Delia Ciobanu

Anaplastic Thyroid Carcinoma or Thyroid Metastasis fromCholangiocarcinoma? A Case Report

Anaplastic thyroid carcinoma presents as an extremely localy invasive neck mass while metastases in the thyroid are most commonly described as small, indolent, solitary nodules usually originating from kidney, breast, lungs and skin tumors. We report the case of a 74-year old male patient illustrating the difficulties of differential diagnosis between an anaplastic thyroid carcinoma and a thyroid metastasis of a peripheral cholangiocarcinoma in a cirrhotic patient diagnosed and operated for a locally advanced thyroid tumor. The history, clinical and imagistical features strongly pleaded for the diagnosis of anaplastic thyroid carcinoma presumably with liver metastases, also supported by the rapid recurrence following total thyroidectomy. Immunohistochemical tests showed a malignant carcinomatous proliferation with anaplastic prophile. Positive immunochemical staining for cytokeratin AE1/AE3, CK7 and negative CK20, AFP, CD15, CD30, CD5, TTF1 and thyroglobulin directed the possible diagnosis toward a secondary thyroid tumor from a peripheral cholangiocarcinoma. Immunohistochemical tests showed a malignant carcinomatous proliferation with anaplastic prophile. Positive immunochemical staining for cytokeratin AE1/AE3, CK7 and negative CK20, AFP, CD15, CD30, CD5, TTF1 and thyroglobulin directed the possible diagnosis toward a secondary thyroid tumor from a peripheral cholangiocarcinoma. A CT-guided percutaneous hepatic punction biopsy was planned but the patient presented an ischemic stroke with fatal outcome. In conclusion, in spite of surgical treatment the rapid recurrent thyroid cancer either primary or metastatic had a poor prognosis with fatal outcome mainly in the presence liver cirrhosis and cardio-vascular co-morbidities.

Particularities of Primary Breast Cancer in Men.

Background: Breast cancer in men is rare (1% of all breast cancers) and shows some particularities. Methods: We performed a retrospective study analyzing patients admitted and treated in First Surgical Clinic, Emergency Hospital “St. Spiridon” Iasi from 1 January 2008 to 31 December 2015 with malignant breast tumors. Patients included in the study were diagnosed with breast cancer after pathological examination. We followed the clinical data, laboratory and postoperative follow-up of patients. Results: Between 2008 to 2015 in our clinic were treated 319 breast cancers, of which only 11 men, so 3.4%, higher rate to literature data. Most of the patients were aged and with an advance clinical stage. The mean age of men with breast cancer was 67 years, ten years older than women with same disease. The favoring factors in the study group, were smoking, alcohol consumption in 10 patients, obesity present in 9 patients, blood type IIA, Rh + in 8 patients, periurethral adenoma in 7 patients, diabetes in 6 patients. Neoplastic family histories were recorded in 3 patients, one of Lynch syndrome type II, with BRCA2 mutation. In three cases the breast cancer was the 2nd or 3rd cancer after skin cancer after cancer urothelium and sarcoma soft tissue and in one case with colon cancer, 4 years after breast cancer surgery, with chemotherapy and radiotherapy (Lynch syndrome). We performed radical mastectomy with axillar lymphadenectomy in 9 cases and whiteout lymphadenectomy (sentinel lymphnode negative) in 2 cases. Median survival was 4.2 years (range 1-8 years). Conclusion: Men have a particular form of breast cancer. Unlike women, this cancer is found in men at an older age, with a higher rate of lymphatic invasion and hormone receptor positivity. Treatment should be personalized by a multidisciplinary team.

Giant retroperitoneal paraganglioma debuting with gestational hypertension

We present the case of a 26-year-old female patient with no significant personal or collateral history of diseases, first time pregnant, diagnosed with gestational hypertension, arising de novo in ...

Distal Pancreatectomy with Spleen Preservation in Two Rare Types ofPancreatic Tumors

Cystic neoplasms of the pancreas have an incidence of 10% of all cystic tumors, represented by serous cystadenomas, mucinous cystic neoplasm and solid pseudopapillary neoplasm. We present two cases with rare pancreatic tumors: two women of 18 years old and 67 years old respectively were admitted for non specific abdominal pain and dyspepsia. The CT-scans diagnosed with corporeal pancreatic of 30 × 40 mm in the first case and 98 × 66 mm in the second. Distal pancreatectomy with spleen preservation was performed in both cases with uneventful postoperative course. The pathological exam revealed pseudopapillary pancreatic tumor in the first case and mucinous cystic neoplasm, in the second case. A short review of the literature was also performed.

Malignant Paraganglioma; a Story of a Long Time Survival

Pheochromocytoma and paraganglioma are catecholamine secreting tumors. Malignancy is uncommon - approximately 10% for pheochromocytoma and 20% for paraganglyoma. Surgery, when possible, is the first line treatment. Prognosis is poor because of a frequent local recurrence and/or metastases and the lack of specific chemotherapeutic agents. We report the case of a 60 years old man who was hospitalized at the age of 48 for episodes of paroxystic hypertension with spells. The high levels of vanillylmandelic acid (VMA), more than 50 mg/24h at 3 determinations, confirmed the excess of catecholamine, but the CT scan failed to reveal the tumor. The iodine-131- meta-iodobenzylguanidine (I-MIBG) scintigraphy showed the presence of a 1.5 cm nodule in the left abdominal paraaortic region. The patient refused surgery and had a satisfactory evolution with antihypertensive therapy. 11 years later he was admitted in the Vascular Surgery Department for acute ischemia of inferior limbs; a voluminous para-aortic tumor was diagnosed and resected. The pathology confirmed paraganglioma and described some atypical cells without being able to discriminate between benign or malignant pattern. Anamnesis could not identify any other case in the family. After another year he was admitted in the Endocrine Department for the reappearance of the adrenergic syndrome, with VMA at 30.8 mg/24h. The thoracic and abdominal CT-scan showed abdominal and thoracic metastatic tumors. The patient was referred to a specialized center were octeotride scintigraphy confirmed local recurrence and metastatic tumors in the lungs. He was treated with Sunitinib with a good initial response and he died after 16 years from the initial diagnostic of paraganglioma.