Capsular Vessels Research Articles

SUN-490 Mass Cord Compression: Metastasis of Insular Thyroid Cancer

Intro: Insular thyroid cancer is a rare and complex form of thyroid cancer, often referred to as poorly differentiated carcinoma. The exact incidence of insular thyroid cancers is difficult to assess due to controversial classification of this thyroid cancer over the years. It is termed poorly differentiated as it falls between the well-differentiated and undifferentiated carcinomas both morphologically and biologically[1]. Case: A 41 year old Hispanic female, with a history of prolactinoma and hyperparathyroidism, presented to the hospital with 10 days of progressive lower extremity weakness and paresthesias from T4 downwards, inability to bear weight, and no bowel movement for 12 days. MRI revealed a large thoracic soft tissue mass (7x4x4cm) centered in the posterior and medial aspect of the chest wall at T4-T5 with involvement of the spinal cord and vertebral bodies. She was also found to have a right sided thyroid mass (4.5x5x4 cm) with tracheal deviation-HerThyoid function test, were normal Intact PTH was 261, Thyroglobulin over 300, and Thyroid Antibodies were negative. Patient underwent T3-T6 laminectomy, T2-T7 fusion, and T4-T5 tumor resection, which was subtotal due to vascularity. Second procedure included a right thoracotomy, chest wall resection of ribs 4 and 5 with full resection of paraspinal mass, total thyroidectomy, parathyroidectomy with central cervical lymphadenectomy. Pathology results of paraspinal mass showed insular thyroid carcinoma.Post operatively, the patient reported improvement of sensation and strength in lower extremities. Genetic testing for MEN syndrome was negative. Discussion: Insular thyroid carcinoma, also referred to as poorly differentiated carcinoma is a rare form of thyroid cancer. Insular carcinoma was characterized by to include the following complex histologic features, “formation of solid clusters (insulae) of tumor cells containing a variable number of small follicles; variable but consistently present mitotic activity, capsular and blood vessel invasion; and frequent necrotic foci, sometimes leading to formation of peritheliomatous patterns”[1]. The cells originate from follicular epithelium and possess the potential to concentrate radioiodine[2]. Unlike anaplastic carcinoma of the thyroid, p53 and p21 staining was negative in insular carcinomas[3]. Thyroglobulin staining is generally positive[4]. Distant metastasis occurs in about 31% of patients with insular thyroid carcinoma[5]. In cases of distant metastasis, treatment with thyroidectomy and radioiodine therapy were shown to independently improve survival[5].The Constellation of Insular thyroid cancer, hyperparathyroidism and Prolactinoma, has not been reported before.

Case of late hematoma after breast augmentation.

We present a case report of a patient who experienced a late, spontaneous breast hematoma 26 years after primary breast augmentation. Late hematomas are a rare complication of breast augmentation with uncertain etiology. In this case, there was no trauma, calcifications, or implant rupture. We believe the patient’s hematoma was secondary to erosion of a capsular vessel due to capsular contracture.

Chromophobe Renal Cell Carcinoma Presented with Wunderlich Syndrome

Introduction: Chromophobe renal cell carcinoma (RCC) like other types of RCCs maybe asymptomatic but few of them existing with rare presentations. Case Presentation: A male patient attended the emergency department of our center with sudden right flank pain. According to investigations performed, he had a tumor mass measuring 75 mm with extracapsular extension and heterogeneous enhancement in lower pole of the right kidney and a perinephric hematoma secondary to rupture of capsular vessels. Conclusions: Wunderlich syndrome can be the first presentation of chromophobe RCC.

Anatomical Variations of the Venous Drainage from the Left Adrenal Gland: An Anatomical Study.

For radiologists, the venous drainage of adrenal glands is a key to the technique of selective adrenal venous sampling. For endocrine surgeons, it is key to adrenalectomy for carcinoma and pheochromocytoma. This study aims to demonstrate direct anastomosis between the left adrenal vein, the diaphragmatic circulation and the azygos system. Anatomical textbooks only offer very little information concerning the left adrenal vein (LAV) and its potential anastomosis with the reno-lumbo-azygo trunk (RLAT) and the diaphragmatic circulation. Between November 2014 and October 2015 in the LADAF (French Alps Anatomy Laboratory), we dissected 44 formalin-fixed adult cadavers. We found no direct anastomosis between the left adrenal vein and the reno-azygo-lumbar trunk and two anastomoses (4.5%) between the adrenal capsular vein and azygos system. A lumbo-azygo trunk has been found 38 times (86.3%), drained 35 times (79.5%) into the left renal vein and 3 times (6.8%) into the left genital vein. An inferior phrenic vein ending into an adrenal vein was highlighted in all cases, 6 times (13.7%) in a double adrenal vein and 38 times (86.3%) in a single one. No connections have been found between left adrenal vein and the RLAT, and frequency of the IPV is discordant with the literature. However, our findings concerning the capsular vessels' anastomosis with the azygos system, inferior diaphragmatic flow and double adrenal vein could have two clinical applications: Firstly, the ligation of the adrenal vein solely is not enough to entirely interrupt the adrenal vein drainage, and secondly, sampling of hormones in the LAV could be underestimated because of the risk of dilution.

