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H Dralle

Publications and source records attributed to H Dralle.

At least 73 records · Page 4Linked to original sources

Mutation analysis of NTRK2 and NTRK3, encoding 2 tyrosine kinase receptors, in sporadic human medullary thyroid carcinoma reveals novel sequence variants.

Somatic mutations in the proto-oncogene RET are found in 25% to 80% of sporadic medullary thyroid carcinomas (MTCs). The significance of somatic RET mutation in MTC initiation and progression, however, remains unknown. Like RET, TRK is a neurotrophic receptor tyrosine kinase. Immunostaining has shown that only a subset of normal C cells expresses Trk family receptors, but in C-cell hyperplasia, they consistently express NTRK2, with variable expression of NTRK1 and NTRK3. In later stages of MTC, NTRK2 expression was reduced while NTRK3 expression was increased. In the context of these data, we sought to determine whether sequence variants in NTRK2 and NTRK3 are responsible for these differences in protein expression. We determined the genomic structure of NTRK2 and found that it consists of at least 17 exons varying in size from 36 to 306 bp. Mutation analysis of sporadic MTC did not reveal any sequence variants in NTRK2 but did reveal 3 variants in NTRK3, c.573C >T (N191N, exon 5), c.678T > C (N226N, exon 6) and c.1488C > G (A496A, exon 12) occurring among 19 chromosomes (31%), 1 chromosome (2%) and 24 chromosomes (39%), respectively. Corresponding germline also harbored these variants. There was a trend toward excess association of the NTRK3 variant c.1488C > G (A496A) in cases (24/62 chromosomes, 39%) compared to controls (18/62, 29%), but this difference did not reach significance (p > 0.05). The remaining 2 NTRK3 variants occurred with similar frequencies between MTC cases and population-matched controls (19 vs. 17 and 1 vs. 0, p > 0.05). We conclude that sequence variants in NTRK2 and NTRK3 are not likely to be responsible for large differences in expression at the protein level, but we cannot exclude very low penetrance effects.

Carcinoma, Medullary↗

Multivariate analysis of clinicopathologic parameters for the insular subtype of differentiated thyroid carcinoma.

HYPOTHESIS: Insular carcinoma represents a more aggressive subtype of differentiated thyroid cancer on multivariate analysis after controlling for various clinicopathologic parameters. DESIGN: Retrospective analysis. SETTING: Tertiary referral center at a university hospital. PATIENTS: One hundred twenty-seven consecutive patients having a histological diagnosis of the follicular variant of papillary thyroid carcinoma or follicular thyroid carcinoma. MAIN OUTCOME MEASURE: A logistic regression model was used to examine the relationship between various clinicopathologic parameters and the insular subtype. RESULTS: The insular subtype involved 14 of 127 tumors. Unlike extrathyroidal extension and nodal metastasis, primary tumor diameter (> 40 mm vs < or = 40 mm; P = .008) and distant metastasis (P = .003) correlated with the insular subtype. Both parameters were interrelated since tumors greater than 40 mm displayed distant metastasis more often (30% vs 8%; P = .008) than tumors measuring 40 mm or less. CONCLUSIONS: These findings suggest that an unidentified somatic event may induce an accelerated proliferation of the transformed thyrocytes, which may ultimately result in enhanced rates of distant metastasis with increasing tumor volume.

Adult↗

Mycotic aneurysm of common carotid artery induced by Staphylococcus aureus infection after cervical reoperation.

The objective of this study was to define a novel type of mycotic aneurysm of the carotid artery arising after cervical reoperation. We retrospectively analyzed all staphylococcal mycotic aneurysms of the common carotid artery. These aneurysms had developed after reoperative thyroid or parathyroid surgery, including resection of the central lymph node compartment and cervical reexploration. Mycotic aneurysms were found in three patients, with an incidence of 0.77% (2/261) and 0.62% (1/161) for thyroid and parathyroid reoperations, respectively. Postoperatively, a lymphatic fistula and cervical hematoma emerged in all patients, as did cervical wound infections on days 3, 4, and 6. Deep wound infections were noted on surgical revision. Cultures grew exclusively Staphylococcus aureus, which was resistant to methicillin (MRSA) in one patient. Mycotic aneurysms were identified 1 week after cervical reoperation. One aneurysm was discovered incidentally on planned lavage. The other two aneurysms presented as severe arterial hemorrhages, resulting in exsanguination in one patient. The other two patients had their aneurysms replaced by saphenous venous autografts. There seems to be accelerated arterial media destruction with formation of mycotic aneurysms in staphylococcal wound infections after cervical reoperation. It is important to recognize this novel type of mycotic aneurysm, as it must be repaired immediately to anticipate imminent rupture.

