Multiple endocrine neoplasia type 1 (MEN 1) is characterized by the coexistence of primary hyperparathyroidism, enteropancreatic tumors, and anterior pituitary adenoma. Also adrenal adenoma, lipoma, carcinoid tumors could exist simultaneously on the atypical clinical course of MEN 1. Among these diseases, primary hyperparathyroidism is the most common manisfestation of MEN 1 syndrome. However, it sometimes presents no clinical symptoms and is incidentally detected on medical checkup. A 48-year-old woman, while undergoing a regular medical check-up, was diagnosed with primary hyperparathyroidism. Further studies showed concurrence of pancreatic tumor and adrenal tumor, but there was no pituitary lesion. The patient underwent parathyroidectomy with auto-implantation of parathyroid tissue, pylorus preserving pancreatico-duodenectomy and partial adrenalectomy. The pathological test confirmed it to be parathyroid hyperplasia, well-differentiated pancreatic endocrine carcinoma and adrenal cortical adenoma. We report this atypical and asymptomatic case of MEN 1 with a review of the relevant literature.
Adenoma ; Adrenalectomy ; Adrenocortical Adenoma ; Carcinoid Tumor ; Female ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Hyperplasia ; Lipoma ; Mass Screening ; Middle Aged ; Multiple Endocrine Neoplasia ; Multiple Endocrine Neoplasia Type 1 ; Parathyroidectomy ; Pituitary Neoplasms ; Pylorus

BACKGROUND AND OBJECTIVES: Follicular thyroid carcinoma (FTC) is the second most common thyroid malignancy after papillary thyroid carcinoma. We performed this study to obtain further understanding and more supporting ideas for the diagnosis and treatment of thyroid follicular carcinoma. SUBJECTS AND METHOD: Over a 12-year period, 126 patients surgically treated for FTC with an average follow-up of 57.5 months were retrospectively studied. RESULTS: Eighteen (14.3%) patients had distant metastasis at presentation and completion thyroidectomy was performed for 58 patients (46%) after partial thyroidectomy. This implies how difficult it is to diagnosis this type of cancer at the preoperative or intra-operative stage of treatment. Fine-needle aspiration cytology has been shown to be an ineffective method for the diagnosis of FTC. Five patients developed recurrent distant metastasis 6 month after their initial treatment and 3 patients died of persistent distant metastatic disease. The 10-year overall survival rate were 97.6%, and 10-year disease free survival rate was 82.5%. The patients with minimally invasive follicular carcinoma (n=92) and low risk group according to AMES classification, stage IV in TNM classification had more favorable prognosis. But the results showed no statistically significant difference. CONCLUSION: Several staging systems can be applied specifically to patients with FTC. The distinction of FTC in minimally invasive and widely invasive carcinoma, analysis of prognostic factor (recurrence, local invasion, distant metastasis, age, tumor size) is important in identifying low risk patients for a more conservative treatment.
Adenocarcinoma, Follicular ; Biopsy, Fine-Needle ; Carcinoma ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Survival Rate ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy

BACKGROUND AND OBJECTIVES: Despite relatively high incidences of follicular variant of papillary thyroid carcinoma (FV-PTC), there is a continuous debate regarding the clinical behavior, treatment outcome, prognostic variables and survival of this disease. We performed this study for the purpose of getting further understanding and more supporting ideas for the treatment of FV-PTC. SUBJECTS AND METHOD: A clinicopathologic analysis of 116 patients who underwent a thyroidectomy with a final diagnosis of FV-PTC divided the patients into three groups: the FV-PTC only group (group A, n=78), the FV-PTC group who developed classical papillary thyroid carcinoma (C-PTC) (group B, n=38) and the C-PTC only (group C, n=320, 2003, Korea Cancer Center Hospital). The three groups were compared with respect to the following various clinicopathological characteristics: age at diagnosis, tumor size, stage of tumor, capsular invasion, age, metastasis, extent, size score, multifocality of tumor, LN metastasis, treatment, and recurrence. RESULTS: The mean tumor sizes, disease stage, and type of initial surgery were similar in three groups. However, the prevalence of nodal disease and capsular invasion were significantly higher in the groups B and C compared to the patients of group A. The 8-year disease-free survival rate was 93.7% in the patients with FV-PTC only, 90.4% in the patients with C-PTC only and 88.2% in the patients with FV-PTC group, who developed C-PTC (p>0.05). CONCLUSION: The clinical behavior and prognosis of PTC and FV-PTC groups did not differ significantly. In treating FV-PTC, we find that it is desirable to choose a similar strategy as that used to treat C-PTC.
Carcinoma ; Disease-Free Survival ; Factor IX ; Humans ; Incidence ; Korea ; Neoplasm Metastasis ; Prevalence ; Prognosis ; Recurrence ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy ; Treatment Outcome