Static pulmonary nodules from thyroid malignancy.

Papillary carcinoma of thyroid tends to be indolent. This is an unusual case of papillary carcinoma of thyroid with asymptomatic pulmonary metastasis for more than a decade, finally presenting with mild respiratory symptoms in a 21-year-old female. Fine needle aspiration and cytology (FNA-C) of a nodule in the lungs revealed features consistent with a papillary carcinoma of thyroid. Confirmed on thyroidectomy specimen. She subsequently received Iodine-131 (I131). A follow-up radio-iodide scan, 48 hours after, revealed diffuse uptake within the lung parenchyma. With static nodular shadowing on radiograph, a metastatic origin, in particular that of the thyroid, should be considered. I131 scintigraphy can help support the diagnosis of carcinoma of thyroid.

Renal involvement in systemic lupus erythematosus in Pakistan.

OBJECTIVE: To find the prevalence of lupus nephritis, delineate its clinical, immunological and therapeutic characteristics and compare them with the data worldwide. PATIENTS AND METHODS: Between 1985 and 2001, 198 patients with SLE fulfilling the clinical and laboratory criteria of the American Rheumatism Association (ARA) admitted to the hospital were studied by means of a retrospective review of their records. RESULTS: Renal involvement was found in 89 (45%) patients. Biopsy showed lupus nephritis in 42 patients; there were 9 male and 33 females. Mean age at initial presentation was 27 years and mean duration of follow-up was 2 .3 years. The histological types (WHO Classification) were mainly class. 4 (n = 27), class 3 (n = 7) and class 5 (n = 6). Immunoflourescence showed a predominantly granular pattern of IgG, IgA and C3. Renal manifestations included renal failure (50%), microscopic hematuria (67%), active urine sediment (22%), and proteinuria (74%). Proteinuria was nephrotic range in 45% patients. Treatment was with combinations of prednisolone and cyclophosphamide (n = 13), prednisolone and azathioprine (n = 27). 19 patients received high dose methyl prednisolone (1 gm/day for 3 days). There was no difference in mortality rate between prednisolone and cyclophosphamide and prednisolone and azathioprine treatment groups. The overall mortality rate was 17% (n = 7). Mortality was higher in WHO class 4 and 5 as compared to class 2 and 3 (p < 0.001). CONCLUSION: The prevalence of lupus nephritis in our population is an intermediate between Caucasians and other Asians. Certain clinical characteristics in our patients with lupus nephritis are different as compared to various other studies. Because of limited resources for treatment in developing countries, we believe that patients with lupus nephritis should be treated with improved ancillary medical therapies and more effective immunosuppressive regimens.