Adult↗

[Multi-modality therapy concept in metastatic follicular thyroid carcinoma with hyperthyroidism].

The coincidence of hyperthyroidism and thyroid carcinoma seldom occurs. Only few reports on functionally metastases of thyroid carcinoma have been published. We report a 59-year-old man who underwent subtotal thyroidectomy for toxic nodular goiter. Histological examination revealed a follicular thyroid carcinoma. After thyroidectomy and cervical lymphadenectomy the patient developed a strong hyperthyreosis. Scintigraphy showed strong radioiodine uptake in the sacrum. De-bulking resection of the metastasis followed by high-dose radioiodine treatment was performed. After radioiodine therapy the patient became euthyroid. Treatment of hyperthyreosis in metastatic thyroid cancer requires a multimodal therapeutic concept.

Adenocarcinoma, Follicular↗

Minimally invasive video-assisted parathyroidectomy: multiinstitutional study.

Unilateral and minimally invasive parathyroidectomies with endoscopic and video-assisted technique have been introduced. Most of these procedures utilize preoperative localization and intraoperative monitoring of parathyroid hormone. There are only a few reports on these procedures. The objective of this study was to evaluate video-assisted parathyroidectomy (MIVAP) for surgery in patients with primary hyperparathyroidism (pHPT). From February 1997 to June 1999 a series of 123 consecutive patients with pHPT at four surgical centers were evaluated. The patients' ages ranged from 18 to 77 years (median 50 years). Preoperatively, sestamibi scintigraphy and ultrasonography for localization were performed for all patients. Selection criteria for a MIVAP procedure excluded patients with negative localization, suspicion of multiglandular disease (MGD) or thyroid malignancy, a large thyroid mass, and prior surgery or irradiation to the neck. MIVAP was performed with a 1.5 cm suprasternal incision; the operation was then done through this incision with a 30 degree 5 mm endoscope and microsurgical instruments with brief CO2 insufflation for adenoma identification. We then proceeded with an open technique through the small incision under video-assistance. Intraoperative monitoring of intact parathyroid hormone (iPTH) assays was used in all patients. Among the 123 patients in whom MIVAP was attempted, the procedure was accomplished in 109 (89%). Conversion to conventional cervicotomy was required in 14 (11%) patients because of failed localization, failure of the iPTH level to fall appropriately, or technical problems. There was no persistent or recurrent HPT during the 3 to 12-month follow-up. Oral calcium replacement for symptomatic hypocalcemia postoperatively was given in 7 (6%) cases. A unilateral transient laryngeal nerve palsy, resolving within 6 months postoperatively, occurred in two (2%) patients. The median hospital stay was 1.5 days (range 0.5-5.0 days). This study showed the feasibility of MIVAP as an alternative surgical treatment for pHPT in a selected group of patients. Further studies are necessary to evaluate the efficacy and rationale of MIVAP compared to other techniques for parathyroidectomy in pHPT patients.

Adenoma↗

Importance of early screening and prophylactic thyroidectomy in asymptomatic nonindex RET germline carriers.

