Cytological diagnosis of microfilaria at unusual sites in clinically unsuspected cases: some rare presentations of filariasis.

Filariasis is a major concern, particularly in endemic regions. The majority of patients harbouring the parasite may remain asymptomatic for years. Here, we present six patients who were sent for routine cytological examination to rule out neoplastic pathology, in whom cytology identified filarial infestation. The main purposes of our paper are to highlight the importance of fine needle aspiration cytology (FNAC), a cheap and quick investigation to detect the microfilaria from tissue swelling and body fluids, and to point out that clinicians practising in endemic regions should always consider filarial infestation in patients presenting with longstanding swelling.

Fine-needle aspiration diagnosis of primary hydatid disease of the thyroid; first reported case in the USA.

Echinococcosis or hydatid disease (HD) is a parasitic disease caused by species of the Echinococcus genus. Since the incidence of HD in the USA is very low and the primary HD of the thyroid is extremely rare even in endemic regions, the occurrence of primary thyroid HD is exceptional in the USA. Thyroid HD is rarely diagnosed by fine-needle aspiration (FNA). Our literature review revealed less than ten cases of primary HD of thyroid diagnosed by FNA worldwide. Hereby, we report the first case of a primary thyroid HD diagnosed by fine-needle aspiration in the USA.

Spirorchiid Infection in Olive Ridley Turtle, Lepidochelys olivacea (Eschscholtz, 1829) (Testudines: Cheloniidae), from Brazil.

The Olive Ridley turtle, Lepidochelys olivacea (Eschscholtz, 1829) (Testudines: Cheloniidae), is 1 of the 5 species of sea turtle found along the coast of Brazil. Little is known regarding infection by species of the family Spirorchiidae in the host, as only 1 report exists. This case report describes granulomas in different tissues associated to type 1 and 3 spirorchiid eggs in 5 L. olivacea from the Brazilian coast. The occurrence of the eggs was considered an incidental finding and may have contributed to the debility and death of the hosts. This is the second report of tissue lesions due to spirorchids eggs in this host and the first occurrence in Olive Ridley turtle from the Brazilian coast.

[Disseminated cysticercosis: report of three cases in Togo]. / Cysticercose disséminée: trois cas au Togo.

We report 3 cases of disseminated cysticercosis (DC) in adult male subjects in Togo. All had consulted in dermatology for asymptomatic subcutaneous nodules. The diagnosis was confirmed by histology of a resected nodule. Computed tomography allowed us to bring out the widespread dissemination of cysticerci. The skin, brain, muscle, eye, thyroid, and pleura were the affected organs. Treatment was based on albendazole and betamethasone, with adverse side effects in 2 of our 3 patients. Our 3 observations seem to be the first of their kind in Togo. The mechanism of contamination in these disseminated forms is not yet elucidated, however ingesting a gravid proglottis could be the basis of the widespread dissemination of cysticerci in the body. No consensus has yet been established in the treatment of DC and the management should follow the guideline for treatment of neurocysticercosis and ocular cysticercosis.

Hydatid cyst disease of the thyroid gland: report of two cases.

Hydatid cyst disease may develop in any organ of the body, most frequently in the liver and lung, but occasionally can affect other organs such as the thyroid gland. Although the prevalence of thyroidal cyst disease varies by region, literature data suggest that it ranges between 0% and 3.4%. The aim of this report was to share 2 cases with thyroid hydatid cyst. Two female patients aged 26 and 57 years were admitted to our outpatient clinic with different complaints. While the first case presented with front of the neck swelling and pain, the second case presented with hoarseness, sore throat, and neck swelling. Both patients were living in a rural area in the southeastern region of Turkey and had had a long history of animal contact. Both patients had undergone previous surgeries for hydatid cyst disease. Both patients presented with a clinical picture consistent with typical multinodular goiter, and both underwent total thyroidectomy after detailed examinations and tests. The exact diagnosis was made after histopathologic examination in both patients. They both had a negative indirect hemagglutination test studied from blood samples. They both have had no recurrences during a 4-year follow-up. In conclusion, although thyroid gland is rarely affected, hydatid cyst disease should not be overlooked in differential diagnosis of cystic lesions of thyroid gland in patients who live in regions where hydatid cyst disease is endemic and who had hydatid cysts in other regions of their body.

Toxoplasma gondii infection in llama (Llama glama): acute visceral disseminated lesions, diagnosis, and development of tissue cysts.

