[A rare intestinal neoplasm of connective tissue origin: leiomyosarcoma of the cecum].
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Adult↗
Biomedical subjects
G Ardito
Publications and source records attributed to G Ardito.
Fine needle aspiration of a warthin-like thyroid tumor. Report of a case with differential diagnostic criteria vs. other lymphocyte-rich thyroid lesions.
BACKGROUND: Warthin-like papillary carcinoma of the thyroid (WLT), a recently described entity, should be included among lymphocyterich lesions of the thyroid. The diffuse sclerosing variant of papillary carcinoma (DSV), the oxyphilic variant of Hashimoto thyroiditis (OHT) and primary lymphoplasmacytic lymphoma (PLT), the FNA appearances of which have many similarities, belong to the same category. CASE REPORT: A case of WLT occurred in a 31-year-old female, who was admitted with a 1.5-cm, nodular lesion of the thyroid; fine needle aspiration (FNA) yielded a diagnosis of papillary carcinoma. Histologic examination revealed the characteristic picture of WLT, with papillae lined with large, oxyphilic thyreocytes, with nuclear pseudoinclusions and grooves filled with lymphocytes, mostly mature plasma cells. The FNA picture of WLT was compared with those of the other lymphocyticrich lesions of the thyroid--DSV, OHT and PLT. CONCLUSION: The differences between these forms provide diagnostic criteria that could be useful for the preoperative management of patients affected by suspicious, inflammation like thyroid lesions.
Adult↗
[Vascular cysts of the adrenals. Association with aneurysm of the abdominal aorta].
A rare case of an adrenal vascular cyst associated to an abdominal aorta aneurysm is reported. Adrenal cysts are an uncommon clinical finding, in most cases incidentally discovered for nonspecific abdominal pain, during US, TC or RM evaluation or at autopsy. Small adrenal mass are clinically silent. They may be symptomatic (lumbar tension, pain) for dimensions over 10 centimetres. Cysts of large size can cause displacement and compression of adjacent organs. They present a difficult problem of differentiation between benign and malignant lesions. Non-neoplastic adrenal cysts have been divided into four categories: parasitic (7%), epithelial (9%), endothelial (45%) and haemorrhagic or pseudocystic (39%). Vascular adrenal cysts may be a traumatic consequence of an hamartomatous vascular anomaly. The aim of this paper is to discuss, on the basis of the literature, the etiology, diagnosis and treatment of the adrenal mass. Surgical timing is discussed for the concomitant vascular lesion. The elective treatment was left adrenalectomy performed through transperitoneal approach. Surgery for abdominal aorta aneurysm was differed because the adrenal mass was suspected to be an infected neoplastic lesion and for the feasibility of endovascular procedure. The adrenal specimens contained a cystic structure with fluid blood, fibrin and calcifications. Normal adrenal cortical tissue was found in the cystic wall. This lesion (arising from vascular anomalies) require separation from haemorrhagic adrenal neoplasm. Awareness of adrenal pseudocysts and careful attention to the hystological features aids this distinction.
Adrenal Gland Diseases↗
[Drainage in thyroid surgery].
Bleeding represents a rare complication of thyroid surgery but when it occurs it may be life-threatening. To prevent this complication drainage is widely used. However no study has demonstrated the drains' value and recent reports have questioned its benefits. Therefore we have analyzed our experience of a 10 year-period in which 1.217 thyroidectomies were performed by the same surgical team and prophylactic routine drainage was always adopted. In 13 patients (1.06%) a benign hematoma occurred with spontaneous remission. In 6 patients the bleeding was severe and compressive hematoma occurred; it required surgical re-exploration. Such a complication is unusual in the neck surgery (0.49% in the authors' series) performed by experienced surgeons and when life-threatening hematomas do occur they depend on various uncontrolled factors and drainage is often not helpful. Otherwise a meticulous haemostatic technique is necessary and patients should be observed very closely during the few first hours following surgery on the thyroid gland. Therefore on the basis of the analysis of their series, although it is not always possible to prove the benefit of the drainage, the authors suggest its indication in the neck surgery, as in other fields with dead space, to remove blood and secretions reducing postoperative complications. They have never observed wound infections and patients were discharged within 72 hours.
Adolescent↗
Surgery of differentiated thyroid carcinoma, lymph node metastases and locoregional recurrence.
Surgery of differentiated thyroid carcinoma is burdened with risk factors that significantly impact on prognosis, as age at diagnosis and tumor stage. Problems involved concern the extent of surgical resection and the indication for regional lymphadenectomy. As for the former, the most popular approach is total thyroidectomy "on principle" with neck lymphadenectomy. Lobectomy may represent an alternative to total thyroidectomy in low risk patients with unifocal papillary carcinoma 1 cm or less in size, or minimally invasive follicular carcinoma. As for lymphadenectomy, most authors do not agree with surgery "on principle" but rather "of necessity", that is, in presence of clinically evident lymphadenopathy and neck lymphadenectomy is the preferred surgical strategy. In most cases surgery is the treatment of choice of locoregional recurrence. Careful preoperative work-up and accurate surgical procedure are mandatory.
