Lech Pomorski

Total Thyroidectomy and Adjuvant Radioiodine Treatment Independently Decrease Locoregional Recurrence Risk in Childhood and Adolescent Differentiated Thyroid Cancer

We sought to assess whether extensive surgical treatment, postsurgical radioiodine therapy, or both decrease the risk of locoregional recurrence (LR) after curative primary treatment in children and adolescents diagnosed with differentiated thyroid cancer (DTC) at age ≤18 y. Methods: To determine the incidence of and identify predictive factors for thyroid bed recurrence (TBR) or lymph node recurrence (NR), we performed a chart review and retrospective multivariate Cox regression analysis on 235 patients with DTC diagnosed at age ≤18 y and managed with curative intent at our tertiary referral center from 1973 to 2002; 40 of these patients had distant metastases at diagnosis. We also determined overall and recurrence-free survival and generated curves for these variables using Kaplan–Meier and Cox univariate analysis. Results: During a median follow-up of 82 mo (range, 5–402 mo), no DTC-related deaths occurred, 203 (86%) children remained recurrence-free, and 32 (14%) children had LR, including TBR in 9 (28% of LR), NR in 20 (63% of LR), and both in 3 (9% of LR). Among patients treated with radical intent and showing no distant metastases, the most recent thyroglobulin level was <1 ng/mL in all but 4% of cases. The median time from the first surgery to LR was 37 mo (range, 9–280 mo). In multivariate analysis, significant risk factors for TBR were less than total thyroidectomy and lack of postsurgical radioiodine treatment (respective risk increases of 9.5 [P = 0.04] and 11 times [P = 0.03]). For NR, classic papillary histology, incomplete primary lymph node management (i.e., lack of modified lymphadenectomy of affected lymph nodes or lack of confirmation of disease-free nodes by intraoperative staging), and absence of adjuvant radioiodine therapy were independent significant predictive factors that increased the recurrence risk by 1.9 (P = 0.02), 3.3 (P = 0.02), and 3.2 (P = 0.02) times, respectively. Age or sex did not correlate with LR risk. Conclusion: In DTC patients ≤18 y of age, extensive initial therapy—consisting of total thyroidectomy combined with modified lymphadenectomy performed in case of lymph node metastases and followed by radioiodine therapy—is associated with a substantial decrease of DTC LR risk.

Histologic changes in thyroid nodules after percutaneous ethanol injection in patients subsequently operated on due to new focal thyroid lesions

This paper reports macro‐ and microscopic changes in hyperfunctioning thyroid nodules (HTN), initially diagnosed as solitary, in patients treated with percutaneous ethanol injection (PEI). In 78 patients, benign solitary HTN were diagnosed by clinical and hormonal examination. High resolution ultrasonography confirmed the solitary nodule. The results of fine needle aspiration biopsy (FNAB), performed twice, ruled out malignancy of the nodule. The patients were referred for PEI treatment. At 1‐year follow‐up, newly formed thyroid nodules, whose volumes increased, were detected in five patients (6.4%) with HTN, initially diagnosed as solitary. Therefore, these patients were operated on. Subtotal thyroidectomy was performed. At the intraoperative macroscopic evaluation, a hard fibrous solid mass was found in place of three nodules (n1, n2, n3) following PEI treatment. The middle area of the cut surface of PEI‐treated nodules (n4 and n5) in the other two patients was firm and haemorrhagic, surrounded by a fibrous mass. Histolopathologic examination of n1, n2 and n3 revealed fibrosis and hyalinosis. Examination of n4 and n5 showed haemorrhagic necrosis in the middle of the nodules surrounded by fibrous tissue.

Differences in glycosylation of intracellular proteins between benign and malignant thyroid neoplasms

Differences in glycosylation of nuclear and cytosolic proteins isolated from benign and malignant human thyroid neoplasms were analyzed by lectin blotting and enzyme linked lectino-solid-phase assay using Erythrina cristagalli and Ricinus communis agglutinins. The results reported in this study have not shown any significant differences in lectin binding by nuclear proteins of benign and malignant tumors, however, quantitative and qualitative differences were observed in the patterns of cytosolic glycoproteins. In the majority of carcinomas samples lectin binding to cytosolic proteins was definitely weaker in comparison with adenomas and non-neoplastic specimens, which suggested alterations in glycosylation of cytosolic proteins in malignant tumors.

