As important drugs for the treatment of nodular goiter(NG),Prunella Spica preparations are widely used clinically,and have a significant effect on NG.Various active ingredients in the preparations intervene in the for...As important drugs for the treatment of nodular goiter(NG),Prunella Spica preparations are widely used clinically,and have a significant effect on NG.Various active ingredients in the preparations intervene in the formation of NG by inhibiting the proliferation of thyroid follicular cells,promoting cell apoptosis,regulating immunity,improving the microcirculation of thyroid tissue and other mechanisms,and can reduce the postoperative recurrence of NG.展开更多
Background: Schwannoma is a benign tumor derived from Schwann cells. The most common location was cerebellopontine angle (CPA). Neurilemmoma originated from the thyroid gland is very rare. Purpose: To discuss the diag...Background: Schwannoma is a benign tumor derived from Schwann cells. The most common location was cerebellopontine angle (CPA). Neurilemmoma originated from the thyroid gland is very rare. Purpose: To discuss the diagnosis and treatment of cervical vagal schwannoma and the causes of misdiagnosis and preventive measures. Case Presentation: A case of cervical vagal schwannoma misdiagnosed as nodular goiter by ultrasonography was analyzed retrospectively. This patient was found to have pain in the neck for 1 month and then went to our hospital for treatment. After admission, a 5 cm × 4 cm mass was found on the left side of the neck, with a medium texture and clear margin. It could move with swallowing. Initially ultrasound showed a well circumscribed hypoechoic mass in the left thyroid lobe, which is suggestive of hemorrhage of thyroid nodule. Biopsy of thyroid nodules after ultrasound guided biopsy revealed Schwannoma. Surgical treatment and postoperative pathological examination confirmed cervical vagal schwannoma. The patient recovered well and was discharged 9 days after operation. Conclusion: The location of thyroid schwannoma is rare, the relationship between thyroid schwannoma and surrounding tissues is unclear, and there is no typical ultrasonic manifestation. Moreover, if doctors are not aware of their knowledge, it is easy to cause misdiagnosis. Radiologists should raise awareness of the disease and carefully analyze the results of ultrasonography in combination with the clinical manifestations of the patients so as to reduce or avoid misdiagnosis of cervical schwannoma.展开更多
Objective:To investigate the Computed Tomography(CT)features of papillary thyroid carcinoma and nodular goiter.Methods:Ninety patients were enrolled in this study.All patients were treated with thyroid disease admitte...Objective:To investigate the Computed Tomography(CT)features of papillary thyroid carcinoma and nodular goiter.Methods:Ninety patients were enrolled in this study.All patients were treated with thyroid disease admitted to our hospital from January 2016 to December 2018.Among them,sixty patients with thyroid papillary carcinoma and thirty patients with nodular goiter were examined by CT scan and enhanced examination.Results:There was no statistically significant difference in the volume index of left lobe,right lobe and isthmus in thyroid patients(P>0.05).There were significant statistical differences in the growth site,morphology,border,density,calcification and enhancement mode of nodules(P<0.05).Conclusion:CT examination has significant diagnostic value in the differential diagnosis of papillary thyroid carcinoma and nodular thyroid.展开更多
BACKGROUND Elderly giant retrosternal thyroid goiter is a rare yet significant medical condition,often presenting clinical symptoms that can be confused with other diseases,posing diagnostic and therapeutic challenges...BACKGROUND Elderly giant retrosternal thyroid goiter is a rare yet significant medical condition,often presenting clinical symptoms that can be confused with other diseases,posing diagnostic and therapeutic challenges.This study aims to delve into the characteristics and potential mechanisms of this ailment through pathological diagnosis and immunohistochemical analysis,providing clinicians with more precise diagnostic and treatment strategies.A 77-year-old male,was admitted to hospital with the chief complaint of finding a goiter in the semilunar month during physical examination,accompanied by dyspnea.Locally protruding into the superior mediastinum,the adjacent structure was compressed,the trachea was compressed to the right,and the local lumen was slightly narrowed.The patient was diagnosed with giant retrosternal goiter.Considering dyspnea caused by trachea compression,our department planned to perform giant retrosternal thyroidectomy.Immunohistochemical results:Tg(+),TTF-1(+),Calcitonin(CT)(I),Ki-67(+,about 20%),CD34(-).Retrosternal goiter means that more than 50%of the volume of the thyroid gland is below the upper margin of the sternum.As retrosternal goiter disease is a relatively rare disease,once the disease is diagnosed,it should be timely surgical treatment,and the treatment is more difficult,the need for professional medical team for comprehensive treatment.CONCLUSION The imaging manifestations of giant retrosternal goiter are atypical,histomorphology and immunohistochemistry can assist in its diagnosis.This article reviews the relevant literature of giant retrosternal goiter immunohisto-chemistry and shows that giant retrosternal goiter is positive for Tg,TTF-1,and Ki-67.展开更多
BACKGROUND Lithium carbonate is used to manage various mood disorders,but it can cause thyroid abnormalities,including goiter,hypothyroidism,and hyperthyroidism.In rare cases,it can lead to giant goiter and subclinica...BACKGROUND Lithium carbonate is used to manage various mood disorders,but it can cause thyroid abnormalities,including goiter,hypothyroidism,and hyperthyroidism.In rare cases,it can lead to giant goiter and subclinical hyperthyroidism,which may require surgical intervention in severe cases.CASE SUMMARY This case represents a rare development of giant goiter and subclinical hyperthyroidism in a schizophrenia patient who was subjected to prolonged lithium carbonate treatment.The enlarged thyroid gland caused pressure on the airway and recurrent laryngeal nerve,which led to respiratory distress,hoarseness,and dysphagia.The immediate danger of suffocation required urgent surgical intervention.In this report,we describe the case of a 41-year-old Chinese woman.This sheds light on the etiology and challenges associated with managing a giant goiter.The patient underwent a subtotal thyroidectomy to relieve airway compression and facilitate airway expansion.Prior to the procedure,the patient was given iodine to prepare.Concurrently,changes were made to the psychiatric medication regimen.Following surgery,the patient's respiratory function and vocal cord functionality improved significantly,and her mental state remained stable.CONCLUSION It is essential to monitor thyroid function,test thyroid antibody levels,and perform thyroid ultrasounds consistently in all patients undergoing long-term lithium carbonate treatment.This vigilance helps prevent severe and potentially life-threatening thyroid enlargement.展开更多
