Comparison of Modified Rose Method of Thyroid Palpation versus other Methods for the Detection of Retrosternal and Nodular Goitre / Journal of the ASEAN Federation of Endocrine Societies

Objectives@#This is a diagnostic test research study to evaluate the various existing methods of thyroid examination and their comparison with the novel modified Rose method. It also aims to measure inter-examiner variation in clinical findings based on the level of education and training, as compared to ultrasonography.@*Methodology@#This cross-sectional study was conducted at a tertiary care hospital with 83 patients presenting to surgery OPD with neck swelling. Each patient was examined by one trained Junior Resident and a Surgery Consultant with all the four methods and with ultrasonography. Data was analysed by Stata-14, agreement between the two categorical variables was assessed by Kappa. In case of continuous variable agreement was assessed by Intra class correlation and Bland-Altman plot.@*Results@#Modified Rose method by the consultant has the highest sensitivity (98%) and diagnostic odds (210) as compared to others but its specificity ranges from 46.7-91.1% to diagnose retro-sternal extension of a goiter. It has 93.98% agreement for identification of nodules. It has a high specificity (Consultant - 100%, Resident - 95.5%) with relatively lower sensitivity (Consultant - 94%, Resident - 86.8%) to diagnose solitary thyroid nodule (STN) but the sensitivity and specificity for diagnosing a multinodular goitre (MNG) was high. However, the highest sensitivity to diagnose STN was highest with Crile’s method, but specificity was low. Lahey’s method was a better clinical method to palpate lymph nodes compared to the other three.@*Conclusion@#Examination in modified Rose’s position is a better method of clinical examination of thyroid especially in patients with occult substernal extension. Lahey’s method is a better method to examine cervical lymph nodes.

Myeloid sarcoma of the breast in an aleukemic patient:a rare entity in an uncommon location

Myeloid sarcoma (MS) is an extramedullary solid neoplasm of immature myeloid cells. These tumours usually develop in concurrence with or following acute leukemia. The breast is an uncommon site for presentation of this tumour, where it is often misdiagnosed as lymphoma or carcinoma.A 33- year-old female presented with a right breast lump in a private hospital, which was diagnosed as ductal carcinoma on lumpectomy. Subsequently she developed a lump in the left breast and a similar diagnosis of carcinoma was made on biopsy. A left mastectomy was performed. Histopathological examination revealed a tumour composed of mononuclear cells arranged in sheets and cords with round to oval vesicular nuclei and occasional prominent nucleoli. IHC for CK was very weak and focal. The tumour cells were immunonegative for ER, PR, Her2neu,epithelial membrane antigen, e-cadherin, CD3 and CD20. Diffuse immunopositivity for myeloperoxidase, CD34 and CD117 established a diagnosis of myeloid sarcoma. A histopathological review of the right breast lesion, with immunohistochemistry, also confirmed the diagnosis of myeloid sarcoma. Investigatory workup for acute myeloid leukemia, including bone marrow aspirate and biopsy and karyotypic studies, proved negative. The patient was treated with high dose cytarabine (HDAC) regimen and was disease free during the 12-month follow-up.Although extremely rare, awareness of such a presentation is crucial. This case also illustrates that careful histopathological review along with an expanded panel of immunohistochemistry is extremely important for recognizing such cases as a misdiagnosis can lead to unnecessary surgery and inappropriate therapy.

Infant feeding practices in the rural population of north India

Breastfeeding is one of the most important determinants of child survival, birth spacing, and the prevention of childhood infections. The beneficial effects of breastfeeding depend on its initiation, duration, and the age at which the breastfed child is weaned. Breastfeeding practices vary among different regions and communities. To assess the pattern of infant feeding and its relation to certain practices of maternity and newborn care, and to assess the knowledge of mothers on the advantages of exclusive breastfeeding. The cross-sectional study was carried out in randomly selected villages of the Bhojipura Block of Bareilly district, Uttar Pradesh. A total of 123 women who had delivered within the last year were interviewed in a house-to-house survey. A study instrument was used to collect data. Chi- square test and regression analysis were used to analyze the data. Most of the mothers were aged less than 30 years [78.04%] and were Hindus [73.9%]. Most were illiterate [69.9%] and belonged to the lower socioeconomic class [97.5%]. The majority were housewives [99.1%] and multiparous [68.2%]. Most had initiated breastfeeding [78.8%] within 24 hours of delivery. About 15.4% of the infants did not receive colostrum and 22.8% of the infants were not exclusively breastfed. Ghutti [water mixed with honey and herbs], boiled water, tea, and animal milk were commonly used pre-lacteal feeds. About 47.2% of the respondents were not aware of the benefits of exclusive breastfeeding. About one quarter of the mothers started complementary feeding before the child was six months old. About half the deliveries had taken place at home and only a quarter of the females had had three or more antenatal visits during pregnancy. The birth weight of the majority [78%] of newborns was not measured. A majority [69.9%] of the mothers did not receive advice on child feeding. Multivariate logistic regression analysis showed that maternity and newborn care variables had no significant association with exclusive breastfeeding. Despite higher rates of early initiation of breastfeeding and exclusive breastfeeding, awareness of the benefits of exclusive breastfeeding was low. This indicates the need to promote awareness of the correct method of infant feeding and care of the newborn. Creating an awareness of the advantages of exclusive breastfeeding will further strengthen and support this common practice in rural communities and avoid an early introduction to complementary foods for sociocultural reasons

Giant Myofibroblastoma of the Male Breast: A Case Report and Literature Review

Myofibroblastomas are soft-tissue neoplasms that are thought to arise from myofibroblasts. They are mostly observed in males 41–85 years of age; however, this lesion also occurs in women. The usual clinical presentation is a unilateral painless lump that is not adherent to overlying or underlying structures. Microscopically, myofibroblastomas can be divided into 5 subtypes: classical, epithelioid, collagenised, cellular, and infiltrative. Mammary ducts and lobules are absent in the typical histological subtypes and the adjacent breast parenchyma may form a pseudocapsule. The majority of myofibroblastomas are immunoreactive for CD34, desmin, smooth muscle actin, and vimentin and are negative for cytokeratin and S-100 protein. We present a case of a giant myofibroblastoma arising in the background of gynecomastia in an adult male.