Revisiting the utility of identifying nuclear grooves as unique nuclear changes by an object detector model.

BACKGROUND: Among other structures, nuclear grooves are vastly found in papillary thyroid carcinoma (PTC). Considering that the application of artificial intelligence in thyroid cytology has potential for diagnostic routine, our goal was to develop a new supervised convolutional neural network capable of identifying nuclear grooves in Diff-Quik stained whole-slide images (WSI) obtained from thyroid fineneedle aspiration. METHODS: We selected 22 Diff-Quik stained cytological slides with cytological diagnosis of PTC and concordant histological diagnosis. Each of the slides was scanned, forming a WSI. Images that contained the region of interest were obtained, followed by pre-formatting, annotation of the nuclear grooves and data augmentation techniques. The final dataset was divided into training and validation groups in a 7:3 ratio. RESULTS: This is the first artificial intelligence model based on object detection applied to nuclear structures in thyroid cytopathology. A total of 7,255 images were obtained from 22 WSI, totaling 7,242 annotated nuclear grooves. The best model was obtained after it was submitted 15 times with the train dataset (14th epoch), with 67% true positives, 49.8% for sensitivity and 43.1% for predictive positive value. CONCLUSIONS: The model was able to develop a structure predictor rule, indicating that the application of an artificial intelligence model based on object detection in the identification of nuclear grooves is feasible. Associated with a reduction in interobserver variability and in time per slide, this demonstrates that nuclear evaluation constitutes one of the possibilities for refining the diagnosis through computational models.

Cytopathology of mesenchymal tumors of the thyroid gland: analysis of 12 cases from multinational institutions with review of the literature.

INTRODUCTION: Mesenchymal tumors of the thyroid gland are extremely rare. We report the cytomorphologic characteristics of 12 mesenchymal tumors occurring in the thyroid gland and highlight the diagnostic difficulties encountered in their cytologic evaluation. MATERIALS AND METHODS: The cytopathology and surgical pathology archives from 5 large institutions were searched for thyroid mesenchymal tumors that had an FNA available for review. Clinicopathologic and cytomorphologic characteristics for each case were evaluated. RESULTS: Twelve cases of mesenchymal tumors occurring in the thyroid were identified in our search. Patient age ranged from 28 to 84 years (median, 60 years). The cases occurred in 7 women and 5 men. The tumor size ranged from 1.4 to 14 cm (median, 3.3 cm). The tumors were as follows: hemangioma (n = 4; 33.3%), angiosarcoma (n = 2; 16.7%), schwannoma (n = 2; 16.7%), solitary fibrous tumor (n = 2, 16.7%), metastatic synovial sarcoma (n = 1, 8.3%) and metastatic pleomorphic rhabdomyosarcoma (n = 1, 8.3%). The cytomorphologic features of the tumors were similar to those of their counterparts occurring in different sites. An accurate diagnosis was achieved in six primary thyroid mesenchymal cases (60%). Five patients (41.7%) underwent total thyroidectomy, and 3 patients received partial thyroidectomy (25%). Three patients (25%) did not receive a thyroidectomy and subsequent surgical information was not available in 1 case (8.3%). CONCLUSIONS: Mesenchymal tumors of the thyroid are extremely uncommon. Cytologic diagnosis of these tumors is often challenging due to the morphologic overlap with diverse epithelial and non-epithelial thyroid lesions. Ancillary studies such as immunohistochemistry and molecular studies are essential for accurate diagnosis.

Amiodarona: uma agressäo à funçäo tiroidiana / Amiodarone: a agression to the thyroid function

A presente revisao foi realizada com a finalidade de verificar os efeitos da amiodarona sobre a funcao tiroidiana , visto que a droga e um derivado benzofurano de estrutura similar a iodo-tironina e tambem possui atomos de iodo em sua composicao molecular. O estudo foi baseado na analise retrospectiva dos ultimos 10 anos, quanto as propriedades da aminodarona em relacao ao tempo de administracao e quanto aos possiveis efeitos sobre os hormonios tiroidianos TSH e proteinas ligadoras de tiroxina, bem como o desencadeamento do fenomeno autoimune corroborando numa das provaveis patogeneses do desenvilvimento de hipo ou hipertiroidismo. Foram tambem relatados estudos da cinetica dos hormonimos tiroidianos e acoes farmacologicas da aminodarona em outros orgaos. Um numero significativo de pacientes desenvolveu alteracoes da glandula tireoide durante a terapia com amiodarona e tal fato pode ser explicado pelo excesso de iodo contido na droga, o qual pode acarretar tanto hipotiroidismo como hipertiroidismo, existindo controversias quanto a incidencia de ambos. A aminodarona e um antiarritmico de classe III, usado no tratamento e prevencao das arritmias cardiacas, sendo de suma importancia que sua administracao seja criteriosa, uma vez conhecidas as anormalidades induzidas pela droga, principalmente na glandula tireoide. Se possivel proscrever o seu uso em individuos com antecedente pessoal ou familiar, com patologias da tireoide

Prenhez ectópica: aspectos atuais / Ectopic pregnancy: actual aspects

Os autores realizaram um extensa revisäo da literatura ocidental acerca de todos os aspectos da Prenhez Ectópica, indo desde o seu conceito até seus métodos diagnósticados mais atuais, bem como tratamento e complicaçöes