In this editorial,we comment on an article by Ruan et al published in a recent issue of the World Journal of Clinical Case.Pulmonary meningothelial proliferative lesions,including primary pulmonary meningiomas,minute ...In this editorial,we comment on an article by Ruan et al published in a recent issue of the World Journal of Clinical Case.Pulmonary meningothelial proliferative lesions,including primary pulmonary meningiomas,minute pulmonary meningothelial-like nodules,and metastatic pulmonary meningiomas are rare pulmonary lesions.These lesions are difficult to differentiate from lung cancers based on clinical and imaging manifestations.Herein,we briefly introduce the clinical,imaging,and pathological characteristics of these lesions and discuss their pathogenesis to strengthen the current understanding of pulmonary meningothelial proliferative lesions in clinical diagnosis and therapy.展开更多
Introduction: Total thyroidectomy is an operation that involves the surgical removal of the whole thyroid gland, with the preservation of the parathyroid glands. The aim of the present study was to assess the complica...Introduction: Total thyroidectomy is an operation that involves the surgical removal of the whole thyroid gland, with the preservation of the parathyroid glands. The aim of the present study was to assess the complication rates of total thyroidectomy on benign indication and first-time thyroid surgery and investigate the early outcome after opotherapy. Materials and Methods: In this retrospective study, patients who underwent total thyroidectomy for benign multinodular goiter in the department of thoracic surgery in our Hospital from January 2012 to December 2014 were included. In postoperative time, we evaluated surgical complication, histopathological examination and opotherapy. Results: A total 53 patients underwent total thyroidectomy for multmodular goiter;they were 49 (92.45%) bilateral and 4 (7.55%) unilateral (recurrence). The mean age was 47 years and mean diameter of goiter was 10.75 cm. Among the patients 88.68% were females and 11.32% were male. Preoperative hormonal statuses were (70%) in euthyroid and (30%) hyperthyroid following surgery complications like transient laryngeal nerve palsy (3.77%), transient hypocalcemia (7.55%), hematoma (1.9%) and wound infection (1.9%). On histopathological examination of the surgical specimen, 5.7% were reported to be malignant. Six month following surgery 92.45% of patients was a good hormonal balance. Conclusion: Total thyroidectomy for multinodular goiter has a low morbidity and mortality;this procedure olves both the problem of recurrence of disease and reintervention. The opotherapy is doable with a good hormonal balance.展开更多
Nodular goiter has become increasingly prevalent in recent years.Clinically,there has been a burgeoning interest in nodular goiter due to the risk of progression to thyroid cancer.This review aims to provide a compreh...Nodular goiter has become increasingly prevalent in recent years.Clinically,there has been a burgeoning interest in nodular goiter due to the risk of progression to thyroid cancer.This review aims to provide a comprehensive summary of the mechanisms underlying the therapeutic effect of Chinese medicine(CM)in nodular goiter.Articles were systematically retrieved from databases,including PubMed,Web of Science and China National Knowledge Infrastructure.New evidence showed that CM exhibited multi-pathway and multi-target characteristics in the treatment of nodular goiter,involving hypothalamus-pituitary-thyroid axis,oxidative stress,blood rheology,cell proliferation,apoptosis,and autophagy,especially inhibition of cell proliferation and promotion of cell apoptosis,involving multiple signal pathways and a variety of cytokines.This review provides a scientific basis for the therapeutic use of CM against nodular goiter.Nonetheless,future studies are warranted to identify more regulatory genes and pathways to provide new approaches for the treatment of nodulargoiter.展开更多
Approximately 25%of goiters extend to the substernal area,and most of them can be removed through a cervical incision.Goiters that extend into the posterior mediastinum are very rare,and resection usually requires tho...Approximately 25%of goiters extend to the substernal area,and most of them can be removed through a cervical incision.Goiters that extend into the posterior mediastinum are very rare,and resection usually requires thoracotomy.In recent years,there have been several reports of resection of substernal goiters by minimally invasive surgery.Here,we present a 75-year-old female with a giant substernal goiter who successfully underwent resection of the goiter extending to the posterior mediastinum using low cervical incision combined with video-assisted thoracoscopy.展开更多
Objective:To explore the mechanism of Huatan Sanjie Fang(HTSJ)in regulating goiter in Graves'disease(GD)mice by detecting key factors of the Hippo signaling pathway.Methods:A mouse model of GD was established by i...Objective:To explore the mechanism of Huatan Sanjie Fang(HTSJ)in regulating goiter in Graves'disease(GD)mice by detecting key factors of the Hippo signaling pathway.Methods:A mouse model of GD was established by injecting Ad-TSHR289 adenovirus into the bilateral quadriceps femoris of female mice.Successful mouse models were then randomly divided into a model group,methimazole(MMI)group,and HTSJ group,and fed with deionized water,MMI(4.5 mg/kg per day),and HTSJ(35.10 g/kg per day),respectively,for 10 weeks.Histopathological changes of the thyroid gland were subsequently observed by hematoxylin-eosin staining.Radioimmunoassay was used to detect serum total thyroxine(T4)and thyrotrophin-receptor antibody(TRAb)levels.The relative expression of mRNA of Mst1,YAP,and TAZ were detected by quantitative real-time polymerase chain reaction,while the protein expression of Mst1,YAP,TAZ,pMst1,and pYAP were detected by western blot.Results:After 10 weeks of drug intervention,goiter and other pathological changes in the HTSJ group significantly improved compared with the model group,and the levels of serum T4 and TRAb significantly decreased(P=.002,P<.001,respectively).Decreased mRNA expression of Mst1,YAP,and TAZ,the key factors of the Hippo signaling transduction pathway,was also observed(P=.002,P=.022,P<.001,respectively).In contrast,protein expression of Mst1(P=.046),pMst1(P=.026),and p YAP(P=.004)increased,while protein expression of YAP and TAZ decreased(P=.041,P<.001,respectively).Conclusion:HTSJ can effectively improve goiter in GD mice through the Hippo signaling pathway.展开更多
