RESUMEN
INTRODUCTION: Riedel´s thyroiditis is a thyroid inflammation with invasive fibrosis. CASE REPORT: Female 84 years old, studied by dysphagia to liquids and dysphonia, with cervical mass poorly demarcated and immobile. Computed Tomography (CT) (CT) showed tumor that diverted the trachea and esophagus compressed. Fine Needle Aspiration (FNA) obtained cells with atypia. Thyroidectomy was performed, appreciating a stony tumor which included the right recurrent laryngeal nerve. Given the high suspicion of thyroid malignancy tracheostomy it was performed. The pathology report as fibrosing Riedel thyroiditis. DISCUSSION: This is the less common type of chronic thyroiditis. Etiology is unknown. The normal thyroid parenchyma is replaced by fibrous connective tissue. Clinically usually a hard mass, fast growing, why is confused with thyroid carcinoma and Hashimoto's thyroiditis. It´ss more common in women and is usually bilateral. The CT or MRI (Magnetic Resonance Imaging) help assess the extent. Puncturing the mass could give us the diagnosis but is often difficult. Treatment to relieve symptoms or rule out malignancy is surgery. The prognosis is usually good. CONCLUSIONS: Riedel´s thyroiditis is an entity with histopathologic diagnosis essential
Asunto(s)
Humanos , Tiroiditis/patología , Neoplasias de la Tiroides/diagnóstico , Carcinoma Anaplásico de Tiroides/diagnóstico , Tiroidectomía , Tiroiditis/cirugía , Tiroiditis/patología , Tomografía Computarizada por Rayos X , Diagnóstico DiferencialRESUMEN
OBJECTIVE: To assess performance of TIRADS classification on a prospective surgical cohort, demonstrating its clinical usefulness. METHODS: Between June 2009 and October 2012, patients assessed with pre-operative ultrasound (US) were included in this IRB-approved study. Nodules were categorised according to our previously described TIRADS classification. Final pathological diagnosis was obtained from the thyroidectomy specimen. Sensitivity, specificity, positive/negative predictive values and likelihood ratios were calculated. RESULTS: The study included 210 patients with 502 nodules (average: 2.39 (±1.64) nodules/patient). Median size was 7 mm (3-60 mm). Malignancy was 0 % (0/116) in TIRADS 2, 1.79 % (1/56) in TIRADS 3, 76.13 % (185/243) in TIRADS 4 [subgroups: TIRADS 4A 5.88 % (1/17), TIRADS 4B 62.82 % (49/78), TIRADS 4C 91.22 % (135/148)], and 98.85 % (86/87) in TIRADS 5. With a cut-off point at TIRADS 4-5 to perform FNAB, we obtained: sensitivity 99.6 % (95 % CI: 98.9-100.0), specificity 74.35 % (95 % CI: 68.7-80.0), PPV 82.1 % (95 % CI: 78.0-86.3), NPV 99.4 % (95 % CI: 98.3-100.0), PLR 3.9 (95 % CI: 3.6-4.2) and an NLR 0.005 (95 % CI: 0.003-0.04) for malignancy. CONCLUSION: US-based TIRADS classification allows selection of nodules requiring FNAB and recognition of those with a low malignancy risk. KEY POINTS: ⢠TIRADS classification allows accurate selection of thyroid nodules requiring biopsy (TIRADS 4-5). ⢠The recognition of benign/possibly benign patterns can avoid unnecessary procedures. ⢠This classification and its sonographic patterns are validated using surgical specimens.
