Anaplastic thyroid carcinoma (ATC) is a rare type of malignancy of thyroid follicular cell origin. It is one of the most aggressive human cancers, and typically associated with a fatal prognosis. Most patients are presenting as locally advanced and systemically disseminated disease. A single mode of therapy, whether it is surgery, chemotherapy, or radiotherapy, fails to afford significantly favorable outcomes. While multimodality approaches may enhance the treatment response to a small degree, such implementations of these modalities are often impractical as many patients are of old age and are unable to tolerate the intensity of treatments. As in many other types of carcinomas, radical resection may be the mainstay of therapy for ATC, but surgery itself is seldom possible for this condition. Even with aggressive surgical therapy for those invasive ATCs, there is no evidence of decreased recurrence rates, while only the post-surgical morbidity rates increase. One chemotherapeutic agent that seems to demonstrate some effect against ATC is adriamycin, which is more effective when administered in combination, and is also known to act synergistically with radiotherapy. A commonly employed treatment modality is the combination therapy of adriamycin and cisplatin administration with hyperfractionated radiation therapy. Other chemotherapeutic agents proven to be effective are taxanes such as paclitaxel and docetaxel. Despite of disappointing result of conventional radiotherapy, however, hyperfractionated radiation therapy and combined chemotherapy has been suggested to improve survival rates by some institutions, while others disagree. The dismal results of conventional treatments for ATCs have stimulated the investigation for new therapeutic methods with improved outcome. There have been a number of trials of new materials or therapeutic methods. In recent studies, some trials were partially successful or promising in vitro or in vivo. The examples of these trials are; redifferentiation therapies, molecular targeted therapies, and some other miscellaneous methods. Although the observations may suggest that some of the methods may have a therapeutic effect on ATCs, or may act as an adjunct to other primary treatment modality, the efficacy and safety have not been ascertained yet in human trials, and further confirmation through in-depth studies are required.
Cisplatin ; Doxorubicin ; Humans ; Molecular Targeted Therapy ; Paclitaxel ; Prognosis ; Recurrence ; Survival Rate ; Taxoids ; Thyroid Gland ; Thyroid Neoplasms

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Segmentally distributed cutaneous eruptions and neuralgia are common manifestations of herpes zoster. However, motor loss is another aspect of this manifestation, which is less well known and considered a rare finding. In many cases the loss of motor function may be easily overlooked because the pain is the more prominent feature and the weakness probably goes unrecognized with only a mild impairment of the motor function. We experienced a 71-year-old male patient with a herpes zoster-related motor paralysis of right arm whose clinical features of a weak limb mimicked other spinal motor diseases and confirmed motor involvement using electromyographic (EMG) and motor nerve conduction velocity (MNCV) studies.
Aged ; Arm ; Extremities* ; Herpes Zoster* ; Humans ; Male ; Neural Conduction ; Neuralgia ; Paralysis*

Paraffinoma is a well known complication of previous paraffin injection into the subcutaneous layer that presents as various conditions including firm mass formation, edema, induration, ulceration, and skin necrosis. Paraffinoma can mimic neoplasm on physical examination and imaging studies and may complicate ultrasonographic diagnoses due to typical posterior shadowing and high echogenicity. When paraffinomas involve around the thyroid gland, the diagnosis of thyroid tumors is very difficult. We present a case of thyroid cancer, the evaluation of which was complicated by the presence of cervical paraffinoma.
Edema ; Hydrazines ; Necrosis ; Paraffin ; Physical Examination ; Shadowing (Histology) ; Skin ; Thyroid Gland ; Thyroid Neoplasms ; Ulcer

For the differential diagnosis of head and neck mass lesions, the age and presenting locations should be the primary considerations. The characteristic patterns of age- and sitepredilection allow a diagnostic work-up and treatment plans for the patients with head and neck mass lesions. In children and young adults, the underlying causes are; inflammatory, congenital and developmental, and neoplastic masses in decreasing frequency. By contrast, neoplastic diseases are most frequent in the elderly. Because of the characteristic lymphatic spread patterns of head and neck diseases, the location of the mass in the cervical lymphatic nodal chain may be the key for the identification and differential diagnosis of the primary disease site. Besides, the evaluation of specific historical and physical findings is mandatory for the accurate diagnosis. When the signs of inflammation are associated, conservative treatment and observation is first considered. On the other hand, for persistent or progressively enlarging masses and those with suspicious findings of malignancy, surgical intervention should be considered.
Aged ; Child ; Diagnosis ; Diagnosis, Differential* ; Hand ; Head* ; Humans ; Inflammation ; Neck* ; Young Adult

