Diagnostic cytological features and differential diagnosis of subacute granulomatous (De Quervain's) thyroiditis.

BACKGROUND: The aims of the study are to identify the diagnostic cytological features of subacute granulomatous thyroiditis (SGT), to compare our results with previous literature studies, and to investigate the cytological changes in SGT that mimic other thyroid lesions. METHODS: This retrospective study was conducted with 69 cases. The cytology slides were re-evaluated. The diagnostic cytomorphological features of the disease were identified. The results were compared with the literature. Differential diagnosis of the disease is discussed with the results obtained. RESULTS: The diagnostic cytological features consisted of lymphocytes, multinucleated giant cells, loose epithelioid histiocyte groups, granulomas, isolated epithelioid histiocytes, colloid, and neutrophil leukocytes. The highest degree of concordance between our results and the published literature was the presence of giant cells while the lowest was for microfollicles. Some reactive cytological features of SGT were similar to other benign or malignant diseases of the thyroid. CONCLUSION: SGT is a rare and self-limiting disease. Cytological features are not specific. The diagnosis should be confirmed by clinical and laboratory results. Reactive atypia in the early phase of the disease and microfollicles in the late phase may lead to a false cytological diagnosis, thus resulting in unnecessary resection. To prevent such misdiagnoses, cytopathologists should be aware of the reactive cytological changes in this disorder.

Should pancreas cyst fluids be divided into two for cytological diagnosis and biochemical tests?

BACKGROUND/AIMS: The aim of the present study was to investigate whether pancreas cyst fluids should be divided into two for cytological diagnosis and biochemical tests. MATERIALS AND METHODS: The present study was conducted with fluids aspirated from 12 pancreas cysts. The fluids were divided into two and sent to the cytopathology (fluid 1) and biochemistry (fluid 2) laboratories. Fluid 1 was centrifuged at the cytopathology laboratory. Cytology slides were prepared from the deposit, and the supernatant was sent to the biochemistry laboratory. Fluid 2 was centrifuged at the biochemistry laboratory, and amylase, carcinoembryonic antigen, and cancer antigen 19.9 levels were determined in the supernatant. These procedures were repeated for fluid 1 from the cytopathology laboratory. The remaining fluid 2 was sent to the cytopathology laboratory. Fluid 1-like slides were prepared from fluid 2 in the cytopathology laboratory. Cytological diagnoses of fluid 1 and fluid 2 were compared, and the Pearson correlation coefficient for biochemical test results was identified. RESULTS: 92% of fluid 1 and 50% of fluid 2 were diagnostic. Biochemical test results of fluid 1 and fluid 2 were similar, and the Pearson correlation coefficient was high. CONCLUSION: Our results showed that pancreatic cyst fluids did not need to be divided into two for cytological diagnosis and biochemical tests. Following centrifugation of the whole fluid at the cytopathology laboratory, the deposit and the supernatant can be used for cytological diagnosis and for biochemical tests, respectively. With this protocol, the sensitivity of cytological diagnoses and biochemical tests of pancreatic cyst fluids may increase.

Comparison of muscle-to-nodule and parenchyma-to-nodule strain ratios in the differentiation of benign and malignant thyroid nodules: which one should we use?

OBJECTIVE: The aim of this study is to investigate the diagnostic accuracy of muscle-to-nodule strain ratio (MNSR) in the differentiation of benign and malignant thyroid nodules and to see if there was a difference between MNSR and parenchyma-to-nodule strain ratios (PNSR) in diagnosis. METHODS: A total of 106 consecutive patients (88 women and 18 men; age range 19-79 years) with thyroid nodules were prospectively examined using ultrasound and sonoelastography before the fine-needle aspiration biopsy. The mean MNSR and PNSR were calculated for each nodule and the elasticity score was determined according to four-point scoring system. RESULTS: According to the four-point scoring system, 44 of the 83 benign nodules had a score of one or two while 22 of the 23 malignant nodules had a score of three or four (p<0.001). Using ROC analysis, the best cutoff point for MNSR 1.85 and for PNSR 3.14 was calculated. The sensitivity and specificity for the MNSR were 95.6%, 92.8%, respectively; for the PNSR were 95.6%, 93.4%, respectively, when the best cutoff points were used (p<0.001). The κ value for the PNSR and MNSR methods was 0.87, which indicated an almost perfect agreement (p<0.001). CONCLUSIONS: Sonoelastography has a high diagnostic accuracy in the differentiation of benign and malignant thyroid nodules. There was no significant difference between MNSR and PNSR in the differentiation of benign and malignant thyroid nodules. Therefore, we think that MNSR could safely be used in situations where PNSR could not be used.

