ABSTRACT
Papillary thyroid carcinoma usually presents as a palpable thyroid swelling, and presenting as cervical lymphadenopathy is uncommon. Metastasis to the cervical lymph nodes could have several primary sources. A 70 year old male presented with painless left cervical mass which was insidious in onset, gradually increasing in size since past one year. Physical examination revealed an oval left cervical mass, extending from anterior border of sternocledomastoid (SCM) muscle to the posterior triangle of neck at level III, IV and V. Plain and contrast enhanced Computed tomography (CT) of neck and thorax demonstrated an ill defined irregular intensely enhancing multi-lobulated lesion in the left supraclavicular region. Fine needle aspiration cytology (FNAC) was suggestive of either a metastatic lesion or a primary lesion. Level V lymph node biopsy suggested papillary carcinoma thyroid. The patient underwent total thyroidectomy with bilateral lymph node dissection with excision of mediastinal lymph nodes via cervical approach without sternotomy. Histopathological examination of the specimen confirmed Papillary Thyroid Carcinoma (conventional type) with secondaries to the neck. On discharge, the patient was given radioactive iodine therapy for two weeks, followed by lifelong oral thyroxine. No signs of recurrence were noted in the follow up visits. A combination of radiological and histopathological investigations can help to assess a cervical mass of thyroid origin. The transcervical approach is simpler and safer than the transsternal approach and avoids the morbidity of a sternal split.
ABSTRACT
Effect of zinc cyanide on protein and certain metabolites content and some enzymes activities was evaluated in liver, muscle and gill tissues of the freshwater fish, Cirrhinus mrigala, during exposure and following cessation of exposure. Fish exhibited significant alterations in the biochemical parameters in all tissues studied. Levels of total protein decreased in all tissues, where as free amino acids [FAA] and protease activities significantly increased [P<0.05]. Similarly decrease was observed in the ammonia level with increased urea and glutamine levels at all exposure periods. The enzymes involved in the protein metabolism altered under the zinc cyanide intoxication. Increase in the protease and aminotransferases revealed amplified transamination processes. Significant increase of phosphatases indicated increased rate of phosphorylation and transport of molecules across the cell membrane. Withdrawal study also exhibited significant recovery in all above biochemical parameters, in all tissue after the 7th day post recovery treatment. Present study exhibited negative effects of zinc cyanide on protein metabolism. Fish with low protein content were not fit for human consumption. Patterns of effects on intermediary metabolism suggest avenues to determine the mechanisms by which such effects occur