Balázs G

Immunogenetic and immunologic studies of differentiated thyroid cancer

The authors have studied in detail human leukocyte antigen (HLA) association in 87 Hungarian patients with thyroid epithelial carcinoma. The authors also examined in a small group of patients, five parameters of cell‐mediated immunity and related them to HLA as well as to lymphocytic infiltration of the tumor/ normal tissue interface. HLA‐DR1 was significantly associated with thyroid carcinoma; the strongest association was in patients with follicular histologic features and DRI homozygotes were not at greater risk for thyroid cancer. The HLA‐DR3 was nonsignificantly increased in patients with papillary or mixed histologic features. The HLA‐DR1, 3 heterozygotes were highly associated with follicular carcinoma, carried no risk for papillary carcinoma, and an intermediate risk for tumors with mixed histologic features. Because of the small proportion of DR1, 3 heterozygotes in the follicular and mixed histologic group, its predictive value at the population level was low. Better predictive potential was shown for the phenotype DR1 and/or DR3. Neither metastatic disease nor age at diagnosis (<45 years) could be related to HLA phenotypes. Patients in all histologic variants showed some measure of cell‐mediated immunity compared to controls. Patients with papillary carcinoma showed an overall better response than those with tumors with follicular or mixed histology. The HLA‐DR could not be related to cell‐mediated immune response. Patients with papillary carcinoma with a good cell‐mediated immune response occurred with much lower infiltration of the tumor boundary with lymphocyte whereas the follicular carcinoma less cell‐mediated immunity was associated with dense lymphocytic infiltration, suggesting the biological relevance of lymphocytic infiltration may be different for the two histologic variants.

Technetium-99m-sestamibi/pertechnetate subtraction scintigraphy vs ultrasonography for preoperative localization in primary hyperparathyroidism

Abstract. A prospective study was performed to evaluate the efficacy of technetium-99m-sestamibi and technetium-99m-pertechnetate subtraction scanning and US for imaging parathyroid glands in primary hyperparathyroidism. Sixty-three patients were surgically treated for primary hyperparathyroidism (HPT). Preoperative scintigraphy and US were performed in all cases. Bilateral neck exploration was carried out on each patient. Results of radionuclide studies and US were compared with surgical and histological findings. In 57 patients with primary HPT the radionuclide scanning gave true-positive results. Four false-negative and two false-positive scintigrams were obtained. The sensitivity and the positive predictive value (PPV) of scintigraphy were 93 and 97%, respectively. Forty-one cases were correctly localized by the US. Seventeen US results were false negative and five were false positive. The sensitivity and the PPV for US were 71 and 89%, respectively. There was a statistically significant difference between the sensitivity of the scintigraphy compared with the US (p=0.001). Sensitivities of radionuclide scans and US were higher for adenomas (100 and 83%) than for hyperplastic glands (75 and 40%). The sensitivity of technetium-99m-sestamibi and technetium-99m-pertechnetate subtraction scintigraphy was significantly higher compared with US. This sensitive method could help surgeons in performing a rapid and directed parathyroidectomy.

The relation of susceptibility to and biologic behavior of thyroid epithelial cell cancer to HLA‐DR1

Fifty‐two patients with thyroid epithelial cell cancer were studied for evidence of association with human leukocyte antigens (HLA). Twenty‐eight patients (53.8%) and 19.4% of 160 controls were HLA‐DR1‐positive, conferring a relative risk of 4.85 (x2 = 21.3, P < 0.0001). HLA‐DR1 was increased in all histologic types of thyroid cancer. Interestingly 10 of 12 patients with metastatic disease were DR1‐positive compared to 18 of 41 patients without metastases (relative risk = 6.1, x2 = 4.7, P < 0.05). This study suggests that major histocompatibility complex‐linked gene(s) determine susceptibility to and the biologic behavior of thyroid cancer. Cancer 58:52–54, 1986.

The first case of human alveolar Echinococcosis in Hungary

Infection caused by Echinococcus multilocularis is a rare helminthiasis, human cases have not been diagnosed in Hungary until now. The endemic region is Central Europe; the occurrence of this infection has been reported from most of the neighbouring countries; however, E. multilocularis has been found in the red fox population in Hungary. Summarizing the recent knowledge concerning epidemiological, clinical patterns and therapeutic options, the authors describe the first Hungarian case of alveolar echinococcosis. In the presence of appropriate clinical findings, the possibility of this rare infection has to be considered in the differential diagnosis of infiltrative hepatic lesions.

