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Clinico-morphological, epidemiological and surgical particularities of adenoma and thyroid gland cancer


Author: Ţîbîrnă Andrei
Degree:doctor of medicine
Speciality: 14.00.14 - Oncology and Radiotherapy
Year:2010
Scientific adviser: Vladimir Hotineanu
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Scientific consultant: Anatolie Cernîi
doctor habilitat, professor, Public Medical Sanitary Intitution Institute of Oncology
Institution: Public Medical Sanitary Intitution Institute of Oncology
Scientific council: DH 52-14.00.14-27.03.08
Public Medical Sanitary Intitution Institute of Oncology

Status

The thesis was presented on the 14 April, 2010
Approved by NCAA on the 3 June, 2010

Abstract

Adobe PDF document – 2.09 Mb / in romanian

Keywords

Thyroid gland, cancer, adenoma, epidemiology, echography, cytology, histopathology, immunohistochemistry, electron microscopy, surgery

Summary

The thesis structure: introduction, 6 chapters, conclusions, bibliography of 170 works, 1 supplement, 157 pages of basic text, 98 figures, 20 tables. The obtained results are published in 17 scientific papers and 2 patents.

The field and aim of study. The current study is referred to oncology, especially to aspects of evaluation, diagnosis and surgical treatment of thyroid adenoma and cancer. The aim of the work was to evaluate the interrelations between thyroid adenomas and cancer using epidemiological, morphological and clinical methods, as well as to resolve some problems in surgical treatment of studied thyroid pathology.

Novelty and scientific originality. It was distinguish knew epidemiological aspects of morbidity by thyroid cancer depending on pollution of territory with radioactive isotopes and it was established the evolution frequency of cancer on the background of follicular adenoma. On the basis of sensibility and specificity of different methods of investigation was elaborated an algorithm of diagnosis of thyroid nodular pathology. It was elaborated new surgical proceedings to prevent postoperative complications and to improve the thyroid cancer treatment.

Theoretical significance and applied value of the work. For the first time it was used a complex methodology to evaluate the evolution characteristics of thyroid cancer in different period of time and relating to background tissue predisposing to malignization. For the first time it was distinguished by immunohistochemical criteria adenomas in which appeared atipic follicular cells of adenoma associated with cancer, and it was put in evidence a new category of carcinoma with epithelio-mezenchimal transition of thyrocites. It was elaborated a new surgical proceeding that consists in implantation of parathyroid gland in cervical muscles.

Obtaining results. The epidemiology study was based on data of 2411 patients with thyroid cancer and 2543 patients with benign thyroid pathology. In clinico-morphological studies were included 534 of patients with cancer developed on the background of adenoma and struma Hashimoto. Epidemiologically in the Republic of Moldova it was established an increasing annual incidence of thyroid pathology, more prominent between women than men. In conformity with our data, the main factors of increasing incidence could be considered the pollution with Cs137 isotope and I131, also Iodine deficiency in water and ground. It was elaborated a diagnostic algorithm of thyroid nodules, that included clinical examination, scintigraphy, ultrasound and cytology examination by punction. It was demonstrated the importance of immunohystochemy and electron microscopy in diagnosis of thyroid nodules and in appreciation of differentiation degree of thyroid carcinoma. Regarding the surgical treatment of patients with nodular pathology of thyroid gland, the most adequate and conservative surgery was proved to be extrafascial operation, which assure ablation and radicalism. Such operation preserves hormonal function of thyroid tissue and good quality of life, allows to obtain a survival rate at 5 years to 98,7% of patients.