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Background: The rising incidence of thyroid cancer observed in the last few decades requires an improvement in diagnostic tools and management techniques for patients with thyroid nodules. Aims: The aim of this study was to assess serum concentrations of IGF-1 and IGF-1R in patients diagnosed with thyroid cancers. Methods: 36 patients diagnosed with papillary thyroid cancer (PTC), 11 subjects with follicular thyroid cancer (FTC), 9 patients with anaplastic thyroid cancer (ATC) and 19 subjects with multinodular nontoxic goiter (MNG) were enrolled to the study. The control group (CG) consisted of 20 healthy volunteers. Blood samples were collected one day before surgery. Serum IGF-1 and IGF-1R concentrations were measured using specific ELISA methods. Results: Significantly higher concentrations of IGF-1 were found in patients with PTC as compared with controls but not that obtained from subjects diagnosed with MNG. The concentration of IGF-1R was significantly elevated in subjects with PTC and ATC as compared with healthy volunteers. Similarly, patients diagnosed with PTC or ATC presented significantly higher serum concentration of IGF-1R in comparison to the MNG group. Conclusions: Our results show that the IGF-1 - IGF-1R axis plays a significant role in the development of PTC and ATC and imply that serum concentrations of both cytokines may be considered as additional markers for the differentiation of malignancies during the preoperative diagnosis of patients with thyroid gland tumors. These results indicate that IGF-1R serum concentrations allow us to differentiate between MNG and PTC or ATC. Moreover IGF-1R serum values appear to be better predictor of PTC and ATC than IGF-1 concentrations.

Breast cancer is the most common malignant neoplasm among women. Metastases to the thyroid are relatively rare. Those lesions annunciate neoplasm dissemination in most cases. Metastatic breast cancer of thyroid lobe regrowth hasn’t been described yet. In the article the authors present a case of a 66-year old women with isolated, metachronous breast cancer metastasis in regrowth of the right thyroid lobe. Resection of the right lobe with metastatic tumor was performed with a purpose of total recovery. Despite surgery, multiple bone metastases were detected a few months after. In conclusion, regrowth of the thyroid is a potential site of recurrence and metastasis. Therefore, the thyroid bed cannot be omitted in routine examination during and after oncological treatment.

Introduction βKlotho (βKL) is known to act as co-receptor for fibroblast growth factor receptor 4 (FGFR4) which is the main cognate receptor for fibroblast growth factor 19 (FGF19). Dysregulation of this FGF19/FGFR4/βKL signaling axis has been implicated in the pathogenesis of several cancers. However, its role in the pathogenesis of thyroid cancer has not been determined. Materials and methods The aim of this study was to assess FGF19, FGFR4 and βKL concentrations in a group of 36 patients with papillary thyroid cancer (PTC), 11 patients with follicular thyroid cancer (FTC), 9 patients with anaplastic thyroid cancer (ATC) and a group of 19 subjects with multinodular nontoxic goiter (MNG). The control group consisted of 20 healthy volunteers. Serum FGF19, FGFR4 and βKL concentrations were measured using specific ELISA methods. Results Significantly lower concentrations of βKL and higher concentrations of FGF19 were found in patients with PTC, FTC and ATC as compared with MNG group and controls. An elevation of FGFR4 serum concentration was observed in all thyroid cancer groups in comparison to MNG group and controls; however, in FTC group it was statistically insignificant. A positive correlation was found between βKL and FGFR4 concentrations in PTC patients. The levels of βKL, FGF19 and FGFR4 did not differ significantly between MNG group and healthy controls. Conclusions Our results indicate that a disrupted FGF19/FGFR4/βKL signaling pathway may play a role in the development of thyroid cancers. However, further studies are needed to elucidate the molecular mechanism of the neoplastic transition of thyroid epithelial cells.

Background Loss of heterozygosity (LOH) and microsatellite instability (MSI) are frequent molecular events in thyroid tumor etiopathogenesis occurring in several chromosomal critical areas, including 3p12–25.3, 7q21–31, 10q22–24, and 15q11–13, with loci of tumor suppressor genes. Objective We evaluated the usefulness of LOH/MSI as a diagnostic/prognostic biomarker in lesions derived from thyroid follicular cells: follicular thyroid carcinoma (FTC); follicular adenoma (FA), papillary thyroid carcinoma (PTC), and nodular goiter (NG). Methods We performed allelotyping (GeneMapper Software v. 4.0.) of ten microsatellite markers linked to the 1p31.2, 3p21.3, 3p24.2, 9p21.3, 11p15.5, and 16q22.1 region on DNA from 93 primary thyroid lesions then evaluated the LOH/MSI frequency and overall frequency of allelic loss (OFAL). Results We found regions with significantly increased frequency of LOH/MSI for specific histotypes: the 3p24.2 region for FA and 1p31.2 for FTC. LOH/MSI in 3p21.3 was significantly elevated in PTC and FTC. LOH/MSI in 3p21.3 was increased for small size tumors (T1a + T1b), tumors with no regional lymph node involvement (N0 + Nx), American Joint Committee on Cancer (AJCC) stage I tumors, and tumor diameter (Td) 30 mm. OFAL values were significantly higher in younger patients (

Medullary thyroid cancer (MTC) is a relatively rare thyroid neoplasm derived from neuroendocrine C cells which secrete calcitonin. αKlotho (αKL) and βKlotho (βKL) are transmembrane proteins which modulate different signaling systems, such as endocrine FGFs and IGF1 pathways. Dysregulation of the FGF19/FGFR4/βKL and IGF-1/IGF-1R/αKL signaling axes has been implicated in the pathogenesis of several cancers. However, their role in the pathogenesis of MTC has not been determined.The aim of this study was to assess αKL, βKL, FGF19, IGF-1, FGFR4, and IGF-1R concentrations in a group of 11 patients with medullary thyroid cancer (MTC). The control group consisted of 20 healthy volunteers. Serum concentrations of these factors were measured using specific ELISA methods.Significantly lower concentrations of βKL and higher concentrations of FGFR4 and IGF-1R were found in patients with MTC as compared to controls.Our results indicate that a disrupted signaling pathway for βKL, FGFR4 and IGF-1R may play a role in the development of medullary thyroid cancers. However, further studies are required to confirm these findings and to use this knowledge in clinical practice.