Background:Early singular nodular hepatocellular carcinoma(HCC)is an ideal surgical indication in clinical practice.However,almost half of the patients have tumor recurrence,and there is no reliable prognostic predict...Background:Early singular nodular hepatocellular carcinoma(HCC)is an ideal surgical indication in clinical practice.However,almost half of the patients have tumor recurrence,and there is no reliable prognostic prediction tool.Besides,it is unclear whether preoperative neoadjuvant therapy is necessary for patients with early singular nodular HCC and which patient needs it.It is critical to identify the patients with high risk of recurrence and to treat these patients preoperatively with neoadjuvant therapy and thus,to improve the outcomes of these patients.The present study aimed to develop two prognostic models to preoperatively predict the recurrence-free survival(RFS)and overall survival(OS)in patients with singular nodular HCC by integrating the clinical data and radiological features.Methods:We retrospective recruited 211 patients with singular nodular HCC from December 2009 to January 2019 at Eastern Hepatobiliary Surgery Hospital(EHBH).They all met the surgical indications and underwent radical resection.We randomly divided the patients into the training cohort(n=132)and the validation cohort(n=79).We established and validated multivariate Cox proportional hazard models by the preoperative clinicopathologic factors and radiological features for association with RFS and OS.By analyzing the receiver operating characteristic(ROC)curve,the discrimination accuracy of the models was compared with that of the traditional predictive models.Results:Our RFS model was based on HBV-DNA score,cirrhosis,tumor diameter and tumor capsule in imaging.RFS nomogram had fine calibration and discrimination capabilities,with a C-index of 0.74(95%CI:0.68-0.80).The OS nomogram,based on cirrhosis,tumor diameter and tumor capsule in imaging,had fine calibration and discrimination capabilities,with a C-index of 0.81(95%CI:0.74-0.87).The area under the receiver operating characteristic curve(AUC)of our model was larger than that of traditional liver cancer staging system,Korea model and Nomograms in Hepatectomy Patients with Hepatitis B VirusRelated Hepatocellular Carcinoma,indicating better discrimination capability.According to the models,we fitted the linear prediction equations.These results were validated in the validation cohort.Conclusions:Compared with previous radiography model,the new-developed predictive model was concise and applicable to predict the postoperative survival of patients with singular nodular HCC.Our models may preoperatively identify patients with high risk of recurrence.These patients may benefit from neoadjuvant therapy which may improve the patients’outcomes.展开更多
BACKGROUND Papillary thyroid carcinoma(PTC)is regarded as a fairly common endocrine malignancy,which can be divided into different multiple variants due to wide morphologic differences.The majority of PTC variants hav...BACKGROUND Papillary thyroid carcinoma(PTC)is regarded as a fairly common endocrine malignancy,which can be divided into different multiple variants due to wide morphologic differences.The majority of PTC variants have been reported,but PTC with nodular fasciitis-like stroma(NFS)is a rare pathological variant and has been infrequently reported in the relevant literature.This condition involves abundant reactive stromal components rich in spindle cells,which may account for 60%-80%of the tumor along with a typical papillary carcinoma.CASE SUMMARY A 44-year-old man presented with a 4-mo history of a palpable mass over the anterior aspect of the left neck,the tumor demonstrated gradual enlargement but was painless during the 4 mo prior to discovery.Thyroid function test results were normal.Physical examination showed an enormous and firm nodular mass in the left lobe of the thyroid gland extending to the level of the hyoid bone.Ultrasonography of the neck revealed a well-defined heterogeneous lesion measuring around 5.0 cm×4.0 cm with a hypoechoic complex nodule,decreased vascularity and speckles of microcalcification.The patient underwent left thyroidectomy with central compartment lymph node dissection.Final histopathological examination confirmed the diagnosis of PTC with extensive fibromatosis-like stroma combined with typical PTC.The patient was asymptomatic at the 3-mo follow-up.CONCLUSION PTC-NFS is a rare pathological variant and its diagnosis and prognosis may be similar to typical papillary carcinoma.展开更多
Background: Multinodular goiter is a relatively common thyroid disorder with a marked female preponderance. Most of these goiters weigh less than 100 grams with those weighing more than 500 grams being exceptional. Th...Background: Multinodular goiter is a relatively common thyroid disorder with a marked female preponderance. Most of these goiters weigh less than 100 grams with those weighing more than 500 grams being exceptional. The massively expanding goiter due to the strategic anatomic location of thyroid gland, in addition to being cosmetically disfiguring can seriously compromise the patency of the trachea and oesophagus. Thyroidectomy for such goiters is a surgical challenge due to the possible association of tracheomalacia, retrosternal extension, skin involvement and the difficulty in intubation and dissection of the thyroid gland due to distorted and displaced anatomy. Material and methods: While presenting 2 patients who underwent thyroidectomy for glands weighing more than 500 grams, the literature is reviewed to analyze the technical difficulties and approach in such patients and the frequently encountered complications in them and their management. Results: A review of the literature revealed an additional 7 cases of patients who had undergone thyroidectomy for glands weighing more than 500 grams. Massively enlarged goiter was often associated with tracheomalacia, tracheal stenosis and retrosternal extension. Difficulty during surgery was most often encountered in establishing the airway and in exposure of the gland particularly when the skin was involved. The predominant postoperative complications were related to respiratory distress as a consequence of tracheomalacia and tracheal stenosis. Conclusion: In spite of the technical challenge related to the airway, and thyroidectomy, surgery continues to be the best option in experienced hands due to its distinct advantage of its immediate effect and complete resolution of compressive symptoms.展开更多
Intrathoracic goiter(IG) is commonly located in the anterior mediastinum. Here, we report the case of a 54-year-old Chinese woman with successful removal of an intrathoracic goiter and improvement of dyspnea by a righ...Intrathoracic goiter(IG) is commonly located in the anterior mediastinum. Here, we report the case of a 54-year-old Chinese woman with successful removal of an intrathoracic goiter and improvement of dyspnea by a right posterolateral thoracotomy approach. Conclusion: Posterior mediastinal thyroid goiter with mediastinal compressive symptoms is an indication for surgery.展开更多
BACKGROUND Focal nodular hyperplasia(FNH)commonly occurs in women;it is usually asymptomatic and sometimes difficult to differentiate from hepatocellular carcinoma(HCC).CASE SUMMARY A large space-occupying lesion in t...BACKGROUND Focal nodular hyperplasia(FNH)commonly occurs in women;it is usually asymptomatic and sometimes difficult to differentiate from hepatocellular carcinoma(HCC).CASE SUMMARY A large space-occupying lesion in the right lobe of the liver was incidentally detected in an adult man and diagnosed as HCC.Transcatheter arterial chemoembolization was applied once monthly for 2 years,but the lesion did not decrease in size.It was revealed by biopsy to be FNH.Eleven years later,the patient underwent liver resection due to hemorrhage and the pathological examination confirmed FNH.CONCLUSION For a space-occupying lesion,it is prerequisite to pathologically confirm the diagnosis and the corresponding intervention can be effective.展开更多
