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Poiana C.,Carol Davila University of Medicine and Pharmacy | Poiana C.,Constantin I Parhon National Institute Of Endocrinology | Neamtu M.C.,University of Medicine and Pharmacy of Craiova | Avramescu E.T.,University of Craiova | And 8 more authors.
Romanian Journal of Morphology and Embryology | Year: 2013

Dedifferentiation is a process that may be found in metastasis from the neuroendocrine tumors. We present the case of a female within the seventh decade of life incidentally diagnosed with a mature teratoma with element of cartilages, bronchia, mucinous glands, and a poorly differentiated neuroendocrine carcinoma (Ki67 of 30%). After six months of chemotherapy and another six months of disease free interval, a metastasis of the great omentum was removed. The dedifferentiation was diagnosed based on much higher Ki67 (of 70%). The loss of estrogen receptor of 40% from the initial site to 3% into metastasis indicates an exclusive neuroendocrine aggressive pattern. The ovarian carcinoid is a rare situation, and metastasis to the great omentum with dedifferentiation is even seldom.


Poiana C.,Constantin I Parhon National Institute Of Endocrinology | Poiana C.,Carol Davila University of Medicine and Pharmacy | Carsote M.,Constantin I Parhon National Institute Of Endocrinology | Carsote M.,Carol Davila University of Medicine and Pharmacy | And 11 more authors.
Romanian Journal of Morphology and Embryology | Year: 2013

The neuroendocrine tumors (NETs) have an increased incidence related to the age. Secondary osteoporosis might be found in patients with bone metastases and in those with NETs associated Cushing's disease or primary hyperparathyroidism. Primary osteoporosis might be found in postmenopausal women, but in case with non-metastatic NET as G1 NET it is difficult to establish the NET contribution to the bone loss. We present the case of a 53-year-old female accidentally diagnosed with G1 lung NET after surgery of the tumor. The immunohistochemistry pointed positive reaction for CHROMO, SYN and negative for CK7 and TTF1, and a Ki67 of 1-2% (well-differentiated neuroendocrine tumor). The central Dual X-Ray Absorptiometry (DXA) showed osteoporosis based on a T-score of -3. The patient had normal neuroendocrine markers and she was asymptomatic. She remained so for one year and the only therapy provided was weekly alendronate with adequate vitamin D and calcium supplements. Based on the pathological and immunohistochemistry profile, the low risk NET was diagnosed. We encourage the skeletal status assessment as central DXA in postmenopausal women with NETs, regardless clinical evidence of bone loss. The future will provide more epidemiological and pathogenic connections between the two dynamic fields of medicine as neuroendocrine tumors and osteoporosis.


Miulescu R.D.,Carol Davila University of Medicine and Pharmacy | Miulescu R.D.,Constantin I Parhon National Institute Of Endocrinology | Neamtu M.C.,University of Medicine and Pharmacy of Craiova | Margina D.,Carol Davila University of Medicine and Pharmacy | And 4 more authors.
Romanian Journal of Diabetes, Nutrition and Metabolic Diseases | Year: 2014

Background and Aims. The interactions between kidney and thyroid functions are well established: thyroid hormones are necessary for the maintenance of electrolyte and water homeostasis and kidney is involved in the regulation of thyroid hormones metabolism. The aim of our study was to estimate the prevalence of thyroid dysfunction in patients with diabetes mellitus and chronic kidney disease (CKD). Material and Method. 23 patients with diabetes mellitus and CKD in pre-dialysis phase were recruited for this study. All subjects were investigated with thyroid ultrasound and laboratory tests to determine thyroid function, including: serum triiodothyronine (T3), free thyroxine (free T4), thyroid-stimulating hormone (TSH) and antithyroid peroxidase antibodies (ATPO). Results were compared with the same measurements in 21 patients with diabetes mellitus but without CKD. Results. The prevalence of goiter (52.17% vs. 19.04%, p<0.05), subclinical hypothyroidism (23.80% vs. 9.52%, p<0.05), hypothyroidism (8.69% vs. 4.76 %, p<0.05) and low T3 syndrome (23.80% vs. 0.00% p<0.05) were significant high in diabetic patients with CKD compared with patients with diabetes mellitus but without CKD. Conclusions. We observed high prevalence of thyroid morphology abnormalities and thyroid function disorders in diabetic patients with CKD. Low T3 syndrome and subclinical hypothyroidism are the most frequently thyroid function disorders in CKD patients. © 2014 ILEX PUBLISHING HOUSE, Bucharest, Roumania.


