Fine needle aspiration biopsy of thyroid nodules: Cytohistological Correlation

OBJECTIVE: Fine-needle aspiration biopsy (FNAB) currently is the main procedure for distinguishing benign from malignant thyroid nodules. The aim of our study was to assess the accuracy of FNABs in our hospital by comparing the cytological and histological diagnosis.METHODS: We performed a prospective study including 321 patients with thyroid nodules admitted to "St. Marina" Hospital from January 2004 to December 2006. Clinical and US data, TSH, FT3, FT4, anti-TPO, cytological and histological findings were evaluated.RESULTS: FNABs were performed in all 321 cases, 290 of them were women and 31 men; mean age 52,9 years. Cytological evaluation considered 67,3% of FNABs as benign, 15,6% as suspicious, 4,7% as malignant and 12,4% as inadequate sample. 88 of the patients underwent thyroid surgery. The comparison between cytological and histological findings showed that 99,1% of cytologically benign nodules were histologically confirmed, as well as 100% of the malignant lesions. 89,5% of the cases classified as suspicious on FNAB turned out to be benign on histology and 10,5% were malignant. The discrepant cases were 2 false-negative results, which had a cytological diagnosis of nodular hyperplasia and turned out to be a medullary carcinoma. Our results showed a sensitivity of 88,2% and a specifity of 100%.CONCLUSION: Thyroid FNAB is an accurate and cost-effective preoperative tool for selection of patients who would benefit from surgery.Scripta Scientifica Medica 2008;40(1):39-4

Galectin-3 expression in thyroid tumors

Aim. To evaluate the expression of Galectin-3 in benign and malignant thyroid nodules and to assess its diagnostic value.Methods. Immunohistochemical analysis of Galectin-3 expression was performed on 64 surgically removed thyroid nodules, including 38 carcinomas (13 papillary, 2 tall cell variants, 4 lymph node metastases from papillary carcinoma,6 follicular variants of papillary carcinoma (FVPTC), 4 anaplastic, 5 follicular and 4 Hürthle cell carcinomas), as well as 26 benign lesions (10 follicular adenomas, 5 Hürthle cell adenomas, 11 nodular goiters with surrounding normal thyroid tissue).Results. We found strong and diffuse Galectin-3 expression in all malignant lesions except for one case of FVPTC and one follicular carcinoma. Normal thyrocytes and the majority of the benign lesions were negative for Galectin-3. This molecular marker was expressed in the cytoplasm as well as in the nuclei of follicular cells. Statistical analysis determined sensitivity 94.7%, specificity 69.2%, PPV 81.8%, NPV 90% and accuracy 83% of Galectin-3.Conclusion. Our findings suggest that immunohistochemical expression of Galectin-3 might contribute to differential diagnosis between malignant and benign thyroid nodules, including those with follicular architecture

Gallbladder adenomyomatosis mimicking carcinoma - a clinical case

Gallbladder adenomyomatosis is hyperplastic cholecystosis of the gallbladder. This is a relatively common and benign cause for diffuse or focal wall thickening.We present a case of a 48-year-old woman with complaints from 3 - 4 years of epigastric pain, abdominal swelling, occurring after eating, with a temporary effect after antispasmodics or antisecretors. There was a reduction in body weight. All laboratory tests were normal. An ultrasound examination revealed a diffusely thickened, stratified gallbladder wall and parenchymal mass in the lumen. Due to clinical suspicion of acalculous cholecystitis, antibacterial treatment was performed, which did not lead to relief of symptoms. The ultrasound picture also did not change. Magnetic resonance imaging showed an image of gallbladder adenomyomatosis. Given the differential diagnostic possibility of gallbladder cancer, a planned cholecystectomy was performed, which, together with histological examination, confirmed the benign nature of the disease. After the surgery, the patient's complaints completely disappeared.Gallbladder adenomyomatosis is a benign and degenerative condition characterized by mucosal proliferation and thickening of the muscle layer. Given the possible premalignant character, cholecystectomy remains the treatment of choice for patients with clinically manifested gallbladder adenomyomatosis.  

