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Karatzas T.,National and Kapodistrian University of Athens | Vasileiadis I.,Venizeleio Pananeio General Hospital | Charitoudis G.,Venizeleio Pananeio General Hospital | Karakostas E.,Venizeleio Pananeio General Hospital | And 2 more authors.
Hormones | Year: 2013

Objective: the extent of thyroidectomy for papillary thyroid microcarcinoma (PtMc) is debatable. this study investigated the rate and predictive factors of bilateral versus unilateral PtMc with the objective of identifying those patients who may benefit from total thyroidec-tomy. design: between January 2001 and December 2008, 2019 patients who underwent total thyroidectomy were examined. A total of 319 patients diagnosed histopathologically as PtMc were included in the study. the predictive value of age at diagnosis, gender, tumor size, multifocality, lymph node metastasis, thyroid capsule invasion and nonincidental diagnosis using univariate and multivariate analyses were retrospectively analyzed. Results: Of the 319 patients with PtMc, 77 (24.1%) presented bilateral disease. In univariate analysis, size of tumor ≥5mm (p<0.001), multifocality (p<0.001), lymph node metastases (p<0.001), thyroid capsule invasion (p<0.001) and nonincidental diagnosis (p=0.002) were significantly associated with bilaterality. In multivariate analysis, tumor size (p<0.001), multifocality of the primary tumor in the unilateral lobe (p<0.001) and lymph node metastasis (p<0.001) were independent predictive factors for bilateral PtMc. Conclusions: tumor size ≥5mm and multifocality of the primary carcinoma in the unilateral lobe were independent risk factors for bilateral PtMc. total thyroidectomy should be considered for these patients, which is of importance for the prediction of possible recurrence of disease.


Boutzios G.,National and Kapodistrian University of Athens | Vasileiadis I.,Venizeleio Pananeio General Hospital | Zapanti E.,National and Kapodistrian University of Athens | Charitoudis G.,Venizeleio Pananeio General Hospital | And 3 more authors.
Thyroid | Year: 2014

Background: Patients with Graves' disease (GD) and thyroid nodules have an elevated risk of developing thyroid carcinomas, which is primarily accounted for by well-differentiated tumors. Among these tumors, certain histological variants, such as the diffuse sclerosing and tall cell carcinoma, are characterized by a more aggressive behavior. The aim of this study was to evaluate the incidence, the clinical behavior in relation to histological variants, and the outcome of papillary thyroid carcinoma (PTC) in a cohort of patients with GD who had undergone thyroidectomy. Methods: A total of 2188 patients who underwent total thyroidectomy participated in this retrospective, nonrandomized, population-based study at a General Hospital. Of these patients, 181 had GD. The parameters examined included the clinical characteristics of the tumor and the final pathological examination of the thyroid carcinoma. Results: PTC was diagnosed in 570 patients. Among the 61 with PTC GD-positive, 59.0% presented with the pure papillary variant, 19.7% with the follicular variant, 6.6% with the sclerosing variant, and 18.0% with the tall cell variant (TCV) of PTC. Among 509 PTC GD-negative, 80.6% had pure papillary variant, 9.0% follicular variant, 3.7% sclerosing variant, and 6.1% TCV. Patients with tumor size >5 and ≤10 mm demonstrated that lymph node metastasis (p=0.001) and TCV in histological examination (p=0.003) were statistically significantly associated with GD-positive PTC. Conclusions: The incidence of PTC in GD-positive patients is higher than that in GD-negative patients. Aggressive variants of PTC, such as the TCV, were more frequent in nodular micro-PTC. These findings suggest that prompt and meticulous evaluation of nodules in any patient with GD associated with nodular alterations must be considered. © Copyright 2014, Mary Ann Liebert, Inc.


