Case presentation of the smallest non-functional parathyroid carcinoma and review of the literature

INTRODUCTION

Non functional parathyroid carcinoma (PC) is one of the rarest malignant neoplasms. Due to the lack of symptoms and laboratory findings, it is mostly diagnosed in late AQ2 stages, when local invasion and dissemination are already present. However, our case is an exception, because it was detected in early stage, with no local invasion present. We present a case of the smallest non-functional PC yet reported and review of the literature.

CASE PRESENTATION

A 47-year-old woman was admitted to outpatient Clinic where fine-needle aspiration biopsy (FNAB) of bilateral thyroid nodules (slide 1) and central neck mass (slide 2), which was suspected to be an enlarged lymphatic nodule or parathyroid gland was performed. Results came back as Bethesda I-colloid (slide 1), and Bethesda IV (slide 2), stating that it is hard to distinguish thyroid gland oxyphil lesions from parathyroid cells. Total thyroidectomy was performed as well as excision of the left central neck mass, without any involvement of surrounding structures. Pathological examination revealed bilateral thyroid follicular nodular disease, papillary microcarcinoma, and parathyroid carcinoma with vascular and capsular invasion, measuring 10 × 8 × 7 mm. The immunohistochemical profile included positive PTH, Chromogranin A, and negative TTF1.

CONCLUSION

Non-functional PC is usually diagnosed in advanced stages, already involving adjacent structures; however, this case presents a rare example. It is important not to exclude PC as a differential diagnosis in the absence of elevated Ca and PTH serum levels. Follow-up will be difficult, since there are no prognostic parameters to rely on.

Neuronal coordination of motile cilia in locomotion and feeding

Efficient ciliary locomotion and transport require the coordination of motile cilia. Short-range coordination of ciliary beats can occur by biophysical mechanisms. Long-range coordination across large or disjointed ciliated fields often requires nervous system control and innervation of ciliated cells by ciliomotor neurons. The neuronal control of cilia is best understood in invertebrate ciliated microswimmers, but similar mechanisms may operate in the vertebrate body. Here, we review how the study of aquatic invertebrates contributed to our understanding of the neuronal control of cilia. We summarize the anatomy of ciliomotor systems and the physiological mechanisms that can alter ciliary activity. We also discuss the most well-characterized ciliomotor system, that of the larval annelid Platynereis. Here, pacemaker neurons drive the rhythmic activation of cholinergic and serotonergic ciliomotor neurons to induce ciliary arrests and beating. The Platynereis ciliomotor neurons form a distinct part of the larval nervous system. Similar ciliomotor systems likely operate in other ciliated larvae, such as mollusc veligers. We discuss the possible ancestry and conservation of ciliomotor circuits and highlight how comparative experimental approaches could contribute to a better understanding of the evolution and function of ciliary systems.

This article is part of the Theo Murphy meeting issue ‘Unity and diversity of cilia in locomotion and transport’.

Extranodal marginal zone B-cell lymphoma most probably of MALT type appearing in CNS as parasagittal extracerebral tumor

A 63 years old male patient with systemic extranodal marginal zone lymphoma, most probably originating from mucosa associated lymphoid tissue (MALT) involving central nervous system (CNS) is presented. The usual site of origin of this type of lymphoma was not identified. The diagnosis was stated after neurosurgery according to histopathology, immunohistochemistry and additional haematologic examination. Postoperative therapy included local irradiation (30Gy) of rest tumor, combined by Rituximab-CHOP (R-CHOP) protocol, which resulted in complete remission lasting three years up to now.

The changes of serum immunoglobulins in patients treated by a combination of anti-CD20 monoclonal antibody rituximab plus chlorambucil for low-grade non- Hodgkin's lymphoma

PURPOSE

To assess whether the therapeutic application of monoclonal anti-CD20 antibody (rituximab) may affect normal B lymphocyte function, since CD20 is involved in their activation, proliferation and differentiation.

PATIENTS AND METHODS

Serum immunoglobulins (Igs) concentrations and their possible relation to pretreatment levels of Igs and B-cells ratio as well as the T/B cell ratio were investigated in 9 patients with low-grade non Hodgkin's lymphoma (NHL) during the administration of rituximab (Mabthera(R)) and chlorambucil combination therapy. Serum Igs concentrations were determined by the radial immunodiffusion (RID) method and the number of B and T lymphocytes by flow cytometry analysis.

RESULTS

The altered values of Igs concentration and B cell number were registered in each patient before therapy. Generally, the therapy did not normalize the pretreatment alterations of these parameters, though it depleted malignant clones from peripheral blood. Nevertheless, IgM and IgA concentrations have been considerably changed from baseline level (35-74%) in 5 patients. The concentration of IgA and IgM raised in 4, while the IgM declined from baseline values in 1 patient, irrespective of their therapeutic response. Four of these patients had a normal concentration of these Igs classes, and a profound B cell number alteration before therapy.