English

AIMS AND OBJECTIVES: To study and differentiate neoplastic (Malignant) and nonneoplastic (Reactive and tubercular)cervical lymph nodes by High resolution ultrasonography. To correlate the diagnostic accuracy of ultrasound with FNAC in differentiating neoplastic (malignant) and nonneoplastic (reactive and tubercular) cervical lymphadenopathy. MATERIAL AND METHODS: Data was collected from a total of 100 cases referred for ultrasound of neck to the Department of Radiodiagnosis, Sri R. L. Jalappa Hospital and Research Center over a period of 24 months from January 2012 to January 2014, with 5-10 MH linear transducer using SEIMENS G 40/G 50/ Acuson Ax 300 ultrasound equipment. Lymph nodes were assessed using grey scale and colour Doppler parameters like: nodal level and site, size, shape, L/S ratio, border, hilum, echotexture, necrosis, matting and angioarchitecture (hilar vessels, capsular vessels (peripheral) and mixed flow). A provisional diagnosis was suggested after the ultrasound examination and these findings were correlated with Fine Needle Aspiration Cytology/ Histopathological findings. RESULTS: In our study out of 45 non neoplastic nodes (reactive and tubercular) only 41 nodes were identified as non- neoplastic (reactive/ tubercular) on ultrasound prior to FNAC/ histopathology. Out of 55 possible neoplastic (malignant nodes) detected on ultrasound only 46 lymph nodes turned out to be neoplastic on FNAC/ histopathology. Lymph node with oval shape (L/S ratio > 2) echogenic hilum, homogenous echotexture and hilar vascularity were considered as significant parameters in detecting non-neoplastic (reactive) lymph nodes, which showed matting with soft tissue edema were considered nonneoplastic lymphnodes (Tubercular lymphnodes). Nodes which were Round shape (L/S ratio < 2), absent hilum, heterogeneous echotexture, hilar, capsular vessels and mixed vascularity were considered as significant parameters in detecting neoplastic (malignant) lymph nodes. Correlation of sonographic findings with Fine Needle Aspiration Cytology/ Histopathological findings was performed. Sensitivity and Specificity of ultrasound in differentiating neoplastic from non-neoplastic cervical lymphadenopathy was found to be 90% and 74% respectively. CONCLUSIONS: This study concludes that: 1) High resolution ultrasonographic examination proved as a valuable primary investigation to identify lymph nodes and differentiate nonneoplastic and neoplastic lymphadenopathy. 2) Combination of ultrasonographic features with vascular pattern of the lymph nodes have a high sensitivity, specificity in differentiating neoplastic and non-neoplastic

An historical perspective on ulnar intraneural ganglion cysts and their joint origins.

An historical perspective on ulnar intraneural ganglion cysts and their joint origins.

Post-hatch Changes in the Immunoexpression of Desmin, Smooth Muscle Actin and Vimentin in the Testicular Capsule and Interstitial Tissue of the Japanese quail (Coturnix coturnix japonica)

The post-hatch development of immunoreactivity to desmin, smooth muscle actin (SMA) and vimentin in the testicular capsule and interstitial tissue of day-old to adult quails was described in this study. The tunica albuginea of the testicular capsule was composed mainly of myoid cells. A zonal arrangement of desmin and SMA immunostaining was observed in myoid cells of the tunica albuginea in 1- to 24-day-old quails. Immunostaining for SMA and desmin was uniform in the tunica albuginea of adult birds. Vimentin immunostaining in the testicular capsule was demonstrated in mesothelial cells, endothelial cells and fibroblasts. The interstitial tissue contained mesenchymal cells, peritubular myoid cells, Leydig cells and fibroblasts. Desmin-immunopositive mesenchymal cells were present in the interstitial tissue of 1- to 17-day-old quails. Peritubular myoid cells expressed strong desmin immunostaining in all developmental stages, while the intensity of SMA immunostaining increased with testicular maturation. Vimentin was demonstrated in Leydig cells and fibroblasts, while the peritubular myoid cells displayed strong vimentin immunostaining only in adult birds. Strong vimentin immunostaining was demonstrated in the endothelial cells of capsular and interstitial blood vessels. The tunica media of these blood vessels displayed desmin and SMA immunostaining. The results of the study have established that variability exists in the distribution and intensity of desmin, SMA and vimentin immunostaining in the testicular capsule and interstitial tissue of the post-hatch Japanese quail.

