[Diagnostics and treatment of the functional autonomy of the thyroid gland].

Functional autonomy of the thyroid gland (FATG) remains an important problem due to iodine deficiency over the whole territory of Russian Federation and the fact that iodine prophylaxis has not been conducted for a long period of time. Since iodine deficiency affects the thyroid gland (TG) as a whole, the formation of nodules is not limited to a single lobe, but leads to the development of multinodular goiter, the main feature of which is morphological and functional heterogeneity of TG tissue. Active cell proliferation in the iodine deficiency related goiter is associated with an elevated risk of somatic mutations, including activating mutations leading to thyrocyte functional autonomy. Diagnosis is often late due to the absence of any specific complaints in most patients. Hence, the pathology is often an accidental finding and is mostly revealed in patients with cardial diseases. For a long time, TG scintigraphy has been the only method allowing the diagnosis of FATG, while other techniques, such as ultrasonography and the measurement of the hormone levels in blood, only make it possible to assume the presence of this pathology. Nowadays, fine needle biopsy plays an important role since it gives a possibility to obtain direct cell-level findings concerning the morphological structure of TG nodules and, in some cases, the functional condition of cells. Of late, great importance to clinical practice has been attached to new developments in FATG diagnostics, immunomorphological (immunocytochemical and immunohistochemical) techniques in particular. Most probably, new techniques of FATG verification will be based upon the study of TSHR as the specific marker of this pathology, and it will be possible to use immunocytochemical assay as an additional diagnostic method for the verification of autonomic nodular formations as early as right after the puncture.

[Galectin-3 in differential diagnosis and prognosis of follicular tumors of the thyroid gland]. / Galektin-3 v differentsial'noi diagnostike i prognozirovanii follikuliarnykh opukholei shchitovidnoi zhelezy.

Differential diagnosis between follicular thyroid tumours (FTT) is difficult both at cytological and histological levels. Infiltrative growth is authentic criterion of malignancy. Immunohistochemical reaction (PAP-method) with galectin-3 antibodies was used. The results allow to make differential diagnosis of thyroid tumours before the surgery. Immunohistochemical identification of galectin-3 in the tissue of follicular adenomas with grave dysplasia and follicular carcinoma is an unfavourable prognostic sign.

[Target thin-needle puncture biopsy in diagnosis of thyroid cancer]. / Pritsel'naia tonkoigol'naia punktsionnaia biopsiia v diagnostike raka shchitovdnoi zhelezy.

One hundred medical histories of patients with thyroid cancer (TC) were analyzed. Patients were divided into two groups depending on the variant of thin-needle biopsy technique (TNB). In group 1TNB was performed with "blind" method (with palpation control)--43 cases, in group 2 target TNB (ultrasound-guided) was carried out--57 cases. Patients of each group were divided depending on cytological presurgical diagnosis. Statistical analysis was carried out with two-sided Fisher's criterion. It is demonstrated that detection of TC in group 2 (84.2%) was higher than in group 1 (62.8%) where "blind" method of puncture was used (p = 0.020). It is recommended to perform target TNB in all cases of nodular goiter that improves quality of TC diagnosis.

[Clinical and morphological characteristics of thyroid adenomatosis]. / Kliniko-morfologicheskaia kharakteristika adenomatoza shchitovidnoi zhelezy.

Surgical (374 cases) and puncture (6148 cases) material from patients with multinodular goiter was studied. Definitions and a working classification characterizing morphological and cytological signs of adenomatous goiter were formulated. Prognostic significance of thyroid adenomatosis and approaches to its treatment in multinodular goiter are shown.

[Pathogenesis and clinical morphology of congenital disorders of sex differentiation]. / Patogenez i klinicheskaia morfologiia vrozhdennykh narushenii polovoi differentsirovki.

Bisexual structure of genitalia presents difficulties for clinical diagnosis. Therefore, knowledge of pathogenesis and clinical morphology of congenital disturbances of sexual differentiation helps to establish earlier hermaphroditism variant, appropriate surgery for complete social-psychological adaptation of this group of patients.