Genetic testing for RET germline mutations affords rapid identification of germline carriers, offering the prospect of cure before C-cell hyperplasia (CCH) has progressed to medullary thyroid carcinoma (MTC). Although nonindex RET mutation carriers have a better prognosis than do the index patients, it remains to be ascertained whether age represents a risk factor for MTC when screening patients. The current institutional study (October 1994 through June 1999) was set up to compare asymptomatic nonindex patients who were grouped by age: < 20 years and > or = 20 years. Inclusion criteria were confirmed RET mutations in the germline, with no MTC being more advanced than pT1pN1M0. Adult patients (> or = 20 years) had MTC significantly more often (84% vs. 43%), significantly larger tumors (5 mm vs. 3 mm), and significantly higher basal calcitonin levels preoperatively (78.0 vs. 9.7 pg/ml) than their pediatric/adolescent counterparts (< 20 years). There was a close correlation between pT1 MTC and an elevated basal serum calcitonin level (r = 0.67; Spearman's rho). All three patients with lymph node metastases from MTC had elevated basal calcitonin levels. The two groups did not differ in terms of multifocality of MTC (pT1b), lymph node involvement (pN1) or bilateral lymph node metastasis (pN1b), or preoperative stimulated and postoperative basal and stimulated serum calcitonin. Prophylactic thyroidectomy should not be postponed beyond the age of 20, and it should be performed before basal serum calcitonin has turned positive. Pathologic conversion of stimulated serum calcitonin obviously marks the time in carriers of RET germline mutations when surgery should be scheduled at the latest to be prophylactic.

Adolescent↗

["Physiological" and "neoplastic" C-cell hyperplasia of the thyroid. Morphologically and biologically distinct entities?].

C-cell hyperplasia (CCH) occurs regularly in the setting of type 2 multiple endocrine neoplasia (MEN2), either separately or in association with medullary thyroid carcinoma (MTC). It can also accompany sporadic MTC and appear without any tumour association. To test the practicability of the terms "physiologic" and "neoplastic", 18 cases with incidental sporadic, non-MTC associated CCH were investigated and the morphological patterns were described. We found CCH of various degrees, including so-called neoplastic CCH. In 16 of the 18 cases, a MEN2 setting could be ruled out by mutation analysis of the RET proto-oncogene. Morphologically, one can not distinguish with certainty between sporadic and hereditary or reactive and tumour-associated CCH. While MEN2-associated CCH can be regarded as true preneoplasia, sporadic CCH possesses variable biologic potential. The preneoplastic potential of sporadic CCH is still obscure. A pure morphological distinction between "physiologic" and "neoplastic" CCH regardless of the RET status should not be used.

Adult↗

Surgery on the cervicovisceral axis for invasive thyroid cancer.

BACKGROUND AND AIMS: Invasion of the cervicovisceral axis (i.e., larynx trachea esophagus) by thyroid cancers still poses a surgical challenge. PATIENTS AND METHODS: Between November 1994 and October 1999, all patients who underwent surgery at this institution for differentiated (DTC) or medullary (MTC) thyroid carcinoma invading the cervicovisceral axis were recruited into this study. RESULTS: The cervicovisceral axis was invaded in 34 consecutive patients (19 DTC, 15 MTC). Of these, 20 patients underwent cervicovisceral resections. These resections were performed less often in MTC than in DTC patients (20% versus 89%; P<0.0001). Full-thickness invasion was present in 3 patients (2 DTC, 1 MTC). In the 20 resectional patients, tracheal wedge resection was the most common procedure followed by extramucosal esophageal resection. Surgical mortality was nil. There were five major complications, most of which occurred in either lateral tracheal or high-risk combined laryngo-tracheo-esophageal resections. CONCLUSION: The surgical approach to invasive thyroid carcinoma must balance surgical morbidity against the potential benefits of cervicovisceral resection. Individual factors must be considered, such as patient age and co-morbidity, the extent and nature of the tumor, and quality-of-life issues. Lateral resection of the trachea may cause significant tracheal instability and morbidity and, thus, be inferior to segmental tracheal resection.

Carcinoma, Medullary↗

Diagnosis and therapy of sporadic and familial medullary thyroid carcinoma.

Medullary thyroid carcinoma (MTC) is a rare thyroid malignancy. About 75% are sporadic (sMTC) while the remaining 25% are hereditary (hMTC). The treatment of choice for both sMTC and hMTC is surgery. An adequate initial operation provides the best chance of cure. Hence, the diagnosis of MTC should be made preoperatively. In sMTC, ultrasound, ultrasound-guided fine-needle aspiration cytology and measurement of calcitonin levels (basal and after injection of calcitonin-stimulating reagents, e.g., pentagastrin) are sensitive diagnostic tools. In hMTC, identification of a germline mutation in the proto-oncogene RET is sufficient for making the diagnosis. Total thyroidectomy is recommended in all patients, sporadic and hereditary. In addition, lymphadenectomy of the cervicocentral and both cervicolateral compartments should be performed. The only indication to perform a less extensive operation may be given in young patients with hMTC. Sufficient treatment of MTC beyond local disease is still non-existent. Future research should concentrate on this issue.

