-94 1980 [PUBMED Abstract]

4)bull Aldinger KA Samaan NA Ibanez M et al Anaplastic carcinoma of

the thyroid a review of 84 cases of spindle and giant cell carcinoma of the thyroid Cancer 41 (6) 2267-75 1978 [PUBMED Abstract]

5)bull Carling T Udelsman R Thyroid tumors In DeVita VT Jr Hellman

S Rosenberg SA eds Cancer Principles and Practice of Oncology Vols 1 amp 2 8th ed Philadelphia Pa Lippincott Williams amp Wilkins 2008 pp 1663-82

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 21: Carcinoma medular de tiroides

bull ldquoTargeted systemic radiotherapy of pheochromocytoma and medullary thyroid cancerbull Divgi Cbull Sourcebull Columbia University New York NYbull Abstractbull Targeted systemic radiotherapy constitutes the systemic administration of a radioactive agent that

targets a molecule expressed preferentially on cancer cells The archetypal such therapy is 131-iodine ((131)I) therapy for differentiated thyroid cancers Radiotherapy typically delivers a calculated radiation-absorbed dose to tumor that takes into account (contiguous) normal tissue Systemic radiotherapy development currently uses schema more analogous to chemotherapy-a radioactivity estimate that does not cause any irreversible toxicity Historically arbitrary amounts of radioactivity shown to be effective on the basis of retrospective review were used for thyroidcancer therapy with (131)I as well as for neuroendocrine tumor therapy with (131)I-labeled meta-iodo-benzylguanidine (MIBG) Their established safety record has led to adaptations that include repeat therapies with nontoxic amounts of radioactivity There remains however a lack of clear understanding of the safety limits of systemic targeted radiotherapy This is probably most true in systemic therapy with MIBG in adult neuroendocrine tumors Bone marrow is the primary critical organ for most targeted systemic radiotherapy second organ involvement may be renal as with MIBG and targeted radiopeptide therapy or pulmonary as with radioimmunotherapy Most therapies have tended toward multiple administrations of subtoxic amounts of radioactivity Therapy with MIBG in pheochromococytoma as well as targeted radiopeptide therapy in medullarythyroid cancer has followed this model Radioimmunotherapy appears very promising a definitive Phase 2 study needs completion All therapy has shown promise in extending disease survival (as compared with historical controls) with few major structural (or biochemical) responses This review will attempt to compliment the excellent existing literature by providing an overall systemic therapeutic approach to this promising endeavorrdquo11

bull Este articulo es realmente interesante ya que plantea una mejora en el tratamiento con radioterapia para pacientes con caacutencer medular de tiroides los estudios que aquiacute presentan demuestran que la mejora del tratamiento se ve reflejada en el aumento de la expectativa de vida de los pacientes tratados con el nuevo meacutetodo frente a los tratados con el meacutetodo tradicional

bull http1bpblogspotcom_nbADpD65WD4SmDX1fuRnVIAAAAAAAAGygbXhKLyxMhAEs320tiroidesjpg

bull ldquoCurrent role of metaiodobenzylguanidine in the diagnosis of pheochromocytoma and medullary thyroid cancer

bull Ilias I Divgi C Pacak Kbull Sourcebull Department of Endocrinology E Venizelou Hospital Athens

Greecebull Abstractbull Despite early reports of excellent diagnostic characteristics of

[(131)I][(123)I]-metaiodobenzylguanidine (MIBG) in the evaluation of pheochromocytomasparagangliomas (PHEOsPGLs) or medullary thyroid cancer as experience with it was accumulated the sensitivity dropped Nevertheless this modality is still useful in the diagnostic work-up of PHEOsPGLs because it is widely available and in case of positive scans it might indicate patients who are potential candidates for [(131)I]MIBG therapy

bull Published by Elsevier Incrdquo12

bull El medicamento que referencia el articulo medico se encuentra ampliamente difundido y es esta la principal ventaja del este faacutermaco Aun faltan bastantes estudios el articulo deja muchos interrogantes

bull ldquoAnn Acad Med Singapore 2011 Jun40(6)300-2

bull Melanocytic variant of medullary thyroidcarcinoma in a previously treated papillarycarcinoma patient

bull Mohamad I Zainuddin N Zawawi N Naik VR

bull Source

bull Department of Otorhinolaryngology - Head amp Neck Surgeryrdquo13

bull Este articulo propone que los melanocitos son una variante significativa de el carcinoma medular de tiroides despueacutes de que esta haya sido exitosamente tratada

bull http4bpblogspotcom_Fnq-_ypIXdgTO6t_bKf53IAAAAAAAAAEgQLDhcalP0hks1600melanocitosjpg

bull ldquoBreast metastasis by medullary thyroid carcinoma detected by FDG positron emission tomography

bull Nofech-Mozes S Mackenzie R Kahn HJ Ehrlich L Raphael SJbull Sourcebull Department of Anatomical Pathology Sunnybrook Health Sciences Center

Toronto ON Canada M4N 3M5bull Abstractbull Medullary thyroid carcinoma (MTC) is an uncommon thyroid cancer

comprising 5 to 8 of thyroid neoplasms In contrast to common thyroid tumors this tumor originates from the calcitonin-producing C cells Regional metastases to cervical lymph nodes occur early in the disease whereas distant metastasis occurs late Common metastatic sites include the liver bone brain and adrenal medulla We present a case of MTC metastatic to the breast We report on this case for the following reasons (1) metastasis to the breast is an extremely rare occurrence and could be easily confused clinically and pathologically with a primary breast neoplasm and (2) this is the first reported case of detection of breast metastasis by an MTC using FDG ((18)F-fluoro-2-deoxy-D-glucose) positron emission tomography with an accompanying histologic descriptionrdquo14

bull El articulo trata el tema de las metaacutestasis de el carcinoma medular de tiroides haciendo especial eacutenfasis en las metaacutestasis a distancias especialmente en mama

bull http4bpblogspotcom_YmCZlFt2utMTOv2n-jvZKIAAAAAAAAABIKqnwuja7pLQs1600CancerMetastasisjpg

bull ldquoCytology of hyalinising trabecular adenoma-like variant of medullarythyroid carcinoma

bull Santosh KV Raychaudhuri S Subramanya H Naveen Kumar BJbull Sourcebull Department of Pathology Vydehi Institute of Medical Sciences and