Chemical composition of surgical smoke formed in the abdominal cavity during laparoscopic cholecystectomy – Assessment of the risk to the patient

ObjectivesThe aim of this study was to assess the exposure of patients to organic substances produced and identified in surgical smoke formed in the abdominal cavity during laparoscopic cholecystectomy.Material and MethodsIdentification of these substances in surgical smoke was performed by the use of gas chromatography-mass spectrometry (GC-MS) with selective ion monitoring (SIM). The selected biomarkers of exposure to surgical smoke included benzene, toluene, ethylbenzene and xylene. Their concentrations in the urine samples collected from each patient before and after the surgery were determined by SPME-GC/MS.ResultsQualitative analysis of the smoke produced during laparoscopic procedures revealed the presence of a wide variety of potentially toxic chemicals such as benzene, toluene, xylene, dioxins and other substances. The average concentrations of benzene and toluene in the urine of the patients who underwent laparoscopic cholecystectomy, in contrast to the other determined compounds, were significantly higher after the surgery than before it, which indicates that they were absorbed.ConclusionsThe source of the compounds produced in the abdominal cavity during the surgery is tissue pyrolysis in the presence of carbon dioxide atmosphere. All patients undergoing laparoscopic procedures are at risk of absorbing and excreting smoke by-products. Exposure of the patient to emerging chemical compounds is usually a one-time and short-term incident, yet concentrations of benzene and toluene found in the urine were significantly higher after the surgery than before it.

Acinetobacter Baumannii Nosocomial Infections

UNLABELLED Nosocomial infections caused by strains Acinetobacter baumannii strands are a growing clinical problem. The occurrence of multidrug-resistant strands is observed and that limits the ways of therapy considerably. The aim of the study was to determine the rate of infection and susceptibility spectrum of the species Acinetobacter baumannii isolated from patients treated at Maria Skłodowska-Curie Memorial Hospital in Zgierz with particular emphasis on surgical wards. MATERIALS AND METHODS The material consisted of Acinetobacter baumannii isolates were obtained from samples of materials from patients treated at Maria Skłodowska-Curie Memorial Hospital in Zgierz from January to December 2011. Isolated bacterial strains were cultured at microbiological substrates. Isolates were identified to species using the VITEK 2 GN card (bioMérieux) and Vitek 2 automated system (bioMérieux). Susceptibility towards antibiotics of particular strains was determined by the means of AST NO 93 card. In the case of resistance towards carbapenem, the MIC was marked by E-test with Mueller Hinton substrate. The occurrence of MBL was verified by the means of disc system with Mueller Hinton substrate. RESULTS We have shown that total number of Acinetobacter baumannii infections at hospital was 140 (10,31% of total results of cultures). Percentage of Acinetobacter baumannii infections at wards: Intensive Care Unit 48%, Surgical Departments 20%, Internal Diseases Department 16%, Neurology 13%, other wards - 3%. The susceptibility percentage of Acinetobacter Baumannii against antibiotics: colistin 90%, imipenem 64%, meropenem 43%, ampicillin-sulbactam 28%, amikacin 27%, gentamicin 24%, cefepime 9%, ceftazidime 7%, ciprofloxacin 7% CONCLUSIONS Acinetobacter baumannii infections are a significant proportion of nosocomial infections. Most relate to surgical wards and ICUs. Acinetobacter baumannii is resistant against most antibiotics. The highest percentage of sensitivity demonstrated for colistin and carbapenems.

Expression, Localization, and Phosphorylation of Akt1 in Benign and Malignant Thyroid Lesions

The serine/threonine protein kinase Akt is a key molecule in the phosphatidyl inositol 3-kinase pathway that is often overactivated in human cancers. Three Akt isoforms (Akt1, Akt2, Akt3) have been identified in human cells and they show different distribution and have non-redundant functions. The aim of this study was to determine whether the expression, phosphorylation, and localization of Akt1 isoform in human thyroid malignant lesions are different from those in benign lesions. Nuclear and cytoplasmic fractions were isolated from tissue samples and Western blot method was used to detect Akt1 presence in both cellular fractions. Akt1 expression was also assessed by ELISA method. To estimate Akt1 phosphorylation, kinase was immunoprecipitated from cell lysates and tested with anti-phospho-Akt antibodies. The Akt1 expression in majority of thyroid cancer samples was significantly higher than in benign lesions (p < 0.05). Akt1 both in differentiated cancers (follicular and papillary) and benign lesions was localized mainly in cytoplasmic fraction. In two of three anaplastic cancer samples Akt1 was predominantly localized in nucleus. The ratio of phosphorylated Akt1 to total Akt1 was lower in cancers than in non-neoplastic lesions and adenomas. Thus, although Akt1 seems to be overexpressed in thyroid neoplasms, its high phosphorylation is not characteristic for thyroid cancers.

Detection of lymph node metastases of papillary thyroid cancer—comparison of the results of histopathology, immunohistochemistry and reverse transcription-polymerase chain reaction—a preliminary report

BackgroundThe range of lymphadenectomy in differentiated thyroid cancer remains still a matter of controversy because of the lack of reliable diagnostic methods for nodal metastases, other than histopathology.AimTo compare the results of detection of lymph node metastases of papillary thyroid cancer by conventional histopathology and immunohistochemistry with the results of reverse transcription–polymerase chain reaction for thyroglobulin mRNA.Patients and methodsEach of 166 cervical lymph nodes obtained from 21 patients was divided into two halves: one was used for conventional histopathology and immunohistochemistry, the other part was investigated by molecular examination.ResultsWe obtained different results from examination of the lymph nodes in six (28.6%) patients. In four patients (19.1%) reverse transcription–polymerase chain reaction (RT-PCR) was more sensitive in detection of positive lymph nodes; in two patients (9.5%) it revealed fewer metastasised lymph nodes than did histopathology. The rest of the patients did not have any differences: 12 (57.1%) of them had negative lymph nodes and three (14.3%) had positive lymph nodes in all examinations.Conclusions(1) Thyroglobulin (Tg) RT-PCR is an appropriate method of detection for thyroid cancer cells. (2) In combination with histopathology, it might help to qualify patients’ nodal status better.

