Gland Nodes Research Articles

Low-Dose Ionizing Radiation and Thyroid Diseases and Functional Modifications in Exposed Workers: A Systematic Review.

Background/Objectives: With technological development, ionizing radiation has found applications in numerous occupations. However, the determination and quantification of the damage resulting from exposure to it remains rather unclear, along with the damage to particular organs. The aim of this systematic review was to investigate the relationship between low-dose ionizing radiation (LDIR) in exposed workers and possible functional changes and cancer development in the thyroid gland. Methods: We included observational studies evidencing the correlation under study. Data extraction and analysis was conducted on all included studies. The research strategy included three electronic databases (PubMed, Scopus, and Web of Science). The systematic review followed PRISMA guidelines, and the research protocol was submitted to PROSPERO (CRD:42023425839). Results: The search initially yielded 166 articles and, once duplicates and irrelevant articles were removed, a total of 15 useful articles were reviewed. Qualitative analysis of the studies showed that the TSH value does not change following exposure, while a reduction in fT3 and an increase or reduction in fT4 can be observed. Furthermore, the correlation between thyroid cancer and occupational exposure to radiation was not shown with certainty, but there was some evidence of increased gland volume and nodule formation. Conclusions: Even at low doses, ionizing radiation adversely affects thyroid activity. In this regard, new studies should be carried out in order to further investigate and define this issue and, consequently, outline useful measures to ensure the protection of workers in contact with this particular physical agent.

Diagnostic Accuracy of Bethesda Classification of Thyroid Nodules at a Kenyan Hospital: A Retrospective Study

Background: The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was developed to standardize the reporting of thyroid nodule fine-needle aspiration cytology (FNAC) results. The adoption of TBSRTC is based on the implied risk of malignancy per category, but this has shown wide variation in different regions worldwide. Aim: The aim of this study is to determine the diagnostic accuracy of the Bethesda classification of thyroid nodules in a Kenyan hospital. Methods: A retrospective longitudinal study examined FNAC and histopathology data of thyroid gland nodules at a Kenyan hospital from 2010 to 2019; specimens from 347 patients were found. An analysis was performed to determine the diagnostic accuracy of the Bethesda classification in detecting malignancy among these patients. Results: The malignancy rate was 16.1%. The risk of malignancy as per the Bethesda category was as follows: non-diagnostic— 19.6%, benign—6%, atypia of undetermined significance—20%, follicular neoplasm—16.7%, suspicious for malignancy—80%, and malignant—85.7%. The diagnostic properties of FNAC defining “malignant” and “suspicious for malignancy” categories as malignant were as follows: sensitivity—64.7%, specificity—97.6%, and accuracy—92.7%. Conclusion: The Bethesda classification had high diagnostic accuracy, with the risk of malignancy consistent with the Bethesda findings. Classifying malignancy as “malignant” and “suspicious for malignancy” yielded the most favorable diagnostic properties for FNAC.

Oncocytic cells in the punctate of a thyroid gland nodule. Is there a reason to suspect cancer

Oncocytic cells in the punctate of a thyroid gland nodule. Is there a reason to suspect cancer

Cytodiagnosis of a Metastatic Anaplastic Carcinoma of Thyroid Presenting as Multiple Subcutaneous Nodules

Anaplastic thyroid carcinoma (ATC) is a rare malignancy with highly aggressive behavior. It has an overall survival from 3 to 5 months in most of the cases. The most common metastatic sites are the lungs, followed by the intrathoracic and neck lymph nodes. Soft-tissue involvement is extremely rare and only a few cases have been published in English literature. Here, we report a case of ATC in a 22-year-old male who presented in early decade of life with multiple soft-tissue metastases as a rare initial presentation. Clinical examination revealed a diffusely enlarged thyroid gland, cervical lymphadenopathy, and multiple subcutaneous nodules over left thigh, chest and abdominal wall. Cytology from all sites of lesions followed by cell block with immunohistochemistry confirmed a diagnosis of ATC with nodal and cutaneous metastases. The patient succumbed to death before further management.

