Učinak terapije metimazolom na patohistološki izgled tkiva štitnjače koji može oponašati maligne promjene

Diffuse toxic goiter, as the most common cause of hyperthyroidism, is usually initially treated with thyrostatic drugs such as methimazole, followed by radioiodine therapy or surgery which may be indicated as definitive treatment. Radioactive iodine therapy has a known association with various histopathologic features including cytologic atypia, but herein we present a rare example of morphological thyrocyte changes induced by long-term pharmacological treatment with methimazole that mimicked thyroid malignancy in a pathohistological sample.Difuzna toksična struma, kao najučestaliji uzrok hipertireoze, se uglavnom liječi tireostaticima kao što je metimazol a nakon početne farmakološke terapije, ukoliko ne dođe do spontane remisije bolesti, liječenje se nastavlja primjenom radioaktivnog joda (I-131) ili kirurškim zahvatom. Primjena radioaktivnog joda dovodi do brojnih histopatoloških izmjena u parenhimu štitnjače, uključujući i staničnu atipiju, no u našem radu prikazujemo rijedak slučaj utjecaja dugotrajne farmakološke terapije metimazolom na izmjenu morfologije tireocita koja može oponašati izgled malignih stanica na histološkom uzorku tkiva štitnjače

Postoperative Morbidity and Histopathologic Characteristics of Tonsillar Tissue Following Coblation Tonsillectomy in Children: A Prospective Randomized Single-Blind Study

The aim of this prospective randomized single blind study was to determine the depth of thermal damage to tonsillar tissue due to coblation, and to compare it with thermal damage to tonsillar tissue following conventional tonsillectomy; to correlate the depth of thermal damage to tonsillar tissue with the parameters of postoperative morbidity, to compare intraoperative blood loss, postoperative pain severity, time to resuming normal physical activity, and incidence of postoperative bleeding between two groups of tonsillectomized children aged up to 16 years. 72 children aged 3–16 years scheduled for tonsillectomy randomly assigned into two groups submitted either to conventional tonsillectomy with bipolar diathermy coagulation or to coblation tonsillectomy, with a 14-day follow up.Statistically significant differences were observed in the depth of thermal damage to tonsillar tissue (p<0.001), intraoperative blood loss (p<0.004), in postoperative pain severity (p<0.05) and in time to resuming normal physical activity between the two groups (p<0.001). There was no case of reactionary or secondary bleeding in either group. In this paper for the first time we have correlated postoperative morbidity and thermal tissue damage: less thermal damage is associated with less postoperative morbidity

Prognostička vrijednost kliničkih i patohistoloških osobitosti melanoma srednje očne ovojnice: retrospektivna studija

