Purpose. Interstitial fibrosis in papillary thyroid microcarcinoma is a subject which is under-investigated. The aim of this study is to determine the relationship between interstitial fibrosis, the subtypes of papillary microcarcinoma, and the established prognostic factors. Material and Methods. A total of 75 patients diagnosed with papillary microcarcinoma of the thyroid from January 2011 to December 2020 have been evaluated retrospectively, using demographic features, tumor size, subtype of the tumor, surgical margin status, unifocality, lymphovascular invasion, extracapsular spread and lymph node metastasis as parameters. Hematoxylin and eosin slides were reviewed for interstitial fibrosis. Results. The study includes 13 males and 62 females, in a total of 75 patients. There were 51 patients (68%) with interstitial fibrosis and 24 (32%) patients without interstitial fibrosis. Among them, 45 (60%) were classic, 27 (36%) were follicular variant and 3 (4%) were other subtypes. Interstitial fibrosis is significantly associated with bilaterality (p = 0.023), multifocality (p = 0.004), capsule invasion (p < 0.001) and lymph node metastasis (p = 0.043). Evaluation of tumor sub groups showed significant increased risk of lymphovascular invasion in the follicular variant (p = 0.019). Conclusion. Although the relationship of interstitial fibrosis and prognosis of other cancer types has been discussed, there are few studies in the literature regarding its effect on the prognosis of papillary microcarcinoma. Our results show that interstitial fibrosis can be used as a risk factor. However, new studies are needed to clearly reveal the physiopathology of interstitial fibrosis and its effect on tumorigenesis.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Sınavları hele sözlü olanlarını kimse sevmez. Bütün bir staj boyunca veya bir yıl boyunca ve hatta yıllar boyunca çalışıp girilen sözlü sınavlarda, ne sorulacağını ve nasıl yanıtlayacağını bilmemenin yarattığı belirsizlik duygusu ve yüksek katekolamin salgısına bağlı heyecan içinde insan çoğu kez en iyi bildiklerini bile söyleyemez olur. Öte yandan sınavda yanıtlanamayan soruları, sınavı yapanhoca ya da sınav sonrası bir arkadaşınız yanıtladığında “ne kadar kolaymış” duygusuna kapılır ve çoğunu hayat boyu unutmazsınız.

Background: The aim of this study was to evaluate the degradation of tryptophan (Trp), neopterin production and antioxidant capacity in patients with benign and malignant thyroid disease. Methods: For this reason, the levels of tryptophan, kynurenine (Kyn) and neopterin, and superoxide disintitase (SOD) and catalase (CAT) enzyme activities in 67 thyroid patients were evaluated in our study and the results were compared with 30 healthy controls. Results: Tryptophan and kynurenine levels in thyroid patients decreased compared to the control group. Patients with thyroid disease had lower CAT activity than the control group. The neopterin and tryptophan levels in malignant and benign patients were also significantly different. Conclusion: The results of the present study suggest that thyroid disorders may lead to changes in tryptophan degradation, neopterin production and CAT enzyme activities.

Parathyroid carcinomas are rare endocrine tumors which comprise 0.3-5.6% of all causes of hyperparathyroidism. 90% of them are hormonally active, while 10% of them may be non-functional. They mostly occur in a single parathyroid gland. Concurrent involvement of both parathyroid glands is quite rare. A 57-year-old male patient was admitted to emergency department with the complaint of dyspnea. Thorax tomography revealed a retrosternal mass. The mass was thoracoscopically excised by thoracic surgeons. Histopathological examination result of the mass was reported as parathyroid carcinoma. Parathyroid scintigraphy performed and focal activity increase in the lower pole of the left lobe. Parathyroid hormone level was 118 pg/ml and calcium level was measured as 11.4 mg/dl. The patient with these findings was operated and pathological examination of excised left lower parathyroid tissue was reported as carcinoma. In addition, micropapillary carcinoma was detected in left thyroid lobectomy specimen.Our case was also unusual in that double parathyroid carcinoma, which is a rare condition, was hormonally inactive. We aimed to present our case in the light of the literature due to its rare occurrence.

Background. High-resolution ultrasonography and the ability to perform fine-needle aspiration biopsy even for nodules smaller than three millimeters have considerably increased the detection rate of thyroid micropapillary carcinoma (TMPC). Despite favorable prognosis, the prevalence of cervical lymph node metastases in patients with TMPC is approximately 30%. Aim. In this study, we aimed to determine the central lymph node metastasis rate and its relation to the characteristics of the tumor. Methods. One hundred nine patients who underwent surgery due to TMPC between December 2009 and January 2014 were analyzed retrospectively. Patients were divided into two groups according to whether they underwent lymph node dissection and the two groups were then compared with respect to tumor size and multicentricity, age, and presence of lymphocytic thyroiditis. Results. There were no statistically significant differences between the two groups of patients in terms of tumor size, tumor multicentricity, age, and presence of lymphocytic thyroiditis. When the patient group that received lymph node dissection was further analyzed, it was found that patients with lymphocytic thyroiditis had a significantly lower number of metastatic lymph nodes. Conclusion. Central lymph node dissection in TMPC patients with macroscopic lymph node detected intraoperatively would ensure accurate staging without an increase in morbidity.

