BACKGROUND. Currently, pheochromocytomas are classified as malignant tumors (WHO 2017), which means that special postoperative tactics are required for patients with different risks of pheochromocytoma aggressiveness.

AIM. Assess the predictors of malignant potential of pheochromocytomas using the GAPP and PASS scales.

MATERIALS AND METHODS. From 2016 to 2021, 24 patients diagnosed with pheochromocytoma, age from 18 to 81 years (median 50.4+-3.3), were hospitalized at the Primorsky Regional Center for Diabetes and Endocrine Diseases, 21 of them were women and 3 were men. Hormone producing adenoma in the right adrenal gland was found in 13 patients (54.2%), on the left in 8 (33.3%) cases, bilateral pheochromocytoma — in 3 (12.5%) cases. Clinical manifestation: a sharp increase in systolic blood pressure of more than 200 mmHg accompanied by crises, tachycardia was detected in 14 patients, the rest of the clinical symptoms were nonspecific: persistent arterial hypertension, as well as general weakness. The sizes of the revealed formations varied from — 1.1x1.6x1.6 cm to — 7.7x10.6x8.5 cm. (median 37+-1.2). The diagnosis was confirmed by standard examinations. All patients underwent unilateral adrenalectomy at the Surgery Center of the FEFU Medical Center, using two main methods: retroperitoneoscopy and laparoscopy. After the operation, histological and immunohistochemical studies were performed. The analysis of immunohistochemical studies was carried out. The expression of Ki67, Chromogranin A, Synaptophysin was determined. Since it is currently impossible to absolutely accurately determine the malignant potential of pheochromocytomas, the PASS and GAPP scores have been introduced into clinical practice. A retrospective analysis of the cytological material of patients operated on in 2020 and 2021 was carried out.

RESULTS. According to the PASS scale, more than 4 points were detected in 7 out of 10 patients. GAPP scores ranged from 0 to 2 in 3 out of 10 people; 3-6 points for 5; more than 7 points in 2 patients. At the same time, the results of the calculation on both scales in 100% of cases correspond to each other, which makes it possible to identify patients with moderate and high malignant potential.

CONCLUSION. The results obtained confirm the need to use additional tools in clinical practice to determine the prognosis in a particular patient, which means it will allow developing an algorithm for dispensary observation, the timing of the follow-up examination.

Aim. A clinical case of a non-functioning tumor of the adrenal gland, its diagnosis and treatment.

Materials and Methods. Histological preparations were stained with hematoxylin and eosin, photographed at 200 magnification.

Results. Adrenal cysts are benign neoplasms that are hormonally inactive and can be asymptomatic for a long time. They are often discovered incidentally during an ultrasound or CT scan. Prior to the improvement of diagnostic methods, formations such as adrenal cysts were extremely rare. To date, there is a trend towards a steady increase in the frequency of adrenal tumors detected incidentally and is about 6–10%. Hormonally inactive adrenal tumors usually do not require surgery, but there are clinical situations in which surgery is necessary. As an example of a disease, a clinical case is given below.

Patient P., 39 years old, was hospitalized in the urology department from 12/13/2021 to 12/24/2021 with a diagnosis: D35.0 Benign neoplasm of the adrenal gland (cyst of the left adrenal gland). Upon admission, there were complaints of aching pain in the left lumbar region.

He considers himself ill for several years, was treated for another disease, an ultrasound in 2018 accidentally revealed a neoplasm of the adrenal gland on the left. At the last ultrasound control, an active growth of the neoplasm was detected, for this reason he was sent for surgical treatment to the urological department of RCH 1.

Surgery was performed in the hospital by laparoscopic excision of a cyst of the left adrenal gland under endotracheal anesthesia. The adrenal gland was sent for post-mortem examination, the results are presented below.

The wall of the cystic formation is represented by cells of the cortical layer of the adrenal gland, corresponding to the cells of the glomerular zone. The cells are large with abundant light cytoplasm and a monomorphic nucleus. In the wall of cyst there are foci of hemorrhages and accumulations of hemosiderin pigment. Outside, the cystic formation is surrounded by a fibrous capsule.

Conclusion. This paper presents an analysis of a large adrenal cyst. It is important to pay attention to the fact that this incidentaloma was asymptomatic, without any clinical signs and hormonal activity. Incidentalomas are often «silent», so it is extremely difficult to identify them, but the likelihood of degeneration into a malignant tumor is high.