Research Center Bangalore Indiabull Abstractbull Medullary thyroid carcinoma is a rare thyroid neoplasm that can be

either sporadic or familial It occurs in adults presenting as a solitary cold nodule on thyroid scan Most are solid firm and non-encapsulated and occur in the mid portion or upper half of the thyroid gland corresponding to areas with greater numbers of C cells We present a case of a 36-year-old female with a swelling in the front of her neck for six years Fine needle aspiration done elsewhere revealed spindle cells suggestive of a spindle cell neoplasm The histopathology of the thyroidectomyspecimen showed features of a hyalinizing trabecular adenoma-like variant of medullary carcinoma Subsequently we performed aspiration on the received specimen and studied the cytological findings The cytological diagnosis of this variant requires identification of the dual spindle and ovoid cell population and the granular neuroendocrinechromatinrdquo15

bull Este trabajo investigativo plantea la posibilidad de una variante del carcinoma medular de tiroides en forma de un adenoma hialinizante trabecular Este estudio fue hecho en una mujer de 36 antildeos es necesario hacer estudios en otros pacientes para reafirmar la tesis del articulo

BIBLIOGRAFIacuteA

bull 1) httpbibliotecafucsaludeduco2052bookspagedoeid=4-u10-B978-1-4377-0324-500011-0--s0030ampisbn=978-1-4377-0324-5ampuniqId=270438322-24-u10-B978-1-4377-0324-500011-0--f0015

bull 2)

bull httpwwwnlmnihgovmedlineplusspanishencyarticle000374htm

bull 3)bull Goldman JM Goren EN Cohen MH et al Anaplastic thyroid

carcinoma long-term survival after radical surgery J Surg Oncol 14 (4) 389-94 1980 [PUBMED Abstract]

4)bull Aldinger KA Samaan NA Ibanez M et al Anaplastic carcinoma of

the thyroid a review of 84 cases of spindle and giant cell carcinoma of the thyroid Cancer 41 (6) 2267-75 1978 [PUBMED Abstract]

5)bull Carling T Udelsman R Thyroid tumors In DeVita VT Jr Hellman

S Rosenberg SA eds Cancer Principles and Practice of Oncology Vols 1 amp 2 8th ed Philadelphia Pa Lippincott Williams amp Wilkins 2008 pp 1663-82

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 22: Carcinoma medular de tiroides

bull Este articulo es realmente interesante ya que plantea una mejora en el tratamiento con radioterapia para pacientes con caacutencer medular de tiroides los estudios que aquiacute presentan demuestran que la mejora del tratamiento se ve reflejada en el aumento de la expectativa de vida de los pacientes tratados con el nuevo meacutetodo frente a los tratados con el meacutetodo tradicional

bull http1bpblogspotcom_nbADpD65WD4SmDX1fuRnVIAAAAAAAAGygbXhKLyxMhAEs320tiroidesjpg

bull ldquoCurrent role of metaiodobenzylguanidine in the diagnosis of pheochromocytoma and medullary thyroid cancer

bull Ilias I Divgi C Pacak Kbull Sourcebull Department of Endocrinology E Venizelou Hospital Athens

Greecebull Abstractbull Despite early reports of excellent diagnostic characteristics of

[(131)I][(123)I]-metaiodobenzylguanidine (MIBG) in the evaluation of pheochromocytomasparagangliomas (PHEOsPGLs) or medullary thyroid cancer as experience with it was accumulated the sensitivity dropped Nevertheless this modality is still useful in the diagnostic work-up of PHEOsPGLs because it is widely available and in case of positive scans it might indicate patients who are potential candidates for [(131)I]MIBG therapy

bull Published by Elsevier Incrdquo12

bull El medicamento que referencia el articulo medico se encuentra ampliamente difundido y es esta la principal ventaja del este faacutermaco Aun faltan bastantes estudios el articulo deja muchos interrogantes

bull ldquoAnn Acad Med Singapore 2011 Jun40(6)300-2

bull Melanocytic variant of medullary thyroidcarcinoma in a previously treated papillarycarcinoma patient

bull Mohamad I Zainuddin N Zawawi N Naik VR

bull Source

bull Department of Otorhinolaryngology - Head amp Neck Surgeryrdquo13

bull Este articulo propone que los melanocitos son una variante significativa de el carcinoma medular de tiroides despueacutes de que esta haya sido exitosamente tratada

bull http4bpblogspotcom_Fnq-_ypIXdgTO6t_bKf53IAAAAAAAAAEgQLDhcalP0hks1600melanocitosjpg

bull ldquoBreast metastasis by medullary thyroid carcinoma detected by FDG positron emission tomography

bull Nofech-Mozes S Mackenzie R Kahn HJ Ehrlich L Raphael SJbull Sourcebull Department of Anatomical Pathology Sunnybrook Health Sciences Center

Toronto ON Canada M4N 3M5bull Abstractbull Medullary thyroid carcinoma (MTC) is an uncommon thyroid cancer

comprising 5 to 8 of thyroid neoplasms In contrast to common thyroid tumors this tumor originates from the calcitonin-producing C cells Regional metastases to cervical lymph nodes occur early in the disease whereas distant metastasis occurs late Common metastatic sites include the liver bone brain and adrenal medulla We present a case of MTC metastatic to the breast We report on this case for the following reasons (1) metastasis to the breast is an extremely rare occurrence and could be easily confused clinically and pathologically with a primary breast neoplasm and (2) this is the first reported case of detection of breast metastasis by an MTC using FDG ((18)F-fluoro-2-deoxy-D-glucose) positron emission tomography with an accompanying histologic descriptionrdquo14

bull El articulo trata el tema de las metaacutestasis de el carcinoma medular de tiroides haciendo especial eacutenfasis en las metaacutestasis a distancias especialmente en mama

bull http4bpblogspotcom_YmCZlFt2utMTOv2n-jvZKIAAAAAAAAABIKqnwuja7pLQs1600CancerMetastasisjpg

bull ldquoCytology of hyalinising trabecular adenoma-like variant of medullarythyroid carcinoma

bull Santosh KV Raychaudhuri S Subramanya H Naveen Kumar BJbull Sourcebull Department of Pathology Vydehi Institute of Medical Sciences and

Research Center Bangalore Indiabull Abstractbull Medullary thyroid carcinoma is a rare thyroid neoplasm that can be

either sporadic or familial It occurs in adults presenting as a solitary cold nodule on thyroid scan Most are solid firm and non-encapsulated and occur in the mid portion or upper half of the thyroid gland corresponding to areas with greater numbers of C cells We present a case of a 36-year-old female with a swelling in the front of her neck for six years Fine needle aspiration done elsewhere revealed spindle cells suggestive of a spindle cell neoplasm The histopathology of the thyroidectomyspecimen showed features of a hyalinizing trabecular adenoma-like variant of medullary carcinoma Subsequently we performed aspiration on the received specimen and studied the cytological findings The cytological diagnosis of this variant requires identification of the dual spindle and ovoid cell population and the granular neuroendocrinechromatinrdquo15

bull Este trabajo investigativo plantea la posibilidad de una variante del carcinoma medular de tiroides en forma de un adenoma hialinizante trabecular Este estudio fue hecho en una mujer de 36 antildeos es necesario hacer estudios en otros pacientes para reafirmar la tesis del articulo

