A Man in His Forties with Recurrent Cat-Scratch Disease.

Cat-scratch disease (CSD) is a self-limited zoonotic infection transmitted by felines caused by the Gram-negative bacillus Bartonella henselae. It usually presents with lymphadenopathy and constitutional symptoms that resolve within eight weeks, with, or without antibiotic treatment. The diagnosis is made by serology, molecular diagnosis in a biopsy, or a positive culture. The recurrence or reactivation of B. henselae has rarely been reported. We present the case of a 45-year-old man with a history of CSD two years before who presented to the clinic with groin lymphadenopathy. The patient had a history of close contact with felines though no known risk exposure was reported. The diagnosis was made with a positive serology suggestive of recent infection along with histopathological changes suggestive of CSD. Subsequently, azithromycin was administered with complete resolution of symptoms.

Individual Ultrasonographic Characteristics of Thyroid Nodules and Their Cytopathological Correlation to Determine Malignancy Risk.

Background Ultrasonographic evaluation of thyroid nodules is challenging due to their high frequency and low malignancy rate. The risk stratification system developed by the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) focuses on addressing the primary contemporary objectives for these lesions, aiming to decrease unnecessary biopsies while maintaining a similar specificity compared with other risk stratification systems. Generally, when indicative of malignancy by ultrasound findings, the next best step in management is an evaluation by fine needle aspiration biopsy (FNAB) and cytological analysis with The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) results that determine further evaluation requirements, actions that are based on the risk of malignancy (ROM) of the assigned category, which could include surgical intervention. Objectives To validate and analyze the individual impact of each ultrasonographic finding indicative of malignancy in the ACR TI-RADS guidelines based on their respective correlation with results obtained by TBSRTC. Materials and method Reports for 212 thyroid ultrasound-guided FNABs from 2018 to 2020 were assessed. Only 117 had both ACR TI-RADS and TBSRTC reports available and were analyzed. Nodules were divided into two groups: ROM < 5% (Bethesda 1, 2; n = 58), and ROM > 5% (Bethesda 3, 4, 5, 6; n = 59). Statistical analysis was performed using the x2 test and bivariate logistic regression model for each characteristic included in ACR TI-RADS. Results Individual ultrasound characteristics with a more pronounced distribution towards the Bethesda > 5% malignancy group were: solid or almost completely solid composition (n=53, 62.3%), very hypoechoic echogenicity (n=3, 75%), wider-than-tall shape (n=50, 50.5%), lobulated or irregular margin (n=23, 65.7%), punctate echogenic foci (n=18, 72%), and thyroid isthmus location (n=6, 75%). Statistically significant individual ultrasonographic characteristics indicative of malignancy included solid or almost completely solid (p = 0.005), very hypoechoic echogenicity (p = 0.046), margin lobulated or irregular (p = 0.031), and punctate echogenic foci (p = 0.015). No significant association was found in the taller-than-wide shape for differentiating malignant from benign lesions (p = 0.969). Conclusions Specific ultrasound characteristics identified in the ACR TI-RADS system demonstrate a stronger correlation with an increased risk of malignancy when compared with cytologic evaluation results. These characteristics include a solid composition, lobulated or irregular margins, punctate echogenic foci, and very hypoechoic echogenicity. Our findings revealed that the scale points for the taller-than-wide characteristic do not adequately represent its true influence on the risk of malignancy.

Patología quirúrgica de las neoplasias foliculares de la tiroides en el Centro Médico ABC / Surgical pathology of follicularthyroid tumors in the ABC Medical Center

Se realizó un estudio retrospectivo, observacional y longitudinal de tiroidectomías efectuadas en el Centro Médico ABC durante el periodo comprendido de enero de 1998 a julio del 2001. Se efectuaron un total de 156 cirugías tiroideas, 22 (14. 1 por ciento) de ellas fueron por neoplasias foliculares. En 16 (72.72 por ciento) casos se tomó biopsia por aspiración con aguja fina, el diagnóstico se reportó como indeterminado. A diez (45.45 por ciento) se les practicó garmmagrama, todos con nódulo frío. Cuatro (18.18 por ciento) pacientes fueron diagnosticados con ultrasonido convencional. A uno (4.54 por ciento) se le hizo el diagnóstico de nódulo tiroideo mediante palpación. A dieciocho (81.8 1 por ciento) pacientes se les realizó estudio transoperatorio; de éstos, diez (55.55 por ciento) casos fueron reportados como neoplasia folicular, cinco (27.77 por ciento) como adenoma folicular y dos (11. 11 por ciento) como carcinoma folicular. Un estudio (5.55 por ciento) fue diferido. Diecinueve (86.36 por ciento) de los diagnósticos definitivos correspondieron a neoplasias benignas y tres (13.63 por ciento) malignas. No hubo mortalidad perioperatoria. El estudio transoperatorio es ampliamente usado por los cirujanos del Centro Médíco ABC. La correlación entre los casos que se diagnosticaron como carcinoma o adenoma folicular fue perfecta. El manejo de las neoplasias foliculares de la tiroides en el Centro Médico ABC es seguro, no se ha registrado mortalidad perioperatoria y la morbilidad es mínima.