Retrospective analysis of treatment outcomes of 65 patients with purulent-necrotic forms of diabetic foot: group I (35 patients), who received integrated treatment using laser therapy, group II (30 patients), who received traditional treatment. It was established that the use of laser therapy in these patients compared to traditional therapy allows reducing the duration of the inflammatory reaction in tissues (from 6-8 days to 4-5 days), and subsequently to the appearance of granulations on day 7-8 and marginal epithelization by the end of 10 days, which leads to a reduction in the length of treatment.

Background. From 10 to 20% of highly differentiated papillary thyroid cancer show signs of local prevalence: invasion into the surrounding fatty tissue, organs and tissues adjacent to the gland — the anterior muscles of the neck, recurrent nerve, esophagus, laryngopharynx, larynx, trachea. A tumor that has a massive spread, often with life-threatening symptoms in the form of dysphagia, stenosis of the trachea or larynx, has no alternatives to surgical treatment.

Aim. Evaluation of the results of extended and extended-combined interventions for locally advanced highly differentiated thyroid cancer (immediate surgical and long-term results of treatment).

Materials and methods. During the period from 2010 to 2021, 82 patients with locally advanced thyroid cancer were operated on. This cohort included patients in whom the tumor process spread not only to the neck, but also to the mediastinum: either in the region of the upper thoracic inlet, or there was a lesion of deeper parts of the mediastinum. The average age is 56.8 years. The ratio of men and women: 34 (41.5%) and 48 (58.5%), respectively. According to the prevalence of the tumor process, T4 tumors were diagnosed in 54.8% (n= 45). 37 patients had T3 (45.2%) tumors. In 57.3% (n= 47), the primary tumor was combined with the presence of a metastatic lesion in the regional lymph nodes of the neck. 34.1% (n 28) had distant metastases. In all cases it was a lesion of the lungs. Papillary thyroid cancer was verified in 89.6%. 21 patients underwent operations with resection of the larynx and trachea: in 7 cases, laryngectomy with resection of 5 to 8 rings of the trachea, in 4 cases, circular resections, in 6 cases, “shaving”, in 2 cases, “terminal” resections of the trachea with plasty of the defect of the sternum-clavicle-mastoid muscle, in 2 patients the plates of the thyroid cartilage were resected while maintaining the integrity of the organ. In 24 patients, mediastinal lymph node dissection (sternotomy) was performed; in 2 cases, mediastinal lymph node dissection was performed thoracoscopically. In 2 cases, resection of bone structures was performed — the manubrium of the sternum and sternoclavicular joints. In 33 patients, removal of the primary tumor, paratracheal, paraesophageal metastases and metastatic conglomerates from the posterior mediastinum (4 cases) was performed through the cervical approach.

Results. The postoperative period in this group of patients was complicated by the development of pneumonia in 52 (63.4%) patients. Purulent mediastinitis developed in 6 (7.8%) patients, arrosive bleeding in 6% (n= 5), osteomyelitis of the sternum in 2 (2.4%) cases, gastric bleeding in 1 patient (1.5%), lymphorrhea in 2 (2.4%), parathyroid insufficiency developed in 70.7% (n 58) of observations. Postoperative mortality was 6% (n= 5).

OS and disease-free survival amounted to 66.7% and 53.4%, respectively. Death from the progression of the disease occurred in all cases due to the growth of distant metastases against the background of resistance to radioactive iodine that developed during treatment or the implementation of new metastatic foci in terms of 2 to 5 years.

Conclusions. This group of patients demonstrates satisfactory results of OS and disease-free survival, but requires further dynamic monitoring and evaluation of the effectiveness of drug treatment of radioiodine-resistant tumors.

Background. Adrenocortical cancer (ACC) is a rare malignant endocrine tumor endowed with an aggressive biological potential and a poor prognosis. Surgical adrenalectomy remains the only radical treatment for local ACC. The overall 5-year survival rate of stages with local ACC varies from 56% to 96% and depends on the level of surgical training of a specialized center and the use of adjuvant therapy. Mitotan is the only approved chemotherapeutic agent for the adjuvant treatment of both the primary tumor and relapse and metastases.