BACKGROUND: Focal nodular hyperplasia (FNH), the second most common benign hepatic tumor after hemangioma, is characterized by a stellate central scar and hyperplastic nodules. Although some large FNH may be associate...BACKGROUND: Focal nodular hyperplasia (FNH), the second most common benign hepatic tumor after hemangioma, is characterized by a stellate central scar and hyperplastic nodules. Although some large FNH may be associated with significant symptoms, more frequently they are discovered incidentally on physical examination or the work-up of unrelated symptoms. Since its nature and pathogenesis are still controversial, accurate diagnosis of FNH based on clinical presentation and radiographic studies is difficult. The purpose of this study was to explore the diagnosis and treatment of FNH. METHODS: Eighty-six FNH patients confirmed pathologically were treated at the Liver Cancer Institute in our hospital from 1996 to 2006. Their clinical manifestions, imaging presentation, pathological findings, and surgical results were analyzed retrospectively. RESULTS: Of the 86 patients with 99 foci, 54 were male and 32 female, with a mean age of 37 years. Eighty patients had a single solitary focus and 6 had multiple foci. Tumor diameter was less than 5 cm in 69 patients, 5-10 cm in 15, and more than 10 cm in 2. The overall rate of correct preoperative diagnosis was 59.3% (51/86) including 32.9% (26/79) by color Doppler flow imaging (CDFI), 60.3% (35/58) by CT, and 77.4% (24/31) by MRI. All the 86 patients underwent resection with good curative effect. CONCLUSIONS: CT and MRI are important diagnostic methods for FNH but it is difficult to make a definite preoperative diagnosis for partial classical and all non-classical FNH patients. We suggest that patients with clinical symptoms or with indefinite diagnosis should accept surgical removal.展开更多
Objective We aimed to evaluate goiter prevalence and iodine nutritional status in areas with high levels of water iodine; to monitor the prevalence of iodine deficiency disorders (IDD) in areas at high risk of IDD; ...Objective We aimed to evaluate goiter prevalence and iodine nutritional status in areas with high levels of water iodine; to monitor the prevalence of iodine deficiency disorders (IDD) in areas at high risk of IDD; and to compare the prevalence of goiter and urine iodine (UI) concentrations between children living in the two areas. Methods Based on surveillance from 2012-2014, we analyzed the concentration of UI and prevalence of goiter in 8-10-year-old children from 12 high-risk IDD provinces, and from 8 provinces and municipalities with excessive water iodine. We calculated goiter prevalence for each UI level according to World Health Organization (WHO) standards and constructed predictive prevalence curves. Results The goiter prevalence and median UI of children from areas with high water iodine were not optimal, being above the WHO standards (5% and 100-199 μg/L, respectively), whereas those in high-risk areas fell within the standard. UI and goiter prevalence exhibited a U-shaped relationship in high-risk endemic areas and a parabolic relationship in areas of iodine excess. Conclusion Iodine surplus in high-iodine areas leads to high goiter prevalence and UI. However, in high-risk areas, UI was optimal and goiter prevalence met the national criteria for IDD elimination.展开更多
We report three rare cases of sclerosing angiomatoid nodular transformation(SANT) in the spleen.We compared the conventional and contrast-enhanced ultrasonographic appearance.The conventional sonographic examinations ...We report three rare cases of sclerosing angiomatoid nodular transformation(SANT) in the spleen.We compared the conventional and contrast-enhanced ultrasonographic appearance.The conventional sonographic examinations exhibited solitary lesions without common respects,while contrast-enhanced ultrasonography(CEUS) revealed nodular appearance mimicking its pathologic characteristics.It suggests that CEUS can provide morphologic information for diagnosing SANT.展开更多
BACKGROUND: Focal nodular hyperplasia (FNH) is increasingly diagnosed as a result of the advances in imaging studies such as contrast-enhanced ultrasonography (CEUS), enhanced computed tomography and magnetic resonanc...BACKGROUND: Focal nodular hyperplasia (FNH) is increasingly diagnosed as a result of the advances in imaging studies such as contrast-enhanced ultrasonography (CEUS), enhanced computed tomography and magnetic resonance imaging. However, FNH with atypical features can be difficult to differentiate from other benign and malignant tumors. The aim of this study was to investigate the influence of fatty liver background on the CEUS characteristics of FNH. METHODS: Twenty-six patients with FNH were divided into two groups: group A included 14 patients with fatty liver and group B included 12 patients with normal liver background. Conventional two-dimensional ultrasonography and color Doppler flow imaging (CDFI) were conducted and followed by real-time dual-frame CEUS. RESULTS: On two-dimensional ultrasonography, hypoechoic nodules were present in most of the patients in group A (12/14) and hyperechoic nodules in most of those in group B (7/12). The difference in the nodule echotextures between the two groups was statistically significant (P<0.05). Nodules with centrifugal blood flow signals on CDFI were found in 6 of the 14 patients in group A and 5 of the 12 in group B (P>0.05). On CEUS, nodules with a central spoked-wheel-like enhancement pattern in the early arterial phase were observed in 8 patients in group A and those with an eccentric enhancement pattern in the remaining 6 patients. In this group, 3 patients had hypoechoic nodules in the delayed phase. Eleven of the 14 patients in this group were diagnosed accurately with CEUS. In group B, nodules with a rapid central spoked-wheel-like enhancement pattern in the early arterial phase were found in 8 patients by CEUS and those with rapid an eccentric enhancement pattern in 4. The nodules were found to be continuously enhanced in the delayed phase. All of the patients in group B were accurately diagnosed with CEUS. CONCLUSIONS: A FNH nodule on a background of fatty liver may present a hypoechoic pattern on two-dimensional ultrasonography and a hypoechoic wash-out pattern in the delayed phase on CEUS. At this time, punch biopsy is needed for the diagnosis or differential diagnosis of FNH.展开更多
BACKGROUND: Focal nodular hyperplasia (FNH) is a benign tumor-like lesion of the liver, predominantly affect- ing women. Its etiology is obscure and its pathogenesis is poorly understood. FNH should be differentiated ...BACKGROUND: Focal nodular hyperplasia (FNH) is a benign tumor-like lesion of the liver, predominantly affect- ing women. Its etiology is obscure and its pathogenesis is poorly understood. FNH should be differentiated from oth- er benign and malignant hepatic lesions. The aim of this study was to explore the pathological characteristics of FNH of the liver. METHODS: Eleven patients with FNH were studied retro- spectively by using hematoxylin and eosin, immunohisto- chemical and histochemical staining. RESULTS: In 8 female and 3 male FNH patients aged 19 to 54 years (mean 32), most of lesions showed central scars macroscopically. Microscopically 8 patients were found of classical type, 2 were of telangiectic type, and 1 was of mixed type. CONCLUSION: FNH is an uncommon benign hyperplastic lesion of the liver. It should be differentiated from hepato- cellular adenoma, alpha-fetoprotein negative hepatocellular carcinoma, and fibrolamellar carcinoma.展开更多
基金Supported by the Key Project of Teaching Reform Research of Taishan Vocational College of Nursing(202307).
