Incidental detection of pulmonary infection during the evaluation of protein-losing enteropathy with In-111 transferrin.
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Biomedical subjects
Publications and source records attributed to T Michigishi.
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To evaluate the efficacy of ultrasound (US)-guided automated core biopsy of thyroid nodules, 74 biopsies were performed in 61 consecutive patients with an 18-gauge short-throw (1.1-cm excursion) biopsy gun. Results were correlated with diagnoses made at surgery (n = 38) or at sonographic follow-up of at least 6 months (n = 36). Sensitivity, specificity, and accuracy of diagnoses made with automated core biopsy were 84%, 95%, and 91%, respectively. US-guided biopsy with an automated biopsy gun allowed accurate assessment of thyroid nodules.
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Eleven cases of medullary thyroid carcinoma (MTC), which were experienced at Kanazawa University Hospital between 1975 and 1993, were examined to correlate the clinical, histologic, and immunohistochemical findings. Seven patients were women and four men, and the mean age was 46.6 years. The mean follow-up was 88.3 months. Three patients had familial non-multiple endocrine neoplasia (MEN) MTC (familial MTC unassociated with other endocrinopathies) and the remaining eight had sporadic disease. At the end of the observation period, six patients were alive without disease and four were alive with metastatic disease. One patient died of MTC 8.3 years after surgery. Thus, the 10-year survival and disease-free survival rates were 67% and 53%, respectively. Histologically MTCs from the 10 surviving patients showed a classic type, while the one patient who died had a tubular variant MTC. Immunohistochemically, there were no significant correlations between the outcome of the patients and the expression of calcitonin (CT), carcinoembryonic antigen (CEA), calcitonin gene-related peptide (CGRP), or chromogranin A (CgA) in the primary tumors, and there were no differences in expression of these antigens between the primary and the recurrent tumors. Although only a small number of patients with MTC were studied here, it was suggested that the prognosis of MTC is worse than that of papillary and follicular thyroid carcinoma. The patients with lymph node involvement at the time of primary surgery showed a high risk of persistent or recurrent disease. The expressional level for the antigens did not influence the prognosis of MTC.
We performed lymphoscintigraphy with 99mTc-human serum albumin in a case of suspected lymphedema of the right leg after inguinal lymph node dissection. Dermal backflow of the leg and lymphocele at the inguinal chain were observed, and lymphatic reflux into the scrotum was also delineated. The scintigraphy could demonstrate a persistent lymphatic problem under conservative treatment, and could lead the physician to conduct surgical treatment. Scintigraphic demonstration of the inguinoscrotal lymphatic reflux has not been previously reported.
Metastatic calcification is often detected by bone scintigraphy. We recently saw metastatic calcification in the stomach and kidneys of a patient on continuous ambulatory peritoneal dialysis. Tc-99m HMDP accumulation into both organs was noted even in the first frame of dynamic data acquisition of 4 min/frame, suggesting that calcium deposits may create an aggressive process and we may obtain information on the calcium deposit rate to better understand the mechanism of metastatic calcification.
Thallium-201 SPECT was performed to evaluate a pulmonary lesion in a 73-year-old male which had been considered to be an inflammatory lesion for two years. The lesion has slowly increased in size on x-CT. Tl-201 was intensely taken up and retained in the lesion, suggesting a malignant lesion. Histological examination revealed that the lesion was bronchioloalveolar carcinoma. This case suggested that Tl-201 uptake of pulmonary carcinoma would not be necessarily related to cell growth rate.
We describe an unusual case of a thyroid carcinoma exhibiting glandular and sarcomatous features. The tumor occurred in a 16-year-old girl. Histologic study of the resected thyroid gland revealed an encapsulated tumor composed predominantly of glandular structures and some solid areas. In the glandular areas, the tumor cells showed a cribriform growth pattern, and neither colloid secretion into the lumen nor clear-cut cytologic features suggestive of papillary or follicular thyroid carcinoma were observed. In the solid areas, tumor cells became spindled and showed a sarcomatous arrangement with occasional whorl formation. A transition from the glandular areas to the solid ones was observed. Immunohistochemical study revealed that tumor cells were positive focally for epithelial membrane antigen, cytokeratin and secretory component. Thyroglobulin was positive only in a few and limited areas of the glandular component. Calcitonin was negative throughout the tumor. The histologic and immunohistochemical evidence indicates that this tumor is of thyroid origin and is probably derived from thyroid follicular cells. The histology of this tumor is unique, so we report this case briefly.
