RESUMO
This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. It introduces the current best practice in histopathology and cytopathology as it pertains to head and neck and thyroid cancers. Recommendations ⢠Accurate diagnosis of the type of malignancy is a key component of effective management. (R) ⢠Surgeons and oncologists should understand the scope and limitations of cellular pathology in order to inform multidisciplinary discussions. (R) ⢠A clinically suspected diagnosis of malignancy should be confirmed by biopsy or cytology before operation. (R) ⢠Cytopathological diagnoses should be discussed with surgeons and radiologists to maximise the information gained from each modality of investigation. (R) ⢠Pathological investigations are the basis for accurate cancer staging and stratification of clinical outcomes. (R).
Assuntos
Neoplasias de Cabeça e Pescoço/patologia , Adenocarcinoma Folicular/diagnóstico , Adenocarcinoma Folicular/patologia , Biópsia por Agulha/normas , Carcinoma Medular/diagnóstico , Carcinoma Medular/patologia , Carcinoma Papilar/diagnóstico , Carcinoma Papilar/patologia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patologia , Neoplasias de Cabeça e Pescoço/diagnóstico , Humanos , Comunicação Interdisciplinar , Metástase Linfática/patologia , Equipe de Assistência ao Paciente/normas , Neoplasias das Glândulas Salivares/diagnóstico , Neoplasias das Glândulas Salivares/patologia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/patologia , Reino UnidoRESUMO
INTRODUCTION: In the National Institute for Health and Clinical Excellence (NICE) guidance on cancer services published in 2004, it was recommended that specialist clinics should be set up for the assessment of patients with neck lumps, structured in a similar way to one-stop breast lump clinics with a cytopathologist present and preferably ultrasound guidance. The aim of this study was to audit the performance of ultrasound-guided fine needle aspiration (FNA) with on-site cytology in a one-stop neck lump clinic at The Royal Liverpool University Hospital. PATIENTS AND METHODS: Data were collected between November 2008 and May 2009 (7 months). Details of the adequacy rate for the FNA were recorded and whether multiple passes were required. The likely adequacy rate if ultrasound guidance was not available was also calculated. RESULTS: A total of 274 patients were included in the audit. Of these, 227 (83%) patients required a single pass for adequate diagnostic material. Of the remaining, 45 (16%) required two passes and 2 (1%) required three passes. The overall sample inadequacy rate was 11 of 274 (4%). From these results, it could be predicted that, if immediate cytological evaluation was unavailable, the inadequacy rate would have been 41 of 274 (15%). CONCLUSIONS: This audit has illustrated the benefits of a one-stop clinic with on-site cytology in providing a rapid diagnostic head and neck cancer service.
Assuntos
Neoplasias de Cabeça e Pescoço/patologia , Ambulatório Hospitalar/organização & administração , Biópsia por Agulha Fina/métodos , Biópsia por Agulha Fina/normas , Diagnóstico Precoce , Inglaterra , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Acessibilidade aos Serviços de Saúde/organização & administração , Humanos , Auditoria Médica , Ambulatório Hospitalar/normas , Estudos Retrospectivos , Ultrassonografia de IntervençãoRESUMO
We report on a young patient with decompensated alcohol-induced liver disease (Child-Pugh score C) who presented with clinical, biochemical and radiological evidence suggestive of spontaneous bacterial peritonitis. She was however subsequently found to have multiple small bowel perforations, which were diagnosed only at laparotomy. The histology of the bowel showed evidence of vasculitis. This case illustrates two important points. Firstly, even if a patient has all the prerequisites to develop spontaneous bacterial peritonitis, a secondary cause of peritonitis (eg. bowel perforation or intra-abdominal abscess) must always be considered as a differential diagnosis and a repeat ascitic tap is mandatory after 48 h of antibiotic therapy to confirm a decrease in the white cell count. Secondly, it shows the rare co-existence of alcoholic liver disease and vasculitis.
Assuntos
Infecções Bacterianas/diagnóstico , Perfuração Intestinal/diagnóstico , Cirrose Hepática Alcoólica/complicações , Peritonite/diagnóstico , Vasculite/complicações , Diagnóstico Diferencial , Feminino , Humanos , Perfuração Intestinal/complicações , Intestino Delgado/irrigação sanguínea , Pessoa de Meia-Idade , Vasculite/diagnósticoAssuntos
Adenocarcinoma , Neoplasias Pulmonares , Mesotelioma , Neoplasias Pleurais , Diagnóstico Diferencial , HumanosRESUMO
Although senile ecchymoses are a well-recognized phenomenon on hospital wards, in patients who die in other settings they may be wrongly interpreted as bruising caused by physical assault. Therefore, we studied a total of 410 elderly (> 50 years of age) patients by a prospective examination of autopsy reports to elucidate their nature, including their general frequency, their anatomical distribution, and their physical appearance. We found a clear association with increasing age and a common distribution on the arms, rather than the neck or legs. One unique finding is that ecchymoses are related to place of residence, in that less mobile elderly persons are more likely to develop this condition, possibly as a result of lifting.
Assuntos
Envelhecimento/patologia , Equimose/patologia , Mudanças Depois da Morte , Idoso , Idoso de 80 Anos ou mais , Equimose/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-IdadeRESUMO
Peliosis hepatis is an unusual disorder characterized by blood filled hepatic spaces. We describe the appearances of this entity on ultrasonography, computed tomography and magnetic resonance imaging. The importance of peliosis hepatis is that it may be an indicator of a treatable underlying condition.