Poiana C.,Carol Davila University of Medicine and Pharmacy | Poiana C.,Constantin I Parhon National Institute Of Endocrinology | Neamtu M.C.,University of Medicine and Pharmacy of Craiova | Avramescu E.T.,University of Craiova | And 10 more authors.
Romanian Journal of Morphology and Embryology | Year: 2013

Background: The G2 neuroendocrine tumors (NET) or well-differentiated neuroendocrine carcinomas (2010 WHO Classification of Tumours of the Digestive System) embrace different types of evolution despite the fact that they actually are included in the same group of prognosis based on mitotic count and the Ki-67 proliferation index. Aim: We studied the pathological and clinical aspects in patients with G2 NET. Materials and Methods: This is a retrospective pilot observational study in patients admitted between January 2008 and January 2013 in "Constantin I. Parhon" National Institute of Endocrinology, Bucharest, Romania. They were evaluated based on the pathological report, imagistic scan, and neuroendocrine markers. Results: Nine patients (female/male ratio: 5/4) with G2 NET were included (mean age at diagnosis 54.11 years). Surgery was performed in 66.66% of cases. 44.44% of tumors had unknown origin. 22.22% of patients had negative immunostain for chromogranin A. Synaptophysin was positive in all cases. Neuronal specific enolase (NSE) was performed in 44.44% of cases and it was positive in all these situations. 88.88% of patients had high neuroendocrine markers. Multiple tumors were found in two cases (follicular thyroid adenoma, and a carcinoma of the port vein, respective bilaterally pheochromocytomas). The youngest patient (39-year-old) had atypical onset with bilateral adrenal tumors (positive for CHROMO, EMA, CK-19, CK-20, negative for SOMATO, CK-7, S-100, glucagon, CD57, and a Ki-67 of 15%). Death was registered in two cases, both with bone metastases. Discussion: Some poor prognosis factors may be taken into account as lack of CHROMO immunostain, young age at diagnosis, genetic background, and lack of therapy options as surgery. Larger databases will provide more information. Conclusions: It is possible that the G2 NET group of tumors actually includes some different subtypes or in fact, a late diagnosis of the tumor might be associated with a poor diagnosis.


Paun D.,University of Bucharest | Paun D.,Constantin I Parhon National Institute Of Endocrinology | Neamtu M.-C.,University of Medicine and Pharmacy of Craiova | Avramescu E.T.,University of Craiova | And 7 more authors.
Romanian Journal of Morphology and Embryology | Year: 2014

Aim: The aim of this study was to make immunohistochemical analyses with Inhibin alpha-subunit, Melan A and MNF116 (pan-Cytokeratin antibody) in pheochromocytomas, because immunohistochemistry is useful for the distinction between adrenal tumors. Patients and Methods: We used 20 patients with pheochromocytomas submitted to laparoscopic (n=19) or classical (n=1) surgery and we have explored immunostaining with Inhibin alpha-subunit, Melan A and MNF116 in these tumors. This can be helpful when we cannot make the distinction between adrenal tumors. Results: Pheochromocytomas did not stain with Inhibin alpha-subunit, Melan A and MNF116. Conclusions: In our study, Inhibin alpha-subunit, Melan A and MNF116 were not sensitive for pheochromocytomas. © 2014 ROMANIAN ACADEMY PUBLISHING HOUSE. All rights reserved.


Poiana C.,Carol Davila University of Medicine and Pharmacy | Poiana C.,Constantin I Parhon National Institute Of Endocrinology | Carsote M.,Carol Davila University of Medicine and Pharmacy | Ardeleanu C.,Victor Babes National Institute | And 5 more authors.
Romanian Journal of Morphology and Embryology | Year: 2011

Thyroid metastasis is atypical. We present a 70-year-old female case that was first diagnosed as gastric cancer after surgical approach. Two years later a thyroidectomy was performed and the immunohistochemistry (IHC) profile revealed a neuroendocrine tumor (NET): poorly differentiated neuroendocrine carcinoma (with small cells), with positive reaction for SYN, CROMO, negative for calcitonin, TTF1 and thyreoglobulin. The Ki-67 index was 25%. Considering the unusual metastasis, the IHC exam of the stomach tumor was performed pointing the same features as the thyroid findings. This proved that the thyroid tumor was a metastasis from a primary gastric neoplasia. This is an unusual case of NET because of the thyroid involvement. Nevertheless, the IHC exam played the major role in elucidating the diagnosis and the prognosis of the case.


