Indian Journal of Endocrine Surgery and Research

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Volume 16, Number 2, July-December 2021

Message from Editor in Chief's Desk

Pooja Ramakant

Message from Editor in Chief's Desk

[Year:2021] [Month:July-December] [Volume:16] [Number:2] [Pages:1] [Pages No:00 - 00]

   DOI: 10.5005/ijesr-16-2-iv  |  Open Access |  How to cite  | 

Surgeons and Creativity

Dr Himagirish K Rao

Surgeons and Creativity

[Year:2021] [Month:July-December] [Volume:16] [Number:2] [Pages:1] [Pages No:00 - 00]

   DOI: 0.5005/ijesr-16-2-v  |  Open Access |  How to cite  | 

IAES Presidents Message

Kailash Chandra Mohapatra

IAES Presidents Message

[Year:2021] [Month:July-December] [Volume:16] [Number:2] [Pages:1] [Pages No:00 - 00]

   DOI: 10.5005/ijesr-16-2-vii  |  Open Access |  How to cite  | 

Letter from Secretary

Dr Sabaretnam Mayilvaganan

From Desk of Honorary Secretary IAES

[Year:2021] [Month:July-December] [Volume:16] [Number:2] [Pages:1] [Pages No:00 - 00]

   DOI: 10.5005/ijesr-16-2-viii  |  Open Access |  How to cite  | 

EDITORIAL

Supriya Sharma, Vinay K Kapoor

Gastrointestinal Neuroendocrine Neoplasms

[Year:2021] [Month:July-December] [Volume:16] [Number:2] [Pages:8] [Pages No:51 - 58]

Keywords: Cancer, Gastrointestinal, Neuroendocrine

   DOI: 10.5005/jp-journals-10088-11177  |  Open Access |  How to cite  | 

Original Article

Sushma Yadav, Gopal Puri, Yashwant S Rathore, Sunil Chumber, Surabhi Vyas, Kamal Kataria, Ankit Anand

Diagnostic Evaluation of Ultrasound and Cytology for Solitary Thyroid Nodules in a Tertiary Care Setup in India

[Year:2021] [Month:July-December] [Volume:16] [Number:2] [Pages:5] [Pages No:59 - 63]

Keywords: Bethesda, Diagnostic evaluation, Sensitivity, Solitary thyroid nodule, Thyroid imaging reporting and data system

   DOI: 10.5005/jp-journals-10088-11167  |  Open Access |  How to cite  | 

Abstract

Aim and objective: To determine the sensitivity, the specificity, the positive predictive value (PPV), and the negative predictive value (NPV) of ultrasound and cytology to detect malignancy for solitary thyroid nodules. Materials and methods: Prospective observational study conducted at a tertiary care hospital in India. The patients with solitary thyroid nodule, aged more than 12 years with consent of the patients/their parents and planned to undergo surgery, were included in the study. The patients were evaluated with history, examination, sonography, and cytology. Then, they planned for surgical hemi-/total thyroidectomy depending on indications, and the thyroidectomy specimens were sent to Department of Pathology for routine processing. Results: A total of 140 patients were considered for recruitment, but 80 patients were operated, and their data were analyzed. Sonographic findings were reported using thyroid imaging reporting and data system (TIRADS) classification, and the sensitivity was 75.00% with a specificity of 84.62% and PPV, NPV, and diagnostic accuracy of 72.41, 81.25, and 81.25%, respectively. Cytology was assessed by the Bethesda system for reporting thyroid cytopathology (TBSRTC), and considering Bethesda IV, V, and VI as true positives and Bethesda II as benign, the sensitivity and the specificity were 89.5 and 78.4%, respectively. When a composite analysis was performed, the sensitivity and the specificity of TBSRTC and TIRADS combined were 100 and 36%, respectively. The PPV and NPV were 45 and 100%, respectively, with the accuracy of 58.5%. Conclusion: The American College of Radiology TIRADS is a sensitive method to detect malignancy in thyroid nodules in Indian population with good specificity and PPV. Fine needle aspiration cytology (FNAC) was observed to be a sensitive technique having achieved a high sensitivity and NPV with a low specificity and PPV. The composite test (incorporating TIRADS and TBSTRC) had 100% predictive value for benign and malignant pathology.

