Thyroid nodules with Hürthle cells: the malignancy risk in relation to the FNA outcome category.

PURPOSE: The aim was to find whether the presence of Hürthle cells (HC) in a smear influences the categorization of FNA results or the risk of malignancy (RoM) of particular categories of cytological diagnosis. METHODS: 25,220 FNA performed in a single center in years 2005-2017 were analyzed. Almost all the examined patients were exposed to moderate iodine deficiency for most of their lives. The distribution of FNA outcome categories was compared between two groups: with or without HC (HC and non-HC). The RoM was evaluated on the basis of postoperative histopathological examination (3082 patients). RESULTS: HC were found in 7.5% of diagnostic FNA. HC nodules were classified into categories II (78.2% vs. 91.9%, p < 0.0000) and VI (0.4% vs. 1.2%, p = 0.0017) less often than non-HC nodules, but more frequently to categories III (14.4% vs. 5.8%, p < 0.0000), IV (11.2% vs. 0.9%, p < 0.0000) and V (1.5% vs. 0.8%, p = 0.0013). There were no significant differences in RoM between HC and non-HC nodules. The RoM in HC and non-HC nodules of particular categories of the Bethesda system was as follows: II: 1.8% vs. 0.8%, III: 9.7% vs. 3.8% when only the last FNA was considered and 10.8% vs. 6.4% when the category III in any performed FNA was considered; IV: 12.7% vs. 10.9%; V: 41.7% vs. 58.2%; and VI: 100% vs. 96.9%. CONCLUSIONS: HC nodules are classified into categories of equivocal cytological outcomes more often than nodules without HC. Nevertheless, the presence of HC in a smear does not significantly affect the RoM of FNA categories.

The association between polymorphisms of the RAD51-G135C, XRCC2-Arg188His and XRCC3-Thr241Met genes and clinico-pathologic features in breast cancer in Poland.

BACKGROUND: XRCC2 and XRCC3 genes are structurally and functionally related to RAD51 which plays an important role in homologous recombination, the process frequently involved in cancer transformation. MATERIAL AND METHODS: In the present work the distribution of genotypes and frequency of alleles of the RAD51 G135C polymorphism, XRCC2 Arg 188His and XRCC3 Thr241Met polymorphism in 790 cases of breast cancer were investigated. The control group consisted of 798 cancer-free blood donors (age +/- 5 years) who were sex and ethnicity-matched. The polymorphisms were determined by PCR-RFLP methods. We also correlated genotypes with the clinical characteristics of breast cancer patients. RESULTS: Our results obtained for the 135G>C polymorphism of the RAD51 gene indicated that both the C/C genotype and the C allele are strongly associated with breast cancer. The Arg/His genotype of XRCC2 (OR = 2.16, 95% CI = 1.48-3.16) and Thr/Met of XRCC3 increased the risk of type I breast cancer occurrence (OR = 2.33, 95% CI = 1.60-3.41). We did not find any association with the RAD51, XRCC2/3 gene polymorphism and estrogen and progesterone receptor status. CONCLUSION: The results support the hypothesis that the polymorphism of RAD51 and XRCC2/3 gene may be associated with the incidence of sporadic breast cancer in Polish women.

Association between Arg399Gln polymorphism of X-ray repair cross-complementing 1 (XRCC1) gene and sporadic endometrial cancer in the Polish population.

BACKGROUND: Endometrial cancer is one of the most common malignant neoplasms which appear in the uterine body. X-ray repair cross-complementing 1 (XRCC1) protein can be involved in the repair of DNA lesions, which are known to contribute to endometrial cancer. MATERIAL AND METHODS: The genotype analysis of XRCC1 Arg399Gln gene polymorphisms for 456 endometrial cancer patients and 300 controls of cancer-free subjects in the Polish population were performed using the PCR-based restriction fragment length polymorphism (PCR-RFLP). RESULTS: The association between endometrial cancer occurrence and the Gln/Gln genotype of the Arg399Gln polymorphism (odds ratio, OR 2.28; 95% confidence interval, CI 2.02-2.54) was found. The Gln/Gln genotype of XRCC1 increased the risk of type I endometrial cancer occurrence (OR = 2.42, 95% CI = 2.12-2.72). No statistically significant association was found between gene polymorphisms and endometrial cancer risk factors such as BMI, HRT, uterine bleeding, endometrial ultrasound transvaginal, diabetes and hypertension. CONCLUSION: The results support the hypothesis that the Arg399Gln polymorphism of the XRCC1 gene may be associated with the incidence of sporadic endometrial cancer in Polish women.