Carcinoma↗
[Papillary microcarcinoma [correction of carcinoma] of the thyroid: clinical experience and prognosis factors].
Thyroid neoplasm of less than 10 mm in the largest diameter are defined as minimal thyroid cancer (MTC). These tumors are a common incidental finding at autopsy and in thyroid glands excised for other pathology. These tumors can metastasize and can cause significant morbidity and mortality. Clinical significance and optimal operative procedures of these lesions are still questioned. We studied 35 MTC in order to identify clinical and histologic characteristics as prognostic factors and to establish therapeutic management strategies. From January 1988 to December 1998, 177 patients with a primary thyroid cancer underwent surgery in the Department of endocrine-surgery of Catholic University in Rome: 35 of them (19.7%) had a MTC. In the post-operative follow-up 13 of the patients with MTC had a lymph node recurrency and/or distant metastases. Careful histologic examination showed multifocality in 12 patients, capsular infiltration in 10 patients and a solid tumor in 9 patients. MTC are common and they are associated with a good prognosis. Our multifactorial analysis has identified as important risk factors: capsular infiltration, solid lesion and multifocal disease. In these cases total thyroidectomy is mandatory.
Adult↗
[Role of Doppler color ultrasonography in the diagnosis of thyroid carcinoma].
The aim of this study is to assess the efficacy and accuracy of color flow-Doppler sonography (CFDS) in predicting the malignancy of thyroid nodules. Seventy eight consecutive patients (52 females and 26 males), with 78 thyroid nodules (29 single nodules and 49 in a nodular goiter) have been examined by CFDS, before surgery, evaluating the hypoechogenicity of the nodule, the presence of microcalcifications and the halo sign absent and the vascular pattern, which has been classified as follows: absence of blood flow (type I), perinodular blood flow (type II), intranodular, with or without perinodular blood flow (type III), which is considered the most typical pattern of malignancy. On histology 22 nodules as carcinoma (CA) and 56 as benign nodules (BN) have been diagnosed. The most predictive for malignancy, sonographic pattern, "microcalcifications", has been found in 13/22 CA and in 4/56 BN (P < 0.0001, specificity 93%, sensitivity 59%); "hypoechogenicity" in 16/22 CA and in 8/56 BN (P < 0.0001, specificity 86%, sensitivity 73%), "absent halo sign" in 18/22 CA and in 16/56 BN (P < 0.0001, specificity 71%, sensitivity 82%.) have been found. On CFD type III pattern has been detected in 17/22 CA and in 24/56 BN (P < 0.15, specificity 57%, sensitivity 77%); type IIIa pattern (intranodular without perinodular blood flow) has been the most predictive for malignancy (P < 0.0001, specificity 100%, sensitivity 36%). The combination of type III pattern with "hypoechogenicity" in 13/22 CA and in 2/56 BN (p < 0.0001, specificity 93%, sensitivity 59%) has been found, with "absent halo sign" in 15/22 CA and in 3/56 BN (P < 0.0001, specificity 94.6%, sensitivity 68%), has been found, with "microcalcification" in 10/22 CA and in 0/56 BN (P < 0.0001, specificity 100%, sensitivity 45%) has been found. The combination of "microcalcifications" and absent halo sign" with type III pattern has been the most specific for malignancy, being detected in 11/22 Ca and 2/56 BN (P < 0.0001, specificity 96%, sensitivity 50%). In conclusion our results suggest that CFDS has an useful role in the assessment of thyroid nodules and it may provide information highly predictive for malignancy, above all when multiple, sonographic and vascular patterns are contemporaneously present in a thyroid nodule.
Adolescent↗
[The non-recurrent inferior laryngeal nerve. Surgical experience].
During the performance of 1018 thyroid operations, 1497 recurrent laryngeal nerves were identified and exposed. Of the 773 visualized nerves on the right side, 2 were found to be non recurrent (0.26%). This abnormality may represent a pitfall during thyroidectomy even for very experienced thyroid surgeons. We emphasize that the exposure and preservation of this vital structure is the standard of care and an essential component of routine dissection in thyroid surgery.
Humans↗
[Differentiated tumor of the thyroid in children and adolescents].