Technical Learning Points for Robotic Prostatectomy: Video Assessment of Positive Margins at the Prostate Base in Two Cases

Introduction: Surgical technical error is a modifiable cause of positive surgical margins (PSMs) for robot-assisted laparoscopic prostatectomy (RALP). Retrospective intraoperative video review has the potential to evaluate technique. Gross pathology can be used to identify PSMs, which can then be correlated with the retrospective video review to identify where in the operation the positive margin took place. Technical errors, however, have not been well published. We present a 6:48 minute video comparing whole-mount pathology to surgical technique for RALP with a specific focus of evaluating the technical error of each operation at the prostate base. Materials and Methods: We reviewed the patients with PSMs who had video recordings for a single surgeon at our institution (P.M.) at our institution from 2008–2011. Results: We identified two patients with a PSM at the prostate base after RALP at our institution. Both operations utilized the posterior approach for clinical T2 disease. The whole-mount pathology was reviewed and then compared to the dissection of the prostate base. In both videos, we were able to identify the disruption of the prostate due to technical error. The first patient had a PSM at the left posterior base that occurred during dissection of the posterior lateral pedicle. Upon review, we believe that this could have been avoided by opening Denonvillier's fascia before dissecting the posterior lateral pedicles. The second patient had a positive margin was at the right posterior base that occurred at the junction of the seminal vesicle and prostate. This area was exposed during division of the bladder neck. Upon review, we believe that this could have been avoided by extending dissection along the lateral seminal vesicle until the prostate base was established. Conclusions: Video review has the potential to standardize training, improve surgical technique, and ultimately reduce technical error. Touijer et al evaluated positive margins in 12 cases and identified that technical error resulted in 8 positive margins. As a result, their group eliminated blunt teasing of the neurovascular bundles and instead controlled the capsular vessels by dividing them after the dissection plane was defined as well as control the prostatic pedicle higher on the prostate base to better delineate the limits of the neurovascular bundles and prostate. This resulted in a lower PSM rate in the next 90 patients.1 Open prostatectomy has also been evaluated with retrospective video. Walsh et al. retrospectively blinded reviewers to 62 videos and was able to identify four key steps that correlated with the recovery of sexual function. Ultimately, this exercise resulted in modification of surgical technique used by their institution.2 Simulation and video have already been integrated in many teaching programs and has been found to be successful.3,4 At our institution, we hope to improve upon simulation and use retrospective evaluation of robotic prostatectomy to improve resident teaching and outcome. For these two reviewed cases, surgeon technical error resulted in PSMs. A better understanding of previous errors will hopefully decrease future PSMs at this critical step. The authors have no significant financial interest or other relationship with the manufacturers of any products or providers of any service mentioned in this article. Runtime of video: 6 mins 48 secs

Diffuse Sclerosing Variant of Papillary Thyroid Carcinoma with Multiple Metastases and Elevated Serum Carcinoembryonic Antigen Level

Diffuse sclerosing variant of papillary thyroid carcinoma (DSPC) is a rare variant of papillary thyroid carcinoma (PTC). We report a 61-year-old female of DSPC whose course was complicated by multiple metastases and an elevated serum carcinoembryonic antigen (CEA) level. The patient presented with upper back pain. X-ray showed an osteolytic lesion of the sixth cervical spinous process. She had a hard, nonmovable mass with fixed enlarged lymph nodes (LNs) over right neck. Fine-needle aspiration cytology revealed PTC with LNs metastasis. Positron emission tomography demonstrated multiple brain, bone, liver, and lung metastases. However, the patient had an elevated serum CEA level. She underwent a total thyroidectomy and 200 mCi radioactive (131)I therapy. The pathological findings were diffuse sclerosing variant of PTC with capsular and lymph vessel invasion. A double staining of tumor specimen appeared concomitantly positive for CEA and thyroglobulin. To our knowledge, DSPC with an elevated CEA level is extremely rare.

