ABSTRACT
AIM: To evaluate the diagnostic utility of ultrasonography and other antecedents and exams usually availables, in the study of patients with thyroid nodules aged 0-20 years. SUBJECTS AND METHODOLOGY: Cross-sectional analytical observational study. We reviewed the data of patients undergoing FNAP (thyroid puncture with a fine needle) and / or thyroidectomy between January 2007 and December 2013. The ultrasound evaluation was performed by 3 specialists. The surgical biopsy was considered an indicator of benignity or malignancy and, in its absence the FNAP (excluding the Bethesda diagnoses 3 and 4). The association between cancer and the different variables was evaluated through binary logistic regression, with measure of association of odds ratio (OR). With the initially significant variables, a multivariate analysis was carried out and a cut-off score was subsequently defined to allow the diagnosis to be discriminated. RESULTS: 104 nodules are included in the analysis (100 patients), 89â / 11â; age x16 ± 2.8; TSH 2.8 uIU / ml ± 5; lymphocytic thyroiditis 30%; pathological anatomy: benign 46 (44%) cancer 58 (56%). Sonographic findings predictive of malignancy were: hypoechogenicity (OR 2.95 p = 0.008) irregular shape (100% CA) non-smooth edges (OR 8.5 p = 0.000) microcalcifications (OR 39 p = 0.000) thick calcifications (OR 18 p = 0.001) and presence of suspicious adenopathy (100% CA). In the TIRADS classification, cases classified as 4 and 5 corresponded to cancer in 50 and 92%. The presence of thyroiditis did not show an insignificant association with malignancy. From the joint analysis of the significant variables, a score with adequate sensitivity and specificity is obtained. CONCLUSIONS: The usefulness of ultrasound as a fundamental examination in the evaluation of the pediatric patient who consults by thyroid nodule is corroborated. Accurately describing their sonographic characteristics and, above all, analyzing them together, allows us to determine an approximate risk of malignancy and define with greater certainty the indication of performing FNAP
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Young Adult , Ultrasonography/methods , Thyroid Nodule/diagnostic imaging , Thyroid Neoplasms/pathology , Thyroid Neoplasms/diagnostic imaging , Odds Ratio , Chile , Cross-Sectional Studies , Multivariate Analysis , ROC Curve , Sensitivity and Specificity , Observational StudySubject(s)
Humans , Infant, Newborn , Skin Diseases/pathology , Skin Diseases/congenital , Histiocytosis, Langerhans-Cell/pathology , Histiocytosis, Langerhans-Cell/congenital , Skin Diseases/diagnosis , Skin Diseases/therapy , Histiocytosis, Langerhans-Cell/diagnosis , Histiocytosis, Langerhans-Cell/therapy , Remission, Spontaneous , Diagnosis, Differential , PrognosisABSTRACT
Los estudios por imagen permiten diagnosticar y categorizar un tumor de glándula salival (GS). La punción con aguja fina (PAAF) es una herramienta diagnóstica. El ultrasonido (US) permite visualizar el tumor y guiar la aguja de PAAF. Objetivos: Describir la técnica de PAAF. Revisión retrospectiva de los resultados de PAAF bajo US en tumor de GS. Se analizaron 39 pacientes enviados a PAAF en 5 años. Resultados: 31 lesiones parotídeas y 8 submaxilares. 87 por ciento se presentaron como nódulo hipoecogénico y 69 por ciento con refuerzo posterior. Resultado cito-histológico de 36 PAAF realizadas: 29 lesiones benignas, 6 lesiones malignas, 1 punción frustra. No hubo complicaciones. 21 pacientes operados. Concordancia histológica 85 por ciento . No hubo falsos positivos para cáncer. En conclusión, PAAF bajo US es una herramienta diagnóstica en los tumores de GS.
Imaging studies allow the diagnosis and classification of a salivary gland (SG) tumor. Fine needle aspiration (FNA) is a diagnostic tool. Ultrasound (US) allows the visualization of the tumor and guidance of the needle in FNA. Objectives: To describe the FNA technique. A retrospective review of the results of ultrasound guided FNA in a SG tumor. 39 patients referred for FNA in 5 years, were analyzed. Results: 31 parotid and 8 submaxillary lesions. 87% presented as hypoechoic nodule and 69% with posterior acoustic enhancement. Cyto-histological results of 36 FNA performed: 29 benign lesions, 6 malignant lesions, one failed puncture. There were no complications. 21 operated patients. Histological concordance was 85%. There were no false positives for cancer. In conclusion, FNA using ultrasound is a diagnostic tool in GS tumors.
Subject(s)
Humans , Male , Adult , Female , Middle Aged , Aged, 80 and over , Biopsy, Fine-Needle/methods , Salivary Gland Neoplasms/pathology , Retrospective Studies , Salivary GlandsSubject(s)
Humans , Male , Aged , Granuloma Annulare/diagnosis , Granuloma Annulare/pathology , Acute Disease , Biopsy , Pain/etiology , FingersABSTRACT
El Tumor de Bednard es una rara forma de presentación del Dermatofibrosarcoma Protuberans, clasificado como un sarcoma de bajo grado con alta agresividad local y tendencia a la recurrencia cuando no presenta márgenes quirúrgicos adecuados. Presenta una difícil aproximación inicial y notoria demora en el correcto diagnóstico, lo que muchas veces influye negativamente en su pronóstico. Presentamos en el siguiente reporte un paciente de 24 años con diagnóstico de Tumor de Bednard, que se presentó como un tumor sólido subcutáneo de larga data.
