Radiologic and Pathologic Findings of a Follicular Variant of Papillary Thyroid Cancer with Extensive Stromal Fat: A Case Report

Thyroid cancer may have small adipose structures detected by microscopy. However, there are no reports of thyroid cancer with gross fat evaluated by radiological methods. We reported a case of a 58-year-old woman with a fat containing thyroid mass. The mass was hyperechoic and ovoid in shape with a smooth margin on ultrasonography. On computed tomography, the mass had markedly low attenuation suggestive of fat, and fine reticular and thick septa-like structures. The patient underwent a right lobectomy. The mass was finally diagnosed as a follicular variant of papillary thyroid cancer with massive stromal fat.

Pathomechanisms of atrophy in insular cortex in Alzheimer's disease

The insular cortex is associated with neuropsychiatric symptoms, changes in cardiovascular and autonomic control, and mortality in Alzheimer's dementia. However, the insular cortex does not provide information on the contribution of the other cortices to cognitive decline. We hypothesized that the factors that affect to atrophy in insular cortex are different from other cortical regions. A total of 42 patients with probable Alzheimer's dementia were included in the analyses. The manual drawing of regions of interest was used to detect insular cortex located in the deep gray matter and to avoid coatrophy. Covariates, which could affect to the atrophy of the cerebral cortex, were selected based on previous studies. Any of the demographic factors, vascular risk factors, and the severity scales of dementia was not associated with any insular volume ratio. We suggest that the pathomechanisms of atrophy in insular cortex are different from those of other cortex regions in Alzheimer's disease.

THE VALUE OF GROSS VISUAL ASSESSMENT OF SPECIMEN ADEQUACY FOR LIQUID-BASED CYTOLOGY DURING ULTRASOUND-GUIDED, FINE-NEEDLE ASPIRATION OF THYROID NODULES

OBJECTIVE

Major problems of fine-needle aspiration (FNA) of thyroid nodules arise due to nondiagnostic results caused by inadequately obtained FNA specimens. The purpose of this study was to evaluate the value of visual assessment of liquid-based cytology specimens during FNA of thyroid nodules for predicting sampling adequacy.

METHODS

For 3 months, visual assessment of FNA specimens was used for 534 consecutive nodules in 534 patients. The FNA specimens were visually graded immediately following aspiration for each nodule, and the visual grades were classified into 2 categories: inadequate (<6 cell groups) and adequate (>6 cell groups). The cytology results were classified as diagnostic or nondiagnostic based on the Bethesda system. We compared the ultrasound features and FNA characteristics between the diagnostic and nondiagnostic results. Multiple logistic regression analysis was used to determine factors independently predictive of nondiagnostic results. We also evaluated the interobserver agreement regarding the visual assessment.

RESULTS

Visual assessment was feasible in all patients, and the nondiagnostic rate was 11.6% (62 of 534). Nondiagnostic results were more frequent in the inadequate visual assessment group (38.1%) than in the adequate visual assessment group (10.5%) (P = .001). Independent predictive factors for nondiagnostic results were inadequate visual assessment (odds ratio, 5.18), >50% vascularity (odds ratio, 3.98), and macrocalcification (odds ratio, 3.60). Interobserver agreement for the prediction of visual assessment was good (κ value, 0.767; P<.001).

CONCLUSION

Immediate visual assessment of a specimen during FNA of a thyroid nodule is a feasible method for predicting sampling adequacy.

Charcoal-induced granuloma that mimicked a nodal metastasis on ultrasonography and FDG-PET/CT after neck dissection

Charcoal can be used for preoperative localization of metastatic lymph nodes in the neck. Charcoal remains stable without causing foreign body reactions during as hort period. However, foreign body reactions may develop if charcoal is left in situ for more than 6 months. We reported a case of charcoal granuloma mimicking local recurrence on fluorodeoxyglucose-positron emission tomography/computed tomography and ultrasonography in a 47-year-old woman who had cervical lymph node dissection due to metastatic invasive ductal carcinoma of the breast.

Recurrent posterior circulation infarction caused by anomalous occipital bony process in a young patient

Background

Structural anomaly of the cervical spine or craniocervical junction has been reported as one of the rare causes of ischemic stroke. We report a case of a young patient with recurrent posterior circulation infarction that may have been associated with an anomalous occipital bony process compressing the vertebral artery.

