Although most patients with thyroid cancer have a favorable clinical course, some patients develop a more aggressive type of cancer and exhibit more rapid disease progression with worse prognosis. ...Those patients usually exhibit mutations of proteins such as tyrosine kinase enzymes that play a significant role in regulation of tumor proliferation and spreading. Development of targeted therapies is based on the inhibition of mutated kinases which are involved in the MAPK signaling pathway. The aim of this study was to present the initial results of clinical experience with kinase inhibitors in patients with metastatic differentiated thyroid cancer (DTC), poorly differentiated thyroid cancer (PDTC), and medullary thyroid cancer (MTC) who exhibited rapid disease progression. A total of 17 adult patients (11 women, mean age 53.3 years) managed for progressive, metastatic disease were included in the study. Twelve patients with DTC and PDTC were previously tested for BRAF mutations, of whom nine that had tumor tissue negative for the BRAF V600E mutation received sorafenib, while three patients with tumors harboring the BRAF V600E mutation were treated with vemurafenib. Patients with MTC were treated with sunitinib, vandetanib, and sorafenib. Two patients with tumors harboring the BRAF mutation treated with vemurafenib showed restoration of radioiodine uptake. Most of patients showed significant improvement in disease status but of limited duration until disease progression. Although there was an improvement in progression-free survival, future research has to achieve a greater and longer-lasting response, probably by utilizing combined targeted therapy.
SAŽETAK
Dezmoidni tumori su rijetke benigne tvorbe podrijetla vezivnog tkiva koje sporo rastu, ne metastaziraju, ali mogu invadirati okolna tkiva. Cilj izvješća je prikaz bolesnice s dezmoidnim ...tumorom razvijenim u ležištu lijevog režnja štitnjače nakon prethodnoga operacijskog zahvata totalne tireoidektomije zbog multinodularne guše s ekstirpacijom adenoma paratireoidne žlijezde u istom aktu. Zbog promuklosti i osjećaja bolnosti u ležištu štitnjače dvije godine nakon inicijalnog zahvata kod bolesnice je učinjen kontrolni ultrazvuk vrata koji verificira slabo ograničen, nehomogen, pretežno izoehogen čvor tvrde konzistencije u ležištu lijevog režnja štitnjače koji je po svojim ehografskim karakteristikama bio suspektan na malignu promjenu. Ciljana citološka punkcija opisuje rijetke vretenaste stanice, ali bez drugih elemenata za pobližu diferencijaciju. Stoga je ultrazvučni pregled dopunjen drugim slikovnim radiološkim metodama (kompjutorizirana tomografija i magnetska rezonancija) koje postavljaju sumnju na paragangliom ili adenom paratireoidne žlijezde, ali se nije mogla sa sigurnošću isključiti ni promjena druge etiologije. Zbog navedenog kod bolesnice je preporučena kirurška ekscizija koja je bila zahtjevna zbog tvrdoće navedene tvorbe. Patohistološki nalaz je odgovarao ekstraabdominalnoj fibromatozi, odnosno dezmoidnom tumoru s mogućom pojavom recidiva. Iako je dezmoidni tumor općenito benigna bolest, ponekad može biti lokalno invazivan s infiltracijom okolnih struktura oponašajući sliku malignog procesa uz otežanu potpunu kiruršku eksciziju koja je terapija izbora. Štoviše, unatoč potpunom uklanjanju čest je recidiv bolesti pa bolesnike s dezmoidnim tumorom treba povremeno kontrolirati.
The Ninth International Congress of the Croatian Society of Nuclear Medicine (CSNM) was held in Rovinj, from May 04–07, 2017. HIghtlights of the event are presented.
Purpose
Simultaneous analyses of the contents and ratios of 12 cytokines and growth factors in single samples of human tears were performed, and the results were compared between a group of healthy ...subjects and a group of patients with Graves’ hyperthyreosis (GH) without thyroid-associated orbitopathy (TAO).
Methods
Determinations and concentration measurements of interleukins (IL-2, IL4, IL-6, IL-8, IL-10, IL-1α, and IL-1β) interferon (IFN-γ), tumor necrosis factor (TNF-α), monocyte chemoattractant protein (MCP-1), vascular endothelial growth factor (VEGF), and epidermal growth factor (EGF) were performed with single tear samples from 21 patients with hyperthyreosis and 22 healthy subjects. The analyses were performed using a Randox microchip with an Evidence Biochip Array Analyzer.
Results
We found significant differences between the healthy donor group and the hyperthyreosis group in the levels of IL-6, IL-10, VEGF, IL-1α, and MCP-1. The concentration of IL-6 was considerably higher in the hyperthyreosis group, IL-10 was higher in the healthy donor group, and VEGF and MPC-1 were higher in the hyperthyreosis group. The IL-8 and IFN-γ levels were higher in the hyperthyreosis group. The ratios of all of the cytokines to anti-inflammatory IL-10 were significantly elevated in the hyperthyreosis group.
Conclusion
There are clear differences in the levels of cytokines and growth factors in the tears of healthy subjects and patients with GH without TAO. Tear cytokine changes and related dysfunctional tear syndrome (DTS) could be an early sign of occult TAO in Graves’ hyperthyreosis patients.
The cases of relapse in papillary thyroid cancer patients who were initially considered low-risk and for many years were without signs of the disease are extremely rare, but exist. This is supported ...by the clinical case of a patient who underwent a total thyroidectomy due to papillary thyroid cancer and 19 years later metastasis with extracapsular spreading in a presumed thyroid place was revealed. Due to such cases, the importance of long-term ultrasound monitoring is emphasized.