BIBLIOGRAFIacuteA

bull 1) httpbibliotecafucsaludeduco2052bookspagedoeid=4-u10-B978-1-4377-0324-500011-0--s0030ampisbn=978-1-4377-0324-5ampuniqId=270438322-24-u10-B978-1-4377-0324-500011-0--f0015

bull 2)

bull httpwwwnlmnihgovmedlineplusspanishencyarticle000374htm

bull 3)bull Goldman JM Goren EN Cohen MH et al Anaplastic thyroid

carcinoma long-term survival after radical surgery J Surg Oncol 14 (4) 389-94 1980 [PUBMED Abstract]

4)bull Aldinger KA Samaan NA Ibanez M et al Anaplastic carcinoma of

the thyroid a review of 84 cases of spindle and giant cell carcinoma of the thyroid Cancer 41 (6) 2267-75 1978 [PUBMED Abstract]

5)bull Carling T Udelsman R Thyroid tumors In DeVita VT Jr Hellman

S Rosenberg SA eds Cancer Principles and Practice of Oncology Vols 1 amp 2 8th ed Philadelphia Pa Lippincott Williams amp Wilkins 2008 pp 1663-82

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 23: Carcinoma medular de tiroides

bull http1bpblogspotcom_nbADpD65WD4SmDX1fuRnVIAAAAAAAAGygbXhKLyxMhAEs320tiroidesjpg

bull ldquoCurrent role of metaiodobenzylguanidine in the diagnosis of pheochromocytoma and medullary thyroid cancer

bull Ilias I Divgi C Pacak Kbull Sourcebull Department of Endocrinology E Venizelou Hospital Athens

Greecebull Abstractbull Despite early reports of excellent diagnostic characteristics of

[(131)I][(123)I]-metaiodobenzylguanidine (MIBG) in the evaluation of pheochromocytomasparagangliomas (PHEOsPGLs) or medullary thyroid cancer as experience with it was accumulated the sensitivity dropped Nevertheless this modality is still useful in the diagnostic work-up of PHEOsPGLs because it is widely available and in case of positive scans it might indicate patients who are potential candidates for [(131)I]MIBG therapy

bull Published by Elsevier Incrdquo12

bull El medicamento que referencia el articulo medico se encuentra ampliamente difundido y es esta la principal ventaja del este faacutermaco Aun faltan bastantes estudios el articulo deja muchos interrogantes

bull ldquoAnn Acad Med Singapore 2011 Jun40(6)300-2

bull Melanocytic variant of medullary thyroidcarcinoma in a previously treated papillarycarcinoma patient

bull Mohamad I Zainuddin N Zawawi N Naik VR

bull Source

bull Department of Otorhinolaryngology - Head amp Neck Surgeryrdquo13

bull Este articulo propone que los melanocitos son una variante significativa de el carcinoma medular de tiroides despueacutes de que esta haya sido exitosamente tratada

bull http4bpblogspotcom_Fnq-_ypIXdgTO6t_bKf53IAAAAAAAAAEgQLDhcalP0hks1600melanocitosjpg

bull ldquoBreast metastasis by medullary thyroid carcinoma detected by FDG positron emission tomography

bull Nofech-Mozes S Mackenzie R Kahn HJ Ehrlich L Raphael SJbull Sourcebull Department of Anatomical Pathology Sunnybrook Health Sciences Center

Toronto ON Canada M4N 3M5bull Abstractbull Medullary thyroid carcinoma (MTC) is an uncommon thyroid cancer

comprising 5 to 8 of thyroid neoplasms In contrast to common thyroid tumors this tumor originates from the calcitonin-producing C cells Regional metastases to cervical lymph nodes occur early in the disease whereas distant metastasis occurs late Common metastatic sites include the liver bone brain and adrenal medulla We present a case of MTC metastatic to the breast We report on this case for the following reasons (1) metastasis to the breast is an extremely rare occurrence and could be easily confused clinically and pathologically with a primary breast neoplasm and (2) this is the first reported case of detection of breast metastasis by an MTC using FDG ((18)F-fluoro-2-deoxy-D-glucose) positron emission tomography with an accompanying histologic descriptionrdquo14

bull El articulo trata el tema de las metaacutestasis de el carcinoma medular de tiroides haciendo especial eacutenfasis en las metaacutestasis a distancias especialmente en mama

bull http4bpblogspotcom_YmCZlFt2utMTOv2n-jvZKIAAAAAAAAABIKqnwuja7pLQs1600CancerMetastasisjpg

bull ldquoCytology of hyalinising trabecular adenoma-like variant of medullarythyroid carcinoma

bull Santosh KV Raychaudhuri S Subramanya H Naveen Kumar BJbull Sourcebull Department of Pathology Vydehi Institute of Medical Sciences and

Research Center Bangalore Indiabull Abstractbull Medullary thyroid carcinoma is a rare thyroid neoplasm that can be

either sporadic or familial It occurs in adults presenting as a solitary cold nodule on thyroid scan Most are solid firm and non-encapsulated and occur in the mid portion or upper half of the thyroid gland corresponding to areas with greater numbers of C cells We present a case of a 36-year-old female with a swelling in the front of her neck for six years Fine needle aspiration done elsewhere revealed spindle cells suggestive of a spindle cell neoplasm The histopathology of the thyroidectomyspecimen showed features of a hyalinizing trabecular adenoma-like variant of medullary carcinoma Subsequently we performed aspiration on the received specimen and studied the cytological findings The cytological diagnosis of this variant requires identification of the dual spindle and ovoid cell population and the granular neuroendocrinechromatinrdquo15

bull Este trabajo investigativo plantea la posibilidad de una variante del carcinoma medular de tiroides en forma de un adenoma hialinizante trabecular Este estudio fue hecho en una mujer de 36 antildeos es necesario hacer estudios en otros pacientes para reafirmar la tesis del articulo

BIBLIOGRAFIacuteA

bull 1) httpbibliotecafucsaludeduco2052bookspagedoeid=4-u10-B978-1-4377-0324-500011-0--s0030ampisbn=978-1-4377-0324-5ampuniqId=270438322-24-u10-B978-1-4377-0324-500011-0--f0015

bull 2)

bull httpwwwnlmnihgovmedlineplusspanishencyarticle000374htm

bull 3)bull Goldman JM Goren EN Cohen MH et al Anaplastic thyroid

carcinoma long-term survival after radical surgery J Surg Oncol 14 (4) 389-94 1980 [PUBMED Abstract]

4)bull Aldinger KA Samaan NA Ibanez M et al Anaplastic carcinoma of

the thyroid a review of 84 cases of spindle and giant cell carcinoma of the thyroid Cancer 41 (6) 2267-75 1978 [PUBMED Abstract]

5)bull Carling T Udelsman R Thyroid tumors In DeVita VT Jr Hellman

S Rosenberg SA eds Cancer Principles and Practice of Oncology Vols 1 amp 2 8th ed Philadelphia Pa Lippincott Williams amp Wilkins 2008 pp 1663-82

