Medullary thyroid carcinoma,follicular variant

We report here a 48-yr-old woman presenting with a solitary thyroid nodule in the left lobe of the thyroid. The aspiration cytology of the nodule was reported as follicular neoplasia and she underwent surgery. Frozen section was suspicious for medullary thyroid carcinoma and a total thyroidectomy was performed. The pathology report revealed medullary thyroid carcinoma, follicular variant. Immunohistochemical analysis was negative for thyroglobulin and positive for calcitonin. A few patients with this variant have been reported in the literature, mainly diagnosed by immunohistochemical features of the tumor. In light of the limited information we have obtained from the literature, it is reasonable to emphasize that these cases should be distinguished from the mixed medullary-follicular thyroid carcinomas and medullary carcinomas with entrapped follicles. Immunohistochemical examination with calcitonin and thyroglobulin is also essential.     

Clinical importance of vascular endothelial growth factor (VEGF) for papillary thyroid carcinomas

Vascular endothelial growth factor (VEGF) is a major regulator of angiogenesis and may be produced by some cancer cells. Several recent reports have documented that increased expression of VEGF is associated with risk of recurrence or decreased recurrence-free survival in papillary thyroid cancers (PTC). The aims of this study were to determine whether immunohistochemical expression of VEGF is related to local and distant recurrence of PTC and to evaluate the relationship between hypervascularization and VEGF expression in papillary thyroid carcinomas. VEGF expression was examined immunohistochemically in 48 papillary carcinomas. Ten normal thyroids were used as controls. Patients were followed for 61.7 (range 24-143) months. Twelve of the patients had local and distant recurrences. VEGF immunostaining, blinded for clinicopathological data, was evaluated semiquantitatively by two pathologists. The difference between the recurrent (n:12) and nonrecurrent (n:36) carcinomas was statistically significant (p:0.001). VEGF expression was also stronger in papillary thyroid carcinomas than in normal thyroid tissues. The mean microvascular densities were significantly higher than in normal thyroid tissues. These data indicate that VEGF staining is strongly associated with increased frequency of local and distant recurrence in PTC and that the immunohistochemical profile of the expression may be used as a marker for predicting which tumors have metastatic potential.     

Primary breast lymphoma cytologic diagnosis

Primary non-Hodgkin lymphoma of the breast is a rare pathology, and bilateral involvement is exceptional. We report a case of bilateral primary non-Hodgkin lymphoma of the breast in a 40-year-old woman. Predominantly atypical lymphocytes and rare plasma cells were found in the microscopic evaluation of the fine-needle aspiration biopsy of the right and left breasts. Microscopic findings of the incisional biopsy of the left breast were in accordance with non-Hodgkin diffuse large B-cell lymphoma. The patient received systemic chemotherapy and is alive with no evidence of recurrence for 2 years.     

Pseudomass of the sternal manubrium in osteogenesis imperfecta

Skeletal abnormalities such as hypertrophic callus formation and "popcorn" calcifications are rare radiological findings of osteogenesis imperfecta, causing tumor-like appearances on imaging. We report on a 7-year-old girl with osteogenesis imperfecta presenting with hepatomegaly and palpable lymphadenopathy in the left inguinal region on physical examination. Computed tomography examination revealed a high-density mass-like lesion of the manubrium sterni. Ultrasonography and a lateral roentgenogram of the chest verified that this was a pseudomass caused by a bowed sternal manubrium.     

A transmission electron microscope investigation of the effect of lead acetate on the hepatopancreatic ceca of Gammarus pulex

The freshwater Amphipod Gammarus pulex is a sensitive indicator organism for environmental contamination. In this study, effects of heavy metal lead acetate were investigated by using electron microscopy techniques. Control group was not expose to lead acetate but experimental group was for 96 h. The ultrastructural changes of hepatopancreatic ceca cells were studied in these two groups by electron microscopy techniques analysing cellular structure, structure of organelles and vacuolization. The number of cells based on the toxic effects of lead acetate was increased compared with the control group. The number and length of cell microvilli was decreased. Additionally degenerated mitocondria, dilation of golgi vesicules and cytoplasmic vacuolization were observed. The results of present study suggest that the exposure to the lead acetate may cause some ultrastructural changes on hepatopancreatic ceca of digestive system in Gammarus pulex. The significance of this change in terms of environmental toxicology needs to be further studied.     

