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Aim: To determine the prognostic value of cell cycle regulators cyclin D1 and p27 for papillary thyroid carcinomas., Methods: Analysis included 180 patients with papillary thyroid carcinoma who underwent surgery at Split University Hospital Center between 1999 and 2001. Clinical data were obtained from clinical charts and histopathology reports. Immunohistochemistry was performed on formalin-fixed, paraffin-embedded tissue by antibody p27 and cyclin D1. Quantification was based on the intensity and distribution of nuclear staining., Results: Univariate analysis showed that sex (P=0.019) and capsular invasion (P=0.010) were significant predictors of lymph node metastases, whereas age (P=0.96), histopathological variant (P=0.075), size (P=0.556) and multifocality (P=0.131) were not. Univariate analysis also showed that overexpression of cyclin D1 (P<0.001) and underexpression of p27 (P<0.001) predicted lymph node metastases in papillary thyroid carcinomas. There was a significant correlation between cyclin D1 (P=0.024) and p27 (P=0.029) expression in two prognostic groups of low and high risk. Low risk group was cyclin D1 negative and p27 positive, while high risk group was cyclin D1 positive and p27 negative. Multivariate analysis confirmed that sex (P=0.041), capsular invasion (P=0.027), and p27 (P<0.001) were strong independent predictors of lymph node metastases in the high-risk group., Conclusions: Immunohistochemical analysis of p27 expression may be a valuable tool for identifying risk of lymph node metastases and more aggressive behavior of papillary thyroid carcinoma.

We report the case of an unusual penetrating injury of the temporal region of the head caused by knife. A long kitchen knife was protruding from the upper auricular area of the left temporal region of victims head. It cut through the posterosuperior part of the left auricula and remained fixed to the postauricular region. Brain computorized tomography (CT) scan revealed that the knife had reached deep into the petrous part of the temporal bone, and was directed toward the sulcus of the sigmoid sinus. There were no signs of intracranial bleeding. An otorhinolaryngologist and a neurosurgeon removed the knife in operating room, with the patient in general anesthesia. The audiogram obtained after 7 days of hospitalization showed left conductive hearing loss of 40 dB at frequencies up to 2 kHz, and of 90 dB above 2 kHz, probably due to hemotympanum caused by the operation. Control examinations performed 14 days and one month after discharge confirmed the patients complete recovery and no significant defects in his hearing or balance. We suggest multidisciplinary teamwork as a proper approach in the treatment of such injuries.

Muscular echinococcosis accounts for 0.5% to 5.4% of all hydatid disease cases, with very little data on the incidence of muscular echinococcosis of the head and neck. We report a unique case of primary echinococcosis of the right sternocleidomastoid muscle in a 56-year-old man. Preoperative assessment by ultrasound and fine needle aspiration did not point to echinococcosis. We suspected the right diagnosis intraoperatively and confirmed it postoperatively by pathohistology and serologic tests. Echinococcosis of the liver and the lungs was also excluded postoperatively. Combination of operative treatment and postoperative albendazole herapy in two 28-day cycles one month apart resulted in complete regression of the disease. Echinococcosis should be considered as differential diagnosis of a multicystic mass in neck, particularly if it is of longstanding duration. Serologic tests for echinococcosis should be included in differential diagnostic procedures for each multicystic formation on the neck, especially in endemic areas.