Objective: We report a rare case of a patient who developed papillary thyroid carcinoma (PTC) arising from thyroglossal duct cysts (TGDCs) with lateral lymph node metastasis who had a normal thyroid gland and benign central compartment lymph nodes.Methods: We present a case with metastatic PTC arising from TGDC together with a brief review of the relevant literature.Results: A 38-year-old man patient was admitted with a cystic lesion in the midline of his neck. There was also an easily palpable lymph node on the left neck, which was suspected of being metastatic PTC on ultrasonography (USG). There was no nodule in the thyroid gland. A fine-needle aspiration cytology of the lymph node was positive for metastases of PTC. We performed an excision of the cystic lesion and total thyroidectomy with the central and left neck lymph node dissection. The cystic lesion pathology was reported as PTC, 10 mm in size. There was a metastatic lymph node in the lateral left neck compartment (regions III–IV), 7 cm in diameter, without central lymph node involvement. Radioactive iodine ablation therapy with 150 mCi of 131I was given after the surgery. The patient is in remission for PTC 2 years after his surgery, and he is currently receiving levothyroxine suppression therapy.Conclusion: While evaluating a TGDC, a detailed neck USG should be performed in all cases. Furthermore, a biopsy should be conducted of suspected lymph nodes before planning the surgery.Abbreviations: DTC = differentiated thyroid cancer; FNA = fine-needle aspiration; MRI = magnetic resonance imaging; PTC = papillary thyroid carcinoma; RAI = radioactive iodine ablation; TGD = thyroglossal duct; TGDC = thyroglossal duct cyst; USG = ultrasonography

INTRODUCTION:The aim of this study was to compare the diagnostic adequacy of thyroid samples obtained by aspiration or capillary biopsy techniques, with 22 or 27 gauge needles, and with or without on-site cytological analysis (OCA).MATERIAL AND METHODS:Four hundred patients with thyroid nodules underwent ultrasound (US)-guided fine-needle biopsies. Patients were divided into eight groups according to needle size (22 vs. 27 gauge), biopsy technique (aspiration vs. capillary), and whether or not OCA was performed. Sample adequacy rates were calculated for each group and subgroups and compared using chi-square tests.RESULTS:When all nodes were evaluated (n = 400), the adequacy rate was significantly greater with the capillary than with the aspiration technique (97% vs. 91.5%, p = 0.032) and when OCA was than was not performed (97% vs. 91.5%, p = 0.032). When only solid nodules were evaluated (n = 205) the adequacy rate was also significantly greater with the capillary than with the aspiration technique (98.9% vs. 89.7%, p = 0.008) and when OCA was than was not performed (97.9% vs. 89.6%, p = 0.014). In contrast, the adequacy rate was similar for 22 and 27 gauge needles (94.2% vs. 93.1%, p = 0.733).CONCLUSIONS:Optimal results were obtained with the capillary technique and OCA. The capillary technique and OCA should be the preferred approach in thyroid nodule biopsy, optimising adequacy rates and patient comfort.

Objective: Fine needle aspiration (FNA) biopsy and ultrasonography are the methods used to evaluate thyroid nodules and to predict malignancy together with the clinical characteristics of nodules. It is important to know false positive and false negative incidences of FNA especially in the case of follicular neoplasia or indeterminate lesions such as atypia of undetermined significance (AUS) to decide whether surgery is necessary or not. The aim of this retrospective study was to evaluate ultrasonographic characteristics of histopathologically verified malignant thyroid nodules and histopathologic correlation of cytologically indeterminate lesions with histopathologic diagnosis.Methods: One hundred and fifty-four patients who underwent thyroidectomy between January 2010 and January 2012 are included in this study. Demographic characteristics, cytological and histopathological results, preoperative TSH levels of all patients and ultrasonographic characteristics of the nodules were evaluated retrospectively.Results: Histopathology of 104 patients (67.5%) was benign and 50 patients (32.5%) was malignant. TSH levels in the group of benign pathology are significantly lower than the group of malignant ones. Sensitivity, specifity, positive predictive value and negative predictive value of FNA were calculated as 90.7%, 72.2%, 62.7%, 93.8%, respectively. Diagnostic accuracy of FNA was 78.5%. Incidence AUS was calculated as 7% and 25% of these lesions were histopathologically malignant. Hypoechogenicity (OR=2.3, p<0.05), microcalcifications (OR=2.5 p<0.05) and increased peripheral and central perfusion (OR=11 p<0.05) were the independent risk factors for malignancy.Conclusion: Cytological and hispathological findings of thyroid nodules in our study correlate with other studies. Hypoechoic nodules that have microcalsifications and increased peripheral and central perfusion are more likely to be malignant.

The aim of the study was to determine folate reserve in patients with thyroid and breast diseases. Erythrocyte folate concentrations of ninety-eight patients and thirty healthy subjects were determined by a modified microbiological assay. An increase in folate levels was observed in of both thyroid (n = 15) and breast (n = 22) cancer patients compared to controls, while a decrease was observed in benign breast disease patients (n = 24) compared to both control group and breast cancer patients. Patients with benign thyroid diseases (n = 37) had significantly lower folate concentrations as compared to both control and thyroid cancer groups. The results pointed out the elevated erythrocyte folate levels in the patients with malignant tumors.