Significant advances have been made in thyroid can-cer research in recent years, therefore relevant clinical guidelines need to be updated. The current Polish guidelines "Diagnostics and Treatment of Thyroid Carcinoma" have been formulated at the "Thyroid Cancer and Other Malignancies of Endocrine Glands" conference held in Wisła in November 2015 [1].

Reoperations of the thyroid gland are challenging to any surgeon. Such procedures are technically difficult and involve higher risk of complications than primary procedures. Recurrent laryngeal nerve (RLN) palsy is one of such complications The aim of the study was to evaluate the effectiveness of intraoperative neuromonitoring (IONM) in preventing RLN palsy during recurrent goiter operations. Material and methods. We retrospectively analyzed the results of thyroid reoperation performed at the Department of Endocrine, General and Vascular Surgery of Medical University of Lodz in the period from January 2014 to June 2016. The study included 80 patients, who were divided into 2 groups: group A consisted of 27 patients, who had undergone surgery with the use of IONM, while group B included 53 patients, in whom RLN was identified visually. During statistical analysis we took into account the number of nerves at risk, not the number of patients. There were 47 nerves at risk In group A and 86 in group B. We analyzed whether application of IONM had any effect on the frequency of RLN palsy and procedure duration. Results. The frequency of RLN palsy was 10.64% (5/47) in group A and 15.12% (13/86) in group B (no statistical significance, p=0,47). Mean operation time was shorter in group B 71.29 ± 17.125 minutes vs. 75.75 ± 17.94 minutes in group A (no statistical significance, p=0,377). Conclusion. Use of IONM did not significantly reduce the occurrence of RLN palsy and procedure duration.

The aim was to assess the usefulness of strain elastography (SEG) in the diagnostics of two groups of thyroid nodules (TNs): follicular lesions (FL) with low malignancy risk (20.0%) and low percentage of papillary carcinomas (PTCs) among cancers as well as TNs with unequivocal cytology (UC) and high percentage of PTCs among cancers.168 TNs were analysed and eventually surgically treated: 100 UC (50 benign and 50 malignant - 90.0% PTCs) and 68 FL (60 benign, 8 malignant - 50.0% PTCs). Elasticity score (ES) and strain ratio (SR) were evaluated, and their effectiveness was compared with the evaluation of the number of ultrasound malignancy risk features (NoUMRFs).In the UC group the evaluation of mean values of SR and ES in both sections (meanSR, meanES) was more efficient than NoUMRFs analysis (AUC: 0.903 and 0.869 vs. 0.754, p0.05). The following thresholds: meanSR ≥ 2.01, meanES ≥ 2.5, NoUMRFs ≥ 2, were related to the increased malignancy risk in nodules (OR: 45.0; 23.2; 5.4, respectively), but only meanSR ≥ 2.01 was an independent risk factor (OR: 20.3; SEN: 86.0%, SPC: 88.0%). In the FL group, only the evaluation of tSR (SR assessed in transverse section) had the value of AUC0.7, and only the set of features: tSR ≥ 1.7 and NoUMRFs ≥ 1 increased the malignancy risk in nodules (OR: 12.0; SEN: 75.0%, SPC: 75.0%).SEG is more reliable than conventional US in the diagnostics of TNs. The efficacy of SEG decreases with lowering percentage of PTCs among cancers. But in FL nodules SEG may support the selection of nodules for surgical treatment.

Introduction. SERPINE2 and secretory leukocyte protease inhibitor (SLPI) are proteins with anticoagulant properties which could promote solid tumor growth. However, their role in the pathogenesis of thyroid cancer has not been determined. Materials and Methods. The aim of this study was to assess serum SERPINE2 and SLPI concentrations in a group of 36 patients with papillary thyroid cancer (PTC) and a group of 19 subjects with multinodular nontoxic goiter (MNG). The control group (CG) consisted of 20 healthy volunteers. Blood samples were collected one day before surgery. Serum SERPINE2 and SLPI concentrations were measured using specific ELISA methods. Results. Significantly higher concentrations of SERPINE2 and SLPI were found in patients with PTC as compared with MNG and controls. Positive correlation was found between SERPINE2 and SLPI concentrations in PTC patients. The levels of SERPINE2 and SLPI did not differ significantly between MNG and healthy controls. Conclusions. Our results indicate that SERPINE2 and SLPI play a significant role in the development of papillary thyroid cancer and imply that the evaluation of serum concentrations of both anticoagulant molecules may be considered as additional marker for the differentiation of malignancies during the preoperative diagnosis of patients with thyroid gland tumors.

The diagnostic category of follicular lesion of undetermined significance (FLUS) was intended to allow selection of cases with low risk of malignancy from all smears with indeterminate, suspicious cytology (ISC), which can potentially take advantage from repeat fine-needle aspiration (rFNA). Aim of the study was a comparison of the risk of malignancy related to FLUS nodules and other nodules with ISC: suspected follicular neoplasm (SFN) and suspected malignancy (SM), as well as analysis of the usefulness of assessing ultrasonographic malignancy risk features (UMRF) in nodules with ISC.We analysed UMRF, rFNA, and results of histopathological examination (H) in 441 FLUS, 135 SFN, and 72 SM nodules.The frequency of exposing cancer in H in FLUS nodules was 5.9%, and when cytological follow up was also included it was 2.9%. rFNAs made the diagnosis more precise in 72.7% of FLUS, and in 5.2% it was diagnosis/suspicion of cancer. The incidence of cancer in SFN nodules was 8.2%, in SM nodules with suspicion of papillary cancer - 61.1%, and in nodules with suspicion of other or unspecified malignancy - 53.8% (p0.0001 FLUS vs. both groups). The presence of calcifications is the only independent UMRF for nodules with ISC (OR 4.7). Features of importance are also microcalcifications (OR 3.8), especially in the SM group, and taller-than-wide-shape (OR 2.2). FLUS and SFN nodules are characterised by particularly low value of assessing suspicious margins; analysis of hypoechogenicity is of low value in SFN nodules, like suspected vascularisation in SFN and SM nodules.The risk of cancer in FLUS and SFN nodules is lower than in SM nodules. rFNAs of FLUS nodules make the diagnosis more precise in more than 70% of cases and are effective in revealing cancers. UMRFs present variable diagnostic value depending on the subcategory of ISC.