Clinical, histopathological and mineralogical analysis findings of an unusual case of pneumoconiosis.

A 43-year-old man with a long history of dyspnea which had progressively worsened over the preceding month is presented. He had worked in an antimony mine for 3 years. Radiologically, there were diffuse reticulonodular shadowing opacities in both lung parenchymas. Histopathologic examination of the open-lung biopsy specimen revealed alveolar spaces filled with dust-laden macrophages and amorphous proteinaceous semifluid, the latter being immunoreactive for Human Surfactant Apoprotein A, associated with marked interstitial accumulation of the similar-looking macrophages along the bronchovascular bundles and mild interstitial fibrosis. Silicotic nodules or mixed dust fibrosis were not seen. The patient was diagnosed as silicoproteinosis with unusual histopathological features because he had worked in an antimony mine for only 3 years and had 86% silica in a mineralogical analysis. Pneumoconiosis is a rare lung disease which may be confused with other interstitial lung diseases. Clinical, radiological and unusual histopathologic features of this rare case are presented and discussed with the differential diagnosis, especially of mixed dust pneumoconiosis.

Fine-needle aspiration cytology of metastatic oligodendroglioma: case report and literature review.

BACKGROUND: Systemic metastasis of a glial tumor is a rare event. However, metastatic cases are anticipated to increase due to prolongation of survival as a result of the development of new treatment modalities. The possibility of metastasis should be considered in patients with a history of a glial tumor rather than a second primary tumor. Fine-needle aspiration cytology is one of the diagnostic procedures primarily applied for confirmation of metastasis in cases with a known primary focus. Therefore, comprehensive knowledge of diagnostic cytomorphologic findings is required in these cases. CASE REPORT: We report a young woman with oligodendroglioma metastasizing to the cervical lymphatic chain 5 years after initial diagnosis. Fine-needle aspiration cytology revealed a highly cellular smear with dispersed single cells and loosely cohesive cell clusters showing rosette-like features on a clean background. The relatively monotonous tumor cells were small sized and had round nuclei with moderate anisonucleosis and scant cytoplasm without extensions. Diagnostic confirmation was made by excisional biopsy and demonstration of 1p19q codeletion on tissue section by fluorescence in situ hybridization. CONCLUSION: A brief review of the literature with an emphasis on the cytologic features of metastatic oligodendroglioma and differential diagnosis with respect to other metastatic small round cell tumors is provided.

Morphometric analysis in cytologic evaluation of papillary thyroid carcinoma.

OBJECTIVE: To compare the morphometric features of papillary carcinomas with follicular neoplasias and benign lesions and to determine the potential role of nuclear morphometric features in their differential diagnosis. STUDY DESIGN: Morphometric features were investigated in the cytologic samples of 64 cases, including 27 benign lesions, 6 follicular neoplasias and 31 papillary carcinomas. We analyzed 6 morphometric parameters: nuclear area, nuclear perimeter, maximum diameter (MaxD), minimum diameter (MinD), form factor and ratio of MaxD/MinD. RESULTS: There were no significant differences between the benign lesion and follicular neoplasia groups for any nuclear parameters. However, between benign lesions and papillary carcinomas, there were significant differences for all parameters, except for form factor. Between follicular neoplasms and papillary carcinomas, only the MaxD/MinD ratio was significantly different. CONCLUSION: The results of this study indicate that the ratio of MaxD/MinD is a distinct nuclear morphometric feature for distinguishing papillary carcinoma from other thyroid lesions, and it may be employed with other cytologic criteria in diagnosing problematic cases.

Rhabdomyosarcoma arising in a mature cystic teratoma with contralateral serous carcinoma: case report and review of the literature.

SUMMARY: Malignant transformation of a mature cystic teratoma of the ovary is rare, and occurs in approximately 2% of all cases. The most common malignancy arising in mature cystic teratoma is squamous cell carcinoma. Sarcomas very rarely develop in mature cystic teratoma. We describe the case of a 65-year-old patient with mature cystic teratoma, and with rhabdomyosarcomatous transformation and contralateral serous carcinoma. To our knowledge, this is the first case of a pure rhabdomyosarcoma arising in a mature cystic teratoma. The clinicopathologic and immunohistochemical findings of this exceptional case are reported and the literature is reviewed.

Comparison of ProEx C with p16INK4a and Ki-67 immunohistochemical staining of cell blocks prepared from residual liquid-based cervicovaginal material: a pilot study.

