Serdar Ugras

Preoperative and Postoperative Evaluation of Thyroid Disease in Patients Undergoing Surgical Treatment of Primary Hyperparathyroidism

OBJECTIVE To evaluate the occurrence of thyroid disease in patients undergoing parathyroidectomy for primary hyperparathyroidism. METHODS In this case series, records of all patients with a diagnosis of primary hyperparathyroidism who underwent parathyroidectomy between January 2005 and December 2008 in our clinic were analyzed retrospectively. Preoperatively, all patients were evaluated with ultrasonography and parathyroid scintigraphy; when needed, thyroid scintigraphy and ultrasound-guided fine-needle aspiration biopsy (FNAB) were used. All patients underwent standard neck exploration. Postoperative histopathologic findings of thyroid tissue were classified as nodular/multinodular hyperplasia, Hashimoto thyroiditis, papillary thyroid carcinoma, or normal. RESULTS Fifty-one women and 9 men were included. In the 60 patients, preoperative ultrasonography revealed thyroiditis (without nodules) in 13 (22%), a solitary nodule in 9 (15%) (coexistent with thyroiditis in 7 patients), multinodular goiter in 24 (40%) (coexistent with thyroiditis in 5 patients), and normal findings in 14 (23%). Rates of thyroiditis and nodular goiter were 42% and 55%, respectively. Collectively, prevalence of thyroid disease was 77%. Total thyroidectomy was performed in 27 patients, and hemithyroidectomy was performed in 15 patients. Indications for total thyroidectomy were nondiagnostic or suspicious FNAB results in 5 patients, hyperthyroidism in 4 patients, ultrasonography findings in 11 patients, and intraoperatively recognized suspicious nodularity in 7 patients. Postoperatively, thyroid carcinoma was diagnosed in 9 patients (15%). CONCLUSIONS Thyroid disease, particularly thyroid carcinoma, is common in patients with primary hyperparathyroidism. This association should be considered when selecting the surgical procedure. Intraoperative evaluation of the thyroid is as important as preoperative evaluation with ultrasonography and FNAB in patients with thyroid disease and primary hyperparathyroidism.

Acinar Cell Cystadenoma (Acinar Cystic Transformation) of the Pancreas: the Radiologic-Pathologic Features

Acinar cystic transformation of the pancreas is also known as acinar cell cystadenoma (ACC), and this is an extremely rare benign lesion that was first described in April 2002. We report here on a case of a previously asymptomatic patient with pancreatic ACC and this was diagnosed by computed tomography (CT) and magnetic resonance imaging (MRI). To the best of our knowledge, there is no previous report concerning the CT or MRI features of ACC in the medical literature. We present here the CT, MRI and pathological findings of pancreatic ACC.

Percutaneous laser ablation of an autonomous thyroid nodule: effects on nodule size and histopathology of the nodule 2 years after the procedure.

