The authors have studied in detail human leukocyte antigen (HLA) association in 87 Hungarian patients with thyroid epithelial carcinoma. The authors also examined in a small group of patients, five parameters of cell-mediated immunity and related them to HLA as well as to lymphocytic infiltration of the tumor/normal tissue interface. HLA-DR1 was significantly associated with thyroid carcinoma; the strongest association was in patients with follicular histologic features and DR1 homozygotes were not at greater risk for thyroid cancer. The HLA-DR3 was nonsignificantly increased in patients with papillary or mixed histologic features. The HLA-DR1, 3 heterozygotes were highly associated with follicular carcinoma, carried no risk for papillary carcinoma, and an intermediate risk for tumors with mixed histologic features. Because of the small proportion of DR1, 3 heterozygotes in the follicular and mixed histologic group, its predictive value at the population level was low. Better predictive potential was shown for the phenotype DR1 and/or DR3. Neither metastatic disease nor age at diagnosis (less than 45 years) could be related to HLA phenotypes. Patients in all histologic variants showed some measure of cell-mediated immunity compared to controls. Patients with papillary carcinoma showed an overall better response than those with tumors with follicular or mixed histology. The HLA-DR could not be related to cell-mediated immune response. Patients with papillary carcinoma with a good cell-mediated immune response occurred with much lower infiltration of the tumor boundary with lymphocyte whereas the follicular carcinoma less cell-mediated immunity was associated with dense lymphocytic infiltration, suggesting the biological relevance of lymphocytic infiltration may be different for the two histologic variants.
Central nervous system involvement is a rare complication of multiple myeloma with extremely poor prognosis as it usually fails to respond to therapy. We present 13 cases diagnosed at two centers in Budapest and review the current literature. The majority of our cases presented with high-risk features initially; two had plasma cell leukemia. Repeated genetic tests showed clonal evolution in 3 cases. Treatments varied according to the era, and efficacy was poor as generally reported in the literature. Only one patient is currently alive, with 3-month follow-up, and the patient responded to daratumumab-based treatment. Recent case reports show promising effectivity of pomalidomide and marizomib.
Introduction: We retrospectively reviewed the data of patients with papillary thyroid cancer who were node positive and treated at our department between 1955 and 1994. Of 362 cases of papillary cancer, 134 were identified with lymph-node metastases (37%). Methods: Two types of dissection procedures were applied by a large community of surgeons. When only the cervical central lymph nodes were involved, the procedure of choice was thyroidectomy, with local lymph-node excision (LD); if the lateral nodes were also affected, modified radical neck dissection (MRND) was applied. Results: Of 88 patients considered to have minimal involvement, 70 underwent procedures of a lesser magnitude than MRND. Most of the operations were localised "picking procedures". Recurrence of the disease developed in 16 cases, twice in 8 of these. The new tumourous lymph node was found to be ipsilateral in every case and close to the place of the first operation. The rate of recurrence was 23%. In the same group, 18 MRNDs were performed, with ipsilateral lymph-node recurrence in six cases. In 41 patients undergoing surgery for extended lymph-node metastases, conservative excisions were carried out in 17 and MRND in 24 cases, including six bilateral dissections. In this group, late recurrence was 47%. Conclusion: The results of the follow-up of 30 childhood and juvenile patients with papillary thyroid carcinoma is very interesting; all of our young patients are alive.
Severe abdominal pain and vomiting are common symptoms in children with pediatric multisystem inflammatory syndrome (PIMS). Mesenteric lymphadenitis and aseptic peritonitis are predominantly reported in cases where acute surgical abdomen was suspected and laparotomy was performed at the early stage of the pandemic. These reports generally discouraged surgeons to perform exploration in COVID-19-related cases and medical management was prioritized. Only a few COVID-19-specific surgical cases with intestinal ischemia were published. Here, we report another case of COVID-19-related intestinal ischemia complicated with Meckel's diverticulitis in a non-immunocompromised child who clearly required surgical intervention. In our case, the combination of COVID-19-related vasculitis and low blood pressure episodes may have contributed to this severe outcome.
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