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Case Reports 2017; 37(8): 535-539 PubMed PMID: 28326748 Citation  Keywords:  Adult, Appendiceal Neoplasms:diagnosis, Carcinoid Tumor:diagnosis, Female, Follow-Up Studies, Humans, Parturition:physiology, Pregnancy, Pregnancy Complications, Neoplastic:diagnosis, Prognosis, Receptors, Somatostatin:metabolism, Treatment Outcome,.   

: Neuroendocrine neoplasms are detected very rarely in pregnant women. The following is a case report of carcinoid tumor of the appendix diagnosed in 28 year-old woman at 25th week of gestation. The woman delivered spontaneously a healthy baby at the 38th week of gestation. She did not require adjuvant therapy with somatostatin analogues. The patient remained in remission. There are not established standards of care due to the very rare incidence of carcinoid tumors in pregnancy. A review of the literature related to management and prognosis in such cases was done....

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Journal Article 2015; 36(4): 316-319 PubMed PMID: 26454486 Citation  Keywords:  Chorionic Gonadotropin:physiology, Female, Humans, Male, Pregnancy, Testicular Neoplasms:diagnosis, Trophoblastic Neoplasms:diagnosis, Uterine Neoplasms:diagnosis,.   

: Human chorionic gonadotropin (hCG) is a polypeptide hormone studied as far as 1912, but researchers has no complete knowledge concerning its biological function. Since 1970' it is known that hCG can be found not only in the urine and serum of pregnant, but in choriocarcinoma and testicular cancer patients. Up-to-date one can distinguish four subtypes of hCG differing in secondary carbohydrate chains configuration as well as it regular and glycosylated forms, but non trophoblastic sources of this hormone, such as pituitary are still not widely known. The article gives an overlook on hCG studies in order to help clinicians in taking wise, evidence based decisions in asymptomatic patients with elevated hCG....

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Case Reports 2015; 36(2): 124-126 PubMed PMID: 26071579 Citation  Keywords:  Central Nervous System Neoplasms:diagnosis, Demyelinating Diseases:diagnosis, Fatal Outcome, Female, Humans, Lymphoma, Non-Hodgkin:diagnosis, Middle Aged,.   

: We report a case of histopathologically-confirmed primary central nervous system lymphoma who was initially diagnosed as demyelinating encephalopathy. A 58-year-old woman was admitted with confusion and left hemiparesis. Head MR showed abnormal flaky hypointense T1 and hyperintense T2 signals at right thalamus, splenium of corpus callosum, bilateral cerebral peduncle, pons, medulla oblongata, basal ganglia and right corona radiata. Her mental status improved a little and she was discharged from hospital after neuroprotective treatment. 10 days after her discharge, her confusion appeared again with hallucination and unsteady walking. Pathological examination revealed non-Hodgkin's lymphoma (WHO classification: DLBCL). The patient continued to deteriorate after the surgery and died 10 days later....

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Clinical Trial 2013; 34(8): 798-801 PubMed PMID: 24522016 Citation  Keywords:  Acute Pain:diagnosis, Biopsy, Fine-Needle, Biopsy, Large-Core Needle, Female, Humans, Male, Middle Aged, Patient Acceptance of Health Care:psychology, Preoperative Care, Thyroid Neoplasms:diagnosis, Thyroid Nodule:diagnosis,.   

OBJECTIVE: A crucial problem in the non-operative diagnosis of thyroid nodules is the significant amount of non-diagnostic biopsies. This is a challenge for practicing endocrinologists especially when the results of the repeated biopsies remain non-diagnostic. The lack of a concrete preoperative diagnosis may result in unnecessary thyroidectomies in patients. Alternatively, it may also lead to the delayed diagnosis of cancer. One method of biopsy specimen acquisition that could potentially increase the diagnostic accuracy of thyroid biopsies is the application of core-needles. The aim of the study was to compare the diagnostic value and patient tolerability of core-needle aspiration biopsies (CNAB) with fine-needle aspiration biopsies (FNAB).

