Rola krążącego sTWEAK w patogenezie choroby Hashimoto — badanie pilotażowe

  Introduction: We aimed to investigate the role of sTWEAK in the pathogenesis of Hashimoto’s thyroiditis, which is a chronic inflammatory autoimmune disease. Material and methods: A total of 80 patients were included in the study, 60 of whom were newly diagnosed with Hashimoto’s thyroiditis (20 patients in each of the euthyroid, subclinical hypothyroid, and overt hypothyroid subgroups), and 20 of whom were healthy volunteers. Thyroid function tests and autoantibodies were measured using the electro-chemiluminescence immunoassay method, and sTWEAK, IL-17A, IL-12, and TGF-beta1 were measured using enzyme-linked immunosorbent assay method. Results: The Hashimoto’s Thyroiditis group had lower levels of sTWEAK and TGF-beta1, but had higher levels of IL-12 and IL-17A as compared to the control group. Of these, only the difference between IL-17A levels reached statistical significance (2.1 pg/mL vs. 1.8 pg/mL, respectively; p < 0.001). While the levels of sTWEAK were similar in the control, euthyroid, and subclinical groups, the overt hypothyroidism group had lower level of sTWEAK than that of subclinical hypothyroidism (687.6 ± 153.3 pg/mL vs. 888.2 ± 374.4 pg/mL, respectively; p = 0.03). A negative correlation was determined between sTWEAK level and anti-TPO (r = –0.533, p = 0.028) and IL-17A (r = –0.600, p = 0.005) levels in the overt hypothyroidism group. Conclusions: The reduced levels of sTWEAK with progression of Hashimoto’s Thyroiditis and the significant correlation between the sTWEAK levels and anti-TPO found in this study suggest that sTWEAK plays an active role in chronic inflammation in the pathogenesis of Hashimoto’s Thyroiditis and in the progression of autoimmunity. (Endokrynol Pol 2016; 67 (6): 562–566)    Wstęp: Badanie przeprowadzono w celu ustalenia roli sTWEAK w patogenezie zapalenia tarczycy Hashimoto, przewlekłej zapalnej choroby autoimmunologicznej. Materiał i metody: Do badania włączono łącznie 80 chorych, w tym 60 osób z nowo rozpoznaną chorobą Hashimoto (po 20 chorych w podgrupach z eutyreozą, subkliniczną niedoczynnością tarczycy i jawną niedoczynnością tarczycy) i 20 zdrowych ochotników. Badania czynności tarczycy oraz oznaczenia stężenia autoprzeciwciał przeprowadzono przy użyciu metod elektrochemiluminescencji, a stężenia sTWEAK, IL-17A, IL-12 i TGF-beta1 oznaczono za pomocą testów enzymatycznych. Wyniki: W grupie osób z chorobą Hashimoto stężenia sTWEAK i TGF-beta1 były niższe, a stężenia IL-12 i IL-17A wyższe niż w grupie kontrolnej. Jednak tylko różnice między stężeniami IL-17A osiągnęły poziom istotności statystycznej (odpowiednio 2,1 pg/ml vs. 1,8 pg/ml; p < 0,001). Podczas gdy stężenia sTWEAK były podobne w grupach kontrolnej, z eutyreozą i z subkliniczną niedoczynnością tarczycy, stężenia sTWEAK w grupie z jawną niedoczynnością tarczycy były niższe niż u osób z subkliniczną niedoczynnością tarczycy (odpowiednio 687,6 ± 153,3 pg/ml vs. 888,2 ± 374,4 pg/ml; p = 0,03). Stwierdzono ujemną korelację między stężeniem sTWEAK a stężeniami przeciwciał przeciw TPO (r = –0,533; p = 0,028) oraz IL-17A (r = –0,600; p = 0.005) w grupie z jawną niedoczynnością tarczycy. Wnioski: Obniżanie się stężenia sTWEAK z progresją choroby Hashimoto oraz istotna korelacja między stężeniem sTWEAK a stężeniem przeciwciał przeciw TPO stwierdzone w tym badaniu wskazują, że sTWEAK odgrywa aktywną rolę w przewlekłym zapaleniu w patogenezie choroby Hashimoto, a także w progresji autoagresji. (Endokrynol Pol 2016; 67 (6): 562–566)