Aim. To evaluate the experience of mitotane successful use in a young patient with recurrent ACC using the experience of a large medical institution.

Clinical observation. Patient R., 31 years old, is under dispensary observation for recurrent adrenocortical cancer of the left adrenal gland T1N0M0 stage 1, class 3. Progression from 2015, 2017, February 2019, April 2019, September 2020 (in the bed, MTS to the left kidney, MTS to the retroperitoneal tissue, MTS to the soft tissues of the lumbar region on the left, MTS to the lungs). Eradication of the tumor tissue was performed surgically, followed by morphological confirmation of the removed foci. For the first time, the diagnosis was established at the age of 23 during an examination for Itsenko-Cushing’s syndrome. Morphologically, the diagnosis of ACC was established after a histological examination of the tumor biopsy obtained by left-sided adrenalectomy (adrenocortical cancer, ki67 up to 20%).

During a scheduled dispensary examination in September 2020, according to CT scan of the chest with contrast, two foci were identified in the right lung: in C1 — 10 * 15 mm, in C2 — 30 * 21 mm. By decision of the council (consisting of an oncologist-endocrinologist, a thoracic surgeon and a chemotherapist), a decision was made to prescribe mitotane with dose titration under the control of the level of mitotane in the blood until it reaches 14–20 ng/l, without morphological examination of the foci. Hypocorticism was corrected by the simultaneous use of hydrocortisone with mitotane at a dose of 20 mg per day under the control of ACTH levels. In X-ray evaluation by CT of the chest with a frequency of 3 months, the therapeutic effect in the form of a decrease in the size of the foci (RESIST1.1) occurred in the first 3 months. Mitotan was canceled in November 2021 after complete regression of tumor foci according to CT scan of the chest (pneumosclerosis areas 10*4 mm). Currently, the patient is receiving hormone replacement therapy with hydrocortisone 25 mg per day and is under dispensary observation.

Conclusion. Clinical observation has demonstrated the successful use of mitotane in the treatment of metastatic adrenocortical cancer.

Background. In recent decades, there has been an increase in the incidence of malignant neoplasms of the thyroid gland by 20%. In 2020, thyroid cancer was diagnosed in 586,202 people worldwide and caused 43,646 deaths. Diagnosis of thyroid carcinoma has stepped forward due to the introduction of fine needle aspiration biopsy into widespread practice, with the classification of cytological material according to the Bethesda system. However, one category of this classification traditionally remains a gray area of diagnosis. The detection of a follicular tumor in the cytological material (category IV according to Bethesda) does not allow one to reliably classify the formation as benign or malignant and requires surgical intervention. At the same time, in the vast majority of cases, the tumor is benign.

Aim. To evaluate the possibilities of trephine biopsy for the differential diagnosis of benign and malignant neoplasms of the thyroid gland in the cytological category Bethesda IV.

Materials and methods. The study included 8 patients (2 men and 6 women) with a nodular thyroid gland and a cytological picture of a follicular tumor (Bethesda IV). The age of the patients ranged from 21 to 67 years, mean age 52.12±16.12. The sizes of nodule at US in three projections were accordingly 11,66±1,52; 11.33±1.15; 10.66±1.52 mm. Before the intervention, patients canceled drugs that affect the blood coagulation system. All patients underwent a trephine biopsy under ultrasound guidance with a mandatory assessment of blood supply in the mode of color Doppler mapping and power Dopplerography. Manipulation was performed along the midline of the neck through the isthmus of the thyroid gland. The material was taken from at least two sites, one through the tumor tissue, the other along the edge of the tumor with the capture of the capsule with a 18G needle. Additional biopsies were performed if a tumor site suspicious of malignancy was identified.

Results. The results of trephine biopsy coincided in 8 cases (100%) with the results of an urgent and planned histological examination. The obtained data were regarded as highly informative in 5 cases (62.5%) and medium informative in 3 cases (37.5%). The material reliably assessed the morphological type of the tumor, the degree of vascularization of the capsule, the presence or absence of invasion into the capsule or vessels. Histological studies made it possible to assess the size of the follicles, the presence of colloid, cell polymorphism, mitoses, and the contents of the cytoplasm; evaluate cell atypia.

Conclusion. In the future, trephine biopsy may become an additional opportunity to identify tumor-like formations in patients with follicular thyroid tumors.