[Functional morphology of the hypophyseal-adrenal-gonad system in different variants of prostatic hyperplasia]. / Funktsional'naia morfologiia gipofizarno-nadpochechnikovo-gonadnoi sistemy pri razlichnykh variantakh giperplazii predstatel'noi zhelezy.

Two forms of prostatic hyperplasia are distinguished: fibro-glandular (FGH) and glandular-fibrous (GFH). An increase in the number of adenohypophysis cells producing gonadotrophic hormone, hyperplasia of the adrenal reticular zone, hyperplasia and hypertrophy of Leydig and Sertoli cells in the testis were observed in FGH. Signs of enhanced functional activity were observed in all cases of hyperplasia. In GFH there was an increase in the number of adenohypophyseal cells producing adrenocorticotrophic hormone, hyperplasia of the fascicular layer in the adrenals, atrophy of Leydig cells in the presence of Sertoli cell hyperplasia. The variant of prostatic hyperplasia is determined by the hormonal changes and this may help in choosing of approaches to therapeutic correction of prostatic hyperplasia and its early diagnosis.

[Functional morphology and prognosis of hormonally-active pituitary adenomas]. / Funktsional'naia morfologiia i prognoz gormonal'no-aktivnykh adenom gipofiza.

This paper is a review of literature on the etiology, pathogenesis and morphogenesis (electron microscopy, immunocytochemistry) of pituitary adenomas (PA). Clinical manifestations of PA are considered depending on their structure. Approaches to the clinico-morphological classification of PA and factors of their prognosis are discussed.

[Clinical morphology of hormonally-inactive adrenal neoplasms]. / Klinicheskaia morfologiia gormonal'no-neaktivnykh opukholei nadpochechnikov.

94 patients with primary diagnosis "adrenal incidentaloma" were operated. Ultrasound investigation, MR-tomography, computed tomography, hormonal tests were made in examination of these patients. The results were compared with morphology and histochemistry of the removed adrenals. True hormonally inactive tumors were detected in 11 cases only. The conclusion is made that the term "adrenal incidentaloma" is a collective term which does not reflect the essence of the processes in the adrenals. Verification of morphofunctional features of adrenal tumors is possible only after clinical and morphobiochemical examinations.

[Role of endocrine factors in the development of stomach cancer]. / Rol' éndokrinnykh faktorov v razvitii raka zheludka.

Current information on hormone-sensitivity and hormone-activity of stomach carcinoma is presented. The development of this tumor is shown to depend on the functional state of the pituitary, adrenals and gonads. The study of hormone-sensitivity and hormone-activity of stomach cancer will help in new approaches to its prevention, early diagnosis, radical pathogenetic treatment and adequate clinical prognosis.

[Functional morphology of the adenohypophysis in gastric precancer and cancer]. / Funktsional'naia morfologiia adenogipofiza pri predrake i rake zheludka.

135 hypophyses of patients who had died of stomach precancer and cancer versus those of healthy controls were studied by histochemical methods allowing to distinguish various hormone producing cells. Participation of ACTH, TTH in the antitumor protection and that of FSH, LM, LTH and STH in the promotion and progression of stomach cancer is shown.

[Sex hormone receptors in the gastric mucosa in gastric precancer and cancer]. / Retseptory polovykh gormonov v slizistoi obolochke zheludka pri ego predrake i rake.

Sex hormones receptors from 240 patients with stomach cancer and precancer were studied using an immunoperoxidase method. Reception of steroid hormones was shown to influence stomach cancer development while the "perversion" of this reaction may determine unfavourable prognosis.

[Functional morphology of the adrenals in stomach cancer and precancer]. / Funktsional'naia morfologiia nadpochechnikov pri predrake i rake zheludka.

Adrenal glands were studied histochemically in 110 autopsy cases with stomach precancer and cancer. Glucocorticoids, mineralocorticoids and catecholamines can be considered, with a high degree of probability, as factors of antitumor protection while sex hormones as stimulators of stomach carcinoma development and progression. Scirrhous carcinomas were non-homogeneous in regard to the adrenal gland changes.

