RESUMO
BACKGROUND: Malignant peripheral nerve sheath tumors (MPNST) are very rare in the general population and challenging to treat. A paucity of data exists regarding the incidence of MPNST across all age groups and treatment outcomes in the pediatric population. We aimed to characterize both using the Survival, Epidemiology, and End Results (SEER) database. PROCEDURE: The SEER-18 database with information on the United States population from 1973 to 2009 was queried for cases of MPNST. For incidence data, 1,182 cases were found among the general population. Of those, 165 cases were in individuals aged 0-19. After exclusions, 139 cases from the SEER-18 database met study criteria for outcomes analysis. For each patient, variables including gender, age, race, stage (localized, regional, or distant), surgical treatment, and radiotherapy were obtained. RESULTS: The overall incidence of MPNST was 1.46 per million person-years, with increased incidence among the elderly. In the pediatric population, the incidence was 0.56 per million person-years, and was higher among post-pubertal children aged 10-19. Median overall survival in the pediatric population was 30 months, with only localized disease and treatment with surgery being positive prognostic factors on multivariate analysis. CONCLUSIONS: MPNST is a rare disease and, among children, is most frequent seen in adolescents. Surgery is crucial as first-line treatment for MPNST, especially if the tumor is localized at diagnosis. In patients with non-localized MPNST, the disease remains extremely difficult to manage, and both surgery and radiotherapy are interventions that should be considered.
Assuntos
Neoplasias de Bainha Neural/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Genes da Neurofibromatose 1 , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Análise Multivariada , Neoplasias de Bainha Neural/mortalidade , Neoplasias de Bainha Neural/terapia , Modelos de Riscos Proporcionais , Programa de SEERRESUMO
OBJECTIVE: The purpose of this study was to validate whether ex vivo multispectral photoacoustic imaging can be used to differentiate malignant tissue, benign nodules, and normal human thyroid tissue. SUBJECTS AND METHODS: Fifty patients undergoing thyroidectomy because of thyroid lesions participated in this study. Multispectral photoacoustic imaging was performed on surgically excised thyroid tissue, and chromophore images that represented optical absorption of deoxyhemoglobin, oxyhemoglobin, lipid, and water were reconstructed. After the imaging procedure, the pathologist marked malignant tissue, benign nodules, and normal regions on histopathologic slides, and digital images of the marked histopathologic slides were obtained. The histopathologic images were coregistered with chromophore images. Areas corresponding to malignant tissue, benign nodules, and normal tissue were defined on the chromophore images. Pixel values within each area were averaged to determine the mean intensities of deoxyhemoglobin, oxyhemoglobin, lipid, and water. RESULTS: There was a statistically significant difference between malignant and benign nodules with respect to mean intensity of deoxyhemoglobin (p = 0.014). There was a difference between malignant and normal tissue in mean intensity of deoxyhemoglobin (p = 0.003), lipid (p = 0.001), and water (p < 0.0001). A difference between benign nodules and normal tissue was found in mean intensity of oxyhemoglobin (p < 0.0001), lipid (p < 0.0001), and water (p < 0.0001). The sensitivity, specificity, and positive and negative predictive values of the system tested in differentiating malignant from nonmalignant thyroid tissue were 69.2%, 96.9%, 81.8%, and 93.9%. CONCLUSION: The preliminary results of this ex vivo human thyroid study suggest that multispectral photoacoustic imaging can be used to differentiate malignant and benign nodules and normal human thyroid tissue.