Ultrasound (US)–guided percutaneous laser ablation (PLA) is a new procedure for decreasing the size of thyroid nodules (1–5). It has been used to treat compressive symptoms in benign solitary cold thyroid nodules (1–5) and to reduce thyroid hormone production in autonomous functioning thyroid nodules (6–9). In two cases of anaplastic thyroid carcinoma, it was used for palliative purposes (7,10). Pacella et al. (11) first described thermal injury of thyroid tissue by PLA. We previously studied the effects of PLA on the cytology of hypofunctioning thyroid nodules, nodule volume, and thyroid function, but did not report data on histopathologic changes produced by US-guided PLA in thyroid nodules (4). We now describe the histopathology of an autonomously functioning thyroid nodule 2 years after PLA. A 25-year-old woman presented with swelling of the neck and difficulty breathing. On physical examination, a nontender, mobile, moderately firm nodule of about 3 cm was noted in the right lobe of the thyroid. Serum thyrotropin (thyroid-stimulating hormone, TSH) was 0.55 mIU=mL (normal range: 0.4–4 mIU=mL), serum free thyroxine level was 1.21 ng=dL (normal range: 0.85–1.78 ng=dL), and serum free triiodothyronine level was 3.85 pg=mL (normal range: 1.57– 4.71 pg=mL), all within normal limits. Serum antithyroid peroxidase antibody was 5 IU=mL (normal range: 0–35 IU=mL), anti-thyroglobulin antibody (anti-TgAb) was 10 IU=mL (normal range: 0–40 IU=mL), serum Tg level was 10 ng=mL (normal range: 0–55 ng=mL), and serum calcitonin level was 1 pg=mL (normal range: 5.0–11.5 pg=mL). US was performed using a Pro 200 Scanner (GE Medical Systems Kyunggido, Korea), and a 13.50 mL solid nodule was detected in the right lobe of the thyroid. Echogenity was normal in the remaining thyroid tissue. Technetium-99m (Tc) scintigraphy showed a hot nodule in the right lobe, with slight suppression of 99m Tc uptake in the remainder of the thyroid (Fig. 1). US-guided fine-needle aspiration biopsy of the nodule showed benignappearing thyrocytes, which formed occasional follicles. The patient refused surgery or radioiodine treatment. PLA of the thyroid nodule was advised, and she accepted and gave informed consent to the procedure. The approval of the local ethics committee was obtained (Ataturk Education and Research Hospital, Ankara; date: 09.11.2004; record no.: 2004=10=009). A 16-mm-long, 21-gauge (0.8 mm) needle was custommanufactured for the nodule. Sedation was obtained with 7.5 mg diazepam (SABA Pharmaceuticals, Istanbul, Turkey) 1 hour prior to the procedure. The skin above the nodule was sterilized with 95% ethanol, and 2 mL of 2% Lidocaine was injected subcutaneously. The custom-produced needle was inserted under US guidance into the proper position within the nodule along its long axis. Then, a bare flat-end fiber, 400mm in diameter, was inserted through needle lumen. The fiber tip was aligned with the needle tip, and then advanced 5 mm to provide direct contact with thyroid tissue. Two-plane US imaging was used to confirm that the fiber tip was at least 2 cm from surrounding vital organs. A total of 3000 J of energy was transferred through the fiber tip within 600 seconds with 5 W power by an electronic infrared diode laser at 810 nm wavelength using a gallium-aluminumarsenide power source (model 15 plus; Diomed, Cambridge, UK) (1,2,4,6,9,10). The patient experienced neck discomfort and pain extending toward the chin. The pain ceased after power transfer was stopped, and no complications were encountered after the procedure. Indirect laryngoscopic examinations before and after the procedure were normal. The thyroid nodule volume, which was 13.50 mL before the procedure, decreased to 8.40 mL 3 months later and to 4.20 mL 6 months after PLA. The patient’s compression symptoms (difficulty in breathing and difficulty in swallowing) decreased from 7 points to 2 points when evaluated by visual analog scale (min, 0; max, 10) (1,2,4). Nine months after PLA, however, the volume of the nodule had increased to 5.5 mL; at 1 year it was 6.6 mL; at 2 years it was 10 mL. Serum TSH, triiodothyronine, and thyroxine remained normal, but serum anti-TgAb level, which was 10 IU=mL before the procedure, increased to 150 IU=mL at the 6th month and regressed to 60 IU=mL at the 24th month. US-guided fine-needle aspiration biopsy was performed 1 year after PLA and showed no evidence of malignancy. Scintigraphies performed at 12th and 24th months by Tc showed that the hot nodule was still present, but serum TSH was normal (0.72mIU=mL) at 24 months. The patient felt that the size of the nodule was increasing, and the visual analog scale was increased to 7 points. Therefore, thyroidectomy was advised, and the patient agreed to this. The patient underwent complete resection of the right lobe, which contained the nodule, isthmusectomy, and near-total resection of the left lobe. Macroscopic examination showed a white-gray lesion in the region of the nodule, surrounded by hemorrhagic areas (Fig. 2). Rare old and new hemorrhagic regions, minimal fibrosis, and multiple microfollicles with colloid in their lumen were observed (Fig. 3) on histopathological examination. In the thyroid tissue surrounding the nodule, lymphoid cells with occasional germinal centers were observed (Fig. 4). Also, lymphocytic infiltration was observed in the opposite lobe. PLA-induced thermal injury in human thyroid tissue was first described by Pacella et al. (11). They reported the histopathology of single nodules in two patients whose THYROID Volume 18, Number 7, 2008 a Mary Ann Liebert, Inc. DOI: 10.1089=thy.2007.0316

The effect of platelet-rich plasma on osteochondral defects treated with mosaicplasty.

PurposeThis study investigated the efficacy of platelet-rich plasma (PRP) on articular surfaces on which the mosaicplasty technique was performed. Our hypothesis was that PRP can accelerate the osseointegration process and enhance the quality of articular integrity after the mosaicplasty procedure.MethodsStandard defects were created in the femoral groove of both patellofemoral joints of 12 New Zealand rabbits. PRP solution was placed inside the defect before fixation of the osteochondral autografts and injected inside the involved joint after capsular closure of the tested knees. The contralateral knees served as the control sides. The animals were euthanized three or six weeks after mosaicplasty, and both limbs were assessed according to Pineda’s histological grading scale. Significance level was set at p ≤ 0.05 a priori, and the Mann–Whitney U test was used for statistical analysis.ResultsHistologic findings at the interface between the transferred autograft and the original cartilage revealed better integration of the adjacent surfaces in the mosaicplasty with PRP group three weeks after the procedure; the difference was significant (p < 0.05). However, no significant difference in the transition zone was observed between the groups six weeks after the experiment (p = 0.59).ConclusionsOur animal model showed that adjunctive use of PRP produced a better healing response and resulted in superior histological scores after three weeks compared with the mosaicplasty-only procedure. Interpretation of our results is important in terms of rapid return to previous activity levels. Thus, application of PRP can represent a valid therapeutic option for improving the efficacy of mosaicplasty by stimulating the local healing response.

Comparison of 21 and 27 gauge needles for determining sample adequacy in the aspiration biopsy of thyroid nodules.