Difficulties in the diagnosis of ovarian carcinoma: case report of squamous cell ovarian carcinoma in a 26-year-old woman.

A 26-year-old woman who was admitted to the Gynecology Department with abdominal pain was later diagnosed with a multi-chamber tumor in the left ovary. Neoplastic markers were within normal limits. It was proposed that the patient should be operated on in order to remove the tumor, and a left salpingo-oophorectomy was performed. During the intraoperative histopathological examination, the tumor was described as being benign. However, in the final histopathological examination, a malignant neoplasm, a squamous cell carcinoma (G-2) of the ovary (pT1a), was found. It was decided that a hysterectomy and a right salpingo-oophorectomy should be performed. No other neoplastic foci were found in the postoperational material. The patient is currently undergoing periodic control examinations.

Adipohormones as prognostric markers in patients with nonalcoholic steatohepatitis (NASH).

Nonalcoholic steatohepatitis (NASH) represents one of the most common liver diseases. It is strongly associated with obesity and insulin resistance and is thought to be part of the metabolic syndrome. NASH can progress to cirrhosis and liver failure. Adipohormones, synthesized in adipose tissue, are involved in the pathophysiology of many acute and chronic liver diseases. The aim of this study was to evaluate the plasma concentrations of adiponectin, resistin, leptin, TNF-alpha and Il-6 in patients with NASH, as well as their correlation with the pathologic parameters. Serum concentration of leptin, adiponectin, resistin, insulin, TNF-alpha, IL-6 were measured with ELISA method. Liver biopsies were obtained from 18 (age 42.55+/-21 years) patients. NASH has been classified according to Dixon score. The control group was represented by 16 non-obese subjects. Mean serum concentration of adiponectin in patients with NASH was significantly lower than in healthy subjects (4.87+/-1.96 vs. 8.33+/-4.56 ng/ml; p<0.05). Mean serum levels of TNF-alpha in patients with NASH were significantly higher than in controls (34.2+/-19.7 vs. 20.7+/-15.5 ng/ml; p<0.05). In patients with more advanced inflammation (grade 2-3) and fibrosis (stage 2) in pathology, serum concentration of leptin was significantly higher than in patients with steatosis and less advanced inflammation (grade 1) and fibrosis (stage 1) (median 8.94 vs. 16.2 ng/ml; p<0.05). No significant differences of serum concentration of others adipohormones between these two groups of patients were stated. Moreover, we observed the correlation in serum levels (examined group vs controls) between: resistin and TNF-alpha (r = 0.62; p<0.05), adiponectin and IL-6 (r = -0.60; p<0.05) and leptin and insulin (r = -0.51; p<0.05). In conclusion, based on our study we speculate that changes of adipohormones levels may be markers of NASH and the serum level of leptin can be associated with more advanced form of NASH.

Multiparameter analysis of AgNOR in thyroid lesions: comparison with PCNA expression.