BACKGROUND: Although liquid-based cervicovaginal cytology has high sensitivity for detecting dysplastic/malignant lesions, many pitfalls exist. Cell blocks can be prepared from residual liquid-based cervicovaginal material and used for immunohistochemistry. The aim of this study was to evaluate a new marker, ProEx C, on cell blocks and its ability to distinguish dysplastic/malignant lesions from morphologically abnormal but benign cells. The results of this study were compared with previously reported results for p16 and Ki-67 on the same material. METHODS: ProEx C is a cocktail of monoclonal antibodies against proteins associated with aberrant S phase cell cycle induction (topoisomerase IIA, minichromosome maintenance protein 2). ThinPrep (CytycCorp., Boxborough, Mass) cervicovaginal specimens from 79 patients were selected. Four cases had no residual abnormal cells in the cell block. On the basis of the cell block diagnosis, 29 cases were negative for intraepithelial lesion or malignancy (NILM), 27 had low-grade squamous intraepithelial lesions (LSIL), 16 had high-grade squamous intraepithelial lesions (HSIL), and 3 had squamous cell carcinomas (SCC). Cell block sections were immunostained with ProEx C. RESULTS: Thirteen of 16 (81%) cases of HSIL stained positively with ProEx C. Two of 27 (7%) LSIL stained positively, and 2 (7%) cases of NILM stained positively. All 3 cases of SCC were strongly positive (100%). Staining for ProEx C showed a higher positive predictive value compared with p16. CONCLUSIONS: ProEx C can be used on cell blocks prepared from residual liquid-based cervicovaginal cytologic specimens. Being a nuclear only stain, it is cleaner and easier to interpret even in scant specimens.

The effects of experimental left varicocele on the epididymis.

Most of the studies investigating the relationship between varicocele and male infertility are mainly focused on the testicles. It is obvious that varicocele would affect the morphology and function of the epididymis which is an intrascrotal organ. In this study, the effects of experimental left varicocele (ELV) on the epididymal morphology were investigated in adult rats. ELV was induced via partial obstruction of the left renal vein in 20 Sprague-Dawley adult rats. An additional twelve rats served as controls, and another twelve served as shams. Half of the rats in the groups were sacrified by the end of the first month of the experiment, and the rest were sacrified by the end of the second month. Epididymides were weighed; tubular diameters of the caput, corpus, and cauda of the epididymis were measured. The TUNEL assay was used to assess apoptosis within the epididymal tubules. The mean weight of each right and left epididymis in the varicocele group was lower than that in the control and sham groups (p < 0.01). In the varicocele group, the left epididymis weighted less than the right by the end of the second month (p < 0.01). The mean tubular diameter in the varicocele group was narrower than that in the control and sham groups (p < 0.001). Tubular diameter was significantly narrower in the caput segments in rats with varicocele by the end of the second month (p < 0.001). Apoptosis was significantly increased in principal cells of the epididymal epithelium in the varicocele groups. The apoptotic cells in the caput epididymis epithelium were more numerous than those in the other segments. In conclusion, ELV significantly decreases epididymal weight and tubular diameters presenting increased apoptosis within the principal cells. There is a positive correlation between the epididymal damage and the duration of varicocele.

The coexistence of invasive ductal carcinoma and malignant phyllodes tumor with liposarcomatous and chondrosarcomatous differentiation in the same breast in a post-osteosarcoma case.

Malignant phyllodes tumors of the breast are rare biphasic neoplasms, the stromal component of which may show homologous and heterologous sarcomatous elements. Malignant epithelial transformation is rare. It has been reported in a few cases of in situ and infiltrating ductal or lobular carcinoma. Rarely, breast carcinomas and phyllodes tumors may also develop in the same breast independent of each other. To our knowledge, this is the first case of two different types of tumor occurring in the same breast at the same time in a post-osteosarcoma case.

Renal Behçet's disease: an update.

