Fine needle aspiration biopsy in the preoperative management of patients with thyroid nodules.

The aim of this study was to evaluate the role of Fine Needle Aspiration Biopsy (FNAB) in the preoperative diagnostic management of patients with solitary or dominant thyroid nodules. This study was performed on 1054 patients followed for various thyroid disorders during a three year period (1992-1995). One hundred thirty eight patients were surgically treated, 61 after cytological indication and 77 after clinical indication, of these, 67 were cytologically negative and 10 were not conclusive. The cytological diagnosis was compared to the final histological result. Among the 138 cases, 27 were malignant, 39 were adenomas and 72 were benign lesions. Of the 67 cytologically negative cases, 63 (94%) were histologically benign, three were papillary carcinomas and one was an oxyphilic adenoma. Of the 45 cytologically suspicious aspirates, four were malignant neoplasias, 38 were follicular adenomas, two were hyperplastic goiters and one was an Hashimoto thyroiditis. All the 16 cytologically positive cases, were confirmed histologically. The limits of FNAB, which emerge from our and other studies, were based mainly in the difficulty of discriminating follicular adenomas from well differentiated follicular carcinomas. Nevertheless, FNAB with ultrasonographic support, has been unanimously accepted as a guide test in the selection of patients with thyroidal pathology who need surgery.

Cytological and immunocytochemical analysis of laterocervical lymph nodes in patients with previous thyroid carcinoma.

BACKGROUND: In the follow-up of patients with a history of thyroid carcinoma, an enlarged cervical lymph node may indicate metastatasis is underway. Various methods may be utilized in the differential diagnosis between cancer metastasis of thyroid origin and aspecific lymphoadenitis. The aim of the present study was to evaluate the sensitivity and specificity of fine needle aspiration biopsy (FNAB) and the additional diagnostic value of immunocytochemical thyroglobulin staining on FNAB of neck nodes. METHODS: We evaluated cytologically 38 samples obtained by ultrasound-guided FNAB on laterocervical nodes from patients with a history of thyroid carcinoma. One smear for each case was selected for the immunocytochemical stain. RESULTS: Twenty-eight of those samples were adequate (16 positive for metastasis of thyroid origin and 12 negative) and 10 inadequate. Two of the cytologically positive samples from poorly differentiated neoplasia showed no reaction to thyroglobulin (Tg). In ten of the 11 cases classified as lymphoadenitis, no immunoreaction was present; in the last case, blastic-like cells showed a scanty cytoplasmic rim which was immunoreractive to Tg. Therefore, this case was reclassified as a metastatic tumor. CONCLUSIONS: Based on our results, we would recommend that FNAB be routinely performed in the diagnostic evaluation of neck masses. If the FNAB is inconclusive, aspiration should be repeated, while immunoperoxidase stain to evidence Tg, may be an adjunctive diagnostic tool in cytologically negative cases.

[Value of immunohistocytochemistry in the diagnosis of laterocervical masses in patients with a previous history of thyroid carcinoma]. / Valore della immunocitochimica nella diagnosi di masse laterocervicali in pazienti con pregresso carcinoma della tiroide.

BACKGROUND: The aim of this study is to evaluate the additional diagnostic significance of immunocytochemical staining of thyreoglobulin (TG) in Fine Needle Aspiration Biopsy (FNAB) of neck lymph-nodes, in patients with a previous history of thyroid carcinoma. METHODS: Twenty-five smears performed by ultrasound-guided FNAB on laterocervical nodes with a 21-23 gauge needle were evaluates. All smears were stained according to Papanicolaou and microscopically examined. RESULTS: Of these 25 smears, 15 were diagnostic and 10 were non diagnostic. Of the 15 diagnostic cases, 10 were positive for metastatic lesions from thyroid neoplasm and the other 4 were classified as reactive lymphoadenitis. One smear for each case was selected for the immunohistochemical stain. All the 10 non-diagnostic cases showed no reaction to thyreoglobulin. Neoplastic cells, from 9 out of 11 cytologically positive smears, expressed thyreoglobulin in the cytoplasm. In one case no reaction was evident and the other one was discarded for technical reasons. In 3 of the 4 cases cytologically classified as lymphoadenitis, immunoreactive thyreoglobulin was not found. In the fourth case, blastic-like cells showed a scanty cytoplasmic rime which was immunoreactive for TG and thus was classified as a metastatic tumour. On this basis, it is suggested that FNAB should be performed routinelly in the diagnostic evaluation of neck masses of unknown origin in patients with a previous history of thyroid neoplasm. CONCLUSIONS: If the FNAB is inconclusive, a second aspiration should be performed while immunoperoxidase stain to evidentiate TG may be an adjuntive diagnostic tool in cytologically negative cases.

[Automation of cytological analysis of cervical smears]. / L'automazione applicata all'analisi citologica dei preparati eso-endocervicali.