Flow cytometric DNA analysis of benign hyperfunctioning parathyroid glands: significant difference in the S phase fraction and proliferative index between adenomas and hyperplasias

Aims: Flow cytometric DNA analysis was performed to measure the DNA content of benign parathyroid tumours in patients with primary hyperparathyroidism. Methods: DNA analysis of paraffin‐embedded parathyroid samples was performed on 51 parathyroid glands from 29 patients after parathyroidectomy. Histopathology showed parathyroid adenoma in 25 cases and hyperplasia in four patients. DNA ploidy status, DNA index (DI), percentage of cells in S phase and proliferative index (PI) were determined. Results: Normal cells from normal glands were all diploid. DNA cytometry showed 12 aneuploid and 13 diploid adenomas. There were 12 diploid and four aneuploid hyperplastic glands. Incidence of aneuploid DNA histograms did not show a statistically significant difference between adenomas and hyperplasias ( P = 0.216). Mean S phase fraction was 3.45% in adenomas and 1.53% in hyperplasias ( P = 0.015). Mean PI was 6.48% in adenomas and 2.78% in hyperplastic parathyroid glands. This difference was statistically significant ( P = 0.006). Diploid cases had a mean PI of 4.78% and aneuploid glands a mean PI of 7.7% ( P = 0.08). Aneuploid DNA content did not reveal statistically significant correlation with age, gender, pre‐operative Ca, alkaline phosphatase, i‐PTH levels, and tumour size. The mean S phase fraction and PI were 2.25% and 4.78% in diploid glands, and 4.5% and 7.7% in aneuploid cases. Conclusion: Aneuploid DNA content may be present in benign parathyroid diseases, but not in normal parathyroid glands. Aneuploid DNA histograms and higher PI occur more often in adenomas compared with hyperplasias, but the nuclear DNA analysis is unable to make a distinction between adenomas and hyperplasias.

Special features of childhood and juvenile thyroid carcinomas

A retrospective analysis was conducted on 36 patients who underwent surgery for childhood or juvenile thyroid cancers and who were regularly followed up during the course of 30 years. The biological properties and late prognosis of these patients were assessed, and the clinical and morphological characteristics of the tumors were examined. The distribution of the DNA content in the tumor cells was compared with that in adult tumor cells, and the results of cytogenetic tests performed on mothers operated on for thyroid tumors and their children are also discussed.

Late Prognosis of Childhood and Juvenile Thyroid Carcinomas

The authors report on the biological properties and late prognosis of 16 children and juvenile patients operated on during the past 24 years for thyroid tumour who underwent regular followup. The clinical and morphological characteristics of the carcinomas are described, together with the late immune response of the patients undergoing complex treatment. The study is also concerned with the characteristics of the DNA content of the tumorous cell nuclei, the pregnancy success rate of the operated patients and the thyroid function of the children born.

Intracardiac echocardiography guided cardiac tumormass biopsy

Primary cardiac tumors are rare and often occur without major symptoms. The appropriate therapy for cardiac tumors without metastasis is surgical resection and chemotherapy. However, for certain patients, when the tumor cannot be safely removed, biopsy is recommended since it allows histology examination and further therapeutical considerations. The aim of our case presentation is to describe the case of a 56-year-old woman, in whom cardiac tumor-mass was revealed because of recurrent pericardial fluids. The mass appeared to be non-resectable, therefore biopsy with an eventual histological examination was planned. Intracardiac echocardiography guided percutaneous biopsy was performed. Intracardiac ultrasound ensured accurate localization of the tumor, the catheter-based grasping device and the excision could be instantly monitored. This case demonstrates that an intracardiac ultrasound-guided tumor mass biopsy is a feasible method, which increases accuracy and ensures safety.

Late Results of Thyroid Surgery for Hyperthyroidism Performed in Childhood

The authors report on the complex follow-up of 60 patients operated on for hyperthyroidism in childhood, on average 13.7 years after surgery. In 16.7% of the patients manifest hypothyroidism, in 45% subclinical hypothyroidism was found; 30% of the patients were euthyroid, and manifest hyperthyroidism recurred in 8.3%. Autonomous adenomas were enucleated in two children and three young adults. Severe disorders in thyroid function developed especially after the surgery of diffuse toxic goiters accompanied by ophthalmopathy. The disorders of humoral and cellular immunity were detected most frequently in recurrent manifest hyperthyroidism. There was no case where ophthalmopathy progressed after the operation. In the offspring of the operated patients the incidence of hyperthyroidism was not increased in childhood. The authors call attention to the importance of postoperative follow-up and hormone treatment.

A képalkotó módszerek szerepe az élő donoros májtranszplantáció donorjelöltjeinek pre- és intraoperatív vizsgálatában, valamint posztoperatív követésében Magyarországon@@@The role of imaging methods in the pre-, intra- and postoperative evaluation protocol of living donors in liver transplantation in Hungary

The evaluation protocol for liver donors can vary from centre to centre, but the main points are the same. Medical history, physical examination, common laboratory tests and psychosocial evaluation are followed by imaging, and specific haemostasis and viral serology tests. The first imaging examinations have the aim of excluding any disease; conventional chest radiography and abdominal ultrasound are performed. Liver volume, fat content, and vascular and biliary anatomy are then evaluated with contrast-enhanced, multiphase, multidetector row CT/CTA and MR cholangiography. Ultrasound guided liver biopsy, and in some cases digital subtraction angiography, should also be performed. During the first phase of the donor operation, intraoperative investigations are done: cholangiography for the final evaluation of the biliary tree and ultrasound of the hepatic and portal venous system to help draw the resection plane. Donors have regular imaging examinations in the early postoperative period for early detection of complications: mainly US or CT to check the remnant hepatic vascularisation and fluid collections in the operated area, or X-ray for thoracic disorders. It is recommended that regular checkups are performed in the late postoperative period. The paper describes the imaging protocol for donor evaluation applied at our institute at the beginning of our living related liver transplantation programme.