The peripheral blood levels of TNF alpha and its soluble receptors were studied in 39 patients with malignant and benign adrenal tumors treated by adrenalectomy. The concentrations of TNF alpha were significantly elevated in patients with malignant tumors of the adrenal cortex and in patients with Conn's syndrome compared to control. In patients with non-functioning adenomas and pheochromocytomas, TNF alpha levels were similar to those detected in the control. In subjects with myelolipomas, the serum concentration of TNF alpha was lower compared to the control. After adrenalectomy, the levels of TNF alpha were decreased in patients with malignant tumors and in patients with Conn's syndrome, nonfunctioniong adenomas and pheochromocytomas compared to the concentration before surgery. The serum concentrations of soluble receptors of TNF alpha did not differ among different patient groups and compared to the control. After adrenalectomy, the blood concentrations of TNF alpha R1 and TNF alpha R2 were decreased in patients with Conn's syndrome. However, to confirm practicality of the evaluation of TNF alpha and its soluble receptors in differential diagnosis in patients with adrenal tumors, a larger study group is needed.

Venous insufficiency is a common, chronic disease that affects nearly half of the population in highly developed countries. The vast majority of affected patients suffer from varicose veins (VV). Recently, the priority in medicine has been patient satisfaction with treatment and high quality of life. Therefore, disease-specific questionnaires that measure quality of life have been developed. One of these is VEINES-QOL/Sym with two subscales that assess quality of life and disease symptoms. To date, it has been used to examine patients with venous ulcers and thrombosis. No data are available concerning the use of VEINES to assess patients after VV surgery.was to investigate the change in QOL after VV surgery and verify the usefulness of VEINES in daily phlebological practice.The study recruited 69 patients (CEAP class C2-C3) in need of surgery for VV. The patients responded 2 hours before surgery and after 3 months. Patients were differentiated into several categories according to CEAP stage, age, sex, BMI, the use/lack of compression therapy, and education level.The quality of life increased significantly in C3 patients and in patients over the age of 50. Quality of life increased significantly in all patients regardless of education. There were no differences between groups differentiated according to sex, the use or lack of compression therapy, or BMI.The VEINES-QOL/Sym questionnaire can be used in daily phlebological practice to assess patients before and after surgical treatment of VV. VEINES-QOL/Sym is reliable and highly valid.

There are limited and conflicting studies investigating the role of the angiopoietin family in human thyroid cancer development and progression. We have investigated cytokines angiopoietin-1, -2 and their receptor (Tie-2), known to be involved in angiogenesis, in the serum of 52 thyroid cancer patients (21 cases of papillary cancers, PTC; 8 follicular cancers, FTC; 12 medullary cancers, MTC and 11 anaplastic cancers, ATC), using ELISA assays. The control consisted of 27 healthy volunteers. Statistically significant lower concentrations of Ang-1 were found in patients with thyroid cancers as compared with the control (p < 0.003). The levels of Ang-2 and Tie-2 did not differ significantly between thyroid cancer patients and control. We have also compared the results of Ang-1, Ang-2, and Tie-2 determinations obtained in different histopathological subgroups of cancer patients. These results revealed lower Ang-1 concentrations in ATC (p < 0.05), MTC (p < 0.02), FTC (p < 0.01) and in PTC patients (p < 0.05) than control. We have also observed lower Ang-2 concentration in PTC patients (p < 0.03) and Tie-2 in FTC patients (p < 0.02 ) in comparison to controls. In conclusion, the Angs/Tie-2 system dysfunction may play an important role in thyroid cancerogenesis and decreased concentration of Ang-1 in serum can be a useful additional biomarker for the presence of thyroid cancers.

THE AIM OF THE STUDY was to evaluate the safety of one-day thyroid surgery based on the assessment of the incidence of early postoperative complications. MATERIAL AND METHODS The study comprised 726 patients who underwent total thyroidectomy during the period between January, 2012 and February, 2013. The study considered the three most common thyroidectomy complications. RESULTS In the group of 726 patients, recurrent laryngeal nerve paralysis was observed in 22 cases, accounting for 3.07% of all patients. Postoperative bleeding was observed in 12 cases (1.65%). In 8 cases, bleeding occurred during the first 8 hours after surgery, while in the remaining four cases- 9, 12, 18, and 26 hours after surgery. The study group was divided into three subgroups, in which the concentrations of calcium and parathyroid hormone, 6 hours and 20 hours after surgery, were determined. In the first group (223 patients), only the parathyroid hormone level was determined. The decreased PTH level was associated with the appearance of tetany symptoms in 15% of cases. Amongst patients in whom the parathyroid hormone level was normal, tetany symptoms were observed in 0.5% of cases. In the second group (256 patients), only the serum calcium level was determined. Amongst patients with normal serum calcium levels, 1% of cases presented with tetany symptoms. In patients where the serum calcium level was reduced, tetany symptoms appeared in 35% of cases. In the third group (247 patients), both serum calcium and parathyroid hormone levels were determined. In the group of patients with normal, both serum calcium and parathyroid hormone levels, tetany symptoms were not observed. Amongst patients with normal serum calcium levels and decreased PTH levels on the day of surgery, tetany symptoms were observed in 25% of cases, while during the first postoperative day-37% of cases. CONCLUSION One-day thyroid surgery, due to the appearance of complications cannot be regarded as a completely safe procedure.