Vasileiadis I.,Venizeleio Pananeio General Hospital | Vasileiadis I.,Democritus University of Thrace | Karakostas E.,Venizeleio Pananeio General Hospital | Charitoudis G.,Democritus University of Thrace | And 4 more authors.
European Journal of Clinical Investigation | Year: 2012

Background There is debate concerning the clinical significance of papillary thyroid microcarcinoma (PTMC), and therefore, the rise in the incidence of PTMC creates management dilemmas. The purpose of this study was to analyse the clinicopathological characteristics of PTMC in an island region that has a high prevalence of goitre and to determine risk factors for the worst prognosis. Materials and methods Data from 1874 patients who underwent a total thyroidectomy between January 2002 and December 2008 were reviewed retrospectively. A total of 276 patients who were diagnosed with PTMC in a final pathology report were included in the study. A PTMC was defined as a papillary thyroid carcinoma with a diameter ≤10mm. Clinicopathological features were evaluated by both univariate and multivariate analyses. Results Of the 276 patients with PTMC, 219 patients (79·3%) were incidentally diagnosed. Two hundred and two patients had carcinomas of ≤5mm, and 74 patients presented with carcinomas that ranged in size from 0·6 to 1·0cm. Lymph node metastasis was diagnosed in 3·5% of patients with tumours ≤5mm, and 21·6% of patients presented tumours >5mm. Upon multivariate analysis, clinically suspected diagnosis, a tumour size >5mm and an age over 45years at diagnosis were independent risk factors for capsule invasion, while tumour multifocality, bilaterality, size of tumour >5mm and thyroid capsule invasion were independent risk factors for lymph node metastasis at diagnosis. Conclusions Patients presenting multifocal, bilateral PTMC with a maximum diameter >5mm and thyroid capsule invasion may have an increased risk of lymph node metastasis. These factors should be considered in the follow-up for these patients. © 2011 The Authors. European Journal of Clinical Investigation © 2011 Stichting European Society for Clinical Investigation Journal Foundation.


Vasileiadis I.,Venizeleio Pananeio General Hospital | Boutzios G.,National and Kapodistrian University of Athens | Charitoudis G.,Venizeleio Pananeio General Hospital | Koukoulioti E.,National and Kapodistrian University of Athens | Karatzas T.,National and Kapodistrian University of Athens
Annals of Surgical Oncology | Year: 2014

Background. Hashimoto thyroiditis (HT) is associated with an increased risk of developing papillary thyroid carcinoma (PTC). The relationship between thyroid autoimmunity and cancer remains controversial. The purpose of this study was to investigate whether the preoperative TgAb could be a potential predictor of PTC in patients with thyroid nodules and to assess whether there is an association of preoperative TgAb with lymph node metastases. Methods. This retrospective, nonrandomised study included 854 patients who underwent standard total thyroidectomy. Benign thyroid nodules were diagnosed in 447 patients, and 407 presented with malignant nodules. The examined parameters included the clinical characteristics, preoperative TSH and TgAb levels, and the histopathological characteristics of the tumour. Results. Tumour size >10 mm (p = 0.01), the presence of PTC (p < 0.001), elevated TSH levels (2.64 ± 1.28 μU/ml vs. 2.09 ± 0.98 μU/ml, p = 0.001), HT (p < 0.001), and lymph node metastasis (p = 0.005) were significantly associated with positive TgAb. Additionally, tumour size >10 mm (p < 0.001), preoperative TgAb positivity (p = 0.003), and elevated TSH levels (TSH > 3.4 μU/ml, p = 0.038) were independent risk factors for PTC based on the multivariate logistic regression analysis. Conclusions. This study showed that TgAb positivity was an independent risk factor for PTC. A positive correlation between TgAb and PTC in patients with indeterminate nodules was existed. Additionally, a positive correlation existed between TgAb and lymph node metastases in patients with PTC. Prospective studies with a larger number of patients and long-term follow-up are needed clarify the potential role of positive serum TgAb in the prediction of PTC. © 2014 Society of Surgical Oncology.