The aim of the study was to determine clinical and histopathologic prognostic factors for tumor related survival of patients with uveal melanoma. Clinical and histopathologic records of 20 patients with histologically verified uveal melanomas were retrospectively analyzed. Patients were operated on at University Department of Ophthalmology, Split University Hospital in Split, January 1, 1991 and December 31, 2000. Histopathologic confirmation was obtained from the Hospital Department of Pathology, Forensic Medicine and Cytology, Split University Hospital. Standard histological staining with hemalaun and immunohistochemical staining with primary antibody against melanoma antigen and S-100 protein were performed. Data on the cause of death were collected from death certificates obtained from Hospital Department of Pathology, Forensic Medicine and Cytology and from Split Population Registry, Split-Dalmatia County government. The overall annual incidence of uveal melanoma in Split-Dalmatian County was 0.44 per 100,000. Out of 20 intraocular melanomas, 4 (20%) were located at the ciliary body, 13 (65%) at the choroid, and 3 (15%) at the ciliary body and at the choroid. There was no statistically significant survival difference between groups with different tumor localization (c²=2.747; df=3; p=0.253). The largest tumor diameter was 35 mm and the smallest 9 mm (median 12 mm), and there was no statistically significant correlation between tumor diameter and survival (Spearman\u27s correlation 0.21). Histological study revealed pure spindle A type melanoma in one (5%) case, pure spindle B type melanoma and pure epithelioid type melanoma in 4 (20%) cases each, and mixed type melanoma in 11 (55%) cases. There was no statistically significant survival difference between groups of patients with different histopathologic types of melanoma (χ²=5.312; df=4; p=0.150). Study results indicated that none of the study parameters (localization, tumor diameter and histopathology finding) could be considered a valid prognostic factor of uveal melanoma survival.Cilj studije bio je ustanoviti kliničke i patohistološke prognostičke čimbenike preživljenja od melanoma srednje očne ovojnice kod bolesnika s tom bolešću. Provedena je retrospektivna analiza kliničkih i patohistoloških podataka 20 bolesnika s histološki dokazanim melanomom srednje očne ovojnice. Bolesnici su operirani u Klinici za očne bolesti KB Split u razdoblju od 1. siječnja 1991. do 31. prosinca 2000. godine. Melanomi su patohistološki verificirani u Zavodu za patologiju, sudsku medicinu i citologiju KB Split. Primijenjeno je standardno HE (hemalaun-eozin) bojenje i imunohistokemijsko bojenje na melanoma antigen i S-100 protein. Uzrok smrti utvrđen je uvidom u mrtvozorničke prijave o uzroku smrti u Zavodu za patologiju, sudsku medicinu i citologiju KB Split i u Matičnom uredu Split, Uredu državne uprave Splitsko-dalmatinske županije. Godišnja incidencija melanoma srednje očne ovojnice u Splitsko-dalmatinskoj županiji bila je 0,44 na 100.000 stanovnika. Od 20 intraokularnih melanoma, 4 (20%) su imala polazište iz zrakastog tijela, 13 (65%) iz žilnice, a 3 (15%) su bila smještena u zrakastom tijelu i žilnici. Nije nađena statistički značajna razlika u preživljenju prema lokalizaciji tumora (χ²=2,747; df=3; p=0,253). Najveći promjer tumora iznosio je 35 mm, najmanji 9 mm (medijan 12 mm). Nije utvrđena statistički značajna korelacija između preživljenja i veličine tumora (Spermanova rang korelacija 0,21). Histološka analiza utvrdila je 1 (5%) melanom vretenastog tipa A, 4 (20%) vretenastog tipa B, 4 (20%) epiteloidnog tipa i 11 (55%) miješanog tipa. Nije dokazana statistički značajna razlika u preživljenju ovisno o patohistološkom tipu tumora (χ²=5,312; df=4; p=0,15). Na temelju dobivenih rezultata može se zaključiti kako niti jedan od ispitivanih parametara (lokalizacija, veličina i patohistološki tip tumora) nije valjan prognostički čimbenik preživljenja kod melanoma srednje očne ovojnice

The Epidemiology of Non-Traumatic Prehospital Sudden Death in Split-Dalmatia County

The aim of this study was to determine epidemiology of non-traumatic prehospital sudden adult deaths in Split- -Dalmatia County from 2000. to 2005. The following information were collected from autopsy reports in the archives of University Hospital Split: gender of deceased, birth date, date of death, location of death, immediate cause of death, previously diagnosed diseases that might lead to terminal outcome. There were 160 non-traumatic prehospital sudden adult deaths in the observed period, with 104 (65%) male and 56 (35%) female autopsies performed. Diseases of cardio- vascular system were the main cause of death, responsible for 95 (59.37%) sudden deaths, followed by diseases of respira- tory system (14.37%) and central nervous system (8.12%). The most frequent cause of non-traumatic sudden death was myocardial infarction, found in 50 cases. July and September were the months of the most frequent occurrence of sudden death. In this study it was confirmed that sudden death incidence increases with age, with almost half of all deaths occurring in people between ages of 61–80. The result that a fifth of all sudden deaths occurred in people aged 51–60 is troubling and potentially preventable. The most frequent location of death was deceased’s place of residence (N=29), followed by the ambulance vehicle (N=17). In conclusion, this is the first publication describing the incidence of pre- hospital sudden non-traumatic adult death in Split-Dalmatia County. Causes of sudden death and its incidence are in accordance with World Health Organization’s information on general causes of death in Croatia and Western Europe

