Association hyperthyroïdie et cancer thyroïdien différencié (médullaire exclu). À propos de sept observations

The aim of this study was to draw attention to the fact that hyperthyroidism does not exclude the possibility of concurrent thyroid carcinoma. We analyzed the frequency and consequences of this association through seven cases of thyrotoxic patients with differentiated thyroid carcinoma followed by a review of literature.

Patients and methods

The nuclear medicine department of the CHU Ibn Sina has more than 3000 cases of differentiated thyroid carcinoma where 10 patients with association of hyperthyroidism could be retrieved. Our study focused on seven cases well documented and regularly followed. The main parameters collected were the following: age, sex, personal and family history of thyroid disease, clinical presentation, etiology of hyperthyroidism, preoperative paraclinical explorations, surgery performed, histopahological findings, complementary therapy and follow-up.

Results

Group included six females and one male, average age was 41.4 years. There were four cases of Graves’ disease, two cases of single toxic nodule and one case of functional multinodular goiter. All patients underwent total thyroidectomy. Final pathologic examination disclosed five papillary carcinomas and two follicular carcinomas. During 2 to 8 years follow-up, there was neither local recurrence nor metastasis.

Conclusion

The diagnosis of hyperthyroidism does not preclude concurrent thyroid carcinoma. Careful assessment of such patients is mandatory to exclude an associated thyroid malignancy particularly in the presence of a nodule in a hyperfunctioning thyroid.     

Métastase rénale d’un carcinome vésiculaire de la thyroïde révélée par le balayage du corps entier à l’iode 131

Distant metastasis of differentiated thyroid carcinoma generally affect lung and/or bone tissue. Renal metastasis from thyroid carcinoma is extremely rare. We report a case of renal metastasis from a follicular thyroid carcinoma in a 55-year-old man, occuring 11 years after total thyroidectomy, fortuitously discovered on a whole body scan carried out after 131-iodine therapy for neck recurrence of disease. Salient features of our clinical case are the fortuitous mode of discovery the unilateral localization of metastases and especially the long time interval which separates its detection from that of the primitive tumour. This case report exemplifies the useful role of the whole body scan carried out after 131-iodine therapy better adapted to reveal often undetectable occult metastases with low dose, but also to ensure a regular and protracted follow-up of patients treated for differentiated thyroid carcinoma.     

Introduction à l’étude du site de Longgupo

The site of Longgupo, discovered in 1984, is located south of the crossing of the Three Gorges of the Yangtze, in the eastern part of Chongqing Province. Situated on the limestone slope of the Miaoyu Valley, three excavation campaigns have been carried out since 1985. The first two seasons took place from 1985–1988 and 1997–1998, directed by W.B. Huang and the last campaign from 2003–2006 by E. Boëda and Y.M. Hou. After the first two campaigns, the presence of several bones, with an estimated age of 1.9 My, notably including a mandible fragment attributed to a hominid² and the discovery of more than 20 lithic artifacts incited not only great interest in the scientific community, but controversy as well since these data contradicted diffusion models of the first hominids out of Africa. Paleoanthropological data often being privileged over other data, including lithic artifacts, the anthropic nature of the site was contested. Yet the few artifacts from the initial excavations irrefutably demonstrate their manufacture by humans, in particular those in exogenous stone. To definitively re-establish the authenticity of this site by applying the latest investigative methods, a new Franco-Chinese campaign was organized. The objective of the 2003–2006 field seasons focused on understanding and analysis of the archaeological data in their geomorphological and stratigraphic contexts.     

