Turker Acar

US findings in euthyroid patients with positive antithyroid autoantibody tests compared to normal and hypothyroid cases.

PURPOSE We aimed to compare the ultrasonographic and laboratory parameters of euthyroid patients who have only positive antithyroid autoantibody test results with those of patients with a hypothyroid status of Hashimotos thyroiditis (HT). MATERIALS AND METHODS Thirty-five patients with newly diagnosed HT, 35 euthyroid patients who have autoantibodies against thyroid peroxidase (TPOAb) and/or thyroglobulin (TgAb), and 40 controls were enrolled in the study. Plasma free T3, free T4, thyroid stimulating hormone, TPOAb, and TgAb levels were obtained retrospectively. For gray-scale ultrasonography, each thyroid gland of all individuals graded with gray-scale grading (GSG), which was determined according to the gland size, parenchymal structure, echogenicity, micronodulation, contour irregularity, and existence of hyperechoic septa. For Doppler analysis, the peak systolic velocity (S), resistive index (RI), and pulsatility index (PI) values were obtained from the superior thyroid artery (STA) and intrathyroidal artery (ITA). The color pixel ratio (CPR), which was computationally evaluated from a power Doppler image of all individuals, was used for quantification of the intrathyroidal vascularity. RESULTS Although the mean GSG values were higher in the HT and antibody-positive groups than they were in the control group, there was no significant difference between the HT and antibody-positive groups. The three study groups demonstrated no statistically significant difference with regard to the S, RI, or PI variables obtained from the STAs and ITAs. Although the CPR values were highest in the HT group, the difference between the HT and antibody-positive group did not reach statistical significance. CONCLUSION The euthyroid antibody-positive group revealed gray-scale and Doppler ultrasonographic findings that were similar to those of the HT group.

Primary mesenchymal liver tumors: radiological spectrum, differential diagnosis, and pathologic correlation

With the exception of hemangioma, benign or malignant primary mesenchymal tumors of the liver are seldom encountered. The aim of this review was to discuss the clinical, histopathological, and imaging features of liver hemangiomas (cavernous, capillary, and sclerosed types), liver lipoma, angiomyolipoma, mesenchymal hamartoma, neurofibroma, infantile hemangioendothelioma, epithelioid hemangioendothelioma, myofibroblastoma, angiosarcoma, malignant fibrous histiocytoma, undifferentiated embryonal sarcoma, and nested stromal tumor. In most of these rare liver tumors, radiological findings obtained by cross-sectional imaging may reflect the characteristic pathologic features required for differential diagnosis; however, definitive diagnosis should be confirmed using histopathological examination.

Variable sonographic spectrum of parathyroid adenoma with a novel ultrasound finding: dual concentric echo sign.

AIMS To review the detailed gray-scale and Doppler ultrasonography features of histologically proven parathyroid adenomas (PAs) evaluated with high-end ultrasonography devices and to present a novel ultrasonography finding called the dual concentric echo sign in PA with histopathologic correlation which was encountered during detailed analysis. MATERIAL AND METHODS Fifty-six PAs with histopathological result were enrolled. The longest dimension, shape, distance to skin surface, internal echo and Doppler US features obtained with high-end US devices were evaluated. RESULTS PAs had variable range of shape including oval, irregular, fusiform, lobulated, crescent-shaped, and nodular configuration. In nine patients the lesions were shown to have cystic components and calcifications were seen in four cases. Dual concentric echo sign was detected in 18% PAs. Histological reevaluation of this subgroup demonstrated significantly increased edema (p<0.01), and ectatic vessels (p=0.02) in the central part of the lesion compared to the rest of the PAs. CONCLUSIONS The results of the study led to the conclusion that PAs have variable gray-scale and Doppler findings. Typical sonographic features like ovoid shape, homogeneously hypoechoic pattern may not be present in all PAs. Dual concentric echo sign which is a novel sonographic pattern may be suggestive of a PA.

Supraclavicular lymphadenopathy: should it be perceived as the virchow's node of head and neck tumors?

Background: In this study, we aimed to determine the correlation between supraclavicular lymph node involvement (SLNI) and metastatic potential, frequency, and metastases predilection sites in patients diagnosed with various head and neck tumors (HNT) and staged via positron emission tomography/computed tomography (PET/CT) imaging. We also investigated the impact of different variables on SLNI. Patients and Methods: 270 patients diagnosed with HNT were enrolled in the study (194 males and 96 females, mean age 54.9 ± 14.7 years (range 18-89 years)). Results: Nasopharyngeal carcinoma demonstrated significant SLNI (p < 0.01); however, other subtypes of HNT did not. In all HNT studied, no apparent metastatic predilection tendency for the supraclavicular region was observed, as opposed to the well-described Virchows node. Age, gender, tumor size, and systemic metastases were not identified as statistically significant variables contributing to SLNI. Multivariate regression analysis revealed an increased cervical (p < 0.01) and thoracic (p = 0.001) lymph node involvement in patients with SLNI. Conclusion: SLNI with the possibility of metastasis was more frequently observed in nasopharyngeal carcinoma, advancing the nodal status without significantly influencing the T and M stages. A careful evaluation of this very small region is of critical importance for proper nodal staging in nasopharyngeal cancer patients.