Carsote M.,Carol Davila University of Medicine and Pharmacy | Paun S.,Carol Davila University of Medicine and Pharmacy | Paun S.,Floreasca Emergency Hospital | Neamtu M.C.,University of Medicine and Pharmacy of Craiova | And 10 more authors.
Romanian Journal of Morphology and Embryology | Year: 2012

Type 1 neurofibromatosis associates various abdominal tumors as gastrointestinal stromal tumors, duodenal or pancreatic carcinoid, and adrenal tumors like pheochromocytoma. We present the immunohistochemistry report in two cases with different profile regarding the evolution. One case is a 7th decade women diagnosed with unilateral pheochromocytoma and GISTs, with a good prognosis after surgery. The other case is a 41-year-old male diagnosed with duodenal metastatic somatostatinoma after an intestinal occlusive syndrome and later the hormonal profile leaded to the diagnosis of pheochromocytoma. The patient had a fulminate evolution within six months from diagnosis.


Baciu I.,Carol Davila University of Medicine and Pharmacy | Radian S.,Carol Davila University of Medicine and Pharmacy | Capatina C.,Carol Davila University of Medicine and Pharmacy | Botusan I.,Carol Davila University of Medicine and Pharmacy | And 7 more authors.
Acta Endocrinologica | Year: 2013

Background. Germline aryl hydrocarbon receptor-interacting protein (AIP) mutations are found in familial isolated pituitary adenoma syndrome (FIPA) families and in a small number of sporadic pituitary adenoma (PA) patients. Although the tumorigenic mechanisms of AIP mutations are unclear, truncating mutations are considered pathogenic, but missense mutations are difficult to evaluate. p.R16H (c.47G>A) is a controversial AIP variant of unknown significance. Aim. To describe a new PA case associated with AIP p.R16H. Patients and methods. One AIP p.R16H non-functioning pituitary adenoma (NFPA) case identified by mutation sequencing screening of sporadic PA patients; 108 controls were screened for p.R16H. Results. The 38 yrs old male NFPA patient had no family history of PA and harboured a heterozygous p.R16H variant. The proband and two brothers presented severe intellectual disability. Severe visual impairment was the initial symptom and clinical, biochemical and imaging examination demonstrated a large NFPA invading the right cavernous sinus. After transsphenoidal debulking, the remaining tumor continued growth. One of proband's sisters was negative for p.R16H. Among controls, we identified one heterozygous p.R16H carrier, presenting a thyroid follicular neoplasm. Loss of heterozygosity analysis of the pituitary and thyroid tumors was not performed. Conclusions. We report two new occurrences of AIP p.R16H, associated with a NFPA and with a thyroid tumor. The NFPA patient was young and presented an invasive macroadenoma, features typical of AIP-mutated patients. Because the association between p.R16H and PAs has not been conclusively established, further research of p.R16H is warranted, in view of its implications for AIP genetic testing.


Bumbea H.,Carol Davila University of Medicine and Pharmacy | Badiu C.,Constantin I Parhon National Institute Of Endocrinology | Dobrescu R.,Constantin I Parhon National Institute Of Endocrinology | Vladareanu A.,Carol Davila University of Medicine and Pharmacy
Acta Endocrinologica | Year: 2013

We report the case of a 24 years old male, diagnosed with severe pancytopenia, possibly myelodysplastic syndrome with ringed sideroblasts associated with immune thrombocytopenia, who presented with hyperthyroidism due to Graves' disease. Standard antithyroid drugs were postponed for fear of exacerbation of cytopenia. Instead, steroid and immunoglobulin therapy gradually induced euthyroidism which was followed by correction of the hematological abnormalities. We review in this paper literature reports that discuss the association of thyrotoxicosis with pancytopenia, with reversibility of both the hematological and endocrine autoimmune picture after immunosuppressive treatment.

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