Risk of lymph node metastases in multifocal papillary thyroid cancer associated with Hashimoto's thyroiditis.

AIMS: The aim of this study was to evaluate the risk factors of lymph nodes metastases (LNM) in patients with papillary thyroid cancer (PTC) and coexisting Hashimoto's thyroiditis (HT). PATIENTS AND METHODS: This was a retrospective cohort study of patients with PTC and HT who had undergone total thyroidectomy (TT) with central neck dissection (CND) over an 11-year period (between 2002 and 2012). Pathological reports of all eligible patients were reviewed. Multivariable analysis was performed to identify risk factors of LNM. RESULTS: During the study period, PTC was diagnosed in 130 patients with HT who had undergone TT with CND (F/M ratio = 110:20; median age, 52.4 ± 12.7 years). Multifocal lesions were observed in 28 (21.5 %) patients. LNM were identified in 25 of 28 (89.3 %) patients with multifocal PTC and HT versus 69 of 102 (67.5 %) patients with a solitary focus of PTC and HT (p = 0.023). In multivariable analysis, multifocal disease was identified as an independent risk factor for LNM (odds ratio, 3.99; 95 % confidence interval, 1.12 to 14.15; p = 0.033). CONCLUSIONS: Multifocal PTC in patients with HT is associated with an increased risk of LNM. Nevertheless, the clinical importance of this finding needs to be validated in well-designed prospective studies.

Coexistence of papillary thyroid cancer with Hashimoto thyroiditis.

AIMS: Conflicting data have been reported with regard to Hashimoto thyroiditis (HT) and risk of malignancy. The aim of this study was to evaluate coexistence of papillary thyroid cancer (PTC) with HT. PATIENTS AND METHODS: This is a retrospective cohort study in which HT was diagnosed in 452 (F/M ratio = 405:47, median age 53.5 ± 12.1 years) of 7,545 patients qualified for thyroidectomy throughout the years 2002 to 2010. Pathological reports were reviewed to identify prevalence of PTC in HT vs. non-HT patients. RESULTS: PTC was diagnosed in 106 of 452 (23.5 %) HT patients vs. 530 of 7,093 (7.5 %) non-HT patients (p < 0.001). Metastases to level VI lymph nodes were observed in 81 of 106 (76.4 %) patients with PTC in HT vs. 121 of 530 (22.8 %) patients with PTC in non-HT disease (p < 0.001). CONCLUSIONS: HT was associated with a threefold increase of PTC prevalence as compared to other non-HT thyroid diseases, and the spread of PTC to level VI lymph nodes was four times more frequent in HT than in non-HT patients.

[Somatostatin receptors expression (SSTR1-SSTR5) in pheochromocytomas]. / Ekspresja receptorów somatostatynowych (SSTR1-sSTR5) w guzach chromochlonnych.

Confirmation of somatostatin receptors (SSTR) expression in neuroendocrine tumours has changed their modern diagnosis and therapy, and starts to influence the approach to pheochromocytomas. In vitro studies have revealed the SSTR expression in pheochromocytomas, particularly subtype 2A and 3. They also have indicated that their confinement to cell membranes is essential for successful diagnostics with the use of somatostatin analogues. Scintigraphy with radiolabeled somatostatin analogues is nowadays an approved complementary method of pheochromocytoma localization, particularly the malignant ones. Cell culture studies have indicated that the commercially available somatostatin analogues are able to control tumour growth and secretion. Unfortunately these results have not been confirmed by clinical studies. It seems that the analogues with the broader affinity to sstr may be a good therapeutic option for pheochromocytoma patients. Promising results of radiotherapy with labeled analogues have been recently announced.

[A case of primary malignant lymphoma of thyroid in young man]. / Przypadek pierwotnego chloniaka zlosliwego tarczycy u mlodego mezczyzny.

The aim of this study is to present a case of a 36-year old male with a rare thyroid malignancy--a primary thyroid lymphoma. The patient was admitted to the Department of Endocrinology due to a rapidly enlarging left-sided tumor of the neck and hoarseness lasting for 2 weeks. The only abnormality found on biochemical testing was a slightly elevated titre of anti-TPO antibodies. On X-ray examination, both a compression and deviation of the trachea was found. Ultrasound examination of the neck revealed a left-sided thyroid lesion and fine needle aspiration (FNA) was performed under ultrasound guidance. A monotonous population of mid-size lymphoid cells was found with negative immunocytochemistry for thyroglobuline and CD 68. After hematological and pathological evaluation the FNA report was considered as non-diagnostic. Taking into consideration the presence of rapidly occurring compressive symptoms caused by a tumor of unknown cytological origin, the patient was referred to urgent thyroid surgery. Pathological report of postoperative specimen allowed for the final diagnosis of a malignant lymphoma originating from non-Hodgkin B cells of the thyroid gland; diffuse large B-cell lymphoma (DLCL) according to WHO classification. L-thyroxin substitution therapy, chemo- and radiotherapy were used after the operation. The described case of a very rare type of primary thyroid malignancy illustrates difficulties which can be encountered in diagnostic approach and therapeutic decision making in patients with rapidly enlarging thyroid tumors.

[Primary adrenal lymphoma in incidentally discovered adrenal tumour]. / Pierwotny chloniak w przypadkowo wykrytym guzie nadnercza.

