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Differentiated thyroid carcinomas (DTC) are the most common carcinomas in thyroid pathology. The most common DTC is papillary thyroid carcinoma (PTC) which tends to spread lymphogenously. Beside spreading of malignant disease from the primary focus toward local and regional lymph nodes, intrathyroid lymphogenous spreading is also seen, as well as multifocal character of PTC. From this reason, after the diagnosis of PTC is established, desired therapy should be total thyroidectomy (with/without neck dissection) along with additional radioiodine therapy.

Autoimmune polyglandular syndrome by definition consists of two or more endocrinological insufficiencies or two organ specific autoimmune diseases. There are no stringent criteria for endocrinological evaluation of patients with one endocrine insufficiency. However, detailed endocrinological evaluation should be undertaken in patients with two autoimmune diseases. Additionally, follow up thereafter should be a must in these patients in order to avoid the possibility of not diagnosing subsequent autoimmune diseases that can occur. The aim of this case report is to point to the necessity of endocrinological screening to be made in patients presenting with gastric carcinoid type 1. We report on a 62-year-old woman who was diagnosed with primary hypothyroidism in 1993. In 2011, she was re-admitted to the hospital due to increasing fatigue. Macrocytic anemia, low vitamin B12 levels and positive parietal antibodies confirmed pernicious anemia. Furthermore, she underwent gastroscopy, which revealed two polyps in the corpus of the stomach and one in the fornix. Endoscopic mucosal resection was performed and histopathologic analysis confirmed three G1 gastric carcinoids (Ki67 2%). Additional endocrinological evaluation disclosed positive glutamic acid decarboxylase antibodies, but normal fasting and postprandial glucose and HbA1c. In 2013, she was diagnosed with glucose intolerance and subsequently with latent autoimmune diabetes of adulthood. Plasma glucose and HbA1c normalized after dietary intervention. Due to the increase of serum chromogranin A, prophylactic antrectomy was performed in 2014. The patient is still followed-up and has normal chromogranin A, gastrin and HbA1c levels.

Two cases of osteoid osteoma tumor (OO) are presented and our early experience with intraoperative gamma probing to localize OO during surgery is reported. The concept of radioguided surgery was developed 60 years ago and the gamma detection probe technology for radioguided biopsy and/or resection of bone lesions has been applied since the early 1980s. Bone scintigraphy is very important for initial diagnosis of OO with almost 100% sensitivity. The bone scan finding is specific, with so called double density appearance, very intense accumulation of radiopharmaceutical in the nidus and therefore great difference between the nidus and the surrounding healthy bone, thus making possible to treat this lesion with probe guided surgery. Three phase bone scintigraphy and single photon emission computed tomography were conducted in our patients for initial diagnosis of OO. A second bone scintigraphy was performed before surgery. The surgery followed 12-15 hours later by intraoperative nidus detection with a hand-held gamma probe. Gamma hand-held probe is a system that detects gamma photons. The count rate in the nidus area on the day of surgery was 3 to 4 times higher than in the healthy bone area. Drilling was performed until the counts decreased to the level of the surrounding bone counts, thereby confirming complete excision. This is the method of choice for minimizing bone resection, the risk of pathologic fracture, the need of bone grafting, and reducing the period of convalescence. Evidence for the treatment efficiency is pain disappearance after the surgery.

Pancreatic neuroendocrine tumors (PETs) are increasingly recognized. In order to assure an optimal treatment of patients and to propose an efficient diagnostic algorithm we were prompted to organize meetings, with participating experts, specialists in different fields of expertise. The idea for the meetings was to try to give a standardized approach, which would in future help in stratification of PET patients. Results of meetings are given in a form of Consensus guidelines for diagnosis, treatment and follow-up of patients with pancreatic neuroendocrine tumors.

The case of a six-month-old boy with mandibular Caffey's disease is described. Emphasis is placed on the role of bone scintigraphy, as a diagnostic method which would be, because of the clinical picture and the beginning of the disease (suspected osteomyelitis), one of the first methods performed. Highly characteristic scintigraphic image, when the mandible is involved, can play the most important role in further treatment, and its recognition can also spare many unnecessary procedures.

