An unusual cause of protein losing enteropathy in a 2.5-year-old girl: meso-intestinal fibrosis.

Introduction Protein losing enteropathy is a symptom characterized by loss of protein in intestines resulting in low protein levels in serum and generalized edema. Several causes are reported for this condition. Hereby we report an as yet unreported cause of protein losing enteropathy that we named meso-intestinal fibrosis. Case Report A 2.5-year-old girl referred with features of partial intestinal obstruction and underwent laparotomy. She had history of protein losing enteropathy since 16 months of age with generalized edema and received albumin every other week. Workup of protein losing enteropathy was inconclusive and only a histology report denoted increase in eosinophils in lamina propria of small intestine and hypoallergenic diet was started for her, but no significant response was noted. Laparotomy revealed lace-like white areas in meso of small intestine and intestinal wall was firm in palpation in some areas. Biopsy was taken from these sites and histology revealed severe fibrosis of meso overlying muscularis propria and also patchy fibrosis of intestinal meso led to severe lymphangiectasis in submucosa of small intestine. Discussion Secondary lymphangiectasis due to obstruction of lymphatic flow is mentioned as cause of protein losing enteropathy. Meso-intestinal fibrosis seen in this case that led to secondary lymphangiectasis and also motility disorder has not been reported as yet.

Role of fine-needle aspiration in the management of thyroid nodules.

OBJECTIVE: To show the benefits of fine-needle aspiration biopsy (FNAB) in managing thyroid nodules. METHODS: As a retrospective study, reports of 888 FNABs of the thyroid performed during a period of 11 years (1996-2007) at Tehran University of Medical Sciences, Sina Hospital and Endocrine Clinic, Tehran, Iran were reviewed. Histological diagnoses were available for 182 cases, and we compared cytological diagnoses of FNAB with pathologic reports. RESULTS: The cytology diagnoses by FNAB were: papillary 6 (3.2%); follicular neoplasm 51 (28%); follicular adenoma 10 (5.4%); Hurthle cell neoplasm 8 (4.3%); suspicious 20 (10.9%); inconclusive 2 (1%); and benign 85 (46.4%). Due to surgery pathologic reports, malignant cytologies were: 6 (100%) for papillary, 1 (1.96%) for follicular neoplasm, 4 (50%) for Hurthle cell neoplasm. In suspicious reports, 11 (55%) reports of pathology were malignant; and in inconclusive reports, one report (50%) was malignant. CONCLUSION: Fine needle aspiration is a useful technique for selecting patients with nodular thyroid disease for surgery.