Primary Diagnosis of an Anaplastic Thyroid Carcinoma by the Dentist: Case Report

Za primarnu procjenu i vođenje slučaja u stomatološkim ordinacijama najvažnija je detaljna sustavna anamneza te ekstra/intraoralni pregled pacijenata s bilo kakvom cervikalnom i facijalnom patologijom. Taj je pristup ključan u inicijalnoj procjeni i zbrinjavanju bolesnika s nekoliko kliničkih stanja u cervikalnoj regiji koja se često mogu primarno dijagnosticirati kod stomatologa. Na taj se način sprječavaju nepotrebne terapijske intervencije u klinikama. U ovom prikazu opisujemo slučaj 85-godišnjakinje kojoj je u našoj klinici postavljena dijagnoza anaplastičnog karcinoma štitne žlijezde nakon inicijalne procjene zbog bola u srednjem dijelu mandibularne regije. Povijest bolesti bila je bez osobitosti, osim zabilježene hipertenzije. Tijekom temeljitoga intraoralnog pregleda nije uočena nikakva patologija koja bi objasnila bolove. Maksila je bila bezuba. Ekstraoralnim pregledom otkrivena je cervikalna asimetrija nastala zbog neprepoznate mase u lijevom lobusu štitnjače, zajedno s oteklinom lijevoga inferiornog cervikalnog limfnog čvora. Nije bila planirana nikakva stomatološka terapijska intervencija u ordinaciji. Nakon dijagnostičke obrade pacijentica je bila podvrgnuta operaciji totalne tiroidektomije, bez cervikalne disekcije. Histopatološkom diferencijacijom bio je potvrđen anaplastični karcinom štitnjače. Slučaj je zanimljiv zato što podsjeća na to koliko je važno imati detaljnu sustavnu anamnezu i obaviti ekstra-/intraoralni pregled tijekom inicijalne procjene pacijenata u stomatološkoj ordinaciji, što se ne bi smjelo zanemarivati ako se u klinikama žele izbjeći nepotrebne intervencije.A thorough/systematic medical history taking and extra-/intraoral examination is essential in the primary evaluation and in the management of the patients with any neck and facial pathology in the dental clinics. This approach is crucial in the initial evaluation and the management of the patients with several clinical conditions which may be frequently diagnosed primarily by the dentist in the neck and prevent unnecessary therapeutic interventions in the dental clinics. In this case report, an 85 years old female, who was primarily diagnosed with anaplastic carcinoma of the thyroid gland after initial evaluation for pain in the middle mandibular region in our dental clinic, was presented. Medical history was not specific except hypertension. In thorough intraoral examination no pathology was observed to explain the pain. Maxillary jaw was edentulous. In extra oral examination cervical asymmetry due to an unrecognized mass in the left thyroidal lobe with the enlargement of the left inferior cervical lymph nodes was noted. No dental therapeutic intervention was planned in the dental clinic. After diagnostic workup the patient was treated with total thyroidectomy without cervical dissection. Anaplastic thyroid carcinoma was confirmed with histopathological examination. This case was interesting to recall the importance of the thorough/systemic medical history taking and extra-/intraoral examination in the initial evaluation of the patients in the dental clinic, which should not be ignored to prevent unnecessary interventions in the dental clinics

Cholesterolosis in routine histopathological examination after cholecystectomy: What should a surgeon behold in the reports?