Case presentation

A 23-year-old man experienced recurrent posterior circulation infarction 5 times over a period of 5 years. He had no conventional vascular risk factors. Young age stroke work-up including thorough cardiac, intra- and extracranial vascular evaluation and laboratory tests for the hypercoagulable state or connective tissue disease yielded unremarkable results. An anomalous bony process from the occipital base compressing the left vertebral artery was observed on brain CT. All the recurrent strokes were explainable by the arterial thromboembolism originating from the compressed left vertebral artery. Therefore, the left vertebral artery compressed by the anomalous occipital bony process may have been the culprit behind the recurrent thromboembolic strokes in our patient. Intractable recurrent strokes even under optimal medical treatment led us to make a decision for the intervention. Instead of surgical removal of the anomalous occipital bony process, the left vertebral artery was occluded permanently by endovascular coiling after confirming that this would cause no neurological deficits or flow disturbance in the posterior circulation. There was no recurrence of stroke for 2 years after permanent occlusion of the left vertebral artery.

Conclusion

Arterial thromboembolism originating from the left vertebral artery compressed by the anomalous occipital bony process is a rare but not to be overlooked cause of posterior circulation infarction. When intractable to medical treatment, endovascular occlusion of the vertebral artery without flow disturbance to the posterior circulation may be a useful treatment option when surgical removal is not feasible.

Cumulus cell-expressed type I interferons induce cumulus expansion in mice

Ovulation resembles the inflammatory response. The purpose of the present study was to examine the expression and role of type I interferons (IFNs) Ifnalpha and Ifnbeta in mouse ovaries during the process of ovulation. An in vivo injection of equine chorionic gonadotropin (CG)-human CG (hCG) stimulated Ifnalpha and Ifnbeta mRNA in cumulus-oocyte complexes (COCs) within 6 h. Type I IFN receptor (Ifnar1 and Ifnar2) genes were also expressed in preovulatory follicles without a change by hCG. Immunofluorescent study revealed the expression of protein signals of Ifnalpha, Ifnbeta, and Ifnar1 in cumulus cells. Treatment of COCs with Ifnalpha or Ifnbeta in vitro induced cumulus expansion that was comparable to that mediated by epiregulin. In cultured COCs, the levels of Ifnalpha and Ifnbeta mRNA increased by epiregulin and follicle-stimulating hormone, but not by prostaglandin E2. Ifnalpha and Ifnbeta activated multiple signaling events (signal transducer and activator of transcription-1/3, Akt, and mitogen-activated protein kinase 1/2) and stimulated the expression of genes known to impact COC expansion (Has2, Ptx3, Tnfaip6, and Ptgs2). Interestingly, treatment of COCs with Toll-like receptor (TLR) 2 and TLR4 ligands (lipopolysaccharides, Pam3Cys, and hyaluronan fragments) increased Ifnalpha and Ifnbeta mRNA, while coculture with anti-TLR2/4 neutralizing antibody abolished these effects. Taken together, these results demonstrate that the type I IFN system is operating in mouse cumulus cells and plays a role in the induction of cumulus expansion during the ovulatory process in mice.

Osteoblast cell adhesion and viability on nanostructured surfaces of porous titanium oxide layer

Surface characteristics and osteoblast cell functions were investigated for the nano-structured oxide layer on commercially pure titanium (CP-Ti) fabricated using microarc oxidation (MAO) and hydrothermal treatment (HT) methods. Ti-MAO-135HT, Ti-MAO-150HT, and Ti-MAO-175HT groups were fabricated by hydrothermally treating the MAO-treated specimens (Ti-MAO) in phosphorus-containing alkaline solution at temperatures of 135, 150, or 175 °C, respectively. After hydrothermal treatment, a nanosheet-shaped morphology, nano-needles and nanorods were observed on the porous surface of the Ti-MAO-135HT, Ti-MAO-150HT and Ti-MAO-175HT groups, respectively. The roughness was not significantly different for all groups. However the contact angle decreased dramatically as the hydrothermal temperature increased. The osteoblastic cell adhesion and viability of the Ti-MAO-150HT and Ti-MAO-175HT groups were significantly lower compared to those of the Ti-MAO group. This study showed that nano-topology formed on micro porous oxide layer was more important than hydrophilicity in its effect upon initial osteoblastic cell functions.

Effect of imaging time in the magnetic resonance detection of intracerebral metastases using single dose gadobutrol

OBJECTIVE

To compare the effect of imaging time delay on the MR detection of intracerebral metastases using single dose gadobutrol.