文摘As important drugs for the treatment of nodular goiter(NG),Prunella Spica preparations are widely used clinically,and have a significant effect on NG.Various active ingredients in the preparations intervene in the formation of NG by inhibiting the proliferation of thyroid follicular cells,promoting cell apoptosis,regulating immunity,improving the microcirculation of thyroid tissue and other mechanisms,and can reduce the postoperative recurrence of NG.
文摘Background: Schwannoma is a benign tumor derived from Schwann cells. The most common location was cerebellopontine angle (CPA). Neurilemmoma originated from the thyroid gland is very rare. Purpose: To discuss the diagnosis and treatment of cervical vagal schwannoma and the causes of misdiagnosis and preventive measures. Case Presentation: A case of cervical vagal schwannoma misdiagnosed as nodular goiter by ultrasonography was analyzed retrospectively. This patient was found to have pain in the neck for 1 month and then went to our hospital for treatment. After admission, a 5 cm × 4 cm mass was found on the left side of the neck, with a medium texture and clear margin. It could move with swallowing. Initially ultrasound showed a well circumscribed hypoechoic mass in the left thyroid lobe, which is suggestive of hemorrhage of thyroid nodule. Biopsy of thyroid nodules after ultrasound guided biopsy revealed Schwannoma. Surgical treatment and postoperative pathological examination confirmed cervical vagal schwannoma. The patient recovered well and was discharged 9 days after operation. Conclusion: The location of thyroid schwannoma is rare, the relationship between thyroid schwannoma and surrounding tissues is unclear, and there is no typical ultrasonic manifestation. Moreover, if doctors are not aware of their knowledge, it is easy to cause misdiagnosis. Radiologists should raise awareness of the disease and carefully analyze the results of ultrasonography in combination with the clinical manifestations of the patients so as to reduce or avoid misdiagnosis of cervical schwannoma.
文摘Objective:To investigate the Computed Tomography(CT)features of papillary thyroid carcinoma and nodular goiter.Methods:Ninety patients were enrolled in this study.All patients were treated with thyroid disease admitted to our hospital from January 2016 to December 2018.Among them,sixty patients with thyroid papillary carcinoma and thirty patients with nodular goiter were examined by CT scan and enhanced examination.Results:There was no statistically significant difference in the volume index of left lobe,right lobe and isthmus in thyroid patients(P>0.05).There were significant statistical differences in the growth site,morphology,border,density,calcification and enhancement mode of nodules(P<0.05).Conclusion:CT examination has significant diagnostic value in the differential diagnosis of papillary thyroid carcinoma and nodular thyroid.
基金Supported by the Scientific Research Foundation of Peking University Shenzhen Hospital,No.KYQD202100Xthe National Natural Science Foundation of China,No.81972829and Precision Medicine Research Program of Tsinghua University,No.2022ZLA006。
文摘BACKGROUND Elderly giant retrosternal thyroid goiter is a rare yet significant medical condition,often presenting clinical symptoms that can be confused with other diseases,posing diagnostic and therapeutic challenges.This study aims to delve into the characteristics and potential mechanisms of this ailment through pathological diagnosis and immunohistochemical analysis,providing clinicians with more precise diagnostic and treatment strategies.A 77-year-old male,was admitted to hospital with the chief complaint of finding a goiter in the semilunar month during physical examination,accompanied by dyspnea.Locally protruding into the superior mediastinum,the adjacent structure was compressed,the trachea was compressed to the right,and the local lumen was slightly narrowed.The patient was diagnosed with giant retrosternal goiter.Considering dyspnea caused by trachea compression,our department planned to perform giant retrosternal thyroidectomy.Immunohistochemical results:Tg(+),TTF-1(+),Calcitonin(CT)(I),Ki-67(+,about 20%),CD34(-).Retrosternal goiter means that more than 50%of the volume of the thyroid gland is below the upper margin of the sternum.As retrosternal goiter disease is a relatively rare disease,once the disease is diagnosed,it should be timely surgical treatment,and the treatment is more difficult,the need for professional medical team for comprehensive treatment.CONCLUSION The imaging manifestations of giant retrosternal goiter are atypical,histomorphology and immunohistochemistry can assist in its diagnosis.This article reviews the relevant literature of giant retrosternal goiter immunohisto-chemistry and shows that giant retrosternal goiter is positive for Tg,TTF-1,and Ki-67.
