Tumor aggressiveness risk factors in the differentiated thyroid carcinoma.

BACKGROUND: The differentiated thyroid carcinoma (DTC) is the most frequent malignancy in endocrinology (95%). Our aim was to retrospectively compare risk factors of tumor aggressiveness and history of thyroid disease in patients with conventional DTC and differentiated thyroid microcarcinoma (DTMC). METHODS: Retrospective analysis of 167 patients after total thyroidectomy with a histologically confirmed DTC, of which 83 patients with conventional DTC (> 1 cm) and 84 with DTMC (≤ 1 cm). The analyzed factors were tumor size, its aggressiveness (i.e. multifocal or bilateral occurrence, angioinvasion, extracapsular growth, presence of cervical lymph node metastases, distant metastases, and early local relapse) and medical history of thyroid diseases. RESULTS: In the DTMC group, there were 80/84 (95.2%) papillary carcinomas compared with 58/83 (69.9%) in the conventional DTC group (p=0.001). Patients with DTMC were significantly older than those with conventional DTC (p=0.006). In the conventional DTC group, there was a significantly higher occurrence of angioinvasion and extracapsular growth (p=0.001), cervical lymph node metastases (p=0.013), relapse (p=0.018), and distant metastases (p=0.007), compared with the DTMC group. CONCLUSION: In patients with DTMC, there was a significantly lower presence of risk factors of tumor aggressiveness, compared with the conventional DTC group (Tab. 2, Ref. 17).

[Radical operation of infected aortofemoral prosthesis using fresh arterial allograft: our mid-term experience]. / Radikální operace infekce cévní protézy v aortofemorální pozici s pomocí cerstvého tepenného allograftu: nase strednedobé zkusenosti.

INTRODUCTION: The mid-term experience with the use of the fresh arterial allografts in the treatment of aortic or aortofemoral prosthetic infection is presented. MATERIAL AND METHODS: Between 2001-2010 24 patients (23 with the infected graft in aortic or aortofemoral position and one with a mycotic aneurysm of the aortic bifurcation) were operated with the use of the fresh arterial allograft. Male/female ratio was 15/9, average age 65.8 (36-81) years. The gastrointestinal comorbidities dominated this cohort. The total of 70 previous vascular operations (1-9; m. 2.9/patient) were performed with the median of 5.8 years between the first and the last procedure. Seven patients had sepsis (29.2%), aortoeneteric fistula occurred in three. Various technical modifications of the aortobifemoral (13), aortounifemoral (8) bypass, aortic and aortoiliac replacement (3) were performed including the sequential distal reconstructions. The arterial allograft was used within 8-48 hours following harvest (the median cold ischemic time of 20 hours) and all patients were given cyclosporine A perioperatively. RESULTS: In-hospital mortality was 20.8% (5/24), twice caused by postoperative hemorrhage from either the aortic anastomosis or the graft necrosis. The remaining deaths were not related to the allograft itself. Two limbs, preoperatively ischemic, were amputated (8.3%). The median follow-up is 4.6 years (3 m.-8 yrs.). The three-years survival was 68.4% and the known causes of death had no relation to the allograft. The late occlusion of the graft limb occurred twice, stenoses within its course twice and three femoral anastomotic stenoses were disclosed. All were treated either surgically or by PTA/stent and the redo procedures' rate has thus reached 20.5% in the mid-term follow-up interval. One graft has shown a slight diffuse dilatation since requiring but follow-up. CONCLUSIONS: Under the conditions of the ABO compatibility tolerance and ongoing postimplantation immunosuppression the shortly ischemic arterial graft helds its anatomic structure and function and within the hostile setting of the previous infection represents a valuable alternative of the surgical treatment of the vascular prosthetic infection in the aortofemoral position or of the mycotic aneurysm.

[An occult acetabular fracture revealed by magnetic resonance imaging]. / Skrytá zlomenina acetabula prokázaná pri vysetrení MR.