Clinical toxoplasmosis has been reported in many species of warm-blooded animals but is rare in camelids. Here we report acute fatal systemic toxoplasmosis involving heart, thyroid gland, stomach, intestine, diaphragm, kidneys, adrenal glands, and liver of a 13-mo-old llama (Llama glama). Many Toxoplasma gondii tachyzoites were associated with tissue necrosis in multiple organs. Death was attributed to severe myocarditis. Ulcers associated with numerous tachyzoites were present in the C3 compartment of the stomach. Tissue cyst development was followed using bradyzoite-specific T. gondii antibodies. Individual intracellular, and groups of 2 or more, bradyzoites were identified in hepatocytes, biliary epithelium, myocardiocytes, lung, diaphragm, thyroid gland, spleen, and stomach. Lesions in the brain were a few microglial nodules and very early tissue cysts containing 1-3 bradyzoites. These observations suggest that the animal had acquired toxoplasmosis recently. Diagnosis was confirmed immunohistochemically by reaction with T. gondii -specific polyclonal rabbit serum but not with antibodies to the related protozoan Neospora caninum . Genetic typing using the DNA extracted from paraffin-embedded myocardium of llama and 10 PCR-restriction fragment length polymorphism (RFLP) markers revealed a type II allele at the SAG1, SAG2, SAG3, BTUB, GRA6, c22-8, c29-2, PK1 L358, and Apico loci; therefore, this isolate belongs to the ToxoDB PCR-RFLP genotype #1, which is most common in North America and Europe.

Increased mortality in patients with differentiated thyroid cancer associated with Graves' disease.

CONTEXT: We previously reported that differentiated thyroid cancer (DTC) has higher aggressiveness and poorer prognosis in patients with Graves' disease (GD) than DTC in euthyroid control patients. Subsequent studies on this issue reached controversial conclusions. Genetic and environmental factors, as well as the lack of appropriate control subjects and/or inadequate patient follow-up, may account for these discrepancies. OBJECTIVE: The aim of this study was to investigate the long-term disease-specific mortality of nonoccult DTCs occurring in patients with GD compared with DTCs in matched euthyroid control patients. PATIENTS AND DESIGN: The previously described cohorts of nonoccult DTCs occurring in either patients with GD (DTC-GD, n = 21) or matched euthyroid DTC control patients (n = 70) were compared again after a longer follow-up (50-363.6 months; median, 165.6 months) to compare the major clinical endpoints of persistent/recurrent disease and overall survival. Both cohorts were recruited in 1982-1994 at a single institution. All patients had undergone total thyroidectomy and were followed up according to a standardized protocol. RESULTS: Persistent/recurrent disease was more frequent in DTC-GD patients than in control patients (P = .0119). Disease-specific mortality was also significantly higher in DTC-GD patients (6 of 21, 28.6%) than in euthyroid control patients (2 of 70, 2.9%) (P = .0001). At the last visit, the percentage of disease-free patients was 57.1% (12 of 21) in the DTC-GD group vs 87.1% (61 of 70) in the control group (P = .0025). CONCLUSIONS: Nonoccult DTCs occurring in patients with GD cause increased disease-specific mortality compared with DTCs in matched euthyroid control patients. These findings emphasize the need for early diagnosis and aggressive treatment of nonoccult DTCs in patients with GD.

Significance of incidental detection of filariasis on aspiration smears: a case series.

Filariasis is a major public health problem in tropical and subtropical countries including India. Although there are reports of incidentally diagnosed cases of lymphatic filariasis in the existing literature, the significance of this finding needs to be summarised in one place. The association of filariasis with neoplasms is still debatable. For this series, cases diagnosed as filariasis on aspiration cytology (with or without coexistent pathology) over a period of 1 year were retrieved. The cases with a clinical suspicion of filariasis were excluded. Hence, five cases with incidental diagnosis of filariasis on aspiration cytology were included. The site of aspiration included one case each of thyroid, breast, bone marrow, cervical lymph node, and subcutaneous nodule. Of these, three cases showed microfilariae, one showed only adult female worm while one showed both microfilariae and adult worm. Two cases did not show any inflammatory response while three cases showed a variable inflammatory reaction. Only one case (thyroid aspirate) had a coexistent pathology (colloid goitre). Filariasis may be detected in a clinically unsuspected case, especially in an endemic zone. The spectrum of host response may vary from no reaction to a marked inflammatory response. The entire spectrum of changes should be kept in mind while practicing cytopathology in an endemic area. In such situations, a high index of suspicion and careful screening of cytology smears are keys to a correct diagnosis. At the same time, keen search for a coexisting pathology, benign or malignant, is also mandatory.

Primary echinococcal cyst in the thyroid gland: a case report from Iran.

Hydatid disease is prevalent in most sheep-raising countries in Asia , Australia , East, and Southern Europe. Hydatid disease caused by Echinococcus granulosus is often manifested by a slow growing cyst mass. Hydatid cysts may be found in almost every parts of the body. However the lungs and liver are the most involved locations. Due to the vital cycle of the parasite the thyroid gland is an uncommon site of infection even in the countries where the disease is endemic. However, hydatic origin was suspected in only 50% of patients preoperatively and immunologic test had 33% false positive rate. Although hydatid cyst was considered intra-operatively and confirmed by a frozen section histology. This study is to report a case of primary hydatid disease of the thyroid.