Bednard tumor is a rare form of presentation of dermatofibrosarcoma protuberans. It is classified as a low-grade sarcoma with high local aggressiveness and relapse tendency when inadequate surgical margins are present after surgery. Diagnosis is difficult and shows a marked delay in the correct diagnosis, affecting the prognosis. We present a case-report of a patient with the diagnosis of Bednard tumor presented as a subcutaneous long standing solid tumor.
Subject(s)
Humans , Male , Young Adult , Dermatofibrosarcoma/surgery , Dermatofibrosarcoma/diagnosis , Skin Neoplasms/surgery , Skin Neoplasms/diagnosisSubject(s)
Humans , Male , Middle Aged , Hidrocystoma/surgery , Laser Therapy , Skin Neoplasms/surgery , Sebaceous Gland Neoplasms/surgery , Biopsy , Diagnosis, Differential , Hidrocystoma/diagnosis , Hidrocystoma/pathology , Skin Neoplasms/diagnosis , Skin Neoplasms/pathology , Sebaceous Gland Neoplasms/diagnosis , Sebaceous Gland Neoplasms/pathology , Treatment OutcomeABSTRACT
La Pitiriasis Rubra Pilaris (PRP) es una dermatosis papuloescamosa crónica, de etiología desconocida. Se caracteriza por la presencia de pápulas foliculares hiperqueratósicas que coalescen formando placas eritematoescamosas, dejando islotes de piel sana entre las lesiones. Puede llegar a una eritrodermia. Se clasifica en base a la edad de presentación, características morfológicas, evolución y pronóstico. Existen múltiples opciones de tratamiento descritas en la literatura, siendo los retinoides sistémicos el tratamiento de primera línea en estos pacientes. Presentamos dos casos de pacientes con PRP eritrodérmica tratados exitosamente con Acitretín y revisión de la literatura a la fecha.
Pityriasis Rubra Pilaris is a chronic inflammatory dermatosis of unknown etiology, characterized by the presence of multiple follicular papules that coalesce into large erythematous or salmon colored plaques with islands of non-involved skin between them. It can eventually evolve into erythroderma. Descriptions and therapeutic experiences are mainly based on case reports. Today retinoids have become de first line treatment in these patients. We present two cases of erythrodermic PRP treated successfully with Acitretin and an updated review of the literature.
Subject(s)
Humans , Male , Female , Adolescent , Middle Aged , Pityriasis Rubra Pilaris/diagnosis , Pityriasis Rubra Pilaris/pathology , Pityriasis Rubra Pilaris/drug therapy , Acitretin/therapeutic use , Cetirizine/therapeutic use , Dermatitis, Exfoliative , Diagnosis, Differential , Pityriasis Rubra Pilaris/classification , Keratolytic Agents/therapeutic use , Retinoids/therapeutic useABSTRACT
Thyroid nodular disease is a highly prevalent condition. Most nodules are asymptomatic and only identifiable on images. We have established a relationship between the particular spoke wheel pattern of thyroid masses and a benign histology. A review of our institutional database of thyroid punctured under ultrasound guidance, histologically studied between 2003 and 2011, was performed. Node selection criteria included: mixed /solid, round /oval, surrounded by a halo, with radial structures converging toward a central point, with or without calcifications, and with peripheral vessels along with others oriented toward the center of the thyroid masses. Seventy-nine (2.5 percent) out of 3.204 punctured masses exhibited this sign. Average size: 28.3 mm. Fifty-eight masses were benign colloid nodules as diagnosed on FNA biopsy. Remaining masses corresponded to Lesion Follicular (4 benign, surgically treated; 7 under follow-up, stable; 10 with no information). Despite being a rare radiologic finding, the spoke wheel sign may be another element contributing to ultrasonographic discrimination between benignity and malignancy, especially in large thyroid masses.
La patología nodular tiroidea es altamente prevalente. La mayoría de los nódulos son asintomáticos y solo identificados en imágenes. Hemos establecido la relación entre una morfología especial del nódulo en rueda de carreta e histología benigna. Se realizó una revisión de la base de datos de nódulos puncionados bajo US y estudiados histológicamente entre 2003 y 2011. Criterios de selección: nódulos mixtos/sólidos, redondos/ovales, rodeados por un halo, presentando estructuras convergentes hacia un punto central con o sin calcificaciones y vasos periféricos con otros orientados hacia el centro del nódulo. De 3.204 nódulos puncionados 79 (2,5 por ciento) presentaron el signo. Tamaño promedio: 28,3 mm. Cincuenta y ocho resultaron nódulos coloideos benignos en PAAF. El resto fueron informados como lesiones foliculares (4 operados benignos, 7 en seguimiento y estables, 10 sin información). Este signo es poco frecuente, pero puede ser un elemento más que colabore en la discriminación ecográfica de benignidad/malignidad, especialmente en nódulos tiroideos de gran tamaño.
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Aged, 80 and over , Ultrasonography , Thyroid Nodule/pathology , Thyroid Nodule , Punctures , Retrospective StudiesABSTRACT
Se presenta un caso de teratoma quístico inmaduro (TQ) en paciente de 11 que consultó al servicio de urgencia por presentar cuadro de dolor abdominal agudo, encontrándose masa que ocupaba flanco izquierdo e hipogastrio y la ultrasonografía reveló tumoración anexial izquierda de 15 cm de diámetro con signos sospechosos de malignidad. Se efectúa laparotomía con equipo oncológico con estudio citológico peritoneal y biopsia rápida del tumor que revela: teratoma quístico inmaduro por lo que se realiza anexectomía omentectomía, la biopsia diferida confirma el diagnóstico clasificándolo como grado I. Se revisa el tema en pacientes infanto-juveniles y dada su baja frecuencia se presenta como caso clínico con manejo de urgencia y resolución