The thyroid: review of imaging features and biopsy techniques with radiologic-pathologic correlation.

Knowledge of the normal and abnormal imaging appearances of the thyroid gland is essential for appropriate identification and diagnosis of thyroid lesions. Thyroid nodules are often detected incidentally at computed tomography, magnetic resonance imaging, and positron emission tomography; however, ultrasonography (US) is the most commonly used imaging modality for characterization of these nodules. US characteristics that increase the likelihood of malignancy in a thyroid nodule include microcalcifications, solid composition, and central vascularity. Nuclear scintigraphy is commonly used for evaluation of physiologic thyroid function and for identification of metabolically active and inactive nodules. When fine-needle aspiration biopsy (FNAB) of a lesion is indicated based on clinical and radiologic features, appropriate US-guided biopsy technique and careful cytologic analysis are crucial for making the diagnosis. FNAB and core biopsy are the two percutaneous techniques used to obtain a specimen, with the latter technique being indicated following nondiagnostic or indeterminate FNAB. Specimen adequacy and diagnostic accuracy vary due to several factors, including location of aspiration and biopsy technique used. The radiologist must have a basic knowledge of thyroid disease, be familiar with specimen processing, and recognize the cytologic and radiologic appearances of thyroid lesions, all of which will facilitate the management of these lesions. Online supplemental material is available for this article.

Cytology of nonneoplastic occupational and environmental diseases of the lung and pleura.

CONTEXT: Cytologic examination of the respiratory tract has been a useful diagnostic tool when evaluating neoplastic lesions of the respiratory tract. However, we have limited experience in the application of this technique in the management of nonneoplastic occupational and environmental diseases of the lung and pleura. This review focuses on the cytologic characteristics of a variety of occupational lung diseases, grouping them into 2 broad diagnostic categories: reactive cellular changes and noncellular elements. The former includes entities such as reactive mesothelial proliferation, goblet cell metaplasia, Creola bodies, and reserve cell hyperplasia, and the latter encompasses Curschmann spirals, Charcot-Leyden crystals, and asbestos bodies. OBJECTIVE: To illustrate the cytologic features of several nonneoplastic occupational and environmental diseases and correlate the cytology with various etiologic agents. DATA SOURCES: Case-derived material and literature review. CONCLUSIONS: The role of cytology in the diagnosis of nonneoplastic occupational and environmental lung diseases is limited. This may be because more than one agent can elicit a similar host reaction and/or the offending agent can be associated with more than one pathologic process. However, in the appropriate clinical and radiographic setting, the cytology can render valuable diagnostic information. Examples include pulmonary alveolar proteinosis in patients with acute silicoproteinosis and asbestos bodies in bronchoalveolar lavage samples of patients with asbestos exposure.

Intraosseous innervation of the human patella: a histologic study.

BACKGROUND: The soft tissue structures surrounding the human knee joint have been the subject of extensive anatomic study. The detailed histologic findings within the bone of the human patella, however, have not been systematically studied. While the nerves supplied to the periarticular soft tissues have been very well documented, the nerves supplied to the interior of the bony patella have never been described. HYPOTHESIS: This study tests the hypothesis that the patella contains an intraosseous nerve network. Further, the authors investigate the anatomic location of these intraosseous nerves to better understand their possible clinical relevance. STUDY DESIGN: Descriptive laboratory study. METHODS: Ten matched pairs of cadaveric patellae (left and right patellae from the same individual; 20 total) were prepared for evaluation by hematoxylin and eosin staining using a technique that allows the creation of complete, large histologic sections of individual patellae. The matched specimens were dissected free of soft tissue and then sectioned using a diamond-wafering saw into 3-mm sagittal (left patella) and transverse (right patella) sections. Sections were then decalcified and whole-mounted into paraffin blocks for further sectioning using a large-format microtome. All 20 specimens were prepared for evaluation. Age at death averaged 80 years (range, 64-91). All specimens demonstrated at least grade II chondromalacia. RESULTS: Nineteen of 20 (95%) specimens demonstrated intraosseous nerves. Of 248 sections studied, 116 (47%) demonstrated intraosseous nerves, with 227 individual nerves identified. The density of intraosseous nerves was greatest in the medial and central portions of the patella, with a significant paucity identified laterally. CONCLUSION: The primary intraosseous innervation of the patella derives from a medially based neurovascular bundle. CLINICAL RELEVANCE: A better understanding of the nerves within the human bony patella may improve understanding the patho-physiology of anterior knee pain syndromes.