Thyroid carcinoma is a slowly growing tumor and rarely invades adjacent tissues or organs. However, up to 21% of the patients with well-differentiated thyroid cancers show local invasion, and of those 10 to 15% of patients with papillary cancer who eventually die of the disease, active local disease has been the most common finding at the time of death. The common sites of local invasion are strap muscle, recurrent laryngeal nerve, laryngotracheal tree, esophagus, and great vessels in the lateral compartment and mediastinum. Uncontrolled local invasion to vital organs in the neck causes significant morbidity, affects the quality of life, and finally influences the survival. In cases with limited involvement of the larynx or trachea, the option of treatment includes limited shaving-off resection or radical resection followed by reconstructive procedures. When operation is planned, the level of acceptable morbidity and the achievement of therapeutic outcomes should be determined in advance. In cases with aggressive invasion to the adjacent tissues, radical resection is the treatment modality of choice with favorable prognosis. Postoperative adjuvant therapies have been the matter of controversy, however, there is a general consensus, especially for the high-risk patients, that radioiodine therapy and TSH suppression after radical resection are beneficial. The benefits of external radiation therapy in locally advanced thyroid cancers are unclear, however, it can be effective in patients with microscopic residual disease postoperatively. Radical eradication of locally advanced thyroid carcinoma followed by appropriate adjuvant therapy should be considered to be the treatment of choice in locally advanced thyroid cancers.
Consensus ; Esophagus ; Humans ; Larynx ; Mediastinum ; Neck ; Prognosis ; Quality of Life ; Recurrent Laryngeal Nerve ; Thyroid Gland ; Thyroid Neoplasms* ; Trachea

OBJECTIVES: Thyroid cancer patients may experience emotional distress during cancer treatment including surgical operation and radioactive iodine treatment. The aims of this prospective study were to investigate changes of anxiety and depressive symptoms in patients with differentiated thyroid cancer(DTC) under preoperative, postoperative and short-term hypothyroidism state. METHODS: Using the Hospital Anxiety and Depression scale(HAD) and the Distress Thermometer, we sequentially assessed the levels of anxiety, depression and distress in 41 DTC patients at 3 time points such as preoperative state, postoperative state and short-term hypothyroidism state. RESULTS: The HAD-anxiety score was significantly higher in preoperative state(6.93+/-3.97) than postoperative state(4.22+/-2.92) and short-term hypothyroidism state(4.93+/-3.64). Any other significant change in depression or distress thermometer score was not observed. Especially, difference of HADS score between the distress and none-distress groups was significant in preoperative state and post-operative state, but the difference become not significant in the short-term hypothyroidism state. CONCLUSIONS: Induced thyroid hormone deficiency during cancer treatment does not significantly affect emotional distress in patient with DTC. Anxiety and depression in these patients may be associated with distress of the patient before active cancer treatment.
Anxiety ; Dapsone ; Depression ; Humans ; Hypothyroidism ; Iodine ; Prospective Studies ; Thermometers ; Thyroid Gland ; Thyroid Neoplasms

No abstract available.

Anaplastic thyroid carcinoma (ATC) is one of the most malignant human neoplasms and has a grave prognosis. This study gives an update on our experience with this unusual neoplasm, with specific focus on the response to various treatment modalities. Forty-seven patients with histologically proven ATCs were enrolled (19 men, 28 women; mean age, 62.8 years). This number represents 1.5% among a total of 3, 088 thyroid cancers treated between 1977 and 2002. The mean tumor diameter was 8.8 cm, and 22 patients had distant metastasis. Extrathyroidal extension was seen in 26 (89.7%) of the cases that underwent surgery. Treatment modalities adopted could be classified into 5 groups: Group 1, biopsy only; Group 2, biopsy and chemoradiotherapy; Group 3, debulking only; Goup 4, debulking and chemoradiotherapy; Group 5, complete excision and chemoradiotherapy. Survival was calculated from the time of diagnosis, and comparisons of survival were done by log-rank analysis. The mean survival was 4.3 months (range, 1.0-21 months). The mean survival based on treatment modalities were as follows: Group 1 (n = 10), 2.1 months, Group 2 (n = 8) ; 3.6 months; Group 3 (n = 7), 3.0 months; Group 4 (n = 14), 3.5 months, Group 5 (n = 8), 9.4 months. There was no significant difference in survival time between the various types of treatment modalities. Even though a small improvement in survival was observed with complete excision and aggressive multimodality therapy, nearly all ATCs remain unresponsive to ongoing treatment modalities and as such, present a therapeutic dilemma. A more effective treatment regimen should be sought in order to improve survival.
Treatment Outcome ; Thyroid Neoplasms/mortality/surgery/*therapy ; Survival Analysis ; Radiotherapy, Adjuvant ; Neoplasm Metastasis ; Middle Aged ; Male ; Humans ; Female ; Combined Modality Therapy ; Chemotherapy, Adjuvant ; Carcinoma/mortality/surgery/*therapy ; Aged, 80 and over ; Aged ; Adult