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 24: Carcinoma medular de tiroides

bull ldquoCurrent role of metaiodobenzylguanidine in the diagnosis of pheochromocytoma and medullary thyroid cancer

bull Ilias I Divgi C Pacak Kbull Sourcebull Department of Endocrinology E Venizelou Hospital Athens

Greecebull Abstractbull Despite early reports of excellent diagnostic characteristics of

[(131)I][(123)I]-metaiodobenzylguanidine (MIBG) in the evaluation of pheochromocytomasparagangliomas (PHEOsPGLs) or medullary thyroid cancer as experience with it was accumulated the sensitivity dropped Nevertheless this modality is still useful in the diagnostic work-up of PHEOsPGLs because it is widely available and in case of positive scans it might indicate patients who are potential candidates for [(131)I]MIBG therapy

bull Published by Elsevier Incrdquo12

bull El medicamento que referencia el articulo medico se encuentra ampliamente difundido y es esta la principal ventaja del este faacutermaco Aun faltan bastantes estudios el articulo deja muchos interrogantes

bull ldquoAnn Acad Med Singapore 2011 Jun40(6)300-2

bull Melanocytic variant of medullary thyroidcarcinoma in a previously treated papillarycarcinoma patient

bull Mohamad I Zainuddin N Zawawi N Naik VR

bull Source

bull Department of Otorhinolaryngology - Head amp Neck Surgeryrdquo13

bull Este articulo propone que los melanocitos son una variante significativa de el carcinoma medular de tiroides despueacutes de que esta haya sido exitosamente tratada

bull http4bpblogspotcom_Fnq-_ypIXdgTO6t_bKf53IAAAAAAAAAEgQLDhcalP0hks1600melanocitosjpg

bull ldquoBreast metastasis by medullary thyroid carcinoma detected by FDG positron emission tomography

bull Nofech-Mozes S Mackenzie R Kahn HJ Ehrlich L Raphael SJbull Sourcebull Department of Anatomical Pathology Sunnybrook Health Sciences Center

Toronto ON Canada M4N 3M5bull Abstractbull Medullary thyroid carcinoma (MTC) is an uncommon thyroid cancer

comprising 5 to 8 of thyroid neoplasms In contrast to common thyroid tumors this tumor originates from the calcitonin-producing C cells Regional metastases to cervical lymph nodes occur early in the disease whereas distant metastasis occurs late Common metastatic sites include the liver bone brain and adrenal medulla We present a case of MTC metastatic to the breast We report on this case for the following reasons (1) metastasis to the breast is an extremely rare occurrence and could be easily confused clinically and pathologically with a primary breast neoplasm and (2) this is the first reported case of detection of breast metastasis by an MTC using FDG ((18)F-fluoro-2-deoxy-D-glucose) positron emission tomography with an accompanying histologic descriptionrdquo14

bull El articulo trata el tema de las metaacutestasis de el carcinoma medular de tiroides haciendo especial eacutenfasis en las metaacutestasis a distancias especialmente en mama

bull http4bpblogspotcom_YmCZlFt2utMTOv2n-jvZKIAAAAAAAAABIKqnwuja7pLQs1600CancerMetastasisjpg

bull ldquoCytology of hyalinising trabecular adenoma-like variant of medullarythyroid carcinoma

bull Santosh KV Raychaudhuri S Subramanya H Naveen Kumar BJbull Sourcebull Department of Pathology Vydehi Institute of Medical Sciences and

Research Center Bangalore Indiabull Abstractbull Medullary thyroid carcinoma is a rare thyroid neoplasm that can be

either sporadic or familial It occurs in adults presenting as a solitary cold nodule on thyroid scan Most are solid firm and non-encapsulated and occur in the mid portion or upper half of the thyroid gland corresponding to areas with greater numbers of C cells We present a case of a 36-year-old female with a swelling in the front of her neck for six years Fine needle aspiration done elsewhere revealed spindle cells suggestive of a spindle cell neoplasm The histopathology of the thyroidectomyspecimen showed features of a hyalinizing trabecular adenoma-like variant of medullary carcinoma Subsequently we performed aspiration on the received specimen and studied the cytological findings The cytological diagnosis of this variant requires identification of the dual spindle and ovoid cell population and the granular neuroendocrinechromatinrdquo15

bull Este trabajo investigativo plantea la posibilidad de una variante del carcinoma medular de tiroides en forma de un adenoma hialinizante trabecular Este estudio fue hecho en una mujer de 36 antildeos es necesario hacer estudios en otros pacientes para reafirmar la tesis del articulo

BIBLIOGRAFIacuteA

bull 1) httpbibliotecafucsaludeduco2052bookspagedoeid=4-u10-B978-1-4377-0324-500011-0--s0030ampisbn=978-1-4377-0324-5ampuniqId=270438322-24-u10-B978-1-4377-0324-500011-0--f0015

bull 2)

bull httpwwwnlmnihgovmedlineplusspanishencyarticle000374htm

bull 3)bull Goldman JM Goren EN Cohen MH et al Anaplastic thyroid

carcinoma long-term survival after radical surgery J Surg Oncol 14 (4) 389-94 1980 [PUBMED Abstract]

4)bull Aldinger KA Samaan NA Ibanez M et al Anaplastic carcinoma of

the thyroid a review of 84 cases of spindle and giant cell carcinoma of the thyroid Cancer 41 (6) 2267-75 1978 [PUBMED Abstract]

5)bull Carling T Udelsman R Thyroid tumors In DeVita VT Jr Hellman

S Rosenberg SA eds Cancer Principles and Practice of Oncology Vols 1 amp 2 8th ed Philadelphia Pa Lippincott Williams amp Wilkins 2008 pp 1663-82

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 25: Carcinoma medular de tiroides

bull El medicamento que referencia el articulo medico se encuentra ampliamente difundido y es esta la principal ventaja del este faacutermaco Aun faltan bastantes estudios el articulo deja muchos interrogantes

bull ldquoAnn Acad Med Singapore 2011 Jun40(6)300-2

bull Melanocytic variant of medullary thyroidcarcinoma in a previously treated papillarycarcinoma patient

bull Mohamad I Zainuddin N Zawawi N Naik VR

bull Source

bull Department of Otorhinolaryngology - Head amp Neck Surgeryrdquo13

bull Este articulo propone que los melanocitos son una variante significativa de el carcinoma medular de tiroides despueacutes de que esta haya sido exitosamente tratada

bull http4bpblogspotcom_Fnq-_ypIXdgTO6t_bKf53IAAAAAAAAAEgQLDhcalP0hks1600melanocitosjpg

bull ldquoBreast metastasis by medullary thyroid carcinoma detected by FDG positron emission tomography

bull Nofech-Mozes S Mackenzie R Kahn HJ Ehrlich L Raphael SJbull Sourcebull Department of Anatomical Pathology Sunnybrook Health Sciences Center

