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Parathyroid Carcinoma - Diagnosis and Surgical Treatment a 24-year Experience

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Gawrychowski J., Kowalski G., Buła G.
Polish Journal of Surgery
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2010
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vol. 82
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issue 2
88-94
EN
The aim of the study was to evaluate the clinical, surgical and pathological prognostic factors of postoperative disease progression in parathyroid cancer patients.Material and methods. This is a retrospective study of 19 patients operated on between 1983 and 2007 for parathyroid cancer at the Department of General Surgery of the Silesian Medical University constituting 4.6% of the total 416 patients operated on during that time for primary hyperparathyroidism.Results. The study is based on a group of 7 (27%) men and 12 (63%) women aged 27 - 77 (av. 56). On admission, serum calcium levels exceeding 3.5 mmol/L were observed in 11 (58%) patients with parathyroid cancer and in 4 (1%) of the 397 patients with benign changes. Serum parathormone (PTH) levels higher than 450 pg/ml were found in 9 (47.4%) and 11 (2.8%) patients, respectively. Whenever parathyroid cancer was suspected, an en block resection of the parathyroid tumor including a wide margin of adjacent tissue was performed. Ipsilateral thyroid lobectomy was performed on 14 patients but in 5 cases total thyreoidectomy was required. 14 (73.7%) patients underwent either ipsilateral (11x) or bilateral (3x) lymphadenectomy. Within the group of 19 patients a total of 41 operations were required, including 4 operations in other medical centers. Three patients underwent adjuvant radiation therapy. The cumulative postoperative 5-, 10- and 15-year survival rate for the 19 parathyroid cancer patients was 95%, 82.5% and 62% respectively. Local and/or regional recurrences as well as remote metastases were found in 7 and 6 patients, respectively. Of the former group six patients are still alive after 3, 7, 9, 10, and - in two cases - 12 years (the 7th patient died 14 years after the first operation). Of the latter group three patients died of cancer dissemination 5, 7 and 8 years after the initial operation, but three others are still alive after 7, 10 and 14 years while still displaying the disease symptoms. Six patients, all of whom underwent one-stage resection of parathyroid glands and both ipsilateral thyroid lobectomy and lymphadenectomy, are still alive 8, 10, 11, 13, 14 and 21 years after with no evidence of the disease.Conclusions. 1. Parathyroid cancer should always be suspected while dealing with primary hyperparathyroidism in patients with significantly elevated serum calcium and PTH levels. 2. Ipsilateral lymphadenectomy is advocated for parathyroid cancer patients already during the initial operation. 3. In order to avoid parathyroid cancer relapse even many years after the surgery, periodic checks are recommended for the rest of the patients' lives.
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Parathyroid Cancer - Occurrence, Diagnosis, Treatment

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Gawrychowski J., Kowalski G., Gawrychowska A.
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Lateral and median cysts of the neck

88%
Buła G., Waler J., Niemiec A., Mucha R., Gawrychowski J.
Polish Journal of Surgery
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2012
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vol. 84
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issue 9
445-448
EN
The aim of the study was to present clinical picture, indications for surgery, immediate and remote results of surgical treatment for lateral and median cysts of the neck. Material and methods. A total of 17247 patients were operated between 1 January 1990 and 31 December 2011 for neck tumors. Results. Neck cysts were diagnosed in 34 (0.2%) patients, including lateral in 12 (35.3%) and median in 22 (64.7%). Lateral cyst once descended to the mediastinal. Nodular goitres were diagnosed in 17 (50%) of them - with the lateral cysts 4x and median cysts 13x. Guided fine-needle aspiration biopsy of the cyst-like lesions revealed the presence of protein masses in all patients. The lesions were found to have inflammatory character in 6 patients (17.6%) regarding median cysts (5x) or lateral cyst (1x). Out of them, 3 patients developed purulent inflammatory process. All patients were operated. The operation consisted of radical resection of the cyst only or plus partial resection of both thyroid lobes and total resection of pyramidal lobe if concomitant goitre was found. Two patients required one-stage resection of the enlarged lymph nodes in the neck. Suspected focus of thyroid papillary cancer was found by intra-operative examination in neck median cyst wall in one patient. However, paraffin tests did not confirm the suspicion. Another patient was found by histopathological examination to have active tuberculotic process within both lateral cyst and lymph nodes. The patient received intensive antituberculotic treatment postoperatively. Conclusions. 1. Median cysts of the neck are more often accompanied by thyroid tumor-like goitres than lateral cysts. 2. Radical resection of the cysts in operative treatment results in good long term patient condition and prevent in recurrence of the illness.
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Postoperative Acute Respiratory Failure In Patients Treated Surgically For Goiters

