Lymphangioma of the Thoracic Spine with Epidural Compression: A Case Report.

Lymphangiomas are benign lesions consisting of abnormal proliferations of lymphatic vessels. Lymphangiomas associated with bone involvement, particularly in vertebral bodies, accompanied by cord compression, are extremely rare, and our literature review yielded only a few relevant reports. We describe a 61-year-old man presenting with progressive paraparesis and sphincter disturbance of 5 months' duration. Magnetic resonance imaging (MRI) revealed an enhancing T8 vertebral body involvement as well as a homogeneously enhancing posterior epidural mass at the T7-T8 level, with severe cord compression and cerebrospinal fluid (CSF) blockade. The patient underwent surgery via T7-T8 laminectomy, and after the removal of the epidural mass, the surgical procedure was stopped due to severe bleeding. Histopathologic examination reported a lymphangioma. After 10 days, the patient was able to walk. In the sixth postoperative month, MRI showed complete relief of the mass effect. The wide spectrum of the preoperative differential diagnosis of lymphangiomas renders a definite preoperative diagnosis impossible; therefore, histopathologic examination is the sole definite route for their diagnosis. In case of the solitary lymphangiomas of the spine with epidural compression, preoperative angiography and embolization should be considered to reduce intraoperative bleeding and enhance the chance of total resection and total surgical resection should be performed to decrease the likelihood of recurrence.

Cutaneous Metaplastic Synovial Cyst: A Case Report.

Cutaneous metaplastic synovial cyst (CMSC), presents as a solitary, tender subcutaneous nodule that usually occurs at the site of previous surgery or trauma. Histologically, the lesion is characterized by a cystic structure with villous-like projections that lined by metaplastic synovial tissue. The main cause remains unclear, but trauma is presumed to be a precipitating factor, as most reported cases have a history of antecedent cutaneous injury. Here we present a case of CMSC in a 51 year old man, presented with a painless deep-seated dermal nodule in the medial aspect of left ankle without history of any trauma or surgery in this site. Immuno-histochemistry study reveals positive reaction for CD68 in the cystic wall and negative reactions for S-100. CMSC is a unique lesion and worthy to attention, and should be included in the differential diagnosis of deep dermal cutaneous cysts.

Nasolacrimal duct obstruction as a complication of iodine-131 therapy in patients with thyroid cancer.

PURPOSE: There are few studies evaluating the effect of radioioine therapy on the lacrimal drainage system. This study reports on symptomatic and asymptomatic nasolacrimal duct obstruction (NLDO) as complications of high-dose radioiodine therapy in these patients. METHODS: Eighty-one cases were randomly selected from a population of radioiodine-treated differentiated thyroid carcinoma patients and were enrolled in a historical cohort study. The patients were categorized into four subgroups on the basis of the received cumulative dose of iodine-131 (I-131). In addition, 17 age-matched and sex-matched individuals were selected as the control group. Using dacryoscintigraphy and a clinical datasheet, the patients and controls were evaluated for partial or complete and symptomatic or asymptomatic NLDO. The data on different subgroups of patients were compared with the data of the control group. RESULTS: Twenty-nine out of 162 exposed eyes (18%) and three out of 34 control eyes (9%) had evidence of NLDO on scintigraphic images. Among patients treated with less than 11.1 GBq of I-131 (subgroup A), six out of 78 eyes (7.7%) had partial or complete NLDO. This was evident in 23 out of 84 eyes (27.4%) among patients treated with 11.1 GBq or more (subgroup B). The frequency of complete NLDO increases significantly when the cumulative dose of radioiodine exceeds 11.1 GBq (2.9% in the control group, 3.8% in subgroup A, and 23.8% in subgroup B; P=0.006). CONCLUSION: NLDO may be considered as a side effect of I-131 therapy, especially with a cumulative dose of 11.1 GBq or more.

Association of Arg194Trp, Arg280His and Arg399Gln polymorphisms in X-ray repair cross-complementing group 1 gene and risk of differentiated thyroid carcinoma in Iran.