PubMed | National and Kapodistrian University of Athens and Venizeleio Pananeio General Hospital
Type: Journal Article | Journal: American journal of surgery | Year: 2016

We investigated the efficacy of thyroglobulin antibodies (TgAb) in detecting malignancy in indeterminate thyroid nodules and evaluated the possible association between TgAb and autoimmunity in papillary thyroid carcinoma (PTC).This retrospective, nonrandomized study included 1,646 patients who had undergone preoperative fine-needle aspiration biopsy to evaluate their thyroid nodules, and then standard total thyroidectomy. Of 194 patients (11.8%) with indeterminate nodules, 61 (31.4%) had PTC and 133 (68.6%) had benign nodules at the final histologic examination.Univariate analysis showed that multifocality (P = .002), bilaterality (P = .003), lymph-node metastasis (P = .030), and capsule penetration (P = .003) were significantly associated with positive TgAb in patients with indeterminate cytology and histopathologic diagnosis of PTC. The multivariate analysis showed that TgAb positivity (P < .001) and preoperative thyroid-stimulating hormone levels (P = .022) were independent predictive factor for PTC diagnosis in patients with indeterminate cytology.Preoperative TgAb could be a marker for PTC in patients with indeterminate thyroid nodules, increasing diagnostic accuracy. TgAb positivity could also influence the clinical assessment and subsequent selection of total thyroidectomy.


PubMed | National and Kapodistrian University of Athens and Venizeleio Pananeio General Hospital
Type: Journal Article | Journal: JAMA otolaryngology-- head & neck surgery | Year: 2016

Injury of the recurrent laryngeal nerve (RLN) is one of the most serious complications of thyroid surgery. Intraoperative neuromonitoring (IONM) has been introduced to verify RLN function integrity and may be a helpful adjunct in nerve dissection.To determine whether the use of IONM can reduce the incidence of RLN injury in patients undergoing total thyroidectomy.This cohort study included 2556 patients who underwent total thyroidectomy between January 2002 and December 2012 in the Department of Otolaryngology-Head and Neck Surgery of Venizeleio General Hospital, Heraklion, Greece. Patients who had IONM during the procedure (n=1481) were compared with patients who underwent surgery with nerve visualization alone (n=1075). All patients underwent indirect laryngoscopy-fiberoptic nasopharyngoscopy both preoperatively and on day 2 after surgery to assess vocal cord motility.Use of IONM and incidence of RLN injury.A total of 2556 patients (2028 women and 528 men [5112 RLNs at risk]; mean [SD] age, 51.35 [14.18] years; age range, 18-89 years) underwent total thyroidectomy. Univariate analysis showed that the use of IONM resulted in a significant reduction in RLN injury incidence (3.3% vs 0.7%) with a relative risk reduction of 2.6% (odds ratio [OR], 5.15; 95% CI, 3.12-8.49; number needed to treat, 19). Multivariate logistic regression showed that no use of IONM was an independent risk factor for RLN injury in patients who underwent total thyroidectomy (adjusted OR [AOR], 5.44; 95% CI, 3.26-9.09). Additional risk factors for RLN injury were operative time (AOR, 12.91; 95% CI, 6.66-25.06), maximum diameter greater than 45 mm of right thyroid lobe (AOR, 4.91; 95% CI, 3.12-8.56) and left thyroid lobe (AOR, 2.24; 95% CI, 1.39-4.32), extrathyroid extension (AOR, 3.26; 95% CI, 1.62-6.59), incidental parathyroidectomy (AOR, 3.30; 95% CI, 2.13-5.09), and tumor size larger than 10 mm (AOR, 3.24; 95% CI, 1.59-6.62).Our findings showed that the use of IONM decreased significantly both temporary and permanent RLN injuries. The technology of IONM is safe and reliable, and this technique is an important adjunct in nerve dissection and functional neural integrity. The routine use of IONM reduced pitfalls and provided guidance for our surgeons in difficult cases, reoperations, and high-risk patients.


