Influence of autoimmune thyroiditis on the prognosis of papillary thyroid carcinoma.

OBJECTIVES: The association of autoimmune thyroiditis (AIT) with papillary thyroid carcinoma (PTC) has been studied for over 60 years, yet their causal relationship has not been elucidated. Most published papers report a better prognosis of the patients with tumour in the field of thyroiditis. In our work we aimed to find out the differences in the clinical behaviour of PTC depending on the presence of autoimmune inflammation. METHODS: We retrospectively analysed a group of 1,201 patients with PTC dispensed in St. Elisabeth Cancer Institute and Faculty of Medicine from 2000 to 2015. We divided patients with AIT according to the time of diagnosis of inflammation into the AIT1 subgroup, which included patients monitored for AIT before tumour detection. In them, we assumed that the factor of long-term endocrinological monitoring could speed up the diagnosis of the tumour and thus improve the prognosis. The AIT2 subgroup consisted of patients with both tumour and inflammation diagnosed simultaneously, thus eliminating the factor of prior monitoring. RESULTS: PTC in the AIT1 subgroup had better prognostic parameters (TNM stage, persistence, disease remission). Patients in the AIT2 group had all monitored parameters comparable with patients with tumours without autoimmune inflammation. CONCLUSION: AIT alone does not have a protective effect on the course of PTC, the cause of a better prognosis in the AIT1 subgroup is a different pathomechanism of carcinogenesis, as well as previous endocrinological monitoring and earlier detection of malignancy (Tab. 4, Fig. 2, Ref. 27).

Pretreatment Levels of Chromogranin A and Neuron-specific Enolase in Patients With Gastroenteropancreatic Neuroendocrine Neoplasia.

BACKGROUND/AIM: Chromogranin A (CgA) and neuron-specific enolase (NSE) are applied in the diagnosis of neuroendocrine neoplasms (NENs), especially non-functional ones. The aim of this study was to investigate the predictive values of CgA and NSE in long-term survival. PATIENTS AND METHODS: Our retrospective analysis included 65 patients with histologically verified gastroenteropancreatic NEN between 2005 and 2019. We performed bivariate and multivariable analyses to evaluate the relationship between CgA and NSE values before histological assessment and overall survival. Distribution of time-to-event was analyzed using Kaplan-Meier survival curves and modelled by Cox regression models. RESULTS: Elevated NSE levels prior to histology were significantly associated with worse survival (HR=1.13, p=0.004) and were associated with low-differentiated NENs (rs=0.321, p=0.0338). CgA was associated with well-differentiated tumors (rs=0.233), but not significantly. CONCLUSION: Pretreatment serum levels of NSE can serve as a valuable additional predictor of long-term survival in patients with NEN.

An incidental finding of pheochromocytoma in a 33-year-old patient with Lynch syndrome.

Pheochromocytoma is a catecholamine-producing neuroendocrine tumor arising from chromaffin cells of the adrenal medulla. The detection of these tumors is extremely important because they are associated with high cardiovascular morbidity and mortality. Progress in molecular genetics has revealed that up to 35% of pheochromocytomas are inhereted. Lynch syndrome (hereditary nonpolypous colorectal cancer - HNPCC) is an autosomal dominant genetic condition that is associated with a high risk of colorectal cancer or other extracolonic tumors (adenocarcinoma of endometrium, stomach, ovarian carcinoma, carcinoma of urinary tract, small intestine, brain tumors and skin cancer). Foreign medical journals are reporting an increasing number of cases on coexistence of HNPCC and neuroendocrine tumors, including pheochromocytoma. It increases the likelihood that this type of tumor could represent an additional extracolonic manifestation of Lynch syndrome.

Characteristic CT features of pheochromocytomas - probability model calculation tool based on a multicentric study.

OBJECTIVES: The aim of the study was to evaluate the CT features of adrenal tumors in an effort to identify features specific to pheochromocytomas and second, to define a feasible probability calculation model. METHODS: This multicentric retrospective study included patients from the period 2003 to 2017 with an appropriate CT examination and a histological diagnosis of an adrenal adenoma, pheochromocytoma, adrenocortical carcinoma, or metastasis. In total, 346 patients were suitable for the CT image analysis, which included evaluation of the largest diameter, the shape of the lesion, the presence of central necrosis and its margins, and the presence of an enhancing peripheral rim ("ring sign"). RESULTS: Pheochromocytomas have a significantly more spherical shape (P<0.001), whereas an elliptical shape significantly reduces the probability of a pheochromocytoma (odds ratio = 0.015), as does another shape (odds ratio = 0.006). A "ring sign" is also more frequent in pheochromocytomas compared to other adrenal tumors (P=0.001, odds ratio = 6.49). A sharp necrosis also increases the probability of a pheochromocytoma more than unsharp necrosis (odds ratio 231.6 vs. 20.2). The probability calculation model created on the basis of the results confirms a high sensitivity and specificity (80% and 95%). CONCLUSION: This study confirms the value of anatomical features in the assessment of adrenal masses with the ability to significantly improve the identification of pheochromocytomas. Advanced assessment of the tumor shape was defined and a original comprehensive calculating tool of the pheochromocytoma probability was created on the basis of the results presented here and could be used in clinical routine.

[The course of differentiated thyroid microcarcinoma in patients treated by different therapeutic strategies]. / Priebeh ochorenia u pacientov s diferencovaným mikrokarcinómom stítnej zlazy pri pouzití rôznych liecebných postupov.

Low risk differentiated thyroid microcarcinoma therapy is a controversial area of thyroid tumor management. Major international medical societies and reputable institutes consider lobectomy to be sufficient therapeutic intervention for the pT1a cN0cM0 stage of papillary thyroid microcarcinoma. However different views and therapeutic strategies exist and result in unnecessary overtreatment and worsening of patients quality of life. We researched the course of the differentiated thyroid microcarcinoma in patients using different therapeutic strategies: lobectomy, total thyroidectomy, total thyroidectomy with central compartment prophylactic lymphadenectomy and total thyroidectomy followed by radioactive iodine treatment. Apart from an excellent prognosis we did not find out any clinically significant differences in the course of the disease. We can conclude that lobectomy is sufficient therapeutic intervention for patients with differentiated thyroid microcarcinoma without known metastases.Key words: differentiated thyroid microcarcinoma - management - overtreatment - the course of the disease.