A retrospective analysis of prognostic factors predictive of lymph-node metastasis and recurrence in thyroid papillary microcarcinoma

AIM

The literature is inconclusive concerning the prognostic factors and therapeutic management of papillary thyroid microcarcinoma (PTMC). Herein we report on our extensive experience with PTMC in relation to clinicopathological characteristics and prognostic factors.

METHODS

In all, 248 patients that were diagnosed and treated for PTMC between 2007 and 2012 were retrospectively analyzed. Demographic and tumor characteristics at presentation, and recurrence during follow-up were noted.

RESULTS

Total thyroidectomy and radioactive iodine (RAI) ablation treatment were performed in all patients. Bilateral involvement, vascular and capsular invasion, extra-thyroidal extension, and lymph node metastasis occurred significantly more frequently in patients with tumor size>5 mm (P<0.05). Multivariate statistical analysis showed that a clinically suspected diagnosis (OR:0.095; P=0.043) and elevated thyroglobulin (TG) level (OR: 1.083; P=0.011; cut-off value≥7.98 ngmL(-1)) were significant and independent risk factors for lymph node metastasis, with a sensitivity of 57% and specificity of 83%. After a median follow-up of 2 years (range:0.3-11 years), 10 (4%) of the 248 patients had recurrent disease. According to multivariate analysis, lymph node metastasis (OR: 51.4; P=0.003) was the only independent predictor of recurrence.

CONCLUSION

Our findings revealed that serum TG level and a clinically suspected diagnosis were risk factors for lymph node metastasis, while nodal metastasis was a predictor of recurrence.

Correlation of thyroid fine-needle aspiration with final histopathology: a case series

AIM

The aim of this study was to evaluate the correlation between preoperative thyroid fine-needle aspiration result and final histopathology in patients with thyroid nodules.

METHODS

The medical records of 298 patients (mean age, 47.7±12.3 years; 79.5% females) who underwent fine-needle aspiration for thyroid nodules and who were operated and have final pathological diagnosis were retrospectively reviewed. For reporting fine-needle aspiration specimen pathology, the Bethesda thyroid fine-needle aspiration classification was used. Tyroglobulin (Tg) and anti-Tg and anti-thyroid peroxidase (anti-TPO) antibody levels were determined preoperatively.

RESULTS

Thyroid nodules were non-diagnostic, benign or atypia (Bethesda groups 1-3) in 76.8% of patients; and follicular neoplasm, suspicious for malignancy or malignant (Bethesda groups 4-6) in 23.1% of patients. Final pathology of surgery specimen was most commonly nodular goiter (36.6%) and papillary carcinoma (35.6%). Nodular goiter was significantly more prevalent in Bethesda 1 group while papillary carcinoma was more common in Bethesda 3 group (P<0.05). Tg level is significantly higher in the nodular goiter group (90.49±126.93 ng/mL), while anti-Tg and anti-TPO levels are significantly higher in the lymphocytic thyroiditis goiter group (229.77±494.42 U/mL and 282.86±360.77 U/mL, respectively) than the other pathology groups (P<0.05 for all).

CONCLUSION

Papillary carcinoma is more common in Bethesda thyroid fine-needle aspiration classification 3 group. Therefore, preoperative fine-needle aspiration for thyroid nodules is predictive of final pathology and should be applied for diagnosis and follow-up.

Effects of static and 50 Hz alternating electric fields on superoxide dismutase activity and TBARS levels in guinea pigs

The toxic oxygen free radicals are extremely reactive and can cause considerable damage to biomolecules, such as RNA, enzymes, membranes, proteins, and lipids, which may in turn lead to various pathological consequences. Lipid peroxidation, evaluated by determination of thiobarbituric acid reactive substances (TBARS) is the free radical-induced oxidation of polyunsaturated fatty acids. Normally, the oxygen free radicals are neutralized by highly efficient systems in the body. These include antioxidant enzymes like superoxide dismutase (SOD). In a healthy subject, there is a balance between free radicals and levels of antioxidants. The aim of this study was to determine lipid peroxidation and SOD levels in plasma, liver, lung and kidney tissues exposed to different intensities, directions and exposure periods of static and 50 Hz alternating electric fields. Electric field intensities ranging from 0.3 kV/m to 1.8 kV/m were applied in vertical or horizontal direction in exposure periods of 1, 3, 5, 7, and 10 days. The increase in SOD and TBARS levels of plasma, liver, lung, and kidney tissues was found to depend significantly on the type of electric field and the exposure period.

