Thyroid Diseases: Bastagli A

Rosato L, Miccoli P, Pinchera A, Lombardi G, Romano M, Avenia N, Bastagli A, Bellantone R, De Palma M, De Toma G, Gasparri G, Lampugnani R, Marini PL, Nasi PG, Pellizzo MR, Pezzullo L, Piccoli M, Testini M. · Dipartimento di Chirurgia - ASL TO/4, Ospedale di Ivrea, Italy. · G Chir. · Pubmed #19351456 No free full text.

Abstract: AIM: To review and to update the management protocols in thyroid surgery proposed two years ago by 1st Consensus Conference called on the topic by the Italian Association of Endocrine Surgery Units (UEC Club). METHOD: The 2nd Consensus Conference took place November 30, 2008 in Pisa within the framework of the 7th National Congress of the UEC Club. A selected board of endocrinologists and endocrine surgeons (chairmans: Paolo Miccoli and Aldo Pinchera; speaker: Lodovico Rosato) examined the individual chapters and submitted the consensus text for the approval of several experts. This plain and concise text provides the rationale of the thyroid patient management and wants to be the most complete possible tool for the physicians and other professionals in the field. CONCLUSIONS: The diagnostic, therapeutic and healthcare management protocols in thyroid surgery approved by the 2nd Consensus Conference are officially those proposed by the Italian Association of Endocrine Surgery Units (UEC Club) and are subject to review by two years.

Rossi S, Fugazzola L, De Pasquale L, Braidotti P, Cirello V, Beck-Peccoz P, Bosari S, Bastagli A. · Pathology Unit, Department of Medicine, Surgery and Dentistry, Ospedale S Paolo and Ospedale Maggiore IRCCS, University of Milan School of Medicine, Milan, Italy. · Endocr Relat Cancer. · Pubmed #15947103 links to  free full text

Abstract: We report the simultaneous occurrence of medullary thyroid carcinoma (MTC) and papillary thyroid carcinoma (PTC), presenting as spatially distinct and well-defined tumour components, in three cases. In the first patient, histology, immunohistochemistry and electron microscopy demonstrated an MTC in the one nodule and PTC in two additional lesions. Non-neoplastic thyroid parenchyma separated the three nodules. Metastasis from PTC was diagnosed in a regional lymph node. Genetic analysis of both tumour components showed a distinctive mutational pattern: in the MTC a Cys634Arg substitution in exon 11 of the RET gene and in the two PTC foci a Val600Glu substitution in exon 15 of the BRAF gene. The other two patients are members of a large multigenerational family affected with familial MTC due to a germline mutation of the RET gene (Ala891Ser). Both patients harboured, besides medullary cancer and C-cell hyperplasia, distinct foci of papillary thyroid cancer, which was positive for Val600Glu BRAF mutation. Review of the literature disclosed 18 similar lesions reported and allowed the identification of different patterns of clinical presentation and biological behaviour. So far, the pathogenesis of these peculiar cases of thyroid malignancy has been completely unknown, but an underlying common genetic drive has been hypothesised. This is the first report in which two mutations, in the RET and BRAF genes, have been identified in three cases of MTC/PTC collision tumour, thus documenting the different genetic origin of these two coexisting carcinomas.

De Pasquale L, Sommaruga L, Andreani S, Bastagli A. · Unità di Chirurgia Endocrina, Azienda Ospedaliera, Polo Universitario San Paolo, Milano. · Chir Ital. · Pubmed #15452996 No free full text.

Abstract: In this paper the authors describe the case of 64-year-old woman who had been suffering from poorly defined thyroid disease for 30 years and Hashimoto's thyroiditis for 3 years, with recent detection of high serum calcitonin and CEA. Her family history was negative for endocrinological diseases and her general medical history was not significant for any diseases, except for mild hypertension. There were no pathological findings at physical examination. Cervical ultrasound showed 2 nodular lesions of the right lobe of the thyroid and the isthmus. FNABs of these nodules were performed under ultrasound control and proved non-diagnostic. The patient underwent total thyroidectomy. Intra-operative frozen sections were negative for cancer. Definitive histological examination was positive for medullary carcinoma of the right thyroid lobe (diameter 0.6 cm) in Hashimoto's thyroiditis. The association between thyroid cancers deriving from follicular cells and Hashimoto's thyroiditis is documented in the literature and would appear to determine a better prognosis. Cases such as the one presented in this paper, however, are rare and it is debated whether lymphocyte infiltration may predispose to the onset of medullary carcinoma or whether it is a defence against the tumour.