PATIENTS AND METHODS: The study included patients with thyroid nodular goiter in whom previous conventional FNAB yielded non-diagnostic results. CNABs were performed using 22G core-needles. The control group consisted of patients undergoing conventional FNAB with 25G fine-needles. Pain during core-needle biopsies of thyroid nodules was assessed using the 10-point visual analog scale.

RESULTS: There were a total of 30 lesions in 26 patients undergoing CNAB (22 women, 4 men, mean age 48.3) and a total of 59 lesions in 40 patients undergoing FNAB (34 women, 6 men, mean age 57.3). 56.6% of CNABs and 50.8% of FNABs were diagnostic (p=0.60). When assessing pain via the visual analog scale, the median score for biopsies performed with core-needles was four. 60.0% of patients considered the pain of core-needle aspiration biopsies to be similar to the pain experienced during the previous conventional fine-needle aspiration biopsies, while 40% of patients claimed that the pain was more intense.

CONCLUSIONS: CNAB did not prove to be superior to FNAB. Despite the larger needle gauge used during core-needle biopsies, the patients' tolerability was comparable to conventional fine-needle biopsies....

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Case Reports 2013; 34(7): 610-614 PubMed PMID: 24464010 Citation  Keywords:  Adenoma:diagnosis, Adult, Diagnosis, Differential, Female, Giant Cell Tumors:diagnosis, Humans, Hyperparathyroidism:complications, Occipital Bone:pathology, Osteitis Fibrosa Cystica:diagnosis, Parathyroid Neoplasms:diagnosis, Parietal Bone:pathology, Skul.   

: Brown tumors are rare skeletal manifestations of hyperparathyroidism (HPT) that may mimic cancer metastases. Histopathologically, they are difficult to differentiate from other giant cell lesions. A case is presented of 41-year-old woman with giant cell tumor in parieto-occipital region with injury of external bone lamina, growing into the skull cavity. The mass was suspected of being neoplastic. Numerous osteolytic lesions in the skull skeleton and multifocal bone injuries were observed, also. Elevation in calcium (5.91 mEq/L) and parathormone (1188 ng/mL) concentrations and hypercalciuria (52 mEq/24 h) suggested the diagnosis of HPT initially manifesting as a brown tumor of the skull. Further exploration confirmed the existence of parathyroid adenoma as a cause of the disease. The key treatment for the condition was surgical excision of the adenoma followed by the normalization of parathyroid function and significant reduction in size of skull tumor and other lesions....

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Case Reports 2013; 34(7): 606-609 PubMed PMID: 24464009 Citation  Keywords:  Adult, Aged, Carcinoma:diagnosis, Carcinoma, Adenoid Cystic:diagnosis, Diagnosis, Differential, Female, Goiter:diagnosis, Humans, Neck:pathology, Neurilemmoma:diagnosis, Thyroid Gland:pathology, Thyroid Neoplasms:diagnosis,.   

OBJECTIVE: Neck nodular lesions may derive from several different tissues, often mimicking thyroid tumor in the preoperative examination.

METHODS: We described three patients admitted in 2012 to the Department of Endocrine Surgery in Wrocław with nodular lesion in the neck area mimicking tumor of the thyroid gland.

RESULTS: In the first patient with a tumor in projection on the isthmus and the left thyroid lobe, neurilemmoma was discovered in the histopathological exams. In the second one with the suspicion of papillary thyroid carcinoma, adenoid cyst carcinoma was identified in the pathological examination. In the third case, suspected to being a recurrent or split goiter, non-specific, chronic lymphonodulitis was recognized in the final histology.

CONCLUSIONS: Appropriate and careful diagnostics of a nodular lesion in the neck before surgery has crucial significance for choosing optimal method of surgical treatment which has great influence on mortality rate and reducing complications....