Prediction of malignant risk stratification model for parotid gland nodules based on clinical and conventional ultrasound features: construction and validation.

Ultrasound is widely used in the examination of the parotid gland, but no single ultrasound feature has demonstrated satisfactory diagnostic performance in predicting the nature of parotid nodules. Unlike the established and widely used grading systems for breast and thyroid nodules, a universally adopted and clinically accepted risk stratification system for malignancy in parotid gland nodules remains absent at present. This study aims to establish a malignant risk stratification model for parotid nodules by analyzing patients' clinical features and conventional ultrasound image characteristics. In this study, clinical data and ultrasound images of 736 patients with parotid nodules were retrospectively analyzed. Pathological results served as the gold standard, and the patients were randomly divided into training and validation groups in a 7:3 ratio. Clinical and ultrasound features of parotid nodules in the training group were compared. Multifactor logistic regression analysis was employed to screen for risk factors of malignant nodules and quantify scores. The probability of malignant risk was assessed and classified into five grades (Grade 1, normal parotid; Grade 2, definitive benign; Grade 3, possibly benign; Grade 4, suspicious malignant; Grade 5, high probability of malignancy). The diagnostic performance of the model was assessed by using calibration curves, receiver operating characteristic curves, decision curves, and clinical impact curves. Facial symptoms, unclear margin, irregular shape, microcalcification, and abnormal cervical lymph nodes were independent risk factors for malignant parotid nodules. The area under the curve of the model was 0.850 [95% confidence interval (CI): 0.816-0.879] in the training group and 0.846 (95% CI: 0.791-0.891) in the validation group. The malignancy risk stratification model based on clinical and ultrasound image features has a good differentiation between benign and malignant parotid nodules, which is helpful for diagnosis and guiding clinical treatment.

Bocio y enfermedad nodular tiroidea

Goiter and thyroid nodular disease are very common conditions of the thyroid gland. Goiter refers to growth of the normal thyroid parenchyma and thyroid nodule when the growth is located in a delimited, distinguishable area of the normal parenchyma. Its etiology is diverse, although the etiopathogenesis is not entirely clear. There tend to be few symptoms and the diagnosis is usually made through incidental findings on imaging tests. When evaluating thyroid nodules, it is essential to conduct a glandular function analysis, with an initial screening by measuring thyroid stimulating hormone (TSH) and describing the gland and possible nodules by means of thyroid ultrasound. Ultrasonography allows for evaluating nodule characteristics and classifying them according to the risk of malignancy by means of EU-TIRADS. In case of asymptomatic goiter, observation and clinical monitoring can be carried out, reserving other interventions for cases with compression of neighboring structures. On the other hand, management of the nodules will depend on symptoms, EU-TIRADS ultrasound features, and the Bethesda histological classification (in case of puncture). Observation and ultrasound monitoring or an invasive approach can be chosen.

Přínos tenkojehlové aspirační bio psie a klasifi kace Bethesda v diagnostice tumorů štítné žlázy – retrospektivní studie

Introduction: Thyroid nodule is a pathology with a prevalence of 19–68% of the population, with a thyroid gland carcinoma proven in 7–15% of these cases. Bethesda classifi cation is a standardized system for cytology fi ndings evaluation. Aim of work: The aim of our work was to compare a predicted preoperative dia gnosis including Bethesda classifi cation and the fi nal histology results, to defi ne malignancy risk for Bethesda categories and to compare our fi ndigs with foreign papers. Material and methods: A retrospective, observational study. In a group of 330 patients with performed operation on the thyroid gland (total thyroidectomy or hemithyroidectomy) at the ENT department of the University hospital in Pilsen between 2016 and 2017 there was a group of 180 patients (147 female and 33 male patients) with preoperatively known Bethesda category. We have compared an expected dia gnosis and postoperatively known histology dia gnosis, determined a risk of malignancy rate for each category of Bethesda classifi cation and compared our results with a foreign literature. Results: In the group of our patients, we have determined a risk of malignancy rate for Bethesda I. category as 14.29%, same as for Bethesda II. For Bethesda III. as 15.79%, Bethesda IV. as 10.64%, Bethesda V. as 52.17% and Bethesda VI. category as 100%. Conclusion: Fine- -needle aspiration bio psy of thyroid gland nodules is a basic dia gnostic method, which facilitates categorization and stratifi cation of a risk of malignancy in cytological fi ndings. In our group of patients, a risk of malignancy rate diff ers in Bethesda I. and II. category, our risk of malignancy rate is higher compared to foreign literature, which, we believe, is a statistical error due to a rather small set of patients. Key words thyroid nodule – fine-needle aspiration bio psy – Bethesda classifi cation – risk of malignancy rate