Asunto(s)
Enfermedad de Hashimoto/diagnóstico por imagen , Nódulo Tiroideo/diagnóstico por imagen , Tiroiditis/diagnóstico por imagen , Adulto , Anciano , Biopsia/métodos , Biopsia con Aguja Fina/métodos , Femenino , Enfermedad de Hashimoto/patología , Enfermedad de Hashimoto/cirugía , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Medición de Riesgo , Sensibilidad y Especificidad , Neoplasias de la Tiroides/patología , Nódulo Tiroideo/patología , Nódulo Tiroideo/cirugía , Tiroidectomía/métodos , Tiroiditis/patología , Tiroiditis/cirugía , Ultrasonografía , Procedimientos InnecesariosRESUMEN
Introducción: la labor decisiva de la citología en la evaluación prequirúrgica del nódulo tiroideo ha promovido cada vez más la aplicación del sistema de Bethesda en el diagnóstico de la biopsia por aguja fina de esta glándula por las ventajas que ofrece, lo cual constituyó el motivo para realizar el presente trabajo. Objetivos: evaluar la utilización del sistema de Bethesda en la citología con aguja fina de tiroides en el Hospital Universitario Clínico Quirúrgico Cmdte. Faustino Pérez Hernández, de Matanzas, y determinar la correlación citológico-ultrasonográfica. Métodos: se realizó un trabajo retrospectivo, descriptivo, aplicado a las biopsias por aguja fina del tiroides del año 2012, a las que se le aplicó en su diagnóstico el sistema Bethesda, y se relacionaron sus resultados con los ultrasonográficos a 652 casos, que constituyeron el universo de estudio.Resultados: de 1 516 citologías realizadas en la consulta de biopsia por aguja fina, 652 correspondieron al tiroides, lo que representó el 43 % del total, siendo la mayoría en el sexo femenino, con 605 casos. El grupo de edad predominante fue el de 40-49 años, para un 31,29 por ciento. La clase II de Bethesda fue la más representada, con 536 casos (82,2 por ciento), y existió pobre correlación entre los resultados citológicos y la descripción ultrasonográfica. Conclusiones: la aplicacion del sistema de Bethesda en la biopsia por aguja fina tiroidea es de gran utilidad en el diagnóstico preoperatorio, y es importante una buena descripción ultrasonográfica en aras de mejorar el diagnóstico citológico y disminuir en casos innecesarios la realización de este proceder(AU)
Background: the decisive task of cytology in the pre-surgical evaluation of the thyroidal nodule has promoted more and more the application of the Bethesda system in this glandule diagnosis by fine needle biopsy because of the advantages it offers, being the motive of the present term.Aim: to evaluate the Bethesda system usage in thyroids cytology with fine needle in the University Clinical Surgical Hospital Comandante Faustino Pérez, of Matanzas, and to determine cytological-ultrasonographic correlation. Methods: we carried out a retrospective, descriptive study of the thyroids fine needle biopsies of 2012 where the Bethesda system diagnosis was used; their results were related with the ultrasonographic ones in 652 cases who formed the universe of study.Outcomes: 652 of the 1 516 cytologies carried out in the consultation of fine needle biopsy were thyroidal ones, representing 43 % of the total, being most of the patients female ones, with 605 cases. The predominant age group was the one grouping people aged 40-49 years, for 31,29 percent. Class II Bethesda was the most represented, with 536 cases (82,2 percent), and there it was a poor correlation between cytological results and ultrasonographic description. Conclusions: the application of Bethesda system in the thyroidal fine needle biopsy is very useful in pre-surgery diagnosis; it is also important a good ultrasonographic description for the sake of improving cytological diagnosis and avoiding carrying out this procedure in unnecessary cases(AU)
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Biopsia con Aguja Fina/métodos , Glándula Tiroides/patología , Carcinoma Papilar/patología , Bocio/patología , Tiroiditis/patología , Epidemiología Descriptiva , Estudios RetrospectivosRESUMEN
BACKGROUND: Fine-needle aspiration (FNA) for thyroid nodules is the most important method for determining a diagnosis. The system for reporting results is based on a cytopathologic classification that stratifies the risk of malignancy. METHODS: We retrospectively studied 197 patients who underwent FNA for diagnostic evaluation of a thyroid nodule and had their results reported as a follicular lesion of undetermined significance (FLUS) using the Bethesda classification system. The objective of the study was to analyze the incidence and histopathologic types of malignancy in these cases. RESULTS: The final histopathologic breakdown is as follows: 65 cases (32.9%) of follicular adenoma, 81 cases (41.1%) of microfollicular adenomatoid nodule, 19 cases (9.6%) of microfollicular adenomatoid nodule on the background of thyroiditis, 17 cases (8.6%) of follicular carcinoma, 9 cases (4.6%) of follicular variant papillary carcinoma, and 6 cases (3.1%) of classic papillary carcinoma, for a 16.2% incidence of malignancy. Beyond these diagnoses in the FNA-biopsied nodules, we observed 29 cases (14.7%) of incidental ipsilateral papillary thyroid microcarcinoma (PTM) and 13 cases (6.6%) of incidental contralateral thyroid lobe PTM. CONCLUSIONS: This study observed a 16.2% incidence of thyroid cancer in the nodule designated FLUS compared to the 5 to 15% rate reported by the Bethesda FNA classification. The overall incidence of incidental PTM in the thyroid gland was 21.3%. These data support considering surgical intervention for at least diagnostic purposes in a patient with the FNAB diagnosis of FLUS.