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Journal Article 2013; 34(6): 539-542 PubMed PMID: 24378457 Citation  Keywords:  Adult, Aged, Aged, 80 and over, Choroid Neoplasms:diagnosis, Diagnosis, Differential, Female, Follow-Up Studies, Humans, Male, Melanoma:diagnosis, Middle Aged, Nevus, Pigmented:diagnosis, Optic Disk:pathology, Retinal Pigment Epithelium:pathology, Tomogra.   

OBJECTIVE: To assess the utility of the optical coherence tomography (OCT) in diagnosing, differentiating and monitoring of choroidal nevi situated in the posterior pole and optic disc area.

MATERIAL AND METHOD: 116 consecutive patients (65 women, 51 men) aged 27-95 years, with choroidal nevus were included to the research. Routine ophthalmoscopic evaluation and OCT using the Zeiss Stratus OCT as well as fundus photography were performed in each patient. The OCT was used to assess the structure of the retina overlying the choroidal nevus, the retinal pigment epithelium (RPE) - choriocapillaris complex, as well as the anterior portion of the choroidal lesion. In 31 patients due to suspected malignant melanoma fluorescein angiography and ultrasound were additionally performed. Follow-up OCT was done after 12 months in 51 out of 85 patients with characteristics of choroidal nevi, and after 6 and 12 months in 27 patients with "suspicious" lesion.

RESULTS: The basal dimension of the lesion ranged from 0.5 mm to 12 mm (mean 2.75mm), mean thickness was 1.25 mm. The pigmented lesion did not affect visual acuity. In 85 patients the lesion was flat or slightly elevated, without secondary changes in the retina. In 31 patients additional changes in the retina were observed - most frequently subretinal fluid. Two patients were eventually diagnosed with malignant melanoma. The follow-up OCT did not show progression in neither patients without secondary changes nor those with risk factors of malignancy.

CONCLUSION: Optical coherence tomography enables detailed evaluation of the retina overlying the pigmented lesion. Secondary changes in the retina need additional exams and strict observation. OCT could be an additional tool in the evaluation of treatment of malignant melanoma....

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Journal Article 2013; 34(3): 207-211 PubMed PMID: 23685418 Citation  Keywords:  Adult, Cohort Studies, Female, Follow-Up Studies, Galactorrhea:diagnosis, Humans, Hyperprolactinemia:diagnosis, Middle Aged, Pituitary Gland, Anterior:physiology, Pituitary Neoplasms:diagnosis, Pregnancy, Pregnancy Outcome, Prolactin:blood, Prolactinoma:d.   

OBJECTIVES: To determine the frequency of macroprolactinemia in a cohort of hyperprolactinemic women, describing 1) the association of macroprolactinemia with clinical variables and morphological changes in the pituitary gland and 2) clinical status and prolactin levels after 10 years of follow-up.

DESIGN: Blood samples were obtained from 32 patients for hormonal assessment. Treatment with cabergoline or bromocriptine was interrupted 3 months before the determination of serum prolactin and macroprolactin. Macroprolactin was measured using the polyethylene glycol (PEG) precipitation method. Computed tomography was performed in all patients.

RESULTS: The frequency of macroprolactinemia was 28.1%. In 19 patients prolactin remained elevated (persistent hyperprolactinemia). In 13, prolactin returned to normal (former hyperprolactinemia). Nine patients with PEG recovery between 40 and 50%, and the only two macroprolactinemic patients with previous hyperprolactinemia were excluded from the analysis of clinical outcomes. Only one of seven macroprolactinemic patients had an abnormal pituitary image (empty sella). None had galactorrhea.

MAIN FINDINGS: Classic symptoms of hyperprolactinemia and abnormal imaging findings are not common in patients in whom macroprolactin is the predominant form of PRL.

CONCLUSIONS: Women with hyperprolactinemia, especially if asymptomatic, should be routinely screened for macroprolactinemia. Macroprolactinemia remains stable in the long term....

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