CONCLUSION

The changes of IgM and IgA concentrations in relation to pretreatment B cell number, although found in a small number of patients, might deserve further investigation with an aim to study any interference of the anti-CD20-based therapy with lymphocytes function.

The absence of correlation between immunoregulatory T cells and induced lymphoproliferative response in treated B-chronic lymphocytic leukemia patients

BACKGROUND

Many data suggest T cell functional impairment in B-cell chronic lymphocytic leukemia (B-CLL). The mechanism responsible for this phenomenon is still unresolved.

METHODS

In 88 B-CLL patients (RAI II-IV) the relationship between immunoregulatory T cells and PHA induced lymphoproliferative response (LPR) was analysed before and after the therapy. The number of peripheral blood CD3+, CD4+ and CD8+ T lymphocytes was determined by indirect immunofluorescence assay using monoclonal antibodies. LPR was estimated in whole blood culture method.

RESULTS

The absolute number of CD3+, CD4+ and CD8+ cells in untreated CLL patients was much higher than in healthy controls (n = 26), but the percentages of these subpopulations, CD4/CD8 ratio and LPR to PHA were significantly (p < 0.00001) decreased. The chemotherapy induced a significant rise of CD3+ and CD4+ percentages (p < 0.006 < p < 0.022 respectively) in comparison to baseline levels, but their levels remained significantly (p < 0.00001) lower than the controls. The CD4/CD8 ratio was also elevated after the therapy (p < 0.048) but remained below the normal value as well. The absolute number of CD3+ and CD4+ T cells were normalized after treatment, while the CD8+ cells were still higher (p < 0.044) than controls. The increase of LPR has been registered after treatment, but it failed to reach the control values. We could not find any correlation between the number of immunoregulatory T cells and induced LPR (r = 0.07, for CD4+; r = 0.09 for CD8+ cells).

CONCLUSIONS

These data indicate some profound lymphoid cell defect in CLL patients affecting CD8+ proliferation as well as LPR.

Bone marrow involvement and the prognosis of low grade non-Hodgkin's lymphoma

AIM

To analyze the bone marrow (BM) infiltration in low-grade non-Hodgkin's lymphomas (LGNHL) and assess its association with the histopathology type, clinical behavior, and disease prognosis.

METHOD

BM smears obtained by needle biopsy and stained by standard methods were analyzed in 60 patients with LGNHL using the Working Formulation.

RESULTS

BM infiltration was observed in 57% of the lymphocytic lymphomas (A), in 48% of lymphoplasmocytic/ plasmocytoid lymphomas (AI), and in 31% of follicular lymphomas (follicular small cleaved cell and follicular mixed B and C). The difference was not significant. The 5-year survival rates for patients with and without bone marrow infiltration were 53% and 56% respectively, and 10-year survival rates were 31% and 45% (p>0.05).

CONCLUSION

The presence of bone marrow infiltration at diagnosis did not significantly affect the prognosis of LGNHL.

Richter syndrome with emphasis on large-cell non-Hodgkin lymphoma in previously unrecognized subclinical chronic lymphocytic leukemia

The authors report seven cases of Richter's syndrome, i.e. of large-cell non-Hodgkin's lymphoma (NHL) arising in association with chronic lymphocytic leukemia (CLL). Six patients had the recently recognized variant of this syndrome, occurring in patients with previously undiagnosed subclinical CLL. All patients were treated with aggressive chemotherapy and a complete response of large cell NHL was achieved in 4/7. A complete response of NHL was observed in 3 out of 6, and a partial response in 2/6 patients with simultaneous occurrence of subclinical CLL and large cell NHL (response rate 5/6). Our findings might suggest that patients with Richter syndrome occurring in previously undiagnosed subclinical CLL could represent a better prognostic group in the overall population of patients with large cell NHL transformation of CLL.

[Levels of certain immunologic parameters in patients with carcinoma of the epipharynx]

According to several histological and immunological features undifferentiated carcinoma of the nasopharynx (UCNT) is different from other ORL carcinomas (abundant lymphocytic infiltrate and frequent positive serology to EBV). Thus, immunological and virusological investigations were frequently performed in order to determine their diagnostic and prognostic significance. This study mainly concerned EBV serology and related immunological parameters. There are less data about immunological profile in those patients. In the present study, several standard immunological parameters were tested (number of different rosette-forming cells in peripheral blood, immunoglobulins serum levels and blastic transformation in the presence of PHA) in 17 patients with UCNT, 16 males and 1 female, aged 20 to 79 years. The aim of this study was to find out whether these patients were different from healthy controls, and if any of these parameters could be of prognostic value. Results point to the following disturbances in our group of patients: absolute lymphopenia caused by T-lymphopenia and significant decrease in ability of blastic transformation. Contrary to the registered suppression of cellular immunity there was a certain degree of stimulation of humoral response detected by hypergamaglobulinaemia and appearance of monoclonal immunoglobulin components in sera of few patients. All these immunological disturbances have no prognostic value in predicting the treatment response to chemotherapy.