[Rare cases of primary hydatid cyst of thyroid gland].

Our experience in surgical treatment of thyroid pathology summarizes the results of 4215 cases of nodular, diffuse, toxic and mixed goiter. In only 4 cases the hydatid cysts of thyroid gland were diagnosed. The lack of clinical data, laboratory and instrumental tests are the main reasons of impossibility of correct preoperative diagnose of such a rare form of the disease. The absence of diagnostic criteria of other thyroid pathology should prompt a surgeon to think about a possibility of a thyroid hydatid cyst.

Microfilariae in thyroid aspiration smear--an unexpected finding.

Lymphatic filariasis is a major health problem in tropical countries including India. Despite its high incidence it is difficult to find microfilariae in blood and fine-needle aspirates due to the nocturnal periodicity of species endemic in India. Lymphatic filariasis can manifest as asymptomatic microfilaremia, hydrocele, lymphangitis, and lymphadenitis. The presence of microfilariae in thyroid aspirates is a rare finding. A case of microfilariae in a thyroid aspirate is being reported to emphasize the significance of careful screening of smears in endemic areas.

Effect of Fasciola gigantica infection on adrenal and thyroid glands of riverine buffaloes.

Effect of Fasciola gigantica infection on adrenal and thyroid glands was investigated using eight male, yearling Murrah buffaloes. The animals were randomly assigned to two groups of four buffaloes each (Group-A, infected; Group-B, non-infected control). Animals of Group-A were orally infected with 1000 F. gigantica viable metacercariae, keeping other four animals of Group-B as uninfected control. In the infected buffaloes, the clinical signs began appearing from 7th week postinfection (p.i.) and eggs were detected in the faeces between day 93 and 99 (95.5+/-1.25) postinfection (p.i.). The serum cortisol level, revealed a significant (P<0.05) rise during initial stage of the infection, followed by a continuous fall from 12th week onward. Peak cortisol level on 10th week (13.30+/-2.57ngml(-1)) was associated with eosinophilia (11.0+/-0.95%). However, non-infected controls maintained almost uniform cortisol levels (3.97+/-0.15-5.88+/-0.09ngml(-1)) throughout the period of the study. The pathological changes of adrenal glands were correlated with physiological dysfunction of the glands. The levels of T(3) and T(4) were significantly (P<0.05-0.01) low from 14th week onward and were synchronous with in situ migration, growth and development of F. gigantica. Significant reduction in the thyroid hormones was further supported by histopathological evidence of lymphocytic thyroiditis confirming hypothyroidism. A decrease in Hb, PCV, total erythrocyte counts and appearance of reticulocytes in the blood of the infected buffaloes suggested regenerative anemia, which could partly be due to hypothyroidism.

Primary hydatid disease in the adrenal gland: a case report

Hydatid cysts may be found in almost any part of the body, but most often they are found in the liver and lungs. Other organs that are occasionally affected include the brain, muscle, kidney, heart, pancreas, and adrenal and thyroid glands. We report a case of hydatid cyst of the adrenal gland.

Primary hydatid disease in the adrenal gland: a case report.

Hydatid cysts may be found in almost any part of the body, but most often they are found in the liver and lungs. Other organs that are occasionally affected include the brain, muscle, kidney, heart, pancreas, and adrenal and thyroid glands. We report a case of hydatid cyst of the adrenal gland.

Subclinical hypothyroidism in a patient affected by advanced AIDS and visceral leishmaniasis.

Hypothyroidism has been shown to occur in HIV disease. Thyroid function of patients affected by AIDS and leishmaniasis is unknown. Here we report the case of an AIDS advanced patient developing hypothyroidism during leishmaniasis. The thyroid disorder might have been caused by infiltration of the gland by Leishmania. An additive impact of HIV in thyroid function impairment is suggested.

A hydatid cyst of the thyroid gland.

Echinococcosis, although eradicated in many countries, is still widespread in communities in which agriculture is dominant, and cystic hydatidosis is a significant public health problem in regions where echinococcosis is endemic. Hydatid cysts may be found in almost any part of the body, but most often in the liver and lungs. Other organs affected occasionally include the brain, muscle, kidney, bone, heart and pancreas. This report documents a rare case with a cystic nodule in the thyroid detected by ultrasonography. The patient was a 40-year-old woman with an euthyroid multinodular goitre. Ultrasonography revealed a cystic nodule, and the ultrasonic appearance of the cyst liquid showed multiple echoes, suggesting that the nodule could be a hydatid cyst. Bilateral subtotal thyroidectomy was performed. Postoperative examination of the nodule showed it to be a solitary primary thyroid hydatid cyst.