Apport de l’imagerie hybride TEMP-TDM dans le suivi d’un cancer différencié de la thyroïde

In the management of patients with differentiated thyroid cancer (DTC), abnormalities detected on planar whole body scan and ¹³¹I-SPECT are difficult to interpret because of a lack of anatomical landmarks and limited specificity. Integrated ¹³¹I-SPECT-CT imaging has an additional value for characterization of equivocal tracer uptake seen on planar imaging as well as for precise localization. We illustrate through an observation the incremental diagnostic value of ¹³¹I-SPECT-CT images in the diagnosis of a cervical lymph node mimicking a physiological uptake on planar views. A 35-year-old Tunisian female was followed for papillary thyroid carcinoma, for which she underwent total thyroidectomy and iratherapy. Three years after a complete remission, the thyroglobulin (Tg) level on TSH stimulation increased. Diagnostic planar images with ¹³¹I did not disclose any obvious pathological foci. Furthermore, we noticed an increased ¹³¹I-uptake in the left sub-mandibulary area, which suggested a salivary physiological activity. SPECT-CT of the neck and chest were then performed with a Symbia T camera. Fused images demonstrate that this activity corresponds to a cervical lymph node closely adjacent to sub-mandibulary gland. Management of the patient was then changed. In selected patients with DTC, hybrid imaging should be used as a complementary to planar imaging in terms of diagnostic accuracy, because of superior focus localization and additional anatomic information derived from the CT component. Integrated SPECT-CT is then a useful tool, especially in cases of unclear diagnoses, precising anatomical localization of areas of increased ¹³¹I-uptake and distinguishing malignant lesions from normal physiological uptakes. This is particularly important in an oncologic center, as ours, where we don’t yet have a positron emission tomography (PET) camera is not yet available.     

Apport de la fusion d’images tomoscintigraphiques avec la tomodensitométrie X ou l’imagerie par résonance magnétique en pathologie osseuse : expérience du service de médecine nucléaire de Sfax

The aim of our study was to assess the contribution of image fusion of SPECT combined with computed tomography (SPECT-CT) or magnetic resonance imaging (SPECT-MRI) in our daily practice of bone scintigraphy. Seventeen patients underwent a SPECT image fusion, SPECT-CT or MRI in addition to conventional bone scintigraphy. These acquisitions are made separately with images stored in DICOM format. The fusion was operated after a manual coregistration of the images. Results show that in 35.29% of cases, the image fusion allowed to pinpoint the exact location of increased uptake seen on the whole body scan and/or on static images. In 35.29% of cases, the fusion has confirmed a diagnosis doubtful in planar imaging. In five patients, representing 29.41% of cases, the fusion has corrected a diagnosis. In one patient (5.88% of cases), the fusion has eliminated a false positive related to increased uptake visualized on the whole body scan. In two patients (11.11% of cases), the fusion has eliminated false negative of bone scan in one case and of MRI in the other case. Finally, in nine patients (50% of cases), the fusion has influenced the therapeutic management.     

Fixations extra-osseuses du Tc MDP dans le cas d’un cancer du sein métastatique à l’os

Aim

To report and discuss an unusual visceral uptake on bone scan in a case of breast cancer with bone metastases.

Patient and methods

A 40-year-old woman, with untreated bilateral breast cancer was referred to our department for a bone scan.

Results

The bone scan evidenced multiple metastases over the axial skeleton. Uncommonly, visceral uptake was noted associating diffuse bilateral lung uptake and intense myocardium, stomach and kidneys uptakes. Serum calcium level was high: 4.08 mmol/L (normal: 2.38–2.70 mmol/L).

Conclusion

The incidental observation of metastasic calcifications on bone scan is often related to severe hypercalcemia. Such pattern should alert the physician on the existence and the severity of calcium metabolism disturbances that had not been suggested before.     

Valeur pronostique du curage ganglionnaire prophylactique dans le cancer différencié de la thyroïde

Objective

Although the efficacy of total thyroidectomy as the first step in differentiated thyroid cancer (DTC) management is well proven, it is always a matter of controversy whether prophylactic lymph node dissection improves prognosis and survival in DTC patients without suspicion of lymph node metastases either clinically or radiologically. The aim of this work is to study relapse rates in patients according to the initial presentation and type of surgery performed, in order to analyze the prognostic impact of lymph node dissection.

Patients and methods

One hundred and thirty patients with DTC were classified according to clinical presentation and type of surgery performed. They were monitored for six years to watch for recurrence.

Results

In patients with no clinical evident lymph nodes, the relapse rate was lower among patients who underwent total thyroidectomy in one step with prophylactic lymph node dissection.