Asunto(s)
Adenoma/patología , Técnicas de Apoyo para la Decisión , Neoplasias de la Tiroides/patología , Nódulo Tiroideo/patología , Adenoma/epidemiología , Adenoma/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Biopsia con Aguja Fina , Carcinoma , Carcinoma Papilar/epidemiología , Carcinoma Papilar/patología , Carcinoma Papilar/cirugía , Femenino , Humanos , Incidencia , Hallazgos Incidentales , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Medición de Riesgo , Cáncer Papilar Tiroideo , Neoplasias de la Tiroides/epidemiología , Neoplasias de la Tiroides/cirugía , Nódulo Tiroideo/clasificación , Nódulo Tiroideo/epidemiología , Nódulo Tiroideo/cirugía , Tiroidectomía , Tiroiditis/epidemiología , Tiroiditis/patología , Tiroiditis/cirugíaRESUMEN
La disfunción tiroidea es una observación común en el curso evolutivo de las tiroiditis. En las fases avanzadas de la tiroiditis crónica autoinmune es muy frecuente el hallazgo de hipotiroidismo clínico o subclínico, como consecuencia del reemplazo glandular por la fibrosis y atrofia resultantes. El hipotiroidismo permanente también es una secuela común en la tiroiditis silente y poco frecuente en la tiroiditis subaguda. Por otra parte, se conoce como tiroiditis destructiva, al proceso inflamatorio tiroideo acompañado de destrucción del epitelio glandular y tirotoxicosis transitoria, que usualmente ocurre en los primeros meses de evolución de las tiroiditis subaguda y silente o, en un porcentaje menor, durante el curso de la tiroiditis crónica autoinmune. Desórdenes que tienen diferente patogénesis, como, la tiroiditis subaguda, vinculada con las infecciones virales, o las tiroiditis silente o posparto y la enfermedad de Hashimoto, reconocidos procesos autoinmunes, son responsables de fenómenos fisiopatológicos similares que dan origen a la tiroiditis bifásica. De manera característica, estos casos desarrollan secuencialmente, tirotoxicosis pasajera que va seguida de hipotiroidismo transitorio y recuperación. En dos muestras venezolanas, la tirotoxicosis pasajera y el hipotiroidismo transitorio con el patrón de la tiroiditis bifásica se observó, respectivamente, en 86 % y 27 % de los casos de tiroiditis subaguda y, el patrón bifásico, en los cuatro casos de tiroiditis silente o posparto. En la muestra de tiroiditis crónica autoinmune, no se observó ningún caso de tiroiditis bifásica. Los mecanismos fisiopatológicos de la tiroiditis bifásica son consecuencia directa de la inflamación tiroidea y la autoinmunidad, que también implica a los anticuerpos estimulantes o bloqueadores del receptor de la hormona estimulante de la tiroides.
La observación de este patrón funcional y su reversibilidad, constituye indudablemente un comportamiento sui generis en las enfermedades de las glándulas endocrinas, en las que hiper o hipofunción espontáneas, suelen ocurrir aislada y permanentemente. Por eso, parece justificado presentar sendos casos típicos de tiroiditis subaguda, silente y crónica autoinmune, en los cuales, el patrón de la tiroiditis bifásica fue el hallazgo más relevante de su evolución clínica.
Thyroid dysfunction is commonly observed in the clinical course of thyroiditis. Clinical or subclinical hypothyroidism frequently occurred in chronic autoimmune thyroiditis as a consequence of progressive glandular replacement by fibrosis and atrophy. Also, permanent hypothyroidism is a common sequel of silent thyroiditis, unusual in subacute thyroiditis. Thyroid inflammatory process associated to destruction of glandular epithelium and transitory thyrotoxicosis is known as destructive thyroiditis, which frequently occurred in the first months of subacute or silent thyroiditis evolution or, in a little percentage, during the course of chronic autoimmune thyroiditis. Disorders with different pathogenesis, as subacute thyroiditis which is entailed with viral infections or, silent-postpartum or chronic autoimmune thyroiditis, known autoimmune diseases, are responsible of similarly pathophysiological phenomena which originated biphasic thyroiditis. Characteristically, these cases developed sequentially transitory thyrotoxicosis, which is followed by transient hypothyroidism and recovery. In two Venezuelan samples, transitory thyrotoxicosis and hypothyroidism with biphasic patron were observed, respectively, in 86 % and 27 % of thyroiditis subacute cases and, the biphasic patron, in the four cases with silent or postpartum thyroiditis. In the sample of chronic autoimmune thyroiditis, no cases of biphasic thyroiditis were observed.
