ABSTRACT
Resumen INTRODUCCIÓN: La tuberculosis sigue siendo un problema de salud pública global: alrededor de un cuarto de la población mundial está infectada con el bacilo de la tuberculosis, pero solo 5 a 15% realmente resultarán con la enfermedad. Pese a los esfuerzos por controlar la infección, hoy en día es la principal causa de muerte producida por un único agente infeccioso. La forma extrapulmonar es rara, y la genital suele manifestarse con esterilidad, en otros simula un cáncer de ovario avanzado, incluidas la masa anexial y la ascitis, pérdida de peso y elevación del marcador tumoral Ca125. El diagnóstico diferencial prequirúrgico es complejo, de ahí que a la mayoría de las pacientes se les indique una intervención quirúrgica innecesaria. CASO CLÍNICO: Paciente de 29 años con diagnóstico de formación anexial sospechosa de malignidad que se trató de manera conservadora hasta conseguir su regresión total. Además, se efectuó una revisión de la bibliografía relacionada con esta infrecuente entidad. CONCLUSIÓN: La conjunción de ascitis, masa pélvica y elevación del marcador Ca125 puede corresponder al diagnóstico de cáncer de ovario avanzado, ello sin olvidar la posibilidad de tuberculosis extraperitoneal en pacientes con antecedente de tuberculosis o procedentes de zonas endémicas. El diagnóstico es complejo, sobre todo por la baja incidencia en nuestro medio, que a menudo requiere laparoscopias exploradoras para confirmar el origen de las lesiones.
Abstract INTRODUCTION: Tuberculosis remains a global public health problem: about a quarter of the world's population is infected with the tuberculosis bacillus, but only 5-15% will actually develop the disease. Despite efforts to control the infection, today it is the leading cause of death from a single infectious agent. The extrapulmonary form is rare, and the genital form usually manifests with sterility, in others it simulates advanced ovarian cancer, including adnexal mass and ascites, weight loss and elevation of the tumor marker Ca125. The pre-surgical differential diagnosis is complex, hence most patients are indicated for unnecessary surgery. CLINICAL CASE: A 29-year-old patient with a diagnosis of adnexal formation suspicious for malignancy was treated conservatively until complete regression was achieved. In addition, a review of the existing literature related to this rare entity was performed. CONCLUSION: The conjunction of ascites, pelvic mass and elevated Ca125 marker may correspond to the diagnosis of advanced ovarian cancer, without forgetting the possibility of extraperitoneal tuberculosis in patients with a history of tuberculosis or from endemic areas. Diagnosis is complex, especially due to the low incidence in our environment, which often requires exploratory laparoscopy to confirm the origin of the lesions.
ABSTRACT
Background: Fine needle aspiration cytology is considered the gold standard diagnostic test for the diagnosis of thyroid nodules. Fine needle aspiration cytology is a cost effective procedure that provides a specific diagnosis rapidly with minimal complications. Based on the cytology findings, patients can be followed up in cases of benign diagnosis and subjected to surgery in cases of malignant diagnosis thereby decreasing the rate of unnecessary surgery. The purpose of the present study was to correlate the fine needle aspiration cytology findings with histopathology of excised specimens. Methods: This was a prospective study conducted on 310 consecutive patients between June 2012 and May 2015. All patients with clinically diagnosed thyroid nodule were included in the study. Results: In our study sensitivity of the thyroid FNAC ranges from 93.02% to 100% and its specificity from 60.42% to 96.62% respectively. Positive predictive value is 94.44% and negative predictive value is 100%. Commonest benign condition is multinodular goiter and malignancy is papillary carcinoma. Most difficult thyroid lesions to be reported are those in the intermediate category as cytomorphological features are overlapping.Conclusion: Fine needle aspiration cytology is a simple, easy to perform, cost effective, and easily repeated procedure for the diagnosis of thyroid cancer. It is recommended as the first line investigation for the diagnosis of thyroid nodules.