Conclusion

Based on the results of other studies, and on our department experience of thyroid cancer management and monitoring, we strongly advocate careful and systematic exploration of the central lymph node compartments with exploration of the lateral side of the lesion if in doubt.     

Réflexion sur l’extension de l’Ibéromaurusien au Maghreb à la fin du Pléistocène

This paper proposes a new reflection about the late Pleistocene climate impact on the iberomausian coastal expansion. A recent advancement of palaeoenvironment knowledge allows us from now to apprehend a context and circumstances in which are developed diverse late Pleistocene cultures in the Maghreb. This article tries to understand a cultural dynamic of this period by the light of a contemporary climatic evolution.     

Gestion de la « crise du Mo » en 2010 par un service de médecine nucléaire hospitalier au Luxembourg : bilan

To face the challenges of the “⁹⁹Mo crisis” on a nuclear medicine department level, strategies were implemented to maintain numbers of scintigraphies as usual. We evaluated the efficiency of the measures. Using ^99mTc more rationally led to more profitable generator utilization. As long as the amount of ^99mTc at disposal (> 110%, 90–110% (= standard), 70–90%, 50–70%, 30–50% and < 30%) was greater than 30% of the standard, weekly numbers of ^99mTc-based investigations remained at “standard” level. Cost per mCi of administered ^99mTc remained unchanged. The successfully managed “⁹⁹Mo crisis” was based upon a rigorous organization as well as goodwill of all implicated staff, at the cost however of a lesser patient service. Punctual flexibility of staff members, adapted to the fluctuating work load, allowed global balance between numbers of required and delivered working hours. As efficient crisis management is tedious, generalization of the model cannot be thought of. To guarantee secure future availability of ^99mTc, projects for new nuclear reactors dedicated to producing ⁹⁹Mo are first choice.     

Étude préliminaire des industries archaïques de faciès Oldowayen du site de Hummal (El Kowm, Syrie centrale)

The spring site of Hummal is located in Central Syria, near the village of El Kowm between the Euphrates basin and the desert steppe stretching from Palmyra to Deir-ez-Zor. In 1966 the well was noted in a survey as Bir Onusi and a short preliminary study was carried out at the beginning of the 1980s. Since 1997, the Institute for Prehistory and Archaeological Science of the University of Basel has undertaken a complete interdisciplinary research program of this major site under the direction of J.M Le Tensorer, supported by the Swiss National Science Foundation and associated with the Directorate General of Antiquities and Museums of Syria under the direction of S. Muhesen. The site of Hummal is a prominent mound at an artesian spring built out of the sediments, which piled up during the whole Quaternary. Tectonic faults in the bed rock enabled the underlying water in a karstic system to flow out into a dolina, which trapped lacustrine, limnic and aeolian sediments since the Oldest Pleistocene. The impressive stratigraphy – 20 m high – comprises 23 geological units preserving a great number of archaeological levels. It covers an extremely long period of time ranging from the Oldest Palaeolithic (Oldowan) to Upper Palaeolithic (Aurignacian) over more than a million years. This impressive Old and Middle Palaeolithic sequence comprises several layers of Oldowan-like assemblage (23-16), an Acheuleo-Tayacian complex (14-13), five layers of Yabrudian (12-8) at least four levels of Hummalian (7, 6c, 6b, 6a) and a thick sediment complex with 8 Mousterian layers, each of them liable to be subdivided into several sublayers. The lithic industry in the lowest levels of the Hummal sequence, associated with abundant remains of large mammals, can be characterized by non-modified, quite fresh flakes, with, once in a while, traces of use but never bearing intentional retouches. Theses flakes are found with pebble-tools: choppers, chopping-tools, polyhedrons, bolas and core-like artifacts. This assemblage is typical in a broad sense of archaic Palaeolithic whose debitage corresponds to mode 1. From a techno-typological point of view, this industry tallies quite well with the so-called Oldowan stage. It shows remarkable similarities with the oldest assemblages at Ubeidiya but, so far, with no occurrence of bifacial knapping. If the layers 17 and 18 of Hummal relate to this period dating back to 1.6 to 1.2 million years, these levels would be the oldest ones ever found in central Syria. However, as we have no absolute dating at our disposal so far, we will remain careful in assigning a chronological time span for these layers. For this area, from a stratigraphic point of view, the Oldowan levels of Hummal occur before the Acheulean and certainly before the Acheulean sequence of El Meirah (region of El Kowm) which is itself related to the period before Matuyama-Brunhes paleomagnetic reverse. Dating of the lowest sequence of Hummal is underway. If we take into account stratigraphic and techno-typological observations, we assume that the Oldowan-like levels of the site should be older than one million years at least. The sequence of Hummal is one of the largest in the Near-East. Therefore, it can be regarded as a key-site for world prehistory.     