MATERIALS AND METHODS

Twenty-one patients with intracerebral metastases underwent contrast-enhanced MR with three-dimensional T1-weighted sequence at 1 minute, 5 minutes and 10 minutes after a single dose injection of gadobutrol. One hundred index metastatic lesions (1 to 30 mm; median, 7 mm) were chosen for the analysis. For the qualitative analysis, lesion conspicuity were assessed on a 1 (worst) to 5 (best) scale of the index lesions by an expert reader. For the quantitative analysis, signal intensity (SI) of enhancing lesions and normal parenchyma was measured to determine the contrast rate (CR, %) ([postcontrast SI lesion - postcontrast SI white matter] × 100 / postcontrast SI white matter) and the enhancement rate (ER, %) ([postcontrast SI lesion - baseline SI gray matter] × 100 / baseline SI gray matter). Statistical comparisons were made between three different time delays.

RESULTS

Lesion conspicuity did not differ significantly among the three time delays (p = 0.097). Although the SI, CR and ER of lesions did not reveal any significant difference between 1 minute and 5 minutes delayed images, both the 1 minute and 5 minutes delayed images showed significantly higher CRs of lesions compared with the 10 minutes delayed images (p = 0.004 and p = 0.001, respectively).

CONCLUSION

With single dose gadobutrol, imaging time delay did not have an effect on lesion conspicuity. Both 1-minute and 5-minute-delayed imaging after gadobutrol injection appears to be effective for the detection of intracerebral metastases.

Differential cholinergic pathway involvement in Alzheimer's disease and subcortical ischemic vascular dementia

BACKGROUND

This study aimed to evaluate the relationship between loss of white matter cholinergic pathways, atrophy of the nucleus basalis of Meynert (NBM), and cognitive function in patients with subcortical ischemic vascular dementia (SIVD) or Alzheimer's disease (AD).

METHODS

The participants included 26 SIVD, 17 probable AD with or without white-matter changes, and 20 age-matched healthy controls. Thin-section coronal T2-weighted images were acquired using 3.0 T MR. The extent of white matter hyperintensities within cholinergic pathways were assessed using the cholinergic pathways hyperintensities scale (CHIPS). NBM atrophy was assessed from the thickness of the substantia innominata (SI) at the level of the crossing of the anterior commissure. Cognitive impairment was measured using the Mini-Mental State Examination (MMSE) and Clinical Dementia Rating (CDR). Correlations between CHIPSs, SI thickness, and cognitive impairment were evaluated using the Spearman ranked correlation test.

RESULTS

In AD, MMSE scores and CDR were correlated with SI thickness (ρ = 0.450, p = 0.006 and ρ = -0.520, p = 0.030, respectively) but not with CHIPS scores (ρ = -0.160, p = 0.530 and ρ = 0.270, p = 0.292, respectively). By contrast, aggravated MMSE score and CDR in SIVD had a tendency to correlate with elevated CHIPS scores (ρ = -0.344, p = 0.127 and ρ = 0.521, p = 0.021, respectively) but not with SI thickness (ρ = -0.210, p = 0.480 and ρ = 0.080, p = 0.736, respectively).

CONCLUSIONS

Loss of cholinergic pathways correlates with cognitive dysfunction in both AD and SIVD. The mechanisms appear to differ: NBM atrophy is likely to be the predominant contributor to cognitive impairments in AD, whereas, the cognitive dysfunction of SIVD was associated with compromised subcortical cholinergic fibers not with nucleus itself.

Image reporting and characterization system for ultrasound features of thyroid nodules: multicentric Korean retrospective study

OBJECTIVE

The objective of this retrospective study was to develop and validate a simple diagnostic prediction model by using ultrasound (US) features of thyroid nodules obtained from multicenter retrospective data.

MATERIALS AND METHODS

Patient data were collected from 20 different institutions and the data included 2000 thyroid nodules from 1796 patients. For developing a diagnostic prediction model to estimate the malignant risk of thyroid nodules using suspicious malignant US features, we developed a training model in a subset of 1402 nodules from 1260 patients. Several suspicious malignant US features were evaluated to create the prediction model using a scoring tool. The scores for such US features were estimated by calculating odds ratios, and the risk score of malignancy for each thyroid nodule was defined as the sum of these individual scores. Later, we verified the usefulness of developed scoring system by applying into the remaining 598 nodules from 536 patients.

RESULTS

Among 2000 tumors, 1268 were benign and 732 were malignant. In our multiple regression analysis models, the following US features were statistically significant for malignant nodules when using the training data set: hypoechogenicity, marked hypoechogenicity, non-parallel orientation, microlobulated or spiculated margin, ill-defined margins, and microcalcifications. The malignancy rate was 7.3% in thyroid nodules that did not have suspicious-malignant features on US. Area under the receiver operating characteristic (ROC) curve was 0.867, which shows that the US risk score help predict thyroid malignancy well. In the test data set, the malignancy rates were 6.2% in thyroid nodules without malignant features on US. Area under the ROC curve of the test set was 0.872 when using the prediction model.