Intraocular and orbital metastasis as a rare form of clinical presentation of insular thyroid cancer

Insular carcinoma of thyroid is a rare tumor, which accounts for 4 to 6% of thyroid malignancies. Clinically and morphologically it is considered to be in an intermediate position between well-differentiated carcinoma of the thyroid (papillary or follicular) and undifferentiated or anaplastic carcinoma of the thyroid. Capsular and blood vessel invasion is seen frequently, and metastases to regional lymph nodes, lungs and bones are common. The initial presentation of distant metastasis in patients with thyroid cancer is rare. Thus metastatic thyroid carcinoma rarely involves the orbit. We report a rare case of choroidal metastasis from insular thyroid carcinoma.

An anatomically based imaging sign to detect adventitial cyst derived from the superior tibiofibular joint

The origin for complex intraneural cysts remains controversial despite recent emerging evidence to support their articular origin. The coexistence of intraneural and adventitial cysts has been described due to the proximate neurovascular bundle, i.e., the articular (neural) branch and vessels at the joint capsule. To clarify the pathogenesis, anatomically based imaging patterns can be identified. This paper characterizes a common finding identified on MRI describing the adventitial component originating from the superior tibiofibular joint (STFJ). MRIs of patients with fibular (peroneal) (n = 24) and tibial (n = 7) intraneural ganglion cysts were reviewed. Eleven patients with fibular intraneural ganglion cysts were identified as having a coexisting adventitial component. In all cases, the adventitial cyst extended from the anterior portion of the STFJ, within the capsular vessels, and along the anterior tibial vessels. The reproducible anatomy permitted the identification of an imaging pattern: the "vascular U" sign, consisting of cystic anterior tibial vessels running through the interosseous membrane between the proximal tibia and fibula. This sign was seen on axial MR image(s) obtained at the level of the fibular neck in all cases. To generalize these findings, the rare tibial intraneural ganglion cysts (derived from the posterior aspect of the STFJ) were examined; two cases had coexisting adventitial cysts with visualization of the vascular U sign. This new imaging pattern can improve the identification of adventitial cysts at the level of the STFJ.

Hemangioma hepático subcapsular com realce perilesional: achados de RM

OBJETIVO: Descrever os achados de imagem de RM no hemangioma hepático com realce perilesional. MATERIAIS E MÉTODOS: Realizou-se uma pesquisa no banco de dados da unidade de RM para identificar todos os casos de hemangioma hepático com realce perilesional entre março de 2008 e julho de 2009. Todos os pacientes foram submetidos a RM pré-contraste em imagens ponderadas em T1 e T2 e em imagens dinâmicas após injeção de gadolínio. Características do hemangioma e do realce perilesional foram avaliadas nas imagens de RM. RESULTADOS: Sete hemangiomas em sete pacientes (cinco homens, duas mulheres; faixa etária entre 41-69 anos; média de 57 anos) foram incluídos no presente estudo. O tamanho das lesões variou de 7 a 20 mm (média de 12,4 mm). Na fase dominante arterial hepática, todos os sete hemangiomas mostraram realce perilesional cuneiforme que se atenuou nas imagens dois minutos após injeção de gadolínio. Quatro dessas lesões demonstraram realce capsular adjacente. CONCLUSÃO: Todos os hemangiomas hepáticos com realce perilesional eram lesões capsulares medindo menos que 2 cm. Tal localização sugere que esses hemangiomas podem recrutar vasos capsulares responsáveis pelo realce perilesional

Proangiogenetic molecules, hypoxia-inducible factor-1α and nitric oxide synthase isoforms in ovarian endometriotic cysts