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Buła G., Mucha R., Paliga M., Truchanowski W., Gawrychowski J.
Polish Journal of Surgery
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2015
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vol. 87
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issue 7
331-335
EN
The aim of the study was to present a clinical picture, treatment and prognosis regarding patients who developed acute respiratory failure (ARF) while treated surgically for a goiter. Material and methods. A total of 3810 patients were treated for goiters between 2008 to 2013. Symptoms of postoperative ARF were recognized in 39 (1%) patients. Results. Symptoms of postoperative ARF were a postoperative hemorrhage in 31 (79.4%), lymphorrhagia in 1 (2.6%), bilateral paralysis of recurrent laryngeal nerves in 6 (15.4%) and acute circulatory – respiratory failure in 1 (2.6%). Postoperative hemorrhage appeared in 19 patients operated for nodular goiter, 4 with a retrosternal nodular goiter, 1x nontoxic recurrent retrosternal nodular goiter, 1x toxic recurrent retrosternal goiter nodular goiter, 2x Graves'goiter and 4x with malignant goiter. The cause of hemorrhage was parenchymal bleeding from the stumps and / or short neck muscles (29x), arterial bleeding (1x) and bleeding into the subcutaneous tissue (1x). Massive lymphorrhagia appeared as a result of damage to the thoracic duct after total thyroidectomy due to papillary thyroid carcinoma with cervical lymph node dissection on the left side. All patients who were diagnosed with bilateral paralysis of RLN, tracheostomy was performed. Of all 39 patients who underwent surgery two died – one in 6 days after surgery due to myocardial infarction, and another as a result of micropulmonary embolism and acute circulatory – respiratory failure in 18 hours after surgery. Conclusions. 1. The most frequent causes of acute respiratory failure in postoperative period are a hemorrhage from the operation site and bilateral paralysis of recurrent laryngeal nerves. 2. Acute postoperative respiratory failure is an indication for postoperative wound revision
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Intraoperative Assessment of Surgical Treatment used for Primary Hyperparathyroidism

88%
Buła G., Niemiec A., Truchanowski W., Podwińska E., Gawrychowski J.
Polish Journal of Surgery
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2008
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vol. 80
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issue 9
465-468
EN
The aim of the study was intraoperative assessment of surgical treatment used for primary hyperparathyroidism (PH) basing on immediate histopathological findings and of parathormone (PTH) concentrations in blood serum, the latter being determined before and after removal of the affected parathyroid glands.Material and methods. The study group consisted of 110 patients: 85 women and 25 men aged 16-72 years (mean 49.3), treated surgically for PH or its recurrence. Each patient was operated together with bilateral neck exploration. The identified parathyroid glands were assessed. The operation was considered successful if the cause of PH could be confirmed by intraoperative histopathological examination, and PTH level was found lower than 50% of its preoperative value. Negative results of intraoperative tests were considered an indication for wider exploration of the neck or another full imaging diagnostics in order to decide about reoperation.Results. Parathyroid adenoma was detected in 85 (77.3%) patients, proliferation of the gland in 18 (16.4%) and parathyroid cancer in 7 (6.3%). Basing on intraoperative microscopic and immunochemical examinations, the surgical treatment was found successful in 107 (97.3%) patients. PTH concentration was found normal in 94 patients, and significantly lower in 13. The operation was assessed as unsuccessful in 3 (2.7%) patients (2x recurrence of parathyroid cancer, 1x proliferation of parathyroid glands). A non-significant PTH drop was noted in 1 patient, and PTH increase in 2. One patient died because of disseminated tumor disease, and 2 patients received another imaging diagnostics and reoperation with good result.Conclusions. 1. Positive result of intraoperative histopathological examination together with a significant drop in parathormone concentration in peripheral blood serum are essential for successful surgical treatment of PH. 2. Negative results of microscopic and immunochemical examinations are an indication for wider neck exploration. If further procedure is still unsuccessful, a more profound imaging diagnostics is necessary followed by reoperation.
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DNA Ploidy in the Treatment of Stomach Adenocarcinoma: A Follow-Up Study