Quality Control (QC) is essential in cytologic laboratories. To reduce or avoid false negatives due to screening or interpretation errors, all cervical smears may be analyzed twice by two different cytopathologists (CP). During rescreening or Quality Control (QC), the second CP may be assisted by an automated device. Today there are different instruments: computerized microscope Ac Cell Series 2000 Pathfinder System), semiautomated or interactive systems (PAPNET, CytoRich or AutoCyte, ACCESS), automated systems (AutoPap 300). These devices, except computerized microscopes, utilize algorithmic image analysis that values single cells using morphological features but has difficulty in analyzing clusters of overlapping cells. For this reason it is better to use thin or monolayer preparations. This approach results in the loss of background and cells useful for the diagnosis and modifies sampling and processing methods. However, the techniques to obtain thin or monolayer preparations may process a higher number of cells than conventional method; moreover, the samples obtained may be valued also by the optic microscope, making cytologic analysis easier. The only device that combines the use of algorithmic image analysis with neural networks is the PAPNET system. Neural networks was inspired by neurobiology and may identify different cellular morphology and overlapping cells. In our laboratory, the PAPNET was proposed in 1995. In the present study, the last rescreening results of 1958 negative cervical smears are reported, analyzed during primary screening from July 1997 to February 1998. During the QC assisted by the PAPNET, 6 false negatives (0.31%), due to cytologic errors in the primary screening were detected. These results confirm the usefulness and the effectiveness of QC assisted by automated devices. However, only the CP evaluates abnormal cells detected by semiautomated systems or analyzes more atypical smears identified by the instruments. The work of CP is difficult: therefore a strict collaboration between clinician and CP to formulate the correct diagnosis is essential.

Sonographic features of penile-gland lithiasis.

A 52-year-old man presented with a small, red, tender swelling near the penile frenulum at the lower edge of the base of the glans. Lower urinary tract symptoms were absent. Ultrasonography revealed a stone lodged in the distalmost portion of the glands of Littre. Combined with a good knowledge of penile anatomy, use of this simple imaging tool allows reliable diagnosis of even the rarest cases of penile pathology.

Percutaneous vesiculodeferentography in the diagnosis of male infertility: A review of our results and the data reported in the literature.

Vesiculodeferentography was used in the past to evaluate suspected cases of obstruction of the seminal ducts. Over the years, numerous attempts have been made to improve the technique used to perform this examination and to render it less invasive. Its use is currently indicated in selected cases, where it is combined with functional studies like seminal tract washout and followed by immediate interventions to correct the alterations revealed. Vesiculodeferentography includes collection of the contents of the seminal vesicles, which can later be used in vitro assisted fertilization procedures.

SommarioLa vesciculodeferentografia, esame utilizzato in passato nei casi di sospette ostruzioni delle vie seminali, è stato negli anni oggetto di numerosi studi allo scopo di migliorarne la tecnica di esecuzione e renderla meno invasiva. Attualmente è indicata solo in casi selezionati, in associazione a un'indagine funzionale quale il Seminal Tract Washout e prevedendo un contemporaneo ­ o in via subordinata, successivo ­ atto terapeutico.Ovviamente, peraltro, la procedura ­ ipso facto ­ prevede il prelievo di materiale dalla seminale e ciò può consentire una successiva procedura di fecondazione assistita in vitro.

'Advanced' generation lentiviruses as efficient vectors for cardiomyocyte gene transduction in vitro and in vivo.

Efficient gene transduction in cardiomyocytes is a task that can be accomplished only by viral vectors. Up to now, the most commonly used vectors for this purpose have been adenoviral-derived ones. Recently, it has been demonstrated that lentiviral vectors can transduce growth-arrested cells, such as hematopoietic stem cells. Moreover, a modified form of lentiviral vector (the 'advanced' generation), containing an mRNA-stabilizer sequence and a nuclear import sequence, has been shown to significantly improve gene transduction in growth-arrested cells as compared to the third-generation vector. Therefore, we tested whether the 'advanced' generation lentivirus is capable of infecting and transducing cardiomyocytes both in vitro and in vivo, comparing efficacy in vitro against the third-generation of the same vector. Here we report that 'advanced' generation lentiviral vectors infected most (>80%) cardiomyocytes in culture, as demonstrated by immunofluorescence and FACS analyses: in contrast the percentage of cardiomyocytes infected by third-generation lentivirus was three- to four-fold lower. Moreover, 'advanced' generation lentivirus was also capable of infecting and inducing stable gene expression in adult myocardium in vivo. Thus, 'advanced' generation lentiviral vectors can be used for both in vitro and in vivo gene expression studies in the cardiomyocyte.

Heart-targeted overexpression of caspase3 in mice increases infarct size and depresses cardiac function.

Up-regulation of proapoptotic genes has been reported in heart failure and myocardial infarction. To determine whether caspase genes can affect cardiac function, a transgenic mouse was generated. Cardiac tissue-specific overexpression of the proapoptotic gene Caspase3 was induced by using the rat promoter of alpha-myosin heavy chain, a model that may represent a unique tool for investigating new molecules and antiapoptotic therapeutic strategies. Cardiac-specific Caspase3 expression induced transient depression of cardiac function and abnormal nuclear and myofibrillar ultrastructural damage. When subjected to myocardial ischemia-reperfusion injury, Caspase3 transgenic mice showed increased infarct size and a pronounced susceptibility to die. In this report, we document an unexpected property of the proapoptotic gene caspase3 on cardiac contractility. Despite inducing ultrastructural damage, Caspase3 does not trigger a full apoptotic response in the cardiomyocyte. We also implicate Caspase3 in determining myocardial infarct size after ischemia-reperfusion injury, because its cardiomyocyte-specific overexpression increases infarct size.