Differentiated thyroid carcinoma (DTC) is rare in young patients and represents 0,5 to 3,0% of childhood carcinomas. The incidence increases with age: a peak incidence is observed between 15 and 19 years of age. DTC in children is frequently associated with greater risk of cervical lymph node involvement (60-80% of cases) and lung metastases at diagnosis in 20% of patients. However the prognosis for these patients is better when compared with that of adults, despite a high incidence of relapse, leading to reoperation. Young age (<16 years), lymph node involvement or distant metastases at diagnosis and some histopathologic characteristics have been suggested as predictive factors of recurrences. The records of 33 patients with DTC in a 14-year period (1990-2004) were reviewed. There were 31 females and 2 males who ranged from 11 to 21 years. At the diagnosis 15 patients had disease confined to the thyroid, 18 had additional lymph node metastases in the neck; one of them had also lung metastases. Total thyroidectomy (TT) was the elective approach in all patients (4 cases videoassisted). TT was associated to functional neck dissection in 21 cases. 131I was administrated to 28 patients (3,7 GBq as ablative dose): 11 of this received further radioiodine treatments (mean 7,4 GBq) because of elevated serum thyroglobulin levels and presence of loco-regional or lung metastasis at diagnostic total body scan after 131I treatment. The overall survival rate was 100% at a follow up of 4 months to 14 years.
Adolescent↗
Chromosome aberrations and sister chromatid exchanges in occupationally exposed workers.
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Adult↗
[Clinical studies on biliary ileus. Case reports].
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Cholangiography↗
Cytogenetic effect of thiabendazole and diphenylammine on cultured human lymphocytes: sister chromatid exchanges and cell cycle delay.
The two fungicides analysed in this paper, Thiabendazole (TBZ) and Diphenylammine (DPA), are among the pesticides found in higher concentration in fruits and vegetables sold in Tuscany. These compounds were tested in "in vitro" lymphocyte cultures at different concentrations and using 3 protocols; protocol 1: the cultures were treated with the fungicides for 48 h; protocols 2 and 3: the cultures were treated with fungicides for 4 h in the presence or absence of the metabolic activator S9 mix. Both fungicides produced a slight increase in the SCE frequency in the 48 h treatment, at the higher non-toxic concentrations tested, but not when exposed for only 4 h, with or without S9 mix. As far as concerns the Proliferation Rate Index (i.e. the number of first, second and third mitoses), Thiabendazole also produced a significant decrease in the replication rate of the treated cultures, while Diphenylammine did not produce any effect.
Adult↗
[Hyperthyroidism and carcinoma of the thyroid gland].
The incidence of thyroid carcinoma in hyperthyroidism varies considerably from as low as 0.3% to as high as 16.6% with a higher rate in toxic nodular goiters. Occult thyroid carcinoma (< 1.5 cm or microscopic foci) is the rule and only a few tumors are suspected preoperatively with ultrasonography or fine needle aspiration or 131 I scan. In 408 patients who underwent surgery for hyperthyroidism in our Surgery Department from January 1967 through December 1994 the incidence of thyroid carcinoma was 5.6% (23 cases). In detail, a neoplasm occurred in 5 cases of Graves' disease (specific incidence: 3.8%), in 13 cases of toxic nodular goiter (12.5%) and in 5 cases of hyperfunctioning adenomas (2.8%). 19 cancers were papillary (12 in toxic nodular goiter, 3 in Graves' disease, 4 in hyperfunctioning adenomas), three were follicular (1 in Graves' disease, 1 in toxic nodular goiter, 1 in hyperfunctioning adenomas) and 1 medullary in Graves' disease. A papillary carcinoma was diagnosed preoperatively on fine needle aspiration with ultrasonography in only two patients with Graves' disease and confirmed by postoperative histological examination on permanent section. We do not believe in the frozen-section examination intraoperatively because it's not diagnostical for follicular lesions and evaluates rarely capsular invasion. Twenty patients received total thyroidectomy and four of them also lymphoadenectomy. Three patients received emithyroidectomy: in two cases for occult papillary carcinoma and in the last case for local cancer invasion (T4N0M0). Twenty patients are alive and with no evidence of cancer recurrence. Mean follow-up is 59.6 months. Our retrospective study shows a progressive increase of the incidence of coexisting thyroid malignancy and hyperthyroidism especially in toxic nodular goiter, probably related to extended surgical indications. Our findings do confirm that, even in the presence of hyperthyroidism, all thyroid nodules require careful diagnostics for exclusion of malignancy.
Adenocarcinoma, Follicular↗
Increased frequencies of sister chromatid exchanges and micronuclei in "in vitro" lymphocyte cultures treated with the fungicides thiram and ziram.
The two fungicides analysed in this paper, Thiram (TH) and Ziram (ZI) are among the most common residues found in fruit and vegetables sold in Italy. These compounds were tested in "in vitro" lymphocyte cultures, from 16 individuals, at different concentrations (Thiram 5 x 10(-8) M; 5 x 10(-7) M; 5 x 10(-6) M and Ziram 1 x 10(-7) M; 1 x 10(-6) M; 1 x 10(-5) M) in order to ascertain if they are able to modify sister chromatid exchange and/or micronuclei frequencies. Both fungicides produced a significant increase in SCE and Micronuclei frequencies. The two highest doses of TH and ZI were found to be cytotoxic for most of the individuals and were not included in the statistical analysis. With regard to the Proliferation Rate Index (i.e. the number of first, second, third or more mitoses), no difference was found between controls and treated cultures.
Adult↗