UNLABELLED The aim of the study was to assess the efficacy of intraoperative ultrasonography during videoscopic adrenalectomy. MATERIAL AND METHODS The study was conducted in patients undergoing extraperitoneal videoscopic adrenalectomy for adrenal tumours in the Department of Endocrine, General and Vascular Surgery of the Medical University in Łodź in 2008-2011. RESULTS The active group consisted of 20 patients in whom navigation with the use of intraoperative ultrasonography (IOUS) was used in the course of surgery. The comparison group consisted of 46 patients operated without the use of IOUS. In the active group, we managed to obtain a shorter time of surgery by almost 20 min (89.44 ± 27.11 min vs 109.12 ± 33.88 min; p=0.034) and a shorter lesion access time by more than 15 min (28.61 ± 14.93 min vs 45.98 ± 20.44 min; p=0.002). Intraoperative blood loss was also significantly lower in the active group (86.11 ± 157 ml vs 169.27 ± 201.04 ml; p=0.037). In contrast, the use of IOUS did not affect the hospitalisation time (4.39 ± 3.27 days vs 3.83 ± 3.67 days; p=0.227), the rate of intraoperative complications (0/18 vs 2/41; p=1) and the conversion rate (2/20 - 10% vs 5/46 - 10.87%; p=1). CONCLUSIONS 1. Intraoperative ultrasonography is useful for determining the tumour relationship with the surrounding anatomical structures. 2. Intraoperative ultrasonography is a useful technique in the assessment of adrenal tumour infiltration of the surrounding tissues. 3. This technique facilitates finding the pathological lesion, shortening the time of access to the tumour and procedure duration (thus reducing the burden for the patient). 4. Reduced blood loss was also obtained owing to the use of IOUS.

UNLABELLED Splenic cysts are rarely diagnosed lesions. This also includes splenic pseudocysts, which usually develop as a result of a blunt abdominal cavity injury. Splenic cysts are usually diagnosed on the basis of imaging examinations, performed in case of symptomatic patients or those subject to a blunt abdominal cavity injury. MATERIAL AND METHODS The study group comprised six patients with a positive history of blunt abdominal cavity trauma, verified by means of histopathological examinations, which were subject to surgical intervention at the Department of General and Endocrinological Surgery, Medical University in Łodź, during the period between 01.01.2006 and 31.12.2010. Before or during the surgical procedure cystic lesions were diagnosed. The efficacy of the surgical intervention was determined. RESULTS Splenic pseudocysts were diagnosed in only two of the patients, although in all there was a reasonable suspicion of the above-mentioned lesion. One patient required three operations, due to recurrence of the lesion, which proved to be a primary epithelial cyst. Two of the patients required early explorative relaparotomy. Apart from the above-mentioned, treatment proved uneventful. CONCLUSIONS The diagnosis of a splenic pseudocyst is established in case of suspicion of the above-mentioned lesion. This is evidence that in some patients focal lesions of a different nature are present, being detected by means of diagnostic imaging examinations performed after abdominal cavity injuries.

UNLABELLED The AIM OF THE STUDY was to determine postoperative insulin-resistance in patients subject to total thyroidectomy, the prevalence of subjective feelings of hunger immediately before surgery, and the incidence of nausea/vomiting after surgery in patients prepared for elective operations by means of oral glucose solutions. MATERIAL AND METHODS The study group comprised 115 patients, including 71 patients prepared for surgery by means of oral glucose solutions (12.5% glucose) administered 12 and 3 hours before the procedure, at a dose of 800 and 400 ml. The control group comprised 44 patients prepared for surgery by means of the traditional manner- the last meal was served before 2pm the day before the surgical procedure, while fluids before 10pm. Considering both groups, we evaluated glucose and insulin levels three times, as well as determined the insulin-resistance ratio (HOMA-IR) 24 before, and 12 hours and 7 days after surgery. The incidence of nausea and vomiting after surgery, and the subjective feeling of hunger before surgery were also evaluated. RESULTS Statistically significant differences considering insulin level and HOMA-IR values were observed during the II and III measurements. The glucose and insulin values, and the HOMA-IR insulin-resistance ratio, showed no statistically significant differences during measurement I. No statistically significant glucose level differences were observed during measurements II and III. A significantly greater subjective feeling of hunger before surgery and nausea/vomiting afterwards were observed in the control group. CONCLUSIONS The preparation of patients with oral glucose solutions decreases the incidence of postoperative (thyroidectomy) insulin-resistance, and occurrence of nausea/vomiting during the postoperative period.

THE AIM OF THE STUDY was comparison of inflammatory response intensity through estimation of CRP, IL-6 and WBC concentration in blood serum in patients before and after inguinal hernia operations with Stoppa and TEP method. MATERIAL AND METHODS. The study involoved 117 patients operated on inguinal hernia between 2006-2008. The patients were divided into two groups. In the first group (group I - 56) Stopp'a method was used, in the second (group II - 61) TEP method. The patients selection was coincidental. All examined patients were men between 25-75 years old (mean age 54.3). Moreover, the operation's time, state of postoperative wound, the average hospitalization time and intensity of pain were estimated. The observations were directed over two weeks after operation. RESULTS. The inflammatory response estimated with CRP, IL-6 concentration in blood serum was considerably higher in patients operated with Stoppa method. There wasn't observed a relevant difference in increase of white blood cells' concentration in both groups. Moreover, the patients operated on with TEP method experienced lower pain. In group, operated on with Stoppa method, 3 cases of wound healing complications were observed. The operation's time was considerably shorter in the first group. The hospitalization time, was considerably shorter in patients operated on with videoscopic method. CONCLUSIONS. The operation of inguinal hernia with TEP technique in comparison with Stopp'a method is connected with considerably lower inflammatory response of organism, what directly involve with postoperative pain abridgment and reduction of hospitalization time. Moreover it may have influence on frequency of postoperative complications related with wound healing.