Diagnostic value of fine needle aspiration biopsy of space - Occupying lesions of the parotid gland

Новообразуванията на слюнчените жлези представляват 3% от туморите в областта на главата и шията. Приемуществено те засягат паротидната жлеза, като няма самостоятелен метод, който да е достатъчен за поставяне на предоперативна диагноза. Съвременните най-често прилагани нехирургични способи за предоперативна диагностика са образните изследвания и тънкоиглената аспирационна биопсия (ТАБ). Настоящото проучване има за цел да установи диагностичната стойност на ТАБ и да дефинира мястото и в диагностично-лечебния алогоритъм. В проучването са включени 131 пациенти с диагностичен цитологичен материал, подложени на оперативно лечение, на възраст между 19 и 94 г., 76 мъже и 55 жени. След съпоставка на резултатите от ТАБ с хистологичния отговор на резектатите от паротидна жлеза се установи, че 77.9% от обемзаемащите процеси са бенигнени, като най-чест сред тях е плеоморфният аденом (44.7%), следван от кистаденолимфома (36.5%). От малигнените тумори преобладава мукоепидермоидният карцином (24.1%), следван от карцином в плеоморфен аденом (13.8%). Диагностичната класификация за оценка на ТАБ е извършена в шест категории: 0 - недиагностичен; I - дефинитивно бенигнен; II - вероятно бенигнен; III - възможно малигнен; IV - вероятно малигнен; V - дефинитивно малигнен. Кростабулацията на резултатите от цитологичните и хистологични резултати установи, че ТАБ има чувствителност 86.2%, специфичност 85.3% и диагностична точност 85.5%. Представените данни дават основание да се заключи, че тя е надежден начин за предварителна предопертивна диагноза.Salivary gland tumours comprise 3% of all head and neck lesions; the parotid gland is most commonly affected. No single modality is suitable for preoperative diagnosis. The most common non-surgical means of obtaining preoperative information are imaging and needle aspiration cytology. The objective of the present study was to assess the diagnostic utility of fine needle aspiration biopsy (FNAB) and to define its place in the algorithm for diagnosis and treatment. Our study included 131 patients with adequate cytologic material, who underwent parotid gland surgery; the group included 76 men and 55 women, aged 19 to 94 years. Parotid masses were benign in 77.9% of the cases. Pleomorphic adenoma accounted for 44.7% of the benign tumors, followed by Warthin`s tumor (36.5%). Mucoepidermoid carcinoma and carcinoma ex pleomorphic adenoma represented, respectively, 24.1% and 13.8% of the malignancies. FNAB results were classified in six diagnostic categories: nondiagnostic, definitely benign, probably benign, possibly malignant, probably malignant, definitely malignant. Sensitivity of malignancy was 86.2%; specificity 85.3%; diagnostic accuracy 85.5%. The present data suggest that fine needle aspiration biopsy is a reliable tool for preoperative diagnosis

Baseline viral load - a predictor of treatment response in advanced hepatitis C

PURPOSE: The stage of liver disease and genotype of hepatitis C virus (HCV) are well-defined predictors for therapeutic success in chronic hepatitis C. This study aimed at assessing the prognostic role of baseline viral load for response to antiviral therapy in genotype 1 infected patients.MATERIAL AND METHODS: The study covered a total of 163 patients with hepatitis C, 93 of them with absent, mild or septal fibrosis (F0-F2) and 70 cases with bridging fibrosis (F3) or cirrhosis (F4). Viral load (HCV RNA) was determined with a sensitive RT-PCR technique. A high baseline viraemia was defined if HCV RNA exceeded 600000 IU/mL. All the patients were treated with peginterferon alfa and ribavirin for 24 to 48 weeks. They achieved a sustained viral response (SVR) if HCV RNA was undetectable six month after therapy cessation.RESULTS: SVR was registered in 80.6% of the patients with F0-F2 fibrosis stage, in 51.4% of those with F3-F4 fibrosis and in only 25% of 12 patients with early Child B cirrhosis or with present esophageal varices. Baseline viral load was not a prognostic factor for therapeutic effectiveness in early hepatitis C stage. However, in the advanced fibrosis stage, patients who achieved viral eradication had a significantly lower level of HCV RNA (440000 IU/mL) then those with relapse or non-response to therapy (997000 IU/mL).CONCLUSION: The most difficult-to-treat patients with HCV genotype 1 and advanced liver disease may successfully receive a standard treatment. The SVR rate is 51.4%, reaching the results of current triple therapy for F3-F4 stage. The viral eradication is associated with a low baseline viral load.Scripta Scientifica Medica 2013; 45(3): 53-57