Diagnostics and treatment of differentiated thyroid carcinoma in children - Guidelines of Polish National Societies.

1Department of Paediatric Endocrinology and Rheumatology, Poznan University of Medical Sciences, Poznan, Poland 2Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch, Gliwice, Poland. 3Department of Paediatrics and Paediatric Endocrinology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland 4Department of Oncological and Reconstructive Surgery, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch, Gliwice, Poland 5Department of Oncological Endocrinology and Nuclear Medicine, Centre of Oncology – Maria Sklodowska-Curie Memorial Institute, Warsaw, Poland 6Department of Tumour Pathology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch, Gliwice, Poland 7Department of Paediatrics and Endocrinology, Medical University, Warsaw, Poland 8Department of General and Oncological Surgery, Medical University of Lodz, Lodz, Poland 9Private practice, Katowice, Poland 10Department of Paediatric Surgery and Urology, Wroclaw Medical University, Wroclaw, Poland 11Department of Morphometry of Endocrine Glands, Chair of Endocrinology, Medical University of Lodz, Lodz, Poland 12Department of Dental Pathology, Medical University of Lodz, Lodz, Poland 13Department of Tumour Pathology, Poznan University of Medical Sciences, Poznan, Poland 14Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland 15Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital-Research Institute, Medical University of Lodz, Lodz, Poland

Sentinel lymph node in thyroid tumors – own experience

Aim of the study To determine the feasibility of sentinel lymph node biopsy (SLNB) for the evaluation of the cervical lymph node status in patients with thyroid tumors. Material and methods Twenty-three patients with suspected thyroid cancer were enrolled in the study. 0.5–1.0 ml of 1% Patent Blue dye was injected intratumorally. After SLNB, thyroidectomy and proper lymphadenectomy were performed. Results Sentinel lymph node was detected in 20 (86.9%) patients. Thirty-one SLNs were found – 21 (67.7%) were located in the central neck compartment, 4 (12.9%) in the lateral neck compartment, 6 (19.4%) in the upper mediastinum. The number of SLNs ranged from 1 to 3 (mean 1.6). Sentinel lymph node was positive in 5 (25%) patients, negative in 15 (75%) in the final histopathology. Sentinel lymph nodes were located only in the central neck compartment in 13 patients, and in both the central and lateral neck compartments in 2 patients. In one patient, SLNs were located only in the central neck compartment and upper mediastinum. Three patients had SLNs only in the upper mediastinum, while one had them only in the lateral neck compartment. In one patient a node regarded as SLN was negative, while there were metastases in removed non-sentinel lymph nodes (NSLNs). In two patients, histopathology of SLNs showed that they were actually parathyroid glands. Conclusions Our results confirm that thyroid cancer SLNB is rather easy to carry out. Its performance along with intraoperative examination can help to avoid unnecessary lymphadenectomy. However, it should be kept in mind that parathyroid glands can be stained and removed by mistake during SLNB.

First one-step nucleic acid amplification testing in papillary thyroid cancer lymph nodes - a comparison with histopathology and real-time PCR.

INTRODUCTION The significance of lymph node metastases and the optimal extent of lymphadenectomy remain matters of controversy in papillary thyroid cancer. This study was designed to assess the feasibility and reliability of OSNA and real-time PCR for CK19 and TG mRNA in papillary thyroid cancer lymph nodes evaluation compared to standard histopathology. MATERIAL AND METHODS Each of 92 randomised lymph nodes from 32 papillary thyroid cancer patients were divided into representative parts and assessed using the three studied methods. RESULTS Eighteen (19.6%) lymph nodes from ten (31.3%) patients were positive according to histopathology. When the cut-off value distinguishing metastatic from non-metastatic lymph nodes in the OSNA assay was set at 250 copies per microlitre, the results were positive in 16 (17.4%) lymph nodes from 11 (34.4%) patients. Twenty three (25%) lymph nodes were tested positive in real-time PCR for TG mRNA. Real-time PCR for CK19 mRNA was positive in 18 (19.6%) lymph nodes from 13 (40.6%) patients. No statistically significant differences were noted between the diagnostic accuracy of either molecular method compared to the histopathological examination (p = 0.81). Overall, 20 positive molecular biology results were noted in patients with negative histopathology results. Conversely, in 18 lymph nodes, despite a metastasis finding in histopathology, at least one molecular test yielded a negative result. CONCLUSIONS It was revealed that OSNA is a reliable technique for the evaluation of lymph node metastases in papillary thyroid cancer. This method was shown to have equivalent accuracy to histopathology and real-time PCR.