Adolescent↗

Limits of peritoneal cytokine measurements during abdominal lavage treatment for intraabdominal sepsis.

BACKGROUND: Monitoring of peritoneal cytokine concentrations of tumor necrosis factor (TNF)-alpha was recommended for early detection of severe postoperative complications. In the present study the clinical application of cytokine monitoring was examined in the treatment course of severe peritonitis. METHODS: Nineteen patients with secondary peritonitis were followed up during 75 abdominal lavages. Serum and peritoneal interleukin (IL)-6, IL-8, and IL-10 and TNF-alpha were measured before the surgical intervention, after 1 hour, 3 hours, 6 hours, and 24 hours. Additionally, cardiorespiratory parameters, osmolarity, C-reactive protein, and total leucocyte count were recorded. RESULTS: Serum and peritoneal cytokine concentrations did not correlate to each other as well as to the observed cardiorespiratory parameters. Peritoneal cytokine concentrations were 10- to 1000-fold higher to serum concentrations and showed an intermittent wash out. There were no differences in determined cytokine concentrations between survivors and nonsurvivors. CONCLUSIONS: Once elevated, peritoneal cytokine measurements offer no new diagnostic or prognostic tool in abdominal lavage peritonitis treatment.

Ascitic Fluid↗

[Conjunctival neuromas and prominent corneal nerve fibers as diagnostic indication of multiple endocrine disease].

BACKGROUND: Multiple endocrine neoplasias (MEN-syndromes) represent diverse, mostly autosomal-dominant inherited, seldom sporadic diseases. MEN 2B-syndrome comprises medullary thyroid carcinoma, pheochromocytoma and mucosal neuromas. PATIENT: A 30 year old male patient presented with bilateral chronic irritation of the ocular surface. The biomicroscopy revealed intraconjunctival worm-like alterations, prominent corneal nerves and nodules on the upper lid margins. HISTOLOGY: The performed conjunctival biopsy showed nearly no goblet cells, but prominent intrastromal, immunohistochemical S100-positive neuromas. RESULTS: The initiated investigations revealed bilateral multifocal medullary thyroid carcinoma and a left sited pheochromocytoma. CONCLUSION: Conjunctival neuromas and prominent corneal nerves can be diagnostic for the MEN 2B-syndrom. Early diagnosis and prophylactic thyroidectomy are expected to improve the life expectancy even in asymptomatic gene-carriers.

Adult↗

[Quality assurance study of benign and malignant goiter. Prospective multicenter data collection regarding 7,617 patients].

A quality control study was undertaken on 7,265 patients with benign goitre and 352 patients with malignant goitre who were surgically treated between 1.1.98 and 31.12.98. 3 hospital groups were defined according to surgical workload: Group 1: < 50 operations/yr; Group 2: 50-150 operations/yr; Group 3: > 150 operations/yr. The temporary rate of recurrent laryngeal nerve (RLN) palsies for benign goitre was 3.9% and the permanent 1.1%. For malignant goitre the rates were 12.8% and 6.8% respectively. The rate of temporary (p < 0.040) and permanent (0.003) palsies after surgery for benign goitre was lower in group 3 compared to group 1 and 2. There were too few cases for statistical analysis of the malignant goitres. After benign goitre surgery a transient hypocalcaemia rate of 6.3% and a permanent of 1.1% were observed. For malignant goitre the incidence was 23.8% and 7.1%, respectively. A significantly increased rate of permanent hypocalcaemia (p < 0.003) was demonstrated in group 3 after surgery for multinodular goitre. Centres in group 3 made more extended (smaller thyroid remnants) resections (p < 0.01) with the equivalent rate of general complications. The average inpatient stay for malignant goitres was 13.1 days and for benign goitres 8.7 days. On average, patients with bilateral resections for benign goitre stayed 0.4 days longer in hospital than those with unilateral procedures. Prophylactic antibiotics were administered to 2.1% of patients and 94.6% received thrombosis prophylaxis.

