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ABSTRACT Objective To determine whether the size of thyroid nodules in ACR-TIRADS ultrasound categories 3 and 4 is correlated with the Bethesda cytopathology classification. Methods Thyroid nodules (566) subclassified as ACR-TIRADS 3 or 4 were divided into three size categories according to American Thyroid Association guidelines. The frequency of different Bethesda categories in each size range within ACR-TIRADS 3 and 4 classifications was analyzed. Results Most nodules in both ACR-TIRADS classifications fell in the Bethesda 2 category, regardless of size (90.8% and 68.6%, ACR-TIRADS 3 and 4 respectively). The prevalence of Bethesda 6 nodules in the ACR-TIRADS 4 group was 14 times higher than in the ACR-TIRADS 3 group. There were no significant differences between nodule size and fine needle aspiration biopsy classification in any of the ACR-TIRADS categories. Conclusion Size does not appear to be an important criterion for indication of fine needle aspiration biopsy in thyroid nodules with a high suspicion of malignancy on ultrasound examination.
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The patho-mechanism of changes in the thyroid gland, including carcinogenesis, is a complex process, which involves oxidative stress. The goal of our investigation was to verify the extent of stress in the thyroid gland related to glycation. The study samples were comprised of blood sera, thyroid, and adipose tissue sections probed from 37 patients diagnosed with thyroid cancers and goiter. Using immuno-enzymatic and fluorometric assays we analyzed the content of advanced glycation end-products (AGEs), pentosidine, receptors for advanced glycation end-products (RAGE), scavenger receptor class (SR)-A, SR-B, glutathione, malondialdehyde and nitric oxide synthase. In addition to classic AGEs, a recent study detected the melibiose-derived glycation (MAGE) product. We demonstrated the presence of AGEs, MAGE and their receptors of the RAGE and SR-A. In addition, in the control samples of thyroid glands SR-B groups were detected as well as of pathological groups without noticeable tendency to antigen concentration in the area of carcinogenesis. Fluorescent AGEs correlate positively with glutathione, which supports the assumption that glycation stress leads to augmentation of oxidative stress and increase of the intensity of antioxidant mechanisms.
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Productos Finales de Glicación Avanzada/metabolismo , Estrés Oxidativo , Enfermedades de la Tiroides/metabolismo , Glándula Tiroides/metabolismo , Adulto , Anciano , Femenino , Humanos , Masculino , Melibiosa/metabolismo , Persona de Mediana Edad , Óxido Nítrico Sintasa/metabolismo , Receptor para Productos Finales de Glicación Avanzada/metabolismo , Enfermedades de la Tiroides/patología , Glándula Tiroides/patologíaRESUMEN
RESUMEN Fundamento: la tiroides es donde con más frecuencia se originan enfermedades tumorales de naturaleza endocrina maligna. A este antecedente se suman las múltiples variantes histológicas que posee la enfermedad, que en ocasiones son motivo de importantes dudas diagnósticas. Por esta razón, se desarrollan estudios en los que cada vez más se añaden procedimientos morfométricos. Se reconoce que el éxito de un tratamiento individualizado depende de un diagnóstico preciso, donde la morfometría, al descartar la subjetividad en el diagnóstico se convierte en una herramienta de mucho valor. Objetivo: caracterización morfométrica del carcinoma papilar de tiroides diagnosticado por biopsias escisionales. Métodos: se realizó un estudio morfométrico de serie de casos en 12 pacientes con este diagnóstico histopatológico, atendidos en el Hospital Provincial Universitario Vladimir Ilich Lenin. Se seleccionaron 340 campos y se midieron 10 465 núcleos celulares, lo que constituyó la muestra. Se caracterizaron indicadores morfométricos nucleares del carcinoma papilar de tiroides como el área, el volumen y el factor de forma. Resultados: el área y volumen nuclear mostraron valores aumentados comparados con los valores de enfermedades nodulares benignas de otros estudios. El valor del factor de forma nuclear se acercó a uno por lo que los núcleos tienden a ser redondos y se pudo observar que a mayores valores del área nuclear mayores valores del factor de forma nuclear. Conclusiones: se caracterizaron indicadores morfométricos del carcinoma papilar de tiroides en los casos estudiados como el área, el volumen y el factor de forma que contribuyen a su diagnóstico histopatológico.
ABSTRACT Background: thyroid is where malignant endocrine tumor diseases originate more frequently. This entity possesses multiple histological variants added to this antecedent, which are usually the cause of important diagnostic doubts. For this reason, studies in which more and more morphometric procedures are added have been developed. The success of an individualized treatment depends on an accurate diagnosis, in which morphometry is recognized by ruling out subjectivity in diagnosis, becomes a valuable tool. Objective: morphometric characterization of papillary thyroid carcinoma diagnosed by excisional biopsies. Morphometric. Methods: a morphometric study of a series of cases was carried out with 12 patients with this histopathological diagnosis, attended at the Vladimir Ilich Lenin University Provincial Hospital. 340 fields were selected and 10 465 cell nuclei were measured, which was our sample. Nuclear morphometric indicators were characterized, such as area, volume and shape factor. Results: nuclear area and volume showed increased values compared to benign nodular disease values from other studies. The value of the nuclear form factor approached one, so the nuclei tend to be round and it was observed that the higher the values of the nuclear area, the higher the values of the nuclear form factor. Conclusions: morphometric indicators of papillary thyroid carcinoma were characterized in the studied cases that may contribute to histopathological diagnosis.
