Browsing by Author "Paunovic, Ivan (55990696700)"

Thyroid carcinomas in children and adolescents are rare tumors and the most common among them is papillary thyroid cancer (PTC). Its etiology is still under research and has not been clearly defined thus far, especially in young individuals. The aim of this case-control study was to determine potential risk factors for the development of PTC in children and adolescents. This type of study has not been carried out previously in this age group. A case-control study was carried out during a 15-year period, between 1995 and 2009. The case group included 75 patients with PTC younger than 20 years of age, with the youngest patient being 6.5 years old; 45 patients were female and 30 were male. The control group included the same number of participants, and the cases were individually matched by sex, age, and place of residence. Conditional univariate and multivariate logistic regression methods were applied in data analysis. According to univariate logistic regression analysis, PTC in children and adolescents was significantly related to the following factors: family history of thyroid cancer, family history of residence in an endemic-goiter area, family history of benign thyroid disease, and family history of nonthyroid malignant tumors. According to the multivariate logistic regression method, PTC in children and adolescents was independently related to a family history of thyroid cancer (odds ratio=4.5, 95% confidence interval=1.2-19.8) and a family history of nonthyroid malignant tumors (odds ratio=3.8, 95% confidence interval=1.4-8.7). In conclusion, all of the factors associated with the development of PTC in children and adolescents were related to their family history. © 2013 Wolters Kluwer Health Lippincott Williams & Wilkins.

Thyroid carcinomas in children and adolescents are rare tumors and the most common among them is papillary thyroid cancer (PTC). Its etiology is still under research and has not been clearly defined thus far, especially in young individuals. The aim of this case-control study was to determine potential risk factors for the development of PTC in children and adolescents. This type of study has not been carried out previously in this age group. A case-control study was carried out during a 15-year period, between 1995 and 2009. The case group included 75 patients with PTC younger than 20 years of age, with the youngest patient being 6.5 years old; 45 patients were female and 30 were male. The control group included the same number of participants, and the cases were individually matched by sex, age, and place of residence. Conditional univariate and multivariate logistic regression methods were applied in data analysis. According to univariate logistic regression analysis, PTC in children and adolescents was significantly related to the following factors: family history of thyroid cancer, family history of residence in an endemic-goiter area, family history of benign thyroid disease, and family history of nonthyroid malignant tumors. According to the multivariate logistic regression method, PTC in children and adolescents was independently related to a family history of thyroid cancer (odds ratio=4.5, 95% confidence interval=1.2-19.8) and a family history of nonthyroid malignant tumors (odds ratio=3.8, 95% confidence interval=1.4-8.7). In conclusion, all of the factors associated with the development of PTC in children and adolescents were related to their family history. © 2013 Wolters Kluwer Health Lippincott Williams & Wilkins.

Anaplastic thyroid cancer (ATC) is one of the tumors with the shortest survival in human medicine. Aim. The aim was to determine the importance of age in survival of patients with ATC. Material and Methods. We analyzed the data on 150 patients diagnosed with ATC in the period from 1995 to 2006. The Kaplan-Meier method and log-rank test were used to determine overall survival. Prognostic factors were identified by univariate and multivariate Cox regression analysis. Results. The youngest patient was 35 years old and the oldest was 89 years old. According to univariate regression analysis, age was significantly associated with longer survival in patients with ATC. In multivariate regression analysis, patients age, presence of longstanding goiter, whether surgical treatment is carried out or not, type of surgery, tumor multicentricity, presence of distant metastases, histologically proven preexistent papillary carcinoma, radioiodine therapy, and postoperative radiotherapy were included. According to multivariate analysis, besides surgery (P = 0.000, OR = 0.43, 95% CI = 0.29-0.63), only patients age (P = 0.023, OR = 0.68, 95% CI = 0.49-0.95) was independent prognostic factor of favorable survival in patients with ATC. Conclusion. Age is a factor that was independently associated with survival time in ATC. Anaplastic thyroid cancer has the best prognosis in patients younger than 50 years. © 2014 Vladan Zivaljevic et al.