Biopterin as a stable metabolite is produced by oxidation of 5,6,7,8-tetrahydrobiopterin (BH4). It is known that many diseases may cause changes in BH4 concentration and/or dihydropteridine reductase (DHPR) enzyme activity. There is only a limited number of studies correlating DHPR activity in malignancies. The main goal of the present study was to evaluate alterations in the DHPR activity and biopterin levels in patients with breast and thyroid cancers. The breast cancer patients (n=24) were compared to patients with benign breast diseases (n=19) and controls (n=30). In addition; the patients with thyroid cancer (n=17) were compared to patients with benign thyroid diseases (n=42) and the control group. We did not observe any significant difference between the benign disorders and the malignancies. Biopterin concentrations in patients with benign and malign thyroid and breast diseases were lower than the controls (all p < 0.05). DHPR activities in thyroid diseases were significantly higher than the controls while insignificant decreases in DHPR activities in breast patients were detected. Our results suggested significant alterations in unconjugated pteridine pathway in thyroid and breast disorders.

Intestinal anastomotic healing is a complex procedure in which several mediators and cytokines play roles. Calcitonin gene-related peptide is an important neuropeptide in inflammation. In this study we aimed to investigate the effect of calcitonin gene-related peptide on healing of intestinal anastomosis in rats with obstructive jaundice.

Background/aims: During cold preservation of liver grafts, expression of tissue adhesion molecules has been reported as a factor indicative of preservation injury. Some biochemical agents as well as increased levels of intracellular calcium also play important roles in preservation injury during cold storage. In the current study, we aimed to test if the addition of a calcium channel blocker, sodium nitroprusside, or glutathione into preservation solution would reduce upregulation of adhesion molecules, thus leading to decreased preservation injury in the rat liver. Methods: Fifty Albino Wistar rats, weighing 200 50 g, were divided into 1 control (perfused with Wisconsin solution, without preservation) and 4 study groups of rat livers (10 livers each). Livers in study groups were harvested, perfused, and preserved for 16 hours in 4 different solutions (Wisconsin solution alone, Wisconsin solution+verapamil, Wisconsin solution+sodium nitroprusside and Wisconsin solution+glutathione). At the end of the preservation time, levels of graft tissue adhesion molecule (ICAM-1) expression were analyzed. Results: Preservation for 16 hours with Wisconsin solution alone and Wisconsin solution+verapamil perfusates caused significantly more ICAM-1 expression than did preservation for 16 hours with Wisconsin solution+sodium nitroprusside and Wisconsin solution+glutathione perfusates (p=0.010). No significant difference was found in ICAM-1 expression between the Wisconsin solution+sodium nitroprusside and Wisconsin solution+glutathione groups. In the control group, perfusion with Wisconsin solution alone, without preservation, represented minimal ICAM-1 expression, reflecting minimum preservation injury (p=0.0003). Conclusions: Addition of sodium nitroprusside and glutathione into the Wisconsin solution decreased levels of ICAM-1 molecule expression, which reflects lower levels of preservation injury. In this study, the addition of verapamil to the perfusate/preservation solution for reducing the intracellular calcium accumulation had no effect on tissue ICAM-1 molecule expression.

AIM The objective of this study was to compare the dual phase MIBI scinitgraphy with MIBI and Tc-99m pertechnetate (MIBI + Tc-99m) study in defining the parathyroid adenomas, and to evaluate the effect of histologic and biochemical characteristics on the imaging of parathyroid adenomas with Tc-99m methoxyisobutylisonitrile (MIBI) scintigraphy. METHODS Thirty-six patients with parathyroid adenomas were studied prospectively. All patients were evaluated with both MIBI and (MIBI + Tc-99m) study. MIBI uptake of adenomas correlated with oxyphill, chief cell and tumour weight of the surgically excised glands. MIBI uptake was also compared with serum calcium (Ca), phosphorus (P) and intact parathormone (iPTH) levels. RESULTS A total of 38 parathyroid adenomas were surgically excised from 36 patients. MIBI + Tc-99m identified 35 of the parathyroid lesions (92%). Whereas, MIBI study detected 30 of the 38 parathyroid adenomas (79% sensitivity) (p=0.0001). There were no false positives. Adenoma weight showed significiant correlation with MIBI uptake (p=0.001). Oxyphyill cell content also showed high correlation with MIBI uptake. Delayed images showed better correlation than the early views (Early MIBI p=0.033; Delayed MIBI; p=0.001). CONCLUSION MIBI + Tc-99m pertechnetate interpretation is more sensitive than only dual MIBI imaging for the detection of parathyroid adenoma. Oxyphill cell content and weight of the lesions proved to be important determinants of 99mTc-MIBI accumulation in parathyroid adenoma. We found no significant correlation between MIBI accumulation, Ca, P and iPTH serum levels (Tab. 2, Fig. 2, Ref. 15). Full Text (Free, PDF) www.bmj.sk.