The atypia of undetermined significance/follicular lesion of undetermined significance:malignant ratio: a proposed performance measure for reporting in The Bethesda System for thyroid cytopathology

BACKGROUND:

The Bethesda System (TBS) for reporting thyroid cytopathology introduced the atypia of undetermined significance/follicular lesion of undetermined significance (AUS) category, but did not provide adequate guidance for the appropriate use of this diagnosis. In the current study, the authors sought to identify an appropriate measure for AUS use based on experience to date with TBS.

METHODS:

The authors reviewed 8 series, including their own laboratory experiences, with a total of 30,466 thyroid aspirates classified within TBS.

RESULTS:

The median AUS rate was 9.9% with a range of 3.0% to 18.0%. Use of the individual diagnostic categories within TBS varied up to 12.7‐fold. The ratio of “suspicious for follicular neoplasm” plus “suspicious for malignancy” to “malignant” (M) diagnoses varied the least (1.8‐fold). The AUS:M ratio provided a suitable measure of assessing AUS use, with a median ratio of 2.0 and a range of 0.5 to 4.9.

CONCLUSIONS:

Based on available studies, an AUS:M ratio of 1.0 to 3.0 is recommended. AUS:M ratios > 3.0 are likely because of overdiagnosis of AUS or underdiagnosis of M. AUS:M ratios < 1.0 are mostly due to low AUS rates, at the likely expense of sensitivity. Cancer (Cancer Cytopathol) 2012;. © 2011 American Cancer Society.     

Castleman disease presenting in the neck: Report of a case and review of the literature

Castleman disease is a rare lymphoproliferative disorder with two primary subtypes that vary in presentation and course. Unicentric Castleman disease (UCD) presents as a solitary mass, most commonly in the mediastinum, and rarely in the head and neck. In contrast to multicentric Castleman disease (MCD), which features peripheral lymphadenopathy and numerous systemic symptoms, UCD is not typically associated with generalized symptoms. Here, we present an unusual case of UCD presenting as a slowly expanding, isolated neck mass in a 29-year-old woman. This case demonstrates the distinguishing clinical, radiologic, and histologic findings unique to UCD, which is often misdiagnosed as lymphoma or other malignant process. These findings stand in contrast to those observed in MCD patients, and hence, offer insight into the practical aspects of diagnosis and management of Castleman disease in the head and neck.     

Immunohistochemical distinction of intestinal-type sinonasal adenocarcinoma from metastatic adenocarcinoma of intestinal origin

OBJECTIVES: Distinction of intestinal-type sinonasal adenocarcinoma (ITAC) from adenocarcinoma of intestinal origin metastatic to the sinonasal cavity may be extremely difficult on histologic grounds alone. We studied the role of cytokeratin (CK) and mucin (MUC) expression in differentiating ITAC, metastatic adenocarcinoma of intestinal origin, and non-intestinal-type sinonasal adenocarcinoma (non-ITAC). METHODS: We stained specimens from 5 cases of ITAC and 4 cases of non-ITAC, along with 4 colonic and 3 duodenal adenocarcinoma controls, with CK7 and CK20, MUC2 and MUC5, neuron-specific enolase (NSE), chromogranin (CHR), and carcinoembryonic antigen (CEA) in order to examine the possible combinations of markers that best aid in the diagnosis of these lesions. We also performed a retrospective review of our clinical experience with these rare lesions. RESULTS: CK7 staining was positive in all ITAC and non-ITAC cases, whereas all cases displaying gastrointestinal-type differentiation (ITAC and metastatic intestinal cases) stained positive for both CK20 and MUC2. Staining for MUC5, NSE, CHR, and CEA was variable. CONCLUSIONS: Tumors with the CK7+, CK20+, MUC2+ immunophenotype are likely primary sinonasal lesions, whereas tumors with the CK7-, CK20+, MUC2+ profile warrant further clinical evaluation to exclude metastatic disease from the gastrointestinal tract. Complete surgical resection of ITAC remains the mainstay of therapy.     

1-取代吡唑烷酮类抗惊构效关系的研究

1-正癸基吡唑烷-3-酮(Ⅱ结构式见表1)是欧洲专利报道的一种新型减肥剂。White等报道该化合物可通过血脑屏障,并对γ-氨基丁酸氨基转移酶(GABA-T)有强烈的抑制活性,但对谷氨酸脱羧酶的抑制作用较弱,因此可引起脑内γ-氨基丁酸(GABA)水平的升高,故我们相信应有抗惊活性。经我们合成后,发现Ⅱ确有良好的抗癲痫活性,抗小鼠最大电     

Nitrogen-Containing Bisphosphonates Are Associated With Reduced Risk of Pneumonia in Patients With Hip Fracture

The objective of this work was to study the risk of pneumonia and pneumonia mortality among patients receiving nitrogen-containing bisphosphonates (N-BPs), non-N-BP anti-osteoporosis medications, and no anti-osteoporosis medications after hip fracture. We studied a historical cohort using a population-wide database. Patients with first hip fracture during 2005–2015 were identified and matched by time-dependent propensity score. The cohort was followed until December 31, 2016, to capture any pneumonia and pneumonia mortality. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox-proportional hazards regression. Absolute risk difference (ARD) and number needed to treat (NNT) were calculated. We identified 54,047 patients with hip fracture. Of these, 4041 patients who received N-BPs and 11,802 without anti-osteoporosis medication were propensity score–matched. N-BPs were associated with a significantly lower risk of pneumonia compared with no treatment (6.9 versus 9.0 per 100 person-years; HR 0.76; 95% CI, 0.70 to 0.83), resulting in an ARD of 0.02 and NNT of 46. A similar association was observed with pneumonia mortality (HR 0.65; 95% CI, 0.56 to 0.75). When N-BPs were compared with non-N-BP anti-osteoporosis medications, the association remained significant. N-BPs were associated with lower risks of pneumonia and pneumonia mortality. Randomized controlled trials are now required to determine whether N-BPs, non–vaccine-based medications, can reduce pneumonia incidence in high risk groups. © 2020 American Society for Bone and Mineral Research.