Anaplastic thyroid cancer (ATC) is one of the tumors with the shortest survival in human medicine. Aim. The aim was to determine the importance of age in survival of patients with ATC. Material and Methods. We analyzed the data on 150 patients diagnosed with ATC in the period from 1995 to 2006. The Kaplan-Meier method and log-rank test were used to determine overall survival. Prognostic factors were identified by univariate and multivariate Cox regression analysis. Results. The youngest patient was 35 years old and the oldest was 89 years old. According to univariate regression analysis, age was significantly associated with longer survival in patients with ATC. In multivariate regression analysis, patients age, presence of longstanding goiter, whether surgical treatment is carried out or not, type of surgery, tumor multicentricity, presence of distant metastases, histologically proven preexistent papillary carcinoma, radioiodine therapy, and postoperative radiotherapy were included. According to multivariate analysis, besides surgery (P = 0.000, OR = 0.43, 95% CI = 0.29-0.63), only patients age (P = 0.023, OR = 0.68, 95% CI = 0.49-0.95) was independent prognostic factor of favorable survival in patients with ATC. Conclusion. Age is a factor that was independently associated with survival time in ATC. Anaplastic thyroid cancer has the best prognosis in patients younger than 50 years. © 2014 Vladan Zivaljevic et al.

Purpose: In contrast to other thyroid carcinomas it is diffi cult to establish a correct preoperative diagnosis for oxyphile carcinoma of the thyroid. In this study we looked for predic tive malignancy factors in order to enable surgeons to choose operative treatment and to perform an adequate operation for each patient with an oxyphile neoplasm of the thyroid. Methods: In this retrospective study we have analyzed the medical files of all patients with oxyphile tumors of the thy roid operated between 1999 and 2008 in our institution. A total of 256 patients were included and divided into oxy phile adenomas (142) and carcinomas (114) on the basis of their definite histopathological diagnosis. The most import ant demographic and clinical characteristics were analyzed by univariate and multivariate logistic regression analysis. Results: Univariate analysis showed that male gender, thyroglobulin concentrations ≥300 ng/ml and tumor diam eter >30 mm were significantly more frequent in patients with oxyphile carcinoma compared to patients with oxy phile adenoma, while coexisting Hashimoto thyreoiditis and positive AntiTPO antibodies appeared significantly less frequent in the carcinoma group. All variables with a p value <0.1 in the univariate test were subjected to multi variate regression analysis in which elevated preoperative thyroglobulin concentrations (≥ 300 ng/ml) was shown as the only independent predictive factor for oxyphile thyroid carcinomas (OR=5.88, 95%Ci 2.78-12.05, p=0.001). Conclusions: Preoperative thyroglobulin concentration is an independent predictor of malignancy for oxyphile thy roid carcinomas.

Purpose: In contrast to other thyroid carcinomas it is diffi cult to establish a correct preoperative diagnosis for oxyphile carcinoma of the thyroid. In this study we looked for predic tive malignancy factors in order to enable surgeons to choose operative treatment and to perform an adequate operation for each patient with an oxyphile neoplasm of the thyroid. Methods: In this retrospective study we have analyzed the medical files of all patients with oxyphile tumors of the thy roid operated between 1999 and 2008 in our institution. A total of 256 patients were included and divided into oxy phile adenomas (142) and carcinomas (114) on the basis of their definite histopathological diagnosis. The most import ant demographic and clinical characteristics were analyzed by univariate and multivariate logistic regression analysis. Results: Univariate analysis showed that male gender, thyroglobulin concentrations ≥300 ng/ml and tumor diam eter >30 mm were significantly more frequent in patients with oxyphile carcinoma compared to patients with oxy phile adenoma, while coexisting Hashimoto thyreoiditis and positive AntiTPO antibodies appeared significantly less frequent in the carcinoma group. All variables with a p value <0.1 in the univariate test were subjected to multi variate regression analysis in which elevated preoperative thyroglobulin concentrations (≥ 300 ng/ml) was shown as the only independent predictive factor for oxyphile thyroid carcinomas (OR=5.88, 95%Ci 2.78-12.05, p=0.001). Conclusions: Preoperative thyroglobulin concentration is an independent predictor of malignancy for oxyphile thy roid carcinomas.