An unusual case of pseudolymphoma of the thyroid gland is presented. A well-demarcated whitish mass measuring 1.0 cm in diameter was found in the upper center of the right lobe of the thyroid gland. Microscopically, the lesion was composed of hyperplastic lymphoid tissues with many follicular centers and mixed infiltration of plasma cells and macrophages. The immunostain revealed a similar distribution of T-and B-lymphocytes to reactive lymph node and a polyclonal nature of the plasma cell infiltrates. No lymphoepithelial lesion was associated. The adjacent thyroid tissues showed chronic lymphocytic thyroiditis. This finding suggests that the lesion is a pseudolymphoma of the thyroid gland. This condition is rare, but it should be considered during the differential diagnosis of lymphoproliferative lesions occurring in the thyroid gland, especially with low-grade malignant lymphoma of the thyroid gland.
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The biodistribution of 201Tl and of 99Tcm-human serum albumin (99Tcm-HSA) was observed in tumour-bearing mice to investigate if tissue blood circulation could be evaluated in groups of mice infused with angiotensin II at a rate of 0.5 micrograms kg-1 min-1 (L) or 1 microgram kg-1 min-1 (H). Ten minutes after tracer injection, tumour uptake of 201Tl in the angiotensin II infused group showed a 2.20- and a 3.18-fold increase in the L and H groups, respectively, when compared to a group of mice infused with saline (P = 0.0478 and 0.0029, respectively). The effect of angiotensin II infusion on 201Tl uptake was minimal in normal organs. Decreased normal organ uptake of simultaneously injected 99Tcm-HSA in the L and H groups indicated the contraction of normal organ vessels, while increased tumour uptake of the tracer indicated mechanical dilatation of tumour vessels. We conclude that the effect of angiotensin II or other vasoactive agents can be non-invasively assessed by 201Tl and 99Tcm-HSA scintigraphy.
A unique case of encapsulated follicular carcinoma of the thyroid, which lacked histologic evidence of capsular and vascular invasion but developed a late bone metastasis, is described. The thyroid tumor was found in a 42-year-old man. It was relatively small (2.5 cm) and totally encapsulated. Histologically, the thyroid tumor showed a microfollicular growth pattern of follicular cells and revealed no histologic evidence of nuclear atypia, mitotic figures or capsular and vascular invasion. The diagnosis of microfollicular adenoma was made and partial thyroidectomy was performed. Bone (rlb) metastasis of the thyroid tumor developed 22 years after the thyroidectomy. The present case suggested that capsular and/or vascular invasion is not always sufficient for the diagnosis of encapsulated follicular carcinoma of the thyroid.
A rare case of mixed medullary-follicular carcinoma of the thyroid gland, which occurred in a 44-year-old man, is reported. The thyroid tumor was composed of solid nests of polygonal cells, with an admixture of many evenly distributed thyroid follicles that contained colloid. The lymph node metastases were the same composition as the primary, with follicle formations that contained colloid. Immunohistochemically, in both the primary and metastatic lesions, calcitonin and carcinoembryonic antigen were present in the predominant solid areas of medullary carcinoma, whereas thyroglobulin was demonstrated in the follicular structures. At the ultrastructural level, most of the tumor cells contained numerous neurosecretory granules, but some showed follicular cell differentiation. These findings fulfilled the criteria of mixed medullary-follicular carcinoma of the thyroid according to the World Health Organization classification and also suggested dual neuroendocrine and follicular differentiation of this type of thyroid carcinoma. We reviewed the literature on mixed medullary-follicular carcinoma of the thyroid and concluded that it might constitute another clinicopathologic entity different from conventional medullary thyroid carcinoma; it occurs predominantly in younger males and is associated with a more favorable clinical course than the usual medullary thyroid carcinoma.