Recurring desmoid tumor of the neck: A case report.

The infiltrative growth pattern of desmoid tumors and their proximity to important anatomical structures make them difficult to manage. Mutilating surgery should be avoided, while surveillance or radiotherapy remain valid options.

Challenging diagnosis of cervical vagal nerve schwannoma.

Schwannoma arising from vagal nerve is a rare tumour. It is a slow-growing, benign mass, but rarely it might undergo malignant transformation. We report a case of a 55-year-old woman with asymptomatic Xth cranial nerve schwannoma in the left side of the neck. Initially, during the ultrasound examination, the tumour was misconceived to be a malignant lymph node. The patient underwent complete surgical excision of it. Histopathological examination revealed typical features of schwannoma. Clinical diagnose of cervical vagal nerve schwannoma is difficult. Magnetic resonance imaging is as an accurate diagnostic tool for these tumours. Surgical excision is the treatment of choice.

Papillary Thyroid Carcinoma Tissue miR-146b, -21, -221, -222, -181b Expression in Relation with Clinicopathological Features.

We analyzed miR-146b, miR-21, miR-221, miR-21, and miR-181b in formalin fixed paraffin-embedded papillary thyroid carcinoma (PTC) tissue samples of 312 individuals and evaluated their expression relationship with clinicopathological parameters. A higher expression of miR-21 was related to unifocal lesions (p < 0.011) and autoimmune thyroiditis (0.007). miR-221, miR-222 expression was higher in the PTC tissue samples with extrathyroidal extension (p = 0.049, 0.003, respectively). In a group of PTC patients with pT1a and pT1b sized tumors, the expression of miR-146b, miR-21, miR-221, and miR-222 in PTC tissue samples was lower than in patients with pT2, pT3, and pT4 (p = 0.032; 0.0044; 0.003; 0.001; 0.001, respectively). Patients with lymph node metastases had higher expression of miR-21, -221, -222, and -181b (p < 0.05). A high expression of miR-146b, miR-21, miR-221 panel was associated with decreased overall survival (OS) (Log rank p = 0.019). Univariate analysis revealed that presence of metastatic lymph nodes and high expression of miR-146b, miR-21, and miR-221 panels were associated with increased hazard of shorter OS. After multivariate analysis, only sex (male) and age (≥55 years) emerged as independent prognostic factors associated with shorter OS (HR 0.28 (95% CI 0.09-0.86) and HR 0.05 (95% CI 0.01-0.22), respectively). In conclusion, 5 analyzed miRs expression have significant relations to clinicopathologic parameters so further investigations of these molecules are expedient while searching for prognostic PTC biomarkers.

Different stability of miRNAs and endogenous control genes in archival specimens of papillary thyroid carcinoma.

BACKGROUND: The most popular miRNA quantitation technique is RQ-PCR with relative gene expression method that requires an endogenous control (EC) gene for data normalization. However, there are insufficient data and selection criteria on the most suitable ECs for miRNA expression studies in many cancer types including papillary thyroid carcinoma (PTC). Therefore, in this study we evaluated the impact of chosen EC and archival formalin-fixed, paraffin-embedded (FFPE) PTC tissue age on estimated target miRNA expression. METHODS: RQ-PCR was used to determine expression levels of five miRNAs (miR-146b, miR-222, miR-21, miR-221 and miR-181b) and three different endogenous controls (RNU48, let-7a, miR-16), which were used to normalize the data. In total, 400 FFPE PTC tissues were analyzed that have been stored from 1 to 15 years. RESULTS: The stability of commonly used ECs RNU48 and let-7a significantly differs from the stability of target miRNA in archival FFPE PTC tissues. Moreover, these differences have a great impact on miRNA expression results when FFPE tissue samples have been stored for a different period of time. CONCLUSIONS: It is important to select an ECs not only stable in the tissue of interest but also with similar stability to target miRNA, especially when working with samples of different age.

Plasma-Derived miRNA-222 as a Candidate Marker for Papillary Thyroid Cancer.