Assuntos
Técnicas de Imagem por Elasticidade/métodos , Técnicas Fotoacústicas/métodos , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/cirurgia , Adulto , Idoso , Biomarcadores/metabolismo , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagem Multimodal/métodos , Projetos Piloto , Neoplasias da Glândula Tireoide/metabolismo , Tireoidectomia , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVES: Actionable, solid tumor activating neurotrophic receptor tyrosine kinase (NTRK) fusions are best detected via nucleic acid-based assays, while Pan-TRK immunohistochemistry (IHC) serves as a reasonable screening modality. We describe a practical and cost-effective approach to validate pan-TRK and discuss challenges that may be encountered. METHODS: Pan-TRK Clone EPR17341 was validated in accordance with the 2014 consensus statements set forth by the College of American Pathologists. Confirmation of IHC results were guided by the European Society of Medical Oncology recommendations for standard methods to detect NTRK fusions. RESULTS: Within 36 samples, ETV6-NTRK3 (n = 8) and TPM4-NTRK3 (n = 1) fusions were confirmed. ETV6-NTRK3 fusion positive cases revealed cytoplasmic and nuclear staining. A TPM4-NTRK3 fusion positive high grade malignant peripheral nerve sheath tumor revealed diffuse cytoplasmic staining. A high grade ovarian serous carcinoma revealed focal punctate staining and revealed a non-actionable NTRK1 truncation at intron 2. Diffuse cytoplasmic staining was observed in a case of fusion-negative polymorphous adenocarcinoma. Wild-type expression of TRK in pulmonary meningothelial-like nodules was discovered following a false-positive IHC interpretation. CONCLUSION: Pan-TRK IHC shows some utility as a diagnostic and surrogate marker for NTRK screening however, physiologic or non-specific expression may lead to false-positive results.
Assuntos
Adenocarcinoma , Cistadenocarcinoma Seroso , Humanos , Citoplasma , Imuno-Histoquímica , Íntrons , Receptores Proteína Tirosina QuinasesRESUMO
Here we present the first case of sebaceous carcinoma of the middle ear. We discuss the treatment course and post treatment results after 11 years of follow up. We further summarize the available literature of sebaceous carcinoma of the temporal bone, which prior to this case was exclusively limited to the external auditory canal. Laryngoscope, 134:3769-3772, 2024.
Assuntos
Adenocarcinoma Sebáceo , Neoplasias da Orelha , Orelha Média , Humanos , Neoplasias da Orelha/patologia , Neoplasias da Orelha/cirurgia , Neoplasias da Orelha/diagnóstico , Orelha Média/patologia , Orelha Média/diagnóstico por imagem , Adenocarcinoma Sebáceo/patologia , Adenocarcinoma Sebáceo/diagnóstico , Adenocarcinoma Sebáceo/cirurgia , Neoplasias das Glândulas Sebáceas/patologia , Neoplasias das Glândulas Sebáceas/diagnóstico , Neoplasias das Glândulas Sebáceas/cirurgia , Masculino , Idoso , Feminino , Pessoa de Meia-IdadeRESUMO
Histologically, malignant struma ovarii metastasizes rarely, and only a few cases reported bone metastasis. Here, we describe 2 cases of biologically malignant struma ovarii with pelvic bone metastasis. Case 1 is a 22-year-old female who was found to have a large left ovarian mass during routine prenatal ultrasound. Papillary thyroid cancer arising in struma ovarii was identified after laparoscopic salpingo-oophorectomy. After total thyroidectomy, radioactive iodine whole-body scan revealed extrathyroidal iodine uptake in left anterior pelvis. Subsequent I-131 treatment resolved the pelvic metastasis. Case 2 is a 49-year-old female who was diagnosed with malignant struma ovarii in 1996 and presented in 2007 with pelvic recurrence and extensive left hip metastasis. Treatment with resection of the pelvic tumor, total thyroidectomy, and multiple I-131 ablation led to eventual resolution of the abdominal and left hip foci. In conclusion, we present 2 rare cases of malignant struma ovarii, both with metastasis to the pelvic bone. This report makes pelvic bone the most frequent site for bone metastasis in malignant struma ovarii. It also emphasizes the importance of total thyroidectomy in allowing identification and treatment of bony metastasis with radioactive iodine.