Growth of a left atrial sarcoma followed by resection and autotransplantation.

Left atrial sarcomas are among the rarest primary cardiac tumors. This type of tumor has an aggressive behavior and is often resistant to standard approaches to treatment. In this case report we show its rapid growth in vivo and document successful local control with an aggressive surgical approach of ex-vivo resection, reconstruction of the left atrium by a pericardial patch, and subsequent autotransplantation.

MRI in myopathy.

MRI is a promising tool that can be used as an adjunctive test during the evaluation of patients who have myopathy and can help raise the diagnostic yield of a planned biopsy. It also has promise as a clinical endpoint. This article discusses abnormalities visible on MRI of muscle and the use of MRI in patients who have myopathy.

Cardiac angiosarcoma: an unusual presentation simulating mitral stenosis and constrictive-effusive pericarditis.

This case report details a patient with a cardiac angiosarcoma who had an unusual presentation with hemodynamics consistent with mitral stenosis and constrictive-effusive pericarditis. It illustrates how transesophageal echocardiography adds to the information obtained from transthoracic imaging and hemodynamics in this unusual presentation of a cardiac tumor.

Giant cell reparative granuloma of the orbit associated with cherubism.

PURPOSE: To report a case of cherubism with extensive, bilateral orbital involvement occurring in a 27-year-old woman who had the diagnosis established at the age of 4 years. DESIGN: Single interventional case report. INTERVENTION: Ophthalmologic examination and computed tomography were performed. The patient underwent multiple surgical excisions using a bicoronal and transorbital approach. The excised orbital tissues were studied histopathologically. RESULTS: Computed tomography showed bilateral inferior lateral masses involving the orbital floors and producing marked superior displacement of the orbital contents. The intrinsic expansile bone lesions involved the inferior and lateral orbital walls with apical compression of the optic nerves. Histopathologic examination of the masses revealed scattered giant cells in a fibroblastic stroma containing small vascular channels. The lesion was interpreted as giant cell reparative granuloma. CONCLUSIONS: Giant cell reparative granuloma is an uncommon bone lesion that might involve the orbit. Cherubism should be included in the differential diagnosis of lesions that show the histopathologic features of giant cell reparative granuloma.

Composite thymoma and chronic lymphocytic leukemia/small lymphocytic lymphoma involving the anterior mediastinum.

Simultaneous involvement of the anterior mediastinum by thymoma and B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), to our knowledge, has not been previously reported. We describe a composite tumor composed of thymoma and CLL/SLL incidentally discovered in a 62-year-old man who had no history of malignant diseases or immunologic disorders. The preoperative peripheral blood specimen showed a normal complete blood cell count and differential count. The diagnosis was established by histologic examination and immunophenotypic studies of the surgically excised anterior mediastinal mass. Postoperatively, bone marrow aspiration and biopsy specimens showed morphologic evidence of CLL/SLL, and the presence of neoplastic cells in peripheral blood and bone marrow was confirmed by flow cytometry immunophenotypic analysis.

Cartilaginous lesions of the skeleton.

Cartilaginous lesions of the skeleton include those due to genetic diseases (skeletal dysplasias), reparative and hamartomatous processes, and benign and malignant tumors. We review the lesions most commonly encountered by the surgical pathologist, their differential diagnoses, and recently discovered features of these lesions.