Chordoma of the Oropharynx.

Background: Chordoma is a rare malignant neoplasm that predominantly arises from the axial skeleton, but can also develop in unusual locations. However, there are also rare cases of "NOS" chordoma involving the oropharyx and epithelial-myoepithelial carcinoma of the parotid gland in the same patient. According to contemporary research, chordoma is a rare malignant neoplasm that arises from the embryonic remnants of the notochord. and typically involves the clivus, sacrococcygeal bones or vertebrae. Studies have shown that the incidence of chordoma has been estimated to be one per one million people per year. Chordoma can occur at any age, but most commonly it is diagnosed in the 40-60 year old age group with the male predominance. Objective: The aim of this article was to review the case of a 74-year-old female patient with epithelial-myoepithelial carcinoma of the parotid gland and a case of "NOS" chordoma involving the oropharyx. Methods: Diagnostic methods were used to examine a female patient with two primary malignant tumors: CT neck scan, CT of paranasal sinuses, ultrasound examination, scintigraphy and operative finding. Case presentzation: Due to the anatomy complexity, complete resection of the tumor through a transoral-transpharyngeal approach was not possible. Intraoperative palpation of the mass revealed well defined submucosal lesion 20x43x46mm beginning at the level of the oro- and hypopharynx and extending superiorly to the nasopharynx, and posteriorly into the spinal canal and intervertebral foramen causing near complete occlusion of the oro and hypopharynx. The patient also underwent extracapsular dissection of the parotid tumor. Postoperative palliative radiotherapy was performed. Conclusion: Surgical treatment remains the mainstay of treatment for EMC and radiation is imperative for patients who refuse surgery and for those with advanced or inoperable diseases.

Correlation of localization and size of the parathyroid glands by ultrasound and intraoperative findings in hyperparathyroidism.

Aim To determine a correlation between the localization of the parathyroid gland (PTG), based on ultrasound (US) examination and the operative findings, as well as the correlation between the size of the parathyroid glands measured by ultrasonography (USG) with pathological findings+, and prevalence of enlarged parathyroid glands in various forms of hyperparathyroidism. Methods A total of 83 patients with hyperparathyroidism who had undergone parathyroidectomy over a period of seven years were included in the study. US examinations of the neck and scintigraphy were performed before surgery in 83 and 42 patients, respectively. In the pathohistological analysis, in addition to diagnosis, the size and weight of the parathyroid gland were measured. Results US examination revealed 125 enlarged parathyroid glands and two normal-sized glands. Scintigraphy revealed 52 enlarged and three normal-sized parathyroid glands. Enlarged parathyroid glands were more frequently found in the projection of the lower pole thyroid glands. A significantly higher number of enlarged upper parathyroid glands were found by the operative findings than by US. There was no statistically significant difference in the diagnosis of enlarged parathyroid glands in all three forms of hyperparathyroidism. There was a positive correlation between the size of the parathyroid glands obtained by US and the size of the operative finding (κ=0.51; p=0.00 and p<0.0005, respectively). The relationship between parathyroid gland size measured by ultrasound and pathological analysis showed a positive correlation. Conclusion Ultrasound was useful in evaluating enlarged parathyroid glands, especially in combination with scintigraphy.

Hyperparathyroidism: Pathological Diagnosis and Association with Parathyroid Localization.

Background: The most comon patohistological finding in primary hyperparathyroidism is adenoma of the parathyroid gland, followed by hyperplasia and the rarest is carcinoma. However, hyperplasia of the parathyroid glands (PTG) is most commonly found in secondary and tertiary hyperparathyroidism. Objective: To determine the relationship between the localization of the parathyroid glands and pathological diagnosis, as well as the prevalence of individual pathological diagnosis after surgery in patients with hyperparathyroidism. Methods: Analysis of retrospective-prospective database of 79 patiens who underwent parathyreoidectomy for hyperparathyroidism in the 7-year study period. Diagnostic methods were used to identify enlarged parathyroid glands as well as to determine their localization: ultrasound examination, scintigraphy and operative finding. Standard hematoxylin eosin staining was used for pathohistological diagnosis. A correlation analysis between parathyroid gland localization and pathohistological diagnosis was performed. Results: The median age of the patients were 51 age (range 20-73) and 67,1% of the patients were female. In the total number of surgically removed parathyroid glands (182), the most common pathohistological diagnosis was hyperplasia. Parathyroid adenoma was found in 21 cases. Other diagnoses (thyroid nodule / tissue, lymph node, thymus, cancer) were found in 11 cases, while a normal finding was found in 12 glands. Pathohistological diagnosis of hyperplasia and adenoma were more common in the lower parathyroid glands. Using the chi-square test, no association was found between pathohistological diagnosis and localization of enlarged parathyroid glands. Conclusion: The most common pathohistological diagnosis in hyperparathyroidism was hyperplasia and was most commonly found in the inferior parathyroid glands. Adenoma as pathohistological diagnosis is also most commonly found in the lower parathyroid glands, but without statistical significance.

The Relationship Between Thyroid Antibodies and Vitamin D Level in Primary Hypothyroidism.

