Comparison of 21 and 27 gauge needles for determining sample adequacy in the aspiration biopsy of thyroid nodules.

PURPOSE: To compare 21 and 27 gauge (G) needles used for fine-needle aspiration (FNA) of thyroid nodules to obtain better specimens for adequacy and cytological diagnosis. MATERIALS AND METHODS: One hundred patients with thyroid nodules (100 nodules) were included in this study. Each nodule was aspirated with both 27 G and 21 G needles. The obtained aspirates were classified as adequate and inadequate by two separate cytopathologists. The results were analyzed by appropriate statistical methods. RESULTS: There was no statistically significant difference between 21 G and 27 G needles in terms of adequacy, according to each pathologist (P > 0.05). After pathological evaluation with consensus, the adequacy prevalence was the same (84%) for both needle types in all study populations (P > 0.05). According to the ultrasound characteristics of nodules, the prevalence of inadequate samples in patients with hypoechoic or heterogeneous nodules was significantly higher compared with the prevalence of inadequate samples in patients with isoechoic or hyperechoic nodules for both types of needles (P < 0.05). However, according to the size of the needles, there was no significant difference between hypoechoic and heterogeneous nodules or between isoechoic and hyperechoic nodules with regard to the ability to yield adequate samples (P > 0.05). CONCLUSION: The results of our study showed that FNA with 27 G needles can aspirate adequate material for cytopathological diagnosis. The probability of inadequate sample aspiration of hypoechoic and heterogeneous nodules is higher than that for other nodule types.

Ultrasonographic evaluation of thyroid nodules: comparison of ultrasonographic, cytological, and histopathological findings.

Thyroid ultrasonography (US) and fine needle aspiration biopsy (FNAB) are the most important tools in evaluating thyroid nodules. A total of 3,404 nodules in 2,082 cases referred to our clinic between 2005 and 2008 were analyzed retrospectively. Considering US features of nodules, risk factors predicting malignancy were: margin irregularity as the most important predictor, hypoechoic pattern and microcalcification (Odds ratios: 63.2, 13.3, 7.03, respectively). Cytologic results of the patients were as follows: 1,718 (82.5%) benign, 196 (9.4%) suspicious, 68 (3.3%) nondiagnostic, and 100 (4.8%) malignant. In histopathologic examination, we determined a malignancy rate of 7.59% (158/2082). We calculated the sensitivity of FNAB as 89.16%, specificity as 98.77%, positive predictive value as 96.10%, negative predictive value as 96.39%, and accuracy as 96.32%. In cytologic examination, the malignancy rate of subcentimetric (≤1 cm) nodules was higher than supracentimetric (>1 cm) nodules (5.1% vs. 1.5%, P = 0.001). In postoperative histopathologic examination, although the malignancy rate of subcentimetric nodules was higher than that of supracentimetric nodules, the difference was statistically insignificant (5.5%, 4.4%, respectively; P > 0.05). Cytologically diagnosed malignancy was detected in 4.5% of patients with multiple nodules, while it was present in 6% of patients with solitary nodule indicating no significant difference. However, postoperative histopathologic examination revealed a significantly higher malignancy rate in patients with solitary nodule compared to in patients with multiple nodules (11.7%, 6.5%; respectively, P < 0.001). The malignancy rate of patients operated for suspicious cytology was found to be 46.15%; for nondiagnostic cytology, it was 64.29%. In conclusion, ultrasonographically, hypoechoic pattern, microcalcification and margin irregularity of thyroid nodules are important features in determining the malignancy risk. The nodule size alone still remains inadequate to exclude malignancy risk.

Evaluation of the immunohistochemical stain patterns of survivin, Bak and Bag-1 in colorectal cancers and comparison with polyps situated in the colon.