Background. One of the most common complications during thyroid surgery after hypoparathyroidism is a violation of the mobility of the vocal folds - paresis or paralysis of the larynx. The incidence of damage to the recurrent laryngeal nerves during primary surgical interventions can vary from 1 to 30%. Intraoperative neuromonitoring is the most effective method to reduce the amount of damage to the laryngeal nerves during surgical interventions on the thyroid and parathyroid glands. Assessment of the state of the vocal cords in the preoperative and postoperative period is crucial. In the preoperative period, this helps establish baseline characteristics and identify pre-existing laryngeal paresis, while postoperative early identification of vocal cord paresis helps develop a rapid treatment plan. Indirect laryngoscopy is still considered the reference standard for vocal cord examination. The main advantage is the ability to visualize the vocal cords in 99% of cases. However, this is an invasive procedure that can be painful and uncomfortable for patients, and increases medical costs and lead time.

Materials and methods. The results of intraoperative neuromonitoring were analyzed in 25 patients who underwent total thyroidectomy according to indications (diffuse nodular non-toxic goiter — 17 patients (68%), diffuse nodular toxic goiter — 4 patients (16%), autoimmune thyroiditis, diffuse — nodular form — 4 patients (16%)), from September 2021 to February 2022. The patients’ age ranged from 18 to 73 years. There were 23 women (92%), men — 2 (8%). In the study, a C2 neuromonitor (InoMed, Germany), an electrode for EMG recording on an endotracheal tube, and a bipolar forked stimulating probe were used. To assess the mobility of the vocal folds, all patients underwent percutaneous ultrasonography before and after thyroid surgery.

Results and discussion. In 20 patients (80%) before surgery on transcutaneous ultrasound of the larynx, the visualization of the structures of the larynx was good (grade 4-5), in 2 male patients (8%), the visualization of the structures of the larynx was satisfactory (grade 3), in 3 women (older than 45 years (12%)) — visualization of the structures of the larynx was satisfactory (grade 3), in all 25 patients (100%) — complete or normal symmetrical movement of the vocal folds (grade I). During the performance of precision extrafascial thyroidectomy in 3 patients (12%), a decrease in the amplitude of oscillations was recorded during stimulation of the left recurrent laryngeal nerve and the left vagus nerve, in order to prevent bilateral paresis of the larynx, it was decided to confine ourselves to hemithyroidectomy followed by a staged right-sided hemithyroidectomy. A day after the performed left-sided hemithyroidectomy, percutaneous ultrasound of the larynx in 2 patients showed a violation of the mobility of the vocal fold on the left (grade II), in 1 patient — symmetrical movement of the vocal folds (grade I) — a false positive reaction. In 22 patients (88%) who underwent total thyroidectomy on percutaneous ultrasound of the larynx, complete or normal symmetrical movement of the vocal folds (I degree).

Conclusion. Intraoperative neuromonitoring is an effective tool to localize the recurrent laryngeal nerves regardless of whether a loss of signal (LOS) has occurred, as well as to determine the type of LOS (LOS 1, LOS 2) and staged thyroidectomy in the presence of LOS. Percutaneous vocal cord ultrasonography is currently an effective screening tool, saving 80% of patients from unnecessary invasive laryngoscopy. The complex of these methods should be an obligatory component in surgical interventions on the thyroid and parathyroid glands.

