Small nonfunctional parathyroid cysts: single institution experience.

Parathyroid cysts (PCs) account for less than 1% of all parathyroid lesions and are most commonly located along thyroid lobes, rarely at ectopic sites. PCs are important because they can pose a differential diagnostic challenge against other cystic formations of the neck. PCs can be functional (elevated serum parathyroid hormone level) and nonfunctional. Four cases of nonfunctional PCs are presented. All four female patients underwent physical examination and ultrasonography of the neck with ultrasound-guided fine-needle aspiration biopsy (UG-FNA). The material thus obtained was stained by the standard May-Grünwald-Giemsa method. Parathyroid hormone level was determined in aspirate and serum, along with serum levels of total calcium, inorganic phosphates. In two asymptomatic patients, remission occurred after initial aspiration biopsy; one patient had compression syndrome with vocal cord paresis that required surgical treatment; and one patient had cyst recurrence that was surgically removed. Cystic neck masses can pose a major differential diagnostic problem considering different approach, treatment method, and preoperative and postoperative follow up. Surgical treatment is necessary in case of functional and large nonfunctional PCs (due to compression syndrome), whereas individualized therapeutic approach is used in case of small nonfunctional PCs. Ultrasonography with UG-FNA, cytologic analysis of the material obtained, and determination of parathyroid hormone level in aspirate and serum are crucial for making an accurate diagnosis.

Consensus statement on screening, diagnosis, classification and treatment of endemic (Balkan) nephropathy.

Currently used diagnostic criteria in different endemic (Balkan) nephropathy (EN) centers involve different combinations of parameters, various cut-off values and many of them are not in agreement with proposed international guidelines. Leaders of EN centers began to address these problems at scientific meetings, and this paper is the outgrowth of those discussions. The main aim is to provide recommendations for clinical work on current knowledge and expertise. This document is developed for use by general physicians, nephrologists, urologist, public health experts and epidemiologist, and it is hoped that it will be adopted by responsible institutions in countries harboring EN. National medical providers should cover costs of screening and diagnostic procedures and treatment of EN patients with or without upper urothelial cancers.

Morphometry in differential diagnosis of pathologically altered parathyroid glands: adenoma and hyperplasia.

Simple morphological identification of a sample as parathyroid gland tissue is not always sufficient for optimal patient treatment. Instead, patients with parathyroid gland lesions that increase the risk of disease relapse should be identified. To assess the possibility of differentiating adenoma from hyperplasia in preoperative material by use of computerized morphometric analysis in order to enable better preoperative work-up in patients with hyperparathyroidism. Samples obtained by US guided fine-needle aspiration biopsy of 67 parathyroid glands without known histopathologic diagnosis were dried and stained by May-Grünwald-Giemsa. Fifty nuclei per sample were analyzed and designated automatically with manual correction using image analyzer and specific software. The area, circumference, convexity, minimal and maximal radius, length and width, and factors of regularity, i.e. form factor and factor of nucleus elongation, were determined for each nucleus. Basic descriptive parameters and measures of variability (variation coefficient and standard deviation) were calculated for each continuous variable. The correlation of continuous variables was analyzed by use of Mann-Whitney test. Computer analysis of cell image classified the cell nuclei into two groups. The area, circumference, minimal radius, convexity and width of the nuclei showed higher values in the hyperplasia group as compared with the adenoma group. Standard deviation also showed higher values of each of the study parameters in the former group. Our own observations and subjective assessment of variations in nucleus size to represent substantial characteristics differentiating parathyroid adenoma and hyperplasia in cytologic smear were quantitatively verified by the use of objective morphometric measurement and should therefore be considered valid parameters on differentiating these two entities.

A correlative study of histology and imprint cytology of gastric mucosa biopsy in the diagnosis gastric cancer.

The purpose of this paper is to show the importance of gastric mucosa imprint cytology in detecting stomach cancer. Analyzed were 364 cytological and pathohistiological samples taken from 335 patients having suspected diagnosis of gastric cancer. Every specimen was submitted to slide imprinting and then fixed in formalin for further processing with routine histopathology. The imprints were air dried for cytological analysis, stained according to May-Grünwald-Giemsa and analyzed by light microscope. By pathohistological punch-biopsy samples analysis stomach cancer was found in 45 samples. With cytological samples analysis the cancer was detected in 48 samples and 13 cytological samples were suspected of cancer With combining these two methods cancer was found in 68 cases. Patients with positive cytological finding and negative pathohistologic finding underwent gastroscopy with punch-biopsy. All patients with positive pathohistological findings were operated. All materials were histologically examined. Cancer was found in 68 patients. Cytological analysis of stomach mucosa bioptic material imprints, increases the number of positive findings in preoperative stage of gastric cancer diagnosis. The greatest advantage of this method is short period for preparation of material, simplicity and low price. Every data on morphological changes in mucosa has been also pathohistologically checked, because taking imprints does not damage the specimen.

Total hearing loss and blindness caused by relapsing polychondritis and myelodysplastic syndrome.

Relapsing polychondritis is an autoimmune disease that primarily manifests as cartilaginous tissue destruction. However, the immune impairment may also involve noncartilaginous tissues such as kidneys, blood vessels, etc. The disease may occur as a primary disorder or in association with other diseases. The case of a female patient with concurrent manifestation of myelodysplastic syndrome-refractory anemia with excess blasts, and relapsing polychondritis, is presented. The diagnosis of relapsing polychondritis was established ten months after the diagnosis of myelodysplastic syndrome, when the criteria for the former were met. Total hearing loss and blindness developed soon thereafter.