We report a case of pancreatic solid pseudopapillary tumor that was diagnosed in a 36-year-old female patient. This neoplasm usually occurs in young women. Solid and cystic areas form a characteristic appearance of this tumor. Surgical resection is the mainstay of treatment and is possible in the majority of cases. Neoplasm is associated with a low-grade malignancy and a very good outlook.

Peripheral blood osteopontin (OPN) and endostatin (END) levels were studied in 35 patients with adrenal cortex tumors and 10 patients with pheochromocytoma before unilateral adrenalectomy, as well as in 10 healthy subjects (controls). Thirty days after surgery, OPN and END were evaluated again in 16 patients with adrenal cortex tumors and 4 female patients with pheochromocytoma. Before surgery, OPN blood concentrations increased in the group of patients with adrenal cortex carcinomas as compared to controls (p < 0.001) and the group with Conn syndrome (p < 0.05); they did not change after surgery. Before adrenalectomy, OPN blood levels in pheochromocytoma patients were also lower than in Conn syndrome subjects (p < 0.05). After adrenalectomy, the normal concentrations of END decreased only in the group of patients with hormonally inactive cortical adenomas (p < 0.05). We were unable to demonstrate any relationships between removed tumor volumes and OPN or END blood levels.

Neoangiogenesis appears to be an important event in tumour invasion and in the formation of metastases in many endocrine-related human cancers. Vascular endothelial growth factor (VEGF) is a glycoprotein with potent angiogenic, mitogenic and vascular permeability-enhancing activities specific for endothelial cells and acts through VEGF receptors. The aim of the study was to evaluate the plasma blood concentrations of VEGF, sVEGFR1, and sVEGFR2 in patients with benign and malignant adrenal tumours treated by surgery.We studied the blood before surgery of 41 patients with adrenal cortex tumours and 10 normal subjects without hormonal or CT/USG pathology of the adrenal glands (controls). We studied the blood after adrenalectomy of 16 patients with tumours of the adrenal cortex.Concentrations of VEGF, sVEGFR1 and sVEGFR2 in blood plasma before as well as 30 days after surgery were evaluated by ELISA. VEGF blood concentrations before surgery did not differ in the patients with the cortical tumours as compared to the controls. After surgery VEGF concentrations decreased among the patients, taken in total, with adrenal cortex tumours and cortical adenomas. Before surgery sVEGFR1 blood concentrations were increased in the patients with Conn's syndrome only in comparison with the controls. After surgery, sVEGFR1 concentrations decreased significantly in the group with cortical adenomas only. Before and after surgery sVEGFR2 blood concentrations did not differ between the groups of patients studied and the controls.Peripheral blood concentrations of VEGF and its receptors cannot be clinically valuable markers that discriminate between benign and malignant adrenocortical tumours before and after adrenalectomy.

The natural tetrapeptide acetyl-Ser-Asp-Lys-Pro (AcSDKP), generated from thymosin beta4 following its cleavage by prolyl oligopeptidase (POP), is a physiological stimulator of angiogenesis. Because of the critical role of neovascularisation in tumor development, the expression of AcSDKP and the activity of POP were examined in different human solid malignancies.The expression of AcSDKP and the activity of POP were evaluated in human blood samples and tissue specimens of thyroid goiter and thyroid papillary carcinoma as well as in commercial cancer tissue microarray.A significantly increased concentration of AcSDKP in intratumoral blood and enhanced tissular activity of POP were detected in cancer patients. The expression of AcSDKP in human breast, colon, head and neck, kidney, lung, skin, ovary and prostate cancer tissues was shown to be greater than that in normal tissues.AcSDKP and POP contribute to the malignant phenotype and these molecules are potentiel markers of cancer.

The aim of the prospective study was the evaluation of primary, subclinical, normocalcemic hyperparathyroidism (PHPT) incidence in patients, operated on because of non-toxic (NTG), toxic (TG) goiter and papillary thyroid cancer (PTC).The study was performed in the group of 196 patients operated on NTG (115 patients), TG (43 patients) and PTC (38 patients). All patients had never been operated because of goiter. No patient had clinical symptoms of PHPT. Calcium concentration (Ca), phosphorus concentration (P) and alkaline phosphatase activity (ALP) in blood serum were measured in all patients a day before operation. When those parameters were out of range, parathormone concentration (PTH) in blood serum was measured. In the case of elevated PTH concentration PHPT was diagnosed. Furthermore, in order to exclude renal failure and insufficiency tests for creatinine and urea concentrations in blood serum and urinalysis were performed.There was no case of increased Ca concentration among 158 patients with benign goiter. The values of at least one measured parameters (P or ALP) were abnormal in 47 out of 158 patients with benign goiter (29.7%). Increased PTH concentration (mean 101.5 pg/ml) was in 16 of 47 patients (10.1% of 158 patients). Normocalcemic PHPT was diagnosed in 12 (10.4%) NTG patients and 4 (9.3%) TG patients. In patients with PTC hypercalcemia was not affirmed. In 7 (18.42%) cases of 38 PTC patients P concentration and ALP activity were abnormal. Increased PTH concentration (84.85 pg/ml) was found in one female with PTC with normal values of P and ALP. Incidence of PHPT was observed in 2.63% of PTC patients.1. There was no significant difference of PHPT incidence between various type of goiter. 2. In our study coexistence of PTC and normocalcemic, asymptomatic PHPT is rare.

There is growing evidence that cytokines and their antagonists are important in the pathogenesis of various malignancies. While there are several reports on interleukin-1 receptor antagonist (IL-1ra) gene polymorphism and tissue expression, there is only little data available on the impact of IL-1ra serum levels. Therefore, we performed a prospective study, analyzing IL-1ra in thyroid cancer patients. We measured preoperative IL-1ra serum levels of 52 consecutive patients with thyroid cancer, 15 with benign adenoma and 27 healthy volunteers. The final histological diagnosis revealed 21 patients with papillary and 8 patients with follicular carcinoma (FTC), while 12 cases of medullary and 11 cases of anaplastic carcinoma (ATC) were observed. Compared to the control group, serum concentrations of IL-1ra were significantly higher in ATC and FTC patients. Concerning gender differences, this effect reached significance only in women with ATC and FTC. Except for the stage IV disease in ATC, there was no correlation between IL-1ra levels and International Union Against Cancer staging. The findings of our study indicate that IL-1ra may play an important role in the development of ATC and FTC. Future efforts should focus on the possible application of IL-1ra as a biomarker for the above-mentioned thyroid malignancies.

