RESUMEN
Fine-needle aspiration (FNA) biopsy is a safe, simple, and inexpensive procedure that is particularly applicable for lesions of the head and neck. In our department, it is widely used for the evaluation of thyroid nodules. A total of 189 patients participated in a prospective study of benign thyroid nodules. Our aim was to verify the modality of treatment used in our department and the reliability of benign cytologic results of colloid goiter. All patients had cold nodules on thyroid scanning. The patients were divided into two groups, the first comprising 93 patients who did not undergo thyroid surgery and were followed up for 5 to 11 years. One case of malignancy was found in this group during the follow-up. The second group was comprised of 96 patients who were operated on despite FNA results of colloid goiter. Among them, five cases of malignancy were found. Four of these five cases could not be regarded as FNA failure. Our study confirms that the combination of clinical findings with those of the FNA is a reliable approach to the management of benign thyroid nodules. Nevertheless, long-term follow-up is mandatory and repetitive aspirations should be considered.
Asunto(s)
Biopsia con Aguja , Nódulo Tiroideo/patología , Nódulo Tiroideo/cirugía , Adulto , Anciano , Femenino , Estudios de Seguimiento , Bocio/patología , Bocio/cirugía , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/cirugíaRESUMEN
A 27-year-old woman with no previous personal or family history of thyroid disease was referred to us for the evaluation of thyroid nodule, five months postpartum. Thyroid scintigraphy demonstrated a left cold nodule. Fine needle aspiration cytology of the nodule showed a mixture of colloid, follicular cells and lymphocytes, suggesting lymphocytic thyroiditis. Thyroid function tests were normal and thyroid autoantibodies were negative. After two months the thyroid nodule was not palpated and thyroid scintigraphy returned to normal. Thyroid function tests remained normal twelve months after delivery. These findings suggest that postpartum thyroiditis may present as a localized transient form and should be considered in the differential diagnosis of painless solitary nodule that appears postpartum.
Asunto(s)
Periodo Posparto , Nódulo Tiroideo/etiología , Tiroiditis/complicaciones , Adulto , Femenino , Humanos , Factores de TiempoRESUMEN
BACKGROUND: Synovial sarcoma (SS), a malignant mesenchymal tumor, has a biphasic growth pattern characteristically. Histologically and cytologically the tumor can pose diagnostic difficulty when the epithelial component is predominant. CASE REPORT: A 22-year-old female presented with a rapidly enlarging mass on the lower left side of the neck. Fine needle aspiration of the tumor yielded abundant, discohesive round-oval cells mingled with amorphous hyaline material, raising a suspicion of medullary carcinoma of the thyroid. In addition, air-dried, Giemsa-stained smears demonstrated rosettelike structures with central magenta globular material, mimicking adenoid cystic carcinoma. However, histologic examination of the excised tumor, including immunohistochemical and ultrastructural studies, proved it to be a typical SS with copious basement membrane accumulations. CONCLUSION: The cytologic appearance of SS can be confusing. However, a false diagnosis may be avoided if adequate needle sampling is ensured and clinical correlation considered.
Asunto(s)
Membrana Basal/patología , Neoplasias de Cabeza y Cuello/patología , Sarcoma Sinovial/patología , Adulto , Membrana Basal/química , Biomarcadores de Tumor/análisis , Biopsia con Aguja , Carcinoma Medular/diagnóstico , Colágeno/análisis , Diagnóstico Diferencial , Femenino , Neoplasias de Cabeza y Cuello/química , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/radioterapia , Humanos , Laminina/análisis , Proteínas de Neoplasias/análisis , Recurrencia Local de Neoplasia , Sarcoma Sinovial/química , Sarcoma Sinovial/diagnóstico , Sarcoma Sinovial/radioterapia , Neoplasias de la Tiroides/diagnósticoRESUMEN
Recently, we demonstrated that melatonin secretion was increased in male patients with GnRH deficiency and decreased to normal levels during testosterone treatment. These data suggested that gonadal steroids modulate melatonin secretion, probably by activating specific receptors in the pineal gland. We used immunohistochemistry to localize gonadotropin (LH and FSH) and gonadal steroid (androgens and estrogens) receptors in human pineal glands. Tissues were obtained at autopsy from 25 males, aged 19-87 yr, and five prepubertal children, aged 0.2-10 yr. Positive staining for all four types of receptors (LH, FSH, androgen, and estrogen) in the pineal parenchymal cells, pinealocytes, was evident in all 30 glands examined. Double staining revealed that nuclear receptors (androgen or estrogen) co-existed with cytoplasmatic receptors (LH or FSH) in the same cells. The results demonstrate the presence of gonadotropin and gonadal steroid receptors in human pinealocytes from infancy to old age.