Aim: To gain a better insight into the differences in biological behaviour between papillary microcarcinoma (PMC) and clinically evident papillary thyroid carcinoma (PTC). Methods: Immunohistochemical analysis of apoptosis related molecules (Bcl-2, Bax, p53) and proliferation related marker (PCNA) in 39 archival cases of PMC and 46 cases of PTC. Results: Bcl-2 and Bax were expressed in most PMCs and PTCs. The average Bcl-2 staining score did not differ significantly between PMCs and PTCs (p > 0.05), but the average Bax score was significantly lower in PMCs (p < 0.05). The Bcl-2/Bax ratio was significantly higher in PMCs than in PTCs (p < 0.05). The expression of p53 was similar in PMCs and PTCs, without a correlation with clinical data, but was associated with high Bax expression (p < 0.05) in these cases in both groups. Non-malignant tissue expressed only Bcl-2, but not p53 or Bax. PCNA expression was significantly lower (p < 0.05) in PMC than in PTC and positively correlated with tumour size (p < 0.05). Conclusions: The higher Bcl-2/Bax ratio and lower proliferative activity in PMC suggest differences from PTC in the balance between apoptosis and proliferation. However, the presence of p53 and Bax in PMC indicates malignant potential, and thus PMC should be treated with caution. © 2008 Royal College of Pathologists of Australasia.

Background: Post-thyroidectomy bleeding is rare, but potentially life-threatening complication. Early recognition with immediate intervention is crucial for the management of this complication. Therefore, it is very important to identify possible risk factors of postoperative hemorrhage as well as timing of postoperative hematoma occurrence. Methods: Retrospective review of 6938 patients undergoing thyroidectomy in a tertiary center in a ten year period (2009–2019) revealed 72 patients with postoperative hemorrhage requiring reoperation. Each patient who developed postoperative hematoma was matched with four control patients that did not develop postoperative hematoma after thyroidectomy. The patients and controls were matched by the date of operation and surgeon performing thyroidectomy. Results: The incidence of postoperative bleeding was 1.04%. On univariate analysis older age, male sex, higher BMI, higher ASA score, preoperative use of anticoagulant therapy, thyroidectomy for retrosternal goiter, larger thyroid specimens, larger dominant nodules, longer operative time, higher postoperative blood pressure and the use of postoperative subcutaneous heparin were identified as risk factors for postoperative bleeding. Sixty-nine patients (95.8%) bled within first 24 h after surgery. Conclusion: The rate of postoperative bleeding in our study is consistent with recent literature. Male sex, the use of preoperative anticoagulant therapy, thyroidectomy for retrosternal goiter and the use of postoperative subcutaneous heparin remained statistically significant on multivariate analysis (p < 0.001). When identified, these risk factors may be an obstacle to the outpatient thyroidectomy in our settings. © 2022, The Author(s) under exclusive licence to Société Internationale de Chirurgie.

Aims and background: The aim of the present study was to test some hypothetical risk factors for anaplastic thyroid cancer. Study design: A case-control study comprised 110 patients with histologically or cytologically verified anaplastic thyroid cancer and 110 hospital controls individually matched with cases by sex, age, place of residence and time of hospitalization. Univariate and multivariate logistic regressions were used for data analysis. Results: According to the conditional logistic regression analysis, the following factors were significantly and independently related to anaplastic thyroid cancer: history of goiter or thyroid nodules (odds ratio, OR, 37.55; 95% confidence interval, CI, 4.86-290.11), history of residence in endemic goiter area (OR, 2.56; 95% CI, 1.05-6.22), history of previous malignant non-thyroid tumor (OR, 5.51; 95% CI, 1.04-29.25), diabetes mellitus (OR, 4.06; 95% CI, 1.29-12.81) and low educational level (OR, 2.44; 95% CI, 1.17-5.06). Conclusions: The results are in line with the current knowledge on factors related to thyroid cancer, except for the association between thyroid cancer and diabetes mellitus, which as far as we know has not yet been reported.