OBJECTIVE: The aims of this study are (1) to report 33 patients with Behçet's disease (BD) having various renal manifestations, and (2) to update current data using our patients and published papers about BD and renal manifestations. METHODS: The PubMed database was searched using the terms BD or Behçet's syndrome. We found reports of 94 patients (including ours) with BD and specific renal diseases (amyloidosis, 39; glomerulonephritis [GN], 37; renal vascular disease, 19; interstitial nephritis, 1). RESULTS: The presentation of renal disease was edema/nephrotic syndrome in 12 patients (36%). Renal disease was incidentally diagnosed by routine urine analysis and measurement of serum creatinine level in 20 patients (61%). Renal failure was present in 23 patients (70%) and 5 of them have had cyclosporine treatment. The frequency of renal disease among BD patients has been reported to vary from less than 1 to 29%. CONCLUSIONS: The clinical spectrum of renal BD shows a wide variation. Amyloidosis (AA type), GN, and macroscopic/microscopic vascular disease are the main causes of renal BD. Patients with vascular involvement have a high risk of amyloidosis and amyloidosis is the most common cause of renal failure in BD. Several types of glomerular lesions are seen in BD. Current treatment options for renal BD are not evidence based. Radiological vascular intervention combined with immunosuppressive drugs can be useful in selected cases. Routine urine analysis and measurement of serum creatinine level are needed for early diagnosis of renal BD.

Pulmonary involvement in Behçet's disease.

BACKGROUND: Behçet's disease (BD) is a multisystem vasculitis and pulmonary involvement in BD is reported to indicate poor prognosis and high mortality. OBJECTIVES: The aims of this study were to report on patients with pulmonary involvement and to discuss pulmonary artery thrombus and small-sized vasculitis associated with BD, with respect to previously published cases. METHODS: Fifteen patients with BD and pulmonary involvement were included in this study. Massive hemoptysis was observed in all patients having pulmonary artery aneurysm (PAA). RESULTS: Eleven patients had macroscopic pulmonary vascular disease (2 PAA, 3 PAA and thrombi and 6 only thrombi) and 3 patients had microscopic pulmonary vascular disease. The remaining patient had pulmonary cryptococcosis. CONCLUSIONS: Data regarding treatment and outcomes of patients having BD-related pulmonary emboli/infarct and small-sized vasculitis are limited. Pulmonary vasculitis affects different levels of the pulmonary artery in BD and should be classified as macroscopic and microscopic vascular disease. 'Pulmonary artery thrombosis' should be used instead of 'pulmonary emboli'. Spiral CT angiography is the best radiological tool for evaluation of pulmonary problems in BD. Treatment of vasculitis should be based on the type of vascular disease and may vary among different types of vascular disease. Anticoagulation can be used in patients with microscopic vascular disease and nonaneurysmal macroscopic vascular disease. More studies are needed to clarify this issue.

SAA1 alpha/alpha alleles in Behçet's disease related amyloidosis.

Behçet's disease (BD) related amyloidosis is relatively rare. Serum amyloid A protein (SAA) protein gene polymorphism is one of the factors implicated in the pathogenesis of AA type amyloidosis. The aim of this study is to investigate SAA1 gene polymorphism in different patient groups: (1) BD related amyloidosis, (2) BD without amyloidosis, and (3) healthy controls. One hundred eleven patients from three main groups were included in the study: (1) BD related amyloidosis (n = 9), (2) BD without amyloidosis (n = 39), and (3) healthy controls (n = 63). Homozygous alpha/alpha is present in 78% of patients with BD and amyloidosis. The SAA1 alpha/alpha genotype is significantly more common among patients with BD and amyloidosis. This study demonstrated increased frequency of alpha/alpha genotype in BD related amyloidosis. To our knowledge, the relationship between alpha/alpha genotype and BD related amyloidosis was not studied previously. In conclusion, the SAA1 alpha/alpha genotype is a risk factor for amyloidosis in BD.

SAA1 alpha/alpha alleles in amyloidosis.

BACKGROUND: Amyloidosis, mainly AA type, is one of the common diseases in nephrology clinics in Turkey. AA type amyloidosis is a complication of various chronic infections or inflammatory diseases such as familial Mediterranean fever (FMF), rheumatoid arthritis (RA), tuberculosis and bronchiectasis. A controversy exists in the literature regarding the relationship between SAA1 genotypes and AA type amyloidosis. This study aimed to investigate SAA1 gene polymorphism in different patient groups: 1) amyloidosis, 2) FMF and 3) healthy controls. METHODS: Eighty-two patients from the three groups were included in the study: 1) amyloidosis, 2) FMF without amyloidosis, and 3) healthy controls. SAA1 genotypes were studied by the polymerase chain reaction/restriction fragment length polymorphism (PCR-RFLP) method. RESULTS: The homozygous alpha/alpha genotype is the most common SAA1 genotype among patient groups with amyloidosis, and the alpha/alpha genotype frequency is significantly higher than in healthy controls (68 vs. 38%, p<0.05). CONCLUSIONS: The SAA1 alpha/alpha genotype is a risk factor for AA type amyloidosis in Caucasoid populations and more studies are needed to investigate why the gamma/gamma genotype is associated with AA type amyloidosis in Japan.