The use of a hand-held gamma probe during the operation allows a direct approach to the parathyroid adenoma, which is more active than the thyroid. This procedure is significantly less morbid and can be performed in shorter time than standard neck exploration. Hand-held gamma probe already existed at the Department of Oncology and Nuclear Medicine. As a result of a very good cooperation with Department of Internal medicine and Department of Othorhinolaryngology, for the first time in our country minimally invasive radioguided parathyroidectomy was performed on April 16th, 2002. Until now, 15 patients with primary hyperparathyroidism underwent this type of operation. 700 MBq 99m-Tc-SESTAMIBI was injected two hours before the planned operative procedure. Preoperative scintigraphy was performed 10 and 80 minutes after the administration of radiopharmaceutical. This study deals with our first experience of intra-operative localization of parathyroid adenomas using a hand-held gamma probe, as well as our observations concerning the selection of the patients.

The acquired serum Chromogranin A (CgA) positivity was followed-up during 15 months in 79 prostate cancer patients referred to maximal androgen blockade (Mab.) In all patients normal CgA values were initially measured. This study was also performed on 24 Stage C-D1 prostate cancer patients left without therapy through their own choice and in 20 controls with benign prostatic hypertrophy. In all these subjects serum PSA, %FPSA and CgA concentrations were measured at three-month intervals and bone scans were performed 1-2 times during the overall monitoring period. After nine months of monitoring, no differences in CgA-positivity between two prostate cancer patient groups had been observed. However, during the last six months of monitoring, the acquired CgA-positivity was statistically significant in treated patients when compared to the untreated group (p<<0.001). Bone metastases were found in 38% of CgA-positive prostate cancer patients (regardless of the therapy status) and in only 6% of studied patients with a steady normal serum CgA concentration. According to the data reported herein we advocate the assessment of serum CgA concentrations at 3-month intervals during hormonal manipulation. The reported results may reawaken the idea of intermittent hormone therapy and, in particular, the replacement of Mab after 9 months by Casodex (Flutamide) monotherapy for a 6-month period.

In this study, we evaluated the efficacy of bone marrow immunoscintigraphy (BMIS) for the detection of skeletal metastases in 23 patients with histologically confirmed breast cancer. All patients underwent whole-body BMIS 3-6 h after the intravenous injection of 0.20-0.33 mg of the intact anti-NCA 95 MAb BW 250/183 labelled with 259-555 MBq 99Tcm and a whole-body 99Tcm-MDP bone scan. In four patients, BMIS SPET of the lumbar spine was also performed. Serum alkaline phosphatase was determined in all patients and the level of human anti-mouse antibody (HAMA) in 16. Final diagnosis was confirmed by radiology and 2 years follow-up. Compared with the 99Tcm-MDP bone scan, BMIS demonstrated better specificity (88% vs 75%) and a better positive predictive value (92% vs 85%). There were no significant differences between BMIS and the bone scan in the detection of skeletal metastases (P > 0.05). In one patient with normal planar BMIS of the lumbar spine, SPET disclosed a metastatic lesion in the bone marrow. The correlation coefficient between BMIS and bone scan and between BMIS and serum alkaline phosphatase was r = 0.688 and r = 0.483 respectively. One patient developed a minor HAMA response after BMIS. Patients with diffuse increased activity of the skull on the bone scan had a significantly higher skull to whole body ratio on BMIS (P < 0.01). Thus BMIS can improve the specificity and positive predictive value of bone scanning in the detection of skeletal metastases, with a low HAMA response. Diffuse increased activity of the skull on bone scans could be explained by bone marrow extension. SPET scanning of the spine may improve the sensitivity of BMIS.