AbstractIntroduction: Cholecystectomy is one of the most common surgical procedures. Postoperative investigation of cholecystectomy specimen has a great value since histopathological reports may document some entities with significant clinical consequences. The aim of this study was to evaluate the association between cholesterolosis and the reports indicating some histopathological alterations in symptomatic cholecystitis. Methods: This paper is based on a retrospective study. Histopathological reports of 432 cholecystectomy specimens between January 2011 and June 2013 were reviewed. Three reports were excluded due to perioperative diagnosis of cancer. Reports of 429 cholecystectomy specimens of the acute and symptomatic chronic cholecystitis patients were analyzed. Standardization of the reporting was questioned. Age, gender, histopathological wall thickness of gallbladder, reporting rates of acute inflammation, cholesterolosis, polypoid lesions, epithelial hyperplasia, gastric or intestinal metaplasia, dysplasia and incidental cancer were investigated and compared between patients with and without cholesterolosis. Reported rates of histopathological findings were comparable between patients under and over 60 years old and patients with and without reported cholesterolosis. Results: Reported histopathological findings were presented as acute inflammation in 46 (10.7%), cholesterolosis in 79 (18.4%), gallbladder polypoid lesions in 7 (1.6%), epithelial hyperplasia in 16 (3.7%), metaplasia of any type in 34 (7.9%) of 429 patients. Dysplasia was excluded whereas one incidental gallbladder carcinoma was reported. Epithelial hyperplasia and metaplasia were found to be related to age. Gallbladder wall thickness was decreased with cholesterolosis. However, only a correlation between cholesterolosis and gender or metaplasia was noted. Conclusion: Recent study suggests that cholesterolosis is somehow associated with metaplasia. Thus, surgeons should carefully interpret the histopathology reports based on unusual or exceptional findings corresponding to the cholecystectomy specimens. Any abnormal finding in the reports should be investigated in terms of the progress of the pathology and also its clinical consequences

Advanced alveolar echinococcosis disease associated with Budd–Chiari syndrome

AbstractIntroductionAlveolar echinococceal disease of the liver is rare. Echinococcus multilocularis is responsible for the development of the related clinical conditions. Advanced disease may result with serious complications such as end stage liver disease and Budd–Chiari syndrome.Presentation of caseIn this presentation, a 28 years-old woman who was a case with advanced alveolar echinococcosis complicated with a Budd–Chiari syndrome and was performed successful living donor liver transplantation, has been demonstrated with clinical and radiological images.DiscussionInitially there may be no clinical evidence of the disease in humans for years. Severity and fatality are the significant characteristics of the natural history. Extension to the surrounding tissues and metastasis of the parasitic mass may be observed. Prevention is essential in disease control. Serologic assay may identify the parasite. However, early diagnosis is rare. Staging is based on radiologic imaging. Some patients with advanced disease may require surgery. Hepatic resection and liver transplantation are accepted procedures in selected patients.ConclusionThe importance of early diagnosis to prevent advanced complications such as development of Budd–Chiari syndrome and metastasis has been underlined

Dexmedetomidine protects against lipid peroxidation and erythrocyte deformability alterations in experimental hepatic ischemia reperfusion injury

Background: Hepatic ischemia–reperfusion injury is a common clinical problem in hepatic surgery and transplantation. Several cellular and tissue structural and functional alterations are observed in such injury. The aim of this study was to evaluate the effect of dexmedetomidine on lipid peroxidation and erythrocyte deformability during ischemia–reperfusion injury in rats. Methods: Twenty-four Wistar Albino rats were randomly separated into three groups as control (C), ischemia–reperfusion injury (I/R) and dexmedetomidine group (I/R-D). Ischemia was induced with portal clampage for 45 min and reperfusion period was 45 min after declampage. Group I/R-D received dexmedetomidine 100 µg/kg i.p. 30 min before portal clampage. Serum malondialdehyde and superoxide dismutase activities to document lipid peroxidation and erythrocyte deformability index were investigated. Results: Serum superoxide dismutase and malondialdehyde activity levels were significantly higher and erythrocyte deformability index was decreased in hepatic ischemia–reperfusion group. However, these changes were observed to be prevented with dexmedetomidine treatment when given before portal clampage. Conclusion: These findings clearly indicate that erythrocyte deformability index is decreased in hepatic ischemia reperfusion injury and has a potential role to prevent these alterations. The protective effect of dexmedetomidine on hepatic I/R injury is also decreased lipid peroxidation. Further experimental and clinical investigations may clarify the molecular mechanisms and clinical significance of these findings