Toronto ON Canada M4N 3M5bull Abstractbull Medullary thyroid carcinoma (MTC) is an uncommon thyroid cancer

comprising 5 to 8 of thyroid neoplasms In contrast to common thyroid tumors this tumor originates from the calcitonin-producing C cells Regional metastases to cervical lymph nodes occur early in the disease whereas distant metastasis occurs late Common metastatic sites include the liver bone brain and adrenal medulla We present a case of MTC metastatic to the breast We report on this case for the following reasons (1) metastasis to the breast is an extremely rare occurrence and could be easily confused clinically and pathologically with a primary breast neoplasm and (2) this is the first reported case of detection of breast metastasis by an MTC using FDG ((18)F-fluoro-2-deoxy-D-glucose) positron emission tomography with an accompanying histologic descriptionrdquo14

bull El articulo trata el tema de las metaacutestasis de el carcinoma medular de tiroides haciendo especial eacutenfasis en las metaacutestasis a distancias especialmente en mama

bull http4bpblogspotcom_YmCZlFt2utMTOv2n-jvZKIAAAAAAAAABIKqnwuja7pLQs1600CancerMetastasisjpg

bull ldquoCytology of hyalinising trabecular adenoma-like variant of medullarythyroid carcinoma

bull Santosh KV Raychaudhuri S Subramanya H Naveen Kumar BJbull Sourcebull Department of Pathology Vydehi Institute of Medical Sciences and

Research Center Bangalore Indiabull Abstractbull Medullary thyroid carcinoma is a rare thyroid neoplasm that can be

either sporadic or familial It occurs in adults presenting as a solitary cold nodule on thyroid scan Most are solid firm and non-encapsulated and occur in the mid portion or upper half of the thyroid gland corresponding to areas with greater numbers of C cells We present a case of a 36-year-old female with a swelling in the front of her neck for six years Fine needle aspiration done elsewhere revealed spindle cells suggestive of a spindle cell neoplasm The histopathology of the thyroidectomyspecimen showed features of a hyalinizing trabecular adenoma-like variant of medullary carcinoma Subsequently we performed aspiration on the received specimen and studied the cytological findings The cytological diagnosis of this variant requires identification of the dual spindle and ovoid cell population and the granular neuroendocrinechromatinrdquo15

bull Este trabajo investigativo plantea la posibilidad de una variante del carcinoma medular de tiroides en forma de un adenoma hialinizante trabecular Este estudio fue hecho en una mujer de 36 antildeos es necesario hacer estudios en otros pacientes para reafirmar la tesis del articulo

BIBLIOGRAFIacuteA

bull 1) httpbibliotecafucsaludeduco2052bookspagedoeid=4-u10-B978-1-4377-0324-500011-0--s0030ampisbn=978-1-4377-0324-5ampuniqId=270438322-24-u10-B978-1-4377-0324-500011-0--f0015

bull 2)

bull httpwwwnlmnihgovmedlineplusspanishencyarticle000374htm

bull 3)bull Goldman JM Goren EN Cohen MH et al Anaplastic thyroid

carcinoma long-term survival after radical surgery J Surg Oncol 14 (4) 389-94 1980 [PUBMED Abstract]

4)bull Aldinger KA Samaan NA Ibanez M et al Anaplastic carcinoma of

the thyroid a review of 84 cases of spindle and giant cell carcinoma of the thyroid Cancer 41 (6) 2267-75 1978 [PUBMED Abstract]

5)bull Carling T Udelsman R Thyroid tumors In DeVita VT Jr Hellman

S Rosenberg SA eds Cancer Principles and Practice of Oncology Vols 1 amp 2 8th ed Philadelphia Pa Lippincott Williams amp Wilkins 2008 pp 1663-82

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 26: Carcinoma medular de tiroides

bull ldquoAnn Acad Med Singapore 2011 Jun40(6)300-2

bull Melanocytic variant of medullary thyroidcarcinoma in a previously treated papillarycarcinoma patient

bull Mohamad I Zainuddin N Zawawi N Naik VR

bull Source

bull Department of Otorhinolaryngology - Head amp Neck Surgeryrdquo13

bull Este articulo propone que los melanocitos son una variante significativa de el carcinoma medular de tiroides despueacutes de que esta haya sido exitosamente tratada

bull http4bpblogspotcom_Fnq-_ypIXdgTO6t_bKf53IAAAAAAAAAEgQLDhcalP0hks1600melanocitosjpg

bull ldquoBreast metastasis by medullary thyroid carcinoma detected by FDG positron emission tomography

bull Nofech-Mozes S Mackenzie R Kahn HJ Ehrlich L Raphael SJbull Sourcebull Department of Anatomical Pathology Sunnybrook Health Sciences Center

Toronto ON Canada M4N 3M5bull Abstractbull Medullary thyroid carcinoma (MTC) is an uncommon thyroid cancer

comprising 5 to 8 of thyroid neoplasms In contrast to common thyroid tumors this tumor originates from the calcitonin-producing C cells Regional metastases to cervical lymph nodes occur early in the disease whereas distant metastasis occurs late Common metastatic sites include the liver bone brain and adrenal medulla We present a case of MTC metastatic to the breast We report on this case for the following reasons (1) metastasis to the breast is an extremely rare occurrence and could be easily confused clinically and pathologically with a primary breast neoplasm and (2) this is the first reported case of detection of breast metastasis by an MTC using FDG ((18)F-fluoro-2-deoxy-D-glucose) positron emission tomography with an accompanying histologic descriptionrdquo14

bull El articulo trata el tema de las metaacutestasis de el carcinoma medular de tiroides haciendo especial eacutenfasis en las metaacutestasis a distancias especialmente en mama

bull http4bpblogspotcom_YmCZlFt2utMTOv2n-jvZKIAAAAAAAAABIKqnwuja7pLQs1600CancerMetastasisjpg

bull ldquoCytology of hyalinising trabecular adenoma-like variant of medullarythyroid carcinoma

bull Santosh KV Raychaudhuri S Subramanya H Naveen Kumar BJbull Sourcebull Department of Pathology Vydehi Institute of Medical Sciences and

Research Center Bangalore Indiabull Abstractbull Medullary thyroid carcinoma is a rare thyroid neoplasm that can be

either sporadic or familial It occurs in adults presenting as a solitary cold nodule on thyroid scan Most are solid firm and non-encapsulated and occur in the mid portion or upper half of the thyroid gland corresponding to areas with greater numbers of C cells We present a case of a 36-year-old female with a swelling in the front of her neck for six years Fine needle aspiration done elsewhere revealed spindle cells suggestive of a spindle cell neoplasm The histopathology of the thyroidectomyspecimen showed features of a hyalinizing trabecular adenoma-like variant of medullary carcinoma Subsequently we performed aspiration on the received specimen and studied the cytological findings The cytological diagnosis of this variant requires identification of the dual spindle and ovoid cell population and the granular neuroendocrinechromatinrdquo15

bull Este trabajo investigativo plantea la posibilidad de una variante del carcinoma medular de tiroides en forma de un adenoma hialinizante trabecular Este estudio fue hecho en una mujer de 36 antildeos es necesario hacer estudios en otros pacientes para reafirmar la tesis del articulo