Hypocalcemia is the most frequent complication after thyroid surgery. Intraoperative measurement of parathormone levels (ioPTH) in patients undergoing thyroid surgery has been recently described as an accurate method of predicting postoperative parathyroid dysfunction. The aim of the study was to evaluate utility of ioPTH and parathormone level measured 24 hours after surgery (24PTH) as prognostic factors of hypoparathyroidism and consequent hypocalcemia.Fifty-four patients (50 females and 4 males) underwent 55 operations: subtotal thyroidectomy (44), total thyroidectomy (8), completion thyroidectomy due to goiter reoccurrence and cancer (2 and 1 patients, respectively). PTH and serum calcium levels were assessed one day prior to surgery, intraoperatively during wound closure, on the first postoperative day and 2 months after surgery. Hypoparathyroidism was defined as parathormone level less than 15 pg/ml.Seventeen patients presented ioPTH levels below 15 pg/ml. Twelve of them had low 24PTH levels. Only one patient with ioPTH (but not 24PTH) below 15 pg/ml developed persistent hypoparathyroidism, resulting in low parathormone level 2 months after surgery. Three investigated subjects with ioPTH greater than 15 pg/ml had low 24PTH levels but none of them developed persistent hypoparathyroidism. One patient with ioPTH and 24PTH within reference range presented hypoparathyroidism at the 2-month follow-up, presumably due to postoperative iodotherapy.This study suggests that ioPTH and 24PTH levels are not useful prognostic factors of persistent hypoparathyroidism but may indicate transient parathyroid gland dysfunction.

Apoptosis (programmed cell death) is the best described mode of physiological cell death. During embryonal development and morphogenesis, apoptosis may be induced by two pathways. The first is external protein signal originating from other cell--also named as "death signal". Another one is specific cell reaction for external stress factors. Blood concentration of proteins regulating both pathways of apoptosis may be useful in early diagnosis and staging of thyroid tumors. The aim of study was evaluation of p53 and sFasL blood concentration in patients with benign follicular adenoma and follicular thyroid cancer.The study population was composed of 28 patients: 14 with thyroid carcinoma and 14 patients with follicular neoplasm (NF). All patients underwent surgical treatment. P53 and sFasL levels were evaluated before surgery and related to the histopathological diagnosis obtained post-surgery.The analysis revealed high sFasL blood concentration in patients with follicular thyroid cancer in comparison with the group with follicular adenoma. There was no statistically significant difference between levels of p53 in both groups.Evaluation of sFasL serum level concentration may be useful in preoperative diagnosis of follicular thyroid tumors.

Renal insufficiency is the most common etiology of secondary hyperparathyroidism. In case of resistance for conservative treatment, methods of choice are surgical intervention or percutaneous ethanol injections.The aim of the study was to evaluate usefulness of percutaneous ethanol injection therapy in the treatment of patients with secondary hyperparathyroidism.We performed percutaneous 96% ethanol injections under USG guideance in 51 patients: 22 women (mean age 49.6 years) and 29 men (46.6 yrs). The base level of parathormone was 689.35 pg/ml. We managed to visualize one parathyroid gland in 34 patients, 2 in 12, 3 in 5 patients. The mean volume of a single gland was 0,8 cm3. All the injections were performed with the use of needle number 6. We repeated injections in case of no effects. One injection was performed in 18 patients, 2 in 18, 3 in 13, 5 in 1 and 6 in 1 patient. Before and after the treatment patients were examined with USG, scintigraphy and densitometry. Serum levels of calcium (Ca), phosphorus (P), parathormone (PTH) and alkaline phosphatase (FA) activity were also obtained. The main criteria for success was decrease in parathormone level of 50% or more in comparison with pre-injection level or to less than 200 pg/ml.In the whole group of patients after the first month, positive results were observed in 67%. There were no changes in 23%, and PTH level increased in 10%. After 6 months-positive results in 53%, no change in 35% and increase in 12%. We noted the best results in patients with PTH less than 800 pg/ml-72% of them had positive results after 1 as far as after the 6 month.Percutaneous ethanol injections are valuable method of treatment of secondary hyperparathyroidism. The best results can be obtained if PTH level is less than 800 pg/ml, one parathyroid gland dominating over the rest is visualised in USG, and if patient responds after 1 or at least 2 injections.

The purpose of this study was to investigate the clinical usefulness of the color Doppler vascularity index (CDVI) in patients with adrenal masses before surgery. Twenty-four patients with adrenal masses were examined. The correlation between CDVI and microvessel density (MVD), vascular endothelial growth factor (VEGF) level and clinico-pathological factors was studied. There was a significant correlation between CDVI and VEGF level. The CDVI did not correlate with MVD. The CDVI was significantly higher in the patients with malignant or hormonally active tumors than in patients with benign non-hyperfunctioning lesions. Thus, the CDVI may be helpful in qualifying patients for adrenalectomy.