Bastagli A, de Pasquale L, Schubert L. · Clinica Chirurgica, U.D.A. di Endocrinochirurgia, Polo Universitario, Azienda Ospedaliera San Paolo, Università di Milano. · Ann Ital Chir. · Pubmed #11765345 No free full text.

Abstract: PURPOSE: The role of frozen section (FS) in determining thyroidectomy extent in patients with follicular neoplasms is debated. The Authors consider FS usefulness through experience retrospective review. MATERIAL AND METHODS: From January 1980 to June 1999, 1252 Fine Needle Aspirations (FNA) were performed in patients with thyroid nodules. Out of these, 155 (12.4%) resulted follicular neoplasms. All these patients were operated on: 54 had total thyroidectomy because of both lobes disease and 101 had emithyroidectomy with FS. FS results were compared to definitive histological examination. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of frozen section have been estimated. RESULTS: Out of 155 follicular neoplasms, 15 resulted malignant at definitive histological examination: 6 were diagnosed by FS. All 6 patients had a total thyroidectomy during the same operation. Of the rimanenti 9, 6 had a second operation for radicalization within 2-3 days. FS sensitivity was 42.9%, specificity 100%, accuracy 92.0%, PPV 100% and NPV 8.5%. DISCUSSION: Some Authors consider FS useful because it allows to radicalize the operation immediately, in case of positivity for malignancy. Even if only few patients, the possibility to solve the problem in a one-step procedure is a great advantage. Other Authors consider FS useless because to diagnose a poor number malignant neoplasms, a lot of intra-operative examination have to be done. Costs are higher than benefits. CONCLUSIONS: The Authors believe that both attitudes are correct and the decision of using or not FS cannot be standardized.

De Pasquale L, Schubert L, Bastagli A. · Second Department of General Surgery, Post-graduate School of Thoracic Surgery, Milan. · Chir Ital. · Pubmed #11190548 No free full text.

Abstract: AIM: To study the feasibility of thyroid surgery in a short-stay hospitalization regimen, with particular reference to postoperative hypocalcemia. METHODS: The clinical files of 696 patients operated on from January 1977 to January 2000 for thyroid diseases were analyzed. They were divided into groups on the basis of extent of operation and type of disease. Hypocalcemia incidence was compared between the different groups of patients. Data were analyzed statistically using the chi-square and Fisher's exact tests. RESULTS: There were 74 temporary (10.6%) and 12 (1.7%) persistent hypocalcemia cases. None of these occurred in patients undergoing lobectomy. The incidence of hypocalcemia was higher in two-lobe vs. single-lobe operations (p < 0.05), in total thyroidectomy with lymphadenectomy vs. total thyroidectomy (p < 0.05) and in hyperthyroidism vs. patients with normal serum hormone levels (p < 0.05). 84.9% of hypocalcemia cases developed on postoperative day 1, with only one tetanic crisis. CONCLUSIONS: Thyroid surgery in the short-stay hospitalization regimen is feasible for all patients undergoing lobectomy. Patients undergoing subtotal or total thyroidectomy may be treated in a short-stay regimen, only if they are affected with non-hyperfunctioning benign diseases and if they have normal serum calcium levels on postoperative day 1.

Vitri P, Galimberti A, De Pasquale L, Vago L, Boldorini R, Bastagli A. · II Dept. of General Surgery L. Sacco Hospital, University of Milan, Italy. · J Exp Clin Cancer Res. · Pubmed #10746987 No free full text.

Abstract: A rare case of mixed follicular-parafollicular thyroid carcinoma which occurred in a 50-year-old man, is reported. The ultrastructural aspects of the tumor showed: a biphasic growth pattern with microfolliculi and solid areas; the coexpression of thyroglobulin and calcitonin antigens in the same follicle-like structures; the presence of neuroendocrine granules, microvilli and intracytoplasmic canaliculi bordered by microvilli. These characteristics lead us to a diagnosis of mixed follicular-parafollicular thyroid carcinoma.