Importance of FNAC in the detection of tumours within multinodular goitre of the thyroid.

The primary challenge in the management of a multinodular thyroid gland is to rule out malignancy. The present study was undertaken to assess the value of preoperative ultrasound-guided fine needle aspiration cytology (FNAC) in diagnosing tumours of the thyroid gland. Of the 80 patients operated for multinodular lesions, malignant tumours were found in 29 and benign tumours in 36 patients (81%) and non-tumorous lesions in 15 (19%) patients. Compared with the histopathological postoperative diagnosis, the overall sensitivity of FNAC was 85% and specificity 88%. Current morphological diagnosis of the nodules in multinodular goitre requires thorough preoperative examination, including ultrasound-guided FNAC in order to establish the appropriate management.

Fine needle aspiration cytology in the preoperative diagnosis of ultrasonically enlarged parathyroid glands.

The value of fine needle aspiration (FNA) cytology in the diagnosis of ultrasonically suspected parathyroid gland enlargements was reviewed for a six-year series of cases. In 146 patients, 277 FNA biopsies under ultrasound guidance were performed on suspected enlarged parathyroid glands. Smears were routinely stained by the Pappenheim (May-Grünwald-Giemsa) method, and the Grimelius silver stain was used to demonstrate argyrophilic granules in the cytoplasm of parathyroid cells. Diagnostic material was obtained by FNA from 121 (83%) patients, whereas the aspirates were considered inadequate for cytologic diagnosis in 25 (17%) patients. For the 121 cases with adequate FNA samples, cytology diagnosed a parathyroid origin in 80 (55%) of the 146 total patients) and a thyroid origin in 41 (28%). The cytologic-histologic correlation available for 36 patients showed a cytologic sensitivity of 86%. Parathyroid lesions are frequently treated preoperatively as a disease of the thyroid; the results of this study suggest that cytomorphologic analysis of FNA samples can demonstrate the parathyroid origin of such samples, especially when a silver stain is used in addition to the routine stain.

Aspiration cytology of renal-cell carcinoma metastatic to the thyroid.

Fine needle aspiration (FNA) of a thyroid mass clinically suspected of being acute thyroiditis led to a cytologic diagnosis of hypernephroma metastatic to the thyroid and to the subsequent detection of the occult primary tumor. The FNA cytomorphologic findings were substantiated by cytochemical staining of FNA samples and confirmed by subsequent histopathologic examination of the resected thyroid. Postoperative studies revealed an expansive growth in the left kidney; analysis of the nephrectomy specimen showed an invasive renal-cell carcinoma. This case emphasizes the considerable value of FNA biopsy in making the frequently difficult preoperative differential diagnosis of primary and metastatic thyroid tumor and the importance of cytochemical analyses in making that distinction and in suggesting the site of the primary tumor.

[Sclerotization of the parathyroid glands--description of a method]. / Sklerozacija paratiroidnih zlijezda--prikaz metode.

The method of ultrasonically guided percutaneous 95% ethanol injection of enlarged parathyroid gland is presented. Treatment was performed on the patient who has been treated with chronic hemodialysis for eight years and developed the symptoms of secondary hyperparathyroidism and who has had one enlarged parathyroid gland detected with ultrasound and confirmed by cytology. One month later the symptoms subsided, the laboratory findings improved and ultrasound examination revealed the decreased volume of the parathyroid. The paper points out the value of this method in the treatment of hyperparathyroidism.

Parathyroid sonography in secondary hyperparathyroidism: correlation with clinical findings.

We present the results of ultrasonic neck examination in 72 patients (47 males, 25 females) on chronic haemodialysis, with clinical and biochemical signs of increased function of the parathyroid glands. The findings of the ultrasonic examination performed using linear transducers of 5 and 7.5 MHz for the surface tissue are compared with the duration of haemodialysis treatment, biochemical parameters (calcium, phosphate, parathormone, alkaline phosphatase) and skeleton X-ray findings. In 18 patients parathyroid glands were not visible, in 30 patients there were one or two enlarged (i.e. abnormal) parathyroid glands, and in the remaining 24 patients three or four of the glands were enlarged. Abnormal parathyroid glands were more often found in patients who had been dialysed for a longer period of time, as well as in those with a higher parathormone level in the blood. It is concluded that ultrasonic examination of the neck is very useful in the diagnosis of enlarged parathyroid glands, and helpful in the management of patients on chronic haemodialysis.