[Differentiated thyroid carcinomas]. / I carcinomi tiroidei differenziati (CTD).

Differentiated thyroid carcinomas are TSH-dependent tumors induced by genetic and environmental factors. They may be found on 3-12% of single thyroid lesions. Females are more affected than males (F:M 3:1). The combined action of genetic and environmental factors induces the development of these tumors. The cornerstone of diagnostic evaluation is Fine Needle Aspiration (FNA). Size tumors > 2.5 cm and age > 45 aa are unfavorable prognostic factors. Radical surgery is the first choice therapy followed by hormone suppressive therapy and/or I131. Follow-up is based on WBS and serum Tg evaluation. Moreover recombinant TSH offers a new approach in the field of relapse diagnosis and therapy.

[Anaplastic, insular, and medullary carcinoma of the thyroid]. / Il carcinoma anaplastico, insulare e midollare della tiroide.

Anaplastic carcinoma, insular carcinoma and medullary carcinoma (both familiar and sporadic forms) represent the 7-25% of all thyroid tumors. Anaplastic carcinoma is one of most aggressive human tumors and the therapeutic options proposed have failed to improve the prognosis of these patients. Insular carcinoma is a not well known thyroid neoplasia described for the first time in 1984 and showing intermediate biological behaviour between differentiated and anaplastic forms. Medullary carcinoma arises from parafollicular"C" cells of the gland and then may be considered a neuroendocrine tumor. Choice therapy is surgery, tiroxine is only substitutive, familiar screening is mandatory. Chemotherapy (dacarbazine or cisplatin and doxorubicine), radiotherapy and recently octreotide anologues, may be useful for relapsing not operable forms.

[A case of primary non-Hodgkin lymphoma of the breast]. / Un caso di linfoma non-Hodgkin primitivo della mammella.

Primary non-Hodgkin's lymphomas (NHL) of the breast represent less than 3% of extranodal NHL; in comparison to extranodal NHL at other sites, they are characterized by rapid progression and worse prognosis. We report a case of primary NHL of the breast treated, after surgery, with a sequential combination of chemotherapy and radiotherapy. Literature data suggest that the most important factors in therapeutic decisions making are the initial stage of the disease and the histological subtype.

[Metaplastic tumors of the breast: a case of primary squamous cell carcinoma]. / Tumori metaplasici della mammella: un caso di carcinoma squamoso primitivo.

We report a case of primary squamous cell carcinoma of the breast in a 58 years old woman. The diagnosis of this rare tumor is possible after excluding a skin primary lesion or an epidermoid cancer of a distant site. In reviewing the reported cases we didn't find any significant prognostic difference between this form and the breast adenocarcinoma with squamous metaplasia.

Bal T lymphocyte subsets are reduced in primary lung neoplasias.

Direct observation with an optic fibre bronchoscope facilitates the diagnosis, staging and treatment of both neoplastic and other lung diseases, and the varying diameters available enable IVth or even Vth-order bronchi to be examined. The technique can be employed for deep lung lavage or bronchoalveolar lavage (BAL) and for transbronchial biopsy. The BAL fluid, too, can be used to study lung cells and soluble components. In this study, 21 patients aged 32-79 (mean 55.5), namely 16 with lung cancer and with non-neoplastic lung diseases, were subjected to BAL to allow a study to be made of the BAL fluid cell composition. In the neoplastic group, CD3 lymphocytes were 41.3% compared with 63.2% in the peripheral blood. CD4 (24.6% vs 40.6%) and CD8 (16.6% vs 28.7%) displayed the same pattern. The CD4/CD8 ratio, on the other hand, was much the same in both groups: 1.7 vs 1.5. CD19 were higher in the BAL fluid (20.1%) than in the peripheral blood (4.8%). In the non-neoplastic group the differences between the BAL fluid and the peripheral blood are of the same sign, but less marked. In conclusion, the BAL fluid subset composition in primary lung neoplasia differs from that in the peripheral blood through a reduction of CD3, CD4 and CD8 and an increase in CD19 compared with the peripheral blood. These modifications are less evident in patients with non-neoplastic lung diseases.

Susceptibility to ketoconazole of Candida albicans strains from sequentially followed HIV-1 patients with recurrent oral candidosis.