文摘BACKGROUND Lithium carbonate is used to manage various mood disorders,but it can cause thyroid abnormalities,including goiter,hypothyroidism,and hyperthyroidism.In rare cases,it can lead to giant goiter and subclinical hyperthyroidism,which may require surgical intervention in severe cases.CASE SUMMARY This case represents a rare development of giant goiter and subclinical hyperthyroidism in a schizophrenia patient who was subjected to prolonged lithium carbonate treatment.The enlarged thyroid gland caused pressure on the airway and recurrent laryngeal nerve,which led to respiratory distress,hoarseness,and dysphagia.The immediate danger of suffocation required urgent surgical intervention.In this report,we describe the case of a 41-year-old Chinese woman.This sheds light on the etiology and challenges associated with managing a giant goiter.The patient underwent a subtotal thyroidectomy to relieve airway compression and facilitate airway expansion.Prior to the procedure,the patient was given iodine to prepare.Concurrently,changes were made to the psychiatric medication regimen.Following surgery,the patient's respiratory function and vocal cord functionality improved significantly,and her mental state remained stable.CONCLUSION It is essential to monitor thyroid function,test thyroid antibody levels,and perform thyroid ultrasounds consistently in all patients undergoing long-term lithium carbonate treatment.This vigilance helps prevent severe and potentially life-threatening thyroid enlargement.
文摘In this editorial,we comment on an article by Ruan et al published in a recent issue of the World Journal of Clinical Case.Pulmonary meningothelial proliferative lesions,including primary pulmonary meningiomas,minute pulmonary meningothelial-like nodules,and metastatic pulmonary meningiomas are rare pulmonary lesions.These lesions are difficult to differentiate from lung cancers based on clinical and imaging manifestations.Herein,we briefly introduce the clinical,imaging,and pathological characteristics of these lesions and discuss their pathogenesis to strengthen the current understanding of pulmonary meningothelial proliferative lesions in clinical diagnosis and therapy.
文摘Introduction: Total thyroidectomy is an operation that involves the surgical removal of the whole thyroid gland, with the preservation of the parathyroid glands. The aim of the present study was to assess the complication rates of total thyroidectomy on benign indication and first-time thyroid surgery and investigate the early outcome after opotherapy. Materials and Methods: In this retrospective study, patients who underwent total thyroidectomy for benign multinodular goiter in the department of thoracic surgery in our Hospital from January 2012 to December 2014 were included. In postoperative time, we evaluated surgical complication, histopathological examination and opotherapy. Results: A total 53 patients underwent total thyroidectomy for multmodular goiter;they were 49 (92.45%) bilateral and 4 (7.55%) unilateral (recurrence). The mean age was 47 years and mean diameter of goiter was 10.75 cm. Among the patients 88.68% were females and 11.32% were male. Preoperative hormonal statuses were (70%) in euthyroid and (30%) hyperthyroid following surgery complications like transient laryngeal nerve palsy (3.77%), transient hypocalcemia (7.55%), hematoma (1.9%) and wound infection (1.9%). On histopathological examination of the surgical specimen, 5.7% were reported to be malignant. Six month following surgery 92.45% of patients was a good hormonal balance. Conclusion: Total thyroidectomy for multinodular goiter has a low morbidity and mortality;this procedure olves both the problem of recurrence of disease and reintervention. The opotherapy is doable with a good hormonal balance.
基金Supported by Jinan 20 Items in Universities"Funded Project(No.2020GXRC002)。
文摘Nodular goiter has become increasingly prevalent in recent years.Clinically,there has been a burgeoning interest in nodular goiter due to the risk of progression to thyroid cancer.This review aims to provide a comprehensive summary of the mechanisms underlying the therapeutic effect of Chinese medicine(CM)in nodular goiter.Articles were systematically retrieved from databases,including PubMed,Web of Science and China National Knowledge Infrastructure.New evidence showed that CM exhibited multi-pathway and multi-target characteristics in the treatment of nodular goiter,involving hypothalamus-pituitary-thyroid axis,oxidative stress,blood rheology,cell proliferation,apoptosis,and autophagy,especially inhibition of cell proliferation and promotion of cell apoptosis,involving multiple signal pathways and a variety of cytokines.This review provides a scientific basis for the therapeutic use of CM against nodular goiter.Nonetheless,future studies are warranted to identify more regulatory genes and pathways to provide new approaches for the treatment of nodulargoiter.
基金supported by the Fundamental Research Funds for the Central Universities(2021FZZX005-21).
文摘Approximately 25%of goiters extend to the substernal area,and most of them can be removed through a cervical incision.Goiters that extend into the posterior mediastinum are very rare,and resection usually requires thoracotomy.In recent years,there have been several reports of resection of substernal goiters by minimally invasive surgery.Here,we present a 75-year-old female with a giant substernal goiter who successfully underwent resection of the goiter extending to the posterior mediastinum using low cervical incision combined with video-assisted thoracoscopy.
基金supported by the National Natural Science Fund(82004337)the Beijing University of Chinese Medicine new teacher launch fund(2020-JYB-XJSJJ-002)。
文摘Objective:To explore the mechanism of Huatan Sanjie Fang(HTSJ)in regulating goiter in Graves'disease(GD)mice by detecting key factors of the Hippo signaling pathway.Methods:A mouse model of GD was established by injecting Ad-TSHR289 adenovirus into the bilateral quadriceps femoris of female mice.Successful mouse models were then randomly divided into a model group,methimazole(MMI)group,and HTSJ group,and fed with deionized water,MMI(4.5 mg/kg per day),and HTSJ(35.10 g/kg per day),respectively,for 10 weeks.Histopathological changes of the thyroid gland were subsequently observed by hematoxylin-eosin staining.Radioimmunoassay was used to detect serum total thyroxine(T4)and thyrotrophin-receptor antibody(TRAb)levels.The relative expression of mRNA of Mst1,YAP,and TAZ were detected by quantitative real-time polymerase chain reaction,while the protein expression of Mst1,YAP,TAZ,pMst1,and pYAP were detected by western blot.Results:After 10 weeks of drug intervention,goiter and other pathological changes in the HTSJ group significantly improved compared with the model group,and the levels of serum T4 and TRAb significantly decreased(P=.002,P<.001,respectively).Decreased mRNA expression of Mst1,YAP,and TAZ,the key factors of the Hippo signaling transduction pathway,was also observed(P=.002,P=.022,P<.001,respectively).In contrast,protein expression of Mst1(P=.046),pMst1(P=.026),and p YAP(P=.004)increased,while protein expression of YAP and TAZ decreased(P=.041,P<.001,respectively).Conclusion:HTSJ can effectively improve goiter in GD mice through the Hippo signaling pathway.