Effect of using endorectal coil in preoperative staging of rectal carcinomas by pelvic MR imaging

PURPOSE: To assess the accuracy of magnetic resonance imaging with pelvic phased-array and endorectal coils prospectively, and evaluate if endorectal coil provides any additional information to high resolution pelvic MR imaging in rectal carcinoma staging. MATERIALS AND METHODS: Preoperative MRI of 25 patients with rectal carcinoma was performed with pelvic phased-array coil alone, and with both phased-array coil and endorectal coil placed. Staging was made by evaluating images obtained by using both coils prospectively, and correlated with histopathologic staging. The images were then assessed separately, and compared to each other retrospectively. RESULTS: Two and 3 of the 5 histopathologically proved T1 tumors were staged correctly on MRI with pelvic phased-array coil alone and after the endorectal coil placement, respectively. Histopathologically identified five T2 tumors were staged correctly as T2 in 4 of the cases, 1 was understaged and 10 of 14 patients who had T3 tumor were staged as T3, 4 of them were understaged as T2 on both techniques. Specificity, sensitivity and accuracy rates for staging of T3 tumors were found as 71%, 100% and 84%, respectively, for each technique. Sensitivity and positive predictive value of N staging were both 88% on both techniques. CONCLUSION: Pelvic MR imaging after the placement of endorectal coil in addition to the phase-array coil was not superior to the imaging with phased-array coil alone in T staging of rectal carcinomas and the latter achieved better visualization of the lymph nodes by means of larger field of view.     

The comparison between self-expanding and balloon expandable stent results in left anterior descending artery

The first Wallstent results had high thrombosis and death. It was reported that the left anterior descending (LAD) artery was the vessel implicated in major complications that occurred in patients who received a Wallstent. Subsequently, Wallstent applications were refrained from with LAD lesions. However, the promising results of second-generation self-expanding Magic Wallstent implantation have been reported recently. The purpose of this study is to assess the immediate and intermediate clinical outcomes of patients undergoing self-expanding Magic Wallstent implantation at the LAD site and to compare those outcomes with those of a similar group of patients undergoing balloon expandable stenting at the same site. Between 1995 and 1999, 255 consecutive patients underwent LAD stenting at our center. The study population was divided into two groups based on the mode of delivery (self-expanding versus balloon-expandable) of stent design. Group I included 97 patients in whom self-expanding Magic Wallstents were implanted. Group II included 158 patients in whom various types of balloon-expandable stents were implanted. Procedural success was defined as successful deployment of the stent in the absence of adverse cardiac events (death, acute myocardial infarction, emergency coronary bypass surgery). Clinical success was defined as the absence of adverse cardiac events (death, acute myocardial infarction, emergency coronary bypass surgery, repeat balloon angioplasty) within the first two weeks. The mean follow-up period was 8 ± 5.3 months for Group I and 9.8 ± 7.5 months for Group II. There was no difference in baseline characteristics between the two groups. Fourteen patients in Group I and 22 patients in Group II had bailout procedures. The number of patients with reference vessel diameter less than 3 mm was 37 in Group I and 60 in Group II. The stent length was greater in Group I than in Group II (p=0.0003). In Group I, stenting improved minimal lumen diameter (MLD) from 0.65 ± 0.4 mm to 2.35 ± 0.4 and percent diameter stenosis (PDS) from 76.24 ± 17.3 to 22.78 ± 13.6. In Group II, stenting improved MLD from 0.73 ± 0.4 mm to 2.49 ± 0.5 and PDS from 76.71 ± 15.5 to 18.99 ± 9.6. Final MLD and final PDS improved more in Group II than Group I. Stent could not be delivered in three patients in Group I and nine in Group II. In Group II, six stents were dislocated from its delivery system. Procedural and clinical success and subacute stent thrombosis rates were 93.8%, 85.6%, and 7.2% in Group I, and 93%, 86.7%, and 5.1% in Group II, respectively. Within the first two weeks, death occurred in one patient in each group, acute myocardial infarction in four (Group I) and two (Group II) patients; coronary bypass surgery in three (Group I) and five (Group II) patients, and balloon angioplasty in two (Group I) and four (Group II) patients, respectively. In Group I, following the first two weeks, no patients died, two patients had nonfatal myocardial infarction, and coronary bypass surgery and target vessel repeat balloon angioplasty was required in five and ten patients, respectively. In Group II, one patient died in the follow-up period, there was no nonfatal myocardial infarction, and bypass surgery and target vessel repeat balloon angioplasties were required in three and eleven patients, respectively. None of these differences in clinical events was statically significant. We found that self-expanding Magic Wallstent implantation can be performed in LAD lesions and was associated with a rate of early clinical results and intermediate term clinical results similar to that of balloon-expandable stents in LAD arteries. In conclusion, the Magic Wallstent may confidently be used for LAD lesions.     

Coarctation of Persistent 5th Aortic Arch: First Report of Catheter-Based Intervention

Persistent 5th aortic arch, originally called double-lumen aortic arch, is a rarely reported cardiac developmental anomaly that results in systemic-to-systemic or systemic-to-pulmonary shunting. When this malformation occurs, other intracardiac defects are almost always present. We report the case of a 7-month-old girl who presented with a heart murmur; she was found to have an interrupted 4th aortic arch and coarctation of a persistent 5th aortic arch, with no other defects. To our knowledge, this is the 3rd report of a pediatric patient with this condition in isolation, and the first report of its diagnosis and treatment by means of cardiac catheterization and balloon angioplasty.