The pathophysiological mechanisms of biphasic thyroiditis are direct consequence of thyroidal inflammation and autoimmunity, which also imply the effects of stimulating or blocking antibodies for the stimulant thyroid hormone receptor. Undoubtedly, this functional patron and its reversibility, constitutes a sui generis behavior in the endocrine glands diseases, in which spontaneous hyper or hypo function usually occurred isolated and permanently. These reasons justify the report of these typical cases of subacute, silent and chronic autoimmune thyroiditis, in which, the patron of biphasic thyroiditis was the most relevant finding of his clinical evolution.
Asunto(s)
Humanos , Adulto , Femenino , Anciano , Dolor/diagnóstico , Fiebre/diagnóstico , Hipotiroidismo/etiología , Tiroiditis/patología , Tirotoxicosis/etiología , Ultrasonografía , Glándula Tiroides/fisiopatología , Inflamación/etiologíaRESUMEN
Factors that should be considered when studying the effect of dietary iodine in the development of thyroid cancer include pathological criteria, diagnostic techniques, screening programs, radioactive fallout, and standard of medical care in the studied population. In most surveys, papillary carcinoma forms the largest group of thyroid malignancies, both before and after iodine prophylaxis where an increase in the papillary:follicular carcinoma ratio is also noted. Undifferentiated carcinomas decrease after salt prophylaxis. In Salta, Argentina, the increasing incidence of clinically significant papillary thyroid cancer and the decrease of undifferentiated carcinoma after iodine prophylaxis are probably due to better access to health centers and consequent earlier detection of differentiated precursor tumors. Autoimmune focal and diffuse or Hashimoto's thyroiditis are linked to dietary iodine. Pathological studies made in different regions indicate that these types of thyroiditis occur more frequently in areas of iodine sufficiency than in areas of iodine deficiency, and increase after iodine prophylaxis both in non-goitrous and iodine-deficient areas like Salta, Argentina. An increase of lymphocytic thyroiditis could be linked to an increased incidence of primary thyroid lymphoma, and thyroiditis is more commonly associated with papillary carcinoma than with other types of thyroid follicular or C-cell derived carcinomas regardless of iodine intake.
Asunto(s)
Adenocarcinoma Folicular/prevención & control , Adenoma/prevención & control , Carcinoma Papilar Folicular/prevención & control , Yodo/administración & dosificación , Cloruro de Sodio Dietético/administración & dosificación , Neoplasias de la Tiroides/prevención & control , Tiroiditis/etiología , Adenocarcinoma Folicular/epidemiología , Adenocarcinoma Folicular/patología , Adenoma/epidemiología , Adenoma/patología , Argentina , Carcinoma Papilar Folicular/epidemiología , Carcinoma Papilar Folicular/patología , Dieta , Femenino , Bocio Endémico/complicaciones , Bocio Endémico/epidemiología , Bocio Endémico/prevención & control , Humanos , Yodo/efectos adversos , Masculino , Modelos Biológicos , Cloruro de Sodio Dietético/efectos adversos , Neoplasias de la Tiroides/epidemiología , Neoplasias de la Tiroides/patología , Tiroiditis/epidemiología , Tiroiditis/patologíaRESUMEN
INTRODUCCIÓN. El carcinoma de tiroides es infrecuente, pero en cambio constituye la neoplasia maligna más común del sistema endocrino. Fueron objetivos de esta presentación describir los resultados del diagnóstico y tratamiento del cáncer de tiroides durante un quinquenio, en el Centro de Investigaciones Medicoquirúrgicas, caracterizar diversas variables de la población afectada y determinar la relación entre técnica quirúrgica realizada e índice pronóstico a partir de la edad, metástasis a distancia, extensión de la enfermedad y tamaño del tumor (AGES). MÉTODOS. Se realizó un estudio observacional, descriptivo y prospectivo con elementos analíticos incorporados, de 52 pacientes operados de cáncer de tiroides en el CIMEQ, entre enero de 2001 y diciembre de 2005. Se aplicó el índice pronóstico AGES para los pacientes con cáncer de tiroides bien diferenciado y se relacionó con la técnica quirúrgica empleada. RESULTADOS. El cáncer de tiroides predominó en el sexo femenino (86,5 por ciento) en las edades entre 29 y 67 