BIBLIOGRAFIacuteA

bull 1) httpbibliotecafucsaludeduco2052bookspagedoeid=4-u10-B978-1-4377-0324-500011-0--s0030ampisbn=978-1-4377-0324-5ampuniqId=270438322-24-u10-B978-1-4377-0324-500011-0--f0015

bull 2)

bull httpwwwnlmnihgovmedlineplusspanishencyarticle000374htm

bull 3)bull Goldman JM Goren EN Cohen MH et al Anaplastic thyroid

carcinoma long-term survival after radical surgery J Surg Oncol 14 (4) 389-94 1980 [PUBMED Abstract]

4)bull Aldinger KA Samaan NA Ibanez M et al Anaplastic carcinoma of

the thyroid a review of 84 cases of spindle and giant cell carcinoma of the thyroid Cancer 41 (6) 2267-75 1978 [PUBMED Abstract]

5)bull Carling T Udelsman R Thyroid tumors In DeVita VT Jr Hellman

S Rosenberg SA eds Cancer Principles and Practice of Oncology Vols 1 amp 2 8th ed Philadelphia Pa Lippincott Williams amp Wilkins 2008 pp 1663-82

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 27: Carcinoma medular de tiroides

bull Este articulo propone que los melanocitos son una variante significativa de el carcinoma medular de tiroides despueacutes de que esta haya sido exitosamente tratada

bull http4bpblogspotcom_Fnq-_ypIXdgTO6t_bKf53IAAAAAAAAAEgQLDhcalP0hks1600melanocitosjpg

bull ldquoBreast metastasis by medullary thyroid carcinoma detected by FDG positron emission tomography

bull Nofech-Mozes S Mackenzie R Kahn HJ Ehrlich L Raphael SJbull Sourcebull Department of Anatomical Pathology Sunnybrook Health Sciences Center

Toronto ON Canada M4N 3M5bull Abstractbull Medullary thyroid carcinoma (MTC) is an uncommon thyroid cancer

comprising 5 to 8 of thyroid neoplasms In contrast to common thyroid tumors this tumor originates from the calcitonin-producing C cells Regional metastases to cervical lymph nodes occur early in the disease whereas distant metastasis occurs late Common metastatic sites include the liver bone brain and adrenal medulla We present a case of MTC metastatic to the breast We report on this case for the following reasons (1) metastasis to the breast is an extremely rare occurrence and could be easily confused clinically and pathologically with a primary breast neoplasm and (2) this is the first reported case of detection of breast metastasis by an MTC using FDG ((18)F-fluoro-2-deoxy-D-glucose) positron emission tomography with an accompanying histologic descriptionrdquo14

bull El articulo trata el tema de las metaacutestasis de el carcinoma medular de tiroides haciendo especial eacutenfasis en las metaacutestasis a distancias especialmente en mama

bull http4bpblogspotcom_YmCZlFt2utMTOv2n-jvZKIAAAAAAAAABIKqnwuja7pLQs1600CancerMetastasisjpg

bull ldquoCytology of hyalinising trabecular adenoma-like variant of medullarythyroid carcinoma

bull Santosh KV Raychaudhuri S Subramanya H Naveen Kumar BJbull Sourcebull Department of Pathology Vydehi Institute of Medical Sciences and

Research Center Bangalore Indiabull Abstractbull Medullary thyroid carcinoma is a rare thyroid neoplasm that can be

either sporadic or familial It occurs in adults presenting as a solitary cold nodule on thyroid scan Most are solid firm and non-encapsulated and occur in the mid portion or upper half of the thyroid gland corresponding to areas with greater numbers of C cells We present a case of a 36-year-old female with a swelling in the front of her neck for six years Fine needle aspiration done elsewhere revealed spindle cells suggestive of a spindle cell neoplasm The histopathology of the thyroidectomyspecimen showed features of a hyalinizing trabecular adenoma-like variant of medullary carcinoma Subsequently we performed aspiration on the received specimen and studied the cytological findings The cytological diagnosis of this variant requires identification of the dual spindle and ovoid cell population and the granular neuroendocrinechromatinrdquo15

bull Este trabajo investigativo plantea la posibilidad de una variante del carcinoma medular de tiroides en forma de un adenoma hialinizante trabecular Este estudio fue hecho en una mujer de 36 antildeos es necesario hacer estudios en otros pacientes para reafirmar la tesis del articulo

BIBLIOGRAFIacuteA

bull 1) httpbibliotecafucsaludeduco2052bookspagedoeid=4-u10-B978-1-4377-0324-500011-0--s0030ampisbn=978-1-4377-0324-5ampuniqId=270438322-24-u10-B978-1-4377-0324-500011-0--f0015

bull 2)

bull httpwwwnlmnihgovmedlineplusspanishencyarticle000374htm

bull 3)bull Goldman JM Goren EN Cohen MH et al Anaplastic thyroid

carcinoma long-term survival after radical surgery J Surg Oncol 14 (4) 389-94 1980 [PUBMED Abstract]

4)bull Aldinger KA Samaan NA Ibanez M et al Anaplastic carcinoma of

the thyroid a review of 84 cases of spindle and giant cell carcinoma of the thyroid Cancer 41 (6) 2267-75 1978 [PUBMED Abstract]

5)bull Carling T Udelsman R Thyroid tumors In DeVita VT Jr Hellman

S Rosenberg SA eds Cancer Principles and Practice of Oncology Vols 1 amp 2 8th ed Philadelphia Pa Lippincott Williams amp Wilkins 2008 pp 1663-82

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 28: Carcinoma medular de tiroides

bull ldquoBreast metastasis by medullary thyroid carcinoma detected by FDG positron emission tomography

bull Nofech-Mozes S Mackenzie R Kahn HJ Ehrlich L Raphael SJbull Sourcebull Department of Anatomical Pathology Sunnybrook Health Sciences Center

