AGGRESSIVE COURSE OF DIFFERENTIATED THYROID GLAND CANCER IN A PATIENT WITH INSULIN RESISTANCE: CASE ANALYSIS FROM PRACTICE.

Differentiated thyroid cancer (DTC) is usually characterized by a harmless clinical behavior but in some cases it can manifest itself as a metastatic damage to the bone system. The authors reported case from their practice of an aggressive DTC course in a patient with insulin resistance, accompanied by the development of metastases in the bone system. The main goals of the patient's treatment at each stage of radioiodine therapy were to reduce the foci of metastatic bone damage in terms of their number and volume as well as insulin resistance as a risk factor affecting insulin-like growth factors. A clinical case analysis found that radioiodine therapy might be useful for disease control in cases with potentially aggressive variants of DTC. This category of patients requires careful monitoring of insulin resistance, insulin-like growth factors and appropriate antitumor treatment.

INSULIN-LIKE GROWTH FACTORS IN THE SERUM OF PATIENTS WITH PAPILLARY THYROID CANCER.

OBJECTIVE: The aim is to study the level of insulin-like growth factor-1 (IGF-1) and insulin-like growth factor-2 (IGF-2) in the blood serum of patients with papillary thyroid cancer, depending on the main clinical and morphological features of the disease. PATIENTS AND METHODS: Materials and methods: The material was the information about 60 patients with papillary thyroid cancer (group 1). In group 2 there were 10 patients without oncopathology. All patients underwent clinical examination after total thyroidectomy before special treatment (radioiodine therapy): ultrasound diagnosis of the neck, confirmed diagnosis of papillary thyroid cancer by morphological examination of operative material. All patients underwent anthropometric studies (height, weight), on the basis of which the body mass index (BMI) was calculated. The study program also included determination of the level of thyroid-stimulating hormone of the pituitary gland (TSH), thyroglobulin (TG), antibodies to thyroglobulin (AB-TG). It was also determined the serum glucose level. In order to assess insulin resistance, the HOMA-IR index was calculated. All patients were tested for serum IGF-1 and IGF-2. RESULTS: Results: In the blood serum of patients with papillary thyroid cancer in 63% of patients the level of IGF-1 and in 85% - IGF-2 was probably higher than in the control group. There is a relationship between the level of IGF-1, IGF-2 and elevated level of proliferating factor - insulin in the serum of patients with papillary thyroid cancer. This may indicate an aggressive potential of the disease (i.e. clinical data on the prevalence of papillary thyroid cancer coincide with laboratory data). There was found a relationship between the expression of IGF-1, IGF-2 and insulin: at elevated levels of insulin> 24.9 µIU/ml, IGF-1 increases 4.2 times, and IGF-2 - 2.5 times. Evaluation of the relationship between the level of IGF-1 and IGF-2 and cervical lymph node involvement shows that in the absence of lesion (N0) there is an increase in these indicators by 2.2 and 1.8 times, respectively. CONCLUSION: Conclusions: The signaling system of insulin-like growth factors (IGF-1 and IGF-2) plays an important role in the occurrence and progression of malignant tumors. It is especially true for papillary thyroid cancer, so its components can be considered as potential diagnostic and prognostic markers of the disease and targets for anticancer therapy.

MALIGNANT TUMORS OF THE APPENDIX: CLINICAL AND MORPHOLOGICAL ANALYSIS OF CASES FROM THE PRACTICE.

The authors have analyzed medical histories of two patients, treated in health care facilities of Kharkiv region from 2008 to 2020. These patients underwent urgent appendectomy, given the existing clinic of acute appendicitis. Morphological examination of the surgical material allowed us to diagnose adenocarcinoma in one case, and neuroendocrine tumor in combination with endometriosis in the other case. Morphological examination of the surgical material in the first case revealed a moderately differentiated adenocarcinoma and diffuse neutrophilic infiltration in all layers of the appendix, and in the second case - a well-differentiated neuroendocrine tumor (G3), combined with the signs of phlegmonous-ulcerative appendicitis and loci of endometriosis. In both cases, there were no specific for the oncological process anamnestic and clinical-instrumental data, and these tumors were manifested by the clinic of acute appendicitis. Only morphological examination of the surgical material allowed identifying the pathological process. Clinical and morphological analysis of cases from the practice of malignant tumors of the appendix (neuroendocrine tumor and adenocarcinoma) will be useful and interesting for the medical community and should stimulate cancer vigilance in physicians.