años, y en el hombre por encima de los 55 años. La biopsia por aspiración con aguja fina resultó un procedimiento de utilidad en el diagnóstico del cáncer de tiroides, con una alta concordancia con los diagnósticos por congelación y parafina. El carcinoma papilar resultó el más frecuente (71,2 por ciento) y la lesión más asociada, la tiroiditis de Hashimoto. Predominó la cirugía radical en pacientes que requerían cirugía conservadora según el índice pronóstico AGES. Las complicaciones se asociaron a la cirugía radical. CONCLUSIONES. El cáncer de tiroides resulta más frecuente en las mujeres de mediana edad. La biopsia por aspiración con aguja fina cobra valor a la hora de plantear la técnica quirúrgica, teniendo en cuenta el alto índice de concordancia con la biopsia por parafina. El índice pronóstico AGES no siempre fue tomado en cuenta a la hora de elegir la técnica quirúrgica, de ahí que predominaran los procedimientos más radicales(AU)
INTRODUCTION. The thyroid carcinoma is rare; however, it is the most common malignant neoplasia of the endocrine system. The aim of this paper was to describe the results of the diagnosis and treatment of thyroid cancer during a five-year term at the Centre for Medicosurgical Research (CIMEQ, in Spanish), to characterize diverse variables of the affected population, and to determine the relationship between the surgical technique used and the AGES' prognosis index. METHOD. An observational, descriptive and prospective study was conducted with analytical elements obtained from 52 patients operated on of thyroid cancer at CIMEQ from January 2001 to December 2005. The AGES' prognostic index was applied to patients with well-differentiated thyroid cancer and it was related to the surgical technique used. RESULTS. Thyorid cancer prevailed in females aged 29-67 (86.5 percent) and in males over 55. The fine needle aspiration biopsy was a useful procedure in the diagnosis of thyroid cancer with a high concordance with the diagnoses confirmed by freezing and paraffin. The papillary carcinoma proved to be the most common (71.2 percent), whereas Hashimoto's thyroiditis was the most associated lesion. Radical surgery predominated in patients that required conservative surgery according to the AGES' prognostic index. The complications were associated with radical surgery. CONCLUSIONS. Thyroid cancer is more frequent in middle aged females. The fine needle aspiration biopsy is very important at the time of recommending the surgical technique, taking into account the high index of concordance with paraffin biopsy. The AGES' prognostic index was not always taken into account for selecting the surgical technique. That's why, it was observed a predominance of the most radical procedures(AU)
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Neoplasias de la Tiroides/cirugía , Neoplasias de la Tiroides/diagnóstico , Carcinoma Papilar/cirugía , Carcinoma Papilar/diagnóstico , Biopsia con Aguja Fina/métodos , Tiroiditis/patología , Epidemiología Descriptiva , Estudios Prospectivos , Estudios Observacionales como AsuntoRESUMEN
El espectro clinicopatológico de las tiroiditis abarca, desde la rara tiroiditis aguda o supurativa hasta la más rara tiroiditis de Riedel. Las tiroiditis subaguda y silente (y su variante postpartum) también son enfermedades no comunes, mientras que la tiroiditis crónica autoinmune o enfermedad de Hashimoto resulta la tiroiditis y la enfermedad autoinmune órgano específica más frecuente, responsable de la mayor parte de los casos de hipotiroidismo. Efectivamente, en las áreas geográficas no deficientes en yodo, la mayor parte de los desórdenes tiroideos se deben a enfermedad autoinmune. La autoinmunidad como fenómeno primario juega un papel trascendente en la etiopatogenia de la tiroiditis crónica autoinmune, la tiroiditis silente-postpartum y la tiroiditis de Riedel y, sólo un rol secundario en la tiroiditis subaguda. Posiblemente, las infecciones virales causan la tiroiditis subaguda, mientras que los gérmenes piógenos y hongos son responsables de la tiroiditis supurativa. Las tiroiditis autoinmunes y la tiroiditis subaguda se acompañan comúnmente de disfunción tiroidea. Se conoce como tiroiditis destructiva al proceso inflamatorio tiroideo acompañado de destrucción y tirotoxicosis transitoria.