Original Article

Akshay Prasad, Atul Jain, Akash Gupta, Ravi Meena

Clinicopathoradiological Study of Benign Breast Diseases

[Year:2021] [Month:July-December] [Volume:16] [Number:2] [Pages:6] [Pages No:64 - 69]

Keywords: Benign breast diseases, Breast lump, Fibroadenoma

   DOI: 10.5005/jp-journals-10088-11171  |  Open Access |  How to cite  | 

Abstract

Context: Breast complaints are one of the most common reasons for surgical consultation. The majority ultimately proves to have a benign origin. Breast lesions may present with a variety of symptoms often confusing clinical evaluation leading to error in treatment of essentially benign conditions. Aims and objectives: The aims and objectives of the article were to study the age incidence and clinical presentation of benign breast diseases (BBDs) and to assess the role of clinical examination and radiological imaging with histopathological confirmation of diagnosis in such cases. Settings and design: This prospective study was conducted in the department of general surgery in 100 cases of BBDs. Materials and methods: In this study, we have selected patients with age >10–60 years presenting with a palpable breast lump or breast pain in the surgical outpatient department (OPD) or referred from other departments for the same. Results: The commonest age of presentation was between 20 and 40 years. More than half of the patients presented with only a lump as the chief complaint. The comparison correlation between preoperative investigations and histopathological correlation is statistically significant (p <0.001). Conclusion: The majority of the BBDs occur in younger age group. The most common presenting complaints are lumps in the breast, pain in the breast, and followed by nipple discharge. Ultrasonography (USG) is very useful in diagnosing abscesses, cysts, and galactoceles.

Original Article

R Rahul, Priyank Yadav, Asish Singh, Pawan Verma, Sabaretnam Mayilvaganan, Vijai D Upadhyaya, Ankur Bhatnagar, Shantanu Pande, Mandakini Pradhan, Rajan Saxena

Impact of COVID-19 Pandemic Forced Lockdown on Non-COVID Super-specialty Surgical Case Management in India

[Year:2021] [Month:July-December] [Volume:16] [Number:2] [Pages:7] [Pages No:70 - 76]

Keywords: Lockdown, Non-COVID care, Pandemic, Surgical case management

   DOI: 10.5005/jp-journals-10088-11174  |  Open Access |  How to cite  | 

Abstract

Introduction: The nationwide lockdown in India and diversion of healthcare resources toward COVID care have hampered the non-COVID care. In this study, we assessed the effect of the first 6 weeks of lockdown on non-COVID super-specialty surgical case management at a tertiary care center. Materials and methods: This was an observational study involving eight surgical specialties (cardiothoracic and vascular surgery (CVS), Endocrine Surgery, maternal and reproductive health [MRH], Neurosurgery, Pediatric Surgery, Plastic Surgery, Surgical Gastroenterology, and Urology). Information was gathered using two forms: (a) Patient-wise form for surgical procedure (preoperative preparation, anesthesia, and surgical details) (b) Department-wise summary of procedures for comparison with the last year's records. Results: During the study period, 112 cases were performed compared to 1,062 performed last year during the same time frame. CVS department experienced the greatest decline (98%) in cases. Except for COVID testing, no difference in practice was documented (preoperative investigation and anesthesia preference). However, majority of the procedures were performed by an open technique. The use of personal protective equipment (PPE) by anesthetists and surgeons was not widespread and uniform across various specialties; the level of comfort was low suggested by low acceptance. Duration of surgery as well as hospital stay did not increase due to the COVID pandemic. Conclusion: The nationwide lockdown resulted in a marked reduction in the number of non-COVID surgeries, much more than the diversion of the workforce toward COVID facilities. The number of procedures decreased to <20% than in the previous year. The use of PPE was not consistent during procedures on COVID-negative patients.

CASE REPORT

Shawn S Thomas, Deepak T Abraham, Supriya Sen, Varghees Thomas, Priyanka R Singh, MJ Paul

Interesting Images: Thyroglossal Duct Cyst Carcinoma

[Year:2021] [Month:July-December] [Volume:16] [Number:2] [Pages:1] [Pages No:77 - 77]

Keywords: Papillary thyroid carcinoma, Thyroglossal duct cyst, TDCC

   DOI: 10.5005/jp-journals-10088-11170  |  Open Access |  How to cite  | 

Abstract

Thirty-six-year-old man was presented with a new onset swelling in the upper neck of 1 year duration. There were no pressure symptoms or voice change. No history suggestive of hypo/hyperthyroidism. On examination, there was a 6 × 4 cm cystic swelling in the infrahyoid region, which moved with deglutition and protrusion of tongue. The swelling had restricted mobility in the vertical plane. The thyroid gland was not palpable and there were no palpable cervical nodes. Computed tomography of neck and thorax was done in view of the locally advanced nature of the swelling—images attached. He then underwent total thyroidectomy + Sistrunk's operation.