BACKGROUND: X-ray repair cross-complementing group 1 (XRCC1) gene is a DNA repair gene and its non-synonymous single nucleotide polymorphisms (SNP) may influence DNA repair capacity which has been considered as a modifying risk factor for cancer development. METHODS: A case-control study was conducted to investigate impact of three frequently studied polymorphisms (Arg194Trp, Arg280His and Arg399Gln) on developing differentiated thyroid carcinoma (DTC). RESULTS: Increased risks for DTC were shown in homozygous (odds ratio [OR]: 3.66, 95% confidence interval [CI]: 0.38-35.60) and in dominant trait (OR: 1.22, 95% CI: 1.64-2.32) of Arg194Trp genotype. Also, for Arg280His genotype, an increased risk for DTC was shown in dominant trait (OR: 1.42, 95% confidence interval [CI]: 0.76-2.68), while a mildly reduction of risk for DTC (OR: 0.77, 95% [CI]: 0.50-1.17) was estimated in dominant Gln genotype of Arg399Gln. Considering combinatory effects of Arg194Trp and Arg280His genotypes on DTC, the calculated OR and 95% CI for being heterozygous for one of Arg194Trp or Arg280His genotypes were 1.57 and 0.90-2.74, respectively. CONCLUSION: Genotyping of codons 194, 280 and 399 in XRCC1 gene may use in risk assessment of DTC.

An increased risk of differentiated thyroid carcinoma in Iran with the 677C→T homozygous polymorphism in the MTHFR Gene.

BACKGROUND: Methylenetetrahydrofolate reductase (MTHFR) involves in folic acid metabolism which influences DNA methylation. A single nucleotide polymorphism (SNP) called 677C→T in MTHFR gene causes producing a thermolabile enzyme with reducing function and eventually defects DNA methylation. To determine association between germ-line polymorphism in MTHFR gene with differentiated thyroid carcinoma (DTC), this preliminary study was designed. METHODS: This was a case-control study of 154 DTC patients and 198 cancer free individuals. Genotyping was performed by a multiplex PCR method and the frequencies of the 677C→T SNP in cases and controls were compared. The risk estimation was done by multivariate logistic regression analysis. RESULTS: Compared to CC genotype, an increased risk of DTC for the 677C→T homozygous genotype was demonstrated (odds ratio [OR]: 2.08, 95% confidence interval [CI]: 0.82-5.25). Also, multivariate analysis demonstrated an increased risk of DTC in recessive fashion (TT vs. CC or CT) (OR: 2.38, 95% CI: 0.97-5.82). CONCLUSION: The MTHFR 677C→T homozygous variant allele may be associated with increased risk of DTC.

Severe neonatal hyperbilirubinemia; causes and contributing factors leading to exchange transfusion at Ghaem Hospital in Mashhad.

Hyperbilirubinemia is common in neonates; it can have a serious rising course. Due to its critical morbidity called "kernicterus", severe neonatal hyperbilirubinemia causes which lead to exchange transfusion, should be clarified. This descriptive cross sectional study performed with reviewing of files of 118 neonates weighting 2kg and more who had exchange transfusion in pediatrics ward at Ghaem training hospital in Mashhad from April 2004 to March 2007. Among 118 patients, 75 (63.6%) were male, and 43 patients (36.4%) were female. The most common cause of exchange transfusion was ABO incompatibility (38.1%). In order of frequency, unknown etiology (25.4%), Rh incompatibility (16.1%) with no immune hydrops, Sepsis(8.5%), urinary tract infection (5.1%) and others (3.4%) (Including Crigler-Najjar and cephalohematoma) were next ones. Vaginal delivery and exclusive breast feeding were detected as associated factors. Mean serum bilirubin levels was 28.7 mg/dl (SD. 9.2) ABO incompatibility. ABO incompatibility was the main cause of exchange transfusion. Male gender, vaginal delivery and exclusive breast feeding were seen more among patients who need to be exchanged. So in case of ABO incompatibility especially when delivery route is vaginal, newborns should be visited soon again after early discharge from hospital.