Endometriosis is a common disease characterised by ectopic growth of endometrial tissue outside the uterine cavity. Angiogenesis has been implicated in the pathogenesis of the disease; some molecules, like hypoxia-inducible factor-1alpha (HIF-1alpha) and neuronal, endothelial and inducible nitric oxide synthase isoforms (nNOS, eNOS and iNOS), are known as proangiogenetic factors. We evaluated expression of these molecules by immunohistochemistry in 32 cases of ovarian endometriomas, formalin-fixed and paraffin-embedded. Analysis was focused on the cells composing the inner layer of the cyst, constituted by the ectopic endometrial glands, stromal cells and vessels, and the outer one, constituted by a fibrous layer of fibroblasts and vessels. We found that epithelial glands and capsular vessel endothelial cells showed a correlated expression of NOS isoforms; that expression of nNOS, iNOS and HIF-1alpha was correlated in epithelial glands and capsular fibroblasts; that vessel endothelial cells showed a higher mean expression for all the proangiogenetic molecules in the outer layer than in the inner one; and that capsular fibroblasts showed a higher mean expression for HIF-1alpha, iNOS and eNOS compared to the specialised stromal cells of the inner layer. Our data seem to indicate that angiogenesis is stimulated more in the outer capsule than in the inner layer of ovarian endometriotic cysts. The knowledge of the complex mechanisms associated to angiogenesis might be useful in a therapeutic approach of ovarian endometriosis based on anti-angiogenetic drugs. The therapeutic target would be mainly the capsular vasculature, more than the vasculature of ectopic endometrial tissues.

The Anatomy of the Medial Patellofemoral Ligament

Background Fibrous connections and fibrofatty tissue between the layers of the medial retinaculum have prevented accurate definition of the true anatomy of the medial patellofemoral ligament. This has led to confusion about the origin, form, course, and insertion of this structure. Hypothesis The medial patellofemoral ligament is a discrete structure that can be approached, isolated, and definitively described. Study Design Descriptive laboratory study. Methods Fifty fresh or fresh-frozen human knee specimens were carefully dissected to determine the precise anatomy of the medial patellofemoral ligament. Results Present in all specimens, the medial patellofemoral ligament was found to have 2 origins: (1) a transverse 10.6-mm origin from the bony groove between the medial epicondyle and the adductor tubercle, and (2) an oblique decussation originating from the proximal 30 mm of the leading edge of the superficial medial collateral ligament. The 2 origins combined and inseparably joined the vastus medialis obliquus tendon and inserted securely into the ventral edge of the bony patella over a span of 28.2 ± 5.6 mm adjacent to the articular surface of the patella. The length from the femoral origin to the patella was 59.8 ± 4.8 mm. The key to the dissection was finding the fine capsular vessels from the descending genicular artery that is between layers I and II of the medial retinacular structures. Conclusion The medial patellofemoral ligament is a constant structure in la‡yer II, with a complex anatomy that can be defined by careful dissection using the capsular branches of the descending genicular artery as a guide. Clinical Relevance This study provides essential new information that could help surgeons safely locate the medial patellofemoral ligament and repair or reconstruct it anatomically.

Alternative Surgery for Low Grade Thyroid Malignancies

Traditional surgery for thyroid nodule is usually performed via anatomic localization of the recurrent laryngeal nerve (RLN), inferior thyroid artery and parathyroid glands (PTGs) initially. Due to the RLN constantly lying beneath the thyroid gland and low grade malignancy of well-differentiated thyroid cancer (WDTC), it is not necessary to find the nerve initially and impossible to make too deep resection. From May 1998 to July 2005, 33 patients with WDTC underwent total thyroidectomy along the capsule with or without modified radical neck dissection without identifying the RLN and PTGs initially. The isthmus, capsular vessels and Berry's ligament were cut from above and the RLN could be found lying in the surgical bed. The PTGs could be found when the thyroid was retracted medially and removed. The patients were followed-up until December 2007. The safety of the method, complications and clinical outcomes were evaluated. For the patients with WDTC, only one patient (3%) had transient vocal palsy. Incidental parathyroidectomy was found in six (18%) patients, resulting in two (6%) with temporary and two (6%) with permanent hypocalcemia. Only one 86-year-old woman died of disease recurrence; the other patients remained disease-free. Total thyroidectomy for WDTC without identifying the RLN and PTGs initially is an easy and safe alternative method.

Capsular and Pericapsular Contributions to Acetabular and Femoral Head Perfusion

Capsular and pericapsular vessels are believed to contribute to acetabular and femoral head perfusion, but, to our knowledge, there is no anatomic study to support this theory. The purpose of this study was to describe the vascular anatomy of the hip with particular reference to the contributions of the capsular and pericapsular vessels. Twenty fresh cadavers were dissected twenty-four hours after intra-arterial injection of colored silicone. The arteries supplying the hip were followed by careful dissection from their origins outside the pelvis to their terminal branches. Particular attention was paid to the vessels traveling between the acetabulum and the capsule and the femoral head. In all twenty specimens, the hip capsule received blood supply from the superior and inferior gluteal arteries proximally and from the medial and lateral femoral circumflex arteries distally. The contributory vessels entered the capsule peripherally and superficially. The circumflex arteries supplied the anterior capsule. The gluteal arteries supplied the posterior and posterosuperior aspect of the hip capsule, augmented by contributions from the circumflex arteries. Variable anastomoses were found between the gluteal and femoral systems on the capsular surface beneath the gluteus minimus and short hip external rotators. The medial femoral circumflex artery provided the dominant blood supply to the femoral head in eighteen specimens, and the inferior gluteal artery provided the dominant supply in two specimens. Capsular and pericapsular vessels that contribute to the blood supply of the acetabulum run on the posterior and posterolateral surface of the capsule. The dominant blood supply to the femoral head comes from vessels that approach the joint posteriorly and penetrate the joint near the femoral attachment of the capsule.