基金supported by grants from the Shanghai Rising-Star Program(19QA1408700)the National Natural Science Founda-tion of China(81972575 and 81521091)Clinical Research Plan of SHDC(SHDC2020CR5007)。
文摘Background:Early singular nodular hepatocellular carcinoma(HCC)is an ideal surgical indication in clinical practice.However,almost half of the patients have tumor recurrence,and there is no reliable prognostic prediction tool.Besides,it is unclear whether preoperative neoadjuvant therapy is necessary for patients with early singular nodular HCC and which patient needs it.It is critical to identify the patients with high risk of recurrence and to treat these patients preoperatively with neoadjuvant therapy and thus,to improve the outcomes of these patients.The present study aimed to develop two prognostic models to preoperatively predict the recurrence-free survival(RFS)and overall survival(OS)in patients with singular nodular HCC by integrating the clinical data and radiological features.Methods:We retrospective recruited 211 patients with singular nodular HCC from December 2009 to January 2019 at Eastern Hepatobiliary Surgery Hospital(EHBH).They all met the surgical indications and underwent radical resection.We randomly divided the patients into the training cohort(n=132)and the validation cohort(n=79).We established and validated multivariate Cox proportional hazard models by the preoperative clinicopathologic factors and radiological features for association with RFS and OS.By analyzing the receiver operating characteristic(ROC)curve,the discrimination accuracy of the models was compared with that of the traditional predictive models.Results:Our RFS model was based on HBV-DNA score,cirrhosis,tumor diameter and tumor capsule in imaging.RFS nomogram had fine calibration and discrimination capabilities,with a C-index of 0.74(95%CI:0.68-0.80).The OS nomogram,based on cirrhosis,tumor diameter and tumor capsule in imaging,had fine calibration and discrimination capabilities,with a C-index of 0.81(95%CI:0.74-0.87).The area under the receiver operating characteristic curve(AUC)of our model was larger than that of traditional liver cancer staging system,Korea model and Nomograms in Hepatectomy Patients with Hepatitis B VirusRelated Hepatocellular Carcinoma,indicating better discrimination capability.According to the models,we fitted the linear prediction equations.These results were validated in the validation cohort.Conclusions:Compared with previous radiography model,the new-developed predictive model was concise and applicable to predict the postoperative survival of patients with singular nodular HCC.Our models may preoperatively identify patients with high risk of recurrence.These patients may benefit from neoadjuvant therapy which may improve the patients’outcomes.
文摘BACKGROUND Papillary thyroid carcinoma(PTC)is regarded as a fairly common endocrine malignancy,which can be divided into different multiple variants due to wide morphologic differences.The majority of PTC variants have been reported,but PTC with nodular fasciitis-like stroma(NFS)is a rare pathological variant and has been infrequently reported in the relevant literature.This condition involves abundant reactive stromal components rich in spindle cells,which may account for 60%-80%of the tumor along with a typical papillary carcinoma.CASE SUMMARY A 44-year-old man presented with a 4-mo history of a palpable mass over the anterior aspect of the left neck,the tumor demonstrated gradual enlargement but was painless during the 4 mo prior to discovery.Thyroid function test results were normal.Physical examination showed an enormous and firm nodular mass in the left lobe of the thyroid gland extending to the level of the hyoid bone.Ultrasonography of the neck revealed a well-defined heterogeneous lesion measuring around 5.0 cm×4.0 cm with a hypoechoic complex nodule,decreased vascularity and speckles of microcalcification.The patient underwent left thyroidectomy with central compartment lymph node dissection.Final histopathological examination confirmed the diagnosis of PTC with extensive fibromatosis-like stroma combined with typical PTC.The patient was asymptomatic at the 3-mo follow-up.CONCLUSION PTC-NFS is a rare pathological variant and its diagnosis and prognosis may be similar to typical papillary carcinoma.
文摘Background: Multinodular goiter is a relatively common thyroid disorder with a marked female preponderance. Most of these goiters weigh less than 100 grams with those weighing more than 500 grams being exceptional. The massively expanding goiter due to the strategic anatomic location of thyroid gland, in addition to being cosmetically disfiguring can seriously compromise the patency of the trachea and oesophagus. Thyroidectomy for such goiters is a surgical challenge due to the possible association of tracheomalacia, retrosternal extension, skin involvement and the difficulty in intubation and dissection of the thyroid gland due to distorted and displaced anatomy. Material and methods: While presenting 2 patients who underwent thyroidectomy for glands weighing more than 500 grams, the literature is reviewed to analyze the technical difficulties and approach in such patients and the frequently encountered complications in them and their management. Results: A review of the literature revealed an additional 7 cases of patients who had undergone thyroidectomy for glands weighing more than 500 grams. Massively enlarged goiter was often associated with tracheomalacia, tracheal stenosis and retrosternal extension. Difficulty during surgery was most often encountered in establishing the airway and in exposure of the gland particularly when the skin was involved. The predominant postoperative complications were related to respiratory distress as a consequence of tracheomalacia and tracheal stenosis. Conclusion: In spite of the technical challenge related to the airway, and thyroidectomy, surgery continues to be the best option in experienced hands due to its distinct advantage of its immediate effect and complete resolution of compressive symptoms.
文摘Intrathoracic goiter(IG) is commonly located in the anterior mediastinum. Here, we report the case of a 54-year-old Chinese woman with successful removal of an intrathoracic goiter and improvement of dyspnea by a right posterolateral thoracotomy approach. Conclusion: Posterior mediastinal thyroid goiter with mediastinal compressive symptoms is an indication for surgery.
文摘BACKGROUND Focal nodular hyperplasia(FNH)commonly occurs in women;it is usually asymptomatic and sometimes difficult to differentiate from hepatocellular carcinoma(HCC).CASE SUMMARY A large space-occupying lesion in the right lobe of the liver was incidentally detected in an adult man and diagnosed as HCC.Transcatheter arterial chemoembolization was applied once monthly for 2 years,but the lesion did not decrease in size.It was revealed by biopsy to be FNH.Eleven years later,the patient underwent liver resection due to hemorrhage and the pathological examination confirmed FNH.CONCLUSION For a space-occupying lesion,it is prerequisite to pathologically confirm the diagnosis and the corresponding intervention can be effective.