The MIC values of the antifungal drug ketoconazole were evaluated on 66 Candida albicans strains. These strains were isolated from 26 HIV-1 infected patients with oral recurrent candidosis. Each episode of oral candidosis observed in these patients was orally treated with ketoconazole (200 mg/day) until the clinical disappearance of the lesions. The most frequent MIC values were 20 micrograms/ml and 10 micrograms/ml, observed in 37 and 19 isolates respectively. Only strains from five patients showed changes in their susceptibility to ketoconazole. This fact could indicate that a different strain causes the subsequent reappearance of the oral lesions, rather than the drug selecting resistant fungal strains. Our results stress the role of host characteristics in the occurrence of candidal infections, pointing to the progressing failure of the immunological response as the most important factor responsible for the recurrence of oral candidosis during HIV-1 infection.

Candida albicans biotypes in human immunodeficiency virus type 1-infected patients with oral candidiasis before and after antifungal therapy.

A prospective 19-month study of 26 human immunodeficiency virus type 1-infected patients with episodes of erythematous or pseudomembranous oral candidiasis was done to evaluate the significance of Candida albicans biotypes in patients treated with antifungal therapy. Changes in the biotype of C. albicans were frequently noted in recurrent oral candidiasis. However, no correlation was found between the various biotypes and the clinical features of oral candidiasis, the clinical stage of human immunodeficiency virus type 1 infection, or the number of CD4+ lymphocytes. On the contrary, a significant correlation appeared among clinical lesion features, CD4+ cell numbers, and time of clinical disappearance of the oral lesions. Changes in the biotype of C. albicans were observed at the end of the antifungal therapy in 17 of 26 patients who had a second appearance of oral candidiasis as well as in 10 of 14 subjects who experienced a third reappearance of oral candidiasis.

Role of smoking in goiter morphology and thyrotropin response to TRH in untreated goitrous women.

Three groups of women were evaluated for TSH response to TRH and for goiter morphology by means of thyroid ultrasonography: group A = goitrous nonsmokers; group B1 = goitrous moderate-smokers; group B2 = goitrous heavy-smokers. They were compared with a control group (group C) made up nongoitrous, nonsmoking women. The size of the goiter was not correlated with the daily consumption of cigarettes, even though in heavy smokers a nodular goiter was prevalent as shown by ultrasonography. The serum values of TT3 showed significant differences between nonsmokers and heavy smokers (p less than (p less than 0.005), whereas the serum values of TT4 and of basal TSH showed no statistically significant differences. On the contrary, the TSH response to TRH showed a significant difference between heavy and nonsmokers (p less than 0.05). In conclusion, it has been demonstrated that goitrous cigarette heavy smokers show: i) A prevalence of statistically significant nodular goiter; ii) A significantly higher TT3 serum levels; iii) A significantly higher re-of TSH to TRH. These data suggest that cigarette smoking favors the development of nodular goiter and can involve the central regulation of the hypothalamus-pituitary-thyroid interaction.

[Changes in the ratio of T-lymphocyte subpopulations in various cytological samples of Plummer's thyroid adenoma]. / Ecarts dans le rapport des sous-groupes de T-lymphocytes dans divers échantillons cytologiques de l'adénome thyroïdien de Plummer.

UNLABELLED: In order to correlate possible alterations of cell-mediated immune response with the evolutive phases of Plummer Adenoma (P. A.), T lymphocytes subpopulations in FNA samples and in peripheral blood lymphocytes (PBL) have been studied in 5 patients with autonomous nodules. The lymphocyte component in FNA and peripheral blood has been isolated by Lymphoprep gradient centrifugation; the analysis of T helper and T suppressor subpopulations was made by indirect immunofluorescence with OKT8 and OKT4 monoclonal antibodies. Our results show a reduction in OKT4/OKT8 ratio in cytological samples compared with PBL in patients with P. A., while in control subjects there was not statistically significant difference. In the patients with P. A., the relative increase of OKT8 lymphocytes in FNA compared with PBL is correlated with the functional state, that is toxic adenomas have a lower OKT4/OKT8 ratio compared with nodules in pre-toxic phase. IN CONCLUSION: T lymphocyte subpopulations typing in FNA demonstrate that, even in this type of hyperthyroidism, immune response disorders are present and consist of relative increase of suppressor/cytotoxic T cells, compared to T helper cells.