76%
Gawrychowski J., Tyczyński A., Danik A., Lackowska B., Koziołek H., Mucha R.
Polish Journal of Surgery
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2007
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vol. 79
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issue 12
753-761
EN
The aim of the study was to determine unfavourable prognostic factors for patients with stomach adenocarcinoma after their surgical treatment through evaluation of prognostic indicators for cellular ploidy and proliferative activity.Material and methods. A group of 51 patients following surgical treatment due to stomach adenocarcinoma and discharged from our hospital between 1995-2000 were studied here. The material examined was encased in paraffin blocks. After histopathological verification, the tumour segments within these blocks were used for cytofluorometric analysis of DNA-ploidy according to Hedley's method.Results. In 41 (80.4%) stomach cancer patients (out of the total group of 51 patients), diploid tumours were found. No significant relationship between DNA ploidy and sex, age, symptoms, inherited susceptibility to a disease, tumour magnitude, grade of histological malignancy, or grade of clinical progression was observed. Generally, after the stomach cancer operation, the probability of five-year survival was 22.1% for patients with diploid tumours (DI=1.0), and 20% for the patients with aneuploid tumours (DI ± 1.0). The probability of 10-year survival was 19.2% for diploid tumours, and 10% for aneuploid tumours. These differences were not statistically significant (p=0.255).Conclusions. 1. Classical clinicopathologic factors are still the best prognostic criteria for the evaluation of long-term results of surgical treatment for stomach cancer patients. 2. Determination of DNA-ploidy and proliferative activity of stomach cancer did not decrease the gap between long-term results prognosis for surgical treatment and actual results.
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Non-Recurrent Laryngeal Nerve

76%
Buła G., Mucha R., Paliga M., Koziołek H., Niedzielski Z., Gawrychowski J.
Polish Journal of Surgery
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2015
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vol. 87
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issue 7
336-339
EN
The aim of the study was to assess the frequency of non-recurrent laryngeal nerves (Non-RLN). Material and methods. A total of 6110 patients were operated in our hospital between 1 January 2005 and 31 December 2013 for various goiters (5429) and various types of hyperparathyroidism (618). Laryngeal nerve was exposed during operation in 1700 patients from superior aperture of the chest to superior aperture of the larynx. Identification process of RLN was started with dissecting inferior thyroid artery (ITA) and its junction with the nerve. Then main trunk of the nerve was exposed backwards till the region of superior aperture of the chest together with the end portion till the nerve outlet to the larynx. Results. In the group of 1700 patients, RLN was exposed bilaterally in 1400 (82.4%) and unilaterally in 300 (17.6%). In the group of 3100 dissected RLNs the course of RLN was observed on the right side in 1710 patients and on the left in 1390. Irreversible nature RLN was shown in four cases (0.1%) – four women (02%) aged 42-55 (mean 49.3) – three operated for non-toxic nodular goiter and one for primary hyperparathyroidism. Each time the Non-RLN was seen on the right side. The other patients manifested recurrent character RLN. Moreover, interstitial course of RLN was found on the left side in one man. Conclusion. Non recurrent laryngeal nerve is a rare anatomical variation, occurring more frequently on the right side. Surgeon during surgery of the thyroid and parathyroid glands should be aware of its existence to avoid damage.
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Hospital physiotherapy after strumectomy

76%
Pasek J., Waler J., Waler N., Pasek T., Wiesztort M., Gawrychowski J., Sieroń A.
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2010
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vol. 18
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issue 4
69-76
PL
Współcześnie w medycynie coraz częściej obserwuje się wzrost zachorowań dotyczących gruczołu tarczowego. Choroby te występują kilkakrotnie częściej u kobiet niż u mężczyzn. Operacyjne usunięcie gruczołu tarczowego, niestety, nadal często stanowi jedyne skuteczne leczenie tego typu schorzeń. Zalecane jest ono najczęściej w przypadku chorych z olbrzymim wolem, z wolem dającym objawy uciskowe na narządy sąsiadujące oraz u chorych z wolem zawierającym guzki zimne (podejrzenie nowotworu złośliwego) lub autonomicznie nadczynne. Nieodzownym elementem leczenia powinno być wczesne uruchamianie chorego, stosowanie wybranych zabiegów i metod kompleksowej fizjoterapii. W pracy przedstawiono szpitalne postępowanie fizjoterapeutyczne przed i po zabiegu strumektomii, które stanowić powinno nieodłączny element leczenia pacjentów na oddziałach chirurgicznych.
EN
The incidence rate of the thyroid gland diseases has been observed to grow at a increasing pace. Thyroid gland diseases occur more often (several times) in women than in men. Unfortunately, in many cases, surgical ablation of the thyroid gland is often the only way of effective treatment. Strumectomy is recommended for patients with gigantic goitre, with goiter giving compression symptoms on neighbouring organs, with goiter containing cold nodules (suspision of malignant neoplasm) or autonomous hyperfunction. It is vital for patients after strumectomy to be mobilized as early as possible after the operation and be subjected to selected procedures of comprehensive rehabilitation. This paper presents physiotherapeutic procedures employed in hospital rehabilitation before and after strumectomy, which the authors recognize as an indispensible element of treatment at surgical wards operating patients with thyroid gland diseases.
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DNA Ploidy in the Treatment of Large Bowel Adenocarcinoma: A Follow up Study