Lung metastases (LM) in differentiated thyroid cancer in children occur in 7-30% of cases, 3-4 times more often than in adults. Early diagnosis of LM improves the results of radioiodine therapy and the rate of complete remissions. We present a clinical case demonstrating the specific features of LM diagnosis in children. Patient G., a 9-year-old boy, was for two years observed for excessive body weight. Ultrasound thyroid gland examination revealed multiple hypoechogenic nodules, cytologically verified papillary cancer. Computed tomography (CT) of the chest revealed subpleural foci up to 3 mm in both lungs, which were more consistent with intrapulmonary lymph nodes, but did not completely rule out metastatic lesions. A thyroidectomy with central and lateral neck dissections was performed in January 2022. Histologic examination revealed multifocal papillary cancer growth in the entire thyroid gland with Tall cell sites and metastases to multiple cervical lymph nodes. According to TNM classification (American Joint Committee on Cancer (AJCC), 8th edition), the tumor grade was considered as pT2N1bM0, stage I. Seven weeks after surgical treatment, the patient underwent whole body scintigraphy with I-123 (24 hours after I-123 injection for 50 MBq) followed by radioiodine therapy on endogenous TSH-stimulation (4 weeks of L-thyroxine withdrawal). Scintigraphy with I-123 (whole-body and SPECT/CT) did not detect iodine-accumulating tissue. However, post-therapy (72 hours after administration of 2 GBq I-131) scintigraphy (whole-body and SPECT/CT) revealed residual thyroid tissue and diffuse accumulation of I-131 in both lungs. The TSH-stimulated thyroglobulin was 118 ng/ml, and thyroglobulin antibodies were 21 IU/ml. Pathological accumulation of I-131 in the lungs in combination with the elevated thyroglobulin level and chest CT findings were regarded as LM, therefore the tumor process was restaged — pT2N1bM1, stage II and radioiodine therapy was planned to continue.

Conclusion. In this clinical case, when diagnosing LM, the result of scintigraphy with I-123 was false-negative, and chest CT scan was uncertain, requiring dynamic monitoring. Scintigraphy after administration of I-131 therapeutic activity revealed LM, thereby changing further treatment strategy to continued radioiodine therapy and increasing the possibility of achieving complete disease remission. Factors associated with LM were miltifocal growth, massive neck lymph node involvement and high TSH-stimulated thyroglobulin levels.

Background. The relevance of endoscopic interventions on the thyroid and parathyroid glands is beyond doubt, and this explains the interest in this promising choice of surgical approach both among surgeons and patients who want to avoid a scar on the neck.

Aim. To evaluate the first results of own endoscopic interventions in patients with diseases of the thyroid and parathyroid glands.

Materials and methods. In the Research Institute of KCH N 1 named after prof. S.V. Ochapovsky from December 2020 to April 2022, 23 hemithyroidectomies and 8 paraadenomectomies were performed using endoscopic techniques for benign neoplasms of the thyroid and parathyroid glands. All patients in the preoperative period underwent ultrasound, TAPB + CI (for thyroid pathology), and the hormonal background was studied. Indications for endoscopic hemithyroidectomy in 18 cases were colloid goiter, in 5 cases — follicular adenoma. The indication for endoscopic paraadenomectomy in all cases was primary hyperparathyroidism. We used endoscopic three-port axillary-mammary gas access. Under the ETN, an incision was made along the outer edge of the pectoralis major muscle (m. pectoralis major). Carbon dioxide was injected into the pancreas using a Verish needle. A 5 mm port was inserted along the edge of the areola. Another 10 mm trocar was installed at the attachment points (m. pectoralis major).

Results. The average operation time was 190.4 minutes for endoscopic hemithyroidectomy and 78.6 minutes for endoscopic paraadenomectomy. With the increase in the number of performed operations, there was a decrease in the duration of surgical interventions. In two cases in patients after hemithyroidectomy, seromas up to 20 ml in volume were noted in the postoperative period, which required puncture interventions (once).

Conclusion. Endoscopic interventions on the thyroid and parathyroid glands from axillary access are a safe method of surgical intervention, and the cosmetic result is an indisputable advantage of this method.

Background. The need to perform prophylactic central cervical lymph node dissection in localized forms of highly differentiated thyroid cancer remains open at the moment. Preoperative examination does not always allow to reliably determine the presence of regional metastasis in the lymph nodes of the VI group.

Aim. Evaluation of the neck central lymphatic collector damage frequency in clinical N0-Nx based on the results of a morphological study after performing a preventive central cervical lymph node dissection.

Materials and methods. The study involved 295 patients operated on in 2016-2022 for papillary thyroid cancer with the prevalence of the tumor process — cT1-T2, N0-Nx. The ratio of men and women is 11.5% (n=34) and 88.5% (n=261). Of these, 40.7% (n=120) were less than 55 years old, 59.3% were more than 55 years old (n=175). All patients underwent surgical treatment in the amount of thyroidectomy and hemithyroidectomy with central cervical lymph node dissection.