[Dependence of the features of distant metastases and prognosis of stomach cancer on the histologic type of the primary tumor and the volume of regional lymph node metastases]. / Zavisimost' osobennostei otdalennogo metastazirovaniia i prognoza raka zheludka ot gistologicheskogo tipa pervichnoi opukholi i ob"ema regionarnykh limfogennykh metastazov.

Necropsy and surgical material (280 cases of gastric cancer) was studied. Histological types producing the largest number of metastases are revealed. Likewise a "border-line" involvement of regional lymph nodes is established in which distant metastasizing occurs in 100% of cases that is not dependent upon histologic type of tumour. Prognosis in such cases is unfavorable.

[Dependence of stomach cancer prognosis on features of regional lymph node metastasis and mechanisms of further dissemination of the tumor]. / Zavisimost' prognoza raka zheludka ot osobennostei regionarnykh limfogennykh metastazov i mekhanizmov dal'neishei disseminatsii opukholi.

The study of section and operative samples from 280 patients with gastric cancer has established the relationships between characteristics of regional lymphogenic metastases and tumor prognosis, location of regional lymphogenic metastases, probability of distant metastases and survival of the patients. The discussion covers some ways and mechanisms of lymphogenic metastasizing of gastric cancer.

[Analysis of stomach cancer according to data of the autopsy room at the I.M. Sechenov Moscow Medical Academy from 1941-1994]. / Analiz raka zheludka po dannym sektsii prozektury MMA im. I. M. Sechenova za 1941-1994 gg.

Analysis of the above material showed the association of the unfavorable clinico-morphological indices and poor prognosis with the periods of a socioeconomic instability, and the participation of a pathological hormonal background in the development of some variants of undifferentiated carcinoma of the stomach.

[Clinico-morphologic criteria for prognosis of stomach cancer]. / O kliniko-morfologicheskikh kriteriiakh prognoza raka zheludka.

New criteria of prognosis are established on the basis of study of 265 surgically removed stomach carcinomas. The factors of an unfavourable prognosis are as follows: young age, dysproteinemia, low blood coagulability, high leucocytosis and reaction of erythrocyte sedimentation, endocrine diseases, eosinophilic infiltration of stroma with high content of collagen type V and fibronectin, high expression of pepsinogen C, gastrin and carcino-embryonic antigen in the tumour parenchyma.

[Comparative clinico-morphologic characteristics and prognosis of forms of ulcerated stomach cancer]. / Sravnitel'naia kliniko-morfologicheskaia kharakteristika i prognoz form iz"iazvlennogo raka zheludka.

300 cases of ulcerated and non-ulcerated stomach carcinoma and chronic stomach ulcer are analyzed. New criteria for a differential diagnosis and prognosis of ulcerated carcinomas are found.

[Duodenal gastrinoma with the development of Zollinger-Ellison syndrome]. / Gastrinoma dvenadtsatiperstnoi kishki s razvitiem sindroma Zollingera-Ellisona.

Gastrinoma consisting of eosinophilic gastrin--producing cells (this was proven electron--microscopically and immunohistochemically) was found in a 32-year-old female. The tumour, 1 x 1 x 1.5 cm in size, was located in the submucosa of the horizontal part of the duodenum. This was the cause of Zollinger--Ellison syndrome in the above patient.

[Possible markers of the progression and ulcerogenesis of stomach cancer]. / Vozmozhnye markery progressii i ul'tserogeneza raka zheludka.

The stomachs from 40 patients operated on for gastric cancer and chronic ulcer were studied immunohistochemically using antibodies to CEA, galactosyl transferase, pepsinogens A and C, gastrin, alpha 1-antitrypsin. CEA and galactosyl transferase of the cancer parenchyma are shown to mark tumor progression. The ratio of alpha 1-antitrypsin to pepsinogens in gastric epithelium and cancer cells probably plays a role in ulcerogenesis of normal mucosa and tumor tissue. Gastrin in carcinoma tissue is both an ulcerogenesis factor and a marker of tumor progression, an unfavourable prognosis of gastric cancer.