ANAPLASTIC THYROID CARCINOMA IN A 17-YEAR-OLD FEMALE PATIENT

Anaplastični karcinom štitnjače je jedan od četiri najmalignija tumora u čovjeka. Pojavljuje se u jednog do dva bolesnika na milijun ljudi u godini dana. U djece je iznimno rijedak. 17-godišnja bolesnica primljena je u Kliniku za bolesti uha, nosa i grla i kirurgiju glave i vrata u KBC-u Split zbog operacije štitnjače. Ranije joj je nađen nagli porast čvora lijevog režnja štitnjače. Preoperacijska obrada je upućivala na benigan karakter promjena. Napravljena je operacija thyreoidectomia totalis cum dissectione colli regionis VI et VII. Intraoperacijski preparat lijevog režnja štitnjače je bio maligan. Potom se napravio i PET/CT. Nalaz je bio uredan. Bolesnica je upućena otorinolaringološko-onkološkom timu gdje se određuje adjuvantna radioterapija. Stadij bolesti prema TNM klasifi kaciji bio je IVa. Godinu dana nakon operacije bolesnica je dobro, nema znakova bolesti. Ovaj prikaz slučaja je prilog dosadašnjim rijetkim spoznajama o anaplastičnom karcinomu štitnjače u osoba mlađe životne dobi u svijetu.Anaplastic carcinoma of thyroid gland is one of the four most malignant tumors in humans. It appears in one or two patients per million per year. It is very rare in children. A 17-year-old female patient was admitted to the Clinical Department of ENT and Head and Neck Surgery, Split University Hospital Center, for thyroid gland surgery due to rapid growth of a node in the thyroid gland left lobe. Preoperative examination indicated benign nature of changes. Total thyroidectomy with levels VI and VII neck dissection was done. Intraoperative slide of the left lobe was malignant. Positron emission tomography and computed tomography were also done. The finding was negative. The patient was examined by an ENT-oncology team and juvenile radiotherapy was administered. It was found to be carcinoma stage IVa according to TNM classification. One year after the operation, the patient was well and had no signs of illness. This case report is a contribution to the existing but scarce knowledge of anaplastic carcinoma of thyroid gland in young patients in the world

Glomus tumor of the lingual base: a case report

Glomus tumori su pretežito benigni neuroendokrini tumori nastali od ekstraadrenalnih paraganglija autonomnog živčanoga sustava. Iako su vrlo rijetki, problemi vezani za njihovu pravodobnu dijagnozu i liječenje, čine ih zanimljivim i zahtjevnim. U radu je prikazan bolesnik u dobi od 24 godine s glomus tumorom baze jezika. Tumor je dokazan radiološkim metodama (kompjutorizirana tomografija i angiografija). Terapija je bila isključivo kirurška. Do sada je u literaturi opisan samo jedan slučaj paraganglioma orofarinksa.Glomus tumors generally are benign neuroendocrine tumors originating from extra-adrenal paraganglia of the autonomic nervous system. Although very rare, the problems associated with timely diagnosis and treatment of glomus tumors make them rather intriguing and demanding. A case is presented of a 24-yearold man with glomus tumor of the lingual base. The tumor was verified by radiological methods (computerized tomography and angiography) and treated exclusively by surgical approach. To our knowledge, a single case of oropharyngeal paraganglioma has been reported in literature

Prognostička vrijednost kliničkih i patohistoloških osobitosti melanoma srednje očne ovojnice: retrospektivna studija

