Thyroid cancer with coexistent Hashimoto's thyroiditis. Clinical assessment and management.

Hashimoto's thyroiditis is a common thyroid disorder. Because of the difficulty of diagnosing a coexisting thyroid cancer, its management remains controversial. We reviewed 120 cases of thyroid cancer seen in our institution during an 11-year period (1976 through 1986) and defined the clinical characteristics of patients with both entities. Thirteen patients had concomitant cancer and Hashimoto's thyroiditis. Six of the 13 patients had a history of thyroiditis before the diagnosis of thyroid cancer. The remaining seven patients had evidence of Hashimoto's thyroiditis on histologic review of the thyroid specimen. The two most common characteristics prompting surgical intervention were the presence of a nonsuppressing dominant nodule and a cold area on thyroid scan. Twelve patients underwent preoperative fine-needle aspiration cytologic examination, but only in three were the results considered to be indicative of cancer. All 13 patients remained disease free. Despite the apparent indolence of thyroid cancer associated with Hashimoto's thyroiditis, selective surgical treatment of patients with clinical thyroiditis is indicated.

Evaluation of the impact of intraobserver variability on endometrial dating and the diagnosis of luteal phase defects.

OBJECTIVE: To determine the magnitude of intraobserver variation in dating endometrial biopsies and its impact on clinical management. DESIGN: Blinded histopathologic interpretation of endometrial biopsy specimens 1 year apart by five pathologists. SETTING: Large military tertiary care center. PATIENTS: Endometrial biopsy specimens from 51 patients undergoing evaluation for potential luteal phase defects. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Calculation of the magnitude of the individual and overall intraobserver variation in endometrial dating for the five pathologists and estimation of its potential impact on clinical management. RESULTS: The intraobserver variation was 0.69 +/- 0.05 days (means +/- SE). There was no significant difference in the magnitude of the variation for 1-day or 2-day dating ranges. The theoretical probability of altering clinical management by having the same pathologist redate a given specimen ranged from 15% to 28%. CONCLUSION: Histologic dating of endometrial biopsies is subject to a small but highly clinically significant intraobserver variability that may have a major impact on clinical management.

Epithelioid hemangioendothelioma of the lung (intravascular bronchioloalveolar tumor) in a young girl.

This report describes a 7 year old girl who presented with scoliosis and a small right hemithorax. Findings on spine roentgenographs were pleural thickening on the right and parenchymal densities. Computed tomography of the chest and abdomen revealed multiple pulmonary nodules and two hypervascular lesions within the liver. The diagnosis established by lung biopsy was intravascular bronchioloalveolar tumor (epithelioid hemangioendothelioma of the lung). This is the youngest reported case of this rare tumor.

Meningeal melanocytoma. An uncommon diagnostic pitfall in surgical neuropathology.

OBJECTIVE: To describe the neuropathologic findings in four cases of meningeal melanocytoma, a rare benign melanocytic tumor of the central nervous system. DESIGN: Retrospective analysis of surgical pathology and autopsy material. RESULTS: Grossly, all four tumors were well-circumscribed pigmented lesions, and three of four were attached to dura. Microscopically, the neoplasms were composed of spindle cells with epithelioid foci. Mitoses were not seen and only one case exhibited minimal necrosis. Immunohistochemistry and electron microscopy demonstrated the melanocytic nature of the lesions; all four cases showed S100 protein and neuron-specific enolase staining, and three cases exhibited melanoma-specific antigen staining. Immunostaining for epithelial markers and vimentin was uniformly negative. The single case in which electron microscopy was performed demonstrated premelanosomes. CONCLUSIONS: Meningeal melanocytoma is a benign pigmented neoplasm that can easily be confused with melanoma, especially on frozen section analysis. Practicing surgical pathologists should be aware of this entity.

Oculopharyngeal muscular dystrophy: clinical and histopathologic correlations.

Oculopharyngeal muscular dystrophy is an autosomal dominant myopathy that exhibits the symptoms of progressive dysphagia, with ptosis usually occurring after the age of 40. Literature review of this rare disease reveals a high incidence in the French-Canadian population, as well as in five other ethnic groups. Our article details the clinical history and genealogy of the disease through four generations in a family of English descent. Radiographic studies show a cricopharyngeal bar and aspiration. Results of electron microscopic examination of muscle biopsy specimens from the vastus lateralis and cricopharyngeus muscles confirm a chronic, active, severe, myopathic process that is more pronounced in the cricopharyngeus muscle. The recommended treatment for blepharoptosis and the cricopharyngeus muscle pathosis is discussed.

Nonsteroidal anti-inflammatory drug-induced diaphragm disease arising in a bypassed ileal segment.

The formation of mucosal ileal diaphragms has been previously reported in patients receiving nonsteroidal anti-inflammatory drugs over extended periods of time. Whether this effect is the result of a local or systemic action by the medication has remained unknown. We report the first known instance of diaphragm disease arising in a segment of ileum that had been bypassed for many years and therefore was not exposed normally to luminal contact with the drug. This case supports at least a partial systemic mechanism in the production of the lesion.