Asunto(s)
Hormona Folículo Estimulante/metabolismo , Hormona Luteinizante/metabolismo , Glándula Pineal/metabolismo , Receptores Androgénicos/metabolismo , Receptores de Estrógenos/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Distribución TisularAsunto(s)
Cateterismo Venoso Central/instrumentación , Anciano , Falla de Equipo , Humanos , Venas Yugulares , MasculinoRESUMEN
Recently abnormal melatonin secretion was demonstrated in hypogonadal male patients which was normalized during testosterone administration. These results suggested that both gonadal steroids and gonadotropins may modulate melatonin secretion, probably by activating specific receptors in the pineal gland. We used immunohistochemistry to localize luteinizing hormone, follicle stimulating hormone, estrogen and androgen receptors in human pineal glands. Tissues were obtained at autopsy from 53 adult males (aged 19-94 years) over a period of 1 year. Positive staining for the four types of receptors was evident in all 53 specimens examined. The percent of positively stained cells revealed a significant seasonal variation of gonadotropin receptors with higher values in the winter than in the summer. Day-night difference was evident only for follicle stimulating hormone-receptors during the summer and winter, with higher values at night. Androgen receptors and estrogen receptors were present in all specimens but did not reveal day-night or seasonal variations. These data demonstrate the presence of gonadotropin and gonadal steroid receptors in the human pineal gland. Gonadotropin receptors exhibited seasonal variation with higher values in the winter.
Asunto(s)
Gonadotropinas/metabolismo , Glándula Pineal/metabolismo , Receptores de Esteroides/metabolismo , Estaciones del Año , Testículo/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Testículo/fisiologíaRESUMEN
We describe two male patients, aged 17 and 47 years, with clinical and biochemical features of pheochromocytoma. Both patients had normal-sized adrenal glands on abdominal CT scan and abnormal unilateral uptake of I-123 metaiodobenzylguanidine (MIBG) on scintigraphy. The surgical adrenalectomy revealed normal macroscopic glands in both patients. Histological examination showed adrenal medullary hyperplasia with adrenal cortico-medullary ratios of 2:1 and 4:1. Unilateral adrenalectomy resulted in amelioration of symptoms and normalization of catecholamines excretion. DNA examination for RET protooncogene revealed no mutations in exons 10, 11, 13, 14 and 16. Our results suggest that diffuse adrenal medullary hyperplasia may be the initial pathological change in the adrenal gland leading, subsequently, to the development of nodular hyperplasia and adrenal medullary tumor. These results indicate that the syndrome of pheochromocytoma may occur as an unilateral adrenal medullary hyperplasia in patients without evidence for multiple endocrine neoplasia.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/etiología , Glándulas Suprarrenales/patología , Feocromocitoma/etiología , Adolescente , Neoplasias de las Glándulas Suprarrenales/diagnóstico por imagen , Neoplasias de las Glándulas Suprarrenales/cirugía , Glándulas Suprarrenales/diagnóstico por imagen , Adrenalectomía , Humanos , Hiperplasia/complicaciones , Masculino , Persona de Mediana Edad , Feocromocitoma/diagnóstico por imagen , Feocromocitoma/cirugía , CintigrafíaRESUMEN
We report a unique case of hemifacial spasm due to compression of the facial nerve by the main trunk of the external carotid artery within the parotid space. Decompression of the facial nerve as well as partial section of the proximal trunk of the nerve, caused the hemifacial spasm to disappear. Our case gives support to the theory that hemifacial spasm can be caused by pressure on the facial nerve along all its course and not only in its intra-cranial portion.