En estos casos, la disfunción tiroidea adopta usualmente el patrón de tiroiditis bifásica, en la que secuencialmente, la tirotoxicosis pasajera va seguida de hipotiroidismo transitorio y recuperación. Desórdenes con diferente etiopatogenia, como la tiroiditis subaguda, la tiroiditis silente y la enfermedad de Hashimoto, son responsables de los fenómenos fisiopatológicos similares que dan origen a la tiroiditis bifásica. El dolor en la tiroides adquiere relevancia en la tiroiditis subaguda y en la tiroiditis supurativa y, sólo raramente, está presente en la tiroiditis silente o en la exacerbación aguda de la enfermedad de Hashimoto. En la mayor parte de los casos, es posible establecer el diagnóstico de la tiroiditis mediante la historia clínica, las pruebas de función tiroidea y los estudios isotópicos y ecosonográficos. La biopsia tiroidea por aspiración con aguja fina permite resolver los casos dudosos. Esta revisión del Espectro clínico-patológico de las tiroiditis, resulta una síntesis de la información bibliográfica y la experiencia lograda con las tiroiditis a través de un enfoque clínico integral.
Clinical-pathological spectrum of thyroiditis comprises from the rare acute o suppurative thyroiditis as far as the rarest Rieldels thyroiditis. Also, subacute and silent thyroiditis (and it postpartum variant) are non common diseases, while autoimmune chronic thyroiditis or Hashimotos disease results the most frequent thyroiditis and organ-specific autoimmune disorder, that is responsible for most part of hypothyroidism cases. Effectively, in iodine-replete geographic areas, most persons with thyroid disorders have autoimmune disease. Autoimmunity as primary phenomenon plays a transcendent role in etiopathogeny of chronic autoimmune thyroiditis, silent-postpartum thyroiditis and Riedels thyroiditis and only a secondary role in subacute thyroiditis. Probably, viral infections cause subacute thyroiditis, while pyogenic germs and fungus are responsible for suppurative thyroiditis. Commonly, autoimmune and subacute thyroiditis are associated with thyroid dysfunction. It is known as destructive thyroiditis, the thyroidal inflammatory process that is joined to destruction and transient thyrotoxicosis.
Usually, thyroid dysfunction in these cases adopt biphasic thyroiditis pattern, in which sequentially, transient thyrotoxicosis is followed by transient hypothyroidism and recovery. Disorders with different etiopathogeny as subacute thyroiditis, silent thyroiditis and Hashimotos thyroiditis are responsible of similarly physiopathologic phenomenons that originated biphasic thyroiditis. Pain in the thyroidal gland is relevant in subacute and suppurative thyroiditis and, rarely is present in silent thyroiditis or in acute exacerbation of Hashimotos thyroiditis. In most of the cases, it is possible to establish the diagnosis of thyroiditis through clinical history, thyroidal function tests, isotopic studies and ecosonography. Thyroid fine needle biopsy resolves doubtful cases. This review about Clinical-pathological spectrum of thyroiditis, results from the synthesis of bibliographic information and the experience obtained with thyroiditis through and integral clinic focus.
Asunto(s)
Humanos , Hongos/inmunología , Inflamación/patología , Tiroiditis/clasificación , Tiroiditis/etiología , Tiroiditis/patología , Tirotoxicosis/patología , Biopsia/métodos , Enfermedad de Hashimoto/patologíaRESUMEN
Fresh thyroid glands (n=60) from Atlantic bottlenose dolphins that died after stranding along the Texas coast between 1991 and 2005 were examined. Organ weight ranged from 11 g in a neonate (length 109 cm) to 58 g in a large (249 cm) male. More typical weights were 25-45 g (mean=30.6 g). Glands tended to be larger in pregnant and lactating females (mean 37.4 g; n=5) than in non-pregnant animals of comparable size. In infancy, the gland tended to be compact, relatively homogeneous, and sometimes partly lobular, but with advancing age it became more lobular, the lobules being defined by fibrous bands. In one 8-year-old female (233 cm), and in a large male (295 cm) aged>25 years the gland was represented by a cluster of lobules. Lobulation was not necessarily accompanied by increased weight, distinguishing it from hyperplasia. With age, variation in follicle size and colloid density tended to increase. Two animals (3%) had adenomas and five (8%) had discrete hyperplastic nodules, not to be confused with lobulation. Five (8%) had macroscopically identifiable colloid-filled cysts (1-4 mm in diameter). Nine animals (15%) had squamous cysts (4-15 mm) containing creamy white fluid. Other abnormalities included patchy or diffuse interstitial fibrosis (six cases, 10%) amyloidosis (two cases), thyroiditis (one case) and vasculitis (one case). No malignant neoplasms were found. Cells presumed to be C cells (light cells, parafollicular cells) were identified immunohistochemically with synaptophysin antibody.