PURPOSE To compare 21 and 27 gauge (G) needles used for fine-needle aspiration (FNA) of thyroid nodules to obtain better specimens for adequacy and cytological diagnosis. MATERIALS AND METHODS One hundred patients with thyroid nodules (100 nodules) were included in this study. Each nodule was aspirated with both 27 G and 21 G needles. The obtained aspirates were classified as adequate and inadequate by two separate cytopathologists. The results were analyzed by appropriate statistical methods. RESULTS There was no statistically significant difference between 21 G and 27 G needles in terms of adequacy, according to each pathologist (P > 0.05). After pathological evaluation with consensus, the adequacy prevalence was the same (84%) for both needle types in all study populations (P > 0.05). According to the ultrasound characteristics of nodules, the prevalence of inadequate samples in patients with hypoechoic or heterogeneous nodules was significantly higher compared with the prevalence of inadequate samples in patients with isoechoic or hyperechoic nodules for both types of needles (P < 0.05). However, according to the size of the needles, there was no significant difference between hypoechoic and heterogeneous nodules or between isoechoic and hyperechoic nodules with regard to the ability to yield adequate samples (P > 0.05). CONCLUSION The results of our study showed that FNA with 27 G needles can aspirate adequate material for cytopathological diagnosis. The probability of inadequate sample aspiration of hypoechoic and heterogeneous nodules is higher than that for other nodule types.

Giant Mature Adrenal Cystic Teratoma in an Infant

CONFLICT OF INTEREST: NONE DECLARED Introduction Teratomas are derived from embryonic tissues that are typically found in the gonadal and sacrococcygeal regions of adults and children. Primary teratomas in the retroperitoneum are very rare in infant and primary adrenal teratomas are extremely rare. Early diagnosis and surgical resection are important for effective treatment. Case report We report here the case of a histologically unusual adrenal teratomas detected on computed tomography during the workup of abdominal distension 3-mounth-old male infant. The evaluation and treatment of this condition and a review of the literature are included in this paper.

Synovial sarcoma in a premature newborn

Synovial sarcoma is rarely detected in infants, with an annual incidence of 0.5 per million. Synovial sarcoma occurs more frequently in adolescents and young adults, with the majority of patients presenting between 15 and 40 years of age. It is extremely rare, however, in pediatric patients under 2 years of age. In the present study we examined a 3‐day‐old male infant born at 32 weeks who had a mass on his left arm. Synovial sarcoma was identified on histopathological and immunohistochemical analysis of biopsy material acquired from the mass. On whole body magnetic resonance imaging, diffuse metastases were detected in the bilateral lungs in the retroperitoneal zone, in bilateral suprarenal glands, the right liver lobe, the right kidney, and the brain. To our knowledge this is the youngest patient to be diagnosed with synovial sarcoma in the literature.

Coexistent Familial Nonmultiple Endocrine Neoplasia Medullary Thyroid Carcinoma and Papillary Thyroid Carcinoma Associated With RET Polymorphism

Familial nonmultiple endocrine neoplasia medullary thyroid cancer accounts for 10% to 15% of hereditary medullary thyroid carcinoma and is characterized by lack of accompanying endocrine or nonendocrine diseases. Simultaneous occurrence of medullary and papillary thyroid carcinoma in the same patient is rare and known as collision tumor. Here, the authors present familial nonmultiple endocrine neoplasia medullary thyroid cancer in 4 sisters, all having RET proto-oncogene polymorphism in exon 15 at codon 904 and 2 having additional polymorphism in exon 13 at codon 769. The index case had concomitant medullary and papillary thyroid carcinomas, which are suggested to be completely different tumors in terms of incidence, cell origin, histopathologic features and prognosis. Histopathologically, she also had Hashimoto thyroiditis in the remaining thyroid tissue and medullary thyroid carcinoma metastasis in 3 cervical lymph nodes. This case is the first in the literature to report coexistent familial nonmultiple endocrine neoplasia medullary thyroid cancer and papillary thyroid carcinoma related with a RET polymorphism (S904S in exon 15).

Benign metastasising leiomyoma with lymph node metastases in a patient with endometrial cancer after caesarean section

A benign metastasising leiomyoma (BML) is a rare benign smooth muscle proliferation located outside the uterus occurring in association with an uterine leiomyoma (PachecoRodriguez et al. 2016). We present a unique concomitant case of endometrial cancer and BML with pulmonary nodules and lymph node metastases and a history of caesarean sections. The cases of lymph node involvement of a BML are quite few (Tori et al. 2008; Yoon et al. 2011). A BML can mimic other disorders when found in different locations in the body and can be mistaken for metastases.

Süt Çocuğunda Aganglionik Kolon Ansı Yapan Teratom: Olgu Sunumu

Over ve sakrokoksigeal bolgede nadiren gorulen matur teratom literatur gozden gecirilerek sunuldu. Reteoperitoneal teratomlar cocuklarda ender olarak gorulur. Teratomlar, ortaya ciktiklari organa veya bolgeye yabanci bircok dokudan olusur. Barsaklarin organoid gelisimini gosteren teratomlar cok nadirdir. Retroperitoneal bolgede aganglionik kolonik loplara sahip teratomasi olan uc aylik hastanin makroskopik ve histopatolojik bulgularini tanimladik.