Results. In a morphological study, in some patients there was a change in the clinical stage from T1-T2 to T3: pT1 was found in 80.3% (n=237); рТ2 — in 9.2% (n=27); рТ3 — in 10.5% (n=31). In 77 (26.1%) of 295 patients, metastases were found in the lymph nodes of the central tissue of the neck. Primary surgical treatment — thyroidectomy with central cervical lymph node dissection —was performed in 295 patients, of which tumors corresponding to the cT1 — 247 (83.7%), cT2 — 48 (16.3%). According to the results of pathomorphological examination of the tissue of the neck after prophylactic lymph node dissection, pN1a was detected in 57 (23.1%) and 20 (41.7%) patients, respectively.

When assessing the frequency of damage to the regional lymph collector of group VI after performing a morphological study of the removed tissue, it was revealed that with pT1 the frequency of damage to the lymph nodes was 22.8% (n54); at рТ2 — 33.3% (n9); and at pT3 this figure increases to 45.2% (n14).

Conclusion. According to the results of the study, it was revealed that there is a clear dependence of the defeat of regional lymph nodes of the central tissue of the neck on the size of the primary tumor from 22.8% with pT1 to 33.3% with pT2 and 45.2% with pT3. Thus, the implementation of prophylactic central cervical lymphadenectomy for papillary thyroid cancer is an important component of surgical treatment.

BACKGROUND: More than 30,000 surgical interventions on the thyroid gland are performed annually in the Russian Federation. Surgeons are developing methods for the prevention of various postoperative complications, and therefore operations on this organ are considered relatively safe. Currently, there is no unequivocal effective method to prevent postoperative hypoparathyroidism. This complication is often recorded and can threaten the life and health of the patient, which is contrary to the concept of safe surgery.

AIM: To evaluate the effectiveness of intraoperative ICG angiography and intrathyroidal injection of brilliant green for the prevention of postoperative hypoparathyroidism.

MATERIALS AND METHODS: 143 thyroidectomies were performed. The patients were divided into 3 groups: intraoperative angiography was used in 24 cases, brilliant green was injected to identify the parathyroid glands in 58 cases, visual assessment of the preservation of the parathyroid glands was used in 61 case. Calcium levels were measured in all patients included in the study before and after surgery.

RESULTS: Serum calcium levels in the pre- and postoperative period: 2.37±0.14 and 2.27±0.17 in group 1, and 2.38±0.16 and 2.21±0.16 in group 2, 2.39±0.17 and 2.18±0.19 in group 3. Hypocalcemia in the postoperative period was significantly higher in the group with a visual assessment of the parathyroid glands relative to the first two groups. Differences between calcium levels in the postoperative period in groups 2 and 3 were significant with a probability of more than 99% (p<0.01). Significant differences (≥95%) in calcium levels in the postoperative period between groups 1 and 2 (p < 0.05) were obtained. Serum PTH levels in the postoperative period: 6,2±0,4 in group 1, 5,6±0,57 in group 2, 3,5±0,32 in group 3. Differences between PTH levels in the postoperative period in groups 1 and 3 were significant with a probability of more than 99% (p<0.01). Significant differences (≥95%) in PTH levels in the postoperative period between groups 2 and 3 (p < 0.05) were obtained.

CONCLUSION: ICG angiography and brilliant green intrathyroidal injection are safe methods for identifying and preserving the parathyroid glands. The high level of hypocalcemia in group 3 indicates the need to search for new techniques in endocrine surgery in order to improve the safety of patients undergoing surgical treatment of thyroid pathology.

Background. Primary hyperparathyroidism (PHPT) is a rare pathology in pediatric and adolescent patients. Collection, analysis and generalization of the literature data and experience of the leading clinics allow to develop unified, statistically substantiated approaches to diagnostics and surgical treatment of this group of patients.

Material and methods. The article presents a retrospective analysis of 17 cases of PHPT in children and adolescents aged from 6 to 18 years operated on in the department of Surgery of St.-Petersburg State Pediatric Medical University in the period from 1973 till 2021. Among those operated there were 10 girls and 7 boys, the M:F ratio was 1:1.4. The mean age of the patients was 12,9±0,71 years.

Results and discussion. The main criteria of the disease diagnosis were elevated blood calcium and parathormone levels, excessive urinary calcium secretion. Manifest forms of the disease were diagnosed in 10 (58,8%) of 17 children. In 3 (17,6%) cases the parathyroid neoplasms were accompanied neither by clinical, nor laboratory manifestations of the disease and were regarded as incidentalomas. Another 4 (23.5%) patients had only laboratory changes (hypercalcemia and hyperparathyrinaemia) that manifested themselves preoperatively. These observations were referred to the asymptomatic form of PHPT.

