Papillary thyroid carcinomas in patients under 21 years of age: clinical and histologic characteristics of tumors ≤10 mm.

OBJECTIVE: To compare clinical and histologic characteristics of papillary thyroid carcinomas (PTCs) ≤10 mm in patients ≤21 years old with larger ones and with microcarcinomas in adults. STUDY DESIGN: Retrospective study of patients with PTC diagnosed between 1983 and 2012. Medical records were reviewed and information about age, sex, tumor size, intra/extrathyroid extension, lymph node, and distant metastases were collected. RESULTS: Patients ≤21 years old (n = 93) and adults (n = 1235) with PTC were identified. Among the former, 34 had PTC ≤10 mm (37.4%) and among the latter, 584 had papillary thyroid microcarcinoma (PTM) (47.3%), P = .082. Patients with tumors ≤10 mm less frequently had extrathyroidal extension and lymph node metastases compared with larger tumors (8.8% vs 33.3%, P = .017, and 60.0% vs 95.2%, P = .001, respectively). The percentage of PTC ≤10 mm increased with age (7.1%, 32.0%, and 48.1% in age groups ≤15, 15-18, and >18 to ≤21 years old, respectively; P = .016). Mean tumor size was larger (6.8 ± 2.7 vs 5.8 ± 2.8 mm, P = .030), and lymph nodes metastases were more frequent (41.2% vs 18.6%, P = .003) in patients ≤21 years of age compared with adults with PTM. The frequency of multifocal cancers decreased between 1983-1992, 1993-2002, and 2003-2012 (66.7%, 53.6%, and 27.1%, respectively, P = .019). CONCLUSIONS: The frequency of PTC ≤10 mm is low in children, increases in adolescents, and reaches that of adults at 18-21 years of age. Mean tumor size is larger and metastases to regional lymph nodes more frequent in comparison with PTM in adults. Whether their treatment and follow-up could be based on guidelines used for PTM in adults is questionable.

Parathyroid involvement in thyroid cancer: an unforeseen event.

BACKGROUND: Parathyroid metastatic disease from thyroid cancer has not been studied extensively, mainly due to the need for parathyroid preservation during thyroid surgery. METHODS: We reviewed files from 1,770 patients with thyroid cancer followed up in our department and 10 patients with parathyroid metastases (0.5%) were identified. Patient and tumor characteristics were recorded. RESULTS: Six out of ten patients had metastases from papillary thyroid cancer, three from follicular thyroid cancer and one from anaplastic thyroid cancer. In nine patients parathyroid infiltration from thyroid cancer was found in direct contact with the thyroid cancer, and in one patient metastatic foci were observed not in continuity with the thyroid cancer. CONCLUSIONS: Parathyroid involvement, although infrequent, may occur in thyroid cancer independently of patient age and tumor size. The clinical significance of such event is not clear. The influence on disease outcome remains to be elucidated.

Dynamic endocrine test of inhibin B and anti-Müllerian hormone in men with non-obstructive azoospermia.

Although both serum inhibin B (Inh-B) and anti-Müllerian hormone (AMH) concentrations have been proposed as markers of spermatogenesis in men with subfertility, there are wide overlaps with fertile controls. The main aim of this study was to evaluate stimulated serum Inh-B and AMH concentrations in men with non-obstructive azoospermia (NOA). Thirty-seven men with NOA confirmed by testicular fine-needle aspiration and 17 fertile controls participated at this prospective, case-control study. All subjects underwent the Exogenous FSH SErtoli Reserve Test (EFSERT): estimation of serum Inh-B and AMH concentrations before, 24 and 48 hours after administration of 300 IU human recombinant FSH (hrFSH). Basal serum Inh-B and AMH concentrations, as well as Inh-B concentrations at 24 and 48 h were lower in men with NOA as compared to controls. No changes in Inh-B or AMH concentrations were recorded throughout the EFSERT in either men with NOA or controls nor when men with NOA were classified according to their clinical, hormonal and cytological diagnosis. Thus, stimulated serum concentrations of Inh-B and AMH, as obtained by an EFSERT, do not contribute to the diagnostic evaluation of the men with NOA, as the same information can be acquired by the basal serum concentrations of these hormones.

Serum Bisphenol A concentrations in men with idiopathic infertility.

BACKGROUND: Bisphenol A (BPA) has been associated with male reproductive dysfunction. However, few studies have assessed BPA according to the cause of male infertility. AIM: To investigate serum BPA concentrations in infertile men according to infertility cause. PATIENTS AND METHODS: Men with infertility (n = 55) [non-obstructive azoospermia (n = 23), cryptorchidism (n = 12), varicocele (n = 20)] compared with fertile men (n = 25). Serum BPA concentrations were measured along with clinical and hormonal assessment. RESULTS: BPA was detected in all men, with no difference between infertile and control groups [median (IQR) 0.19 (0.45) vs. 0.18 (0.28) ng/ml, p = 0.689] or among the infertility cause [azoospermia 0.30 (0.69), cryptorchidism 0.12 (0.39), varicocele 0.17 (0.23) ng/ml, p = 0.316]. High concentrations of BPA (>3 ng/ml) were observed only in infertile men. Α negative correlation was observed between ΒΡΑ concentrations and AMH (r = -0.320, p < 0.01). CONCLUSIONS: Although male infertility cannot be attributed to exposure to BPA, high concentrations of BPA could contribute to infertility.