Aims and background: The aim of the present study was to test some hypothetical risk factors for anaplastic thyroid cancer. Study design: A case-control study comprised 110 patients with histologically or cytologically verified anaplastic thyroid cancer and 110 hospital controls individually matched with cases by sex, age, place of residence and time of hospitalization. Univariate and multivariate logistic regressions were used for data analysis. Results: According to the conditional logistic regression analysis, the following factors were significantly and independently related to anaplastic thyroid cancer: history of goiter or thyroid nodules (odds ratio, OR, 37.55; 95% confidence interval, CI, 4.86-290.11), history of residence in endemic goiter area (OR, 2.56; 95% CI, 1.05-6.22), history of previous malignant non-thyroid tumor (OR, 5.51; 95% CI, 1.04-29.25), diabetes mellitus (OR, 4.06; 95% CI, 1.29-12.81) and low educational level (OR, 2.44; 95% CI, 1.17-5.06). Conclusions: The results are in line with the current knowledge on factors related to thyroid cancer, except for the association between thyroid cancer and diabetes mellitus, which as far as we know has not yet been reported.

The aim of the study was to examine the factors which play a role in the occurrence of differentiated thyroid cancer as related to anaplastic thyroid cancer (ATC). A case-control study was performed during the period 1993 to 2005. The case group comprised of 126 patients with ATC. The control group comprised of 126 patients with papillary thyroid cancer. Cases were individually matched by gender and place of residence. ATC was significantly related to older age (odds ratio = 1.11, 95% confidence interval = 1.07-1.14) and goiter (odds ratio = 1.20, 95% confidence interval = 1.07-1.35). Copyright © 2010 by Lippincott Williams & Wilkins.

Objectives: Primary hyperparathyroidism in juveniles is extremely rare condition, but in the last few decades the incidence is increasing. The aim of this study was to compare biochemical and clinical characteristics of juvenile and adult primary hyperparathyroidism patients. Methods: A retrospective case-control study was conducted from 2004 until 2017 in high volume endocrine surgery center. Juvenile group consisted of all primary hyperparathyroidism patients younger than 20 who have undergone parathyroidectomy, and two-fold more patients older than 20 were classified in control (adult) group. Results: A total of 14 patients with the age ≤20 years were included in the juvenile group, while 28 patients older than 20 were selected for the control group. Female-to-male ratio in juveniles was 1:1, and in adults 8:1 (p = 0.005). The most common form of the disease in juveniles was bone disease (42.9%) and most of adults were asymptomatic (39.3%). Mean preoperative serum calcium level was significantly higher in juveniles than in adults, 3.47 ± 0.74 mmol/L vs. 2.96 ± 0.25 mmol/L, p = 0.025. Mean preoperative PTH level was higher in juveniles than in control group, 572.6 ± 533.3 ng/L vs. 331.8 ± 347.5 ng/L, p = 0.089. Conclusion: Clinical manifestations of primary hyperparathyroidism significantly differ in juvenile and adult patients. Juvenile primary hyperparathyroidism represents more severe form of the disease, often with end-organ damages, and it should be considered in patients with unspecific symptoms. © 2020 Elsevier B.V.