Utility of UV Signature Mutations in the Diagnostic Assessment of Metastatic Head and Neck Carcinomas of Unknown Primary.

Metastatic carcinoma of unknown primary origin to the head and neck lymph nodes (HNCUP) engenders unique diagnostic considerations. In many cases, the detection of a high-risk human papillomavirus (HR-HPV) unearths an occult oropharyngeal squamous cell carcinoma (SCC). In metastatic HR-HPV-independent carcinomas, other primary sites should be considered, including cutaneous malignancies that can mimic HR-HPV-associated SCC. In this context, ultraviolet (UV) signature mutations, defined as ≥ 60% C→T substitutions with ≥ 5% CC→TT substitutions at dipyrimidine sites, identified in tumors arising on sun exposed areas, are an attractive and underused tool in the setting of metastatic HNCUP. A retrospective review of institutional records focused on cases of HR-HPV negative HNCUP was conducted. All cases were subjected to next generation sequencing analysis to assess UV signature mutations. We identified 14HR-HPV negative metastatic HNCUP to either the cervical or parotid gland lymph nodes, of which, 11 (11/14, 79%) had UV signature mutations, including 4 (4/10, 40%) p16 positive cases. All UV signature mutation positive cases had at least one significant TP53 mutation and greater than 20 unique gene mutations. The management of metastatic cutaneous carcinomas significantly differs from other HNCUP especially metastatic HR-HPV-associated SCC; therefore, the observation of a high percentage of C→T with CC →TT substitutions should be routinely incorporated in next generation sequencing reports of HNCUP. UV mutational signatures testing is a robust diagnostic tool that can be utilized in daily clinical practice.

Diagnosis of benign and malignant nodules with a radiomics model integrating features from nodules and mammary regions on DCE-MRI.

To establish a radiomics model for distinguishing between the benign and malignant mammary gland nodules via combining the features from nodule and mammary regions on DCE-MRI. In this retrospective study, a total of 103 cases with mammary gland nodules (malignant/benign = 80/23) underwent DCE-MRI, and was confirmed by biopsy pathology. Features were extracted from both nodule region and mammary region on DCE-MRI. Three SVM classifiers were built for diagnosis of benign and malignant nodules as follows: the model with the features only from nodule region (N model), with the features only from mammary region (M model) and the model combining the features from nodule region and mammary region (NM model). The performance of models was evaluated with the area under the curve of receiver operating characteristic (AUC). One radiomic features is selected from nodule region and 3 radiomic features is selected from mammary region. Compared with N or M model, NM model exhibited the best performance with an AUC of 0.756. Compared with the model only using the features from nodule or mammary region, the radiomics-based model combining the features from nodule and mammary region outperformed in the diagnosis of benign and malignant nodules.

Diagnostic value of colour Doppler ultrasound in differentiating malignant and benign nodules in thyroiditis background.