CONCLUSION

The predictor model using suspicious malignant US features may be helpful in risk stratification of thyroid nodules.

Effects of Protein-Simulated Body Fluid Mixing Methods on Characteristics of Bone-Like Mineral

This study examined effects of protein mixing methods into modified simulated body fluid (mSBF) on the crystalline structure and morphology of bone-like mineral (BLM) coated on poly(lactic-co-glycolic acid) PLGA. Using bovine serum albumin (BSA) as a model protein, four sample groups were prepared: the N-BLM group was coated by soaking substrates in mSBF without BSA; the B-BLM group was coated by soaking in mSBF with BSA added immediately before soaking; the Ca-BLM group was coated by soaking in Ca-mSBF prepared by premixing BSA with a CaCl(2) solution before preparing the mSBF; the P-BLM group was coated by soaking in P-mSBF made by premixing the BSA with a KH(2)PO(4) solution. The B-BLM and Ca-BLM groups exhibited densely coated, thick BLM layers, whereas the P-BLM group exhibited loosely connected BLM clusters. The hydroxyapatite (HAp) crystallites of the B-BLM and Ca-BLM groups were aligned along the c-axis, but those of the P-BLM group were disordered and had a lower crystallinity. The alignment to the c-axis of Ca-BLM and the disordered orientation of P-BLM was caused by calcium ions bound to BSA in Ca-mSBF and phosphate ions bound to BSA in P-mSBF, respectively. These results show that the crystallinity and morphology of BLM can be controlled by the mixing of BSA in mSBF. The crystallinity of BLM is closely connected to its solubility. Therefore, the release characteristics of growth factors and cell regulation on BLM could be affected by the changes in the crystalinity of BLM.

Fluid-attenuated inversion recovery hypointensity of the pulvinar nucleus of patients with Alzheimer disease: its possible association with iron accumulation as evidenced by the t2(*) map

OBJECTIVE

We hypothesized that prominent pulvinar hypointensity in brain MRI represents the disease process due to iron accumulation in Alzheimer disease (AD). We aimed to determine whether or not the pulvinar signal intensity (SI) on the fluid-attenuated inversion recovery (FLAIR) sequences at 3.0T MRI differs between AD patients and normal subjects, and also whether the pulvinar SI is correlated with the T2(*) map, an imaging marker for tissue iron, and a cognitive scale.

MATERIALS AND METHODS

Twenty one consecutive patients with AD and 21 age-matched control subjects were prospectively included in this study. The pulvinar SI was assessed on the FLAIR image. We measured the relative SI ratio of the pulvinar to the corpus callosum. The T2(*) values were calculated from the T2(*) relaxometry map. The differences between the two groups were analyzed, by using a Student t test. The correlation between the measurements was assessed by the Pearson's correlation test.

RESULTS

As compared to the normal white matter, the FLAIR signal intensity of the pulvinar nucleus was significantly more hypointense in the AD patients than in the control subjects (p < 0.01). The pulvinar T2(*) was shorter in the AD patients than in the control subjects (51.5 ± 4.95 ms vs. 56.5 ± 5.49 ms, respectively, p = 0.003). The pulvinar SI ratio was strongly correlated with the pulvinar T2(*) (r = 0.745, p < 0.001). When controlling for age, only the pulvinar-to-CC SI ratio was positively correlated with that of the Mini-Mental State Examination (MMSE) score (r = 0.303, p < 0.050). Conversely, the pulvinar T2(*) was not correlated with the MMSE score (r = 0.277, p = 0.080).

CONCLUSION

The FLAIR hypointensity of the pulvinar nucleus represents an abnormal iron accumulation in AD and may be used as an adjunctive finding for evaluating AD.

Retrograde stent placement for coil embolization of a wide-necked posterior inferior cerebellar artery aneurysm

Wide-necked aneurysms of the posterior inferior cerebellar artery (PICA) are infrequently encountered in cerebrovascular practice, and endovascular treatment is difficult or impossible even with the use of several neck remodeling techniques. We present the case of a patient with a wide-necked aneurysm of the PICA, which was treated by the retrograde stenting through the contralateral vertebral artery and vertebrobasilar junction with antegrade coil embolization.

