ACTA ENDOCRINOLOGICA (BUC)

Aim: We have undertaken an attempt to compare the application efficacy of the proliferative activity markers in the differential diagnosis of thyroid H?rthle cell tumors using the PCNA and Ki-67 labeling and AgNOR visualization techniques.\r\nMaterials and methods: The present work is a retrospective analysis of proliferative potential in 40 H?rthle cell tumors, on paraffin blocks: 10 H?rthle cell carcinomas (HCC), 16 H?rthle cell adenomas (HCA) and 14 hyperplastic nodules with H?rthle cell metaplasia (HCM). The evaluation of the mean number of nucleolar organizer regions (NORs) per nucleus and the proliferative index (PI-the percentage of PCNA and Ki-67 positive cells) was performed using staining silver impregnation method and antibodies against PCNA (clone PC 10) and Ki-67 (clone MIB-1) in LSAB detection Kit and visualization with DAB (diaminobenzidine). U-Mann-Whitney test was used for statistical analysis. The difference was considered significant for p<0.05.\r\nResults: The values of PI-PCNA, PI-Ki-67 as well as the mean AgNOR counts in nuclei were: 25.5, 12.8, and 5.0 in HCC; 7.6, 4.9, and 3.1 in HCA and respectively 5.1, 4.0 and 2.3 in HCM. Statistically significant differences were found in all the proliferative\r\nactivity markers between malignant and benign tumors: HCM: HCC (p<0.0001) and HCC: HCA (p<0.001). Indifferently of the examined markers and the method of quantification of the reaction, we did not found significant differences between hyperplastic nodules with H?rthle cell metaplasia and oncocytic adenomas (p< 0.07).\r\nConclusions: PI-PCNA, PI Ki-67 and mean AgNOR/ nucleus, used as markers for the appreciation of proliferative activity of oncocytic thyroid tumors (classified as adenomas, carcinomas and hyperplastic nodules with H?rthle cells), reflect differences between the studied thyroid lesions. Our results indicate the utility of these parameters in the differentiation of the benign oncocytic tumors from the malignant ones.

The detection of thyroid nodules in a patient with Graves&#8217; disease is not a rare event.\r\nThe management of these cases still represents a controversial problem for clinical practice.\r\nThis paper describes the case of a patient with Graves&#8217; disease and a concurrent\r\nfollicular thyroid carcinoma, presenting as a clinical palpable nodule in the right lobe.\r\nThyroid function tests confirmed thyrotoxicosis. Immunological investigations showed high\r\nlevels of TSH-R antibodies. Thyroid ultrasound revealed an increased thyroid volume with\r\na diffuse low echogenicity of parenchyma and in the right lobe a single homogeneous\r\nhypoechoic nodule. The scintiscan indicated the presence of a &#8220;cold nodule&#8221; in the right lobe\r\nand increased uptake in the rest of parenchyma. Antithyroid drug therapy was\r\nrecommended. Cytological exam indicated an &#8220;indeterminate&#8221; smear. After euthyroidism\r\nwas achieved, surgical therapy was recommended and near total thyroidectomy was\r\nperformed. The morphopathological exam revealed an invasive follicular carcinoma on a\r\ndiffuse thyroid hyperplasia (Graves&#8217; disease). This case report is followed by a discussion\r\nabout the incidence of malignancy in thyroid nodules concurrent with Graves&#8217; disease. The\r\ncriteria that raised concern about a possible malignancy of the nodule are presented.\r\nIn conclusion, we recommend that patients with Graves&#8217; disease should undergo a\r\nregular examination of the thyroid gland for an early detection of possible malignant\r\nnodules. The intervention of choice in these cases should be near total or total\r\nthyroidectomy, if malignancy cannot be excluded by preoperative evaluation.

Nodular thyroid disease (NTD) is represented by palpable thyroid nodules (solitary, multiple) and thyroid incidentalomas (identified by means of thyroid ultrasonography). The discussed entities carry the same risk of malignancy (about 5 %). The main objective in evaluating NTD is represented by the exclusion of malignancy by means of corroborated investigations, focused on the value of a panel of IHC markers.\r\nMaterial and methods. We included in the study 27 cases of NTD, evaluated by means of: clinical investigation, ultrasonography of the thyroid, cytological examination, morphological analysis and IHC. The used panel of IHC markers comprised: Ki-67, PCNA, CK 19 and c-erbB2 (DAKO LSAB method)\r\nResults. From the total of cases, 8 presented positivity with Ki-67 and 17 with PCNA. Regarding CK 19, the majority of PTC cases stained ++ and diffusely, but not papillary hyperplasia (focal positivity).c-erbB2 diffuse and intense positivity (+++) was noticed in PTC.The case with a follicular tumor of uncertain malignant potential stained weakly only with c-erbB2.\r\nConclusions. From the used panel of IHC markers, CK 19 presented the best value, being able to differentiate FVPTC from FTC and PTC from papillary hyperplasia.

Background. The concept of NE differentiation in prostate carcinoma has two major aspects: prostate tumors with\r\nprimary NE differentiation and NE differentiation occurred during hormonal therapy for prostate adenocarcinoma, with\r\nthe extreme case of tumor dedifferentiation into a NE hormone resistant carcinoma.\r\nMaterial and method. The patient, 62 years old, with a history of poorly differentiated prostate adenocarcinoma,\r\nhormonally treated with the decrease and then constant maintenance of serum PSA level to 0.01 ng/mL was admitted in the hospital, 8 years after prostate tumor diagnosis, and 3 years after ceasing of hormone therapy, with multiple bone and liver metastases of unknown primary source.\r\nResults. The serum levels of CgA, NSE, CEA, CA19.9, serotonin were elevated. The histopathological examination\r\nof the needle biopsy fragment from a liver metastatic lesion revealed small cell neuroendocrine carcinoma. Despite the\r\nprompt chemotherapy, the disease has progressed, with the occurrence of brain metastases and the patient?s death\r\n6 months after detection of the metastatic disease.\r\nConclusions. The present case confirms the diagnostic difficulties in llymetastatic undifferentiated small cells\r\ntumors, and on the other hand, draws attention to the possibility of NE dedifferentiation as a result of hormone\r\ndeprivation in patients with prostate cancer.