Simultaneous medullary carcinoma, papillary carcinoma and granulomatous inflammation of the thyroid

Thyroid tumours with both papillary and medullary carcinoma features are rare and represent less than 1% of all thyroid malignancies. These tumours have a different clinical presentation and biological behaviour from tumours that have only papillary or medullary carcinoma features. The phenomenon of mixed thyroid tumours can be observed in two settings--a mixed tumour showing dual differentiation, or a collision tumour. For a precise diagnosis of this rare mixed thyroid carcinoma, fine needle aspiration cytology results should be correlated with serum calcitonin and thyroglobulin levels. The diagnosis should also be confirmed using immunocytochemistry. Surgery is the treatment of choice, and the role of postoperative radioiodine is controversial. We herein report the case of a 35-year-old man with a mixed medullary-papillary carcinoma of the thyroid, which presented with C-cell hyperplasia, granulomatous inflammation and metastasis to the cervical lymph nodes. The patient was treated with total thyroidectomy and nodal clearance. This case highlights the need for awareness of coexistent entities as they warrant separate treatments.

Intramedullary spinal cord abscess

Intramedullary tubercular abscess is a very rare condition, however it needs to be considered in the differential diagnosis of neurological deterioration in a patient of tuberculosis as timely intervention often gives good neurological recovery. The authors report a rare case of intramedullary tuberculous abscess of dorsal spinal cord in a 35-year-old female patient who presented with paraplegia and bladder involvement. Magnetic resonance imaging scans revealed D6-D10 arachnoiditis with intramedullary lesion with extradural compression locally. A dorsal laminectomy with decompression of intramedullary abscess with biopsy of extradural granulation tissue was carried out and patient was started on antituberculous therapy and gradually improved neurologically postoperatively. Intrameduallry tuberculous abscess is a rare condition and surgical intervention is helpful even in the presence of profound neurological deficits

Giant pituitary adenomas: surgical outcome in a series of 127 cases

To analyze the surgical and visual outcome of giant pituitary adenomas. One-hundred-twenty-seven patients surgically treated over a 9-year period were studied. Fifty-four-point-three percent had non-functioning adenomas. Among the functioning adenomas, prolactinomas were the most common. A total of 90 transsphenoidal and 52 transcranial procedures were performed in 127 patients. The complications and deaths were significantly higher in the transcranial group. There were a total of 15 deaths [11.8%], Thirty-two-point-two percent had single/multiple postoperative complications. Vision improved in 49 patients [41.9%] at the time of discharge. Thirteen-point-eight percent of the pituitary adenomas are giant. Transsphenoidal surgery was the procedure of choice for most of the patients. These tumours represent a difficult group to treat. Prolactin estimation and preferably immunohistochemical analysis should be done in all patients in order to clinically diagnose indistinct prolactinomas

Cerebral vascular changes in experimentally induced hypertensive rats

To study the pathogenesis of cerebral vascular changes in hypertension, especially those predisposing to hemorrhage, we set out to produce a hypertensive rat model by the Goldblatt [2 kidney-1 clip] method. Materials and Fifty rats were rendere d hypertensive by the Goldblatt method in which the left renal artery was ligated surgically. The animals, together with 18 control rats, were divided into three groups as follows: a] on normal diet and water, b] on normal diet and 1% salt water and c] on normal diet and drinking water containing 0.12% of the lathyrogen beta a m i n o p roprionitrile [BAPN]. Slices of brain were examined both macroscopically and microscopically for morphological changes in the cerebral vessels. Mean arterial blood pressures achieved were only moderate [170 mmHg] and corresponding cerebral vascular changes were mild to moderate. None of the s e v e re lesions [hemorrhages, fibrinoid necrosis, microaneurysms, etc.] known to be associated with severe or long-standing hypertension were demonstrated in this study. A few vessels in six animals showed fibrin deposition in the wall, although these could not be directly related to the severity of hypertension or duration of survival of the animal. The six, as well as three additional animals, also showed immunoglobulin G [IgG] deposition in the vessel walls and perivascular tissues within the brain. We have successfully established a rat model for the study of hypertension-related cerebral vascular changes. The deposits of fibrin and IgG in the vessel wall and surrounding tissues re p resent early changes, which appear to occur even in the absence of severe hypertensive vascular disease. Further studies are required to determine the relevance of these changes to other known morphological changes of the cerebral vasculature in hypertension

Helicobacter pylori-associated chronic antral gastritis in Kuwait- A histopathological study

In order to study the causal relationship between Helicobacter pylori [HP] and various inflammatory reactions in gastric antral mucosa, we have reviewed 268 endoscopic gastric biopsies in the Department of Pathology of Mubarak Al-Kabeer Teaching Hospital in Kuwait. Of the 219 HP-positive biopsies, 95.4% showed chronic gastritis [CG], 59.8% active chronic gastritis [ACG] and 78.5% lymphoid hyperplasia [LH]. The prevalence of LH, CG or ACG, either alone or in combination, increased with increasing density [grade] of HP colonization, assuming statistical significance for LH and ACG [P<0.05], especially when these changes in Grade 1 HP cases were compared to those of Grades 2 and 3 combined. Moreover, the grade of LH by itself also showed statistically significant correlation [P<0.01] with the grade of inflammation. Our results confirm a causal relationship between HP colonization of gastric mucosa and the various forms of gastritis, and also provide evidence in support of induction of mucosa-associated lymphoid tissue [MALT] by HP, an observation which may have significance in the genesis of gastric MALTomas

Atrophic gostnitis and intestinol metaplona in helicobocter pyloi-amocioted antrol gostnitis

Although the causal relationship between Helicobacter pylori [H. pylori] infection and chronic gastritis and peptic ulcer disease appears established, the relationship between the organism and gastric carcinoma remains tenuous. We have reviewed 268 gastric antral biopsies from the Department of Pathology, Mubarak Al-Kabeer Hospital, Kuwait, in an attempt to assess the relationship between H. pylori colonizations and the presence of atrophic gastritis and intestinal metaplasia, recognized premalignant lesions of the stomach. H. pylori were found in 219 [81.7%] patients of which 62 [28.3%] had atrophic gastritis and 33 [15.1%] intestinal metaplasia. Both atrophic gastritis and intestinal metaplasia increased with age. The mean age of patients with intestinal metaplasia was about 8 years older than that of patients without intestinal metaplasia. Higher prevalences of both lesions were associated with lower density H. pylori colonization as well as an increasing grade of chronic inflammation. Our results confirm previous findings of a probable causal relationship between H. pylori infection and both atrophic gastritis and intestinal metaplasia. The higher prevalence of these premalignant lesions in older subjects would suggest progressive changes associated with persistent H. pylori infection