We analyzed five miRNA molecules (miR-221; miR-222; miR-146b; miR-21; miR-181b) in the plasma of patients with papillary thyroid cancer (PTC), nodular goiter (NG) and healthy controls (HC) and evaluated their diagnostic value for differentiation of PTC from NG and HC. Preoperative PTC plasma miRNA expression (n = 49) was compared with plasma miRNA in the HC group (n = 57) and patients with NG (n = 23). It was demonstrated that miR-221; miR-222; miR-146b; miR-21 and miR-181b were overexpressed in preoperative PTC plasma samples compared to HC (p < 0.0001; p < 0.0001; p < 0.0001; p < 0.0001; p < 0.002; respectively). The upregulation in tumor tissue of these miRNAs was consistent with The Cancer Genome Atlas Thyroid Carcinoma dataset. A significant decrease in miR-21; miR-221; miR-146b and miR-181b expression was observed in the plasma of PTC patients after total thyroidectomy (p = 0.004; p = 0.001; p = 0.03; p = 0.036; respectively). The levels of miR-222 were significantly higher in the preoperative PTC compared to the NG group (p = 0.004). ROC curve (receiver operating characteristic curve) analysis revealed miR-222 as a potential marker in distinguishing PTC from NG (AUC 0.711; p = 0.004). In conclusion; circulating miR-222 profiles might be useful in discriminating PTC from NG.

A case report of malignant primary pericardial mesothelioma with atypical imaging appearance: multimodality imaging with histopathological correlation.

BACKGROUND: Primary pericardial mesothelioma is a rare primary cardiac malignancy, with three main histopathological types, sarcomatoid histotype being the rarest. The imaging features were atypical due to concomitant extensive calcification, which resulted in aggravated differential diagnosis. CASE SUMMARY: A 45-year-old man presented to our hospital with non-specific clinical symptoms. According to clinical history, a mediastinal tumour had been suspected with a previous unsuccessful attempt of transthoracic computed tomography-guided biopsy at an overseas hospital with limited data of performed imaging procedures. Multimodality imaging at our centre revealed extensively calcified solid masses in the pericardium, invading the left atrium. As the imaging features suggested an atypical primary pericardial malignancy, a diagnostic thoracoscopy was performed. Histopathological analysis of specimen revealed sarcomatoid type of pericardial mesothelioma with areas of necrosis and foci of osteogenic differentiation. Despite planned treatment, 2 weeks after histological diagnosis, the patient passed away due to perforated peptic ulcer-related sepsis. DISCUSSION: The presence of extensive calcification in the lesion resulted in a challenging imaging workup and diagnosis. Initial differential diagnosis included primary or metastatic calcification-prone tumour, secondary calcification due to haemorrhage after previous interventional procedure and other pathologies, such as tuberculous pericarditis, calcified amorphous tumour, among others. Calcification may be part of the histological tumour characteristics; however, proper history taking is crucial as concomitant diseases, previous treatment, and interventional procedures may alter the imaging pattern.

Association of MicroRNA Expression and BRAFV600E Mutation with Recurrence of Thyroid Cancer.

Many miRNAs and cancer-related mutations have been proposed as promising molecular markers of papillary thyroid carcinoma (PTC). However, there are limited data on the correlation between miRNA expression, BRAFV600E mutation, and PTC recurrence. Therefore, to evaluate the potential of BRAFV600E mutation and five selected miRNAs (-146b, -222, -21, -221, -181b) in predicting PTC recurrence, these molecular markers were analyzed in 400 formalin-fixed, paraffin-embedded PTC tissue specimens. The expression levels of miRNAs were measured using qRT-PCR. It was demonstrated that expression levels of all analyzed miRNAs are significantly higher in recurrent PTC than in non-recurrent PTC (p < 0.05). Moreover, higher expression levels of miR-146b, miR-222, miR-21, and miR-221 were associated with other clinicopathologic features of PTC, such as tumor size and lymph node metastases at initial surgery (p < 0.05). No significant differences in the frequency of BRAFV600E mutation in recurrent PTC and non-recurrent PTC were determined. Our results suggest that miRNA expression profile differs in PTC that is prone to recurrence when compared to PTC that does not reoccur after the initial surgery while BRAFV600E mutation frequency does not reflect the PTC recurrence status. However, the prognostic value of the analyzed miRNAs is rather limited in individual cases as the pattern of miRNA expression is highly overlapping between recurrent and non-recurrent PTC.