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Neoplasias Ósseas/secundário , Neoplasias Ovarianas/patologia , Ossos Pélvicos/patologia , Estruma Ovariano/patologia , Adulto , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/cirurgia , Feminino , Humanos , Histerectomia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Imagem Multimodal , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/cirurgia , Ovariectomia , Ossos Pélvicos/diagnóstico por imagem , Ossos Pélvicos/cirurgia , Tomografia por Emissão de Pósitrons , Salpingectomia , Estruma Ovariano/diagnóstico , Estruma Ovariano/cirurgia , Tireoidectomia , Tomografia Computadorizada por Raios X , Imagem Corporal Total , Adulto JovemRESUMO
Pituitary carcinomas are rare tumors defined by distant metastasis or cerebrospinal spread. The morphologic features are poorly characterized because only a handful of reports have been described by fine-needle aspiration cytology. We present a case of pituitary carcinoma diagnosed in a 64-year-old male and highlight this rare entity's key cytomorphologic features and differential diagnosis.
Assuntos
Neoplasias Hipofisárias , Masculino , Humanos , Pessoa de Meia-Idade , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/patologia , Metástase Linfática/patologia , Pescoço/patologia , Biópsia por Agulha Fina , Linfonodos/patologiaRESUMO
Ameloblastic carcinoma is a rare malignant neoplasm arising from the odontogenic epithelium. Ameloblastic carcinoma commonly occurs de novo affecting the posterior segments of the mandible. Presently, only less than 100 cases have been reported arising from the maxilla. We report a unique case of maxillary ameloblastic carcinoma in a 68-year-old male with a 5.6â cm positron emission tomography (PET) avid left maxillary sinus mass. The patient underwent a left maxillectomy which revealed hyperchromatic and pleomorphic tumor cells arranged in a nested and trabecular architecture. The tumor cells showed distinct peripheral palisading with reverse polarization. Areas of bone destruction, necrosis, lymphovascular and perineural invasions, as well as atypical mitoses, were identified. Immunohistochemically, the tumor cells were positive for keratin cocktail (AE1/AE3 and CAM 5.2), keratin 19, p40, and weakly positive for MDM2, while negative for calretinin. Molecular analysis revealed wild-type BRAF; however, alterations in CDKN2A/B, MTAP, RB1, SMARCA4, STK11, FGF12, SETD2, and TP53 were present. This histopathologic and molecular profile supported the diagnosis of ameloblastic carcinoma. There has been no evidence of disease recurrence or metastasis eleven months after the initial diagnosis.
Assuntos
Ameloblastoma , Carcinoma , Tumores Odontogênicos , Masculino , Humanos , Idoso , Maxila/patologia , Tumores Odontogênicos/diagnóstico por imagem , Tumores Odontogênicos/cirurgia , Mandíbula/patologia , Ameloblastoma/diagnóstico , Ameloblastoma/cirurgia , Ameloblastoma/patologia , DNA Helicases , Proteínas Nucleares , Fatores de Transcrição , Fatores de Crescimento de FibroblastosRESUMO
CASE PRESENTATION: A 73-year-old frail woman presented with 3 months of progressively worsening exertional dyspnea, mild cough with white mucus, voice changes, and few episodes of dysphagia. She denied weight loss, night sweats, chest pain, or hemoptysis. Medical history was significant for hypertension, remote 30 years of tobacco use, and regular alcohol use. She had neither asbestos nor occupational exposure. She had no family history of malignancy.
