Diabetic foot syndrome (DFS) is one of the most common complications of diabetes and is a consequence of pathological changes in the peripheral nervous system, microcirculatory bed, as well as the osteoarticular apparatus of the foot, which poses a threat to the development of ulcerative necrotic processes and gangrene. It is reported that approximately 15% of patients with DM develop SDS, of which 14 to 24% undergo limb amputation. SDS also contributes significantly to early mortality, as 68% of amputees die within 5 years. The authors conducted an electronic search for publications in the PubMed and Elibrary databases. Stem cell therapy has been used as adjuvant therapy in the treatment of SDS. The results presented in this study demonstrate that the use of mesenchymal stem cells is safe and effective without clinically significant side effects and, therefore, can help prevent high limb amputations in uncomplicated diabetic foot ulcers. However, there are still a number of problems with the coordination of the most applicable type of cells, the method of their administration and dosages, which requires further research.

BACKGROUND: The current clinical classification and treatment principles for pituitary adenomas are primarily based on the analysis of hormone levels in blood plasma. However, this approach does not account for the heterogeneity and plurihormonal nature of these tumors, which pose significant diagnostic challenges. Immunohistochemical (IHC) analysis is a crucial tool for studying the molecular characteristics of resected tumors, enabling the identification of features that may not be apparent through standard biochemical tests and clinical evaluation.

AIM: To investigate the heterogeneity and hormone co-expression of pituitary adenomas through a comparative analysis of clinical, hormonal, and immunohistochemical data, aiming to optimize the diagnosis and classification of pituitary neuroendocrine tumors.

MATERIALS AND METHODS: The study included 10 pituitary adenoma samples. A comprehensive immunohistochemical analysis was performed to evaluate the expression of transcription factors and pituitary hormones to detect tumor heterogeneity and potential plurihormonal pituitary adenomas.

RESULTS: The analysis confirmed significant heterogeneity of pituitary adenomas and identified cases of hormone co-­expression in certain tumors, which may be overlooked when relying solely on clinical data and blood test results, or in the absence of IHC testing that covers all hormones and transcription factors in pituitary tissue. In our study, we identified heterogeneity in pituitary adenoma samples at the level of transcription factor and hormone expression. For example, in two hormonally active corticotropinomas, we observed not only the expression of standard IHC markers but also the unexpected expression of GH and PIT1. Notably, somatotropinomas exhibited distinct expression of SF1, a transcription factor typically specific to gonadotroph cells. Additionally, we identified signs of heterogeneity in hormone-inactive pituitary tumors — such as silent gonadotropinomas — where co-expression of both SF1 and TPIT was detected.

CONCLUSION: The results of the study confirmed significant heterogeneity of pituitary adenomas and the presence of hormone co-expression, indicating the complexity of their diagnosis when relying solely on clinical and hormonal methods. Comprehensive immunohistochemical analysis plays a key role in the accurate classification of these tumors, which may contribute to the improvement of diagnostic and therapeutic approaches.

BACKGROUND: Thyroid nodules are detected in 20-68% of patients. However, there is no data in the literature on the criteria for malignancy in CT studies. The introduction of CT into widespread practice has led to an increase in the detection of formations, including the thyroid gland, requiring additional examination. The use of additional imaging methods will improve the detection of malignant tumors of the thyroid gland.

AIM: The purpose of this study was to address the gap in thyroid CT imaging and to evaluate whether contrast-enhanced multiphase multidetector CT is suitable for assessing the malignant potential of thyroid mass.

MATERIALS AND METHODS: The study was conducted on the basis of the General Oncology Department No. 71 in Botkin Hospital from 2022 to 2023 A retrospective analysis of CT images included data from 146 electronic medical records of patients with differentiated carcinoma and follicular adenoma of the thyroid gland. A comparative evaluation was performed using contrast-enhanced CT (160 slices; Toshiba Aquilion Prime model) (Omnipaque 350 mg iodine/ml: 100 ml) with assessment in the native, arterial and venous phases.