Adult↗

Thyroid carcinoma invading the cervicovisceral axis: routes of invasion and clinical implications.

BACKGROUND: Controversy exists about the routes of invasion (extrathyroidal versus lymphogenic extension) when differentiated carcinoma (DTC) and medullary thyroid carcinoma (MTC) invade the cervicovisceral axis (ie, larynx, trachea, esophagus). METHODS: We carried out an institutional analysis, from November 1994 to October 1999, of 451 consecutive patients undergoing surgery for DTC and MTC. RESULTS: Irrespective of tumor entity, carcinomas with cervicovisceral invasion (n = 34) were significantly larger and displayed higher pT categories (mainly pT4) than noninvasive carcinomas. In invasive papillary thyroid carcinoma (PTC) and MTC, the rates of positive lymph nodes were significantly higher than in noninvasive controls. When separate logistic regression analyses were fitted for laryngeal, tracheal, and esophageal invasion, extrathyroidal growth (pT4) consistently was a significant factor predictive of invasion in both DTC and MTC, with relative risks of 10.9 to 67.8. As the routes of invasion are similar in DTC and MTC, all data were pooled for multivariate analyses. Herein, the pN1 category had a significant impact only on esophageal invasion, with a relative risk of 4.7. CONCLUSIONS: Invasion of the cervicovisceral axis is more often caused by extrathyroidal growth than by nodal metastasis. To keep nodal metastasis from encroaching onto the cervicovisceral axis, paratracheal and paraesophageal lymph nodes should be cleared from the cervicocentral compartment at the primary operation.

Carcinoma, Medullary↗

Extended surgery and early postoperative radiotherapy for undifferentiated thyroid carcinoma.

The current study was devised to evaluate the therapeutic potential of extended surgery for improving survival in undifferentiated thyroid carcinoma (UTC). An institutional retrospective survival analysis (July 1994 to December 1998) of 30 patients who underwent surgery for UTC with locally curative intent was done. Median and 1-year survival was 4 months and 37%, respectively. Primary patients were older (70 vs. 59 years; p = 0.026) and deceased earlier (median survival 4 vs. 20 months; p = 0.027, log-rank test) than their reoperative counterparts, suggesting a referral bias toward younger patients. Survival analysis was restricted to primary pT4 UTC, leaving 18 patients. On univariate analysis, pN and M category, degree of resection (R2 versus R0/1 and radiotherapy (0-30 Gy versus >30 Gy) were identified as parameters suitable for further testing. On multivariate analysis, pN1 was a significant prognosticator of decreased survival (RR = 5.9; p = 0.043), followed by R2 (RR = 4.1, p = 0.088) and M1 (RR = 3.6; p = 0.089). Because of low patient numbers after stratification for radiotherapy, only pN and degree of resection were analyzed on subsequent multivariate analysis. In the incomplete radiotherapy stratum, neither of the two parameters affected survival, whereas R2 and pN1 limited survival in the complete radiotherapy stratum. In primary pT4 UTC, a subset of pN0 patients with R0/1 resections and radiotherapy greater than 30 Gy seemed to benefit from extended surgery. Because pN1 and R2 patients with radiotherapy of 30 Gy or less comprised most UTC patients, only 1-year, but not median, survival improved compared to literature controls.

Aged↗

Prophylactic completion thyroidectomy for differentiated thyroid carcinoma: prediction of extrathyroidal soft tissue infiltrates.