The authors describe the case of a 35-year-old man with an injury to the left hip joint. When examined at the surgical ward, the patient complained of pain and restricted motion of the left hip. No traumatic changes in the left hip joint were revealed on X-ray and CT examination. When checked-up 13 days later, the patients still complained of persistent pain and restricted movement. Because of the discrepancy between the results of X-ray and clinical examinations, magnetic resonance imaging was recommended. This revealed an infraction of the roof of the acetabulum without trauma to the soft joint tissues and adjacent muscles. A retrospective analysis of the X-ray and CT examination data showed an infraction of the acetabular roof on CT scans. The authors emphasize the role of non-invasive magnetic resonance imaging in the diagnosis of occult fractures.

Benign mixed epithelial and stromal tumor of the kidney.

We describe a distinctive benign tumor of the kidney in a 48-year-old woman, which was composed of well differentiated ducts set in the spindle cell stroma which was muscle actin, smooth muscle actin and desmin positive, and was morphologically similar to the ovarian stroma. No immature appearing epithelial renal or mesenchymal tissue was present in the tumor. Histologically, the tumor differed from the nephrogenic adenofibroma and the rare cases of adult Wilms tumors, mesoblastic nephromas and cystic nephromas.

[Sinus histiocytosis with massive lymphadenopathy--a disseminated form of the Rosai-Dorfman syndrome]. / Sinusová histiocytóza s masivní lymfadenopatií--diseminovaná forma syndromu Rosai-Dorfman.

A 20 year-old black male presented with a generalized lymphadenopathy, skin papules with maximum involvement of the head and trunk region, and elevated temperature. Ultrasound, CT and bone scans revealed infiltration of the kidneys and bones. Surgical specimens of the cervical lymph nodes showed massive infiltration of sinuses by histiocytes with engulfed lymphocytes and granulocytes in their cytoplasm. A similar finding was found in the excised dermis and nasopharyngeal mucosa. Immunohistochemical investigations showed a strong positive reaction of sinusoidal macrophages with anti S100 protein, anti alpha-1 antitrypsin and alpha-1 antichymotrypsin antibodies, negative CD1a. The engulfed granulocytes were positive with lysozyme and MAC387 antibodies; lymphocytes reacted with antilymphocytic antibodies L26, HLADR, UCHL-1 and OPD4 only rarely, possibly due to alterations of their cell membranes in the cytoplasmic environment of histiocytes. Occasional plasma cells were also entrapped in the macrophages. The best results were obtained with CD3 antibody which showed focal predominance of phagocytosed T cells. These findings confirm a nonselective nature of the emperipolesis. In situ hybridization with probes EBER and BHLF against Epstein-Barr virus sequences was negative. The pacient was treated by multidrug chemotherapy with a moderate regression of the infiltrates. The symptoms of the disease persisted for 10 months from the treatment start but further course of the disease is uncertain. The patients is lost to follow up.

[Psammomatous melanotic schwannoma]. / Psamomatózní melanotický schwannom.

Psammomatous melanotic schwannoma is a rare variant of schwannoma. The authors present histological and immunohistochemical findings in two cases of the tumor arising in the spinal nerve roots region at a 56-year-old woman and a 58-year-old man. The latter recurred locally. Microscopically the tumor was composed of polygonal epithelioid or spindle-shaped cells. Some of these cells contained melanin. Small calcifications were dispersed throughout the lesion. Ultrastructural examination of one of these cases revealed nerve sheath origin of the tumor cells and identified premelanosomes and melanosomes within the cytoplasm of neoplastic cells. Histogenesis and relationship of the tumor to Carney complex are discussed.

Correlation among the BRAF gene mutation status, clinicopathological features of primary tumour, and lymph node metastasizing of papillary thyroid carcinoma.

