Along with classic papillary thyroid cancer, there are rare histological variants with special clinical features, and often physicians are not well informed about them. We present a clinical case of 25 years-old female, who was diagnosed with papillary thyroid cancer based on neck ultrasound and fine needle aspiration biopsy followed by thyroidectomy. The histological and immunohistochemical investigation (expression of cytokeratin-19, CD 56, thyroglobulin, β-catenin) were performed and cribriform-morular carcinoma was identified. It’s believed that this type of papillary thyroid cancer in the majority of cases is associated with familial adenomatous polyposis of the colon. This disease with an autosomal dominant type of inheritance is caused by the mutation of the APC suppressor gene and characterized by the presence of multiple adenomatous polyps in the colon with a 100% risk of malignancy and colon cancer. The patient underwent an additional examination with colonoscopy which revealed polyps in all parts of the colon ranging in size from 1 mm to 3.5 cm. We identified mutation in gene APC — p.S1104X and performed a preventive coloproctectomy. The histological examination verified tubular and tubulovillous adenomas with moderate epithelial dysplasia. During 6 years of follow-up of patient, structural and biochemical remission of thyroid cancer was observed.
Работа выполнена в соответствии с плановой НИР отделения хирургической эндокринологии ГБУЗ МО «Московский областной научно-исследовательский институт им. М. Ф. Владимирского» «Разработка инновационных технологий в диагностике, лечении, реабилитации и мониторинге пациентов с эндокринными опухолями», тема № 38 в разделе «Онкология». Учреждением, финансирующим исследование, является Министерство Здравоохранения Московской области. Авторы гарантируют ответственность за объективность представленной информации. Авторы гарантируют отсутствие конфликта интересов и собственной финансовой заинтересованности. Рукопись поступила в редакцию 05.03.2018.
In the lecture on the basis of literature data and the results of our research deals with the basic aspects of insufficiently studied problems of metastatic adrenal tumors. Special attention is drawn to the modern algorithm of examination of these patients, the surgical treatment strategy and evaluation of long-term results. For the period from 1997 to 2016 in the surgical clinics of MONIKI operated on 56 patients with metastatic adrenal tumors (MAT). 22 MAT were synchronous, 36 — metachronous. From the 46 produced a «potentially radical» adrenalectomy with tumor (40 unilateral, 6 bilateral), 6 — partial removal of the MAT, in 4 open biopsy. 46 radically operated patients survival rates were analyzed in 37, the average follow-up period was 36.5 months. Overall and disease-free 5-year survival rate of patients with MAT was 46.8 % and 27.6 %, respectively. The most favorable results of surgical treatment of patients with isolated metastases of clear cell kidney cancer in the adrenal glands. Unilateral adrenalectomy is indicated for patients with solitary synchronous and metachronous tumors, total adrenalectomy — bilateral with isolated neoplastic lesions of the adrenal glands.
Relevance of research: аdrenalectomy remains the only method of potentially radical treatment of adrenocortical carcinoma (AСС), and the complete resection is considered one of the leading factors in the prognosis of disease. The question of the possibility and feasibility of using video- endoscopic technologies in the treatment of patients with ACC is still being discussed. Objective: the purpose of our study was to evaluate the effectiveness of laparoscopic adrenalectomy in the treatment of ACC patients. Material and methods: the study is based on the analysis of the results of diagnostics and surgical treatment of 12 patients who underwent laparoscopic adrenalectomy and verified ACC during histological and immunohistochemical studies. Results: stage I were verified (according to the ENSAT) in 4 cases, in 4 - II stage, and in 4 - III stage. The median of tumor size was 4.9 cm. Intraoperative and postoperative complications did not occur. In all cases, the R0-resection was confirmed by morphological examination. The median patient follow-up was 71 months (1; 141), during this period 11 patients were alive, 1 patient, who had surgery in stage III died of disease progression (distant metastases) 49 months after surgery. During the follow-up period tumor recurrence did not occur. Overall 5-year survival was 75% (95% CI; 30-95%). Conclusion: despite the small number of patients included in this study, satisfactory immediate results (absence of complications, R0-resection) and long-term results allow us to consider video- endoscopic surgery as an effective treatment for patients with ACC.
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