Mixed follicular and parafollicular thyroid carcinoma.

A rare case of mixed follicular-parafollicular thyroid carcinoma which occurred in a 50-year-old man, is reported. The ultrastructural aspects of the tumor showed: a biphasic growth pattern with microfolliculi and solid areas; the coexpression of thyroglobulin and calcitonin antigens in the same follicle-like structures; the presence of neuroendocrine granules, microvilli and intracytoplasmic canaliculi bordered by microvilli. These characteristics lead us to a diagnosis of mixed follicular-parafollicular thyroid carcinoma.

[Pneumocystosis of splenic localization in the course of HIV infection: a new indication for splenectomy. Description of a case]. / Pneumocistosi a localizzazione splenica in corso di infezione da HIV: una nuova indicazione alla splenectomia. Descrizione di un caso.

Pneumocystis carinii is a common cause of interstitial pneumonitis in AIDS patients: it affects 85% of patients with cell-mediated immunodeficiencies. Extrapulmonary infection is much more infrequent and it is observed only in these patients who receive aerosolized pentamidine prophylaxis because of minimal systemic distribution of the drug. No case of extrapulmonary disease was observed in patients receiving systemic prophylaxis for Pneumocystis carinii with cotrimoxazole. The pathogenesis of extrapulmonary infection is not clear: it is probably connected with hematogenous or lymphatic dissemination from the lung. In a small number of case is due to reactivation of extrapulmonary foci or to a new infection. The management of disseminated infection of Pneumocystis carinii is medical: only recently a combination of medical and surgical approach was proposed for a patient with extrapulmonary infection. We report a case of 29 years old patient with AIDS with a demonstrated pulmonary and splenic localisation of pneumocystis carinii submitted to surgical splenectomy. The surgical decision was taken for several reasons: no response to medical therapy, the relative good general condition of the patient despite the immunological status, the presence of thrombocytopenia and abdominal pain in the left upper quadrant, and the risk of rupture of spleen. The post-operative course was eventful. We support splenectomy for splenic infection of Pneumocystis carinii in very small selected cases and only with palliative intent.

Ultrasonographic surveillance after surgery for euthyroid goitre in patients treated or not with thyroxine.

OBJECTIVE: To assess the efficacy of postoperative treatment with I-thyroxine in patients operated on for euthyroid goitre after precise definition of extent of goitre disease preoperatively and postoperatively by ultrasound. DESIGN: Retrospective study in a selected population. SETTING: University hospital, Italy. SUBJECTS: 53 patients operated on from 1984 to 1994 for euthyroid goitre. INTERVENTIONS: 13 patients who had contralateral disease had lobectomy and contralateral enucleation and were treated postoperatively with suppressive doses of thyroxine. 22 patients underwent lobectomy with no medication. 18 patients underwent subtotal thyroidectomy followed by thyroxine in substitution doses. All patients had regular clinical assessments and ultrasound examination for evidence of recurrent disease. RESULTS: There were no significant differences in the incidence of relapses between those who had lobectomy and those who had lobectomy plus enucleation (p > 0.05). CONCLUSIONS: We found no significant evidence that postoperative suppressive treatment had any effect on recurrence of goitre. Subtotal thyroidectomy gave the lowest recurrence rate (p = 0.14).

[Adrenal metastasis of choroidal melanoma: a case report]. / Metastasi surrenalica da melanoma della coroide: descrizione di un caso clinico.

We report on the case of a 32 years old man submitted to right eye enucleation twelve years before for a choroidal melanoma. We observe a metastases located in the left adrenal gland. The blood-tests, the TAC of the abdomen did not show other localizations, while during laparotomy were discovered metastases in the pancreas and in the omentum. In this case, the age of tumor's development, the age of clinical manifestation, the period between the enucleation and the appearance of the metastases and their localization are exceptions to the normal biological behaviour of the choroidal melanoma.

Recurrence of goitre after operation in euthyroid patients.

OBJECTIVE: To try and resolve some of the problems associated with the treatment of goitre in euthyroid patients. DESIGN: Retrospective open study SETTING: University hospital SUBJECTS: 106 out of a total of 161 euthyroid patients operated on for goitre from 1974-1988. Those who underwent total thyroidectomy (n = 14), in whom the histological diagnosis was thyroiditis (n = 10), or who were lost to follow up (n = 31) were excluded from the study. MAIN OUTCOME MEASURES: Recurrence of goitre, and correlation with type of operation, age, and histological type. RESULTS: 62 Patients underwent unilateral, and 44 bilateral resections. There were 24 recurrences (23%), 13 of which were subclinical; 19 occurred after unilateral, and 5 after bilateral, resections (p = 0.02). There were no significant associations between recurrence and age or histological type. CONCLUSION: Subtotal thyroidectomy is the treatment of choice for goitre in euthyroid patients.

[Asymptomatic hyperparathyroidism. Influence of PTH values on the therapeutic decision]. / Iperparatiroidismo asintomatico. Influenza dei valori di PTH sulle decisioni terapeutiche.

The majority of patients affected by primary hyperparathyroidism present now in surgical series are little or totally asymptomatic. This is due to widespread use of multiphasic screening for hypercalcemia as far as to more liberal indications for parathyroid exploration. The debate about the need for parathyroidectomy is open in these patients, having few or no signs at all of primary hyperparathyroidism, because conservative treatment has yielded confused results. The authors analyzed preoperative biochemical values and surgical outcome from 26 patients affected by primary hyperparathyroidism. Thirteen cases had overt primary hyperparathyroidism (group A) and 13 had asymptomatic disease (group B). Patients in group A had higher preoperative PTH values than patients in group (p < 0.05). After surgery, the patients in group A showed parathyroid glands which weighted significatively more than ones in group B (p +/- 0.01). Further, a significant correlation between preoperative PTH value and glandular weight was demonstrated in all cases. The authors conclude surgery for patients having mild primary hyperparathyroidism may give some problems related to the very small size of abnormal glands found during operation. We advise a close follow-up for these patients initially without treatment: surgery should be recommended for those showing PTH values higher than 150 pg/ml.

Ovarian and cervical thyroid struma. A case report.

A case of associated ovarian and cervical thyroid struma in a 24-year old female, is reported. The patient was affected by a right thyroid cold nodule which at fine needle aspiration biopsy showed the cytological pattern of benign follicular adenoma; as the nodule was increasing after one year of suppressive therapy, the patient was selected for surgery. At admission during routine physical examination a previously undetected left pelvic mass was discovered: at laparotomy it proved to be a cystic tumor consisting of benign thyroid tissue at the level of left ovary. Histology confirmed the diagnosis of follicular adenoma of the right thyroid nodule after right lobectomy. Albeit cases of thyroid tissue in the ovary have been reported, true struma ovarii is a rare occurrence. A concomitant hyperthyroidism is seen in only 1/4 of cases and the patients can be divided into three groups: hyperthyroid, ascitic and asymptomatic: our patient was in the asymptomatic group.