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Multifocal Branch Duct Intraductal Papillary Mucinous Neoplasm with 3 cm Lesion in Head of Pancreas
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Atsushi Oba, Robert J. Torphy, Richard D. Schulick, Marco Del Chiaro
A 55-year-old woman presented to a local hospital with abdominal pain. An abdominal ultrasound was advised that revealed a 3 cm cystic mass in the head of pancreas. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) scans were performed which showed three cystic lesions in the pancreatic head (34 mm), body (5 mm), and tail (8 mm) with a maximal main pancreatic duct diameter of 2.4 mm (Figure 39.1). The serum carbohydrate antigen (CA) 19-9 level was 15.4 U/mL and carcinoembryonic antigen was 2.2 mg/dL. The patient had no significant personal or family history neither for pancreatic, nor other malignancies. Her abdominal pain was treated with simple analgesia. An endoscopic ultrasound was performed which confirmed the findings noted on cross-sectional imaging. No solid components were identified in the cyst. A fine-needle aspiration was performed. Cystic fluid carcinoembryonic antigen was 400 ng/mL. Based on all the investiagtions, the patient was diagnosed as a case of multifocal branch duct type intraductal papillary mucinous neoplasm for which a total pancreatectomy was recommended. She was referred to our hospital for a second opinion regarding the management of her lesions.
Neoplasia
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
This technique relies largely on interpretation of the appearance of the individual cells and small clusters of cells, and the degree of cohesion of the tumour cells (a feature of epithelial tumours) can also be assessed. Cells can be found easily in body fluids, e.g. extracted by syringe and needle from the pleural or peritoneal cavities, or in urine or sputum. Fine-needle aspiration of solid tumours is commonly performed; it has the benefit of being relatively atraumatic to the patient who usually does not require an anaesthetic. It is a simple procedure for superficial lesions, e.g. breast lumps, and deeply located lesions can be sampled under imaging control.
Case 12
Published in Simon Lloyd, Manohar Bance, Jayesh Doshi, ENT Medicine and Surgery, 2018
Simon Lloyd, Manohar Bance, Jayesh Doshi
The most useful investigation is fine-needle aspiration cytology with overall accuracy greater than 96%. Imaging with either ultrasound scanning or magnetic resonance imaging (MRI) scans is complementary but not essential in benign disease and is reserved for patients with any ‘red flag’ symptoms such as a recent increase in size, skin involvement, fixed hard mass and/or facial nerve weakness.
Feasibility and early clinical impact of precision medicine for late-stage cancer patients in a regional public academic hospital
Published in Acta Oncologica, 2023
Morten Ladekarl, Anne Krogh Nøhr, Mads Sønderkær, Simon Christian Dahl, Lone Sunde, Charles Vestereghem, Christophe Kamungu Mapendano, Charlotte Aaquist Haslund, Anja Pagh, Andreas Carus, Tamás Lörincz, Kinga Nowicka-Matus, Laurids Ø. Poulsen, René Johannes Laursen, Karen Dybkær, Birgitte Klindt Poulsen, Jens Brøndum Frøkjær, Anja Høegh Brügmann, Anja Ernst, Alkwin Wanders, Martin Bøgsted, Inge Søkilde Pedersen
In agreement with others [54], our study points to improvements in patient selection, methodology, and logistics that could increase the feasibility of precision medicine. The 20% of patients included in the ITT analysis that did not have a molecular tumor profiling done, mainly due to issues related to biopsies, is at least on par with similar reports [54,55], and substantiates the problems of preferred use of fresh histological biopsies [56]. Fine needle aspiration is less risky, induces less discomfort, and may provide similar NGS-results [57], however, generally exclusive of sufficient material for the histopathological and immunohistochemical analysis. ctDNA is increasingly used, either complimentary to biopsies or alone [56,58]. Liquid biopsies may be less sensitive to heterogeneity and may provide early information of progression and resistance [58,59]. The main limitations are small amounts of tumor DNA, lack of tissue for pathological diagnosis, and contamination by non-tumoral variants [60]. The number of patients with immediately available tissue could be increased by storing fresh frozen tissue at diagnosis of the incurable disease. Indeed, we used archived fresh frozen tissue in patients with primary brain tumors and obtained a successful molecular analysis in all cases (data not shown). Using archival materials, temporal evolutions of molecular alterations are missed [60], although a prior study of changes in druggable variants over time showed very limited clinical impact [61].
Thyrotoxicosis secondary to thyroiditis following SARS-CoV-2 infection
Published in Journal of Endocrinology, Metabolism and Diabetes of South Africa, 2021
Ankia Coetzee, Raisa Bhikoo, Bianca Berndorfler, Wilhelmina Conradie, Jantjie J Taljaard, Marli Conradie-Smit
Thyroid scintigraphy is an important imaging modality in the evaluation of thyrotoxic patients and allows for the differentiation of hyperthyroidism from other causes of thyrotoxicosis. In cases of Graves’ disease, or nodular thyroid disease with autonomous function, various patterns of increased uptake are seen. In the early thyrotoxic phase of subacute thyroiditis, decreased or absent uptake is observed.8 It can be confirmed semi-quantitatively by calculating the percentage of thyroid uptake. Differential diagnoses to consider with decreased or absent thyroid uptake in the context of thyrotoxicosis include other types of thyroiditis (subacute thyroiditis, amiodarone-induced thyroiditis, acute thyroiditis), iatrogenic or factitious thyrotoxicosis (due to exogenous thyroxine) and ectopic hyperfunctioning thyroid tissue.9. The role of thyroid ultrasound in diffusely enlarged thyroid glands is to exclude pathology undetectable on clinical examination and, in the case of a painful gland, the exclusion of suppurative thyroiditis. It also enables fine-needle aspiration if malignancy is suspected. The characteristics in subacute thyroiditis include patchy poorly circumscribed hypoechoic areas with decreased vascularity on doppler.10 Lee categorises these changes into nodular, non-nodular and mixed subtypes that can be focal or multifocal, unilateral or bilateral.11 These findings can overlap with malignancy and other forms of thyroiditis, therefore clinical correlation is of utmost importance. Most changes normalise after one year, but nodular change might persist.10
Radiofrequency ablation for treatment of thyroid follicular neoplasm with low SUV in PET/CT study
Published in International Journal of Hyperthermia, 2021
Wei-Che Lin, Yu-Cheng Tung, Yen-Hsiang Chang, Sheng-Dean Luo, Pi-Ling Chiang, Shun Chen Huang, Wei-Chih Chen, Chen-Kai Chou, Yan-Ye Su, Wen-Chieh Chen, Shun-Yu Chi, Jung Hwan Baek
The 3-dimensional measurements of each thyroid nodule were estimated on the basis of their maximal lengths in the anterior–posterior, medial–lateral, and cranial–caudal directions. On the post-ablation ultrasound examination, the changes of size, volume, and echogenicity were evaluated. The post-ablation fine needle aspiration was performed after patient consent. The remnant volume of each thyroid tumor was measured at 6–12 months after RFA (Figure 3). To calculate the volume reduction ratio, the remnant thyroid tumor volume after RFA was divided by the volume prior to RFA. If the follow-up ultrasound showed a viable tumor component, any repeat RFA was performed according to the consensus of the operator and the patient. All measurements were performed by two radiologists with 10–15 years of experience in head and neck imaging. All complications were classified as major complications, minor complications, or side effects, and recorded after RFA [20].