Apport de l’imagerie hybride TEMP/TDM dans la détection des ganglions sentinelles : à propos de 32 cas

Objectives

Retrospective evaluation of the SPECT/CT role in the Sentinel Lymph Node identification.

Patients and methods

Thirty-two patients underwent a lymphoscintigraphy with SPECT/CT imaging. Those patients presented several cancer types (16 melanoma, one squamous cell carcinoma, three breast cancers, eight vulvar cancers, three cervical cancers).

Results

The scintigraphic detection rate was 81% with planar imaging while this rate was 89% with SPECT/CT. The SPECT/CT provided an additional quantitative information in 66% cases. Moreover, the quality of the interpretation was better in two different conditions (planar interpretation followed by routine and blinded SPECT/CT interpretation) with SPECT/CT. In our study, the false negative rate is 4.5%.

Conclusions

SPECT/CT provides quantitative and qualitative informations in the sentinel lymph node detection. Therefore, it can be a valuable tool for the surgeon to find and harvest the sentinel lymph node especially where the lymphatic drainage pattern can be unusual or hard to predict (cervical or trunk localisation). It's a new tool for preoperative detection and it can decrease the false negative rate.     

Étude de faisabilité du ganglion sentinelle dans le cancer de la prostate par cœlioscopie : premiers résultats

Objectives

The standard lymphadenectomy is currently a challenge in the management of prostate cancer. The aim of this prospective study was to evaluate the performance of the sentinel lymph node (SLN) by laparoscopy in patients with localized prostate cancer, candidates for local treatment.

Patients and methods

Patients were injected transrectal ultrasound-guided with 0.3 mL/100MBq 99^mTc-Sulfur rhenium colloid in each prostatic lobe, the day before surgery. Lymphoscintigraphy was performed after 2 hours. The detection was realized intraoperatively with a laparoscopic probe (Gamma Sup Clerad^®) followed by extensive dissection. Counts of SLN were performed in vivo and confirmed ex vivo. The histological analysis was performed by HPS staining and followed by immunochemistry if SLN was free.

Results

Seventy patients with carcinoma of the prostate at intermediate or high risk of lymph node metastases (D’Amico), PSA median 9.5 ng/mL [6–130], were included in the study. The lymphoscintigraphic detection rate was 94.2% (66/70) and intraoperative of 97.0% (68/70). Fourteen patients had lymph node metastases, six only in SLN. The false negative rate was 2/14 (14.0%). The internal iliac region is the first metastatic site (40.9%). Limited or standard lymph node dissection would have ignored respectively 72.7% and 59.0% of lymph node metastases.

Conclusion

The laparoscopy is adapted to a broad identification of SLN and targeted dissection of these lymph nodes significantly limits the risk of surgical extended dissection while maintaining the accuracy of the information.     