Respiratory epithelial adenomatoid hamartoma on the anterior nasal septum

Respiratory epithelial adenomatoid hamartoma (REAH)is a rare benign lesion of the sinonasal cavity. In this report,by physical examination in the anterior part of thenasal cavity, on the septum a mass lesion was detectedand paranasal sinus computed tomography (PSCT) performed.On PSCT; bounded, homogenious, solid lesionwas shown and no evidence of invasion of surroundingbone and cartilage structures. Histopathologic diagnosisof the lesion was evaluated as REAH. Though REAH is avery rare benign lesion of sinonasal cavity the treatmentis only simple excision. Therefore keeping it in mind indifferential diagnosis list, aggressive surgical proceduresshould be avoided. The clinical and radiological featuresare discussed in the light of the literature.Key words: Hamartoma, sinonasal cavity, septu

How high is the inter-observer reproducibility in the LIRADS reporting system?

Purpose: To investigate the reproducibility of LIRADS v2014 and contribute to its widespread use in clinical practice. Material and methods: This retrospective, single-centre study was conducted between January 2010 and October 2015. A total of 132 patients who had dynamic magnetic resonance imaging (MRI)/computed tomography (CT) images in the Picture Archiving and Communication Systems (PACS) with liver nodule were included in the study, 37 of whom had histopathology results. Five radiologists who participated in the study, interpreted liver nodules independently on different PACS stations according to the LIRADS reporting system and its main parameters. Results: We determined that level of inter-observer agreement in the LR-1, LR-5, and LR-5V categories was higher than in the LR-2, LR-3, and LR-4 categories (κ = 0.522, 0.442, and 0.600 in the LR-1, LR-5, and LR-5V categories, respectively; κ = 0.082, 0.298, and 0.143 in the LR-2, LR-3, and LR-4 categories, respectively). The parameter that we observed to have the highest level of inter-observer agreement was venous thrombus (κ = 0.600). Conclusions: Our study showed that LIRADS achieves an acceptable inter-observer reproducibility in terms of clinical practice although it is insufficient at intermediate risk levels. We think that the prevalence of its use will be further increased with training related to the subject and the assignment of numerical values that express the probability of malignancy for each category and including the ancillary features in the algorithm according to clearer rules

A Histologically Diagnosed Case with Infantile Osteopetrosis Complicated by Hypopituitarism

Malignant infantile osteopetrosis is a rarely seen severe disorder which appears early in life with general sclerosis of the skeleton. It is caused by functionally defective osteoclasts which fail to resorb bone. Affected infants can exhibit a wide spectrum of clinical manifestations including impaired hematopoiesis, hepatosplenomegaly, visual impairment, and hypocalcemia. With the exception of secondary hyperparathyroidism, involvement of the endocrine system seems to be quite rare. Hypopituitarism is defined as underproduction of the growth hormone in combination with deficiencies of other pituitary hormones. Any lesion that damages hypothalamus, pituitary stalk, or anterior pituitary can cause secondary hypopituitarism. In this report, we presented a rare combination of malignant infantile osteopetrosis and secondary hypopituitarism in a newborn who presented predominantly with endocrinological symptoms. This is the first case report of malignant infantile osteopetrosis accompanied by hypopituitarism secondary to sclerosis of the sella turcica. On the other hand, this is a very interesting case which was diagnosed based on histological examination of bone marrow biopsy specimens despite lack of any clinical suspicion

GIANT CERVICAL LIPOMA, RARE BENIGN TUMOR OF CERVICAL REGION: TWO CASE REPORTS

Lipomlar, en sık saptanan mezenşimal orjinli benign tümörlerdir. Vücutta herhangi bir yerde izlenebilirler, servikal bölgede ise oldukça nadir olarak karşımıza çıkarlar ve posterior cilt altı düzeyde daha sık rastlanırlar. Asemptomatik yavaş büyüyen yumuşak doku kitlesi olarak karşımıza çıkan lipomlar, dev boyutlara ulaşabilirler. Bu olgu bildirisinde nadir rastlanmaları nedeniyle anterior ve posterior servikal bölgede yerleşimli histopatolojik olarak tanısı doğrulanmış iki dev lipom olgusunun radyolojik bulguları literatür eşliğinde tartışılmıştır. Lipomas are the most frequent benign tumors of mesencymal origin. Even though they can be viewed anywhere in the body, come as quite rare in the cervical region and can be seen more common in the posterior cervical region subcutaneously. Lipomas which appear as asymptomatic, slow growing soft tissue masses can reach giant proportions. In this case report, due to seeing rarely, two cases of giant lipomas in the anterior and posterior servical region are discussed by radiologic findings; the diagnosis was histopathologically confirmed