文摘BACKGROUND: Focal nodular hyperplasia (FNH), the second most common benign hepatic tumor after hemangioma, is characterized by a stellate central scar and hyperplastic nodules. Although some large FNH may be associated with significant symptoms, more frequently they are discovered incidentally on physical examination or the work-up of unrelated symptoms. Since its nature and pathogenesis are still controversial, accurate diagnosis of FNH based on clinical presentation and radiographic studies is difficult. The purpose of this study was to explore the diagnosis and treatment of FNH. METHODS: Eighty-six FNH patients confirmed pathologically were treated at the Liver Cancer Institute in our hospital from 1996 to 2006. Their clinical manifestions, imaging presentation, pathological findings, and surgical results were analyzed retrospectively. RESULTS: Of the 86 patients with 99 foci, 54 were male and 32 female, with a mean age of 37 years. Eighty patients had a single solitary focus and 6 had multiple foci. Tumor diameter was less than 5 cm in 69 patients, 5-10 cm in 15, and more than 10 cm in 2. The overall rate of correct preoperative diagnosis was 59.3% (51/86) including 32.9% (26/79) by color Doppler flow imaging (CDFI), 60.3% (35/58) by CT, and 77.4% (24/31) by MRI. All the 86 patients underwent resection with good curative effect. CONCLUSIONS: CT and MRI are important diagnostic methods for FNH but it is difficult to make a definite preoperative diagnosis for partial classical and all non-classical FNH patients. We suggest that patients with clinical symptoms or with indefinite diagnosis should accept surgical removal.
文摘Objective We aimed to evaluate goiter prevalence and iodine nutritional status in areas with high levels of water iodine; to monitor the prevalence of iodine deficiency disorders (IDD) in areas at high risk of IDD; and to compare the prevalence of goiter and urine iodine (UI) concentrations between children living in the two areas. Methods Based on surveillance from 2012-2014, we analyzed the concentration of UI and prevalence of goiter in 8-10-year-old children from 12 high-risk IDD provinces, and from 8 provinces and municipalities with excessive water iodine. We calculated goiter prevalence for each UI level according to World Health Organization (WHO) standards and constructed predictive prevalence curves. Results The goiter prevalence and median UI of children from areas with high water iodine were not optimal, being above the WHO standards (5% and 100-199 μg/L, respectively), whereas those in high-risk areas fell within the standard. UI and goiter prevalence exhibited a U-shaped relationship in high-risk endemic areas and a parabolic relationship in areas of iodine excess. Conclusion Iodine surplus in high-iodine areas leads to high goiter prevalence and UI. However, in high-risk areas, UI was optimal and goiter prevalence met the national criteria for IDD elimination.
文摘We report three rare cases of sclerosing angiomatoid nodular transformation(SANT) in the spleen.We compared the conventional and contrast-enhanced ultrasonographic appearance.The conventional sonographic examinations exhibited solitary lesions without common respects,while contrast-enhanced ultrasonography(CEUS) revealed nodular appearance mimicking its pathologic characteristics.It suggests that CEUS can provide morphologic information for diagnosing SANT.
文摘BACKGROUND: Focal nodular hyperplasia (FNH) is increasingly diagnosed as a result of the advances in imaging studies such as contrast-enhanced ultrasonography (CEUS), enhanced computed tomography and magnetic resonance imaging. However, FNH with atypical features can be difficult to differentiate from other benign and malignant tumors. The aim of this study was to investigate the influence of fatty liver background on the CEUS characteristics of FNH. METHODS: Twenty-six patients with FNH were divided into two groups: group A included 14 patients with fatty liver and group B included 12 patients with normal liver background. Conventional two-dimensional ultrasonography and color Doppler flow imaging (CDFI) were conducted and followed by real-time dual-frame CEUS. RESULTS: On two-dimensional ultrasonography, hypoechoic nodules were present in most of the patients in group A (12/14) and hyperechoic nodules in most of those in group B (7/12). The difference in the nodule echotextures between the two groups was statistically significant (P<0.05). Nodules with centrifugal blood flow signals on CDFI were found in 6 of the 14 patients in group A and 5 of the 12 in group B (P>0.05). On CEUS, nodules with a central spoked-wheel-like enhancement pattern in the early arterial phase were observed in 8 patients in group A and those with an eccentric enhancement pattern in the remaining 6 patients. In this group, 3 patients had hypoechoic nodules in the delayed phase. Eleven of the 14 patients in this group were diagnosed accurately with CEUS. In group B, nodules with a rapid central spoked-wheel-like enhancement pattern in the early arterial phase were found in 8 patients by CEUS and those with rapid an eccentric enhancement pattern in 4. The nodules were found to be continuously enhanced in the delayed phase. All of the patients in group B were accurately diagnosed with CEUS. CONCLUSIONS: A FNH nodule on a background of fatty liver may present a hypoechoic pattern on two-dimensional ultrasonography and a hypoechoic wash-out pattern in the delayed phase on CEUS. At this time, punch biopsy is needed for the diagnosis or differential diagnosis of FNH.
文摘BACKGROUND: Focal nodular hyperplasia (FNH) is a benign tumor-like lesion of the liver, predominantly affect- ing women. Its etiology is obscure and its pathogenesis is poorly understood. FNH should be differentiated from oth- er benign and malignant hepatic lesions. The aim of this study was to explore the pathological characteristics of FNH of the liver. METHODS: Eleven patients with FNH were studied retro- spectively by using hematoxylin and eosin, immunohisto- chemical and histochemical staining. RESULTS: In 8 female and 3 male FNH patients aged 19 to 54 years (mean 32), most of lesions showed central scars macroscopically. Microscopically 8 patients were found of classical type, 2 were of telangiectic type, and 1 was of mixed type. CONCLUSION: FNH is an uncommon benign hyperplastic lesion of the liver. It should be differentiated from hepato- cellular adenoma, alpha-fetoprotein negative hepatocellular carcinoma, and fibrolamellar carcinoma.