Controversy exists on the extent of completion surgery for differentiated thyroid carcinoma (DTC). Between November 1994 and October 1999, 88 consecutive DTC patients who had no evidence of residual tumor after primary surgery underwent completion total thyroidectomy in conjunction with a systematic en bloc resection of the cervicocentral lymph node compartment. To identify individual parameters predictive of occult residual tumor, three separate logistic regression analyses were fitted for intrathyroidal tumor, extrathyroidal soft tissue infiltrate and cervicocentral nodal metastasis. Altogether, occult residual tumor was found in 22% (19/88) of patients. Occult intrathyroidal tumor, extrathyroidal soft tissue infiltrate, and cervicocentral nodal metastasis were encountered in 11%, (10/88), 6% (5/88), and 10% (9/88), respectively. On logistic regression analysis, patients with multifocal DTC on primary surgery had a 17.4 times higher risk (p = 0.026) on reoperation to harbor extrathyroidal soft tissue infiltrates within the cervicocentral compartment. At least in multifocal DTC, a systematic en bloc resection of the thyroid remnant and cervicocentral lymph node compartment is warranted to ensure clearance of occult extrathyroidal soft tissue infiltrates, setting the stage for radioiodine therapy. Selective lymph node dissection alone does not seem capable of eliminating these soft tissue infiltrates from the cervicocentral compartment.

Humans↗

Genotype-phenotype correlations in hereditary medullary thyroid carcinoma: oncological features and biochemical properties.

In hereditary medullary thyroid carcinoma (MTC), few genotype-phenotype correlations have been established. RET genotypes (exons 10, 11, 13, and 14) of 63 patients with hereditary MTC (from November 1994 to October 1999) were correlated with age at diagnosis, sex, the TNM system, and basal calcitonin levels. Mutations in exons 10, 11, 13, and 14 were demonstrated in 22% (14 of 63), 54% (34 of 63), 21% (13 of 63), and 3% (2 of 63). The median ages at diagnosis differed significantly (38, 27, 52, and 62 yr; P = 0.003). When grouped by cysteine codons (exons 10 and 11 vs. exons 13 and 14), this difference became even more evident (30 vs. 56 yr; P = 0.001). Apart from age at diagnosis, no other significant associations were noted. Based hereon, three MTC risk groups were devised according to genotype: a high risk group (codons 634 and 618) with the youngest ages of 3 and 7 yr at diagnosis; an intermediate risk group (codons 790, 620, and 611) with ages of 12, 34, and 42 yr; and a low risk group (codons 768 and 804) with ages of 47 and 60 yr, respectively. Age at diagnosis was unrelated to specific nucleotide and amino acid exchange within each codon. The current data demonstrate that there is a significant genotype-phenotype correlation, allowing for a more individualized approach to the timing and extent of prophylactic surgery.

Adolescent↗

Somatic mutation and germline variants of MINPP1, a phosphatase gene located in proximity to PTEN on 10q23.3, in follicular thyroid carcinomas.

Various genes have been identified to play a role in the pathogenesis of follicular thyroid tumors. Cowden syndrome is the only known familial syndrome with an increased risk of both follicular thyroid adenoma (FA) and carcinoma (FTC). Germline mutations in the tumor suppressor gene PTEN, which encodes a dual-specificity phosphatase, have been found in up to 80% of patients with Cowden syndrome suggesting a role of PTEN in the pathogenesis of follicular thyroid tumors. Although somatic intragenic mutations in PTEN, which maps to 10q23.3, are rarely found in follicular tumors, loss of heterozygosity (LOH) of markers within 10q22-24 occurs in about 25%. Recently, another phosphatase gene, MINPP1, has been localized to 10q23.3. MINPP1 has the ability to remove 3-phosphate from inositol phosphate substrates, a function that overlaps that of PTEN. Because of this overlapping function with PTEN and the physical location of MINPP1 to a region with frequent LOH in follicular thyroid tumors, we considered it to be an excellent candidate gene that could contribute to the pathogenesis of follicular thyroid tumors. We analyzed DNA from tumor and corresponding normal tissue from 23 patients with FA and 15 patients with FTC for LOH and mutations at the MINPP1 locus. LOH was identified in four malignant and three benign tumors. One of these FTCs with LOH was found to harbor a somatic c.122C > T or S41L mutation. We also found two germline sequence variants, c.809A > G (Q270R) and IVS3 + 34T > A. The c.809A > G variant was found in only one patient with FA but not in patients with FTC or normal controls. More interestingly, IVS3 + 34T > A was found in about 15% of FA cases and normal controls but not in patients with FTC. These results suggest a role for MINPP1 in the pathogenesis of at least a subset of malignant follicular thyroid tumors, and MINPP1 might act as a low penetrance predisposition allele for FTC.

Adenoma↗