R831X mutation of the androgen receptor gene in an adolescent with complete androgen insensitivity syndrome and bilateral testicular hamartomata.

An 18-year old, phenotypically female individual was examined for primary amenorrhea. Three months before her referral, the patient underwent surgery and a pelvic mass was removed. The physical examination revealed normal female external genitalia, normal breast development, sparse pubic hair and absence of axillary hair. The gynecological examination revealed a short blind vagina pouch and absence of cervix and uterus. Serum testosterone and dihydrotestosterone levels were very high. Karyotype was that of a normal male (46,XY). The transabdominal ultrasound, computed tomography (CT) and Magnetic resonance imaging (MRI) showed absence of uterus and fallopian tubes and revealed testis-like gonads located at the internal opening of the inguinal canal bilaterally. Bilateral gonadectomy was subsequently performed. The pathology report was that of "hamartomatous testes" and associated paratesticular leiomyoma. The clinical, laboratory, imaging, genetic and histological findings confirmed the diagnosis of complete androgen insensitivity syndrome. DNA analysis revealed a R831X mutation in exon 7 of the androgen receptor gene. A Sertoli-cell dynamic test showed elevated basal serum inhibin-B and anti-Müllerian hormone levels without further rise following FSH stimulation. The patient was started on hormone replacement therapy with conjugated estrogens. Complete androgen insensitivity syndrome must be considered in any case of primary amenorrhea. Gonadectomy must be planned to eliminate the risk of gonadal malignancy.

Chronic lymphocytic thyroiditis is associated with invasive characteristics of differentiated thyroid carcinoma in children and adolescents.

BACKGROUND: The association between chronic lymphocytic thyroiditis (CLT) and thyroid cancer is an interesting topic. The aim of the present study was to evaluate if demographic and histological characteristics as well as the long-term outcome of thyroid cancer was different in children and adolescents with and without CLT. METHODS: The medical records of children and adolescents (≤21 years old) were reviewed. The following data were recorded: gender, year and age at diagnosis, family history of thyroid cancer, history of external radiation therapy, histological type (papillary and variants, follicular and variants), tumour size, multifocality, infiltration of thyroid parenchyma or surrounding soft tissues, vascular invasion, presence of lymph node and distant metastases. Information about the presence of TgAb and TPOAb was also collected. RESULTS: One hundred eight children and adolescents (median age 19.0, interquartile range 4.0 years) were diagnosed with differentiated thyroid carcinoma (DTC); 31 patients (28.7%) presented histological characteristics compatible with CLT. Infiltration of thyroid parenchyma was more frequent in patients with CLT compared to patients without (74.2% vs 48.1% respectively, P=0.024). Familial papillary thyroid carcinoma (PTC) was more frequent in patients with CLT compared to those without CLT (20.7% vs 2.8% respectively, P=0.009). There was no better outcome with respect to the presence of CLT or not. CONCLUSIONS: Children and adolescents with CLT present more frequently familial PTC as well as thyroid cancer with invasive characteristics.

The Sertoli cell: Novel clinical potentiality.

The Sertoli cell is important for endocrine and paracrine control of spermatogenesis. Functions attributed to Sertoli cells are: (1) supportive and trophic functions for the cells of the seminiferous epithelium, (2) transport of mature spermatids towards the lumen of seminiferous tubules, (3) secretion of androgen binding protein, (4) production of substances with endocrine or paracrine action for spermatogenesis control and (5) interaction with intertubular endocrine Leydig cells. Inhibin B and anti-Müllerian hormone (AMH) are glycoproteins belonging to the transforming growth factor ß (TGF-ß) superfamily; they are produced almost exclusively by the Sertoli cells and have been proposed as direct markers of their function and indirect markers of spermatogenesis. Serum inhibin B and AMH concentrations seem to constitute additional diagnostic parameters in male subfertility as they reflect Sertoli cell function. Stimulated concentrations of serum inhibin B and AMH do not add clinically relevant information in subfertile men compared to basal concentrations of these hormones. Serum inhibin B and AMH concentrations correlate with testicular histology/cytology but are not superior to FSH as predictors of the presence of sperm in testicular sperm extraction (TESE)/fine needle aspiration (FNA) biopsy in men with azoospermia.

Acute and chronic Chlamydia pneumoniae infection in pregnancy complicated with preeclampsia.

