Thyroid carcinoma in patients with familial adenomatous polyposis

There has been a growing awareness of the association between papillary thyroid carcinoma and familial adenomatous polyposis (FAP). The cases of four young patients with papillary thyroid carcinoma occurring with FAP are presented. Three patients underwent surgery to provide specimens for detailed histological examination. The surgical specimens showed well-encapsulated multicentric tumours exhibiting a predominantly papillary architectural growth pattern. In some areas, follicular architecture and cribriform patterns were noted. Atypical areas of spindle cells in a trabecular or solid configuration, which are not normally seen in classical papillary thyroid carcinoma, were evident. Malignant cells exhibited a graduation of cuboidal to tall cells with abundant amphophilic cytoplasm. The nuclei did not exhibit the typical nuclear clearing as seen in papillary thyroid carcinoma, but nuclear grooving and inclusions were noted. Psammoma bodies were not seen in any of the specimens. In a limited review of these patients, features such as young age at presentation, multicentricity and unusual histology suggest that thyroid carcinoma associated with FAP may represent a distinct form of thyroid cancer.     

Traumatic optic neuropathy: a review of 24 patients

AIM: To evaluate the clinical presentations of traumatic optic neuropathy and to assess the visual outcome of three groups of patients managed differently (conservative, intravenous corticosteroids only and combination of intravenous and oral corticosteroids) at an academic tertiary care referral centre. METHODS: A retrospective study was conducted involving 24 consecutive patients (27 eyes) with traumatic optic neuropathy attending Hospital Universiti Sains Malaysia from January 2007 till December 2009. RESULTS: Twenty-four patients (27 eyes) were included. All cases involved were males. Mean age was 33 years old. Motor vehicle accident was the major cause (83.3%). Both eyes were equally involved. Most of the eyes had poor vision on presentation (HM-NPL, 81.5%) with associated periorbital haematoma (22 eyes) and subconjunctival haemorrhage (20 eyes). Majority of patients (19 patients, 79.2%) presented with more than one bony fracture of skull or orbit and 5 patients (20.8%) had no fractures. None of the patients had evidence of optic nerve compression on CT scans or MRI done. Eleven patients (45.8%) had been treated with intravenous and oral corticosteroids. The other 7 patients (29.2%) were treated conservatively and the third group (6 patients, 25.0%) was on intravenous corticosteroids only. Eleven of 12 eyes (91.7%) treated with intravenous and oral corticosteroids had shown 1 line improvement of visual acuity. Those eyes treated conservatively (77.8%) had shown 1 line improvement of visual acuity. As for patients treated with intravenous corticosteroids only, four patients remained NPL, one patient had mild visual improvement and the other one's vision remained the same. The visual improvement in patients treated with conservative management was not significant (P=0.386). Patients treated with intravenous corticosteroids alone have shown no visual improvement statistically(P<0.05). Patients treated with intravenous followed by oral corticosteroids had significant visual improvement (P<0.05). There was no statistically significant difference in visual outcome between patients treated with corticosteroids and patients treated conservatively (P=0.368). No patient underwent surgical decompression of the optic nerve. In this series, the follow up ranges from 6 months to 3 years. CONCLUSION: Most of the traumatic optic neuropathy patients presented with periorbital haematoma, subconjunctival haemorrhage and orbital wall fractures. Patients treated with intravenous followed by oral corticosteroids have better visual outcome compared to conservative management.     

Xanthogranulomatous pyelonephritis. A report of two cases

Xanthogranulomatous pyelonephritis is a rare form of chronic pyelonephritis affecting adults and children. Two patients with the disease are reported.     

Arteriovenous malformation of the stomach: a rare cause of upper gastrointestinal bleeding

Haemorrhage arising from gastric arteriovenous malformation (AVM) is rare and normally occurs in the elderly. Bleeding gastric AVM presenting in the younger age group is even rarer. We report a case of a 14 year old boy who presented with recurrent episodes of haematemesis. He subsequently underwent a proximal gastrectomy and the histological examination confirmed a gastric AVM. After reviewing the literature we believe this is the youngest ever reported case of bleeding gastric AVM reported in English literature.     

Prospective study comparing scrape cytology with frozen section in the intraoperative identification of parathyroid tissue

OBJECTIVE: Intraoperative identification of parathyroid tissue is crucial during parathyroid surgery. Frozen section is the most common tool, but is time-consuming and expensive. Scrape cytology is a modification of imprint cytology that provides rapid and cheap intraoperative identification of parathyroid tissue, but its reliability remains controversial. We assessed the sensitivity and specificity of scrape cytology in the intraoperative identification of parathyroid tissue. METHODS: Scrape cytology samples from parathyroid tissue (n=29), adipose tissue (n=3) and thyroid tissue (n=2) were prepared intraoperatively using May-Grünwald-Giemsa and Papanicolaou staining and subsequently sent for routine frozen section and standard paraffin section. A single pathologist reading the scrape cytology was blinded to the results of the frozen and standard paraffin sections. RESULTS: Scrape cytology identified 25 of 29 parathyroid tissues, all three adipose tissues and one of two thyroid tissues. The remaining samples, four parathyroid tissues and one thyroid tissue, were not identified due to insufficient sample for diagnosis. The result translated to give a diagnostic accuracy of 88.2%, sensitivity of 86%, and specificity of 100%. All tissues were accurately identified by frozen section. CONCLUSION: Scrape cytology is a rapid, economical test with acceptable sensitivity and high specificity. It can be used as an adjunct to frozen section and may be used as a tool in helping surgeons to identify parathyroid tissue.