Differentiating malignant thyroid nodules from benign ones is challenging. Sonography is a non-invasive modality that can be helpful in this regard and is far better than invasive methods like fine needle aspiration (FNA). This study aimed to assess the diagnostic value of colour Doppler ultrasonography in distinguishing malignant and benign nodules of thyroid gland. The study involved patients with thyroiditis and thyroid nodules, who underwent sonography. Ultrasound findings were assessed. All the nodules were classified according to the FNA into malignant, follicular nodules and lymphatic. Then, sonography findings were compared between these three groups. There were 216 nodules, including 108 (50%) malignant nodules, 80 (37%) benign and 28 (13%) lymphatic follicles, were evaluated. Micro-calcification was present in 50 (46.3%) malignant cases, 11 (13.7%) benign cases and 2 (2.1%) lymphatic follicles. Decreased or mixed vascularity was reported in 43 (69%) malignant nodules, 4 (5%) benign cases and 7 (25%) lymphatic follicles. Also, 9.7% and 42% of malignant and benign nodules had peripheral circular vascularity, respectively; however, none of the lymphatic follicles had this finding. With 89% specificity, 49% sensitivity and 73.5% accuracy, calcification with or without decreased or mixed vascularity could differentiate benign and malignant nodules. Decreased or mixed vascularity with or without calcification shows high sensitivity in differentiating malignant and benign nodules.

FEATURES OF THE DIAGNOSIS AND TREATMENT OF PATIENTS WITH SMALL TUMORS OF THE THYROID GLAND

Summary. Aim: to identify the causes of diagnostic errors at the preoperative stage in patients with thyroid nodules measuring < 1.0 cm. Object and methods: the study consists of retrospective and prospective research based on the analysis of examination results of 4509 patients with focal lesions of the thyroid gland. All patients underwent a comprehensive examination (ultrasound, fineneedle aspiration biopsy + cytological examination) in 872 patients with nodules of the thyroid gland measuring < 1.0 cm. The data of histopathological, cytological, and ultrasound findings were compared, and the accuracy, sensitivity, and specificity of ultrasound (US) and fineneedle aspiration biopsy (FNAB) under US control in the diagnosis of thyroid nodules with a diameter < 1.0 cm, including microcarcinoma, were evaluated. Results: out of 1003 cases of thyroid nodules, a correct preoperative US conclusion was formulated in 838 cases (83.6%) relative to postoperative histological examination, incorrect interpretation of the ultrasound image was noted in 165 cases (16.5%), with false-positive results in 85 cases (8.5%) and false-negative results in 80 (8.0%). The sensitivity of US for thyroid nodules measuring < 1 cm was 73.9%, and specificity was 82%. In 159 cases (94.6%) out of 168 patients with verified thyroid nodules, cytological examination data (papillary, follicular, or medullary thyroid carcinoma) corresponded to histological findings. The sensitivity of FNAB for thyroid nodules in less than centimeter sizes was 89.7%, and the specificity for benign less than centimeter thyroid nodules was 83.4%. Conclusions: ultrasound remains the standard for visualizing thyroid nodules, so clear criteria for their assessment will significantly reduce the number of nodules requiring biopsy and help clinicians improve the accuracy of treatment recommendations.

FRI369 SDHB Hereditary Pheochromocytoma Paraganglioma Syndrome With Biochemically Silent Pheochromocytoma

Abstract Disclosure: A.M. Skariah: None. C.C. Zacharia: None. Background: Paragangliomas are rare neuroendocrine tumors arising from extra-adrenal autonomic paraganglia. Majority of cases are sporadic but 30-50% are associated with genetic mutations. Patients with SDHB mutations can present with pheochromocytoma, paragangliomas or both. Lesions are usually extra-adrenal and typically secrete norepinephrine and occasionally dopamine. These cases are often associated with higher malignancy rates (up to 79%) compared to other SDH-x associated mutation cases. Clinical Case: Our patient is a 64-year-old female with history of secondary adrenal insufficiency, hypothyroidism, osteoporosis, GAD who presented in 2005 with left occipital headache and dysphagia. Workup was notable for a glomus tumor. She underwent tumor embolization, resection, radical neck dissection and radiation therapy. Genetic testing was not performed at the time of diagnosis. Routine biochemical surveillance was done postoperatively. In 2018, the patient was found to have a mild elevation of normetanephrine 248 pg/ml (<148 pg/ml) and total metanephrine 297 pg/ml (<205 pg/ml) levels. Subsequent plasma, urinary metanephrine/catecholamine studies were negative. In 2021, her brother was diagnosed with pheochromocytoma. Genetic testing was then pursued in the patient, and she was found to have a pathogenic mutation c.724C>A (p.R242S) in the SDHB gene. In June 2022, CT chest, abdomen and pelvis with contrast was ordered, and she was found to have a homogeneously enhancing 1.3 x 1.1x 1.4 cm left adrenal nodule with indeterminate imaging characteristics. Following this CT, DOTATATE PET CT scan was done and demonstrated somatostatin avidity in the region of previously resected left glomus jugular tumor, right adrenal gland nodule and left inferior pubic ramus sclerotic lesion. Repeat biochemical testing remained negative for catecholamine excess. Despite being asymptomatic, there was concern for a biochemically silent pheochromocytoma. Alpha blockade was completed prior to right adrenalectomy in November 2022 and surgical pathology confirmed pheochromocytoma. The patient remains clinically stable, and she is now undergoing radiation therapy of her left pubic ramus lesion. Conclusion: It is important to have genetic evaluation early in the workup for a newly diagnosed PPGL. Additionally, suspicion for biochemically silent pheochromocytoma should be present even in the setting of negative biochemical workup and positive SDHB mutation. Presentation: Friday, June 16, 2023