Thyroid incidentaloma detected by time-resolved magnetic resonance angiography at 3T: prevalence and clinical significance

OBJECTIVE

To determine the prevalence of thyroid incidentalomas detected by time-resolved magnetic resonance angiography (TRMRA) and to evaluate their clinical significance by using an ultrasonographic (US) and cytologic correlation.

MATERIALS AND METHODS

We retrospectively reviewed 2010 consecutive TRMRA examinations performed at our institution between August 2006 and April 2010. The TRMRA findings of thyroid incidentalomas were analyzed according to location, size, as well as vascularity, and were correlated with the US findings and cytologic results. Each nodule was classified as suspiciously malignant, indeterminate or probably benign according to the US criteria recommended by the Korean Society of Thyroid Radiology.

RESULTS

A total of 102 incidentalomas were detected in 90 of 2010 patients (5%). TRMRA showed homogenous hypervascularity in 48 (47%), inhomogeneous hypervascularity in 46 (45%), and hypovascularity in 8 (8%) thyroid nodules. At follow-up study, out of 26 patients with 30 incidentalomas on TRMRA, 27 nodules were identified on US. Of the 27 nodules, 24 (89%) nodule were classified as indeterminate, two (7%) as probably benign, and one (4%) as suspiciously malignant. Among the 16 nodules with available cytopathologic results, 14 (82%) were benign, one (6%) was indeterminate, and one (6%) was malignant.

CONCLUSION

Thyroid incidentalomas are found in 5% of TRMRA examinations. Although their presence does not necessarily indicate malignancy, nonspecific findings of detected incidentalomas on TRMRA require further evaluation by US.

Unique reflection properties of CdS/butterfly wings nanocomposites

Highly tunable optical properties are quite essential for future nanoscaled smart devices, which could be achieved on the hybrid photonic crystals (PhCs) that combine functional nanomaterials and PhC structures. However, related investigations are limited, since artificial PhCs lack either pattern variety or fabrication convenience. In this paper, the authors focus on exploring unusual optical properties by substituting the natural PhC structures in butterfly wings for artificial PhCs. Novel hybrid PhCs constructed by butterfly wings and the optical functional materials such as cadmium sulfide nanoparticles (nano-cadmium sulfide) are taken as examples. Owing to the conventionally unobtainable quasi-one dimensional PhC structures, nano-cadmium sulfide/wings (Euploea mulciber) display brilliant or gloomy colors depending on the observation directions. Such unique ‘on–off’ angle-dependent reflection properties are quite different from those of typical 1D PhCs and are intensively studied through comparison with the general reflection properties of nano-cadmium sulfide/wings' (Papilio paris) multilayer structures. Simulated reflection spectra match well with experimental results. Finally, a mechanism is established to illustrate the unique on–off angle-dependent reflection properties as well as provide a new understanding of the quasi-1D PhC structures. By introducing natural PhCs in this investigation, attractive properties that could inspire the design and application of hybrid PhCs are achieved.

Bioinspired Au/TiO2 photocatalyst derived from butterfly wing (Papilio Paris)

The reticular hierarchical structure of butterfly wings (Papilio Paris) is introduced as template for Au/TiO(2) photocatalyst by depositing the Au nanoparticles on TiO(2) matrix, which is carried out by a water-ethanol sol-gel procedure combined with subsequent calcination. The obtained Au/TiO(2) nanocomposites present the reticular hierarchical structure of butterfly wings, and Au nanoparticles with an average size of 7 nm are homogeneously dispersed in TiO(2) substrate. Benefiting from such unique reticular hierarchical structure and composition, the biomorphic Au/TiO(2) exhibits high-harvesting capability and presents superior photocatalytic activity. Especially, the biomorphic Au/TiO(2) at the nominal content of gold to titanium of 8 wt% shows the highest photocatalytic activity and can completely decompose methyl orange within 80 min, which is obviously higher than that of commercial Degussa P25 powders.

Morphological effects on surface-enhanced Raman scattering from silver butterfly wing scales synthesized via photoreduction

Through a simple room-temperature photoreduction process, this letter conformally replicates 3D submicrometer structures of wing scales from two butterfly species into Ag to generate practical surface-enhanced Raman scattering (SERS) substrates. The Ag replicas of butterfly scales with higher structural periodicity are able to detect rhodamine 6G at a low concentration down to 10(-9) M, which is three orders of magnitude lower than the detectable concentration limit of using quasi-periodic Ag butterfly structures. This result presents a way to select suitable scale morphologies from 174,500 species of Lepidopterans to replicate, as consumable SERS substrates with low cost and high reproducibility.