Posterior capsule opacification and neovascularization treated with intravitreal bevacizumab and Nd:YAG capsulotomy

We reported a 75-year-old diabetic man, who developed opacification and neovascularization of the posterior capsule after extracapsular cataract extraction and posterior chamber intraocular lens implantation. The patient was treated with two injections of 2.5 mg of intravitreal bevacizumab. The treatment produced an important regression of the posterior capsular new vessels, allowing us to perform a successful Nd:YAG capsulotomy, clearing the visual axis and improving the visualization of the posterior pole. Even though, best corrected visual acuity was 20/200 due to diabetic macular edema.

Lymph Circulation in the Liver

The liver produces a large amount of lymph, which is estimated to be 25 to 50 % of lymph flowing through the thoracic duct. The hepatic lymphatic system falls into three categories depending on their locations: portal, sublobular, and superficial lymphatic vessels. It is suggested that 80 % or more of hepatic lymph drains into portal lymphatic vessels, while the remainder drains through sublobular and capsular lymphatic vessels. The hepatic lymph primarily comes from the hepatic sinusoids. Our tracer studies, together with electron microscopy, show many channels with collagen fibers traversing through the limiting plate and connecting the space of Disse with the interstitial space either in the portal tracts, or around the sublobular veins. Fluid filtered out of the sinusoids into the space of Disse flows through the channels traversing the limiting plate either independently of blood vessels or along blood vessels and enters the interstitial space of either portal tract or sublobular veins. Fluid in the space of Disse also flows through similar channels traversing the hepatocytes intervening between the space of Disse and the hepatic capsule and drains into the interstitial space of the capsule. Fluid and migrating cells in the interstitial space pass through prelymphatic vessels to finally enter the lymphatic vessels. The area of the portal lymphatic vessels increases in liver fibrosis and cirrhosis and in idiopathic portal hypertension. Lymphatic vessels are abundant in the immediate vicinity of the hepatocellular carcinoma (HCC) and liver metastasis. HCCs expressing vascular endothelial growth factor-C are more liable to metastasize, indicating that lymphangiogenesis is associated with their enhanced metastasis.

Die Tübinger Hüftbeugeschiene zur Behandlung der Hüftdysplasie*

The intrauterine hip position coincides with the so called squatting position with more than 90 degrees of flexion. This position is considered the best prerequisite for physiological development of the infant hips. In this position, pressure is equally distributed and there is no tension on the capsular blood vessels. A hip flexion splint is described which in a simple way provides for a reliable fixation of a newborn's hip in a flexion angle of more than 90 degrees an also for controlled abduction. Our splint is indicated in hip dysplasia. The paper illustrates the application on this inexpensive splint and its day-to-day care. Also we report on third party experience. The paper is summarized in the initial poster presentation.

Frozen Section in Thyroid Surgery

Objective: We studied the use of frozen section in the detection of malignancy in thyroid surgery in a large teaching hospital.Materials and methods: We reviewed all case notes of patients operated on for thyroid disease between January 1st 1997 and December 31st 2004. We identified 420 operations in 408 patients. Data were available for 417 operations. Results: In patients with a solitary thyroid nodule, a frozen section is sometimes performed. Frozen section was done in 128 of 417 operations. The specificity for malignancy was 98.16%. The positive predictive value was 81.81% and the negative predictive value 93.85%. However the sensitivity was 56.25%. Frozen section is a time-consuming investigation. With follicular lesions it is very difficult to distinguish between benign disease and malignancy since the diagnosis of malignancy depends on capsular and/or blood vessel invasion. Also it costs about 100 Euro (approximately 125 dollars).Conclusion: This study confirms that adequate histopathologic diagnosis of thyroid disease is based on extensive subsampling of the specimen which is not possible during a peroperatory frozen section procedure.