Asunto(s)
Adenoma/veterinaria , Amiloidosis/veterinaria , Delfín Mular , Glándula Tiroides/anatomía & histología , Glándula Tiroides/patología , Tiroiditis/veterinaria , Adenoma/patología , Factores de Edad , Amiloidosis/patología , Animales , Femenino , Fibrosis/veterinaria , Técnicas Histológicas/veterinaria , Inmunohistoquímica/veterinaria , Masculino , Tamaño de los Órganos , Factores Sexuales , Texas , Tiroiditis/inmunología , Tiroiditis/patologíaRESUMEN
The authors review the epidemiology, clinical manifestations, diagnosis, and treatment of fungal thyroiditis cases previously reported in the medical literature. Aspergillus was by far the most common cause of fungal thyroiditis. Immunocompromised patients, such as those with leukemia, lymphoma, autoimmune diseases, and organ-transplant patients on pharmacological immunosuppression were particularly at risk. Fungal thyroiditis was diagnosed at autopsy as part of disseminated infection in a substantial number of patients without clinical manifestations and laboratory evidence of thyroid dysfunction. Local signs and symptoms of infection were indistinguishable from other infectious thyroiditis and included fever, anterior cervical pain, thyroid enlargement sometimes associated with dysphagia and dysphonia, and clinical and laboratory features of transient hyperthyroidism due to the release of thyroid hormone from follicular cell damage, followed by residual hypothyroidism. Antemortem diagnosis of fungal thyroiditis was made by direct microscopy and culture of a fine-needle aspirate, or/and biopsy in most cases. Since most patients with fungal thyroiditis had disseminated fungal infection with delay in diagnosis and treatment, the overall mortality was high.
Asunto(s)
Tiroiditis/microbiología , Aspergilosis/epidemiología , Aspergilosis/microbiología , Candidiasis/epidemiología , Candidiasis/microbiología , Coccidioidomicosis/epidemiología , Coccidioidomicosis/microbiología , Criptococosis/epidemiología , Criptococosis/microbiología , Humanos , Huésped Inmunocomprometido , Tiroiditis/epidemiología , Tiroiditis/patologíaRESUMEN
AIMS: We report uncommon histopathological findings in fatal measles infection. METHODS AND RESULTS: We describe the autopsies of four patients who died during a measles outbreak in São Paulo, Brazil, in 1997. Two of the patients were children receiving chemotherapy for non-Hodgkin's lymphoma, one was an adult with acquired immunodeficiency syndrome (AIDS) and the fourth was an apparently healthy woman. All patients had their deaths attributed to measles pneumonia. The autopsies revealed extensive giant cell pneumonia and diffuse alveolar damage, severe acute pancreatitis, necrotizing sialoadenitis and thyroiditis due to measles. Measles antigen was detected in lung tissue using a monoclonal anti-measles antibody. CONCLUSIONS: : Pancreatitis, thyroiditis and sialoadenitis are not previously reported histopathological findings in measles infection. Pancreatitis is a potentially severe complication and should be considered when treating patients with atypical measles.
Asunto(s)
Sarampión/patología , Adolescente , Adulto , Preescolar , Resultado Fatal , Humanos , Pulmón/patología , Ganglios Linfáticos/patología , Masculino , Sarampión/complicaciones , Páncreas/patología , Pancreatitis/etiología , Pancreatitis/patología , Sialadenitis/etiología , Sialadenitis/patología , Glándula Submandibular/patología , Glándula Tiroides/patología , Tiroiditis/etiología , Tiroiditis/patologíaAsunto(s)
Glándula Tiroides/citología , Glándula Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/patología , Tiroiditis/diagnóstico por imagen , Tiroiditis/patología , Adulto , Biopsia con Aguja/normas , Reacciones Falso Negativas , Reacciones Falso Positivas , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Sensibilidad y Especificidad , UltrasonografíaRESUMEN
Mediante estudo retrospectivo, os autores revisaram 2.564 casos de punçäo aspirativa por agulha fina (PAAF) da glândula tireóide de pacientes do Hospital das Clínicas da Faculdade de Medicina de Botucatu-UNESP registrados entre 1989 e 1995. Foram observados 1.911 casos de diagnósticos näo-neoplásticos, 134 de neoplásticos e 519 de materiais inadequados ao dagnóstico citológico, sendo que, dentro do critério "näo-neoplástico", foram encontrados 1.244 diagnósticos de Bócio Colóide, 337 de Tireoidites e 323 de Doença de Graves. A PAAF mostrou ser um método diagnóstico útil também nas doenças tireóideas näo-neoplásticas, incluindo os processos difusos como as Tireoidites e a Doença de Graves