OBJECTIVE: To investigate whether Chlamydia pneumoniae (Cp) infection is more common in women whose current pregnancy is complicated with preeclampsia (PE) as compared to pregnant women without PE. METHODS: Thirty pregnant women with PE and 30 pregnant women without PE were studied between 29 and 30 weeks of gestation. The presence of an acute or chronic Cp infection was determined by the estimations of serum IgG, IgM, and IgA Cp antibodies. RESULTS: None of the women were diagnosed as having acute Cp infection. Prevalence of chronic Cp infection was 53 and 66% in the PE and control groups, respectively (X(2), p = 0.068). CONCLUSION: Chronic Cp infection is not more common in women whose pregnancy is complicated with PE as compared to pregnant women without PE. Therefore, no association between Cp infection and PE can be established.

Inhibin B and anti-Mullerian hormone as markers of persistent spermatogenesis in men with non-obstructive azoospermia: a meta-analysis of diagnostic accuracy studies.

INTRODUCTION: A non-invasive test, which could predict the presence of sperm during a testicular sperm extraction (TESE) procedure in men with non-obstructive azoospermia (NOA), would be of profound clinical importance. Inhibin B (Inh-B) and anti-Müllerian hormone (AMH) have been proposed as direct markers of Sertoli cell function and indirect markers of spermatogenesis. METHODS: A search was conducted in the electronic databases MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials from inception through June 2009. Thirty-six different studies reported data on the predictive value of one or more index markers (serum Inh-B: 32 studies, seminal Inh-B: 5 studies, serum AMH: 2 studies, seminal AMH: 4 studies) and were included in the systematic review. Nine studies, which had serum Inh-B as index marker, met the predefined criteria and were included in the meta-analysis. RESULTS: Serum Inh-B demonstrated a sensitivity of 0.65 (95% confidence interval [CI]: 0.56-0.74) and a specificity of 0.83 (CI: 0.64-0.93) for the prediction of the presence of sperm in TESE. When the pre-test probability of 41% was incorporated in a Fagan's nomogram, resulted in a positive post-test probability of 73% and a negative post-test probability of 23% for the presence of sperm in TESE. CONCLUSIONS: Serum Inh-B cannot serve as a stand-alone marker of persistent spermatogenesis in men with NOA. Although limited, evidence on serum AMH and serum/seminal AMH do not support their diagnostic value in men with NOA.

Serum inhibin B and anti-Müllerian hormone are not superior to follicle-stimulating hormone as predictors of the presence of sperm in testicular fine-needle aspiration in men with azoospermia.

OBJECTIVE: To compare FSH, inhibin B (INHB), and anti-Müllerian hormone (AMH) as predictors of the recovery of sperm in testicular fine-needle aspiration biopsy (FNA) performed in men with azoospermia. DESIGN: Cross-sectional, clinical study. SETTING: Academic Unit of Reproductive Endocrinology. PATIENT(S): Fifty-one men with azoospermia and 31 controls. INTERVENTION(S): Testicular FNA. MAIN OUTCOME MEASURE(S): Serum FSH, INHB, and AMH levels. RESULT(S): Clinical diagnoses in men with azoospermia were idiopathic nonobstructive azoospermia (n = 34, 67%), cryptorchidism (n = 4, 8%), varicocele (n = 3, 6%), and other diagnoses (n = 10, 16%). In pairwise comparison of receiver operating characteristic curves, none of FSH (area under curve 0.716), INHB (0.610), AMH (0.565), or volume of the larger testis (0.693) was proved to be superior to the others as predictor of sperm retrieval during an FNA procedure. Similarly, in a logistic regression analysis, none of FSH, AMH, INHB, or volume of the larger testis could predict presence of sperm in FNA. CONCLUSION(S): Serum INHB and AMH, as well as their combination, are not superior to FSH as predictors of the presence of sperm in testicular FNA in men with azoospermia and should not be used for this purpose.

Serum anti-Müllerian hormone levels differentiate control from subfertile men but not men with different causes of subfertility.

AIM: To determine stimulated serum anti-Mllerian hormone (AMH) levels in men with different causes of subfertility. SUBJECTS AND METHODS: We prospectively studied 82 subfertile men and 31 controls. The subfertile men underwent a diagnostic procedure to identify the causes of subfertility. Study parameters included testicular volume, levels of follicle-stimulating hormone, luteinizing hormone, total testosterone, prolactin, inhibin B and AMH, and sperm parameters. RESULTS: Clinical diagnoses in subfertile men were idiopathic non-obstructive azoospermia (n = 26, 32%), idiopathic non-obstructive dyspermia (n = 17, 21%), varicocele (n = 16, 20%), cryptorchidism (n = 10, 12%) and other diagnoses (n = 13, 16%). Serum AMH levels in subfertile men were 60% lower than in controls [median (interquartile range) 4.6 (3.6) vs. 11.6 (7.7) ng/ml, p 0.001], with no significant differences among the different groups of subfertile men. CONCLUSIONS: Serum AMH levels differentiate control from subfertile men but not men with different causes of subfertility.