The utility of p16INK4a and Ki-67 staining on cell blocks prepared from residual thin-layer cervicovaginal material.

BACKGROUND: Cell blocks can be prepared from residual thin-layer cervicovaginal (ThinPrep) material and can be used in immunohistochemical staining assays for p16INK4a and Ki-67, which are surrogate markers related to human papillomavirus infection and cell proliferation, respectively. The objectives of the current study were 1) to investigate the feasibility and the role of cell block preparations in identifying significant neoplastic and preneoplastic lesions of the uterine cervix and 2) to assess the feasibility of using p16INK4a and Ki-67 immunohistochemical staining patterns on cell blocks to identify significant preneoplastic cervical lesions. METHODS: Cervicovaginal cytology specimens from 85 patients were analyzed. Cytologic diagnoses based on ThinPrep Papanicolaou test results were as follows: squamous cell carcinoma was diagnosed in 3 specimens, high-grade squamous intraepithelial lesions (HSIL) were diagnosed in 27 specimens, low-grade squamous intraepithelial lesions (LSIL) were diagnosed in 20 specimens, and atypical squamous cells of uncertain significance (ASCUS) were diagnosed in 11 specimens. Diagnoses of negativity for intraepithelial lesions or malignancy (NILM) were made in 24 specimens. Cell block sections were stained with hematoxylin and eosin and were immunostained with antibodies against p16INK4a protein and Ki-67 antigen. RESULTS: The cytomorphologic diagnoses made using cell block preparations were as follows: SCC in 2 specimens, HSIL in 20 specimens, LSIL in 30 specimens, NILM in 32 specimens, and no diagnosis in 1 specimen. In 62 cases (73%), the diagnoses made using cell block preparations were in agreement with the ThinPrep diagnoses. Immunostaining of cell blocks for p16INK4a and Ki-67 exhibited a statistically significant association (P < 0.05) with the presence of significant lesions on either cell block or ThinPrep analysis. CONCLUSIONS: To the authors' knowledge, p16INK4a has not been analyzed previously in ThinPrep cell blocks, and the correlation between Ki-67 expression and cell block diagnoses also has not been reported previously. The current results indicate that cell blocks prepared from residual ThinPrep material represent an additional reliable diagnostic tool in the evaluation of cervical samples. Furthermore, immunohistochemical studies may be helpful in differentiating significant preneoplastic changes from other cervical lesions, such as atrophy.

Familial Mediterranean fever and glomerulonephritis and review of the literature.

Familial Mediterranean fever (FMF) is an autosomal recessive disease characterized by recurrent and self-limited attacks of fever usually accompanied by polyserositis. Amyloidosis is its most common renal complication. A number of reports have shown vasculitic diseases such as polyarteritis nodosa and Henoch-Schönlein purpura affecting the kidney in FMF. Here we present a patient with FMF and membranoproliferative glomerulonephritis and analyze the data published on these two entities.

Glutathione-S transferase-pi expression in non small cell lung cancer in the assessment of response to chemotherapy.

OBJECTIVE: To determine the relation of glutathione-S transferase-pi (GST-pi) expression and cisplatin resistance in non small cell lung cancer (NSCLC). METHODS: This study was carried out on 61 patients who were admitted to Chest Diseases Clinic, Ondokuz Mayis University, Samsun, Turkey, from 1997 to 1999. Twenty-seven NSCLC patients out of 61 lung cancer cases whose biopsy specimens were evaluated for GST-pi, received multiagent chemotherapy including cisplatin. The correlations between GST-pi expression and age, sex, performance score, histology, stage of the disease and response to chemotherapy were investigated. RESULTS: There was a significant correlation between GST-pi expression and the histological type of the disease (p<0.05). However, no significant relation was found with age, sex, performance score or stage of the disease (p>0.05). Glutathione-S transferase-pi staining characteristics of the 27 patients receiving chemotherapy were: less than 10% in 3 patients (11.1%), 10-50% in 9 patients (33.3%) and more than 50% in 15 patients (55.5%). One of the 3 patients (33.3%) with GST-pi staining percentage of less than 10%, 3 of 9 patients (33.3%) with staining percentage of 10-50% and 4 out of 15 patients (26.6%) with staining percentage of more than 50% had an objective response to chemotherapy. No significant correlation was found between GST-pi expression and response to chemotherapy in the 3 groups (p>0.05). CONCLUSION: Glutathione-S transferase-pi expression might not always predict the response to combination chemotherapy regimens containing cisplatin. Several other mechanisms may play a role in cisplatin-resistance.