Spontaneous regression of laryngeal carcinoma in 10 year old boy: A case report and review of literature.

Laryngeal carcinoma is a rare pathology in children, with only 92 cases reported. Spontaneous regression of laryngeal carcinoma is even more unique clinical event, so far only observed in adults. In this report we present an extraordinary case of a 10 year old patient with laryngeal squamous cell carcinoma that underwent spontaneous regression.

Correlation between throat-related symptoms and histological examination in adults with chronic tonsillitis.

OBJECTIVE: The aim of the study was to evaluate correlations between throat-related symptoms and histological findings in adults with chronic tonsillitis. MATERIALS AND METHODS: A prospective cohort study was carried out. Throat-related symptoms (complaints, tonsillitis rate, and pharyngeal findings) of 81 adults with histologically proven chronic tonsillitis followed by tonsillectomy were analyzed. Four types of histological changes in removed tonsils were determined: (1) pure hyperplasia, (2) chronic inflammation, (3) chronic inflammation with hyperplasia, (4) chronic inflammation with scarring/fibrosis. The power of correlation was tested using the Pearson contingency coefficient (CC). RESULTS: Recurrent throat infections were the most common complaint (74.1%). The mean tonsillitis rate was 3.6 (SD 1.9) episodes per year. Tonsillar cryptic debris (61.7%) and hyperemia of the anterior pillars (59.3%) were the most common pharyngeal findings. Chronic inflammation with hyperplasia was predominant (38.3%) histological type of chronic tonsillitis. The statistically significant correlations between histological type and combination of tonsillitis rate ≥3 times per year with cryptic debris (CC=0.346; P=0.010) and cryptic debris alone (CC=0.294; P=0.051) were detected. CONCLUSIONS: Assessment of throat-related symptoms is complementary to histological examination in adults with chronic tonsillitis.

The most important throat-related symptoms suggestive of chronic tonsillitis as the main indication for adult tonsillectomy.

BACKGROUND AND OBJECTIVE: The literature lacks data about the evaluation of throat-related symptoms proving chronic tonsillitis as the most common indication for adult tonsillectomy. Therefore, the aim of this study was to assess the most important throat-related symptoms suggestive of chronic tonsillitis in adults. MATERIAL AND METHODS: A prospective cohort study was carried out. The analysis of throat-related symptoms (complaints, tonsillitis rate, pharyngeal signs, and antistreptolysin-O titer) in 81 adults with histologically confirmed chronic tonsillitis was conducted. RESULTS: Recurrent tonsillitis was the most common complaint (74.1%). The mean number of tonsillitis episodes was 3.6 (SD, 1.9) times per year. There were no significant differences comparing the frequencies of all the analyzed pharyngeal signs (P>0.05). The antistreptolysin-O titer (mean, 279.8; SD, 211.6 UL) was pathological in 33.3% of patients. The study identified the most important throat-related symptoms revealing chronic tonsillitis: tonsillar cryptic debris (OR, 8.84; 95% CI, 1.93-40.53; P=0.005) and enlarged anterior cervical lymph nodes along with the frequency of tonsillitis episodes exceeding 3 times per year (OR, 8.27; 95% CI, 1.33-51.57; P=0.024). The classification accuracy of 85.2% was obtained. CONCLUSIONS: Tonsillar cryptic debris and enlarged regional lymph nodes along with recurrent tonsillitis could support the diagnosis of chronic tonsillitis in adults when considering tonsillectomy.

The role of mutation status of the epidermal growth factor receptor gene in advanced non-small cell lung cancer.