The aim of the study was to examine numerous features of argyrophilic proteins related to nucleolar organizer regions (AgNORs) in thyroid tumors, relate them to PCNA expression and evaluate which of these features might be useful in the diagnosis of thyroid lesions. Paraffin sections of 100 thyroid tumors were silver-stained and divided into 9 groups: nodular goiter (NG), simple adenoma (SA), microfollicular adenoma (MFA), follicular carcinoma (FC), follicular variant of papillary carcinoma (PC-F), classical variant of papillary carcinoma (PC-C), Hürthle cell adenoma (HA), Hürthle cell carcinoma (HC), and anaplastic carcinoma (AC). The slides were analyzed with the computerized system for image analysis. A weak correlation was found between PCNA expression and AgNOR size. AC differed significantly from all other examined groups in many features of AgNOR dots. Hürthle cell neoplasms were characterized by the presence of a usually single and relatively large dot. With respect to diagnosing follicular lesions, we found that the evaluation of the total area of dots in the nucleus seemed to be the most useful for discrimination: the assumption of 4.9 micro m2, as a cut-off value, allowed a correct classification of 77% of FC cases. Computer-aided morphometric analysis of AgNORs may be useful in the diagnostics of thyroid lesions.

Fine needle aspiration cytology in non-neoplastic non-toxic recurrent nodular goitre.

The aim of the study was to examine whether evaluation of anisokaryosis is helpful in the cytological diagnosis of focal lesions in non-toxic recurrent goitre (NRG) after thyroidectomy for non-malignant goitre. Karyometric analysis was performed in routine cytological smears obtained from 80 females: 40 with focal lesions in non-toxic primary goitre (NPG) and 40 with NRG (postoperative histopathological examination revealed nodular goitre in both groups in all cases). We found that the level of anisokaryosis was significantly (P<0.005) higher in NRG than in NPG. There were no significant differences between the two lesions, in cellular composition or thyroid follicular cell arrangement. Thus, isolated anisokaryosis, a feature of malignancy in patients without a prior thyroidectomy, has limited diagnostic value in recurrent goitre.

[Liver tuberculosis]. / Gruzliczak watroby.

The case of rare localization of extrapulmonary tuberculosis--isolated tuberculoma of the liver--was described. The tumor was found accidentally, during abdominal ultrasound for benign prostatic enlargement. Computed enhanced tomography didn't explain the character of the tumor, so percutaneous thin-needle biopsy was performed. Preliminary histological report suggested primary liver cancer. Patient was operated on, tumor was removed with the margin of the healthy liver tissue. Histological examination of the specimen revealed the nature of the tumor. Diagnosed liver tuberculoma is usually treated without surgery.

[The role of fine needle biopsy in diagnosis of thyroid cancer]. / Rola biopsji cienkoiglowej w rozpoznawaniu raka tarczycy.

The majority of changes in the structure and consistency of the thyroid gland is a clear indication for fine needle aspiration biopsy (FNAB). This does not mean, however, that cytological evaluation provides an unequivocal diagnostic confirmation for every pathological change found by palpation or by imaging technology. The main purpose of FNAB is to differentiate the type of examined pathological lesion (i.e. neoplastic or non-neoplastic) and to help in the selection of appropriate therapy. The diagnoses obtained by FNAB may be divided into five categories. FNAB plays the key role in the diagnostics of papillary and anaplastic thyroid carcinoma.

[Differential criteria between papillary and follicular thyroid carcinoma--initial conclusions from a multicenter trial]. / Kryteria róznicowania miedzy rakiem brodawkowatym i pecherzykowym tarczycy--pierwsze wnioski z badania wieloosrodkowego.

Histopathological diagnosis of thyroid cancer is difficult and requires much experience. Pathologists have to know many histopathological variants and be aware of the current diagnostic criteria. The aim of the study was to unify criteria applied all over the country and compare whether the accuracy of diagnosis has changed in the course of the last fifteen years. In a multicenter trial, 36 pathologists from 25 centers reevaluated 232 thyroid tumors operated between 1985-1998. The reference diagnosis was given on the basis of evaluation made by four experienced pathologists. The two-step analysis was performed. At first, the accuracy of the diagnosis of malignant neoplasm was evaluated. Then, the accuracy of the diagnosis of the cancer histotype was analyzed, with estimation of kappa coefficients and their asymptomatic standard error. Comparison of primary and reference diagnoses revealed statistically significant differences--in 17% of cases the primary diagnosis of cancer was not confirmed by experienced pathologists. Kappa coefficient for the diagnosis of cancer histotype was 0.53 + 0.06. On the contrary, the diagnoses made by the participants of the trial did not differ significantly from the reference ones. Kappa coefficient for the diagnosis of cancer histotype was significantly higher than for primary diagnoses with 0.63 +/- 0.10 (p < 0.001). The first results of the multicenter trial indicated that the most frequent diagnostic error made at primary diagnosis was the overdiagnosis of follicular thyroid carcinoma. Thus, a summary of strict criteria for papillary and follicular thyroid carcinoma is also given.