Assuntos
Dispneia , Tórax , Idoso , Dor no Peito , Tosse/diagnóstico , Tosse/etiologia , Diagnóstico Diferencial , Dispneia/diagnóstico , Dispneia/etiologia , Feminino , HumanosRESUMO
Acinic cell carcinoma (AciCC) may pose a diagnostic challenge, particularly on small biopsies and fine needle aspiration (FNA) because of its variable histology including potential high-grade transformation and its mimickers. Immunoreactivity with circumferential membranous staining for DOG1 can support the diagnosis of AciCC but is not entirely specific. A novel rearrangement t(4;9)(q13;q31) leading to up-regulation of nuclear receptor subfamily 4 group A member 3 (NR4A3) has been described in AciCC, is potentially detectable by fluorescence in situ hybridization (FISH) and may be useful in the evaluation for AciCC. Using NR4A3 Dual Color Break Apart Probe (ZytoVision, Germany) FISH was performed on AciCCs from 3 large academic institutions. NR4A3 rearrangement was defined as positive signal patterns in 15% of tissue interphase nuclei. Fifty-two AciCCs including 47 resections and 5 FNAs (including 5 paired FNA/resections) were analyzed. Five non-AciCC salivary gland tumors and 2 sialadenitis cases were used as controls. Eight AciCCs (15%; 8/52) failed FISH testing. FISH was positive in 23 AciCCs (sensitivity 59%, 23/39) with 100% concordance between 5 matched resection/FNAs (3 were positive for FISH and 2 were negative). FISH was negative in all non-AciCCs (specificity: 100%, 0/7). NR4A3 FISH has a sensitivity of 59% and specificity of 100% in detecting AciCC, which suggests that NR4A3 rearrangement-driven up-regulation is a recurrent, specific oncogenic event in AciCC, consistent with prior results. Hundred percent concordance between matched FNA/resection samples validates its potential utility on cytology samples.
Assuntos
Carcinoma de Células Acinares , Receptores de Esteroides , Neoplasias das Glândulas Salivares , Biópsia por Agulha Fina , Carcinoma de Células Acinares/diagnóstico , Carcinoma de Células Acinares/genética , Carcinoma de Células Acinares/cirurgia , Aberrações Cromossômicas , Proteínas de Ligação a DNA/genética , Humanos , Hibridização in Situ Fluorescente/métodos , Receptores de Esteroides/genética , Receptores dos Hormônios Tireóideos/genética , Neoplasias das Glândulas Salivares/patologiaRESUMO
PURPOSE: In a combined retrospective and prospective study, human salivary glands were investigated after radiation treatment for head and neck cancers. The aim was to assess acinar cell loss and morphologic changes after radiation therapy and to determine whether irradiated salivary glands have regenerative potential. METHODS AND MATERIALS: Irradiated human submandibular and parotid salivary glands were collected from 16 patients at a range of time intervals after completion of radiation therapy (RT). Control samples were collected from 14 patients who had not received radiation treatments. Tissue sections were analyzed using immunohistochemistry to stain for molecular markers. RESULTS: Human submandibular and parotid glands isolated less than 1 year after RT showed a near complete loss of acinar cells. However, acinar units expressing functional secretory markers were observed in all samples isolated at later intervals after RT. Significantly lower acinar cell numbers and increased fibrosis were found in glands treated with combined radiation and chemotherapy, in comparison to glands treated with RT alone. Irradiated samples showed increased staining for duct cell keratin markers, as well as many cells coexpressing acinar- and duct cell-specific markers, in comparison to nonirradiated control samples. CONCLUSIONS: After RT, acinar cell clusters are maintained in human submandibular glands for years. The surviving acinar cells retain proliferative potential, although significant regeneration does not occur. Persistent DNA damage, increased fibrosis, and altered cell identity suggest mechanisms that may impair regeneration.