High-Grade Neuroendocrine Carcinoma of the Cervix

Neuroendocrine tumor of the uterine cervix is a rare and aggressive malignancy. Despite controversial, multimodal treatment methods, prognosis and treatment outcomes are worst in advanced stages. We report an early-stage case treated with the multimodal approach. The nomenclature proposed for this tumor type in 1997 by the College of American Pathologists still has some points of discussion. As in our case some of the tumors cannot be defined exactly into small or large cell types, and this causes confusion at least for nomenclature purposes. A 'mixed' type for this tumor may be appropriate.

Uterine leiomyoma with prominent lymphoid infiltrate

We present a case of a 35-year-old woman whose myomectomy specimen revealed a leiomyoma nodule diffusely infiltrated by lymphocytes which were shown to be clonal in nature. Lymphoid infiltration of leiomyomas is a rare occurrence, and this is the first case with molecular analysis.

A new flap model in rats: iliac osteomusculocutaneous flap

Although osteomusculocutaneous flaps are used frequently in clinical practice to repair defects involving soft tissue and bone, there are still many questions that remain to be answered regarding their basic physiology. To accomplish such basic science studies, simple and reliable animal osteomusculocutaneous flap models are needed. The purpose of this study was to describe a new flap model in rats--namely, the iliac osteomusculocutaneous flap. Thirty adult Wistar rats weighing 200 to 250 g were used in this experiment. In 15 rats, the vascular anatomy of the iliolumbar vessels and their relation with adjacent soft tissues and the iliac bone was determined by anatomic dissection. Based on this anatomic study, the iliac osteomusculocutaneous flap model was created in rats. The flap is comprised of a skin island (3 x 3 cm) in the flank region, a 1 x 1-cm segment of iliac bone, and an abdominal wall muscle cuff. In 10 rats, the flap was raised as an island flap based on its vascular pedicle of iliolumbar vessels, and was replaced in situ. In the remaining 5 rats, the flap was transferred to the groin region as a free flap. Direct observation on postoperative day 7 revealed that the skin island of all the flaps was completely viable. Bone scintigraphy performed on postoperative day 3 in free flaps demonstrated radionuclide uptake, indicating viability of the bony segment. The dye injection study revealed ink staining within blood vessels of the bone, confirming its viability. Microangiography of the flap demonstrated vascularity of each component of the flap by the iliolumbar vessels, including a distinct branch to the iliac bone. The authors conclude that the iliac osteomusculocutaneous flap of the rat is a simple and reliable flap model that offers the following advantages: (1) It is a true osteomusculocutaneous flap, (2) it can be used as a free flap without the need for an isogeneic rat, (3) the vascular pedicle is consistent, and (4) it is harvested from a small-animal species.

Fibroadenoma of the vulva

A well-circumscribed mass was excised from the vulva of a 37-year-old woman. Histological and immunohistochemical findings showed the characteristic features of fibroadenoma of breast. The concepts about the histogenesis of this lesion were discussed.

CD56+ lymphoma presenting as a testicular tumor

A case of an unusual lymphoma type, CD56 (+) T/NK lymphoma, presenting as a testicular tumor is described. A 35 year old man who presented with right testicular swelling, underwent right inguinal orchiectomy, with a presumptive diagnosis of abscess or malignancy. Histopathology showed a diffuse mixed large and small cell lymphoma with a focal angiocentric growth pattern. Immunohistochemically CD45RO and CD56 were found to be positive in the neoplastic cells. In situ hybridization assay for EBV showed the presence of EBV related small ribonucleic acid sequences (EBER) within the tumor cells. Despite systemic chemotherapy, the patient had an aggressive clinical course with two skin and left testicular recurrences in the first year of his disease.

Tumor metastasis to an oncocytoma

A case of squamous carcinoma of the lung metastatic to a renal oncocytoma is described. The terms "tumor-to-tumor metastasis" and "collision tumor" for describing the existence of two neoplasms in the same location are discussed.

