An autonomously functioning thyroid carcinoma associated with euthyroid Graves' disease.

A 39-yr-old man with an autonomously functioning thyroid carcinoma is presented. Only 17 similar cases have been reported in the literature. The patient had unilateral Graves' ophthalmopathy. He was euthyroid as reflected by normal TSH concentration, whereas the results of a T3 suppression test established the presence of autonomous thyroid function. A thyroid scan with (123)I revealed a hot nodule corresponding to the location of a papillary carcinoma and remained substantially unchanged after T3 administration. The hyperfunction of the carcinoma itself was clearly confirmed by the intense concentration of (131)I within the tumor on microautoradiograms. While a hot nodule on radioiodine scan is unlikely to be malignant, the possibility of carcinoma should not be overlooked.     

An unusual cystic appearance of disseminated low-grade gliomas

We report five cases of pediatric disseminated low-grade gliomas of the brainstem or spinal cord that exhibited an unusual, cystic pattern. Leptomeningeal disease was present in three of these at diagnosis, and was detected shortly afterwards in the other two. Four patients are alive up to 5 years later, following minimal to no intervention, while one is dead. Received: 4 February 2001/Accepted: 13 February 2001     

Benign pleomorphic adenoma with extensive cystic degeneration: unusual MR findings in two cases

Two cases of benign pleomorphic adenoma (PA) with extensive cystic degeneration are described. In both cases magnetic resonance (MR) imaging revealed entirely cystic tumors with an irregularity at the cyst wall. Some additional findings were observed: one case showed layering within the cyst contents caused by intratumoral hemorrhage, and the other had a small mural nodule at the cyst wall that showed very low intensity on both T1- and T2-weighted images and corresponded pathologically to the hyaline stroma. In both cases, preoperative diagnosis was difficult based on the MR findings alone. Benign PA should be included in the differential diagnosis of an entirely cystic parotid mass.     

Association of parathyroid adenoma and autonomous nodule of the thyroid. Diagnostic efficacy of 201thallium-99mtechnetium scintigraphy

The thallium-technetium subtraction technique, proposed originally by Ferlin and co-workers, is now widely used to localize parathyroid adenoma. We report here the case of a hypercalcemic woman, referred to our ward with the biologically assessed diagnosis of primary hyperparathyroidism. Thallium-technetium subtraction scintigraphy not only successfully localized the parathyroid adenoma but also revealed the existence of an autonomous nodule of the thyroid, which was not suspected. It has previously been shown that this method can localize parathyroid adenoma in cases of cold thyroid nodule. This report shows that this is also true in the case of hot thyroid nodule. No observations of concomitant parathyroid adenoma and autonomous nodule of the thyroid have been reported (at least during the two past decades). Is this association casual or has it never been noticed? Further examinations can be performed with thallium when a hot thyroid nodule is found in a hypercalcemic patient.     

Association of parathyroid adenoma and autonomous nodule of the thyroid. Diagnostic efficacy of 201thallium-99mtechnetium scintigraphy

The thallium-technetium subtraction technique, proposed originally by Ferlin and co-workers, is now widely used to localize parathyroid adenoma. We report here the case of a hypercalcemic woman, referred to our ward with the biologically assessed diagnosis of primary hyperparathyroidism. Thallium-technetium subtraction scintigraphy not only successfully localized the parathyroid adenoma but also revealed the existence of an autonomous nodule of the thyroid, which was not suspected. It has previously been shown that this method can localize parathyroid adenoma in cases of cold thyroid nodule. This report shows that this is also true in the case of hot thyroid nodule. No observations of concomitant parathyroid adenoma and autonomous nodule of the thyroid have been reported (at least during the two past decades). Is this association casual or has it never been noticed? Further examinations can be performed with thallium when a hot thyroid nodule is found in a hypercalcemic patient.     

Imaging features of unusual intracranial cystic meningiomas.

OBJECTIVE: To describe the imaging features of unusual intracranial cystic meningiomas in infants and adults. METHODS: We retrospectively reviewed the magnetic resonance and computed tomography findings for 2 female patients and 3 male patients, ranging in age from 1 to 73 years (median 41 years), with histopathologically proven cystic meningioma. RESULT: Although cystic meningiomas usually appear as solid and cystic masses, they may present as a mainly multicystic lesion. The wall of a cystic part of the meningioma may include both enhancing and unenhancing areas at imaging. The cystic portion of a meningioma is hypointense on diffusion-weighted images and markedly hyperintense on corresponding apparent diffusion coefficient maps. CONCLUSION: Cystic meningiomas may vary in appearance at imaging. They can be very challenging when present in infants. Knowledge of imaging findings and awareness of variability in the differential diagnosis can help to avoid preoperative diagnostic pitfalls.     

An unusual injury.

The case of a young man who died unexpectedly from myocarditis is presented. The body was partially embalmed before autopsy at the Victorian Institute of Forensic Pathology. Although the cause of death was not a problem to diagnose, this case highlights artefacts that embalming may cause and the difficulties it may create with interpretation of injury. This is of particular relevance to those forensic pathologists who only uncommonly see injuries which are due to embalming.     

Use of the thyroid 99Tcm scintiscan with lead-shield on the hot nodule in the diagnosis of autonomous adenoma

Eighteen patients bearing a hot nodule, imaged by basal 99Tcm scintiscan and toxic in eight of them, were studied. All patients underwent 99Tcm thyroid scintiscan in basal conditions and after placing a lead-shield on the hot thyroid nodule, without other radioisotope administration. In eight cases the thyroid scintiscan after lead-shield overlapping the hot nodule, was compared to a second 99Tcm thyroid scintiscan after thyrotrophic hormone stimulation, TSH. This technique of nodule shielding was able to show the extranodular tissue in 15 patients; in the remaining three cases neither this approach nor the scintiscan after exogenous TSH were able to demonstrate any remainder thyroid parenchyma. Thus, this scintigraphic method can be considered excellent in the diagnosis of autonomous adenoma: it needs, in fact, a single radioisotope administration and does not present the adverse effects frequently induced by exogenous TSH.     

Dysphagia revealing a giant cystic parathyroid adenoma

The aim of this observation was to report a rare case of symptomatic and non-functional cystic parathyroid adenoma in a 52-year-old female, diagnosed with imaging and treated by surgical resection of the gland.