BACKGROUND/AIMS: Colorectal cancer is one of the most common cancers worldwide. The adenoma-carcinoma sequence in colorectal cancer has been documented approximately; however, several series of molecular mechanisms still require elucidation. METHODOLOGY: Fifteen colonoscopic biopsy and 25 colectomy colorectal cancer samples, 12 hyperplastic colon polyps, and 18 tubular and 19 villous adenoma cases were studied. Apoptotic markers, such as Bag-1, survivin, and Bak, were used for staining, and relationships between stain features, clinical and prognostic factors, and polyp and tumor staining features were examined. RESULTS: Significantly different staining patterns were observed between polyps and carcinomas. In tumor cells cytoplasmic Bag-1 expression was increased. As tumor differentiation degree tumor decreased, supranuclear granular staining features of Bcl-xl and Bak disappeared at a higher rate. With Bak, decrease of supranuclear granular staining was also related to vessel and nerve invasion, and tumor location. Survivin was expressed mostly in tumor cells, and sites with high inflammatory infiltration and vessel proliferation, where vessel endothelia were selectively stained. CONCLUSIONS: Cytoplasmic staining of Bag-1 can be considered an indicator of tumor progression. Decrease of supranuclear granular staining with Bak and Bcl-xl, and survivin expression, can be used as indicators of poor prognosis. Survivin expression can also be used as a vessel marker.

An unusual auricular malformation accompanied by accessory tragus: macrotragus.

Definition of malformations of the tragus is important for terminology and treatment. Most common entities are the skin tag, accessory tragus, preauricular sinus, and cyst, whereas macrotragus is an uncommon and unaddressed deformity that should be distinguished from these. In this report, three cases with diagnosis of the macrotragus are presented. The tragus was uniformly large and displaced anteriorly, and external auditory meatus was not obliterated in all cases. For correction, excision of the excess tragal cartilage and skin was performed. In all cases, bilaterally symmetric tragus was achieved. There were no complications in the early postoperative period and there was no enlargement after 6months of observation. Macrotragus and accessory tragus are different entities that should be distinguished for accurate diagnosis. They have similar histopathological but distinct anatomical characteristics. Although both are treated by a simple excision, in the case of macrotragus, special effort should be taken to leave enough cartilage to restore normal tragal contours.

Multiple subcutaneous nodular metastases from transitional cell carcinoma of the bladder.

Skin metastasis from transitional cell carcinoma (TCC) of the bladder is rare. In this report an uncommon metastasis of TCC of the bladder is presented.

Two successive pregnancies after ursodeoxycholic acid therapy in a previously infertile woman with antimitochondrial antibody-negative primary biliary cirrhosis.

OBJECTIVE: To describe the benefit of ursodeoxycholic acid (UDCA) for the initiation and completion of a successful pregnancy in a previously infertile woman with primary biliary cirrhosis. DESIGN: Case report. SETTING: A university hospital with relevant departments. PATIENT(S): A 29-year-old woman with primary biliary cirrhosis and failure to conceive for 6 years. INTERVENTION(S): Establishment of diagnosis with a liver biopsy, pretreatment of patient with UDCA before conception, and continuation of UDCA after first trimester until term. UDCA was used in the second pregnancy again after the first trimester. MAIN OUTCOME MEASURE(S): Achievement of a safe conception and full-term pregnancy. RESULT(S): Two consecutive successful pregnancies, a healthy 3,250-g male infant and a healthy 3,000-g female infant. The second conception occurred in a period without the use of UDCA, implicating a latent beneficial effect of either UDCA or the previous pregnancy via some possible immune mechanism. CONCLUSION(S): Ursodeoxycholic acid could help achieve conception in infertile women with primary biliary cirrhosis. The use of UDCA after the first trimester is shown to be safe in two consecutive pregnancies. Although it cannot be conclusive, the unintentional use of UDCA in the first 20 days after conception did not result in any teratogenicity in the first child.

Cholesterol granuloma of the maxillary sinus.

Cholesterol granuloma is usually associated with middle ear disease and is very rare in the paranasal sinuses. We report a case of cholesterol granuloma originating in the maxillary sinus of a 36-year-old female. Endoscopic sinus surgery was performed on the left maxillary, sinus, and the cholesterol granuloma was successfully removed by the middle meatal antrostomy.

Gastric pseudolipomatosis, usual or unusual? Re-evaluation of 909 endoscopic gastric biopsies.