76%
Gawrychowski J., Tyczyński A., Danik A., Lackowska B., Mucha R., Koziołek H.
Polish Journal of Surgery
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2008
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vol. 80
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issue 1
6-13
EN
The aim of the study was to look for unfavourable prognostic features in colorectal cancer patients after their surgical treatment as well as to evaluate the prognostic value of cellular ploidy and proliferative activity.Material and methods. A group of 71 colorectal cancer patients discharged from the hospital after surgical treatment in the years 1995-2000 was studied. The examined material was acquired from paraffin blocks of tumour segments. After histopathological verification, the tumour segments recovered from paraffin blocks were used for cytofluorometric analysis of cellular ploidy according to the Hedley method.Results. Diploid tumours were found in 45 of 71 (63.4%) colorectal cancer patients. No significant relationship between DNA ploidy and sex, age, complications, inherited susceptibility to a disease, tumour magnitude, grade of histological malignancy, or grade of clinical progression was observed. After colorectal cancer surgery, the probability of five- and ten-year survival was 44.4% and 37.1%, respectively, for the patients with diploid tumours (DI=1.0), and 38.5% and 9%, respectively, for the patients with aneuploid tumours (DI≠1.0). These differences were not statistically significant (p=0.120).Conclusions. 1. Classical clinicopathologic factors are still the best prognostic criteria for the evaluation of the future results of colorectal cancer patients' surgical treatment. 2. Determination of cellular ploidy and proliferative activity of colonic adenocarcinoma cannot increase the ability to predict prognosis based on surgical treatment.
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JunGene Expression is Decreased in Parathyroid Adenoma

52%
Żebracka-Gala J., Waler J., Gawrychowski J., Hasse-Lazar K., Kowalska M., Niemiec A., Szpak-Ulczok S., Jurecka-Lubieniecka B., Buła G., Truchanowski W., Gubała E., Jarząb B.
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issue 10
457-464
EN
The aim of the study was to analyze the gene expression of JUN and CCND1 in a group of parathyroid tissues obtained from patients with primary hyperparathyroidism in comparison to hyperplastic parathyroid and normal/atrophic parathyroid tissues by real-time quantitative PCR. Our goal was to validate the conclusion of Forsberg et al (2005) who reported overexpression of JUN in parathyroid adenomas by a joint microarray and QPCR study.Material and methods. The analysis of JUN, CCND1 was carried out by QPCR in 14 parathyroid adenomas, 8 hyperplasia cases and 50 normal/atrophic parathyroid samples taken intraoperatively. Expression of the examined genes was normalized to the reference index (geometric mean of reference genes expression: EIF3S10, UBE2D2, ATP6V1E).Results. We observed a decrease of JUN expression in parathyroid adenomas in comparison to both normal/atrophic and hyperplastic parathyroids. The fold change value was 0.71 in comparison of adenomas to normal/atrophic samples (p = 0.044) and 0.75 to hyperplastic glands (p = 0.003). For CCND1 we observed one case of parathyroid adenoma with a very clearly increased expression, while 3 adenomas (21.4% of all adenomas) exhibited the increase over the highest value seen in normal parathyroids (fold change = 3.52).Conclusions. In parathyroid adenomas we were not able to confirm any overexpression of JUN gene, as suggested by the previous study. On the contrary, we observed a distinct inhibition of JUN RNA expression in comparison to non-neoplastic parathyroids. For CCND1 gene overexpression in parathyroid adenomas, we report the frequency of 21.4%.
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