Along with classic papillary thyroid cancer, there are rare histological variants with special clinical features, and often physicians are not well informed about them. We present a clinical case of 25 years-old female, who was diagnosed with papillary thyroid cancer based on neck ultrasound and fine needle aspiration biopsy followed by thyroidectomy. The histological and immunohistochemical investigation (expression of cytokeratin-19, CD 56, thyroglobulin, β-catenin) were performed and cribriform-morular carcinoma was identified. It’s believed that this type of papillary thyroid cancer in the majority of cases is associated with familial adenomatous polyposis of the colon. This disease with an autosomal dominant type of inheritance is caused by the mutation of the APC suppressor gene and characterized by the presence of multiple adenomatous polyps in the colon with a 100% risk of malignancy and colon cancer. The patient underwent an additional examination with colonoscopy which revealed polyps in all parts of the colon ranging in size from 1 mm to 3.5 cm. We identified mutation in gene APC — p.S1104X and performed a preventive coloproctectomy. The histological examination verified tubular and tubulovillous adenomas with moderate epithelial dysplasia. During 6 years of follow-up of patient, structural and biochemical remission of thyroid cancer was observed.

We present a case of a 62-year-old patient with multinodular substernal goiter and tracheal compression (up to 5 mm). The multinodular goiter was initially diagnosed 3 years before by a local endocrinologist. The patient had been suffering from difficulty of breathing and exertional dyspnea for two years. He consulted specialists in therapy, pulmonology, cardiology more than once. However, none of the clinicians was able to identify the cause of labored respiration. Eventually an endocrine surgeon diagnosed a case of the complicated multinodular goiter with the development of cervical compression syndrome and tracheal narrowing.

Ultrasound study showed the diffuse enlargement of the thyroid gland mainly due to the large left lobe with a total volume of 132,5 cm3. Computed tomography showed the shift of trachea to the right because of its compression by the left lobe and the luminal narrowing up to 5 mm. The patient needed surgical intervention by life-saving indications. He underwent thyroidectomy. The postoperative period was uneventful, the patient did not complain about labored respiration and reported the improvement of physical activity. It is important to keep in mind that patients with multinodular goiter have the potential risk of developing cervical compression syndrome. Current case demonstrates that such patients should be examined by an endocrine surgeon as early as possible in order to perform timely elective surgery.

This paper presents a clinical case describing hypoglycemic condition with atypical symptoms in a young patient in the early postpartum period. Abdominal ultrasound revealed a large formation in the hook region of the pancreas, which was subsequently confirmed according to endoscopic ultrasound, CT and MRI. The idea of insulinoma was formed according to the presence of pancreatic formation, documented Whipple’s triad, and data on hyperinsulinism at the outpatient stage. However, the 72-hour fasting test showed no significant increase in insulin and C-peptide levels. After excluding other causes of hypoglycemia, the patient was suspected of having proinsulinoma, which was confirmed by increased blood proinsulin level. Gastropancreatoduodenal resection was performed. We detected a highly differentiated neuroendocrine pancreatic tumor with the expression of CD56, NSE, synaptophysin and chromogranin A, with a Ki-67 index of about 1%. After surgical treatment, hypoglycemic conditions were not observed.

Primary hyperparathyroidism is one of the common endocrine diseases, which is an actual medical and social problem. Bone disorders are the most common manifestations of primary hyperparathyroidism and are characterized by increased bone metabolism with a progressive decrease in mineral density and a high risk of fractures. In the Russian Federation, most cases are manifest forms of the disease (70%), which is mainly due to the low level of diagnosis, including due to the lack of awareness of doctors. At the same time, timely detection of the disease is based on relatively accessible laboratory studies, characterized by elevated levels of calcium and parathyroid hormone in the blood, and ultrasound and scintigraphy in most cases provide visualization of the paraadenoma. A clinical case of a severe form of primary hyperparathyroidism, the late diagnosis of which caused the development of severe osteoporosis with multiple fractures, is considered. The presented case indicates that an important role in the timely detection of the disease belongs to the analysis of the clinical picture.

Harvey Cushing is one of the greatest surgeons of the early 20th century. The young doctor was trained in the best medical universities; parents, teachers and colleagues always noted his thirst for knowledge. Cushing opened a new page in the study of neurosurgery, endocrinology, anesthesiology, and neurology. Thanks to the improvement of surgical techniques, the great doctor has achieved a reduction in mortality in surgical interventions, and new diagnostic methods have given life to more than one person. Cushing’s versatility amazed his contemporaries and still surprises the world. His books won the Pulitzer prize, one of the most prestigious literary prizes, he was repeatedly nominated for the Nobel prize, and the American Association of neurosurgeons is named in honor of the greatest doctor.