Microvesicular pneumatosis intestinalis, also called "pseudolipomatosis" for resembling fatty infiltration, is characterized by the presence of small gas voids in the gastrointestinal wall, especially in mucosa. These voids are not lined with epithelia. There are few reported cases about colon, duodenum and skin. Because there is only one case report about pseudolipomatosis in the stomach, we re-evaluated 909 endoscopic biopsies taken from gastric corpus to check the presence of pseudolipomatosis. We determined pseudolipomatosis foci in 3 percent (n=27) of biopsies. In two cases there were pseudolipomatosis foci in endoscopic biopsies having otherwise normal histologic findings, while there were pseudolipomatosis foci in endoscopic biopsies of 25 patients with gastritis. H pylori was found in 85% of biopsies having pseudolipomatosis foci. In this study, we presented some histopathologic characteristics of pseudolipomatosis seen in gastric mucosa.

Micropneumatosis coexistent with Helicobacter pylori and its improvement.

Micropneumatosis intestinalis is the occurrence of gas-filled circular voids with diameter of 20-200 microns, not lined with epithelium. We report a 39-year-old man with superficial gastritis and Helicobacter pylori infection who also had gastric, duodenal and colonic micropneumatosis. Endoscopic biopsy after treatment for H. pylori gastritis showed no micropneumatosis in gastric, duodenal or colonic mucosal sections. We suggest that H. pylori may be one of the causative factors for micropneumatosis.

Papillary carcinoma of the thyroglossal duct cyst in childhood.

Thyroglossal duct carcinoma is a rare malignancy that is usually diagnosed postoperatively. Approximately 150 cases have been reported in the literature. Eighty-five percent of these were papillary carcinomas. Controversies exist concerning its nature and treatment. In this report, we present an 11-year-old boy with an anterior cervical cystic mass originating in the thyroglossal duct. After a primary Sistrunk procedure, the cyst and tract extending to the foramen caecum at the base of the tongue in continuity with the midportion of the hyoid bone were resected. Histopathologic study demonstrated a papillary carcinoma. After 4 months of follow-up, the patient is asymptomatic without any evidence of recurrence. The clinical and histopathological features and therapeutic options are discussed.

Large pedinculated antral hyperplastic gastric polyp traversed the bulbus causing outlet obstruction and iron deficiency anemia: endoscopic removal.

We present here a large (3 cm) hyperplastic gastric polyp prolapsed into duodenum and caused outlet obstruction and iron deficiency anemia in 60 years old male patient. Endoscopic removal was performed successfully.

General features of gastric carcinomas and comparison of HSP70 and NK cell immunoreactivity with prognostic factors.

During the period of 1996-1998 ninety-four gastrectomy specimens with gastric carcinoma referred to Erciyes University, Medical Faculty, Department of Pathology, were examined histopathologically, histochemically and immunohistochemically. General characteristics of gastric carcinomas and prognostic factors were studied. According the Lauren classification, of the 94 cases of gastric carcinomas, 56 were intestinal type, 21 were diffuse type and 17 were mixed type carcinoma. The association rates of Helicobacter pylori, chronic atrophic gastritis and intestinal metaplasia with gastric carcinomas were high. There was strong immunorectivity with HSP70 in 62,5% of the intestinal type carcinomas. This ratios were lower in diffuse and mixed type carcinomas (p<0.05). The more tumor size and invasion depth increased, the more HSP70 immunoreactivity was obtained (p<0.05). HSP70 immunorectivity was considerably higher in the patients having lymph node metastasis and vascular invasion (p<0.05). It was found that the NK cell number was low in the tumor but higher around the tumor in early gastric carcinomas, compared with advanced carcinomas (p>0.05). In the tumors larger than 10 cm with vascular invasion, NK cell number was lower around the tumor (p>0.05). Defining prognostic factors of gastric carcinomas is of importance to clinicians. It is thought that HSP70 immunoreactivity, besides invasion depth, lymph node metastasis, vascular invasion, tumor size and inflammatory reaction against the tumor, is important in prognosis and associated with advanced stage.