The new imaging techniques used during the last several years: ultrasound, computed tomography and magnetic resonance imaging have improved detection of non-functional adrenal tumours s.c. "incidentaloma". Incidence of adrenal incidentaloma is not very low. They are detected in about 0.35-4.36% CT examination. In most of cases incidentaloma are benign and gave no clinical signs; however primary adrenal cortex cancer and metastases of different cancers are not uncommon. The primary adrenal lymphoma is an extremely rare disease. The predominant group of patients are men over 50 years with other manifestations of non Hodgkin lymphoma. Most frequently both adrenal glands are affected and signs of adrenal insufficiency (despite weakness, fever and loss of weight) are present. In our paper we present a case of primary, unilateral lymphoma in a 19 year old women. It was discovered as incidentaloma in ultrasound examination. Hormonal examinations were normal, but the tumour size was indication for surgery treatment. The diagnosis was made by histological examination and adjuvant chemotherapy was administrated.

Anaplastic, sarcomatoid carcinoma of the thyroid originating from a Hürthle cell tumor.

The case of a 43-year old female with neck tumor is presented. Sections of the tumor revealed a poorly differentiated malignant neoplasm. A panel of immunohistochemical reactions was performed, and diagnosis of malignancy, most likely of a non-epithelial origin was given. Clinically, the tumor was characterized by a very high growth rate. An attempt at chemotherapy was made, but the patient died two months after the onset of the disease. At autopsy the tumor was extensively sampled. The histology revealed an anaplastic, sarcomatoid component, as well as a Hürthle cell carcinoma. The presented case is an excellent illustration of diagnostic difficulties that may be encountered in differential diagnosis of anaplastic, sarcomatoid thyroid carcinomas and true sarcomas.

The comparison of the agreement in determining the histological grade of uterine endometrial endometrioid carcinoma, using the three-grade FIGO classification and the two-grade system.

The objective of the investigation was to compare the degree of interobserver agreement in determining the histological grade of uterine endometrial endometrioid adenocarcinoma using the criteria proposed by the three-grade FIGO classification (1988) and the new, two-grade system proposed by Lax et al. (2000). In the FIGO system, the assessment is focused on the amount of solid, non-squamous growth pattern and the additional feature is the presence of the so-called "notable nuclear atypia" (nuclear grade), with the latter criterion not having been precisely defined. In the two-grade system, the evaluation concentrates on the amount of the solid component, regardless of its character, type of neoplastic growth pattern (expansive or diffusely infiltrating) and the presence of necrosis within the tumor mass. A total of 133 cases of uterine endometrial carcinoma were evaluated, determining the stage according to the FIGO classification and assessing the histological grade based on the criteria presented by the above two systems. All the cases were separately examined by 5 pathologists with varying degrees of experience in gynecological pathology. A higher degree of interobserver agreement was demonstrated when the two-grade system was employed as compared to the FIGO system, regardless whether the material was evaluated by experienced pathologists (FIGO k - 0.64 - 0.71, binary - 0.91 - 0.92), or by individuals with little experience in gynecological pathology (FIGO k - 0.23 - 0.48, binary - 0.21 - 0.57). The data point to the superior character of the two-grade system as to the agreement of the histological grade assessment, but also suggest a considerable effect of experience on the precision of the evaluation.

[Diagnostic difficulties in neuroendocrine carcinoma of the larynx]. / Trudnosci diagnostyczne neuroendokrynnego raka krtani.

The rare case of the large cell neuroendocrinic carcinoma of larynx was described. 66 years old man was treated by total laryngectomy because of melanoma. Postoperative, immunohistochemical study shoved large cell neuroendocrinic carcinoma. A special emphasis was put on the preoperative misdiagnose, limiting neck dissection. The authors point out, however, the difficulties of the pathologic differentiation caused by similarity of these tumors. The treatment and prognosis are discussed.

[Actinomycosis of the middle ear]. / Promienica ucha srodkowego.

The authors present the case of primary actinomycosis of the middle ear. The frequency of this disease, treatment and pathological diagnosis are discussed. A check-up examination 20 months after the last surgery of the ear revealed a good local at general condition of the patient.

(99m)TC-octreotide scintigraphy and somatostatin receptor subtype expression in juvenile nasopharyngeal angiofibromas.

BACKGROUND: The main goal of the study was the analysis of somatostatin receptor (SSTR) expression on juvenile nasopharyngeal angiofibroma (JNA) cells and a subsequent analysis of the utility of SST analog-based scintigraphy in JNA diagnostics. METHODS: Nine JNA cases were analyzed. All tissue samples were analyzed for the expression of SSTRs. In 2 cases, scintigraphy was performed after the intravenous (IV) administration of an SST analog. MRI of the craniofacial region was subsequently performed. RESULTS: The SST analogues were accumulated in areas matching pathologic tissue in the nasopharynx. Immunohistochemical evaluation of the tissue samples proved the overexpression of SSTRs. CONCLUSIONS: SSTRs are overexpressed on JNA cells. The SST analog (99m)TC-octreotide is effectively bound to JNA cells. SST analogues might be used in the diagnostics and treatment of primary, recurrent, or residual JNA.