ACTA ENDOCRINOLOGICA (BUC)

Meningiomas are the most common benign tumors of the brain, accounting for about 15 to 20% of all primary brain tumors. They are more common in females than in males and are most likely found in the sixth and seventh decades. Meningiomas arise from leptomeninges. Even the hyperostosis of the overlying skull occurs in 15-20% of cases and most of them have the tendency to calcify. The biological one can find hypercalcemia in a patient with cerebral meningioma, only if it associates other diseases like hyperparathyroidism. Between January 2000 and December 2006, in the Department of Pituitary and Neuroendocrine Pathology of the “C.I.Parhon” Institute of Endocrinology, Bucharest there have been admitted 29 patients with primary hyperparathyroidism, 7 males and 22 females. From the 22 women with primary hyperparathyroidism, 3 cases presented multiple endocrine neoplasia type I and 19 sporadic primary hyperparathyroidism. In the same period of time we found in 3 of these cases the association between sporadic primary hyperparathyroidism and cerebral meningiomas. We present the cases of three female patients of 56, 55, respectively 58 years old, diagnosed with primary hyperparathyroidism during the follow-up for nontoxic goiter. Two of them were known with cerebral meningiomas, unsuccessfully surgically approached, while the third one was newly diagnosed with meningioma, based on neuroimaging. There are a couple of studies regarding the association between cerebral meningiomas and the multiple endocrine neoplasia type 1 (MEN 1), but we found in the literature only three cases of both cerebral meningioma and sporadic primary hyperparathyroidism. Clinicians should be aware of the possible association between cerebral meningiomas and primary hyperparathyroidism.

Anaplastic thyroid carcinoma (ATC) is the most aggressive type of thyroid\r\ndedifferentiation. Rarely, ATC associates rhabdoid characteristics and only few cases have been\r\npresented to date. We present a case of a thyroid papillary carcinoma which shifted to an\r\naggressive anaplastic form with rhabdoid dedifferentiation and concomitant leukemic reaction\r\nwith eosinophilia. A 76 years old man with a long standing history of a thyroid nodule, noticed\r\nwithin months a rapid growth of the nodule associating marked compression phenomena with\r\nleft deviation of the trachea and esophagus and mild dysphonia. Palliative surgery was\r\nperformed, but the evolution was unfortunate with further health deterioration (fatigue, dyspnea,\r\ndysphagia, loss of appetite and weight loss). Laboratory tests proved leukocytosis with\r\nneutrophilia and left deviation of leukocytes formula, with major eosinophilia. The pathology\r\nshowed a thyroid papillary carcinoma with anaplastic changes. By immunohistochemistry,\r\nit was confirmed the thyroid origin of the tumor (thyreoglobulin positive areas) but also the\r\nepithelial nature of the undifferentiated areas (positive areas for cytokeratin and epithelial\r\nmembrane antigen). Moreover, in the anaplastic areas, rhabdoid differentiation was\r\nidentified by positive coloration against vimentin, protein S100 and desmin. The tumor was\r\naggressive by its anaplastic transformation, confirmed by a high proliferation index (Ki67:\r\n40% positive). The computed tomography was concordant with the phenotype predicted by\r\nhistological description showing a malignant thyroid tumor, invading cervical and mediastinal\r\nareas with secondary lung disseminations. Unfortunately, the outcome was fatal even though\r\nadditional treatment methods have been tried: radiotherapy and chemotherapy. The\r\nparticularities of this case reside in the very rare dedifferentiation of a papillary thyroid\r\ncarcinoma towards an anaplastic thyroid carcinoma harboring the rhabdoid phenotype and\r\nalso its association with eosinophilia.

Cervical lymph nodes could be a starting sign for a complex diagnosis work-up. Depending on co-morbidities, medical unit and physician’s previous experience, the differential diagnosis includes thyroid malignancy, lymphoma, chronic infectious disorders, etc.