CASE REPORT

Kailash C Mohapatra, Suraj Ethiraj, Geetanjali Panda, Ramapada Mohapatra

Diagnostic Issues of Primary Hyperparathyroidism in Indian Patients: The Perspectives and Imperatives—A Case Report

[Year:2021] [Month:July-December] [Volume:16] [Number:2] [Pages:4] [Pages No:78 - 81]

Keywords: Diagnostic dilemma, Hypercalcemia, Parathyroid adenoma, Parathyroidectomy, Primary hyperparathyroidism

   DOI: 10.5005/jp-journals-10088-11172  |  Open Access |  How to cite  | 

Abstract

In the last few decades, there has been remarkable progress in the diagnosis as well as treatment of primary hyperparathyroidism (PHPT) worldwide due to the advent of automated serum calcium estimation and radioimmunoassay of parathormone. Consequently, a fairly good number of asymptomatic and incidentally detected cases of PHPT who could have been missed otherwise are now being evaluated and treated successfully. Although this turn around is more pronounced in the West, the scenario has not appreciably changed in India. Lack of awareness and clinical suspicion among the clinicians and negligible use of biochemical screening tests are the common factors responsible for the diagnostic delay as is evident in our case report. Such delay in diagnosis and institution of treatment results in overtly symptomatic disease with affection of several target organs. We report the diagnostic dilemma and delay in treatment in one of our cases; a 28-year-old female who despite having severe PHPT at the time of diagnosis could be managed successfully with parathyroidectomy.

CASE REPORT

Multiple Endocrine Neoplasia Type IIA with Cutaneous Lichen Amyloidosis

[Year:2021] [Month:July-December] [Volume:16] [Number:2] [Pages:4] [Pages No:82 - 85]

Keywords: Medullary thyroid carcinoma, Multiple endocrine neoplasia, Pheochromocytoma

   DOI: 10.5005/jp-journals-10088-11173  |  Open Access |  How to cite  | 

Abstract

A 35-year-old woman presented with episodic abdominal pain associated with palpitation and frontal headache. Physical examination revealed thyroid nodule along with itchy scapular cutaneous lesions suspicious of cutaneous lichen amyloidosis (CLA). Biochemical and imaging workup showed bilateral adrenal lesions with positive 24-hour urinary metanephrine/normetanephrine levels and fine needle aspiration cytology (FNAC) of the thyroid nodule confirmed medullary thyroid carcinoma (MTC) of the thyroid. Bilateral pheochromocytoma with MTC and CLA prompted us for targeted genetic testing for codon 634 in rearranged during transfection (RET) gene which confirmed the diagnosis of multiple endocrine neoplasia type IIA (MEN IIA) CLA variant. The patient underwent bilateral cortical-sparing open adrenalectomy followed by total thyroidectomy with central compartment neck dissection and bilateral modified radical neck dissection. Of her four asymptomatic children, two were found to harbor the mutation and are being managed appropriately. High index of suspicion with detailed history and thorough clinical examination can help us perform targeted genetic testing and appropriate management in resource-constrained settings.

BRIEF RESEARCH COMMUNICATION

Divya Kukreja, Deep Chakrabarti, Mrinalini Verma

Current Role of Radiation in Thyroid Cancers

[Year:2021] [Month:July-December] [Volume:16] [Number:2] [Pages:1] [Pages No:86 - 86]

Keywords: Anaplastic thyroid cancer, Anaplastic thyroid carcinoma, Endocrine, Endocrine cancer, Endocrine surgery, Medullary carcinoma, Papillary thyroid carcinoma, Thyroid cancer

   DOI: 10.5005/jp-journals-10088-11164  |  Open Access |  How to cite  | 

Abstract

Thyroid cancer comes under the category of head–neck cancers (HNC) but unlike other sites, thyroid cancer still has undefined role of radiation. Here, we had briefly summarized the indications of radiation in various types of thyroid cancers.

Journal Watch

Sabaretnam Mayilvaganan, Sarrah Idrees

Comment on “Effectiveness and Safety of Thermal Ablation in the Treatment of Primary Hyperparathyroidism: A Multicenter Study” Published in JCEM

[Year:2021] [Month:July-December] [Volume:16] [Number:2] [Pages:1] [Pages No:87 - 87]

Keywords: Endocrine, Glands, Surgery

   DOI: 10.5005/jp-journals-10088-11165  |  Open Access |  How to cite  | 

LETTER TO THE EDITOR

Sabaretnam Mayilvaganan, Sarrah Idrees, Panchangam Ramakanth Bhargav, Aromal Chekavar

Acute Suppurative Thyroiditis and Thyroid Abscess: A Case Series in a Tertiary Care Hospital

[Year:2021] [Month:July-December] [Volume:16] [Number:2] [Pages:1] [Pages No:88 - 88]

Keywords: Hemithyroidectomy, Incision and drainage, Infection

   DOI: 10.5005/jp-journals-10088-11166  |  Open Access |  How to cite  | 

SHORT COMMUNICATION

Mahesh Hema Meti-Raghava, Chitresh Kumar

Anaplastic Thyroid Carcinoma: Spot Diagnosis

[Year:2021] [Month:July-December] [Volume:16] [Number:2] [Pages:2] [Pages No:89 - 90]

Keywords: Anaplastic thyroid carcinoma, Endocrine cancer, Thyroid cancer

   DOI: 10.5005/jp-journals-10088-11168  |  Open Access |  How to cite  | 

Abstract

Though anaplastic thyroid carcinoma is a rare entity, it is very lethal. It is a surgical semi-emergency because it is rapidly progressive and once it breaches the thyroid capsule, it becomes inoperable. Therefore, every clinician should have a very low index of suspicion.