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Peculiarities of physical development disorders in 334 children were examined in the course of comparative clinical-laboratory research; all these children consumed drinking water with various nitrates content (11.2±1.1 mg/l and up to 3.14 MPC, i.e. 141 mg/l), in a dose equal up to 9.0 mg/kg of body weight (RfD 1.6 mg/kg). A focus group consisted of 158 children aged from 3 to 10, a control group was made up of 176 children of the same age. Nitrates content in urine taken from children of focus group (49.22±11.69 mg/l) was 2.4 fold higher than the same parameter in control group (20.2±3.13 mg/l, Ñ=0,001). Under exposure to nitrates consumed with drinking water endocrine system diseases were detected 1.7-2.1 fold more frequently, and physical development disorders, 2.5-4.3 fold more frequently, than in control group (Ñ=0.02-0.05). We detected authentic correlation between nitrate excretion with urine and deviations in physical development in children consuming drinking water with nitrogenous compounds content which was higher than MPC; such deviations were ICD: Ð44-Ð46 - mild protein-energy malnutrition, Ð34.4 - excessive height, Ð67.8-Ð66.0 - excessive nutrition, ÐR=2.35, DI=1.22-4.53). Explained variance fraction amounted to 42-75% (R2=0.42-0.75; 64.9≤F≤162.3, Ñ=0.001). Changes in thyroid gland volume were detected 2.4 fold more frequently, and changes in its structure 2.5 fold more frequently, in focus group than in control group (Ñ=0.049). We determined statistically significant correlation between thyroidal disorders and nitrate content in urine (ÐR=3.52; DI=1.73-7,0), with factor contribution level reaching 52% (R2=0.52; F=173.3; Ñ=0.001). We detected that 34% of children from focus group had thyrotrophic hormone level 1.2 fold higher than physiological standard and the same parameter in control group (Ñ=0.02). And also free thyroxin level was near age physiological standard in 23.4% of examined children which was 1.2 fold lower than in control group (p=0.05). The research revealed that methemoglobinemia with tissue respiration abnormalities and disorders in liver enzyme system functioning followed by protein-energy malnutrition (ICD: E44.1-E46), were the most relevant for younger children (under 6 years) and children suffering from functional gastrointestinal pathologies. As for older children (6-10 years) we observed mostly disorders in neuroendocrine regulation, thyroid gland, and antioxidant protection, in them together with somatic development potentiation and growth in weight-height parameters (ICD: Ð66.0-Ð67.8). It has been established that reduced thyroid supply, disorder of tissue respiration and antioxidant balance, and dysregulation of hypophysial-adrenal homeostasis section provide the basis for the formation of disturbances in physical development and endocrine pathology in children being under oral exposure to nitrates.
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JUSTIFICATIVA E OBJETIVO: O Câncer de tiróide é a neoplasia endócrina maligna mais frequente com incidência de 1% no Brasil. Os carcinomas diferenciados da tireóide (CDT) - papilífero e folicular- são responsáveis por 90% das neoplasias tireoidianas, com elevado percentual de curas, porém em 7 a 20% dos pacientes, evolui com metástases e recorrências precoces. O objetivo deste estudo foi avaliar os marcadores moleculares que auxiliam no prognóstico e tratamento mais adequado do CDT e as novas perspectivas terapêuticas. CONTEÚDO: Inúmeros estudos vem buscando identificar marcadores prognósticos, que possam dividir os pacientes de baixo e alto risco e assim determinar uma forma de tratamento mais adequada nos casos resistentes ao tratamento convencional. Alguns marcadores moleculares tem sido estudados e relacionados ao CDT, como o NIS, RAS, BRAF, RET/PTC, PAX8/PPARY, p53, NRTK1, Galectina-3 e ciclo-oxigenase-2. Novas drogas estão em estudo em base aos marcadores moleculares, como o sorafenib, zactima, ácido retinóico, inibidores da ciclo-oxigenase-2, troglitazona, dentre outros, com resultados animadores. CONCLUSÃO: A medida que se conhece a patogêse molecular das neoplasias tiroideanas, novos drogas estão sendo estudadas e testadas in vitro e in vivo e avaliados em ensaios clínicos com resultados bastantes promissores para o CDT, principalmente o carcinoma papilífero da tireóide (CPT)...
BACKGROUND AND OBJECTIVE: Thyroid cancer is the most common malignantendocrine neoplasm, with an incidence of 1% in Brazil. Differentiated thyroidcarcinoma (DTC) - papillary and follicular - are responsible for 90% of thyroid cancers with high cure rates, but in 7-20% of patients with metastasis and recurrence develops early. The aim of this study was to evaluate the molecular markers that aid in prognosis and most appropriate treatment of DTC and the new therapeutic perspectives.CONTENTS: Numerous studies has sought to identify prognostic markers that can stratify patients with low or high risk and thus determine a more appropriate form of treatment in cases resistant to conventional treatment. Some molecular markers have been studied and related to CDT, such as NIS, RAS, BRAF, RET / PTC, PAX8/PPARY, p53, NRTK1, Galectin-3 and Cyclooxygenase-2. New drugs are being studied based on the molecular markers, such as sorafenib, zactima, retinoic acid, inhibitors of cyclooxygenase-2, troglitazone, among others, with encouraging results.CONCLUSION: As we know the molecular pathogenesis of thyroid cancer, new drugs are being studied and tested in vitro and in vivo and evaluated in clinical trials with very promising results for the CDT, mainly papillary thyroid carcinoma (PTC)...