Metastases in the thyroid gland are very rare. Even the rarer are sarcoma metastases. A 52-year-old woman was referred to our department for evaluation of a nodule in the right lobe of the thyroid gland. She had a history dermatosarcoma of the abdominal wall with known metastasis in the lung. Clinically she had neck pain and worsened swallowing. Objective assessment (ultrasound, computed tomography, and magnetic resonance) indicated a voluminous right lobe nodule with mechanical syndrome, and a fine-needle aspiration biopsy revealed a very suspicious malignant finding. After surgery, the diagnosis was metastasis of dermatofibrosarcoma protuberans. Subsequent treatment was radio- and chemotherapy.
Infarkt myokardu srdeční síně je jednotkou známou již několik desetiletí, přesto je v klinické praxi často přehlížen. Izolovaný infarkt srdeční síně je vzácný, obvykle se vyskytuje současně s infarktem komorového myokardu. Mezi hlavní komplikace infarktu síňového myokardu řadíme poruchy srdečního rytmu, tromboembolizaci a rupturu srdeční síně. Představujeme kasuistiku 84letého muže se subakutním infarktem myokardu s elevacemi úseku ST (STEMI) inferolaterálně a současným infarktem myokardu levé síně komplikovaným rupturou levé síně.
Introduction: Currently, there is a lack of reliable markers useable in diagnosis and/or management of the pancreatic ductal adenocarcinoma (PDAC). Although detection of KRAS point mutations for the differential diagnosis and determination of miR-21 expression for diagnostic and prognostic purposes have been widely investigated with promising results, neither KRAS nor miR-21 testing have become routine in clinical practice so far. One of the reasons is that analysis of KRAS mutations and miRNA expression is mainly performed on resected pancreatic tissue the use of which is relevant only for a minority of PDAC patients undergoing of surgical treatment.
The present study describes development of a reliable methodology for analysis of KRAS mutations and miR-21 expression from samples acquired by endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB), applicable to all PDAC patients. Consequently, the success rates and clinical validity of KRAS mutation and miR-21 expression analysis in two common types of EUS-FNB samples, i.e. native aspirates and cytology specimens are compared.
Experimental: The study included 118 patients with a confirmed diagnosis of pancreatic ductal adenocarcinoma (PDAC). Each patient underwent EUS-FNB and the sample was divided into two parts, one part was stored in a stabilizing solution as native aspirate and the rest was processed into the cytology specimen. DNA/RNA was extracted and then analyzed for KRAS mutations and miR-21 expression. For both sample types, the yields of DNA/RNA and success rates for KRAS and miR-21 testing were compared along with evaluation of mutant cell fractions. Finally, confirmation of miR-21 prognostic role was tested by Kaplan-Meier analysis.
Data Summary: The overall amount of isolated DNA/RNA from native aspirates was significantly lower compared to the cytology specimens (147 ng vs. 642 ng for DNA, 10 ng vs 164 ng for RNA). The success rates for subsequent KRAS and miR-21 analysis was 100% for both sample types. The KRAS-mutant detection rates in native aspirates were 12% lower than in cytology specimens (78% vs. 90%). The average fraction of KRAS-mutant cells was lower in native aspirates (31%) compared to the cytology specimens (56%). The prognostic role of miR-21 in native aspirates did not reach statistical significance (p = 0.06), but was confirmed in cytology specimens (p = 0.02).
Conclusions: Although both types of EUS-FNB samples are suitable for DNA/RNA extraction and subsequent DNA mutation and miRNA expression analysis, reliable results with clinical validity were only obtained for cytological specimens. Native aspirates exhibit a low and undefined fraction of tumor cells leading to false interpretation of molecular testing results. EUS-FNB samples in the form of cytology specimens are a perspective source for the study of molecular markers in virtually all PDAC patients, including patients in inoperable stages.
Supported by Internal Grant Agency of the Czech Ministry of Health (IGA) grant No. NT 13638
Citation Format: Lucie Benesova, Tereza Halkova, Bohus Bunganic, Barbora Belsanova, Eva Traboulsi, Miroslav Zavoral, Marek Minarik.{Authors}. Molecular cancer testing of KRAS and miR-21 from EUS-guided biopsies of pancreatic tissue: Utility of aspirates vs. cytology. [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer: Advances in Science and Clinical Care; 2016 May 12-15; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2016;76(24 Suppl):Abstract nr B18.
Introduction: Parathyroid cancer is a rare endocrine malignancy. These tumors are typically functional, causing severe hypercalcemia due to primary hyperparathyroidism. Nonfunctional parathyroid cancer with normal serum calcium and parathyroid hormone levels is extremely rare. The disease is usually indolent but progressive with a tendency to metastasize. It is very difficult to diagnose this malignancy. The definitive diagnosis is made by histopathological examination. Radical surgery with ipsilateral lobectomy and en bloc neck dissection is considered to be the most appropriate therapeutic approach. There is no evidence of efficiency of adjuvant cancer therapy and its indication has not been defined. Disease recurrence is common.
Case report: We report the case of a 26-year-old female patient who underwent left hemithyroidectomy for growth progression of a hypoechoic lesion behind the left thyroid lobe detected by ultrasonography. Preoperative cytology and imaging assessments were not suspicious for malignancy. Serum parathyroid hormone and calcium levels were normal. The diagnosis of nonfunctional parathyroid carcinoma was determined based on histopathological examination. No further surgery or adjuvant therapy was indicated. No signs of recurrence or generalization have been observed at 36 months after the surgery.
Conclusion: Nonfunctional parathyroid cancer is extremely rare. In many cases, the diagnosis is made in advanced stages of the disease. No formal classification or treatment protocol has been established so far. A new staging system has been proposed in the 8th edition of AJCC/UICC. Early detection, radical surgery and close follow-up are crucial aspects to affect the mortality and morbidity of patients with this type of malignancy.
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