[Criteria for histopathologic diagnosis of thyroid cancer in a quick test of accuracy]. / Kryteria rozpoznania histopatologicznego raka tarczycy w szybkim tescie zgodnosci.

A quick test of accuracy of histopathological diagnosis of thyroid carcinoma was performed in May 2000 during the meeting of Polish thyroid cancer group (Committee for Epidemiology, Diagnosis and Treatment of Thyroid Carcinoma). 29 pathologists participated in the test and evaluated 8 cases of thyroid carcinoma and 14 benign thyroid lesions. All cases were chosen from the current material sent for pathologic evaluation to the Institute of Oncology in Gliwice due to diagnostic difficulties. In total, 591 diagnoses were made and were the subject of the presented analysis. They were compared with reference diagnosis in two aspects. First, the accuracy of the distinction between malignant and benign lesions was evaluated. 72.5% of diagnoses were concordant with the reference. The false diagnosis of cancer in a benign lesion was observed 133 times (22.5% of all diagnoses). A reverse error--a false exclusion of cancer--was seen in 29 diagnoses (4.9%). Chi 2 test revealed a statistically significant difference between the participants' diagnoses and reference ones (p < 0.0001). Overdiagnosis of cancer was the most frequent at the diagnosis of follicular or oxyphilic cancer. With reference to the diagnosis of cancer histotype, concordant diagnoses were seen in 40-47% of cases with the lowest accuracy of the diagnosis of oxyphilic (40% of correct diagnoses) and follicular (50%) cancer. The causes of false diagnoses may be divided in two groups: sample-related causes (sampling of surgical specimens, lack of standard description, insufficient number of samples, poor quality of staining) and diagnostic errors: non-compliance with diagnostic criteria and inappropriate setting of diagnoses, which require immunohistochemical confirmation.

Circadian variations in hepatotoxicity of carbon tetrachloride in mice.

Male mice of Balb/C strain were administered i.p. carbon tetrachloride, in single doses of 35 and 145 mg/kg, given at variable time of the day. The activity of alanine aminotransferase (ALAT) in serum, and the hepatic level of malondialdehyde (MDA) as well as reduced glutathione (GSH) were adopted as indicators of toxicity. In selected groups, liver histopathology was carried out. The experiment was performed in two series differing in the dynamics of observations. A differentiation of the intensity of toxic effects was found dependent on the time of the day at which animals were administered the xenobiotic. This was especially evident for a lower dose: given in the morning it produced no effects, whereas given in the evening it resulted in distinct elevation of toxicity indicators. Additionally, the correlation was checked between the histopathological evaluation (semiquantitative expression) and serum ALAT activity. A high correlation (r = 0.98) allows for basing the evaluation of liver necrosis on the ALAT activity alone.

Usefulness of computer-aided karyometric examination in preoperative differentiation of Hürthle cell lesions.

We have previously reported that there is a significant difference in the mean size of thyrocyte nuclei among patients with nodular goiter, follicular adenoma, and follicular carcinoma. In the present study, we have examined karyometric parameters of Hürthle cells in smears collected from 41 patients with Hürthle cells adenomas, Hürthle cells carcinomas, nodular goiter, and lymphocytic thyroiditis. The karyometric evaluation was performed with the image analysis computer system-Karyometry Manager 1.2. We measured the mean volume, the mean intersection area, and the mean perimeter of 100 nuclei in each routine smear. We found that the sizes of Hürthle cell nuclei could be arranged in the ascending order from the nodular goiter, through lymphocytic thyroiditis to Hürthle cell neoplasms, but those differences did not reach a border of statistical significance.

