Objectives: . Differentiated thyroid cancer (DTC) has a favorable prognosis. However, indeterminate lymph nodes (LNs) are common, making it challenging to distinguish recurrent from persistent DTC. Previous studies have not specifically compared the prognosis between recurrent and persistent DTC. Therefore, we aimed to compare prognosis and oncologic characteristics between these two groups. Methods: . This retrospective cohort study was conducted at a single tertiary care institution and included 265 patients with DTC (recurrent, 109; persistent, 156) who underwent reoperation between November 1, 1999, and August 31, 2018, for structural disease. Patients with distant metastasis at the time of initial diagnosis were excluded. Clinical and oncological characteristics, patterns of LN metastasis, disease-free survival (DFS), and overall survival (OS) were compared between the two groups. For DFS, time zero was defined as the date of the second operation. Results: . Recurrent DTC had a higher incidence of central LN metastasis (P=0.003), infield recurrence (P<0.001), and distant metastasis (P<0.001). In contrast, persistent DTC more frequently exhibited lateral LN metastasis (P=0.003) and outfield recurrence (P<0.001). The most common site of neck LN metastasis was ipsilateral level VI/VII (51.4%) in recurrent DTC and ipsilateral level IV (43.0%) in persistent DTC. Ten-year DFS was significantly lower in recurrent DTC than in persistent DTC (41.0% vs. 67.9%; P<0.001). Recurrent DTC, older age, a higher number of metastatic LNs at the second operation (first reoperation), and R1/R2 resection at the second operation were associated with decreased DFS. OS did not significantly differ between recurrent and persistent DTC (P=0.160). Conclusion . Recurrent DTC is associated with poorer DFS than persistent DTC, although OS does not significantly differ between the two groups.

Lymphocele is a complication of pelvic surgery that infrequently leads to compressive neuropathy. We present a case of compressive obturator neuropathy resulting from lymphocele development after pelvic surgery. Electrodiagnostic studies revealed severe axonal disruption in the left obturator nerve, which is associated with poor functional recovery. This case underscores the role of electrodiagnostic testing in the diagnosis and rehabilitation of patients experiencing lower limb weakness following gynecological pelvic surgery.

Mutations in the adenylosuccinate synthase 1 (ADSSL1) gene, resulting in adenylosuccinate synthase deficiency, are a rare genetic anomaly characterized by muscular weakness, elevated serum creatine kinase levels, and pathological muscle findings. However, these clinical symptoms are similar to those observed in many other myopathies, increasing the risk of misdiagnosis. In an era of rapidly expanding genetic knowledge, the authors sought to verify the diagnostic utility of electromyography for genetic disorders. Through combined electrophysiological and genetic studies, a patient initially thought to have Becker’s muscular dystrophy was conclusively diagnosed with ADSSL1 mutagenic myopathy. This case underscores the importance of re-evaluating diseases that do not follow the typical clinical progression of traditional myopathies, especially in light of recent diagnostic advancements.

Purpose: This study was conducted to establish whether an ethanol extract of Lycium barbarum leaves (LLE) and an ethanol extract of Lycium barbarum leaves from which chlorophyll has been removed, denoted as LLE(Ch−), have a protective effect against hepatic fat accumulation. Methods: The inhibitory effects of LLE and LLE(Ch−) on liver fat accumulation were examined in C57BL/6 mice with non-alcoholic fatty liver disease (NAFLD) induced by an methionine and choline deficient diet and in HepG2 cells with palmitic acid-induced fat accumulation. Results: The plasma triglyceride, aspartate aminotransferase, and alanine aminotransferase levels were lower in the LLE(Ch−) group, whereas the plasma ALT activity decreased significantly in the LLE group. In both the LLE and the LLE(Ch−) groups, the triglyceride and cholesterol contents in the hepatic tissue were significantly reduced. A greater inhibitory effect on tissue fat accumulation was observed in the LLE(Ch−) group than in the LLE group. In HepG2 cells, LLE and LLE(Ch−) were non-toxic up to a concentration of 1,000 µg/mL. Compared to the control group, intracellular fat accumulation in the LLE and LLE(Ch−) groups were significantly reduced at concentrations of 200 µg/mL and 500 µg/mL, respectively. The expression of phosphorylated adenosine monophosphate-activated protein kinase and phosphorylated acetyl-CoA carboxylase in both LLE groups increased at the concentrations of 100 μg/mL and 500 μg/mL. The fatty acid synthase expression was suppressed in a concentration-dependent manner at 10 μg/mL. Conclusion The examined two ethanol extracts of LLE inhibit hepatic fat accumulation in NAFLD. This effect was more pronounced in the LLE(Ch−) group. Therefore, these 2 extracts have an anti-steatosis effect and can be used for NAFLD treatment.

Pancreatic metastasis from papillary thyroid cancer (PTC) is extremely rare; only 18 cases have been reported in the literature. However, several reviews have highlighted similar characteristics between metastatic and primary pancreatic tumors. The patient was a 51-year-old male with a history of total thyroidectomy, modified radical neck dissection, and radioactive iodine ablation for PTC in 2014. Nodules suspected of metastasis were found in both lungs on chest computed tomography (CT). However, after 6 months, a follow-up chest CT showed no increase in size; thus, a follow-up observation was planned. Six years after his initial diagnosis, abdominal CT and pancreas magnetic resonance imaging revealed a 4.7 cm cystic mass with a 2.5 cm enhancing mural nodule in the pancreas tail. We diagnosed the pancreatic lesion as either metastatic cancer or primary pancreas cancer. The patient underwent distal pancreato-splenectomy. After surgery, the pathological report revealed that the mass was metastatic PTC. Pancreatic metastasis from PTC indicates an advanced tumor stage and poor prognosis. However, pancreatectomy can increase the survival rate when the lesion is completely resectable. Therefore, surgical resection should be considered as a treatment for pancreatic metastasis from PTC.