Toronto ON Canada M4N 3M5bull Abstractbull Medullary thyroid carcinoma (MTC) is an uncommon thyroid cancer

comprising 5 to 8 of thyroid neoplasms In contrast to common thyroid tumors this tumor originates from the calcitonin-producing C cells Regional metastases to cervical lymph nodes occur early in the disease whereas distant metastasis occurs late Common metastatic sites include the liver bone brain and adrenal medulla We present a case of MTC metastatic to the breast We report on this case for the following reasons (1) metastasis to the breast is an extremely rare occurrence and could be easily confused clinically and pathologically with a primary breast neoplasm and (2) this is the first reported case of detection of breast metastasis by an MTC using FDG ((18)F-fluoro-2-deoxy-D-glucose) positron emission tomography with an accompanying histologic descriptionrdquo14

bull El articulo trata el tema de las metaacutestasis de el carcinoma medular de tiroides haciendo especial eacutenfasis en las metaacutestasis a distancias especialmente en mama

bull http4bpblogspotcom_YmCZlFt2utMTOv2n-jvZKIAAAAAAAAABIKqnwuja7pLQs1600CancerMetastasisjpg

bull ldquoCytology of hyalinising trabecular adenoma-like variant of medullarythyroid carcinoma

bull Santosh KV Raychaudhuri S Subramanya H Naveen Kumar BJbull Sourcebull Department of Pathology Vydehi Institute of Medical Sciences and

Research Center Bangalore Indiabull Abstractbull Medullary thyroid carcinoma is a rare thyroid neoplasm that can be

either sporadic or familial It occurs in adults presenting as a solitary cold nodule on thyroid scan Most are solid firm and non-encapsulated and occur in the mid portion or upper half of the thyroid gland corresponding to areas with greater numbers of C cells We present a case of a 36-year-old female with a swelling in the front of her neck for six years Fine needle aspiration done elsewhere revealed spindle cells suggestive of a spindle cell neoplasm The histopathology of the thyroidectomyspecimen showed features of a hyalinizing trabecular adenoma-like variant of medullary carcinoma Subsequently we performed aspiration on the received specimen and studied the cytological findings The cytological diagnosis of this variant requires identification of the dual spindle and ovoid cell population and the granular neuroendocrinechromatinrdquo15

bull Este trabajo investigativo plantea la posibilidad de una variante del carcinoma medular de tiroides en forma de un adenoma hialinizante trabecular Este estudio fue hecho en una mujer de 36 antildeos es necesario hacer estudios en otros pacientes para reafirmar la tesis del articulo

BIBLIOGRAFIacuteA

bull 1) httpbibliotecafucsaludeduco2052bookspagedoeid=4-u10-B978-1-4377-0324-500011-0--s0030ampisbn=978-1-4377-0324-5ampuniqId=270438322-24-u10-B978-1-4377-0324-500011-0--f0015

bull 2)

bull httpwwwnlmnihgovmedlineplusspanishencyarticle000374htm

bull 3)bull Goldman JM Goren EN Cohen MH et al Anaplastic thyroid

carcinoma long-term survival after radical surgery J Surg Oncol 14 (4) 389-94 1980 [PUBMED Abstract]

4)bull Aldinger KA Samaan NA Ibanez M et al Anaplastic carcinoma of

the thyroid a review of 84 cases of spindle and giant cell carcinoma of the thyroid Cancer 41 (6) 2267-75 1978 [PUBMED Abstract]

5)bull Carling T Udelsman R Thyroid tumors In DeVita VT Jr Hellman

S Rosenberg SA eds Cancer Principles and Practice of Oncology Vols 1 amp 2 8th ed Philadelphia Pa Lippincott Williams amp Wilkins 2008 pp 1663-82

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 29: Carcinoma medular de tiroides

bull El articulo trata el tema de las metaacutestasis de el carcinoma medular de tiroides haciendo especial eacutenfasis en las metaacutestasis a distancias especialmente en mama

bull http4bpblogspotcom_YmCZlFt2utMTOv2n-jvZKIAAAAAAAAABIKqnwuja7pLQs1600CancerMetastasisjpg

bull ldquoCytology of hyalinising trabecular adenoma-like variant of medullarythyroid carcinoma

bull Santosh KV Raychaudhuri S Subramanya H Naveen Kumar BJbull Sourcebull Department of Pathology Vydehi Institute of Medical Sciences and

Research Center Bangalore Indiabull Abstractbull Medullary thyroid carcinoma is a rare thyroid neoplasm that can be

either sporadic or familial It occurs in adults presenting as a solitary cold nodule on thyroid scan Most are solid firm and non-encapsulated and occur in the mid portion or upper half of the thyroid gland corresponding to areas with greater numbers of C cells We present a case of a 36-year-old female with a swelling in the front of her neck for six years Fine needle aspiration done elsewhere revealed spindle cells suggestive of a spindle cell neoplasm The histopathology of the thyroidectomyspecimen showed features of a hyalinizing trabecular adenoma-like variant of medullary carcinoma Subsequently we performed aspiration on the received specimen and studied the cytological findings The cytological diagnosis of this variant requires identification of the dual spindle and ovoid cell population and the granular neuroendocrinechromatinrdquo15

bull Este trabajo investigativo plantea la posibilidad de una variante del carcinoma medular de tiroides en forma de un adenoma hialinizante trabecular Este estudio fue hecho en una mujer de 36 antildeos es necesario hacer estudios en otros pacientes para reafirmar la tesis del articulo

BIBLIOGRAFIacuteA

bull 1) httpbibliotecafucsaludeduco2052bookspagedoeid=4-u10-B978-1-4377-0324-500011-0--s0030ampisbn=978-1-4377-0324-5ampuniqId=270438322-24-u10-B978-1-4377-0324-500011-0--f0015

bull 2)

bull httpwwwnlmnihgovmedlineplusspanishencyarticle000374htm

bull 3)bull Goldman JM Goren EN Cohen MH et al Anaplastic thyroid

carcinoma long-term survival after radical surgery J Surg Oncol 14 (4) 389-94 1980 [PUBMED Abstract]

4)bull Aldinger KA Samaan NA Ibanez M et al Anaplastic carcinoma of

the thyroid a review of 84 cases of spindle and giant cell carcinoma of the thyroid Cancer 41 (6) 2267-75 1978 [PUBMED Abstract]

5)bull Carling T Udelsman R Thyroid tumors In DeVita VT Jr Hellman

S Rosenberg SA eds Cancer Principles and Practice of Oncology Vols 1 amp 2 8th ed Philadelphia Pa Lippincott Williams amp Wilkins 2008 pp 1663-82

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 30: Carcinoma medular de tiroides

bull ldquoCytology of hyalinising trabecular adenoma-like variant of medullarythyroid carcinoma

bull Santosh KV Raychaudhuri S Subramanya H Naveen Kumar BJbull Sourcebull Department of Pathology Vydehi Institute of Medical Sciences and

Research Center Bangalore Indiabull Abstractbull Medullary thyroid carcinoma is a rare thyroid neoplasm that can be

either sporadic or familial It occurs in adults presenting as a solitary cold nodule on thyroid scan Most are solid firm and non-encapsulated and occur in the mid portion or upper half of the thyroid gland corresponding to areas with greater numbers of C cells We present a case of a 36-year-old female with a swelling in the front of her neck for six years Fine needle aspiration done elsewhere revealed spindle cells suggestive of a spindle cell neoplasm The histopathology of the thyroidectomyspecimen showed features of a hyalinizing trabecular adenoma-like variant of medullary carcinoma Subsequently we performed aspiration on the received specimen and studied the cytological findings The cytological diagnosis of this variant requires identification of the dual spindle and ovoid cell population and the granular neuroendocrinechromatinrdquo15

bull Este trabajo investigativo plantea la posibilidad de una variante del carcinoma medular de tiroides en forma de un adenoma hialinizante trabecular Este estudio fue hecho en una mujer de 36 antildeos es necesario hacer estudios en otros pacientes para reafirmar la tesis del articulo

