Thyroid cysts and pseudocysts, or hemorrhagic cysts, are quite frequent thyroid pathologies. Surgical theraphy has always been the treatment of choice in this pathology, but percutaneous ethanol injection (PEI) is becoming still more common. PEI was originally used in the treatment of liver nodules and subsequently in solid, hyperfunctioning thyroid nodules, but today it is used exclusively in cysts. The aim of this study was to evaluate the efficacy of PEI in reducing thyroid cyst volume 12 and 84 months after treatment and to compare cost-benefit to that of surgical treatment. The study includes 110 consecutive patients, who all underwent PEI after cytological analysis had excluded the presence of neoplasia. All patients had refused surgical treatment. One patient died during the follow-up due to cerebral hemorrhage. Each patient received an average of 5.3 ± 2.7 PEI treatments. After 12 months, volume was reduced by 82.6% and after 84 months by 93.03%. Dysphonia occurred in 2 cases of which one resolved spontaneously and one received cortisone therapy. The cost of PEI treatment is considerably lower than the cost of surgical therapy (the cost saving in our patient population was about €200,000). PEI should therefore be preferred to surgical treatment due to its efficacy and lower cost.

KEYWORDSThyroid; Thyroid sonography; Thyroid nodules; Sonoelastography; FNAC.Abstract Ultrasoundelastography (USE) is a new imaging technique that is performed with a normal ultrasound transducer. It provides improved characterization of a tissue or nodule based on the latter's elasticity and stiffness. The aim of the present, prospective study was to assess the validity of USE in characterizing thyroid nodules. USE patterns were analyzed in light of nodule cytology (British Thyroid Association classification) to determine whether these patterns can be used to decide whether or not fine-needle aspiration cytology (FNAC) is indicated. We examined a consecutive series of 617 thyroid nodules in patients referred for the first time to the Endocrinology Unit of Atri Hospital (Atri, [TE]). Patients underwent ultrasonographic and USE examinations of their thyroid nodules, which were then subjected to FNAC. All nodules with Thy 1 cytology were excluded, leaving 567 nodules for analysis. USE findings were classified on the basis of the degree and distribution of elasticity within the lesion: four patterns were identified (1, 2, 3a, 3b, or 4).None of the nodules with Thy 4 cytology (malignant) had USE pattern 1 or 2; patterns 3 and 4 were associated with higher cytologic grades. In conclusion, USE provides additional information on thyroid nodules, which can be used with ultrasound features of the nodules, to decide whether FNAC is indicated. In fact, patterns 1 and 2 do not seem to be associated with Thy 4 cytology.Sommario L'Elastosonografia (ESG) è una nuova tecnica d'immagine che, utilizzando una normale sonda ecografica, consente una migliore caratterizzazione tissutale, fornendo informazioni su elasticità e durezza di un tessuto o di un nodulo.L'obiettivo di questo studio prospettico è quello di valutare l'effettiva validità della ESG nel caratterizzare i noduli tiroidei, associando il pattern elastosonografico al grading citologico e, * Corresponding author.E-mail address: raggibruno@virgilio.it (B. Raggiunti). quindi, valutare se eseguire o meno l'agoaspirazione del nodulo tiroideo, in base al pattern ESG. Sono stati studiati, in serie successiva, 617 noduli tiroidei di pazienti afferiti per la prima volta presso la nostra UO di Endocrinologia del P.O. di Atri (TE), sottoposti ad esame ecografico, elastosonografico e ad agoaspirato con ago sottile (FNAC), per lo studio citologico. Tutti i noduli che al referto citologico presentavano un grado Thy 1 sono stati esclusi dallo studio, pertanto sono stati esaminati 567 noduli. Lo score elastosonografico utilizzato prevede 5 patterns cromatografici (1; 2; 3a; 3b e 4) a seconda della distribuzione di tessuto più o meno elastico all'interno del nodulo. I risultati dell'ESG hanno evidenziato che nessun nodulo con citologico Thy 4 presenta un grado elastosonografico 1 o 2; passando ai patterns elastosonografici 3 e 4 si assiste ad una crescita concomitante del grading citologico. In conclusione l'ESG può essere considerata un ulteriore parametro, in associazione alle caratt...

The clinical occurrence of ectopic thyroid gland is an infrequently encountered condition, resulting from a developmental abnormality during the migration of the thyroid anlage from the floor of the primitive foregut to its final position in the neck. It can be found along the way of thyroid descent, in the midline, or laterally in the neck or even in the mediastinum or under the diaphragm. This condition is often asymptomatic, whereas symptoms could be related to ectopic thyroid size, to its relationships with surrounding organs or to diseases affecting the ectopic thyroid in the same way they involve orthotopic glands. Sometimes, a growing mass can lead to the clinical suspicion of a tumor disease. On the other hand, thyroid ectopy must be distinguished from metastasis of thyroid cancer. Scintigraphy and ultrasonography are the main diagnostic means for evaluating ectopic thyroid tissue, whereas fine needle aspiration could be useful in the presence of a nodular ectopic gland or when the coexistence of an orthotopic thyroid can arise the suspicion of a metastasis from a thyroid cancer. Surgical removal is indicated in symptomatic cases, whereas radioiodine ablation is reserved to recurrent disease. In this paper we report an emblematic case of ectopic thyroid gland and a review of the literature dealing with this condition.

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Mixed medullary papillary carcinoma (MMPC) is a rare variant of papillary thyroid carcinoma, according to the WHO classification and it presents as a single lesion histologically composed of two distinct and intermingled neoplastic cell patterns. The histogenesis is still debatable. The lymph node metastases are usually present at the time of the diagnosis and distal metastases may appear late during follow-up. At least 13 similar lesions have been reported in the literature. We describe the case of a 61-year-old woman with a mixed medullary papillary carcinoma found in a hyperfunctioning thyroid nodule and negative pre-surgical serum calcitonin. After surgery, the patient started suppressive L-thyroxine therapy and underwent radioiodine ablation. The follow-up for both papillary and medullary components has shown no signs of persistence or recurrence of disease five years after surgery. However, the rarity of the MMPCs makes the management and the prognosis of these tumors still unclear.