SAT536 A Case of Papillary Thyroid Cancer in Multiple Cervical Lymph Nodes, But Not Found in Thyroid Tissue on Pathology

Abstract Disclosure: M.A. Green: None. G.Y. Kim: None. Introduction:As technology advances, imaging becomes increasingly frequent and within the thyroid gland nodules can often be detected. After detection comes evaluation and lymph nodes within the neck are an integral part of this step. For that reason, fine needle aspiration (FNA) of cervical lymph nodes is known to lend a hand toward diagnosis. Here we present a patient who was diagnosed with Papillary Thyroid Cancer (PTC) from FNA pathology of a lymph node, but PTC was not noted within pathology of the thyroid tissue after total thyroidectomy. Case Presentation: This patient is a 34 year-old female with a history of ovarian cancer who presented to the clinic for a thyroid nodule and Hashimoto’s disease. A bed side ultrasound noted a right upper pole 1.6 x 0.6 x 0.6 cm thyroid nodule and a solid 1.8 x 1.5 x 0.8 cm nodule superior to the isthmus likely representing a delphian lymph node. As well, significant cervical lymphadenopathy was seen. A biopsy of the right upper pole nodule was nondiagnostic on FNA, but the delphian lymph node superior to the isthmus was positive for PTC. The patient then underwent total thyroidectomy and right and central neck lymph node dissections. Interestingly, PTC was noted in 3 of 27 lymph nodes in the central compartment, 5 of 18 lymph nodes excised with the thyroid tissue with extranodal extension, and 5 of 24 lymph nodes in the right neck compartment, but not noted in the thyroid tissue itself. The largest metastatic dimension of PTC within the cervical lymph nodes was noted to be 3 cm. The pathology noted a 1.0 cm tumor in the right lobe “approaching skeletal muscle” and psammoma bodies within the left lobe. After the patient’s surgery her stimulated thyroglobulin reported as 0.21 NG/mL and thyroglobulin antibody 2 IU/mL. She was then able to receive 30 mCi of I 131 sodium iodide. TSH maintained at goal on levothyroxine 200 mcg daily. Discussion: Diagnosis of PTC within multiple cervical lymph nodes, but not noted on thyroid pathology is very uncommon. It is highly unlikely in our patient that a cancer within the thyroid does not exist and there are theories to postulate this unique finding. These include missed pathology on the dissection, tumor regression prior to removal, or possibly ectopic tissue as the source of PTC. Although in our patient, given the significant amount of positive cervical lymph nodes, it is hard to believe that ectopic tissue away from the neck was the source or that tumor regression occurred. The pathological findings of psammoma bodies suggest the presence of PTC that spread to the lymphatic system. As well, the nature of thyroid removal leads to some destruction of tissue prior to evaluation. This case highlights the importance of thorough lymph node evaluation as a complete part of preoperative PTC assessment. Presentation Date: Saturday, June 17, 2023