Asunto(s)
Arteria Carótida Externa , Nervio Facial , Parálisis Facial/etiología , Síndromes de Compresión Nerviosa/complicaciones , Arteria Carótida Externa/patología , Nervio Facial/patología , Parálisis Facial/patología , Humanos , Masculino , Persona de Mediana Edad , Síndromes de Compresión Nerviosa/patologíaRESUMEN
The fine needle aspiration cytology of a thyroid nodule in a 19-year-old female showed Reed-Sternberg (RS) cell variants in clusters, thereby suggesting the possibility of syncytial variant of nodular sclerosing Hodgkin's disease (NSHD). A similar picture was observed on imprint smears of an excised cervical lymph node, the histology of which confirmed the original diagnosis. Following chemotherapy, the nodule disappeared. The patient was spared major thyroid surgery. It is important to recognize the rare morphologic variants and unusual clinical presentations of common diseases in order to perform appropriate studies that will ensure that the patient receives the best clinical management. Morphologic clues that should arouse the cytopathologist's awareness of this rare variant of NSHD are presented.
Asunto(s)
Enfermedad de Hodgkin/diagnóstico , Nódulo Tiroideo/diagnóstico , Adulto , Antígenos CD/metabolismo , Biopsia con Aguja , Diagnóstico Diferencial , Femenino , Enfermedad de Hodgkin/inmunología , Enfermedad de Hodgkin/patología , Humanos , Inmunohistoquímica , Ganglios Linfáticos/patología , CuelloRESUMEN
Two patients with unusual Hodgkin's disease who initially had a painless, solitary, thyroid cold nodule are described. Fine-needle aspiration revealed lymphocytic thyroiditis in one patient and a diagnosis of Hodgkin's disease was made 1 year later. In the second patient, aspiration of the nodule demonstrated a syncytial variant of nodular sclerosis Hodgkin's disease. Both patients underwent radiologic work-up, and surgery of the thyroid was avoided. After chemotherapy, both thyroid nodules disappeared. Thyroid involvement by Hodgkin's disease may be more common than anticipated, and may present atypically as a solitary thyroid nodule. Lymphocytic thyroiditis may accompany the disease and may cause a delay in the diagnosis. Recognition of this entity and the use of fine-needle aspiration may prevent unnecessary thyroid surgery, thus maintaining intact thyroid function after therapy.
Asunto(s)
Enfermedad de Hodgkin/diagnóstico por imagen , Nódulo Tiroideo/etiología , Adolescente , Adulto , Femenino , Enfermedad de Hodgkin/complicaciones , Enfermedad de Hodgkin/terapia , Humanos , Cintigrafía , Nódulo Tiroideo/terapiaRESUMEN
We present two siblings with neonatal Hirschsprung's disease in whom isolated familial medullary carcinoma of the thyroid was diagnosed at the age of 16 and 19 years. Rectal biopsy in each patient revealed total absence of ganglion cells in the myenteric plexus and hypertrophied nerve fibers characteristic of Hirschsprung's disease. Both underwent total thyroidectomy and histological examination revealed bilateral and multifocal medullary carcinoma of the thyroid. These two patients belong to a large family in whom another 12 affected members with medullary carcinoma of the thyroid were found. Our description is the first report of an association between Hirschsprung's disease and isolated familial medullary carcinoma of the thyroid. We suggest that familial occurrence of Hirschsprung's disease could be an early presentation of familial medullary carcinoma of the thyroid either as the isolated form or as part of multiple endocrine neoplasia type IIa or IIb.