Pappas K.,Venizeleio Pananeio General Hospital
Current Opinion in Pulmonary Medicine | Year: 2011

Purpose of Review: Bronchial and bronchiolar abnormalities in interstitial lung diseases (ILDs) are an issue often underestimated. However, new interstitial patterns with bronchiolar involvement are being described and the concept is still evolving. The scope of this review is to introduce a comprehensive approach to airway disorders in the context of ILDs, mainly from a pathologic perspective. Recent Findings: Recent studies have revealed significant inflammatory and structural alterations at the level of small airways in idiopathic interstitial pneumonias, which may participate in the lung-remodeling pathogenetic process. A suggested pathogenetic role of cigarette smoking for lung-remodeling in smoking-related ILDs is further investigated, and unclassified fibrosis as a prominent feature in lung biopsy specimens of smokers has been established. New targeted therapies for lymphangioleiomyomatosis based on molecular and biologic properties of the disease are currently undergoing clinical trials. Combined pharmaceutical and interventional therapeutic regimens are of growing concern for refractory airway lesions in sarcoidosis. The application of volumetric high-resolution computed tomography (HRCT) chest scanning with acquisition of expiratory images provides valuable information about the involvement of small airways in ILDs. Summary: The imaging and pathologic focus on airway abnormalities in ILDs make them an integral part of their pathology with a significant pathogenetic role in interstitial processes and variable contribution to the functional status of patients. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Vasileiadis I.,Venizeleio Pananeio General Hospital | Mastorakis G.,Venizeleio Pananeio General Hospital | Ieromonachou P.,Venizeleio Pananeio General Hospital | Logothetis I.,Venizeleio Pananeio General Hospital
Laryngoscope | Year: 2013

Symmetrical lipomatosis of the tongue is an extremely rare condition. To date, only eight cases have been reported in the literature. We present an extremely rare case of intramuscular lipomatosis of the tongue in a 67-year-old male. The present case is unique because of its infiltrating nature and the extension of the lesion. Glossectomy was performed to reduce the size of the tongue and for diagnosis. The literature is reviewed and clinical characteristics, pathology, and surgical treatment are discussed. Laryngoscope, 2012 Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.


Vasileiadis I.,Venizeleio Pananeio General Hospital | Sofopoulos M.,Greek Anticancer Institute | Arnogiannaki N.,Greek Anticancer Institute | Georgopoulos S.,Venizeleio Pananeio General Hospital
Journal of Oral and Maxillofacial Surgery | Year: 2013

Metastatic tumors to the palatine tonsils are extremely rare, with nearly 100 cases reported. Only 3 cases of Merkel cell carcinoma of the skin metastasizing to the palatine tonsil have been reported. We present the interesting case of a 61-year-old man with an enlargement of the left palatine tonsil that caused a moderate narrowing of the oropharynx. Three years previously he had been treated for Merkel cell carcinoma (MCC) on skin of his left shoulder. A tonsillectomy followed by palatoplasty was performed. Immunohistochemical staining demonstrated a pronounced reaction for cytokeratin 20, chromogranin, and CD56 histodiagnostic markers. Immunohistochemical studies are useful diagnostic tools in the establishment of the diagnosis of MCC. Treatment includes wide local surgical excision of the tumor, radiotherapy, and chemotherapy. Considering the aggressiveness of MCC, an early diagnosis is critical to enable the choice of adequate therapy at an early stage. © 2013 American Association of Oral and Maxillofacial Surgeons.


Vasileiadis I.,Venizeleio Pananeio General Hospital | Stratoudaki R.,Venizeleio Pananeio General Hospital | Karakostas E.,Venizeleio Pananeio General Hospital
International Journal of Pediatric Otorhinolaryngology | Year: 2012

Cogan's syndrome is characterized by interstitial keratitis, vestibular impairment and hearing loss, commonly bilateral. Many patients, especially children, experience a delay in proper diagnosis which may delay treatment and thus impact on prognosis of hearing restoration. Less than 10 pediatric cases of Cogan's syndrome have been reported in literature and only five of them were reported with long-term follow-up. We report an extremely rare pediatric case of Cogan's syndrome typical form with long-term follow-up and evaluation of hearing impairment.Cogan's syndrome must be familiar to otorhinolaryngologists, pediatricians and ophthalmologists because early diagnosis and rapid administration of the proper therapy increase the probability of recovering hearing loss. © 2012 Elsevier Ireland Ltd.

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