Cervix carcinoma and incidental finding of medullary thyroid carcinoma by 18F-FDG PET/CT — clinical case

Thyroid nodules are encountered in clinical practice during the diagnostic procedures or patients’ follow-up due to other diseases quite far from the thyroid gland with prevalence 4–50% in general population, depending on age, diagnostic method and race. The prevalence of thyroid nodules increases with age and their clarification should be done for their adequate treatment. An 18F-FDG PET/CT was done with a PET/CT scanner (Philips Gemini TF), consisting of dedicated lutetium orthosilicate full ring PET scanner and 16 slice CT. The PET/CT scan of the whole-body revealed on the CT portion a hypodense nodular lesion in the left lobe of the thyroid gland with increased uptake of 18F-FDG on the PET with SUVmax 10.3 and demonstrated a complete response to the induction therapy of the main oncological disease of the patient — squamous cell carcinoma. This clinical case demonstrates that whole-body 18F-FDG-PET/CT has an increasingly important role in the early evaluation of thyroid cancer as a second independent malignant localization. Focal thyroid lesion with high risk of thyroid malignancy was incidentally found on 18F-FDG PET/CT

18F-FDG PET/CT in the diagnosis of an extranodal relapse of diffuse large B-cell lymphoma (DLBCL): a clinical case with a literature review

Extranodal lymphoma, secondary to or accompanying nodal disease is uncommon, but not unusual finding. 18-Fluorodeoxyglucose positron emission tomography (18F-FDG PET/CT) imaging has an essential role in the staging of lymphoma, in treatment response monitoring, and in detection of recurrence. We present a case of a 52-year-old man with generalized diffuse large B-cell lymphoma (DLBCL) with multiple extranodal sites involvement detected by 18F-FDG PET/CT. With this clinical case we demonstrate that 18F-FDG PET-CT is a more effective technique than CE-CT for the evaluation of viable extranodal involvement of the diffuse large B-cell lymphoma (DLBCL) and should be combined in the monitoring of DLBCL