Aims and background: Thyroid cancer, whose etiology is largely uncertain, has been negatively associated with cigarette smoking in a several studies. We examined the association between cigarette smoking and risk for female thyroid cancer. Methods: A case-control study including 204 histologically verified female thyroid cancer patients and an equal number of hospital controls individually matched with cases by sex, age (± 2 years), place of residence and time of hospitalization was carried out during the period 1996-2000. In the analysis of data, univariate and multivariate conditional logistic regression methods were applied. Results: According to univariate analysis, female thyroid cancer was negatively associated with the initiation of smoking at a younger age, before the age of 20 (OR = 0.66, 95% CI = 0.50-0.90). None of the smoking habits remained independently related to female thyroid cancer after adjustment for other factors which were significantly associated with thyroid cancer in the present study. Conclusions: The results of the study do not suggest a role of cigarette smoking in the development of thyroid cancer in women.

Aims and background: Thyroid cancer, whose etiology is largely uncertain, has been negatively associated with cigarette smoking in a several studies. We examined the association between cigarette smoking and risk for female thyroid cancer. Methods: A case-control study including 204 histologically verified female thyroid cancer patients and an equal number of hospital controls individually matched with cases by sex, age (± 2 years), place of residence and time of hospitalization was carried out during the period 1996-2000. In the analysis of data, univariate and multivariate conditional logistic regression methods were applied. Results: According to univariate analysis, female thyroid cancer was negatively associated with the initiation of smoking at a younger age, before the age of 20 (OR = 0.66, 95% CI = 0.50-0.90). None of the smoking habits remained independently related to female thyroid cancer after adjustment for other factors which were significantly associated with thyroid cancer in the present study. Conclusions: The results of the study do not suggest a role of cigarette smoking in the development of thyroid cancer in women.

We evaluated some proposed molecular thyroid tumor markers: thyroid peroxidase (TPO), galectin-3, cytokeratin-19, and HBME-1, individually and in combination, by immunohistochemistry in a total of 242 archival thyroid tissue sections. The expression of each individual marker was most helpful for the diagnosis of papillary carcinoma and its follicular variant. However, none of them was sensitive and specific enough to discriminate between Hürthle adenoma and carcinoma. Galectin-3 and HBME-1 could be used as single discriminators between follicular thyroid adenoma and carcinoma, but HBME-1 is the better choice. As a single test, all analyzed tumor markers had sufficient power to predict differentiated thyroid cancer, with sensitivities ranging from 66.5% to 82.2%. The sensitivity was improved by using combinations of some proposed markers. Only two antigens, HBME-1 and TPO, had distinct predictive values for different diagnostic alternatives i.e. a sequential combination improved diagnostic accuracy between follicular thyroid adenoma and the follicular variant of papillary thyroid carcinoma to 92.6% and consequently, between overall benign and malignant thyroid tumors to 89.1%. HBME-1 is the most accurate ancillary stain in discriminating well-differentiated thyroid carcinomas from benign tumors, although the addition of TPO did improve accuracy and served as a useful confirmatory marker. © 2011 The Authors. APMIS © 2011 APMIS.

Purpose: Papillary thyroid carcinoma (PTC) has a strong propensity to metastasize to regional lymph nodes which increases the risk of local-regional relapse and affects the course of the disease. Molecular pathogenesis of lymph node metastasis (LNM) is not yet fully understood. Survivin, a multifunctionale molecule involved in apoptosis, proliferation and angiogenesis, and vascular endothelial growth factor-C (VEGF-C) are suggested to be implicated in lymphatic metastases of human malignancies. Materials and Methods: Expression of survivin and VEGF-C was examined by immunohistochemistry and Western blot in 75 cases of PTCs in relation to their LNM status. Additionally, survivin and VEGF-C were immunohistochemically analyzed in 15 primary PTCs paired with their metastatic tissue in lymph nodes. Results: High expression of survivin and VEGF-C was found in 62.7% and 64.0% cases, respectively, with a positive correlation to each other (Spearman's correlation co-efficient = 0.878, P < 0.001). Expression levels of both proteins were significantly higher in patients with LNM than in those without LNM (P < 0.001). The rate of concomitant high expression of survivin and VEGF-C in patients with LNM involvement was 88.9% (P < 0.01). Metastatic tissue in lymph nodes expressed survivin and VEGF-C at the same high extent as their primary tumors. Conclusion: Concomitant high expression of survivin and VEGF-C is closely associated with LNM status of PTC patients, which suggests their cooperation in the metastatic process. Evaluation of survivin and VEGF-C expression could be clinically significant in predicting the metastatic potential of PTC and subsequent treatment and follow-up of these patients. © 2017 Journal of Cancer Research and Therapeutics.

