Husniye Baser

Diagnostic accuracy of Thyroid Imaging Reporting and Data System in the prediction of malignancy in nodules with atypia and follicular lesion of undetermined significance cytologies

Thyroid Imaging Reporting and Data System (TIRADS) is a simple and reliable reporting system for the prediction of malignancy. We aimed to determine the role of TIRADS in the prediction of malignancy in subcategories of Bethesda Category III, atypia of undetermined significance (AUS) and follicular lesion of undetermined significance (FLUS).

Bethesda classification is a valuable guide for fine needle aspiration reports and highly predictive especially for diagnosing aggressive variants of papillary thyroid carcinoma

A fine needle aspiration biopsy (FNAB) is the most valuable diagnostic procedure for pre‐operative discrimination of benign and malignant nodules. The Bethesda System for Reporting Thyroid Cytopathology provides standardised reporting and cytomorphological criteria in aspiration smears. The aim of the present study was to determine malignancy rates in nodules with different cytology results and evaluate the diagnostic value of Bethesda for variants of papillary thyroid carcinoma (PTC).

Can ratio of the biggest tumor diameter to total tumor diameter be a new parameter in the differential diagnosis of agressive and favorable multifocal papillary thyroid microcarcinoma

OBJECTIVES In this study, we aimed to evaluate the usefulness of a new parameter -ratio of the biggest tumor diameter to total tumor diameter- for the differentiation of agressive and favorable papillary thyroid microcarcinomas (PTMC). MATERIALS AND METHODS The diameter of the biggest tumor focus was taken as the primary tumor diameter. Total tumor diameter was calculated as the sum of the maximal diameter of each lesion. Ratio of primary tumor diameter to total tumor diameter was defined as tumor diameter ratio (TDR). Positive and negative predictive value, sensitivity and specificity of TDR to predict capsular invasion, extrathyroidal extension (ETE) and lymph node metastasis (LNM) were determined. RESULTS Mean TDR was significantly lower in multifocal PTMC patients with capsular invasion, ETE, lymphovascular invasion and LNM compared to patients without these features. The sensitivities of TDR for the detection of LNM, ETE and capsular invasion were 100%, 100% and 94.2%, respectively. Specificity of TDR was 86.2% for LNM, 88% for ETE and 94.7% for capsular invasion. Best cut off values of TDR that can predict capsular invasion, ETE and LNM in multifocal PTMC were 0.62, 0.57 and 0.56, respectively. Multifocal papillary thyroid carcinoma patients with capsular invasion, ETE and LNM had significantly lower mean TDR when compared to ones without these features. CONCLUSION Decreased TDR was associated with capsular invasion, ETE and LNM in patients with multifocal PTMC and PTC. This new parameter might be particularly helpful for the detection of aggressive behavior in multifocal PTMCs.

Mean platelet volume in patients with prolactinoma

OBJECTIVE Prolactin is a multifunctional pituitary hormone. The effect of prolactin on platelet activation is not well understood. Prolactinomas are the most common type of pituitary adenomas, and they are medically responsive to dopamine agonists. Mean platelet volume (MPV) is a marker of platelet function and activation. The aim of this study was to evaluate MPV values before and 6 months of cabergoline treatment when normoprolactinemia was achieved. SUBJECTS AND METHODS A total of 101 newly diagnosed prolactinoma patients and 102 healthy control subjects were included in the study. Patients with hematological disorders that affect MPV and those on medications were excluded. Prolactin, platelet count and MPV levels were recorded before and 6 months after the initiation of cabergoline treatment (0.5 to 1 mg, two times a week). RESULTS There was no significant difference in platelet count and MPV before and after 6 months of treatment with cabergoline in patients with prolactinoma compared with the control group (p > 0.05). CONCLUSION Our results showed that MPV, a marker of platelet function, was unchanged in patients with prolactinoma.

Simultaneous occurrence of different follicular neoplasms within the same thyroid gland: a retrospective study

Purpose: Neoplasms of the thyroid gland are classified according to the cells they originate from and commonly develop from cells of follicular origin. The most common differentiated thyroid cancers (DTC) are papillary and follicular carcinomas. Coexistence of two different histological types of primary follicular thyroid neoplasm is a rare condition. There are previous reports of concomitant medullary and papillary thyroid cancers. However, there is scarce data about the simultaneous occurrence of the two different histological types of primary follicular thyroid tumors and this is the first study on that subject. Material and Method: From January 2007 to September 2014, our institutional database was reviewed for patients who underwent thyroid surgery for various indications. Medical records and cytopathology reports of those patients were examined retrospectively. Simultaneous neoplasms of follicular origin were noted. Results: A total of 3.700 patients were operated. Histopathological examination revealed a benign pattern in 2.686 (73%) patients and a malignant pattern in 1.014 (27%) patients. Among the patients with the diagnosis of DTC, only 20 (1.9%) had a concomitant neoplasm within the same thyroid gland. Discussion: Such simultaneous tumors may be a part of a familial tumor syndrome or an unidentified novel gene mutation playing role in the pathogenesis of more than one type of tumor. Based on the current evidence, the synchronous occurrence of those neoplasms in a given patient is likely coincidental in the literature. Further studies on larger patient population with standardized genetic characterization are needed.

Ultrasonographical and cytological features of exophytic thyroid nodules: do exophytic nodules pretend to be malignant?

. Material ve Method ➢ Fourty-four exophytic and 34 non-exophytic thyroid nodules in which fine needle aspiration biopsy was indicated throughout 3 months were evaluated prospectively. Mean nodule size was similar in two groups (18.83±8.71 mm and 15.28±7,57 mm, p=0.173). The ratio of presence of peripheral hypoechoic halo and marginal irregularity was also similar in both group (p=0.512 and p=0.153, respectively). Microcalcification was present in 21.4% and 29.4% of exophytic and non-exophytic nodules, respectively (p=0.424). Macrocalcification was detected in 4.5% of exophytic and 11.8% of non-exophytic nodules (p=0.111). 47.6% of exophytic nodules was hypoechoic and 52.4% was isoechoic. 47.1% of non-exophytic nodules was hypoechoic and 52.9% was isoechoic. Color flow doppler pattern was defined as non-vascular, peripheral, central, or of mixed type and was similar in both groups (p=0.138). Cytopathologic results of exophytic nodules were 75% benign, 4.3% follicular lesion or atypia with undetermined significance, 2.3% suspicious for malignancy, 2.3% malign, and 15.9% non-diagnostic. In non-exophytic group, 79.4% was benign and 20.6% was non-diagnostic (p=0.497).