[Hyperuricemia and plasma renin activity in essential arterial hypertension]

The frequency of hyperuricemia in 253 patients with essential hypertension (EH) was studied. The level of uric acid in serum and frequency of hyperuricemia were determined in patients divided according to sex and renin plasma activity (RPA). High values of uric acid in serum were found in a total of 69 patients (27.3%), of which there were 40 males (30.1%) and 29 females (24.2%). The highest values of uric acid were found in those with high RPA, but the difference was significant only in males (p < 0.05). No correlation was observed between the values of the uric acid in serum and RPA in none of the renin subgroups. On the basis of our study, it was not possible to explain the high values of uric acid in serum in patients with EH, especially in those with high plasma renin activity, as well as the role of renin-angiotensin-aldosterone system in the pathogenesis of hyperuricemia.

[Comparison of captopril and lisinopril in the treatment of mild and moderate hypertension]

The antihypertensive efficacy and safety of lisinopril (L), a novel ACE inhibitor, was compared to captopril (C), the known and already approved drug in our country in a multicenter double-blind Yugoslav trial. The study included 91 mild-to-moderate hypertensive patients of both sexes. Forty-six patients were randomized to receive captopril and 45 lisinopril. After a 2 week placebo, the examinees were administered either L in increasing dose of 10, 20, or 40 mg per day (amount necessary to achieve normotension), or C in a dosage of 25, 50, or 100 mg per day. During the 8 week formal trial L decreased the systolic blood pressure by an average of 14.9% from the initial values, and the diastolic pressure by some 15.2%. The same parameters were lowered on C by 11.2%, and 11.7%, respectively. Although the L effects were more pronounced, the observed differences did not reach the level of statistical significance (except for the dose-to-normotension relationship which was significantly better in the L group). It is concluded that both ACEIs under study showed comparable efficacy and tolerability, L being marginally more potent, and longer acting.

Percutaneous transluminal renal angioplasty (PTRA) as a method of therapy for renovascular hypertension in children

The results of PTRA in treatment of renovascular hypertension in four children aged 5, 7, 13 and 15 are presented. All patients suffered from severe hypertension. Tests showed all of them to have fibromuscular dysplasia stenosis of the main renal artery and significant lateralization of renin levels. One suffered from associated polycystosis of kidneys and in another the renal artery stenosis was bilateral. In all patients successful patency was achieved. In one patient, the arterial pressure after PTRA was normalized, while in the others it was considerably improved. Two patients, tested 8 and 12 months after PTRA, were lost to further follow-up. In one of the remaining two, stenosis and hypertension reappeared 5 years after PTRA. After autotransplantation the patient was normotensive. In the other, also 5 years later, recurrent hypertension appeared related to the associated polycystosis.

[Renin levels in renal veins in patients with essential arterial hypertension]

The data on plasma renin activity (PRA) obtained by catheterization of renal veins in 272 patients with essential arterial hypertension (EH) are reported. In order to exclude a secondary nature of hypertension, all patients were hospitalized and submitted to the extensive clinical and laboratory examinations (according to the protocol) including renal angiography. The aim of the work was to get evidence whether in the apparently homogeneous group of patients with EH there are differences in renin activity between the renal veins giving the quotient (Q) higher than 1.5, and possibly to recognize the clinical meaning of the differences of Q found. In the examined patients as a whole regardless of PRA, 50 of them (18.3%) showed Q greater than or equal to 1.5 and among them in 16 (5.8%) patients Q greater than or equal to 2 was found. The patients were divided according to PRA into those with low, normal and high PRA. In the hyperreninemic group of patients no Q greater than or equal to 2.0 has been found. In the hyporeninemic group 9 patients (9.9%) exhibited Q greater than or equal to 2.0. Although, one does not expect in EH to find differences in PRA between left and right renal vein, we have found the values of Q greater than or equal to 1.5 in nearly 1/5 of our patients. These differences found could be resulting from the existence of asymmetrical angiosclerotic or other renal pathological changes that can not be examined by the available clinical methods.(ABSTRACT TRUNCATED AT 250 WORDS)