Assuntos
Células Acinares/efeitos da radiação , Neoplasias de Cabeça e Pescoço/radioterapia , Glândula Submandibular/efeitos da radiação , Células Acinares/patologia , Plasticidade Celular , Proliferação de Células/efeitos da radiação , Quimiorradioterapia/efeitos adversos , Dano ao DNA , Humanos , Estudos Prospectivos , Radioterapia/efeitos adversos , Dosagem Radioterapêutica , Estudos Retrospectivos , Glândula Submandibular/efeitos dos fármacos , Glândula Submandibular/patologia , Vimentina/análiseAssuntos
Oxigenação por Membrana Extracorpórea/métodos , Insuficiência Cardíaca/terapia , Transplante de Coração/efeitos adversos , Coração Auxiliar , Edema Pulmonar/etiologia , Edema Pulmonar/terapia , Terapia Combinada , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Transplante de Coração/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Prognóstico , Edema Pulmonar/patologia , Respiração Artificial/métodos , Medição de Risco , Tetralogia de Fallot/diagnóstico , Tetralogia de Fallot/cirurgia , Traqueostomia/métodosRESUMO
BACKGROUND: Patients with cirrhosis develop ascites for physiologic reasons that are unrelated to malignant progression. However, physicians performing paracentesis in these patients, often send fluid to the cytology laboratory, sometimes specifically looking for hepatocellular carcinoma (HCC). We have investigated the diagnostic yield of these specimens. MATERIALS AND METHODS: A computerized pathology database search for all ascites fluid cases submitted to the cytology laboratory at a major liver transplant center between November 2004 and April 2008 was performed. Clinical history was obtained for each case. Patients with cirrhosis, with or without HCC, were included in the study. Cytologic diagnoses were compiled and follow-up information was obtained for cases with non-negative findings. RESULTS: A total of 167 specimens from 133 patients ranging from 29 to 85 years of age (mean 56 years) were submitted over the said time period. The causes of cirrhosis included: alcohol - 44; Hepatitis C - 30; Hepatitis B - 6; non-alcoholic steatohepatitis - 7; cryptogenic - 18; other single causes - 6; and multifactorial (alcohol and hepatitis viruses) - 22. Hepatocellular carcinoma (HCC) was present or strongly suspected in 17 patients and had been previously resected in two others. The status of fifteen patients was post liver transplant, with recurrent liver failure. Human immunodeficiency virus was present in seven patients and eight patients had a history of non hepatic malignancies. Among the specimens, 162 were negative, two had atypical lymphocytes worked up for lymphoma, and three had atypical epithelioid cells; none was positive for HCC. Immunohistochemistry demonstrated a mesothelial origin for the atypical epithelioid cells in two cases; in the third case, the patient died shortly after the specimen was collected, with no radiological evidence of HCC. CONCLUSION: Ascites fluid cytology specimens in patients with cirrhosis, even those known or suspected to have HCC, are almost always negative. Atypical cells seen in such specimens should be treated with skepticism since the likelihood that they represent peritoneal spread of HCC is low..
RESUMO
Second primary cancers are approximately 2.1-2.8 times more common in survivors of bone marrow transplant than in the age-matched general population. We describe a patient who developed high-grade sarcoma in two disparate sites that were clinically involved by chronic cutaneous graft versus host disease (GVHD). This occurred 3.5 years after bone marrow transplant for acute myelogenous leukemia (AML). This suggests that malignant sarcomas may develop in the setting of chronic GVHD, and close surveillance of GVHD-related nodules is warranted.
Assuntos
Transplante de Medula Óssea/efeitos adversos , Doença Enxerto-Hospedeiro/complicações , Leucemia Mieloide Aguda/cirurgia , Segunda Neoplasia Primária , Sarcoma/etiologia , Dermatopatias/complicações , Neoplasias de Tecidos Moles/etiologia , Adulto , Biópsia por Agulha Fina , Quimioterapia Adjuvante , Doença Crônica , Doença Enxerto-Hospedeiro/etiologia , Doença Enxerto-Hospedeiro/patologia , Humanos , Masculino , Terapia Neoadjuvante , Radioterapia Adjuvante , Sarcoma/patologia , Sarcoma/cirurgia , Sarcoma/terapia , Dermatopatias/etiologia , Dermatopatias/patologia , Neoplasias de Tecidos Moles/patologia , Neoplasias de Tecidos Moles/terapia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Transplante Homólogo , Resultado do TratamentoRESUMO
OBJECTIVE: The aim of the study was to analyze the sonographic features of nodular Hashimoto thyroiditis (HT) in patients with diffuse background thyroiditis and normal background thyroid parenchyma. SUBJECTS AND METHODS: Eighty-six patients who had fine-needle aspiration biopsy of 100 thyroid nodules confirmed to be HT and a thyroid ultrasound within 1 year of the biopsy were included in the study. Retrospective analysis of several sonographic features of each nodule was then performed. RESULTS: The mean age of patients with nodular HT was 53 years, 84% of which were female. Nodular HT occurred in a background of diffuse thyroiditis in 85% and in a homogeneous normal background in 15%. Ninety-three percent of nodules were completely solid and 7% of nodules were cystic and solid. Although the sonographic appearance of nodular HT was variable, the most common appearance was a solid (93/100) and hypoechoic nodule (44/100) with a thin hypoechoic halo (42/100) without calcifications (96/100). On color Doppler, 17% of nodules showed peripheral hypervascularity, 14% of nodules were diffusely hypervascular, 34% were iso vascular, 32% were hypovascular, and 3% were avascular. The sonographic appearance of nodular HT was not significantly different in patients with diffuse background thyroiditis compared with those without background thyroiditis. CONCLUSIONS: The sonographic appearance of nodular HT is variable, but the most common appearance is a solid sharply circumscribed hypoechoic nodule with thin hypoechoic halo without calcification. There was no significant difference in the appearance of nodular HT in patients with diffuse background thyroiditis compared with patients with normal background thyroid parenchyma.