Corticosteroid Responsive Sarcoidosis with Multisystemic Involvement Years after Initial Diagnosis: A Lymphoma Mimicker on 18-FDG PET/CT

Sarcoidosis is a chronic multisystemic inflammatory disease characterized by noncaseating epithelioid cell granulomas. 18-Fluorodeoxyglucose positron-emission tomography/computer tomography (FDG-PET/CT) is increasingly used in routine clinical practice to assess active sarcoidosis because it can detect active inflammatory granulomatous disease. However, active sarcoidosis lesions are observed to be hypermetabolic on FDG-PET/CT much like malignancies, which may lead to misinterpretation on imaging. In this case report, we present a rare case of sarcoidosis with multisystem involvement including lung, lymph nodes, bone, pleura, and soft tissue that mimicked lymphoma on FDG-PET/CT and responded to corticosteroid treatment.

Renal Sinus Fat Invasion and Tumoral Thrombosis of the Inferior Vena Cava-Renal Vein: Only Confined to Renal Cell Carcinoma

Epithelioid angiomyolipoma (E-AML), accounting for 8% of renal angiomyolipoma, is usually associated with tuberous sclerosis (TS) and demonstrates aggressive behavior. E-AML is macroscopically seen as a large infiltrative necrotic tumor with occasional extension into renal vein and/or inferior vena cava. However, without history of TS, renal sinus and venous invasion E-AML would be a challenging diagnosis, which may lead radiologists to misinterpret it as a renal cell carcinoma (RCC). In this case presentation, we aimed to report cross-sectional imaging findings of two cases diagnosed as E-AML and pathological correlation of these aforementioned masses mimicking RCC.

Squamous cell carcinoma arising from a Zenker's diverticulum: contribution of FDG-PET/CT to the diagnosis

A 69-year-old man was admitted to the gastroenterology department with bloody vomiting and syncope. He had a history of hepatitis B (with the following serologic markers: HBsAg, negative; HBeAg, negative; anti-HBc IgM, negative; anti-HBc, positive; antiHBs, 173.21 mIU/mL; anti-HCV, negative), alcohol consumption, and chronic liver disease. He had severe anemia with hemoglobin of 8 g/dL (reference value 11.7–15.5 g/dL) at presentation. The Child–Pugh, Model for End-Stage Liver Disease (MELD), and Rockall scores were 6, 11, and 5, respectively, at the time of bleeding. Upper gastrointestinal system endoscopy performed after stabilizing his vital signs revealed esophageal varices with no active bleeding, which were treated with band ligation and a Zenker’s diverticulum (ZD). Reevaluation endoscopy showed regression of the esophageal varices and a barium swallow study following the reevaluation endoscopy showed the extent of the ZD (Fig. 1). At follow-up, right posterior cervical lymphadenopathy (LAP) was detected and follow-up endoscopy revealed a 0.5 cm polypoid mass on the wall of the ZD (Fig. 2). The pathology of the esophageal mass and LAP were consistent with squamous cell carcinoma (SCC) and SCC metastasis, respectively. Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for staging confirmed an FDG-avid mass lesion arising from the ZD (Fig. 3). The patient was initially managed with radiotherapy, and the mass lesion in the ZD regressed completely (Fig. 4). After radiotherapy the patient had complaint of dysphagia. Endoscopic examination following radiotherapy revealed esophagitis, edema and stenosis on the upper esophagus managed with esophageal dilatation (Fig. S1). Currently, he can tolerate aqueous food.

Co-occurrence of thoracolumbar intramedullary lipoma and intracranial lipoma during Gardner's syndrome: a rare occurrence.

Dear Editor, It was with great interest that we read the paper by Kabir et al. [3] and the related papers regarding spinal cord lipomas in Acta Neurochirurgica. True intramedullary lipomas of the spinal cord are extremely rare mass lesions that have been reported only as single-case presentations [3, 4]. Intracranial lipomas are also rare, as their spinal counterparts constitute less than 1 % of intracranial mass-occupying lesions [8]. Herein, we report on a rare case of a thoraco lumbar in t ramedul la ry l ipoma wi th an accompanying intracranial lipoma on the background of Gardner’s syndrome (GS). A 50-year-old woman undergoing regular follow-up examinations due to GS was admitted to our institution with numbness in both legs and difficulty walking. Her medical history described left-sided facial asymmetry because of a known osteoma (Fig. 1) as well as epilepsy controlled with diphenylhydantoin sodium (100 mg/day). A cranial computed tomography (CT) revealed a large lipoma in the middle cranial fossa and in both cerebellopontine angles (Fig. 2a). A lumbar CT and magnetic resonance imaging (MRI) revealed a giant intramedullary lipoma measuring 13 cm in the craniocaudal direction involving the thoracolumbar cord, which caused a tethered cord (Fig. 2b–d). The neurosurgeon recommended a surgical operation after reviewing the radiological findings. However, due to the patient’s recurrent surgical procedures and persistent desmoid tumour history in the old abdominal surgical site, she refused the surgical procedure. The patient is still receiving follow-up care, taking anti-epileptic medication and undergoing regular radiological scans. GS, a variant of familial adenomatous polyposis, is characterised by intestinal polyposis, desmoid tumours, osteomas, epidermoid cysts, dental abnormalities and periampullary carcinomas [2]. Countless polyps in the colon are associated with a predisposition to develop colon cancer; if the colon is not totally removed, a total proctocolectomy is required in patients diagnosed with GS. GS is rarely associated Electronic supplementary material The online version of this article (doi:10.1007/s00701-015-2456-y) contains supplementary material, which is available to authorized users.