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[Therapeutic strategy for adenomatous goiter from the viewpoint of postoperative outcome and epidermal growth factor
A Sugenoya1, H Masuda, M Komatsu
1Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
Abstract:
Adenomatous goiter (AG) is regarded as a benign tumor-like lesion. In the present study, both the postoperative outcome and the localization of epidermal growth factor receptor (EGF-R) were investigated to determine proper therapeutic modalities for AG. In this series, 377 surgical patients were studied. Immunohistochemical observation was carried out according to the ABC procedure. Results were as follows: 1) among the all 377 patients, primary cases were 343 and the remainder, 34 cases (9%), recurrent, 2) majority of the 34 recurrent patients showed multinodular goiter type occupying one whole lobe or both sides. Initial surgical strategy for these cases was only enucleation of the all nodules confirmed macroscopically, 3) coexistence of cancer in AG was observed in 18 cases (5%). Seventeen out of them were latent carcinomas found in the multinodular goiter, and 4) those multinodular patients associated with latent carcinoma revealed presence of EGF-R not only in the malignant lesions but also in the hyperplastic parts. These observations suggest that surgical treatment should be considered for multinodular AG patients. In addition, near-total lobectomy of the diseased side might be recommended as an operative procedure because of the prevention of postoperative recurrence and complications.
Insights
Adenomatous goiter (AG) can recur, especially multinodular types. Epidermal growth factor receptor (EGF-R) presence in AG with latent carcinoma suggests near-total lobectomy for better outcomes.
Area of Science:
- Endocrinology
- Surgical Oncology
- Pathology
Background:
- Adenomatous goiter (AG) is a benign tumor-like lesion.
- Understanding recurrence patterns and associated conditions is crucial for effective management.
Purpose of the Study:
- To investigate postoperative outcomes in adenomatous goiter patients.
- To determine the role of epidermal growth factor receptor (EGF-R) in AG management.
- To identify optimal therapeutic strategies for AG, particularly recurrent and multinodular forms.
Main Methods:
- Retrospective analysis of 377 surgical patients with adenomatous goiter.
- Immunohistochemical analysis using the ABC procedure to detect EGF-R.
- Evaluation of postoperative outcomes and recurrence rates.
Main Results:
- 9% of patients experienced recurrence, predominantly multinodular goiter.
- 5% of AG cases (18 patients) had coexisting cancer, mostly latent carcinomas.
- Epidermal growth factor receptor (EGF-R) was detected in both malignant and hyperplastic tissues of multinodular AG with latent carcinoma.
Conclusions:
- Surgical intervention is recommended for multinodular adenomatous goiter.
- Near-total lobectomy on the affected side may prevent recurrence and complications.
- EGF-R localization may inform therapeutic decisions in complex AG cases.