The original version of this article unfortunately contained a mistake. The author names in the author group are now presented correctly. The original article has been updated. © 2020, Springer Science+Business Media, LLC, part of Springer Nature.

The original version of this article unfortunately contained a mistake. The author names in the author group are now presented correctly. The original article has been updated. © 2020, Springer Science+Business Media, LLC, part of Springer Nature.

Cytokeratin19 (CK19) has been reported as a useful marker of thyroid tumors. We evaluated its value for differential diagnosis of thyroid neoplastic lesions and assessed its usefulness for predicting aggressive behavior of papillary thyroid carcinomas by correlating immunohistochemical results with clinicopathological features of the patients. A total of 351 thyroid tissue samples included 27 follicular adenomas (FTA), 18 follicular carcinomas (FTC), 147 papillary carcinomas (71 of follicular type-PTCfv and 76 of classical type-PTCcl) and 33 cases of anaplastic carcinoma with 126 adjacent thyroid tissues. Diagnostic usefulness of CK19 was determined by ROC analysis, while its value as a predictive marker of PTC was tested by univariate and multivariate analysis. According to ROC analysis, CK19 can discriminate both types of PTC from other neoplasias of the thyroid gland (p < 0.05). Although greatest accuracy was gained for the identification of PTCcl (91.07 %), this marker was also helpful for distinguishing PTCfv from FTA and FTC (accuracy 71.43 and 65.17 %, respectively). Regarding the univariate set of tests, high expression of CK19 correlated significantly with age, multifocality, extrathyroidal extension, pT status and pTNM stage of PTC (p < 0.05 for all). Multivariate analyses confirmed the significant association of high CK19 expression with extrathyroidal extension of PTC as well as with pTNM stage (p < 0.05 and p < 0.01, respectively). CK19 is a useful marker for the identification of both types of PTC. High expression of this protein predicts the aggressive behavior of PTC and can help in the identification of a particular subgroup of PTC patients with a potentially worse prognosis. © 2012 Springer Science+Business Media New York.

Cytokeratin19 (CK19) has been reported as a useful marker of thyroid tumors. We evaluated its value for differential diagnosis of thyroid neoplastic lesions and assessed its usefulness for predicting aggressive behavior of papillary thyroid carcinomas by correlating immunohistochemical results with clinicopathological features of the patients. A total of 351 thyroid tissue samples included 27 follicular adenomas (FTA), 18 follicular carcinomas (FTC), 147 papillary carcinomas (71 of follicular type-PTCfv and 76 of classical type-PTCcl) and 33 cases of anaplastic carcinoma with 126 adjacent thyroid tissues. Diagnostic usefulness of CK19 was determined by ROC analysis, while its value as a predictive marker of PTC was tested by univariate and multivariate analysis. According to ROC analysis, CK19 can discriminate both types of PTC from other neoplasias of the thyroid gland (p < 0.05). Although greatest accuracy was gained for the identification of PTCcl (91.07 %), this marker was also helpful for distinguishing PTCfv from FTA and FTC (accuracy 71.43 and 65.17 %, respectively). Regarding the univariate set of tests, high expression of CK19 correlated significantly with age, multifocality, extrathyroidal extension, pT status and pTNM stage of PTC (p < 0.05 for all). Multivariate analyses confirmed the significant association of high CK19 expression with extrathyroidal extension of PTC as well as with pTNM stage (p < 0.05 and p < 0.01, respectively). CK19 is a useful marker for the identification of both types of PTC. High expression of this protein predicts the aggressive behavior of PTC and can help in the identification of a particular subgroup of PTC patients with a potentially worse prognosis. © 2012 Springer Science+Business Media New York.