Asunto(s)
Humanos , Biopsia con Aguja/métodos , Citodiagnóstico , Enfermedad de Graves/patología , Bocio/patología , Tiroiditis/patologíaRESUMEN
Presentamos una variedad particular de carcinoma papilar de tiroides llamada Carcinoma Papilar Difusante Esclerosante. Esta lesión tiene diferencias de presentación clínica y anatomopatológica que permiten distinguirla. La importancia práctica de su diagnóstico radica en su tratamiento particularmente agresivo y su peor pronóstico comparado con las otras variedades de carcinoma papilar de tiroides (AU)
Asunto(s)
INFORME DE CASO , Humanos , Femenino , Adulto , Carcinoma Papilar , Tiroiditis , Neoplasias de la Tiroides , Tiroidectomía , Tiroiditis/cirugía , Tiroiditis/patología , Tiroiditis , Tiroiditis/terapia , Neoplasias de la Tiroides/cirugía , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/terapiaRESUMEN
Presentamos una variedad particular de carcinoma papilar de tiroides llamada Carcinoma Papilar Difusante Esclerosante. Esta lesión tiene diferencias de presentación clínica y anatomopatológica que permiten distinguirla. La importancia práctica de su diagnóstico radica en su tratamiento particularmente agresivo y su peor pronóstico comparado con las otras variedades de carcinoma papilar de tiroides
Asunto(s)
Humanos , Femenino , Adulto , Carcinoma Papilar , Neoplasias de la Tiroides , Tiroidectomía , Tiroiditis , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/cirugía , Neoplasias de la Tiroides/terapia , Tiroiditis , Tiroiditis/patología , Tiroiditis/cirugía , Tiroiditis/terapiaRESUMEN
O A. faz consideraçöes gerais a propósito da história natural do câncer da tireóide, em particular sobre questöes epidemiológicas e prognósticas. Por fim, discute os aspectos histopatológicos mais salientes sobre as variantes morfológicas do carcinoma papilífero
Asunto(s)
Adulto , Humanos , Masculino , Femenino , Carcinoma Papilar/ultraestructura , Neoplasias de la Tiroides/patología , Carcinoma Papilar/complicaciones , Carcinoma Papilar/patología , Neoplasias Inducidas por Radiación/epidemiología , Estadificación de Neoplasias , Neoplasias de la Tiroides/clasificación , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/genética , Tiroiditis/patología , Tiroiditis/cirugíaRESUMEN
The imputation that a clinically solitary nodule is a suspicious sign of carcinoma has been the cause of too many surgical procedures as well as the subject of much controversy. This study evaluated the effectiveness of fine needle aspiration (FNA) biopsy cytology in diagnosing the uninodular goiters in 286 patients who presented with clinically solitary nodules. The final diagnoses in these cases included carcinoma (4.7%), adenoma (6.3%), autonomous nodule (11.0%), colloid goiter (45.8%), colloid cyst (17.4%) and chronic thyroiditis (13.4%). The proportion of patients with cancer in this group was the same as in patients with multinodular and diffuse goiters. These findings call attention to (1) the fact that any thyroid disease may appear as a uninodular goiter and (2) the frequency with which lymphocytic thyroiditis was cytologically diagnosed, even in cases with negative antibody titers. The cytologic diagnosis of benign disease has contributed to a reduction in the number of unnecessary surgical procedures; only 24.1% of our patients with uninodular goiters underwent surgery.
Asunto(s)
Biopsia con Aguja , Enfermedades de la Tiroides/diagnóstico , Neoplasias de la Tiroides/diagnóstico , Enfermedad Crónica , Bocio/diagnóstico , Bocio/patología , Humanos , Enfermedades de la Tiroides/patología , Neoplasias de la Tiroides/patología , Tiroiditis/diagnóstico , Tiroiditis/patologíaRESUMEN
Relata-se um caso de tiroidite subaguda ou tiroidite de De Quervain diagnosticada pelo método da citopatologia por punçäo aspirativa com agulha fina. Demonstra-se uma estreita correlaçäo entre os achados citopatológicos e os aspectos histopatológicos, opinando sobre a validade do método para uso na rotina médica. Acrescentam-se algumas consideraçöes sobre a fisiopatologia, etiologia, quadro clínico, laboratorial da doença, os quais sendo vistos em conjunto com o método citopatológico, podem levar a um diagnóstico de certeza. Reafirma-se a importância da citopatologia no controle de massas da glândula tireóide