Neoangiogenesis is a significant event in a cascade of growth and progression of solid tumors. Assessment of the tissue expression and measurement of the concentrations of angiogenic and antiangiogenic factors, contributing to this process, in body fluids, can be used not only for an early diagnosis of tumors and their staging but also as an important parameter of treatment efficiency evaluation. The aim of this study is to evaluate the concentrations of crucial angiogenic cytokine VEGF and its soluble receptors in peripheral blood of patients with benign and malignant thyroid tumors. The study comprised 35 patients with thyroid cancer and 10 patients with follicular neoplasm, both diagnosed by means of ultrasound-guided fine-needle aspiration biopsy. For these patients surgical treatment was instituted. The examined angiogenic factors were determined preoperatively and 4 weeks after the surgical procedures. The results were compared with the control group which comprised 10 healthy individuals. Analysing obtained results, we demonstrated high VEGF concentrations and low soluble VEGF receptor concentrations in patients with benign and malignant thyroid tumors. This fact confirms a vital role of VEGF in angiogenesis of thyroid tumors and a hypothetical antiangiogenic activity of its soluble receptors. Disequilibrium of the above-mentioned angiogenic factor concentrations is probably essential for the growth and progression of benign and malignant thyroid tumors.

The growth and persistence of solid tumors and their metastases is connected with angiogenesis. This process is determined by activity of pro- and antyangiogenic factors. VEGF is the one of the most important factors having a stimulant effect on angiogenesis. Soluble forms of VEGF receptors are inhibitors of angiogenesis. The soluble forms of VEGF receptors containing extra cellular part of receptor, which binds ligand, seem to be real inhibitors of VEGF.Evaluation the value of serum VEGF and soluble forms of VEGF receptors concentration as a marker of malignancy in patients with hormonal inactive adrenal tumors.Twenty seven patients (18 female, 9 male; mean age 48+/-4.3 years) with adrenocortical carcinoma (N=8), adrenal metastases (N=4) and adrenocortical adenoma (N=15) were included in this study. Age- and gender-matched control samples were acquired from healthy volunteers (N=10). Serum VEGF and sVEGFR levels were determinated by means of ELISA assay. Statistical analysis was performed using the Student-t test, the Pearson's test and the series test.In healthy controls mean VEGF level was 197.2 pg/ml, sVEGFR-1 43.5 pg/ml and sVEGFR-2 8976.3 pg/ml. Patients with adrenocortical carcinoma had the levels of VEGF (1263.8 pg/ml) significantly higher and of sVEGFR-2 (5893.7 pg/ml) significantly lower in comparison to control group (p0.05). On the other hand the mean VEGF (334.2 pg/ml) concentration in patients with benign adrenocortical adenoma wasn't significant different than in control group (p0.05) but mean sVEGFR-1 (21.7 pg/ml) and sVEGFR-2 (7106.4 pg/ml) concentrations were significantly lower than in the control (p0.05). In metastases group mean VEGF (485.9 pg/ml) level was higher and sVEGFR-2 (5455.2 pg/ml) was lower than in control group (p0.05).These data suggest that determination of VEGF and sVEGFR concentration in the serum of patients with hormonal inactive adrenal tumors may be applied as an additional marker of malignancy.

Total thyroidectomy with lymphadenectomy is the most typical operation in a case of papillary thyroid cancer. Range of lymph node resection still remains a matter of controversy. In some publications treatment of lymph node metastases doesn't affect survival, so only selective lymph node resection is the extended enough operation. The others remark that, local relapse- the worst prognostic factor, appears the most often in the lymph nodes, so they suggest more aggressive treatment. To solve that problem we try to find more sensitive methods to examine lymph nodes.To compare the results of detection lymph node metastases of papillary thyroid cancer by immunohistochemistry with the results of RT- PCR for thyroglobulin (Tg) mRNA.Each of one hundred eighty four cervical lymph nodes obtained from 24 patients, operated in our Department was divided into 2 halves: one was used for conventional histopathology and immunohistochemistry, the other part was investigated by RT- PCR for Tg mRNA. Immunohistochemical staining for Tg was performed on formalin-fixed, paraffin-embedded sections with anti-Tg antibodies.According to routine, histopathological examination 8 (33.5%) patients had involved lymph nodes. One hundred correspondence of the results of immunohistochemistry and histopathology was observed. We obtained different results of examination of the lymph nodes in 6 (25%) patients. In four patients (16.7%) RT-PCR was more sensitive in detection of positive lymph nodes, in two patients (8.3%) it revealed less metastasized lymph nodes than immunohistochemistry. The remaining 18 patients didn't have any differences, fourteen (58.3%) of them had the negative lymph nodes and four (16.7%) had positive, the same lymph nodes in all examinations. Finally, according to RT-PCR 10 (41.7%) of the patients had metastasized lymph nodes.Tg RT-PCR is a sensitive method of detection of papillary thyroid cancer cells and may help to detect the metastases of papillary thyroid cancer in regional lymph nodes.

The tetrapeptide Acetyl-Ser-Asp-Lys-Pro (AcSDKP) a physiologic inhibitor of stem-cell proliferation is also known for it’s strong angiogenic activity. It has been shown that blood levels of this peptide are increased in some hematological malignancies. However, no data on the concentration of AcSDKP present in solid tumor tissue are available. The aim of our study was to measure tissue concentration of AcSDKP in benign and malignant lesions of the thyroid gland. We assessed AcSDKP level in thyroid tissue specimens using enzyme immunoassay kit. The specimens were taken intraoperatively from 20 patients (17 women and 3 men aged 21–68 years): 10 patients with benign nodular goiter and 10 patients with papillary carcinoma of the thyroid gland. The obtained results show that tissue concentration of AcSDKP in malignant thyroid tumors is five times higher when compared to benign lessions. We conclude that AcSDKP may play a role in the development of the thyroid gland lesions. However, the further investigations concerning the tetrapeptide concentration in other thyroid malignancies, toxic nodular, and Grave’s goiter are required to conclude on the eventual use of AcSDKP as a marker of malignancy