Le Paléolithique ancien de l’Europe orientale et du Caucase

Currently, only Tréhougol’naya Cave has reliably dated evidence for human settlement in Eastern Europe and Caucasus, from the beginning through the middle of the Middle Pleistocene. In Eastern Europe, assemblages from Khriatchi and Mikhailovskoé, and possibly Darvagchai I, appear to be the only stratified locations that tentatively can be compared (despite problems with these materials) with Tréhougol’naya. In the eastern limits of Central Europe, layer VI in Korolevo I is the only stratified assemblage that may be compared with Tréhougol’naya. All these Lower Paleolithic occupations yielded the Pre-Mousterian small tool industries with some pebble tools, but without Acheulean bifaces and Levallois technique. These data suggest that Eastern Europe lies outside the distribution range of the Acheulean techno-complex demarcated with the “Movius Line”. In the Southern Caucasus, the Dmanissi hominine and lithic records document the fact that the earliest small-brained humans – probably later H. habilis-rudolfensis or earlier H. ergaster-erectus hominids bearing Pre-Oldowan technology – initially left Africa and appeared in Western Asia as early as 1.8 Ma ago. However, in the Southern Caucasus, the available chronological data indicate that the Acheulean complex has a later temporal appearance here compared to the Upper Acheulean or Acheulo-Yabrudian in Western Asia. Two main Upper Acheulean industrial variants currently can be recognized in the Southern Caucasus. The first, called the Kudarian by the author (from the caves of Kudaro I, Kudaro III, and Azyk), is characterized by lithics made from mostly siliceous rocks, rare Acheulean bifaces, and non-Levallois flaking technique. The second variant is characterized by lithics made from volcanic rocks, numerous Acheulean bifaces, and often more laminar or Levallois debitage. It can be suggested that there are independent origins for these Southern Caucasus Upper Acheulean industrial variants. Possible roots of the Acheulean assemblages of Kudarian variant might be in the local earlier Lower Paleolithic small tool assemblages with some pebble tools but without Acheulean bifaces. The other Caucasus variant of the Upper Acheulean appears to be related to the Levantine Upper Acheulean.     

Intérêt du dosage de la thyroglobulinémie chez les sujets porteurs du goitre en zones de déficience iodée au Bénin

In the present study, we analyze the results of thyroid hormones and thyroglobulinemia of 162 patients with goiter living in the departments of Collines and Donga, known to be areas of iodine deficiency in Benin. These results are compared with those of 85 healthy subjects living in the same departments. This study is a cross-sectional analytical study carried out from 1st July 2009 to 30th June 2010. The population of patients consisted of seven males and 155 females. The average age was of 45.7 years. Most of the patients were suffering of simple goiter. Only six of them had thyroid nodules. The diagnosis of biological hyperthyroidism was positive for 20 patients; 16 of them had subclinical hypothyroidism and four clinical hyperthyroidism. One case of clinical hypothyroidism was found. All other 141 patients were biologically normal (euthyroidism). Seventeen of the patients (including six patients presenting a thyroid nodule) had a normal thyroglobulin rate. Hyperthyroglobulinemia was observed in all other 145 patients. These results suggest that patients with goiter in zone of iodine deficiency are biologically euthyroid with hyper-thyroglobulinemia. Thyroglobulin dosage is then recommended, especially when nodules are perceptible.     

Procédures de ventilation pulmonaire par aérosol Tc-DTPA : contamination aérienne, contaminations interne et cutanée externe des manipulateurs

Efficiency of an optimization procedure of radiation protection measures with lung ventilation by ^99mTc-DTPA aerosol was evaluated by measuring airborne radioactivity and by looking for external and internal contaminations of technologists. Despite numerous precautions, small amounts of radioactivity were airborne in 71.4% of procedures and a small internal contamination of technologists (1.6–881 Bq; median: 36.3 Bq) was found. The latter was highest in case of deficient patient collaboration and with technical incidents. A very low external contamination (0.1-29.1 Bq; median: 0.1 Bq) was demonstrated with 82% of procedures. Estimated effective doses by internal contamination (0.01-6.2 nSv; median 0.3 nSv) was minimal compared with the maximal legally admissible doses for professionally exposed workers (10 mSv/year); it does not represent an excessive irradiation risk.     