The aim of the study was to determine clinical and histopathologic prognostic factors for tumor related survival of patients with uveal melanoma. Clinical and histopathologic records of 20 patients with histologically verified uveal melanomas were retrospectively analyzed. Patients were operated on at University Department of Ophthalmology, Split University Hospital in Split, January 1, 1991 and December 31, 2000. Histopathologic confirmation was obtained from the Hospital Department of Pathology, Forensic Medicine and Cytology, Split University Hospital. Standard histological staining with hemalaun and immunohistochemical staining with primary antibody against melanoma antigen and S-100 protein were performed. Data on the cause of death were collected from death certificates obtained from Hospital Department of Pathology, Forensic Medicine and Cytology and from Split Population Registry, Split-Dalmatia County government. The overall annual incidence of uveal melanoma in Split-Dalmatian County was 0.44 per 100,000. Out of 20 intraocular melanomas, 4 (20%) were located at the ciliary body, 13 (65%) at the choroid, and 3 (15%) at the ciliary body and at the choroid. There was no statistically significant survival difference between groups with different tumor localization (c²=2.747; df=3; p=0.253). The largest tumor diameter was 35 mm and the smallest 9 mm (median 12 mm), and there was no statistically significant correlation between tumor diameter and survival (Spearman\u27s correlation 0.21). Histological study revealed pure spindle A type melanoma in one (5%) case, pure spindle B type melanoma and pure epithelioid type melanoma in 4 (20%) cases each, and mixed type melanoma in 11 (55%) cases. There was no statistically significant survival difference between groups of patients with different histopathologic types of melanoma (χ²=5.312; df=4; p=0.150). Study results indicated that none of the study parameters (localization, tumor diameter and histopathology finding) could be considered a valid prognostic factor of uveal melanoma survival.Cilj studije bio je ustanoviti kliničke i patohistološke prognostičke čimbenike preživljenja od melanoma srednje očne ovojnice kod bolesnika s tom bolešću. Provedena je retrospektivna analiza kliničkih i patohistoloških podataka 20 bolesnika s histološki dokazanim melanomom srednje očne ovojnice. Bolesnici su operirani u Klinici za očne bolesti KB Split u razdoblju od 1. siječnja 1991. do 31. prosinca 2000. godine. Melanomi su patohistološki verificirani u Zavodu za patologiju, sudsku medicinu i citologiju KB Split. Primijenjeno je standardno HE (hemalaun-eozin) bojenje i imunohistokemijsko bojenje na melanoma antigen i S-100 protein. Uzrok smrti utvrđen je uvidom u mrtvozorničke prijave o uzroku smrti u Zavodu za patologiju, sudsku medicinu i citologiju KB Split i u Matičnom uredu Split, Uredu državne uprave Splitsko-dalmatinske županije. Godišnja incidencija melanoma srednje očne ovojnice u Splitsko-dalmatinskoj županiji bila je 0,44 na 100.000 stanovnika. Od 20 intraokularnih melanoma, 4 (20%) su imala polazište iz zrakastog tijela, 13 (65%) iz žilnice, a 3 (15%) su bila smještena u zrakastom tijelu i žilnici. Nije nađena statistički značajna razlika u preživljenju prema lokalizaciji tumora (χ²=2,747; df=3; p=0,253). Najveći promjer tumora iznosio je 35 mm, najmanji 9 mm (medijan 12 mm). Nije utvrđena statistički značajna korelacija između preživljenja i veličine tumora (Spermanova rang korelacija 0,21). Histološka analiza utvrdila je 1 (5%) melanom vretenastog tipa A, 4 (20%) vretenastog tipa B, 4 (20%) epiteloidnog tipa i 11 (55%) miješanog tipa. Nije dokazana statistički značajna razlika u preživljenju ovisno o patohistološkom tipu tumora (χ²=5,312; df=4; p=0,15). Na temelju dobivenih rezultata može se zaključiti kako niti jedan od ispitivanih parametara (lokalizacija, veličina i patohistološki tip tumora) nije valjan prognostički čimbenik preživljenja kod melanoma srednje očne ovojnice

Izražajnost ciklina D1, RET i p27 u papilarnom mikrokarcinomu štitne žlijezde

The aim of the study was to determine the influence of RET, p27 and cyclin D1 on regional lymph node metastases in papillary microcarcinoma. The analysis included 70 patients with papillary thyroid microcarcinoma that underwent surgery at Split University Hospital Center between 1999 and 2001. Immunohistochemistry was performed on formalin-fixed, paraffi n-embedded tissue by the RET, p27 and cyclin D1 antibodies. Quantification was based on the intensity and distribution of nuclear staining, dividing tumors into those that showed expression (expressors) and those that showed no expression (non-expressors). Univariate analysis using χ²-test and Fisher exact test was performed with the level of statistical significance set at p<0.05. Th ere was no statistically significant difference in the incidence of metastases according to the expression or non-expression of RET mutation (χ²-test: p=0.459; Fisher exact test: p=0.672). Among 25 cases with cyclin D1 expression, 6 had metastases, whereas only 2 of 45 cases with no cyclin D expression had metastases (χ²-test: p=0.014; Fisher exact test: p=0.021), indicating that the expression of cyclin D1 is not crucial for the development of metastases in lymph nodes. In contrast,analysis of p27 expression showed it to be significantly associated with lymph node metastasis because 3 of 45 patients with p27 expression had metastases, indicating a statistically significant correlation between p27 expression and lymph node metastases (χ²-test: p=0.093; Fisher exact test: p=0.124). This study confirmed the importance of the evaluation of RET, p27 and cyclin D1 expression and demonstrated the validity of their application in the assessment of microcarcinoma behavior.Cilj istraživanja bio je odrediti utjecaj izražajnosti RET, p27 i ciklina D1 na pojavu metastaza u regionalnim limfnim čvorovima kod papilarnog mikrokarcinoma štitnjače. U analizu su uključeni histološki uzorci 70 bolesnika podvrgnutih operativnom zahvatu zbog papilarnog mikrokarcinoma štitnjače u Kliničkom bolničkom centru Split od 1999. do 2001. godine. Histološki uzorci papilarnog mikrokarcinoma pohranjeni u parafinu i fiksirani formalinom imunohistokemijski su obojani pomoću tri monoklonska protutijela: RET, protein p27 i ciklin D1. Izražajnost je opisana prema intenzitetu i raspodjeli stanične obojenosti, dijeleći tumore na one koji imaju izražajnost (ekspresori) i one koji ne pokazuju izražajnost (ne-ekspresori). Statistička obrada podataka učinjena je pomoću χ²-testa i Fisherova egzaktnog testa, uz razinu statističke značajnosti od p<0,05. Nije uočena statistički značajna razlika u učestalosti metastaza u odnosu na izražajnost RET mutacije (χ²-test: p=0,459; Fisherov egzaktni test: p=0,672). U 25 uzoraka bila je prisutna izražajnost ciklina D1, od kojih su metastaze bile prisutne u 6 slučajeva, a od 45 uzoraka bez izražajnosti ciklina D1 metastaze su bile prisutne u samo 2 uzorka (χ²-test: p=0,014; Fisherov egzaktni test: p=0,021), iz čega proizlazi da ekspresija ciklina D1 nije presudna za razvoj metastaza u limfne čvorove. Nasuprot tome, ekspresija p27 značajno je povezana s metastaziranjem, jer su metastaze bile prisutne u 3 od 45 ispitanika koji su imali povećanu izraažajnost p27 (χ²-test: p=0,093; Fisherov egzaktni test: p=0,124). Ovim istraživanjem potvrdili smo važnost evaluacije izražajnosti p27, ciklina D1 i RET kao i vrijednost njihove primjene u procjeni ponašanja mikrokarcinoma