INTRODUCTION: Vitamin D deficiency is a global health problem. Its deficiency has been reported to be associated with different autoimmune diseases. AIM: The aim of this study was to evaluate the relationship between vitamin D level and thyroid antibodies in autoimmune hypothyroidism. METHODS: A total number of 150 individuals were enrolled in this study. They were divided into the fallowing groups: group I included 50 patients with autoimmune thyroid disease (AITD), group II included 50 patients without autoimmune thyroid disease. Group III included 50 apparently healthy participants representing a control group. All participants underwent a detailed clinical examination and laboratory tests including, 25 (OH) vitamin D, thyroid-stimulating hormone (TSH) and thyroid autoantibodies assessment, including anti-thyroid peroxidase antibodies (anti-TPO) and anti-thyroglobulin antibodies (anti-TG). RESULTS: Serum levels of 25 (OH) vitamin D recorded a highly significant difference between the studies groups (20,76±6,31 ng/ml in group I vs. 24,37±9,05ng/ml in group II vs. 24,57±6,45ng/ml in group III, p<0,01). Moreover, there was a highly significant difference between patients with AITD and patients without AITD (20,76±6,31ng/ml vs. 24,37±9,05ng/ml, respectively; p<0,01). The concentration of anti-TPO and anti-TG antibodies were statistically significant higher in patients with vitamin D deficiency (p< 0,001). Serum TSH were significantly higher in group I (p< 0,001). CONCLUSION: Significantly low levels of vitamin D were documented in patients with AITD that were related to the presence of anti-thyroid antibodies and higher level thyroid-stimulation hormone (TSH), suggesting the involvement of vitamin D in the pathogenesis of AITD and the advisability of supplementation.

Correlation Between the Parathyroid Glands Size and Parathormones Value in Patients with Hyperparathyroidism.

INTRODUCTION: Hyperparathyroidism is a common endocrine disorder with potential complications of bone, renal, neurocognitive and cardiovascular system. AIM: To determine the correlation between the size of parathyroid glands and parathormone values in the patients with hyperparathyroidism. METHODS: We analyzed a retrospective-prospective database of 79 consecutive patients who underwent parathyroidectomy for hyperparathyroidism at our institution between January 2011 and February 2018. The values of parathormone, calcium and phosphorus were determined in all patients before and after surgery. Ultrasonography were performed before surgery. Imaging results were confirmed by pathology. We analyzed the correlation between the sizes parathyroid glands obtained trough ultrasonography and pathology with parathormone values. RESULTS: The median age of the patients were 51 age (range 20-73) and 67,1% of the patients were female. Our study demonstrated that between actual glands sizes (volumes), expresses in millimeters, measured on pathohistological analysis and ultrasound examination and size value of parathormone its increased value does not affect the size of the gland. We investigate the correlation between the size of glands measured according to the pathohistological finding and the value of parathormone we obtained the correlation results close to the statistical features. The correlation value of parathormone and glands sizes according to the pathohistological finding measured trough the determined assessment scale we determined the statistically important of medium value. CONCLUSION: One of the important factors for parathyroidectomy is the value of parathormone. Serum parathormone level might be predictable by a total size of parathyroid glands and could be an effective the predictor of gland localisation.

Death as a Consequence of Foreign Body Aspiration in Children.

AIM: To analyze the rate of mortality in children with foreign body aspiration (FBA). METHODS: We outlined a retrospective review of hospital data of patients between 1971 and 2013. FBA occurring in children 0 year to 14 years was considered for inclusion (patient ages ranged from 0.6 to 15 years, with a median age of 2.2 years). The gender structure within the investigated cases was 75.8% males and 24.2% females. During the study period, 772 patients undergoing rigid bronchoscopy with the diagnosis of FBA were included. Deaths on arrival were excluded. RESULTS: Total rate of mortality (for whole investigated period) was 0.785. For last fifteen years of the investigated period the rate of mortality was zero. CONCLUSION: For prevention of foreign body aspiration in children and its mortality should be taken two strategies: non-medical (alterations in product design and public education campaigns) and medical (education of medical staff and improvement of equipment).

Papillary thyroid carcinoma in a female patient with squamous cell carcinoma of the larynx.

The larynx and thyroid gland are the most common sites for head and neck malignancies. The existence of two primary cancers are rare and especially if they are in the same region, and both are very invasive. Subglotic laryngeal cancer is the rarest, with only 1% frequency of all laryngeal cancers. We are reporting on a case of a forty-seven- year-old female urgently admitted to the Ear, Nose and Throat (ENT) Clinic in Tuzla, with severe respiratory insufficiency. The patient underwent total laryngectomy, total thyreoidectomy, radical and functional neck dissection. Histological examination showed laryngeal squamous cell carcinoma and papillary thyroid carcinoma.

Pattern of head and neck malignant tumours in a Tuzla ENT clinic--a five year experience.

Head and neck neoplasia can affect certain fundamental functions, including eating, drinking, speaking and respiration. One overriding factor in deciding on treatment policy is the tendency for head and neck malignancy to be limited to the primary site and regional lymph nodes with surgery and chemotherapy and radiotherapy. The aim of the study was to analyze the occurrence of Head and Neck tumours operated at ENT clinic Tuzla, University Clinical Center Tuzla, Bosnia and Herzegovina. Medical records of patients with histopathologically confirmed head and neck malignancies over a 5 year period (2003-2007) were analyzed. Eight hundred and eight one (881) cases, made up of 519 (58,8%) males and 362 (41,1%) females were found. The most common sites for head and neck malignancies were found to be in the larynx (26,1%), oral cavity (21,7%), the thyroid gland (14,64 %) and the neck (8,51%). A total of 230 patients were diagnosed with laryngeal carcinoma (M:173; F:57), showing the increasing number of female patients. The histopathological tumour types found in this work were mostly squamous cell carcinoma (72,09%), papillary carcinoma (12,2%), while many other minor histopathological variants accounted for 13%. The most patients were presented with stage I and stage III of disease (27% and 28,3%), and 19,9% with stage IV. About 40% of patients did not have data about smoking habit and alcohol drinking. The incidence of head and neck tumours seems to be relatively high, but without significant increase during investigated period. More investigation concerning risk factors, diagnostic procedures, and management strategies should be done in future.