In 7 (41.2%) cases parathyroid adenomas were found and removed during surgeries for various thyroid diseases (thyroid cancer in 5 cases, diffuse toxic goiter in 1 case). An incidental finding of parathyroid adenoma was during prophylactic thyroidectomy for Sipple syndrome.

A radioisotope method proved to be the most informative way to localize parathyroid tumors.

Conclusion. The diagnosis of the disease in manifest sporadic cases does not differ from that in adults. Genetic study is indicated in the presence of a family history of multiple involvement of the parathyroid glands. Surgical treatment with removal of parathyroid tumor is the main method, which allows to achieve complete recovery. 

Background. Modern methods of topical diagnostics have high accuracy and can determine the morphological structure of the adrenal tumor with high probability before surgery, but none of them has 100% sensitivity and specificity. Contrast-enhanced computed tomography is most commonly used by clinicians. The criteria for the malignancy of an adrenal tumor determined by this method continue to be discussed.

The aim is to evaluate the effectiveness of contrast-enhanced computed tomography in the preoperative diagnosis of adrenal tumors and to analyze errors.

Materials and methods. Contrast-enhanced computed tomography was performed in 69 patients with adrenal tumors. After morphological examination of the removed tumors, the effectiveness of preoperative diagnostics was evaluated with the determination of sensitivity and specificity of the method. If the pre- and postoperative diagnosis did not match, the causes of errors were analyzed.

Results. The attenuation on unenhanced CT in adenomas ranged from 5 to 36 HU, in adrenocortical cancer — from 26 to 80 HU, in pheochromocytomas — from 25 to 99 HU. The attenuation of adenomas on unenhanced CT was significantly less than with pheochromocytomas (p=0.005) and adrenocortical cancer (p=0.012). In the venous phase, no significant differences were found, and in the delayed phase, the attenuation of adenomas was also significantly less than in malignant tumors (p=0.008, p=0.008). The median of absolute percent contrast washout in adenomas was 85%, in pheochromocytes — 59%, in adrenocortical cancer — 57%. When comparing the diagnosis before and after surgery, its non-coincidence was found in 8 cases (10.39%). Two patients (2.59%) with small tumors (diameter of 15 mm) were diagnosed with adenoma in ­combination with pheochromocytoma and adenoma before surgery. After morphological examination, the diagnosis was changed to adrenocortical cancer in combination with adenoma and «mute» pheochromocytoma.

Conclusion. The sensitivity and specificity of contrast-enhanced CT in the diagnosis of adenomas was 95.61% and 94.82%, pheochromocytomas — 95% and 95.08%, adrenocortical cancer — 92.31 and 98.48%. Diagnostic errors of «mute» pheochromocytoma and adrenocortical cancer occurred with small sizes (15 mm) of adrenal tumors.

The case histories of 414 patients who were operated on for mild diseases of the thyroid gland (DTH) were retrospectively studied. The study is aimed at studying the cytological material in the preoperative period and the comparative assessment of the postoperative histological material of patients operated on for the thyroid gland. As a result of the study, it was found that the share of nodular goiter with euthyroid function (UEZ) and multinodular euthyroid goiter (MUEZ) accounts for 269 patients, which is 65%. In 87 patients (21%), diffuse-toxic goiter (DTG) and nodular toxic goiter with the formation of functional autonomy (FA) were revealed; autoimmune thyroiditis (AIT) in 58 cases (14%). All 414 patients with tonic aspiration biopsy of the thyroid gland showed good changes in the cytological material. After the diagnosis, preoperative preparation, 294 patients (71%) out of 414 underwent thyroidectmia with DTZ, FA, with MUEZ and a significant increase in thyroid gland volume. Hemityroidectomy was performed in 178 patients (29%) with one-sided nodular lesion of the thyroid gland with preserved normal hormonal background. In 94% of cases, there is a coincidence of cytological and histological studies, a benign result of a biopsy material was confirmed in 389 patients. In 6% of cases (25 patients), there is a discrepancy between cytological and histological studies.