Sonographic Determination of Thyroid Gland Volume among Patients with Type 2 Diabetes Mellitus in Northern Nigeria

Background: Thyroid disease and type 2 diabetes mellitus (T2DM) are interconnected endocrine disorders with a bidirectional relationship. T2DM patients may present with various thyroid abnormalities, such as gland enlargement and nodule formation, warranting noninvasive assessment through ultrasound scanning. Aim: This cross-sectional study aimed to evaluate thyroid gland volume (TGV) in adult patients with T2DM using ultrasound imaging in Kano. Materials and Methods: A total of 160 participants were randomly selected and underwent sonographic scans of the thyroid gland using a medical ultrasound machine with a 7.5 MHz linear probe. Thyroid volumes were recorded, and demographic information was collected. Statistical analysis was performed using the SPSS software version 29, with significance set at P < 0.05. Results: The mean TGV ± standard deviation was 5.8 ± 3.1 cm3. Females exhibited a statistically higher TGV (6.1 ± 3.4 cm3) compared to males (5.6 ± 2.8 cm3). There was no significant difference in TGV among patients with different diabetes control habits. The mean volume of the right lobe (3.1 ± 1.8 cm3) was significantly greater than that of the left lobe (2.7 ± 1.6 cm3). TGV correlated positively with T2DM duration, age, weight, and body mass index. Conclusion: This study provides valuable insights into the TGV among patients with T2DM in Kano. The findings indicate a positive correlation between TGV and T2DM duration and demonstrate gender and laterality differences. Ultrasound-based assessment of thyroid volume can be a valuable tool in monitoring thyroid health in T2DM patients and may aid in the early detection and management of thyroid abnormalities.

OSTEOCALCIFICATIONS OF THYROID NODULES

According to the world statistics, when performing thyroid ultrasound, calcifications are detected in 20-33% of nodules of various structures. In recent years, there has been a sharp increase in the number of publications devoted to the assessment of this phenomenon, which is the basis for their study and development of their own approach. The aim is to generalize and systematize the materials available in available scientific Russian and foreign publications on the features of the structure and distribution of calcifications in nodular thyroid formations and on the opportunities of ultrasound examination in their detection and identification from the position of oncological risk. Materials and methods. To achieve the aim, methods of comparison, generalization, analysis, synthesis, grouping of classifications and systematization of data contained in publications of domestic and foreign authors were used. Results. Thyroid calcifications were previously rarely detected at the stage of preoperative examination of patients. With the widespread introduction of ultrasound into practice, such "findings" have become frequent. Despite a large number of patients with thyroid calcifications, attempts have not been made to seriously analyze and systematize this ultrasound sign, although some scientists consider them predictors of thyroid cancer. Attempts to seriously study the composition of calcifications in various nodules of the thyroid gland are occasional; they have not yielded practical results yet. Separation of calcium-containing deposits in thyroid nodules into microcalcifications and macrocalcifications significantly increased the diagnostic weight of the first group, which caused the predominant place of the sign "microcalcifications" in papillary thyroid cancer. There is no consensus on macrocalcifications. Various variants of their structure and the duration of their formation do not yet allow them to be adequately systematized from the perspective of predicting the diagnosis. Conclusions. According to the majority of the authors of the sources studied, calcium-containing deposits in the nodules of the thyroid gland indicate a severe irreversible restructuring of tissues with loss of their ability to regulate mineral metabolism. With the help of ultrasound, it is possible to not only get a descriptive presentation of calcifications, but to track their change over time as well.

Diagnosis of salivary gland tumors: Does the triple diagnosis method have value?