Ureteral Jet Flow Dynamics Can Provide Information About the Mechanism of Stone Formation

Ureteral jet dynamics, which have been shown in recent studies to indicate stone formation mechanism in adults and children, provide information about ureteral peristaltism. The dynamics were measured with Doppler ultrasonography and included ureteral jet flows and ureteral jet patterns. In this paper, we present radiographic images of a non-obstructive lower pole stone in the right kidney and a non-obstructive upper pole stone in the left kidney measuring <1 cm and ureteral jet dynamics in a 26-year-old male patient. Our opinion is that the dynamics can provide information about stone formation mechanism

Magnetic Resonance Sialography Findings of Submandibular Ducts Imaging

Purpose. We aimed to assess the problem solving capability of magnetic resonance sialography (MR sialography), a noninvasive method for imaging submandibular gland ducts and determining duct-related pathologies, by comparing diseased and healthy cases. Materials and Methods. We conducted radiological assessment on a total of 60 submandibular glands (mean age 44.7) in 20 cases and 10 volunteers. MR sialography examinations were conducted with single-shot fast spin-echo sequence by using a surface coil placed on the submandibular gland. Each gland was evaluated in terms of the length, width and stricture of the main duct, as well as the difference between the intraparenchymal duct width, and the main duct width. Statistical analysis was performed. Results. In the MR sialography the primary duct mean length was determined as 51 mm (40–57 mm) in all submandibular glands. On the MR sialography imaging, the visualization ratio of the ductal system of submandibular gland was evaluated in the cases and volunteers. Conclusion. MR sialography is an effective and a noninvasive method in imaging submandibular gland ducts, demonstrating the presence, location and degree of stricture/dilatation, and elucidating the disease etiology

Use of shear-wave elastography to distinguish complex and complicated fibroadenomas from simple fibroadenomas

PURPOSESimple fibroadenomas (SFAs), complex fibroadenomas (CFAs), and cellular fibroadenomas (CeFAs) are variants of fibroadenomas. Additionally, some degenerative, hyperplastic, and metaplastic changes may occur in fibroadenomas, forming complicated fibroadenomas. Distinctive ultrasonography (US) features in variants of fibroadenomas and complicated fibroadenomas have not been reported. Shear-wave elastography (SWE) can be applied to effectively discriminate between these variants and complicated fibroadenomas. In this study, we aimed to evaluate SWE findings to discriminate between SFAs and other variants.METHODSIn total, 48 patients (26 with SFAs, 16 with CFAs, 3 with CeFAs, and 3 with complicated fibroadenomas) participated in this study. The lesions were classified into two groups according to histopathologic diagnoses. The SWE evaluation and lesion elasticity scores (Emax, Emean, and Emin) were both assessed in m/s and k/Pa, respectively. Two observers measured Emax, Emean, and Emin. Brightness (B)-mode US findings based on the Breast Imaging Reporting and Data System categorization and elasticity scores were recorded. In the statistical analyses, the chi-square test and non-parametric tests were performed. Fisher’s exact test was used to compare independent groups, and Spearman’s correlation coefficients were used to correlate the SWE data between the two observers. Additionally, receiver operating characteristic curves were analyzed to evaluate the diagnostic performance of the elasticity values.RESULTSThe B-mode US features in both groups showed no statistical significance. The set of SWE values of both observers demonstrated strong statistical significance in discriminating between group 1 (SFAs) and Group 2 (CFAs, CeFAs, and complicated fibroadenomas).CONCLUSIONAs the fibroadenoma variants and complicated fibroadenomas have similar US findings, SWE in addition to a conventional B-mode examination can increase the diagnostic performance to discriminate SFAs from other complex and complicated forms of fibroadenomas