BIBLIOGRAFIacuteA

bull 1) httpbibliotecafucsaludeduco2052bookspagedoeid=4-u10-B978-1-4377-0324-500011-0--s0030ampisbn=978-1-4377-0324-5ampuniqId=270438322-24-u10-B978-1-4377-0324-500011-0--f0015

bull 2)

bull httpwwwnlmnihgovmedlineplusspanishencyarticle000374htm

bull 3)bull Goldman JM Goren EN Cohen MH et al Anaplastic thyroid

carcinoma long-term survival after radical surgery J Surg Oncol 14 (4) 389-94 1980 [PUBMED Abstract]

4)bull Aldinger KA Samaan NA Ibanez M et al Anaplastic carcinoma of

the thyroid a review of 84 cases of spindle and giant cell carcinoma of the thyroid Cancer 41 (6) 2267-75 1978 [PUBMED Abstract]

5)bull Carling T Udelsman R Thyroid tumors In DeVita VT Jr Hellman

S Rosenberg SA eds Cancer Principles and Practice of Oncology Vols 1 amp 2 8th ed Philadelphia Pa Lippincott Williams amp Wilkins 2008 pp 1663-82

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 31: Carcinoma medular de tiroides

bull Este trabajo investigativo plantea la posibilidad de una variante del carcinoma medular de tiroides en forma de un adenoma hialinizante trabecular Este estudio fue hecho en una mujer de 36 antildeos es necesario hacer estudios en otros pacientes para reafirmar la tesis del articulo

BIBLIOGRAFIacuteA

bull 1) httpbibliotecafucsaludeduco2052bookspagedoeid=4-u10-B978-1-4377-0324-500011-0--s0030ampisbn=978-1-4377-0324-5ampuniqId=270438322-24-u10-B978-1-4377-0324-500011-0--f0015

bull 2)

bull httpwwwnlmnihgovmedlineplusspanishencyarticle000374htm

bull 3)bull Goldman JM Goren EN Cohen MH et al Anaplastic thyroid

carcinoma long-term survival after radical surgery J Surg Oncol 14 (4) 389-94 1980 [PUBMED Abstract]

4)bull Aldinger KA Samaan NA Ibanez M et al Anaplastic carcinoma of

the thyroid a review of 84 cases of spindle and giant cell carcinoma of the thyroid Cancer 41 (6) 2267-75 1978 [PUBMED Abstract]

5)bull Carling T Udelsman R Thyroid tumors In DeVita VT Jr Hellman

S Rosenberg SA eds Cancer Principles and Practice of Oncology Vols 1 amp 2 8th ed Philadelphia Pa Lippincott Williams amp Wilkins 2008 pp 1663-82

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 32: Carcinoma medular de tiroides

BIBLIOGRAFIacuteA

bull 1) httpbibliotecafucsaludeduco2052bookspagedoeid=4-u10-B978-1-4377-0324-500011-0--s0030ampisbn=978-1-4377-0324-5ampuniqId=270438322-24-u10-B978-1-4377-0324-500011-0--f0015

bull 2)

bull httpwwwnlmnihgovmedlineplusspanishencyarticle000374htm

bull 3)bull Goldman JM Goren EN Cohen MH et al Anaplastic thyroid

carcinoma long-term survival after radical surgery J Surg Oncol 14 (4) 389-94 1980 [PUBMED Abstract]

4)bull Aldinger KA Samaan NA Ibanez M et al Anaplastic carcinoma of

the thyroid a review of 84 cases of spindle and giant cell carcinoma of the thyroid Cancer 41 (6) 2267-75 1978 [PUBMED Abstract]

5)bull Carling T Udelsman R Thyroid tumors In DeVita VT Jr Hellman

S Rosenberg SA eds Cancer Principles and Practice of Oncology Vols 1 amp 2 8th ed Philadelphia Pa Lippincott Williams amp Wilkins 2008 pp 1663-82

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 33: Carcinoma medular de tiroides

bull 3)bull Goldman JM Goren EN Cohen MH et al Anaplastic thyroid

carcinoma long-term survival after radical surgery J Surg Oncol 14 (4) 389-94 1980 [PUBMED Abstract]

4)bull Aldinger KA Samaan NA Ibanez M et al Anaplastic carcinoma of

the thyroid a review of 84 cases of spindle and giant cell carcinoma of the thyroid Cancer 41 (6) 2267-75 1978 [PUBMED Abstract]

5)bull Carling T Udelsman R Thyroid tumors In DeVita VT Jr Hellman

S Rosenberg SA eds Cancer Principles and Practice of Oncology Vols 1 amp 2 8th ed Philadelphia Pa Lippincott Williams amp Wilkins 2008 pp 1663-82

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 34: Carcinoma medular de tiroides

bull 6)bull Shimaoka K Schoenfeld DA DeWys WD et al A randomized trial of

doxorubicin versus doxorubicin plus cisplatin in patients withadvanced thyroid carcinoma Cancer 56 (9) 2155-60 1985 [PUBMED Abstract]

7)bull Haigh PI Ituarte PH Wu HS et al Completely resected anaplastic

thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival Cancer 91 (12) 2335-42 2001 [PUBMED Abstract]

8)bull De Crevoisier R Baudin E Bachelot A et al Combined treatment of

anaplastic thyroid carcinoma with surgery chemotherapy and hyperfractionated accelerated external radiotherapy Int J RadiatOncol Biol Phys 60 (4) 1137-43 2004 [PUBMED Abstract]

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 35: Carcinoma medular de tiroides

bull 9) httpwwwcancergovespanolpdqtratamientotiroidesHealthProfessionalpage8

bull 10)

bull httpbibliotecafucsaludeduco2079dynameddetailvid=10amphid=110ampsid=4895cac3-c780-4f0c-9aeb-db9349e23b9340sessionmgr104ampbdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU3ddb=dmeampAN=113756ampanchor=Prevention-and-Screening

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 36: Carcinoma medular de tiroides

bull 11)

bull httpwwwncbinlmnihgovpubmed21803187

bull 12)

bull httpwwwncbinlmnihgovpubmed21803186

bull 13)

bull httpwwwncbinlmnihgovpubmed21779621

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710

Page 37: Carcinoma medular de tiroides

bull 14)

bull httpwwwncbinlmnihgovpubmed18164420

bull 15)

bull httpwwwncbinlmnihgovpubmed21768710