In a total of 59 prostate cancer (PCa) patients, 9 patients with PIN. 29 subjects with BPH and 26 healthy men serum TPS and PSA values were measured together with NK cell activity, number and proportion of CD16+ cells, and reactivity of lymphocytes to mitogens (Con A. PHA and PWM). NK activity data indicate highly significant differences between both of patients with local tumor and those with disseminated disease (P < 0.01) and b) responders and nonresponding patients to hormonal therapy (P < 0.01). The number and proportion of CD16+ cells is lowest in BPH patients in comparison with controls and PCa patients. Since benign enlargement is attributed mainly to stromal cell proliferation in the absence of cell death in this compartment, gene expressions which control these events may participate in the surprisingly low CD16+ cell proportion. The reactivity of lymphocytes to mitogens (PHA. Con A and PWM) showed lower numerical values in all categories of PCa and BPH patients when compared with healthy men. The reactivity of T and B lymphocytes reported herein as immunological responses to mitogens (PHA. Con A and PWM) was performed 4-6 months after the beginning of therapy. Our data fit in well with those previously reported. Numerically lowest respective reactivity parameters to all mitogens were assessed in PIN subjects. Reported results show the specific significance of the changes in NK cell activity in regard with both metastatic extention of PCa and tumor response to therapy. These alterations match in their reliability changes with tumor marker values related to prostate cancer activity (TPS) and tumor differentiation (PSA). Lymphocyte reactivity to mitogens (Con A. PHA. PWM) may help in a subclinical discrimination between BPH and PIN patients that is still an important goal of clinical urology.

Ventilation-perfusion (V/P) scintigraphy was performed 62 times in 57 patients suspected of having pulmonary embolism (PE). The aim of this study was to present the results and our first experiences in V/P scintigraphy, as well as to point out some specificities of the study. Perfusion scintigraphy was performed following i.v. administration of 99mTc MAA. If the finding was positive, ventilation scan was performed directly after the inhalation of 99mTc DTPA aerosol. Based on the comparison of both findings the patients were divided into four groups: normal finding (8.1% of patients), low (54.8%), medium (22.6%), and high level of PE probability (14.5%). As V/P scintigraphy is a very sensitive and non-aggressive method, it is our opinion that it should be included in PE diagnosing as a "screening" method, because the scanning results greatly influence further therapeutical and diagnostic treatment of the patient.

We treated twenty-three patients with secondary hypertrophic osteoarthropathy (SHO). Lung cancer was associated with SHO in 21 cases. The underlying conditions for the rest of the patients were pulmonary fibrosis, bronchiastasic, pneumonia and mediastinal cancer. The history, physical examination, radiography and bone-scan were performed. For bone-scan it was used intravenously instilled disfonate compound marked with 99 mTc-HMDP-"Osteocis" in the dosage of 740 MBq. Mild periostosis on the shaft bones was found in 5 patients with positive radio-labelling. In other patients bone-scan showed polytopic radiolabelling whilst radiography didn't show and periostosis. In conclusion we can say that the bone-scan is very sensitive method for the detection of the increase bone-tissue function.

Bone scans, serum tissue-specific polypeptide antigen (TPS), prostate specific antigen (PSA), and neuron-specific enolase (NSE) were assessed in a total of 80 hormonally treated prostate cancer patients. Thirty-nine patients were free of osseous lesions; in 8 subjects, 3 or fewer scintigraphic hot spots were found; in 29 patients, more than 3 bone lesions were recorded. In 3 patients, a partial contribution of endocrine cell cancer structures was found, while in one patient, a homogeneous small cell carcinoma was detected at autopsy. Measurement of the serum PSA test showed a clear-cut rise from stage D0 subjects to stage D2 patients, with a small number of bone lesions (> or = 3). However, a relative decrease in the mean PSA level was measured with further progression in a number of hot spots in bone (> 3). Androgen threshold that is critical for the induction of the PSA (and PAP) expression seems to differ markedly in various cell subpopulations that arise during adenocarcinoma dedifferentiation. This fact explains not only the rise in serum PSA in the majority of progressive and previously castrated subjects after an initial period of hormonal responsiveness, but also a relative decline of androgen-dependent PSA expression with further tumor progression. Localized disease was accompanied with normal or just slightly elevated TPS concentration. In metastatic tumors, serum TPS values revealed a steady increase with the progression in bone. These data seem to reflect not only an increase in tumor proliferation rate with progressively transformed genome, but also the rise in the number of proliferating cells. The presence of nonepithelial transformed tumor structures, such as small cell cancer within a bulk of adenocarcinoma, reduces or normalizes numerical serotests values of both TPS and PSA even during tumor progression. The extent of such decline depends upon the bulk of the endocrine component. The assessment of the above parameters, especially when associated with elevated plasma NSE concentrations, may help in distinguishing an advanced adenocarcinoma with and without elements of malignant neuroendocrine structures. The proposed approach, modified by applying corresponding organ-specific markers, may be checked for its possible general use in staging protocols of various heterogeneous tumors.

