The first case report of metastatic rectal adenocarcinoma to the oral vestibule in a young woman.

BACKGROUND: The available literature regarding metastasis to the oral cavity from colorectal cancer, especially rectal cancer, is currently limited. With this in mind, we aimed to report the first case of rectal adenocarcinoma metastasis to the oral vestibule. CASE REPORT: A 36-year-old Caucasian female with a 17-months history of rectal adenocarcinoma and several metastases was referred to the Dental Oncology Service due to a nodular swelling in the oral cavity. Intraoral examination showed a large, painless nodule with superficial necrosis on the right side of the mandibular vestibule. An incisional biopsy was performed, and the microscopic analysis demonstrated an infiltrative tumor characterized by islands of malignant epithelial cells with a columnar appearance and tubular pattern. The epithelial component presented pseudoductal structures resemble intestinal mucosa, which exhibited intraluminal secretion. The neoplastic cells were immunoreactive for CDX2 and Cytokeratin 20, and negative for Cytokeratin 7. Therefore, the final diagnosis of metastatic rectal adenocarcinoma was established. Unfortunately, the patient died 23 months after the diagnosis of the primary tumor. CONCLUSION: The study highlights that metastases to the oral cavity should be considered in the differential diagnosis of large reactive lesions affecting young patients, especially in the setting of a patient history of cancer.

Value of repeated fine needle aspirations of the thyroid: an analysis of over ten thousand FNAs.

OBJECTIVE: Fine needle aspiration (FNA) has been accepted as the diagnostic method of choice in the initial evaluation of thyroid nodules. However, the value of repeated FNAs in the long-term follow-up of lesions initially diagnosed as benign is being questioned. Do the findings on initial FNA really spare patients thyroidectomy or do they only postpone it? The purpose of the present study is our attempt to answer this question. DESIGN: Retrospective review of cytology reports of patients who underwent thyroidal FNAs at Washington Hospital Center from January 1998 through April 2006. All statistical analyses were done using the statistical package Splus. MAIN OUTCOME: Patients who had thyroid nodules diagnosed as benign on FNA performed at our institution had a 90% probability of a benign diagnosis (with 95% confidence interval [0.87, 0.92]), when they underwent surgery. When the benign cytologic diagnosis was confirmed on a repeat aspiration, this probability increased to 98% (with 95% confidence interval [0.94, 1.0]). CONCLUSIONS: Repeated thyroidal FNAs yielding benign diagnoses are nearly always accurate (98%), and therefore the patients can be followed safely without undergoing surgery, unless an unfavorable clinical change occurs.

Cytologic features of insular carcinoma of the thyroid: a case report.

Fine-needle aspiration of the thyroid has been accepted as one of the initial diagnostic tools in the evaluation of thyroid nodules. As its use becomes more widespread, the demand for more precise diagnosis has increased. The histopathology of insular carcinoma of the thyroid is now well recognized. However, the cytologic diagnostic criteria are not well established. The reported series have been small (4-6 cases), which is not surprising because of the rarity of this tumor. They consist of retrospective reviews of the aspirates (after the histologic diagnosis had been made from the thyroidectomy specimens). Also, the case reports do not provide uniform cytologic criteria; this could be due to limited sampling of these tumors (which are usually large). A cytologic diagnosis of insular carcinoma can be suggested if multiple samples of a thyroidal mass are markedly cellular, with a cytologic pattern reminiscent of a follicular variant of papillary carcinoma. However, the follicular cells are arranged predominantly in rosettes, their nuclei appear more monotonous, some "intranuclear cytoplasmic pseudoinclusions" are seen, and there is an occasional large cell with a pleomorphic nucleus.