Bolesti paratireoidnih žlijezda često dovode do oštećenja bubrega poput primarnog hiperparatireoidizma ili se javljaju kao posljedica insuficijencije bubrega u sekundarnom i tercijarnom ...hiperparatireoidizmu. Bolesnici razvijaju hiperkalcemiju s povišenom razinom PTH, a većina ima smanjenu mineralnu gustoću kostiju uz deformitete, bolove i sklonost prijelomima, ali i oštećenje bubrežne funkcije, nefrokalcinozu ili nefrolitijazu uz opstruktivnu uropatiju. Cilj izvješća je predstaviti nuklearno-medicinske metode u dijagnostici i liječenju bolesnika s poremećajima paratireoidnih žlijezda. Najčešće korištene slikovne metode u dijagnostici jesu ultrazvuk visoke rezolucije s obojenim doplerom, zatim SPECT/CT scintigrafija u kombinaciji s kompjutoriziranom tomografijom s tehnecij-99m sestamibijem (Tc-99m-MIBI), te po potrebi PET/CT s fluor 18-kolinom. Ultrazvuk može biti praćen ciljanom citološkom punkcijom, a iz punktata se može odrediti i razina PTH koji također služi za potvrdu dijagnoze u slučaju da citološka analiza ne pokaže pravo podrijetlo epitelnih stanica iz punktata. U odjelima nuklearne medicine određuju se i laboratorijski parametri, odnosno razina PTH u serumu, važna u praćenju bolesnika. Najčešće se koriste kombinacije nekoliko različitih slikovnih metoda za određivanje veličine, položaja i odnosa paratireoidnih žlijezdi s okolnim strukturama, a u radu su prezentirane glavne indikacije te prednosti i ograničenja svake od metoda uz slikovni materijal.
Sindrom multiple endokrine neoplazije 2B (MEN2B) rijetka je autosomno dominatno nasljedna bolest uzrokovana mutacijama protoonkogena RET. Karakteriziran je pojavom medularnog karcinoma štitnjače već ...od rane, nerijetko dojenačke dobi, feokromocitoma koji je najčešće obostran, sluzničkim neuromima te drugim ekstraendokrinim manifestacijama i specifičnim fenotipskim značajkama koje mogu pomoći u prepoznavanju ovih bolesnika. Prikazujemo pacijenta sa sindromom MEN2B, dijabetesom melitusom tipa 1, inverznim položajem organa te prirođenim malformacijama bubrega i mokraćnog sustava. Pregledom literature uočeno je da se malformacije mokraćnog sustava opisuju i u drugih bolesnika sa sindromom MEN2B. Prepoznata uloga gena RET u razvoju anomalija mokraćnog sustava čini moguću etiološku poveznicu sa sindromom MEN2B. Predlažemo da se malformacije bubrega razmotre kao jedno od obilježja sindroma MEN2B. Budući da se osobine bolesnika sa sindromom MEN2B postupno razvijaju s dobi, prepoznavanje prirođene mane, uz prve znakove ostalih fenotipskih značajki, moglo bi pomoći ranom postavljanju dijagnoze i liječenju ovih bolesnika.
To investigate the prognostic value of urokinase-type plasminogen activator (uPA) and its inhibitor, type-1 plasminogen activator inhibitor (PAI-1), in differentiated thyroid cancer.
Prospective ...cohort study.
University hospital.
Cytosolic concentrations of uPA and PAI-1 were determined in 105 patients with differentiated thyroid carcinoma and normal matched tissues using an enzyme-linked immunoassay (ELISA).
Both uPA and PAI-1 concentrations were significantly higher in differentiated thyroid tumors (uPA = 0.509 ± 0.767 and PAI-1 = 6.337 ± 6.415 ng/mg) compared to normal tissues (uPA = 0.237 ± 0.051, P < .001; PAI-1 = 2.368 ± 0.418 ng/mg, P < .001). uPA and PAI-1 were significantly higher if extrathyroidal invasion (uPA, P = .015; PAI-1, P < .001) or distant metastasis (PAI-1 P < .001) was present, as well as in tumors whose size exceeded 1 cm in diameter (uPA, P = .002; PAI-1, P = .001). Survival analysis revealed the significant impact of both uPA and PAI-1 on progression-free survival (PFS) (82.22 vs 49.478 months for patients with low and high uPA, respectively, P < .001; 87.068 vs 44.964 months for patients with low and high PAI-1, respectively, P < .001). Univariate analysis showed that gender, tumor size, tumor grade, extrathyroid invasion, local lymph node involvement, distant metastasis, uPA, and PAI-1 were significant predictors of PFS. However, multivariate analysis identified only distant metastasis and tumor tissue uPA and PAI-1 as independent prognostic factors.
These findings indicate that high uPA and PAI-1 levels represent independent unfavorable prognostic factors in patients with differentiated thyroid carcinoma.
Details of a case involving a 48-year-old female patient who was referred for bone scintigraphy because of severe osteoporosis (L1L4 T score was 3.5; serum calcium values and 24-h calciuria in normal ...range). Bone scintigraphy showed bilateral, intense pulmonary 99mTc-methylenediphosphonate uptake, which led to clinical suspicion of pulmonary alveolar microlithiasis.
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