Le gisement acheuléen de plein air de La Garde (Loire). Remarques sur une série lithique acheuléenne entre Rhône et Loire

The lithic assemblage of La Garde offers the opportunity to observe a Final Acheulean series located in the Loire department (south-east France). The site was probably a multi-activity place asking large tools and flakes, according to the strategies used by humans. Three main categories of large bifacial tools mainly made of flint can be described, with a triangular or oval shape and with a transversal cutting edge. These tools are more bifacial-tools than bifaces through the kind of shaping and the retouches on the cutting edges. The Levallois flaking is associated to various other types of knapping. The site, located along a small valley, suggests a human circulating between the Saône-Rhône corridor and the interior basins of the Massif Central Mountains. The Rhodanian corridor yielded little evidence of Acheulean settlements while in the Centre of France, they are numerous. La Garde proves that systematic prospecting in this area will permit in future to complete the map of the Acheulean occupations in south-east France.     

Données stratigraphiques, archéologiques et insertion chronologique de la séquence de Longgupo

The site of Longgupo is located north of the subtropical zone and is part of the domain of eastern fauna. The large number of mammal species identified at this site enables clarification of the broad pattern of paleoenvironmental change for the three assemblages from the first stratigraphic sequence (Huang W.-B. excavations). The different species have been classified in four biogeographic groups: subtropical (moderate monsoon), tropical forest (hot and humid climate), montane (cold climate) and prairie (cold and dry climate). Variation in the representation rate of each of these groups enables general reconstruction of the paleoenvironments for the three assemblages identified at Longgupo: a lower assemblage in a hot and humid climate with cold and dry episodes, an intermediate assemblage in a rather cold and dry climate in the lower part, becoming progressively warmer and humid toward the top of the sequence with a monsoon influence more marked than the present day, and an upper assemblage in a rather cold and dry climate. This biochronology and general paleoenvironmental reconstruction are clearly important, but as mentioned above, the stratum by stratum correspondence between the old and new stratigraphic sequences has been quite difficult because the position of material recovered during the early excavations was not recorded.     

Segmentation d’images synchronisées à la respiration en TEP/TDM : étude sur fantôme

The aim of this study is to evaluate the accuracy of segmentation method by adaptive threshold in gated respiratory PET/CT and to deduce their indications and limits. Different acquisitions with phantom allow to study effect of movement, size and tumor activity compared to environment. The validity domain of these techniques, based on optimal threshold, is accurate if the tumor size is superior to 17 mm and the amplitude in a cycle is inferior or equal to 7.5 mm. For patient exams, an acquisition synchronized allows, even in the worst case, to freeze enough displacement in a cycle in which the relative amplitude is the lowest. Threshold adaptive method are validated for gated acquisitions for homogeneous tumors and not subjected to partial volume effect. If tumor size is inferior to three times the spatial resolution of the system, a more complex approach has to be employed.     

Consolidation par Y-epratuzumab en fractionné dans le lymphome B diffus à grandes cellules : résultats préliminaires d’une étude de phase II

Purpose

A multicenter, non-randomized, on-going phase II study, promoted by the GOELAMS aims to evaluate the efficacy and safety of fractionated administration of ⁹⁰Y-epratuzumab (two injections 7 days apart) in consolidation therapy for patients older than 60 years with diffuse large B-cell lymphoma and large tumor mass who presented a complete response (CR), unconfirmed CR (uCR) or partial response (PR) after induction therapy with six courses of R-CHOP14. We report the preliminary results on 41 of the 75 enrolled patients.

Patients and method

Toxicity was evaluated according to NCI-CTC version 3. The CR and uCR rate and the rate of conversion of PR to CR/uCR 6 weeks after injections of ⁹⁰Y-epratuzumab were evaluated using IWRC criteria.

Results

Thirty-three patients received two injections of ⁹⁰Y-epratuzumab. The toxicity of ⁹⁰Y-epratuzumab was mainly hematologic, characterized by neutropenia grade 3/4 in 81.8% of patients and thrombocytopenia grade 3/4 in 78.8% of patients, reversible. Two patients (6.1%) had grade 3/4 non-hematologic toxicity. Six weeks after injection of ⁹⁰Y-epratuzumab, 40.0% of patients improved their response and the rate of CR/RCu was 83.9%.

Conclusion

These preliminary results show significant toxicity, but mainly hematologic, expected in consolidation. The response rate is encouraging and needs to be confirmed by sufficient number of inclusions and follow-up.