Sociedad Quirúrgica S.C.

Hospital ABC Santa Fé

Av. Carlos Graef Fernández #154

www.hiperparatiroidismo.info

The initial thyroid precursor, the thyroid primordium, starts as a simple midline thickening (endoderm) and develops to form the thyroid diverticulum or thyroid anlage (this median anlage forms the bulk of the thyroid gland).

• This structure at the outset is initially hollow, though it later solidifies (forming the follicular elements of the thyroid gland) and becomes bilobed.

Division of the thyroid gland into lateral lobes, if not present from the beginning, takes place so early that it is impossible to establish whether the thyroid arises as a single unit or as a paired organ. The stalk usually has a lumen, the thyroglossal duct, that does not descend into the lateral lobes. The two lobes are located on either side of the midline and are connected via an isthmus.

• This thyroid anlage follows the primitive heart as it descends caudally.

Early during the fifth week of gestation, the attenuated duct loses its lumen and subsequently breaks into fragments.

• The proximal part retracts and vanishes, leaving only the foramen cecum at the base of the tongue to mark its origin, and the caudal end develops as the bilobed encapsulated thyroid gland and reaches its final adult position by the 7^thweek of gestation.

The paired lateral anlages originate from the ventral portions of the fourth and fifth branchial pouches and fuse with the median thyroid anlage at approximately the fifth week of gestation, contributing up to 30% of the thyroid gland weight.

• The lateral anlages are neuroectodermal / neural crest in origin (ultimobranchial bodies) and produce the calcitonin producing parafolicullar or C cells (from the neural crest these the C-cells migrate to the ultimobranchial bodies), which come to lie in the superior posterior region of the thyroid gland.

The fusion of the median thyroid anlage and the ultimobranchial bodies explains why the parafollicular cells or C cells are not scattered throughout the entire thyroid but are limited to a region deep within the middle to upper thirds of the lateral lobes along an imaginary central lobar axis.

• The bases for the fusion of the median and lateral thyroid anlages is unclear, but the site of the fusion of these two structures is stated to occur at the tubercle of Zuckerkandl.
• The parafolicullar or C cells belong to a group of neural-crest derivatives known as the amine precursor uptake and decarboxylation cells (APUD).

Thyroid Gland Embryology

The modern head and neck surgeon / endocrine surgeon should have a complete grasp of the embryogenesis of the thyroid gland as well as knowledge of the possible congenital anomalies arising out of this gland, as they may influence the completeness of the surgery as well as the complications arising from operations of the thyroid gland.

The thyroid gland is the first of the body’s endocrine glands to develop, appearing as an outpouching of the primitive foregut around the third week of gestation (roughly the 24th day).The thyroid gland forms as a proliferation (thickening) of the endodermal epithelial cells found on the median surface of the developing pharyngeal floor. The site of this development lies between two key structures, the tuberculum impar and the copula, and is recognized as the foramen cecum.

The foramen cecum located at the base of the tongue is the site of origin of the thyroid gland (medial thyroid anlage) at the junction between the first and second branchial (pharyngeal) pouches, immediately dorsal to the aortic sac.

The thyroid gland has a double embryologic origin:

• The primitive pharynx
• The neuroectodermal / neural crest.

The thyroid gland initially arises caudal to the tuberculum impar, which is also known as the median tongue bud. This embryonic swelling develops from the first branchial arch and occurs on the midline of the floor of the developing pharynx, eventually helping form the tongue as the two lateral lingual swellings overgrow it.

The foramen cecum begins rostral to the copula, also known as the hypobranchial (hypopharyngeal) eminence. This median embryologic swelling consists of mesoderm that arises from the second branchial pouch (although the third and fourth branchial pouches are also involved).

The thyroid gland, therefore, originates between the first and second branchial pouches.

http://www.oatext.com/oral-tongue-cancer-literature-review-and-current-management.php

El autor principal es Rodrigo Arrangoiz MS, MD, FACS, socio de Sociedad Quirúrgica S.C.

Resumen de su entrenamiento: 

Cirugía General y Gastrointestinal

Michigan State University

Cirugía Oncológica 

Fox Chase Cancer Center

Tumores de Cabeza y Cuello / Cirugía Endocrina

Fox Chase Cancer Center

Tumores de Cabeza y Cuello / Cirugía Endocrina

IFHNOS / Memorial Sloan Kettering Cancer Center

Maestría en Ciencias de Investigación

Drexel University

Certificado por el Colegio Americano de Cirugía

Fellow del Colegio Americano de Cirugía

Fellow de la Sociedad de Cirugia Oncológica 

Sociedad Quirúrgica S.C.
Hospital ABC Santa Fé
Av. Carlos Graef Fernández #154

Consultorio 515
Col. Tlaxala, Delg. Cuajimalpa
México, D.F. 05300
Tel: 1103 – 1600 Ext 4515 a la 4517
Fax:1664 – 7164

rodrigo.arrangoiz@gmail.com

www.sociedadquirurgica.com

www.hiperparatiroidismo.info

There is ongoing debate as to the extent of thyroidectomy required for adequate treatment of differentiated thyroid malignancies.

As such, there are generally accepted absolute indications for total thyroidectomy:

– Those are tumor greater than 4 cm, gross extrathyroidal extension, clinically apparent metastatic disease to cervical nodes, and distant metastasis.