Endemic goiter and primary hyperparathyroidism are two common endocrine disorders, and, consequently, they could coexist in many European countries. The prevalence of nodular goiters is increased in the patients with primary hyperparathyroidism, ranging widely between 22 to 70%, with higher prevalence in endemic goiter areas.\r\nRomania is a country having both endemic goiter and a high prevalence of vitamin D deficiency. Coexisting vitamin D deficiency is associated with more cases of symptomatic primary hyperparathyroidism or may mask a primary hyperparathyroidism, serum calcium being in the normal range.\r\nBecause of the frequent association of parathyroid adenomas with thyroid nodules, the optimal imaging combination is 99mTc-sestamibi and ultrasonography. Thyroid nodules can give false positive results at preoperative scintigraphy because they trap and retain 99mTc-sestamibi similarly as parathyroid adenomas.\r\nBilateral neck exploration (vs minimally invasive parathyroidectomy) is probably necessary in the treatment of primary hyperparathyroidism associated with nodular goiter, because nodular goiters increases the difficulty of preoperative localization of parathyroid lesion(s).

Fine needle aspiration biopsy (FNAB) was designed as a rapid and cost efficient tool in the morphological diagnosis of thyroid nodules. Provided by efficient sampling especially by the wide scale use of ultrasound guidance, by the on-site evaluation of the quality of sampling, the FNAB, as a diagnostic tool, still have an undetermined ratio of diagnosis ranging from 5 to 40 % according to the experience of the examinator. About what are the critical points defining the performance of FNAB in thyroid nodules, and where is the place of molecular biology. I will insert some short comments: the critical steps in performing FNAB are the sampling, the interpreting and the good communication of the diagnosis to the clinician.

Background. Differentiated thyroid carcinoma (DTC) has witnessed an increase in incidence and although it is considered to have a slow grow potential and a 90% 10- year survival rate, local or distant metastases can be observed in 20%. It is essential to recognize other factors associated with malignancy and poor prognosis. Vitamin D and its deficiency has proven useful as a prognostic biomarker for many types of cancer, including thyroid cancer. Aim. Evaluate the relationship between vitamin D status in DTC and benign thyroid disorders patients and correlation between vitamin D and histopathological findings in DTC group. Methods. Study included 170 patients with confirmed DTC and 200 with benign thyroid pathology. Evaluation included 25-hydroxy vitamin D [25(OH)D], ultrasound and histopathologic features. Results. In DTC patients, mean value of vitamin D was significantly lower (17.86 ng/mL ± 9.31 DS versus 20.26 ng/mL ± 9.31 DS, p=0.029). Statistical analysis confirmed a negative correlation between vitamin D levels and tumor size (T) according to TNM classification (r=-0.176, p=0.02). Conclusions. Vitamin D level was significantly lower in the DTC group and 25(OH)D levels may be correlated with histopathology features like tumor size and aggressiveness according to TNM classification.

Background: The solitary benign thyroid nodules represent one of the most common\r\nabnormalities affecting the thyroid gland. The appearance of solitary thyroid nodules is\r\nvariable and all the patients should be assessed as soon as possible in order to establish the\r\nbenign nature of the lesion and to rule-out malignancy.\r\nThe aim of the present study is to show the histological changes that appear during\r\nevolution of benign solitary thyroid nodules and rapid growing rate along 6 years, in 71\r\npatients (65 women and 6 men).\r\nMethods: All cases were evaluated by clinical, ultrasound, biochemical (at every 6\r\nmonths) and FNA (initially and repeated between 10 months and 4 years afterwards); 26 out\r\nof 71 presented, along evolution, an increase of thyroid nodule (24 women and 2 men) from\r\n1.77 cm diameter (1.4-2 cm) to more than 2.5 cm (2.5-4.3 cm), therefore a radical surgical\r\nattitude was performed.\r\nResults: Histological postsurgery data showed degenerative changes in all cases, with\r\nrepetitive nodular hemorrhage (26 cases), sclerohyalinisation of the interfollicular stroma (4\r\ncases), cholesteatoma (5 cases) and inflammatory infiltrate (8 cases).\r\nIn conclusion, the significant growth of a benign solitary nodule is determined by\r\nrepetitive hemorrhages in the thyroid tissue. The associated sclerosis induces changes in the\r\nnodular firmness and might trigger the thyroid surgery.

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