GASTRIC CARCINOID TYPE 1 IN A PATIENT WITH AUTOIMMUNE POLYGLANDULAR SYNDROME: ADDITIONAL ENDOCRINOLOGICAL EVALUATION REQUIRED.

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.

Intraoperative gamma hand-held probe navigation in resection of osteoid osteoma tumor--report of two cases.

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.

[Consensus guidelines for diagnosis, treatment and follow-up of patients with pancreatic neuroendocrine tumors]. / Postupnik za dijagnostiku, lijecenje i pracenje oboljelih od neuroendokrinih tumora gusterace.

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.

Mandibular Caffey's disease--case report.

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.

[Minimally invasive radioguided parathyroidectomy]. / Minimalno invazivna paratiroidektomija vodena sondom.

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.

Acquired neuroendocrine-positivity during maximal androgen blockade in prostate cancer 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.