Correlation between serum TSH and malignancy potential of thyroid nodules

Цел: Последни проучвания показват, че по-високите нива на тиреостимулиращ хормон (ТSH) се свързват с повишена честота на малигненост сред пациентите с нодозна гуша. Серумните концентрации на TSH обаче се повлияват от различни състояния. Целта на проучването бе да се корелира нивото на TSH при пациенти с тиреоидни възли с цитологичните и хистологичните резултати.Материали и методи: 1483 последователни пациенти (1339 жени и 144 мъже) с възлеста струма бяха оценени с тънкоиглена аспирационна биопсия (ТАБ) под УЗ контрол с цитологичен резултат, класифициран като недиагностичен, бенигнен, фоликуларна лезия, суспектен или малигнен. Серумните нива на TSH са изследвани по хемилуминисцентна имуноензимна методика. 390 от пациентите са оперирани и окончателното хистологично изследване потвърди 83 карцинома.Резултати: Чувствителността и специфичността на ТАБ в предсказването на малигненост бяха съотв. 90,32% и 81,11%. Средното ниво на серумно TSH при цитологично доброкачествените възли бе 1,7032,569 mU/l, при фоликуларните лезии 2,3934,119 mU/l, при суспектните нодули 2,3262,317 mU/l и при цитологично малигнените възли 3,0452,781 mU/l. Макар и в референтни граници ТSH нивата при малигнените цитологии са значимо по-високи в сравнение с бенигнените случаи (p<0,0001). Тази връзка бе потвърдена и сред оперираните пациенти, при които средното предоперативно ТSH е сигнификантно по-високо при хистологично злокачествените в сравнение с доброкачествените възли (TSH 3,387 vs. 1,613 mU/l; p<0,0001). С цел да избегнем фактори, влияещи на ТSH нивата, изключихме всички пациенти с тиреоидна автономия, тиреоидит на Хашимото (положителни антитела, УЗ вид, лимфоцитна инфилтрация в хисологичния препарат), както и тези, приемащи левотироксин или тиреостатици. Сред оставащите пациенти средното ТSH остана значимо по-ниско при доброкачествените в сравнение със злокачествените случаи (1,370 vs. 2,805 mU/l; p<0,0001).Изводи: Резултатите ни предполагат директна връзка между серумния ТSH и риска за малигненост при тиреоидните нодули както в цитологични, така и в хистологични серии след изключване на влиянието на различни щитовидни заболявания и медикаменти.Objectives:Recent studies have reported that higher levels of TSH are associated with an increased incidence of thyroid malignancy in patients with nodular thyroid disease. However, different conditions may affect TSH concentration. The aim of our study was to correlate serum TSH levels in patients with thyroid nodules with cytological and histological results.Materialsandmethods:1483 consecutive patients (1339 women and 144 men) with nodular thyroid disease were evaluated by ultrasound-guided fine needle aspiration biopsy (FNAB) with cytological results classified as nondiagnostic, benign, follicular lesion, suspicious or malignant. Serum levels of TSHwere measured at presentation by chemiluminescent immunoassay. 390 of the patients were operated and final histology proved 83 carcinomas.Results:The overall sensitivity and specificity of FNAB in predicting malignancy were 90,32% and 81,11%, respectively. Mean TSH in cytologically benign nodules was 1,7032,569 mU/l, in follicular lesions 2,3934,119 mU/l, in suspicious nodules 2,3262,317 mU/l and in malignant on cytology nodules 3,0452,781 mU/l. Although in the reference range TSH levels in malignant cytologies were significantly higher that those in benign cases (p<0,0001). This relationship was confirmed among operated cases where mean preoperative TSH was significantly higher in histologically malignant than benign nodules (TSH 3,387 vs. 1,613 mU/l; p<0,0001). In order to eliminate the factors influencing TSH concentration, we excluded all patients with thyroid autonomy, Hashimoto`s thyroiditis (positive antibodies, US appearance, lymphocytic infiltration on histology) and those on levothyroxin or thyrostatic treatment. Among the rest of the patients, mean TSH value remained significantly lower in benign than malignant cases (1,370 vs. 2,805 mU/l; p<0,0001).Conclusion:Our results suggest a direct relationship between serum TSH and risk of malignancy in thyroid nodules both in cytological and histological series after excluding the influence of different thyroid diseases and medication

Diagnostic value of fine needle aspiration biopsy of space-occupying soft tissue lesions in the head and neck region

Заболяванията на меките тъкани на главата и шията са разнообразни по своя характер патология - бенигнени и малигнени тумори, кистозни образувания, възпалителни процеси. Морфологичното им диагностициране определя терапевтичния подход. Лесно приложим и с най-малко странични ефекти диагностичeн метод е тънкоиглената аспирационна биопсия (ТАБ), съчетана с, или предшествана от образни изследвания. В настоящото проучване са представени 69 случая на ТАБ от обемзаемащи процеси на меките тъкани в областта на главата и шията. Съпоставката на цитологичен и хистологичен материал, показва висок процент на съвпадение. ТАБ демонстрира висока чувствителност - 100%, специфичност - 88.52% и диагностична точност - 89.96% във всички случаи.Soft tissue pathology in the head and neck region includes benign and malignant tumors, cystic lesions, inflammatory conditions. Fine needle aspiration biopsy (FNAB) is easy to perform and minimally invasive diagnostic procedure, especially in combination with diagnostic imaging. The present study represents 69 cases of FNAB obtained from space-occupying soft tissue lesions in the head and neck. Excisional biopsy confirmed the high diagnostic value. FNAB showed high sensitivity - 100%, specificity - 88.52% and diagnostic accuracy - 89.96%

Therapeutical approach in patients with cutaneous pseudolymphomas

Cutaneous pseudolymphomas are reactive lymphocytic proliferations that appear in the skin and resemble a malignant lymphoma. Most of the pseudolymphomas are caused by infections with B. Burgdorferi, others include tattoo reactions, immunizations or allergens desensibilization injections and infection with herpes simplex and zoster. The most common clinical man if estations include a single large nodule or solitary and multiple lesions. They are sharply bordered, soft, reddish, dome- shaped and covered by thinned skin. The sites of predilection include the ear lobes, nape, nipple and areola, axillae, scrotum and the dorsum of the foot. Scripta Scientifica Medica 2011;V.43(1):23-2