Učestalost RET mutacije u papilarnom karcinomu štitnjače i korelacija s kliničko-patološkim karakteristikama

The purpose of this study was to analyze the possible prognostic value of RET mutation in papillary thyroid carcinoma and its incidence in the past few decades in our population, due to the increasing incidence of papillary thyroid carcinoma. The present study included 180 patients operated for papillary thyroid carcinoma. The clinical and histopathologic characteristics were analyzed. Paraffin sections of the selected histologic slides were cut again and immunohistochemically stained by the Clone 3F8 P (HIER) from Novocastra (Vision Bio Systems Europe, Newcastle upon Tyne, UK) monoclonal antibody to RET oncoprotein. Univariate analysis indicated sex (p=0.01), histologic subtype (p=0.075) and capsular invasion (p=0.010) to be statistically significant predictors of lymph node metastases, whereas age (p=0.796), tumor size (p=0.556) and intraglandular dissemination (p=0.131) showed no such correlation. The presence of RET mutation (p=0.704) was not a statistically significant predictor of the tumor metastasizing potential. RET mutation (p=0.500) showed no statistically significant correlation with papillary thyroid carcinoma classifed into prognostic groups according to clinicopathologic features either. RET mutation was detected in 30% of 180 papillary thyroid carcinomas. This is the first large study demonstrating that RET mutation incidence in papillary thyroid carcinoma in Croatian population is consistent with the classic distribution of sporadic cases, despite the increased prevalence of papillary thyroid carcinoma in the past few decades.Cilj ovoga rada bio je ispitati moguće prognostičko značenje RET mutacije u papilarnom karcinomu štitnjače i učestalost mutacije u odnosu na porast učestalosti papilarnog karcinoma štitnjače u posljednjih nekoliko desetljeća. U istraživanje je bilo uključeno 180 bolesnika operiranih zbog papilarnog karcinoma štitnjače. Analizirane su kliničke i patohistološke osobitosti. Histološki rezovi iz parafinskih blokova odabranih uzoraka imunohistokemijski su obojani monoklonskim protutijelom na RET onkoprotein Clone 3F8 P (HIER) proizvođača Novocastra (Vision Bio Systems Europe, Newcastle upon Tyne, UK). Univarijatnom analizom utvrđena je statistički značajna povezanost spola (p=0,01), histološkog podtipa (p=0,075) i kapsularne invazije (p=0,010) kao prediktora pojave metastaza u limfne čvorove vrata, dok takva povezanost nije zabilježena za dob (p=0,796), veličinu tumora (p=0,556) i intraglandularnu diseminaciju tumora (p=0,131). Prisutnost RET mutacije nije bila statistički značajan prediktor metastatskog potencijala tumora (p=0,704). Također, RET mutacija nije bila statistički značajno povezana s prognostičkim skupinama papilarnog karcinoma koje su sastavljene na temelju kliničko-patološkh osobitosti (p=0,500). RET mutacija bila je prisutna u 30% od 180 papilarnih karcinoma štitnjače. Ovo je prvo veće istraživanje kojim je dokazano da je RET mutacija u papilarnom karcinomu štitnjače u Hrvatskoj u skladu s učestalošću pojave spontane mutacije, iako se bilježi porast učestalosti papilarnog karcinoma štitnjače tijekom posljednjih desetljeća