Serum tissue polypeptide-specific antigen (TPS), prostate-specific antigen (PSA), and prostatic acid phosphatase (PAP) concentrations were serially measured in 31 prostate cancer patients with bone metastases who had relapsed following hormonal therapy. Of these subjects 7 had well-differentiated cancer (G1), 13 patients were assessed to have moderately differentiated tumor (G2) while in 11 subjects poorly differentiated tumor (C13) was found. With increasing tumor grade (G1 to G3), a proportional increase in mean TPS value was found while the increase in respective PAP serotest values was not linear. Simultaneously measured mean PSA values showed a curved effect. Both PSA and PAP serotest concentrations depend on the respective hormone-dependent gene expressions that gradually decrease with tumor dedifferentiation. Therefore, in progressive hormonally treated stage D2 prostate cancer patients an androgen-independent TPS serotest seems to be a useful clinical addition for monitoring protocols. The combined use of TPS, PSA, and PAP seems to give a better reflection of tumor status. According to the bone scan data metastatic tumor mass in G3 carcinomas was virtually equal to cancer burden in G2 tumors. Hence, the marked elevation of TPS serotest values in G3 adenocarcinomas could not be attributed to greater tumor mass but was most likely due to an increase in proliferation rate. Some authors have recently proposed cytokeratins 8, 18, and 19 to be the origin of TPS serum findings. However, cytokeratin content has been proven to be lower in G3 tumors than in better-differentiated neoplasms.(ABSTRACT TRUNCATED AT 250 WORDS)

Whole-body scintigraphy with 131I-meta-iodo-benzylguanidine 131I-MIBG) was performed in 41 patients with neuroblastoma. In patients with clinical remission no pathological concentration of 131I-MIBG was found. In 30 patients with residual, recurrent or metastatic disease neuroblastoma was correctly localized by 131I-MIBG scintigraphy. It is concluded that 131I-MIBG whole-body scintigraphy is useful in the diagnosis and follow-up of neuroblastoma.

In the evaluation of early degenerative changes of lumbocoxal triangle, that is of sacroiliac joints with the patients with above knee amputations, two diagnostic methods were used: X-ray method and scintigraphic method. X-ray method: pictures of sacroiliac joints according to Bársony as morphologic method show first degenerative changes in the period of six to twelve months after amputation. Scintigraphy of sacroiliac joints and the determination of s.i. index as functional method has established the degree of degenerative changes, that is their progression or stagnation. It has been seen that the degree of degenerative changes of sacroiliac joints in not the same with the patients who regularly use prostheses and those who do it occasionally. With the patients who use the prosthesis all the time, the degenerative changes stagnate.

Tissue polypeptide specific antigen (TPS) is a new tumor proliferation serotest marker. The respective radioimmunodetective procedure is based on the application of monoclonal antibodies raised against one the principle epitopes of tissue polypeptide antigen (TPA). TPS is useful tool for the identification of proliferative epithelial cells and is negative in all non-epithelial tissues such as lymph nodes, bone marrow, carcino-sarcomic and neuroendocrine prostatic tumors. In previous studies we have shown the clinical usefulness of this serotest in serial measurements during prostate cancer monitoring. In this study serum prostatic specific antigen (PSA) concentrations and natural killer (NK) cell activity data were compared with serum TPS values in a wide spectrum of prostate cancer condition (99 patients), benign prostatic hypertrophy (BPH, 40 patients), atypical prostate (12 subjects) and in 8 healthy men. Measured parameters reflect different aspects of the disease. Blood PSA concentrations and TPS serotest values were found to denote the status of disseminated prostate cancer with nearly equal significance, while PSA appears to be a more appropriate tumor marker in early stages of the disease. In atypical prostate a nonsignificant elevation of both PSA and TPA values were recorded when compared with BPH. In parallel, a pronounced and sharp drop in NK activity data was assessed resembling closely respective data in progressive Stage D2 patients. TPS serotest clearly detects cancer progression in treated and untreated patients (P < 0.01) while being less efficient in distinguishing between tumor stabilization and partial remission (p > 0.05). In this respect NK activity data serve as a sensitive probe for the presence of epithelial tumor cells in the circulation even during stabilization of the disease. According to the reported results we advocate the application of the TPS serotest as a useful addition in monitoring progressive patients with advanced prostatic carcinoma.