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.

MORPHOLOGICAL FEATURES OF THE UTERUS IN WOMEN AT DIFFERENT TIME INTERVALS OF THE POSTMORTEM PERIOD AS DIAGNOSTIC CRITERIA FOR ESTABLISHING THE POSTMORTEM INTERVAL.

OBJECTIVE: The aim is to identify the morphological features of the uterus layers in women at different time intervals of the postmortem period as diagnostic criteria for establishing the postmortem interval. PATIENTS AND METHODS: Materials and methods: In the study we used surgical and autopsy material - uterine tissue fragments. All materials were divided into two groups. The 1st group (G 1) included surgical material from women (n=6) who underwent removal of the uterus, or uterus with the appendages due to leiomyoma, uterine prolapse. The 2nd group (G 2) included autopsy material from 42 women with known causes of death and postmortem period (from 24 to 48 hours - 6 cases, from 49 to 72 hours - 7 cases, from 73 to 96 hours - 8 cases, from 97 to 120 hours - 6 cases, from 121 to 144 hours - 8 cases, more than 144 hours - 7 cases). Histological and immunohistochemical study methods were used. RESULTS: Results: A comprehensive morphological study of the women uterus revealed a time-dependent increase of postmortem changes in this organ linked with the increase of postmortem period. In cases of postmortem period duration up to 144 hours, the structural elements of the uterine layers were identified. In cases where the duration of the postmortem period was more than 145 hours, microscopically the uterus was represented by eosinophilic fibrous or dusty masses, the histogenesis of which could not be determined. The processes of autolysis occurred more intensely and faster in the mucous membrane of the uterus, in comparison with the muscular and serous membranes, and in the vessels - in their inner membrane, in comparison with the middle and outer membranes. Autolytic changes in the muscular membrane of the uterus and vascular walls occurred more intensely in muscle fibers compared to connective tissue fibers. CONCLUSION: Conclusions: The histological and immunohistochemical features of the women uterus at different postmortem periods have a certain forensic medical significance and can be used for establishing the postmortem interval.

CHARACTERISTICS OF AUTOPSY MATERIAL IN CASES OF CHRONIC DIFFUSE PATHOLOGY OF THE LIVER PARENCHYMA DIAGNOSED DURING PATIENT'S LIFETIME USING THE ULTRASOUND METHOD.

OBJECTIVE: The aim: Of the study is to analyze autopsy cases where chronic diffuse pathology of the liver parenchyma was diagnosed during patient's lifetime using the ultrasound method. PATIENTS AND METHODS: Material and methods: In this study archival material (autopsy protocols and microspecimens of these cases) of the pathological anatomy department of the Communal Nonprofit Enterprise «Regional Clinical Hospital¼ (Kharkiv) was used for the period from 2012 to 2018. The cases diagnosed with a chronic diffuse pathology of the liver parenchyma according to ultrasound data were selected among all cases. Microspecimens stained with hematoxylin and eosin, picrofuxin according to van Gieson were examined using an Olympus BX-41 microscope (Japan). The obtained digital indicators were statistically processed using the programs Statistica 6.0, Microsoft Excel 2003. To compare the parameters, parametric and nonparametric methods were used (Student's t-test, χ2 criterion, Mann-Whitney U-test). Differences were considered significant at p<0.05. RESULTS: Results: According to the analysis of archival material for the period from 2012 to 2018, there was no change in the relative number of cases with fatty hepatosis, fibrosis or cirrhosis of the liver, chronic hepatitis, malignant tumors of the liver, metastatic liver damage and liver infiltration by leukemic cells, liver abscesses. Among all cases with revealed liver pathology, both separately by year and as a whole for the entire studied period, a predominance of the relative number of cases with fatty hepatosis, fibrosis or cirrhosis of the liver was noted. CONCLUSION: Conclusions: The term «chronic diffuse pathology of the liver parenchyma¼, which is widely used in ultrasound diagnostics, is morphologically a collective term that combines pathological conditions such as fatty hepatosis, fibrosis or cirrhosis of the liver, chronic hepatitis, malignant tumors of the liver, metastatic liver damage and liver infiltration by leukemic cells, liver abscesses. The ultrasound term «chronic diffuse pathology of the liver parenchyma¼ needs to be improved as well as additional diagnostic criteria should be developed in order to correctly use it in practice and avoid diagnostic errors.

Clinical and morphological features of the ovarian brenner tumour: current state of the problem.

OBJECTIVE: Introduction: Ovarian tumours are an actual problem of present-day medicine, being one of the most difficult sections of modern oncology. The majority of ovarian tumours are of epithelial origin. The ovarian Brenner tumour represents a rare epithelial ovarian neoplasm and accounts for 1-2% of all ovarian neoplasms. The aim of the study is to identify clinical and morphological features of ovarian Brenner tumour. PATIENTS AND METHODS: Materials and methods: The material was 5 cases of Brenner ovarian tumour, diagnosed in the study of 4 cases of operational material and 1 case of autopsy observation for the period from 2007 to 2019. Histological and immunohistochemical staining methods were used. The microspecimens were examined on an Olympus BX-41 microscope (Japan). RESULTS: Results: Ovarian Brenner tumour is a rather rare pathology, the histogenesis of which is debatable. Morphological examination is the main method for its diagnosing. Ovarian Brenner tumours developed in women of middle and old age (the average age was 51.8 years). Women with a malignant ovarian Brenner tumour were older than women with a benign variant (the average age in women with a malignant variant was 55.8 years, with a benign variant - 49.3 years). Benign ovarian Brenner tumour occurred more frequently compared with a malignant one. Malignant and benign variants of ovarian Brenner tumour were characterized by a one-sided nature of the lesion with frequent involvement in the pathological process of the left ovary. Clinically, in patients with a benign variant of the Brenner tumour in all cases an abdominal pain syndrome was determined, combined in one case with metrorrhagia. A malignant ovarian Brenner tumour was clinically manifested by severe abdominal pain syndrome, combined in one case with complaints of an increase in the size of the abdomen, and in another case with intoxication syndrome and a clinic of small bowel obstruction. In all cases a malignant ovarian Brenner tumour metastasized to the omentum and in one case also to the small intestine wall. Macroscopically the ovarian Brenner tumour had the form of a node, the dimensions of which were significantly larger for the malignant variant compared with a benign, dense or soft consistency, on the cross section of a whitish-gray or brown color with cysts. A damaged ovary with a malignant variant of Brenner tumour significantly increased in size, while with a benign one, its size did not change or increased slightly. In all cases the malignant and benign variants of ovarian Brenner tumour were combined with various reproductive system organs pathologies (mucinous papillary cystadenoma of the ovary, serous ovarian cyst, ovarian endometriosis, endometrial hyperplasia, cervical nabothian cysts, uterine leiomyoma). CONCLUSION: Conclusions: A study conducted by the authors revealed clinical and morphological features of a rare ovarian tumour - Brenner tumour, which will contribute to a better understanding of this pathology by the doctors of various specialties, and improve the treatment and diagnostic process.