Asunto(s)
Carcinoma Medular/complicaciones , Carcinoma Medular/genética , Enfermedad de Hirschsprung/complicaciones , Neoplasias de la Tiroides/complicaciones , Neoplasias de la Tiroides/genética , Adolescente , Adulto , Calcitonina/sangre , Carcinoma Medular/patología , Niño , Femenino , Enfermedad de Hirschsprung/patología , Humanos , Masculino , Plexo Mientérico/patología , Linaje , Neoplasias de la Tiroides/patología , TiroidectomíaRESUMEN
The effect of intraoperative autotransfusion during coronary artery bypass grafting was studied in a randomized double-blind trial involving 38 patients. Nineteen patients had the collected RBCs washed and autotransfused (autotransfusion group), while the remaining patients had their washed cells discarded (control group). Postoperative hemoglobin and hematocrit values were similar. Exposure to banked blood was markedly decreased in the autotransfusion group compared with the control group. In addition, the mean volume of banked packed RBCs transfused per patient was significantly less in the autotransfusion group compared with the control group. Platelet utilization also was markedly decreased in the autotransfusion group. Cryoprecipitate and fresh frozen plasma utilization also was less in the autotransfusion group than in the control group, but this did not reach statistical significance. We conclude that the intraoperative use of autotransfusion decreases the volume of homologous blood products transfused, which results in reduced exposure of the patients to banked blood products.
Asunto(s)
Transfusión de Sangre Autóloga , Puente de Arteria Coronaria , Adulto , Anciano , Anciano de 80 o más Años , Pruebas de Coagulación Sanguínea , Transfusión de Componentes Sanguíneos , Método Doble Ciego , Femenino , Hematócrito , Hemoglobinas/análisis , Humanos , Lactante , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
The frozen section diagnosis of scleroma (rhinoscleroma) may pose some difficulty to the unsuspecting pathologist. Intraoperative cytology is a helpful technique that, when combined with frozen section, enhances the diagnostic accuracy. Imprint smears obtained from a tissue sample of an obstructive nasal mucosal mass demonstrated the characteristic Mikulicz cells, thus confirming the frozen section diagnosis of scleroma. The importance of intraoperative cytology in the evaluation of surgical specimens is emphasized.
Asunto(s)
Rinoscleroma/patología , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Periodo IntraoperatorioRESUMEN
Soft tissue tumors in infants and children often cause considerable concern to the surgeon and pathologist, especially when a rare tumor, such as lipoblastoma, is in question. Frozen section may not yield a definitive diagnosis, and the histologic picture could be deceptive, tempting one to make a false diagnosis of malignancy. Except for a single case report, no detailed cytologic study of this rare benign neoplasm appears to have been reported previously. The varied cytologic findings, as observed on imprint smears of a tumor removed from a 12-month-old boy, are presented. The differential diagnosis of childhood myxoid neoplasms is discussed briefly.
Asunto(s)
Lipoma/patología , Liposarcoma/patología , Neoplasias de los Tejidos Blandos/patología , Diagnóstico Diferencial , Humanos , Lactante , Periodo Intraoperatorio , Lipoma/ultraestructura , Masculino , Neoplasias de los Tejidos Blandos/ultraestructura , MusloRESUMEN
Goiter size, thyroid function tests and thyroid cytology were studied in 100 immigrant Ethiopian Jews, 1-12 months after arrival in Israel on Operation Solomon (1991), who were referred for evaluation of goiter. Female-to-male ratio was 2.2:1. Hypothyroidism was rare (1%) whereas hyperthyroidism was frequently diagnosed (11%). Elevated thyroglobulin (TG) serum levels were found in 36% of the patients. Antithyroid antibodies were not detected. Thyroid cytology revealed rich colloid goiters in all patients. Thyroid carcinomata and chronic lymphocytic thyroiditis were not diagnosed. Both hyperthyroidism and elevated TG levels were found only in female patients and were equally distributed in patients maintained on either Israeli or Ethiopian diets. It is suggested that the major factors in the pathogenesis of endemic goiter in Ethiopian Jews are genetic and/or food goiterogens, with only a minor role for iodine deficiency.