OBJECTIVE: The aim of this study was to examine the prevalence of epidermal growth factor receptor (EGFR) gene mutations among patients with advanced nonsquamous non-small cell lung cancer (NSCLC) treated in our institution and to evaluate the associations between EGFR mutations and clinicopathological characteristics. MATERIALS AND METHODS: A total of 103 patients with NSCLC were examined from April 2010 to September 2011. The patients were screened for EGFR mutations in exons 19 and 21 using sequence analysis. RESULTS: EGFR mutations were detected in 10 patients (9.71%): 23.1% of women and 5.2% of men (P<0.05), 31.8% of never-smokers and 4.7% of smokers (P<0.05), and 12.3% of patients with adenocarcinomas and 6.25% of patients with large cell carcinomas (P>0.05). Eight mutations (80.0%) were found in exon 21: 7 patients had the L858R mutation and 1 patient had the L861G mutation. Two mutations (20.0%) were found in exon 19: 1 patient had the L747-A748 deletion and 1 patient had the L747-A750insE deletion. The overall response rate was significantly greater in the EGFR mutation-positive group than in the EGFR mutation-negative or control groups (P<0.05). The median progression-free survival in the EGFR mutation-negative group and the control group that received systemic standard chemotherapy was 5.6 months (95% CI, 4.3 to 7.0) and 5.3 months (95% CI, 4.9 to 5.7), respectively, but it was not achieved in the EGFR mutation-positive group that received EGFR tyrosine kinase inhibitors (P<0.05). CONCLUSIONS: The frequency of EGFR mutations in our patients with nonsquamous NSCLC was found to be similar to that reported in Europe. EGFR mutations were more frequent in women and never-smokers.

Primary epithelioid sarcoma of the neck: a rare case report.

This report presents a case of a neck epithelioid sarcoma in a 20-year-old man with poor prognosis. The patient underwent surgery followed by external beam radiotherapy and brachytherapy performed as a boost. The treatment was well-tolerated, and there was no local recurrence or distant metastasis.

[Distribution of the epicardiac neural ganglia in human fetuses of different age]. / Epikardiniu nerviniu mazgu pasiskirstymas skirtingo amziaus zmogaus vaisiuje.

OBJECTIVE: The epicardiac neural ganglia of the adult human heart are distributed in the seven neural ganglionated subplexuses. The aim of the present investigation was to determine the distribution of the epicardiac ganglia in human fetuses of different age, because intrinsic cardiac nervous system of the human fetus has not been enough investigated so far. MATERIAL AND METHODS: In the present study seventeen human fetus hearts were investigated, in which epicardiac neural ganglionated plexus was visualized by histochemical method for acetylcholinesterase. RESULTS: Analysis of the total hearts preparations showed that: (1) the epicardiac neural ganglionated plexus of the fetus at fifteen weeks of gestation has already differentiated into seven ganglionated subplexuses, structure of which is typical for the adult human heart; (2) the epicardiac plexus of fetuses at 15-40 weeks of gestation contains on average 865+/-40 epicardiac ganglia, that may widely range in number from 644 to 1193; (3) the largest number of the neural ganglia is concentrated on the posterior surface of both atria, where up to 76% of all ganglia maybe located; (4) the difference between the number of epicardiac ganglia in the human fetuses at the early (15-25 weeks) and late (26-40 weeks) stages of fetogenesis is not statistically significant (p>0.05). In conclusion, both the distribution and the number of the epicardiac ganglia of fetuses ranging from 15 to 40 weeks of gestation are not age-dependent but varied substantially from heart to heart.

[Correlation of power Doppler sonography with vascularity of the synovial tissue]. / Ultragarsinio tyrimo, atliekamo jegos Dopleriu, koreliacija su sinovijos vaskulizacija.

The purpose of this study was to investigate the intra-articular vascularization of the synovium with power Doppler sonography and correlate these findings with histopathologic al findings of synovial vascularity. Before arthroplasty or arthroscopy with synovectomy the knee joints of 20 patients with osteoarthritis or rheumatoid arthritis were examined with power Doppler sonography. Vascularity of the synovial membrane was classified semi quantitatively. The degree of the synovial vascularity was graded quantitatively using histological method. The strong correlation was found between qualitative power Doppler sonography results with histological findings of vascularity (Spearman's correlation coefficient was 0.85, p=0.0005). Power Doppler sonography may be a valuable tool to detect synovial vascularity and to assist clinicians in distinguishing between inflammatory and non-inflammatory synovium.