Mohr syndrome in two sisters: prenatal diagnosis in a 22-week-old fetus with post-mortem findings in both

Oral-facial digital syndrome type II (OFP syndrome II; orofaciodigital syndrome II) is a rare autosomal recessive syndrome, first described by Mohr (1941). We present two sisters with Mohr syndrome from a consanguineous family. One is a three-day-old female patient, the other is 22-week-old fetus. Polydactyly with bifid thumbs in both hands, bilateral polysyndactyly of halluces, lateral polysyndactyly and bilateral pes equinovarus were demonstrated in the fetus sonographically. Corpus callosum agenesis, congenital heart disease, bilateral bifid thumbs and halluces and polydactyly were seen in both patients. In addition, post-mortem findings showed absence of olfactory nerve, single atrium. VSD, abnormal lung lobulation and natal teeth in the fetus. Absence of olfactory nerve and natal teeth have not been reported previously in Mohr syndrome.

Unilateral spinal anaesthesia with hyperbaric bupivacaine

BACKGROUND

The dosage of local anaesthetic and the time the patient must be kept in the lateral decubitus position for a unilateral spinal anaesthesia is not known. The aim of this study was to determine the ideal dosage of hyperbaric bupivacaine and the time required for the lateral decubitus position for a unilateral spinal block.

METHODS

Ninety patients who were scheduled to receive spinal block for surgery in the lower extremity were randomised into 9 groups (n = 10). The spinal block was performed through the L4-L5 intervertebral space with the patient in the lateral decubitus position. Patients in groups Ia, Ib, Ic; IIa, IIb, IIc; IIIa, IIIb, IIIc received 1.5 ml of 0.5%, 2 ml of 0.5%, and 2.5 ml of 0.5% hyperbaric bupivacaine solutions, respectively. The patients were turned to the supine position for 5 min after the injection in groups Ia, IIa, IIIa, 10 min after the injection in groups Ib, IIb, IIIb, and 15 min after the injection in groups Ic, IIc, IIIc. The onset and regression of sensory and motor block were checked and compared between the dependent and non-dependent sides in each group.

RESULTS

The rate of block progression of the non-dependent side was higher in the groups receiving 2.5 ml 0.5% hyperbaric bupivacaine solution than in the other groups; at the same time the level of block was higher and the duration of block was longer. The incidence of hypotension was 10-20% in these groups. In the 2 ml 0.5% hyperbaric bupivacaine solution groups, a satisfactory block level and duration of anaesthesia for surgery was obtained. The rate of block progression to non-dependent side in the groups receiving 1.5 ml of 0.5% hyperbaric bupivacaine solution was lower than the other groups, but the duration of block was shorter and the level of block was lower than the other groups.

CONCLUSION

For unilateral spinal anaesthesia in lower extremity operations, 2ml 0.5% hyperbaric bupivacaine solution for operations above the knee and 1.5 ml 0.5% hyperbaric bupivacaine solution for operations below the knee and keeping the patients for 10 min in the lateral decubitus position were found to be appropriate.

Changes in hydroxyproline levels in electric field tissue interaction

Guinea pigs when exposed to external electric field (1.9 kV/m) for 9 hrs/day for 3 days registered rise in the levels of hydroxyproline in liver, lung and kidney, suggesting increased synthesis of collagen.

Biochemical and structural approach to collagen synthesis under electric fields

The effects of electric fields of different intensities and directions on the collagen synthesis of guinea pigs was studied. The effects of vertical and horizontal electric fields of 1.9 kV/m and 0.9 kV/m, generated with voltages of 300 V and 150 V DC, respectively, on collagen synthesis, was evaluated by assessing the amount of hydroxyproline in the liver tissue, and by histological examination of tissue samples. The Stegemann-Stalder method was used to determine hydroxyproline content of the tissues. While the 0.9 kV/m vertical and horizontal electric fields substantially decreased the amount of hydroxyproline in the liver, the 1.9 kV/m electric fields in both directions increased the hydroxyproline content. The vertical electric field was more effective than the horizontal one both in the increases and the decreases. These findings were verified histologically.