View Point

Sarrah Idrees, Firoz Ahmed, Sabaretnam Mayilvaganan

Lymph Node Yield in Papillary Thyroid Cancer

[Year:2021] [Month:July-December] [Volume:16] [Number:2] [Pages:1] [Pages No:91 - 91]

Keywords: Endocrine cancer, Solid cystic papillary thyroid cancer, Thyroid cancer

   DOI: 10.5005/jp-journals-10088-11169  |  Open Access |  How to cite  | 

Abstract

Papillary thyroid cancer (PTC) is the most common thyroid cancer which spreads via the lymphatic route. Lymph nodes are also the most important prognostic indicators of persistent/recurrent/progressive disease. The lymph node yield (LNY), defined as the total number of lymph nodes retrieved during dissection, has not been determined in surgical resection of PTCs, be it in adults or pediatric population.

REVIEW ARTICLE

Loreno Enny, Surabhi Garg, Kul Ranjan Singh

Von Hippel Lindau Disease: A Review Article

[Year:2021] [Month:July-December] [Volume:16] [Number:2] [Pages:9] [Pages No:92 - 100]

Keywords: Endocrine surgery, Pancreatic mass, Pheochromocytoma, Von Hippel Lindau disease

   DOI: 10.5005/jp-journals-10088-11175  |  Open Access |  How to cite  | 

Abstract

Von Hippel Lindau (VHL) disease is an inherited disease, multisystem cancer syndrome owing to genetic mutation of the VHL tumor suppressor gene located at chromosome 3. It is inherited as highly penetrant autosomal dominant trait with affected individuals at risk of developing various benign or malignant lesions of central nervous system, retina, kidney, adrenal glands, pancreas, and reproductive system. The diagnosis of VHL can be made clinically based on the characteristic history and clinical findings. Genetic testing of germline VHL mutation may also be used to confirm the diagnosis of VHL. Treatment should be based on multidisciplinary approach as there are many complexities associated with the management of various tumors manifesting at different time frames.

REVIEW ARTICLE

Mayank Bhasin, Anshika Arora

Role of Ultrasound in Pretreatment Evaluation of Lymph Node Status in Carcinoma Breast: A Systematic Review

[Year:2021] [Month:July-December] [Volume:16] [Number:2] [Pages:7] [Pages No:101 - 107]

Keywords: Axilla, Breast neoplasm, Lymph node metastasis, Sensitivity, Specificity, Systematic review, Ultrasonography

   DOI: 10.5005/jp-journals-10088-11176  |  Open Access |  How to cite  | 

Abstract

Aim: This systematic review aimed to analyze efficacy of axillary ultrasonography (USG) in differentiating normal from abnormal lymph nodes (LNs) in breast cancer patients, taking into account the different criteria used. Background: Identification of pretreatment axillary LN metastasis is one of the most important prognostic factors in breast cancer, and it affects the surgical plan and oncological management after surgery. Review results: A PubMed search was made using the following items: “Ultrasonography” [Mesh] AND “Axilla” [Mesh] AND “Breast Neoplasms” [Mesh]. A total of 34 studies were included in the review analysis. Studies were divided according to the LN feature studied into six subheadings which include size, cortex thickness, hilum changes, long axis-to-short axis ratio (L/S ratio), combination of multiple morphological factors, and combination of both morphology and size. For LN size, sensitivity and specificity ranged from 49 to 95%, 34 to 97.4%; cortical thickness 35 to 96%, 36 to 92%; hilar changes 24 to 92%, 23 to 100%; L/S ratio 65 to 100%, 18 to 65%; morphological features 26 to 94%, 76 to 100%; and combination of both morphological and size 18 to 100%, 50 to 100%, respectively. Conclusion: Role of USG in pretreatment axillary staging has been extensively studied. Various diagnostic criteria have been used for defining abnormal LN, which leads to difficult comparisons between various studies. Clinical significance: Pretreatment evaluation of axilla with USG, using multiple criteria, like LN size, L/S ratio, cortical, and hilar abnormalities in combination with morphological features, gave the best accuracy for detection of abnormal nodes and lowest false-negative rates in breast cancer patients.

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