Appropriate clinical management of salivary gland lesions requires a determination as to whether a salivary gland nodule is benign or malignant. Approximately three-quarters of all salivary gland nodules represent benign neoplasms. Separation of salivary gland carcinomas from benign lesions can be diagnostically challenging. The Milan System for Reporting Salivary Gland Cytopathology recommends the correlation of cytologic diagnoses with imaging and clinical findings creating a diagnostic triplet. How often the "Triple Diagnosis" method is used and its accuracy in separating salivary gland nodules into benign and malignant groups are unknown. An electronic records search of cytology files at the University of Missouri was performed for fine needle aspirates of the salivary gland obtained between September 2018 and August 2022. Chart review was performed for preoperative clinical and imaging diagnoses. Diagnostic "Triplets" constructed from cytologic, clinical, and imaging diagnoses were correlated with final surgical pathology diagnosis. One hundred and thirty-six FNAs were identified. Eighty-seven cases had preoperative imaging with 52 of these cases having clinical diagnoses. Due to the lack of a definitive clinical or imaging diagnosis for a nodule as benign or malignant, only 12 (23%) cases had definitive "Triplets." Nine (17%) "Triplets" were benign and three (6%) were malignant. Accuracy of concordant triplets was 100% for the prediction of malignancy and 89% for the prediction of a benign result as determined by final histologic diagnoses. While highly accurate in predicting the benign or malignant nature of a salivary gland nodule, concordant triplets made up only 23% of cases limiting their clinical utility.

Abstract #1400950: Chiari I Malformation with Concomitant Nonfunctioning Pituitary and Adrenal Tumors

Chiari I malformation (CM1) is a rare finding with an incidence ranging from 3.3 to 8.2 per 100000. CM1 has been described with growth hormone secreting pituitary adenomas, and with EPAS1 gain-of-function mutation syndrome with multiple paragangliomas/pheochromocytomas, somatostatinoma, and polycythemia. There is only one case report in the literature describing a nonfunctional pituitary adenoma with CM1. We describe the first reported case of a patient with CM1 with concomitant nonfunctional pituitary and adrenal incidentalomas. A 45-year-old female with history of diet-controlled diabetes and HTN presented with a two-week history of bilateral upper extremity weakness and paresthesia, along with gait instability. She had reduced motor power in the upper extremities on physical exam. MRI cervical spine demonstrated a cervicothoracic syrinx, cerebellar tonsillar ectopia consistent with CM1. MRI brain showed diffuse enlargement of the pituitary gland measuring 16 x 14 x 13 mm bulging into the suprasellar cistern and minimally abutting the inferior aspect of the optic chiasm. MRI lumbar spine revealed a left adrenal gland nodule measuring 1.5 x 2.0 cm. Endocrine hormonal evaluation showed normal prolactin, follicle stimulating and luteinizing hormone, estradiol, free T3, free T4, and IGF-I levels. Aldosterone level was high in supine position with normal plasma renin activity initially with normal levels on repeat testing. Plasma free metanephrine, normetanephrine, testosterone levels were also normal. Patient was started on dexamethasone in anticipation of surgery. Patient underwent suboccipital craniectomy, C1 laminectomy, coagulation of cerebellar tonsils and expansile duraplasty for CM1. Patient did well postoperatively and dexamethasone was tapered off. Postoperative follow up after patient had been off steroids for three weeks showed normal levels of all pituitary and adrenal hormones, including normal dexamethasone suppression test. While CM1 is a rare finding, pituitary adenomas are relatively common. In cases of concomitant occurrence of CM1 and growth hormone secreting pituitary adenoma, over-secretion of growth hormone has been proposed as a mechanism to precipitate symptoms of CM1 by causing hypertrophy of connective and ligamentous tissue in the skull base and of the cranio-cervical canal. Our patient had normal IGF-1 levels with a nonfunctional pituitary adenoma raising the question whether there is some other underlying mechanism, possibly a genetic predisposition, that contributed to the concomitant occurrence of CM1 with pituitary and adrenal tumors. Whether these tumors become functional in the future remains to be seen.