Asunto(s)
Emigración e Inmigración , Bocio Endémico/etnología , Bocio Endémico/etiología , Judíos , Adolescente , Adulto , Factores de Edad , Anciano , Niño , Preescolar , Dieta , Etiopía/etnología , Femenino , Bocio Endémico/patología , Humanos , Israel/epidemiología , Masculino , Persona de Mediana Edad , Factores Sexuales , Pruebas de Función de la TiroidesRESUMEN
Small cell carcinoma of the ovary is a rare but lethal neoplasm occurring in the young. In two-thirds of the cases the tumor produces paraendocrine hypercalcemia. The tumor, despite the name, is composed of a dimorphic population of small and large cells, the histogenesis of which is still a controversial matter. Except for a single illustration, no detailed study of this rare entity appears to have been performed previously. The composite cytologic features as seen on touch imprints are presented in this case report, with ultrastructural and immunohistochemical correlations.
Asunto(s)
Carcinoma de Células Pequeñas/patología , Neoplasias Ováricas/patología , Adulto , Carcinoma de Células Pequeñas/complicaciones , Carcinoma de Células Pequeñas/ultraestructura , Femenino , Humanos , Hipercalcemia/etiología , Periodo Intraoperatorio , Neoplasias Ováricas/ultraestructuraAsunto(s)
Adenocarcinoma Mucinoso/secundario , Neoplasias de la Tiroides/secundario , Adenocarcinoma Mucinoso/patología , Anciano , Carcinoma in Situ/patología , Femenino , Neoplasias de la Vesícula Biliar/patología , Humanos , Neoplasias Pulmonares/secundario , Neoplasias Primarias Múltiples/patología , Neoplasias del Colon Sigmoide/patología , Neoplasias de la Tiroides/patologíaRESUMEN
This is an immunohistochemical and ultrastructural study of two small cell carcinomas of the ovary with a review of the literature. These cases showed a dimorphic population of small and large cells sharply demarcated from each other. Cytokeratin 18 and vimentin were mainly expressed in the large tumour cells, some of which also stained for alpha-smooth muscle actin. Periodic-acid-Schiff-positive, alpha-1-antitrypsin-positive hyaline globules were present in one case. Ultrastructural findings included filamentous nucleolonema as well as evidence of smooth muscle differentiation. Some of these observations have not been previously reported. Certain of the above features seem to support a germ cell origin of small cell carcinoma, but they cannot be considered specific for germ cell neoplasms. Thus, small cell carcinoma of the ovary cannot be classified into one of the known categories of ovarian tumours at the present time.
Asunto(s)
Carcinoma de Células Pequeñas/metabolismo , Neoplasias Ováricas/metabolismo , Actinas/análisis , Adulto , Carcinoma de Células Pequeñas/ultraestructura , Femenino , Humanos , Inmunohistoquímica , Queratinas/análisis , Neoplasias Ováricas/ultraestructura , Vimentina/análisis , alfa 1-Antitripsina/análisisRESUMEN
Adenoma of the gallbladder is a rare benign tumor presenting as a sessile or pedunculated lesion with a papillary or nonpapillary structure. Of late, attention has been drawn to its malignant potential; its occurrence has never been reported in children. An 8-year-old girl who was successfully treated by cholecystectomy for a symptomatic adenoma of the gallbladder is reported.
Asunto(s)
Adenoma/cirugía , Neoplasias de la Vesícula Biliar/cirugía , Adenoma/patología , Niño , Colecistectomía , Femenino , Neoplasias de la Vesícula Biliar/patología , HumanosRESUMEN
Arteriovenous (AV) malformation or angiodysplasia of the gastrointestinal tract is a very rare cause of bleeding in children. These lesions are congenital anomalies and thought to be of hamartomatous origin. We report on a 4-year-old child with an AV malformation of the distal ileum treated by local resection. A brief review of the relevant literature is included. The importance of radionuclide blood pool scanning in the evaluation of these patients is emphasized.