Karyometric analysis in the cytologic diagnosis of thyroid lesions.

OBJECTIVE: To assess the possible role of karyometry in improving the diagnostic value of fine needle aspiration biopsy (FNAB) of the thyroid. STUDY DESIGN: Thyrocyte nuclei were evaluated in routine slides obtained from 229 patients. The cytologic specimens were divided into seven groups according to the results of corresponding postoperative histopathologic examinations. Karyometric measurements comprised assessment of nuclear volume intersection area and perimeter as well as level of anisokaryosis, evaluated as standard deviations of those parameters in single slides. The karyometric evaluation was performed with a computerized image analysis system. RESULTS: The size of thyrocyte nuclei increased from nontoxic nodular goiters through follicular adenomas, toxic nodular goiters treated with antithyroid drugs, lymphocytic thyroiditis, papillary and follicular carcinomas to anaplastic carcinomas. The observed differences between those groups were statistically significant, but there was marked overlapping. Our data indicate also that the age and sex of the patient influence the cytologic picture of nodular goiter. The evaluation of anisokaryosis increases the usefulness of karyometry in differentiating malignant neoplasms from benign lesions. CONCLUSION: Karyometric analysis increases the probability of a correct diagnosis with FNAB examination.

Size of thyrocyte nuclei in aspirates from follicular adenomas: correlation with patients' ages.

OBJECTIVE: To determine whether the size of thyrocyte nuclei in aspirates from follicular adenoma correlates with the age of patients. STUDY DESIGN: The karyometric parameters were evaluated in routine aspirates, obtained from 27 patients with follicular adenoma as diagnosed in postoperative histopathologic examinations. The ages of the patients ranged from 11 to 70 years (36.8 +/- 16.3, x +/- SD). The cytologic examination of all the aspirates before surgery revealed "follicular neoplasms." The karyometric evaluation was performed with Karyometry Manager, version 1.2, an image analysis computer system. RESULTS: Neither the mean nuclear volume, mean nuclear intersection area nor mean nuclear perimeter correlated with the ages of the patients. CONCLUSION: These results suggest that in contrast to nodular goiter, in the cytologic examination of follicular neoplasms, the ages of patients should be disregarded when interpreting the size of thyrocyte nuclei.

Comparison of hepatotoxicity of 1,2-, 1,3- and 1,4-dibromobenzenes: the dynamics of changes of selected parameters of liver necrosis in acute poisoning in mice.

Various doses of dibromobenzene isomers (1,2-dBB, 1,3-dBB, 1,4-dBB) were administered (i.p.) to BALB mice. The levels of reduced glutathione (GSH) and malondialdehyde (MDA) in the liver, and glutamate-pyruvate transaminase (GPT) (EC.2.6.1.2) gamma-glutamyltransferase (gamma-GT) (EC.2.3.2.2) and triglycerides (TG) in the serum were estimated. A considerable decrease of GSH was observed between 2 and 12 h after administration of the compounds. Increases in serum GPT activity (up to 100-fold) and gamma-GT (three-to fivefold) were observed after treatment using 1,2- and 1,3-dibromobenzenes; TG decreased in concentration initially and then slightly increased. Histopathological examination confirmed the strong necrotic effect of 1,2- and 1,3-dBB isomers. No such changes (elevation of serum GPT activity and necrosis) were noticed after 1,4-dBB.

[Carcinoma on the base of the ovarian struma]. / Rak na tle wola jajnika.

A rare case of carcinoma developed in struma ovary in 55 year-old woman. During surgical intervention, the carcinoma infiltration in ovary stroma was diagnosed. The metastases were not stated. In the immunohistochemical assay, thyroglobulin and cytokeratin in neoplastic cells were displayed. Clinical examination did not show any signs of hyperthyreosis.