RESULTS: The study included 64 patients diagnosed with follicular adenoma of the thyroid gland and 82 patients with differentiated thyroid cancer. When assessing the relationship between thyroid carcinoma and tumor density in Hounsfield units, a positive correlation was revealed (Spearman correlation in the native phase r=0.48; arterial phase r=0.69; venous phase r=0.64; p<0.001). The sensitivity and specificity of assessing the density of thyroid nodules using CT data was analyzed. The most demonstrative results were demonstrated when analyzing CT scans in the arterial phase. At an arterial phase cut-off point of 121 Hounsfield units, the sensitivity was 75.6% and the specificity was 91.7%. Using a cutoff point of 113 Hounsfield units in the venous phase, the sensitivity was 62.2% and the specificity was 95.8%. In the native phase, a cut-off point of 49 Hounsfield units demonstrated a sensitivity of 68.9% and a specificity of 75%.

CONCLUSION: Contrast-enhanced CT examination of the thyroid gland can become a promising method for the differential diagnosis of carcinomas and can be used in the presence of masses with unclear malignant potential.

Pheochromocytoma (PCС) and paraganglioma (PG) are malignant neuroendocrine tumors (NEO) of paraganglionic origin, producing biologically active substances and characterized by a variable clinical course. Currently, the main method of treatment of PCС and PG is radical surgical treatment; nevertheless, there is a life-long risk of tumor recurrence as well as distant metastases. Here we present a clinical case of recurrent retroperitoneal PG incidentally detected during hospitalization for decompensated diabetes mellitus (DM). In the case PG caused acute cerebral circulatory failure, arterial hypertension, DM, heart rhythm disorders, potentially preventable with timely diagnosis of the disease. The peculiarity of the detected PG was its recurrent course despite repeated surgical interventions.

Primary hyperparathyroidism (PHPT) is an endocrine disease that develops due to excessive production of parathyroid hormone (PTH) by the parathyroid glands (PTG). The only radical treatment for PHPT is surgical removal of the affected gland —parathyroidectomy. The success of the operation directly depends on accurate preoperative diagnosis and determination of the pathological gland’s location, which is the main difficulty. The parathyroid glands are typically found on the thyroid gland’s posterior surface; however, the anatomy of this area is very variable, and the glands can be found in the most unexpected places. A person can have between two and eight parathyroid glands, making the search much more difficult. The pathological gland can be either significantly enlarged or remain within normal sizes, which makes it indistinguishable from healthy glands at visual examination. All these factors make diagnosis difficult and increase the risk of unsuccessful surgery. If the affected gland cannot be detected and removed during surgery, the patient faces persistence of the disease with the preservation of all symptoms and health risks. The diagnostic method is choosen individually by an endocrinologist. It is important to remember that timely diagnosis and proper treatment of PHPT play a decisive role in the prognosis of the disease. This article describes a clinical case demonstrating a variant of the atypical anatomical location of the parathyroid adenoma in zone X, the peculiarity of which emphasizes the importance of imaging methods at the preoperative stage.

An erratum on «Insulinoma: analysis of prevalence and incidence in the world» by Marina Yu. Yukina, Alina R. Elfimova, Ekaterina A. Troshina, Galina A. Melnichenko, Natalia G. Mokrysheva (2023). Endocrine surgery. 17(2):4-10. doi: https://doi.org/10.14341/serg12805.

An error was made in the annotations in Russian and English (section «Results»), table 1, in paragraph 1 on page 7, in paragraph 5 on page 8 — the following prevalence of insulinoma in the Russian Federation is indicated: 11.9 per 1 million population. The correct prevalence of insulinoma in the Russian Federation is 11.5 per 1 million population. The editorial board apologize for this error and state that this does not change the scientific conclusions of the article in any way.

The original article has been updated.