BACKGROUND: Papillary thyroid carcinoma (PTC) is the most common malignant thyroid tumour. A common mutation of papillary thyroid carcinoma (PTC) is the somatic mutation of the BRAF (V600E) gene. AIM: The aim was to 1) determine the association of lymph node metastases of PTC with the BRAF gene mutation of primary tumour; 2) evaluate association of the BRAF mutation in the -primary tumour with clinicopathological para-meters; 3) examine the extent of genetic heterogeneity by monitoring the BRAF mutation in multicentric tumours. SUBJECTS AND METHODS: Retrospective analysis of the BRAF (V600E) mutation in PTC and PTC neck lymph node metastases in 156 patients operated from 2003 to 2012 in Prague and Zlín, the Czech Republic, using a qPCR assay. The results were correlated with clinicopathological factors. RESULTS: DNA was successfully extracted from 137 samples. The BRAF (V600E) mutation was detected in 78 cases (56.9%). The patients with BRAF p.Val600Glu mutation of primary tumour had only non-significantly higher risk of cervical lymph node metastases [OR=2.39 (95%) CI 1.00-5.75, p=0.052]. In the classic papillary variant, the BRAF (V600E) mutation was found significantly more often than in other PTC subtypes (p=0.022). We did not confirm any significant association between the BRAF (V600E) mutation and other clinicopathological findings. CONCLUSION: Except for the higher prevalence in papillary variant of PTC, BRAF p.Val600Glu mutation was not associated with other prognostic clinicopathological factors of PTC. BRAF mutation cannot be regarded as a reliable marker of node metastases in patients with PTC.

Compartment- and malignance-dependent up-regulation of γ-glutamyltranspeptidase and dipetidylpeptidase-IV activity in human brain gliomas.

γ-Glutamyltranspeptidase (GGT, syn. γ-Glutamyltransferase) and dipeptidylpeptidase-IV (DPP-IV) activity participates in metabolic and growth control of normal and tumor cells by processing biologically active peptides. Here, we report on up-regulation of these enzymes in human brain gliomas determined by catalytic enzyme histochemistry and immunocytochemistry. Higher activity of GGT was found in 50%, 68% and 81% of WHO grade II, III and IV tumors, respectively. The process started at/near the microvasculature, from where it spread to the parenchyma. On average, the enzyme activity in grade II, III and IV gliomas exceeded controls 2.0, 3.0 and 3.5-fold, respectively. Up-regulation of DPP-IV-like activity also started at the microvasculature, but mainly in pericytes and mononuclear-like cells around the vessels and dispersed in the parenchyma. Marked elevation of this enzyme activity, comprising also tumor parenchyma, occurred only in grade IV glioblastomas (65% patients; 3.6 times above controls) which can, therefore, help in their differentiation from grade III gliomas. The increase of total DPP-IV-like activity also included its two enzymatic homologs, the canonical DPP-IV/CD26 and FAP-1α. The increase in GGT is supposed to be a tumor grade dependent response of microvasculature and tumor astrocytes to stress induced by tissue hypoxia and/or the metabolic aberrancies. The increase in DPP-IV-like activity in high-grade tumors can be attributed to inflammatory/scavenging processes performed by the mononuclear-like cells and, in glioblastomas, also to regressive changes in the structure and function of the microvasculature and tumor parenchyma, including astrocyte stress response. The inverse relationship between DPP-IV-like activity and Ki67 in most glioblastomas and shorter survival time of patients with low activity of this enzyme also suggest its anti-oncogenic effects.

The severity of mouse pathologies caused by the bird schistosome Trichobilharzia regenti in relation to host immune status.

Cercariae of the nasal bird schistosome Trichobilharzia regenti are able to penetrate into mammalian skin and migrate to the mouse central nervous system (CNS) causing tissue injury in certain cases. Our study shows that the severity of T. regenti pathologies in the CNS closely depends on the host immune status. During the primary infection of immunocompetent mice, the parasites evoked an acute inflammatory reaction in the skin and the CNS involving focal oedema and cellular infiltration of the tissue. Challenge infections resulted in the development of extensive inflammatory foci in the host skin which precluded the subsequent migration of the schistosomula to the CNS. On the other hand, during primary as well as challenge infections of immunodeficient mice (SCID), no significant immune response against the parasites was detected in any of the host organs examined; however, in contrast to immunocompetent mice, the infections were frequently manifested by severe leg paralysis.

A thrombus in the right pulmonary artery and its follow-up using transoesophageal echocardiography.

Using transoesophageal echocardiography, the authors documented development of a right pulmonary artery thrombus in a patient with pulmonary hypertension due to chronic obstructive lung disease. This case confirms the potential of transoesophageal echocardiography in diagnosing pulmonary artery diseases.