– Additionally, a history of head and neck radiation or a strong family history of thyroid malignancies influences the need for total thyroidectomy over a concern for second or recurrent thyroid cancers in these high-risk patients.

Existe un debate sobre el tipo de tiroidectomía necesaria para el tratamiento adecuado de neoplasias malignas tiroideas diferenciadas.

Como tal, hay indicaciones absolutas generalmente aceptadas para la tiroidectomía total:

– Esos son tumores de más de 4 cm, extensión extratiroidea macroscópica, enfermedad metastásica clínicamente aparente en los ganglios cervicales y metástasis a distancia.

– Además, un historial de radiación en la cabeza y el cuello o un historial familiar fuerte de neoplasias tiroideas.

Los nódulos tiroideos son un problema importante de salud pública.

Los estudios epidemiológicos han demostrado que la prevalencia de los nódulos tiroideos palpables es aproximadamente del 5% en mujeres y del 1% en hombres que viven en partes del mundo con suficiente yodo.

Por el contrario, el ultrasonido de cuello y tiroides de alta resolución puede detectar nódulos tiroideos en aproximadamente el 19% al 68% de las personas seleccionadas al azar, con frecuencias más altas en las mujeres y en los ancianos.

La importancia clínica de los nódulos tiroideos radica en la necesidad de excluir el cáncer de tiroides, que ocurre entre el 7% al 15% de los casos, según la edad, el sexo, el historial de exposición a la radiación, los antecedentes familiares y otros factores.

Las neoplasias tiroideas comprenden las que se originan de las células foliculares y las que surgen de las células para-foliculares (células C).

El cáncer diferenciado de tiroides, que son los que se originan de las células foliculares, incluyen al carcinoma papilar, al carcinoma folicular, al carcinoma de células oxínticas (Hürthle), al carcinoma mal diferenciado, y al carcinoma anaplásico.

Estos tumores tiroideos comprende la gran mayoría (más del 90% de los casos) de todos los cánceres de tiroides.

De estos subtipos, el carcinoma anaplásico es poco frecuente y se caracteriza por su extremadamente mal pronóstico. Similarmente el carcinoma mal diferenciado se caracteriza por su comportamiento agresivo y su resultado desfavorable.

Entre los años 2010 al 2014, un promedio de 63,229 pacientes por año, fueron diagnosticados con carcinoma de tiroides.

De estos 63,229 pacientes, el 89.4% tenían carcinoma papilar, 4.6% tenían carcinoma folicular, 2.0% tenían carcinoma de células de oxínticas, 1.7% tenían carcinoma medular, y 0.8% tenía carcinoma anaplásico.

Sociedad Quirúrgica S.C. es el único grupo quirúrgico en México que todos sus socios han tenido entrenamiento en los mejores centros académicos de los estados unidos:

Cuatro de sus socios realizaron todo su entrenamiento como cirujanos y sub especialista en los  Estados Unidos, lo que implica que tienen los consejos de sus especialidades en México y en los Estados Unidos de America.

Rodrigo Arrangoiz MS, MD, FACS

Cirugia General – Michigan State University

(https://surgery.msu.edu/faculty/index.php)

Surgical Oncology / Head and Neck Surgery / Endocrine Surgery – Fox   Chase Cancer Center (https://www.foxchase.org)

Head and Neck Surgery and Oncology / Endocrine Surgery – IFHNOS/Memorial Sloan Kettering Cancer Center

(http://www.ifhnos.net/global_online_fellowship.html)

Master in Science (Clinical research for health care professionals) – Drexel University

Fernando Cordera MD, FACS

Cirugia General – Mayo Clinic (http://www.mayo.edu)

Surgical Oncology / Head and Neck Surgery / Endocrine Surgery – Fox Chase Cancer Center (https://www.foxchase.org)

Head and Neck Surgery and Oncology  – IFHNOS/Memorial Sloan Kettering Cancer Center

(http://www.ifhnos.net/global_online_fellowship.html)

David Caba MS, MD, MPH

Cirugia General –  Dartmouth (http://gme.dartmouth-hitchcock.org/general_surgery.html)

Surgical Oncology – University of Chicago

(https://surgery.uchicago.edu/specialties/general/csp/oncology)

Manuel Muñoz MD, FACS, FACRS

Cirugia General – Mayo Clinic (http://www.mayo.edu)

Colorectal surgery – Mayo Clinic (http://www.mayo.edu)

Visiten nuestra pagina:

http://www.sociedadquirurgica.com

Hospital ABC Santa Fé
Av. Carlos Graef Fernández #154

Consultorio 515
Col. Tlaxala, Delg. Cuajimalpa
México, D.F. 05300
Tel: 1103 – 1600 Ext 4515 a la 4517
Fax:1664 – 7164

Parotidectomia con identificación y preservación del nervio facial secundaria a un adenoma pleomórfico gigante de 10 años de evolución que se extendía hacia el espacio parotideo.

Cirugia realizada por Rodrigo Arrangoiz MS, MD, FACS miembro de Sociedad Quirúrgica S.C. y especialista en Tumores de Cabeza y Cuello / Cirujano Endocrino.

A, Peroral. B, Mandibulotomy. C, Lower cheek flap. D, Visor flap. E, Upper cheek flap.