Clinicopathological study of swellings of the thyroid gland with an emphasis on multinodular goitre

Many suggest that clinical examination is the best tool to detect the nodules of the thyroid gland. They also suggest that ultrasound of the thyroid gland should be used only to monitor any changes in the size of the nodule of the thyroid. To study swellings of the Thyroid gland with an emphasis on multinodular goitre.The study is prospective, involving all the patients of thyroid swelling. All thyroid swelling cases were subjected to FNAC. The type of thyroidectomy was based on the size and type of thyroid whether neoplastic or non-neoplastic. All the 102 patients were treated by surgeries like hemithyroidectomy, subtotal and total thyroidectomy following FNAC. Majority of the study subjects were in the age group of 20-29 years i.e. 29.5%. In this study most common consistency of thyroid swelling was found to be soft in 61 patients, firm in 22 and hard in 19. Lymph nodes were present in 13 patients (12.75%). 95.1% (97) of patients were euthyroid, four were hypothyroid and one was hyperthyroid. most common FNAC finding was colloid nodule in 61.8% of the cases followed by adenoma in 12.8% of the cases. Most common clinical diagnosis was solitary nodular goitre in 49% of the cases followed by multinodular goitre in 24.5% of the cases. Most common type of surgery performed was Hemithyroidectomy in 50.9% of the cases Most common complication was bleeding which occurred in only three cases. FNAC is a very useful and indispensable test in the diagnosis of thyroid lesions.

Long-term effects of radioiodine treatment on thyroid functions and ultrasonographic features in patients with toxic adenoma and toxic multinodular goitre.

This study aimed to investigate the long-term effect of radioiodine (RAI) treatment on thyroid functions and ultrasonographic changes in the thyroid gland and toxic nodules. Thyroid function tests and ultrasonography reports of patients diagnosed with toxic adenoma (TA) or toxic multinodular goitre (TMNG) between 2000 and 2021 were retrospectively analysed. We included 100 patients whom thyroid function and ultrasonography results were obtained from our outpatient clinic before and at least 36months post-RAI. At the end of the follow-up period, the mean thyroid volume reduction in patients with TA and TMNG was 56.6% ± 3.1% and 51.1% ± 6.7%, respectively; the mean volume decrease of all toxic nodules was 80.5% ± 1.9%. The volume of the thyroid and toxic nodules was significantly reduced up to 12years (p < 0.01). Between 3 and 10years after RAI therapy, the annual incidence of hypothyroidism was 2.0% and 1.5% in the TA and TMNG groups, respectively. Toxic nodules were more frequently solid and hypoechoic in post-RAI ultrasounds (p < 0.01). The volume of thyroid gland and toxic nodules continuously decreases, as the risk of hypothyroidism increases up to 10years after RAI treatment. After RAI treatment, patients should be followed up to check their thyroid functions. In post-RAI examinations, toxic nodules may show ultrasonographic features suspicious for malignancy. History taking should include previous RAI therapies and old scintigraphy scans should be evaluated to avoid unnecessary procedures and non-diagnostic biopsy results.

Reproductive evaluation of Luisa, the last jaguar of the Caatinga.

The in situ population of jaguars in the Caatinga is less than 250 individuals, subdivided into five subpopulations, and is classified as endangered regarding its risk of extinction. Luisa, a 15-year-old female weighing 36 kg, was the last known ex situ jaguar from this biome. Her reproductive evaluation is detailed in this manuscript. Luisa was subjected to both a clinical and laparoscopic evaluation of her reproductive system. After 45 days of reproductive investigation, she died unexpectedly, and skin fragments were taken to establish the postmortem fibroblast lineage. At the clinical evaluation, Luisa had small, undeveloped mammary gland and a small vulva, characteristic of a nulliparous female, with no mammary gland nodules, edema, or abnormal masses. By laparoscopy, normal-appearing bladder and bowel loops were observed, as were uterine horns with standard color, shape, and length with no striae. Ovaries and uterine horns seem free of fibrinous adhesions. Both ovaries showed a yellowish color, a fibrous consistency, a decreased size (atrophied), and no follicles, hemorrhagic corpus, corpus luteum, luteal scars, or other abnormal structures. We may assume that this jaguar female was infertile based on Luisa's mature age and the absence of birthing or ovarian activity signs. The harsh conditions of the Caatinga biome, which included low food availability and frequent conflicts with humans, may have impacted both the pregnancy and lactation of Luisa's mother and her development after birth.