Neoplastic angiogenesis is an essential stage of growth, progression and invasion of solid tumours. The process of basement membrane degradation and remodelling of the extracellular matrix (EMC) involves proteolytic enzymes called metalloproteinases. Among the numerous proteolytic enzymes of this group the key role is played by metalloproteinase-2 (MMP-2) and tissue inhibitor of metalloproteinase 2 (TIMP-2). Tissue expression and concentration of these compounds in body fluids have been used in early diagnostics of tumours development, assessment of tumours advancement and treatment results monitoring. The aim of the study was to evaluate the concentration of MMP-2 and TIMP-2 in blood serum of patients with benign and malignant thyroid tumours and the effect of surgical treatment on these parameters in the postoperative period as well as assessment whether to MMP-2 and TIMP-2 serum concentration in patients with thyroid cancer positively correlates with the clinical staging classification of the International Union Against Cancer (UICC).The study group consisted of 53 patients with various types of thyroid cancer and 23 patients with benign thyroid tumours, while 26 healthy adults served as controls. According to clinical staging classification of thyroid cancer the 32 patients were classified with stage I, 6 with stage II, 8 with stage III and 7 with stage IV. We have found higher mean concentration of MMP-2 in 53 patients with thyroid cancer as compared to the control group and the group of 23 patients with benign thyroid tumours. All patients were treated operatively. Additionally, a significant effect of radical surgical treatment on mean concentration of MMP-2 and TIMP-2 in patients with papillary and follicular thyroid cancer was demonstrated.MMP-2 and its tissue inhibitor TIMP-2 apparently play a significant role in the pathogenesis of thyroid cancer. Evaluation of their concentration in peripheral blood serum may be useful for the differentiation between benign and malignant thyroid tumours. Serum MMP-2 and TIMP-2 concentrations in patients with thyroid cancer did not significantly correlate with the clinical staging of thyroid cancer.

The 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. To 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. Each 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. We 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. (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.

We assessed HMGI(Y) gene expression in thyroid tumors, control thyroid tissue and in the blood of patients diagnosed with papillary and follicular thyroid cancers to try to differentiate between malignant and benign disease.HMGI(Y) gene expression was analyzed by reverse transcriptase-polymerase chain reaction (RT-PCR) in 60 cases of thyroid tumors. Among this number 11 were diagnosed as papillary carcinoma, 37 as follicular carcinoma, and 12 as follicular adenoma. All carcinoma cases selected for this study were classified according to the tumor, lymph node metastases, distant metastases (TNM) classification.HMGI(Y) gene expression was detected only in follicular carcinomas, whereas in papillary carcinomas, follicular adenomas and control tissues there was no positive reaction. In follicular carcinomas the percentage of positive cases (number of samples with presence of HMGI(Y) gene transcript) was the highest and reached approximately 84. There was no statistical dependence between the presence of HMGI(Y) gene expression and tumor size or the presence of lymph node and distant metastases. HMGI(Y) gene expression was also analyzed in whole blood taken from a selected group of patients diagnosed with papillary or follicular carcinomas. Among follicular carcinomas there were 83% of positive cases, whereas among papillary carcinomas there were only 6%.On the basis of our study, we conclude that HMGI(Y) gene expression analysis could be helpful in differentiation between follicular carcinoma and adenoma.

Tumour growth and development depend on a complex cascade of angiogenic factors. The aim of the study is evaluation of the level of growth factors VEGF and bFGF, and adhesion molecules sICAM-1, sVCAM-1 in the serum of patients with papillary thyroid cancer. The study comprised 35 patients aged 21-68 years (mean age 46+/-14) who had papillary thyroid cancer diagnosed on the basis of thin needle aspiration biopsy, and were qualified for operative treatment. This group comprised 28 women and seven men. The control group was 26 healthy individuals. Serum concentrations of bFGF, VEGF, sICAM-1, and sVCAM-1 were evaluated by the enzyme-linked immunosorbent assay (ELISA) method. We have observed significantly higher mean concentrations of bFGF, VEGF, and sICAM-1 in the serum of patients with thyroid cancer compared with the control group. There was no significant difference between the sVCAM-1 concentrations of the thyroid cancer group and the control group.

The role of adhesive molecules in the pathogenesis of adrenal gland tumours formation remains unclear. Here we present the concentrations of soluble vascular cell adhesion molecule-1 (sVCAM-1) and soluble intracellular adhesion molecule-1 (sICAM-1) in the blood of patients with adrenal "incidentaloma". We found that the mean concentrations of sVCAM and sICAM in the serum of the patients with adrenocortical cancers were significantly higher than those of the patients with benign adenomas or control cases. These results suggest that the levels of adhesion molecules may be a marker of malignancy of adrenal incidentalomas.

From 1974 to 1999, 1,001 patients were operated on for thyroid cancer, including 778 (78%) for differentiated thyroid cancer and 223 (22%) for other thyroid malignant neoplasms. Radical operations were performed in 716 (92%) patients with differentiated thyroid cancer and in 85 (38%) patients with other thyroid malignant neoplasms. After surgery, all patients underwent various methods of complementary treatment, depending on cancer type and grading (levothyroxine, 131I, radiotherapy and/or chemotherapy). These patients had no evidence of persistent disease after finishing treatment (Tg, CEA, calcitonin, scintigraphy). We observed recurrences of thyroid cancer, although macroscopic, microscopic, biochemical, and scintigraphic criteria of radicality were present. At 18 months' to 24 years' follow-up, we observed recurrences in 94 (11.7%) of 801 patients treated radically, including in 53 (7.4%) of 716 patients with differentiated thyroid cancer and in 41 (48%) of 85 patients with other thyroid malignancies. Among 37 patients with thyroid bed recurrence, 18 (48.6%) underwent radical operations and 19 (51.4%) palliative ones. Of 33 patients with regional lymph node recurrence, radical operations were performed in 26 (78.8%) and palliative ones in seven (21.2%). Of 24 patients with distant metastases, four (17%) (with single metastasis) underwent surgery (three radical operations and one palliative one). Other methods of treatment were used in the remaining patients. Occurrence of thyroid cancer recurrences in the thyroid bed and lymph nodes indicates that macroscopic, microscopic, and scintigraphic criteria of radicality are not sufficient. Recurrences after radical surgery are more infrequent in patients with differentiated thyroid cancers than in those with other thyroid malignant neoplasms. In many patients, thyroid bed and lymph node recurrences can be removed radically during surgery.