Assuntos
Doença de Hashimoto/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico por imagem , Ultrassonografia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Glândula Tireoide/diagnóstico por imagemRESUMO
Ectopic breast tissue has been described rarely in the vulva and is known to develop a variety of pathologic changes. Our review of the literature found a total of 11 reported cases of primary infiltrating ductal adenocarcinoma arising in ectopic breast tissue of the vulva. We report what we believe is the first case of primary mucinous adenocarcinoma arising in ectopic breast tissue of the vulva diagnosed by characteristic histopathologic features and immunohistochemical stain results. We discuss the criteria used in diagnosis of primary breast carcinoma of the vulva and review previously reported cases.
Assuntos
Adenocarcinoma Mucinoso/patologia , Neoplasias da Mama/patologia , Mama , Coristoma/patologia , Neoplasias Vulvares/patologia , Adenocarcinoma Mucinoso/metabolismo , Adenocarcinoma Mucinoso/cirurgia , Biomarcadores Tumorais/metabolismo , Neoplasias da Mama/metabolismo , Neoplasias da Mama/cirurgia , Coristoma/metabolismo , Coristoma/cirurgia , Feminino , Humanos , Imuno-Histoquímica , Pessoa de Meia-Idade , Resultado do Tratamento , Neoplasias Vulvares/metabolismo , Neoplasias Vulvares/cirurgiaRESUMO
OBJECTIVE: The purpose of our study was to test the hypothesis that synovitis on magnetic resonance imaging (MRI) and ultrasound (US) observed in patients with rheumatoid arthritis (RA) who meet remission criteria reflects active inflammation on histopathology. METHODS: We analyzed 15 synovial specimens obtained during surgical procedures from 14 patients with RA in clinical remission as defined by the American College of Rheumatology criteria. Histological specimens were scored for hyperplasia of synovial lining and synovial stroma, inflammation, lymphoid follicles, and vascularity. The histology scores were classified as minimal, mild, moderate, or severe disease activity. US and MRI performed within a 4-month period of surgery were scored for disease activity. The correlation between histology and imaging scores was examined. RESULTS: Four of 14 patients were receiving anti-tumor necrosis factor (TNF) therapy, 4 were receiving methotrexate (MTX) alone, 4 were taking MTX and hydroxychloroquine (HCQ), and 1 was taking HCQ and sulfasalazine. Four specimens had severe, 6 moderate, 3 mild, and 2 minimal disease activity on histology. Three of 4 specimens with minimal and mild histology were observed in subjects receiving anti-TNF therapy. Synovitis was noted on greyscale in 80% of joints and Doppler signal in 60%. MRI demonstrated synovitis and bone marrow edema in 86% of images. Positive but not significant correlations were noted between histology and synovitis scores on US. CONCLUSION: Despite clinical remission, histology and imaging studies documented a persistently active disease state that may explain the mechanism for radiographic progression.
Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/diagnóstico , Imagem Multimodal/métodos , Sinovite/diagnóstico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Idoso , Artrite Reumatoide/tratamento farmacológico , Biópsia por Agulha , Estudos de Coortes , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Indução de Remissão , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Sinovite/tratamento farmacológico , Fatores de Tempo , Resultado do Tratamento , Fator de Necrose Tumoral alfa/administração & dosagem , Ultrassonografia Doppler/métodosRESUMO
The thyroid gland is one of the largest endocrine glands in the human body. It functions as a regulator of metabolism. Diseases involving the thyroid range from benign to malignant and can be associated with major morbidity and mortality. Ultrasound (US) imaging of the thyroid gland is prompted because of a palpable mass on clinical examination; abnormality of thyroid function tests; incidental finding on other imaging modalities, that is, nuclear scintigraphy or computed tomography scan; screening for patients with risk factors for malignancy, such as multiple endocrine neoplasia type II; or prior neck radiation treatment.Ultrasound is an excellent, noninvasive, and cost-effective diagnostic tool in the detection and characterization of thyroid disease. Most thyroid diseases have pathognomonic features on US, which are of diagnostic importance and lead to appropriate clinical management. Ultrasound plays an important role in differentiating benign from malignant thyroid disease, thereby triaging patients for US-guided fine-needle aspiration. Ultimately, thyroid US, in conjunction with thyroid function tests, can aid in characterizing various thyroid diseases.The main objective of this pictorial essay is to illustrate the sonographic appearance of various benign and malignant diseases of the thyroid with their histopathology correlations. Management of thyroid nodules using US-guided fine-needle aspiration is also briefly discussed.
Assuntos
Aumento da Imagem/métodos , Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico por imagem , Ultrassonografia/métodos , Diagnóstico Diferencial , HumanosRESUMO
Metastases to the thyroid gland are uncommon. We present the sonographic features of metastatic breast adenocarcinoma to the thyroid in a 67-year-old woman. The lesion measured up to 0.9 cm in diameter, contained an echogenic focus with associated ring-down, and was predominantly cystic, thereby resembling a benign nodule. Because of the patient's history of breast adenocarcinoma, the nodule nevertheless underwent fine-needle aspiration. The unusual appearance of the thyroid nodule underscores the importance of considering patient history in deciding whether obtaining tissue diagnosis of thyroid nodules is warranted.
Assuntos
Adenocarcinoma/diagnóstico , Adenocarcinoma/secundário , Neoplasias da Mama/diagnóstico , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/secundário , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodos , Idoso , Diagnóstico Diferencial , Feminino , HumanosRESUMO
OBJECTIVE: The purpose of this study is to determine if crawling wave elastography, a novel sonoelastography technique, can be used to provide quantitative measurements of thyroid tissue shear velocity (a measure of tissue stiffness) and distinguish between benign and malignant thyroid nodules. STUDY DESIGN: Diagnostic test assessment. SETTING: Academic university. SUBJECTS AND METHODS: Fresh thyroid specimens (n = 20) with 44 regions of interest were imaged ex vivo with crawling wave sonoelastography over a 9-month period in 2010 at a single institution. Using the sonoelastography technique, shear velocity estimations and contrast-to-noise ratios were calculated. The higher the shear velocity (SV) and contrast-to-noise ratio (CNR), the greater the tissue stiffness. Histological diagnosis was correlated with shear velocity and contrast-to-noise ratio values. RESULTS: Both the shear velocity and contrast-to-noise values of papillary thyroid carcinoma (n = 10, CNR = 5.29, SV = 2.45 m/s) were significantly higher than benign nodules (n = 22, CNR = -0.41, SV = 1.90 m/s). There is a maximum sensitivity and specificity of 100% and 90.9%, respectively, for differentiating papillary thyroid carcinoma from benign nodules using contrast-to-noise ratio values. There is a maximum sensitivity and specificity of 83.3% and 72.7%, respectively, for differentiating papillary thyroid carcinoma from benign nodules using shear velocity values. Insufficient samples were obtained for comparison with other histological types. CONCLUSION: Crawling wave sonoelastography can provide quantitative estimations of shear velocity, thereby depicting the elastic properties of thyroid nodules. The shear velocity and contrast-to-noise ratio can differentiate between benign thyroid nodules and papillary thyroid carcinoma with high specificity and sensitivity.