Transcutaneous Needle Aspiration Research Articles

Mediastinal Mature Teratoma Revealed by Empyema.

Teratomas are germ cell tumors, manifested with a great variety of clinical features; the most common extragonadal site is the anterior mediastinum. In this case, we report the patient with a large mature mediastinal teratoma with several components of ectodermal and endothermal epithelium. A 24-year-old female patient presented with history of persistent chest pain and progressively aggravating dyspnea for the previous 3 months. A chest X-ray showed a large opacity of the entire left hemithorax. Transcutaneous needle aspiration revealed a purulent fluid. The tube thoracostomy was introduced and the effusion was evacuated. Some weeks later, patient was seen in emergency for persistent cough and lateral chest pain. CT scan revealed a mass of the left hemithorax. The mass showed heterogeneous density, without compressing mediastinum great vessels and left hilar structures. Lipase value was elevated in needle aspiration. The patient underwent a total resection of the mediastinum mass via a left posterolateral thoracotomy. Microscopy revealed a mature teratoma with cystic structures. The patient subsequently made a full recovery. This case provide benign mediastinal teratoma with total atelectasis of left lung and elevated lipase value in needle transcutaneous aspiration; this event is explained by pancreatic component in the cystic tumor. Total removal of the tumor is adequate treatment for this type of teratoma and the prognosis is excellent.

Use of ultrasonography in the diagnosis of infections in the locomotor apparatus--possibilities and limitations

Significance of sonography in the detection of soft tissue infections is unclear and discussed controversial in literature. In a retrospective study sonograms of 40 hematomas and 23 infections were evaluated to examine the possibility of detecting infections by means of sonography alone. Accumulation of fluid, however, could not be differentiated by the established sonomorphological criteria. Especially in postoperative infections with unclear clinical pattern no differentiation between hematoma and abscess could be made. Only ultrasonically guided transcutaneous needle aspiration biopsy can prove the character of sonographic findings.

Lymphoma diagnosed as a solitary pancreatic head lesion by fine needle aspiration with endoscopic ultrasound

Purpose: Prymary lymphoma of the pancreas is a rare entity. Non-Hodgkins lymphoma can present in an extranodal site in up to 25% OF Cases. Pancreas is the primary site of origin in less than 3% of all Non-Hodgkin's lymphomas. In recent history, transcutaneous needle aspiration of pancreatic lesions is avoided because of the high percentage of needle tract tumor seeding. We report a case of a pancreatic mass that by CT appeared to be involving the porta hepatis area. Fine needle aspiration (FNA) by endoscopic ultrasound, a method not known for tumor seeding of the needle tract, revealed a B-Cell lymphoma originating in the head of the pancreas.

In vitro fertilization treatment for severe male factor: a comparative study of intracytoplasmic sperm injection with testicular sperm extraction and with spermatozoa from ejaculate.

Our purpose was to evaluate whether the source of spermatozoa influences the results of intracytoplasmic sperm injection (ICSI) treatment in couples with severe male-factor infertility. A retrospective analysis of 40 cases of ICSI with testicular-retrieved spermatozoa, matched with 40 cases of ICSI with ejaculated spermatozoa, was performed. We included only couples with normoovulatory females younger than 37 years who were matched according to the day of ovum pickup with the patients in the study group. Eighty cycles were analyzed: 40 cycles using testicular spermatozoa and 40 cycles using ejaculated spermatozoa. In 32 (80%) of the 40 ICSI transcutaneous needle aspiration cycles, we obtained enough spermatozoa to inject all the mature oocytes retrieved. In eight (20%) cases there were not enough spermatozoa to inject all the oocytes. Only 76 (54%) of 141 available oocytes were injected in these eight patients. The oocyte fertilization rates were 42% for the study group and 55.5% for the controls (P < 0.005). Thirty-six (90%) patients in the group with nonobstructive a zoospermia (NOA) and 37 (92.5%) patients in the oligoteratoasthenospermia (OTA) group had embryos for replacement. The mean cleavage rates per cycle (96% with testicular and 93% with ejaculated spermatozoa), the mean number of embryos per transfer (3.72 +/- 1.6 in the NOA group and 4.24 +/- 1.5 in the OTA group), the embryo quality (cumulative embryo scoring = 34.03 +/- 22.62 in the testicular sperm group and 36.08 +/- 19.28 in the ejaculated sperm group), and the clinical pregnancy rates (22.5% in the NOA patients and 20% in the ejaculate group) were not significantly different between groups. High fertilization, cleavage, and pregnancy rates can be achieved with intracytoplasmic testicular sperm injection from patients with NOA, reaching levels comparable with those of ICSI using ejaculated spermatozoa.

The importance of sonography in the diagnosis of septic complications following spinal surgery.

The detection of infection after surgery on the thoracic and lumbar spine is difficult due to the anatomical circumstances. Clinical symptoms, laboratory findings, and most radiological techniques are of limited diagnostic value. Among other benefits, sonography offers the advantage of early postoperative examination, even with metal implants in the operated area. In a retrospective study, 27 patients with clinically suspicious wounds were evaluated by sonography in the postoperative follow-up; all cases were verified by puncture and/or operative revision. Eleven cases turned out to be hematomas, and 16 cases were found to be infections. Accumulations of fluid, however, could not be differentiated by the established sonomorphological criteria such as internal echo structures, septation, demarcation from the environment, and reaction of the surrounding tissue. Ultrasonically guided transcutaneous needle aspiration biopsy served to differentiate the local findings and to establish the diagnosis and therefore is required as an obligatory method of investigation.

AN OPERATED CASE OF INTRATHORACIC GOITER OF COMPLETE TYPE PRESENTING WITH A TUMOR SHADOW IN THE LEFT HILUM

Recent experience with a case of intrathoracic goiter of complete type is a relatively rate mediastinal is presented here. A 35-year-old woman was referred to the hospital because of an abnormal shadow on a chest X-ray film that was pointed out at medical checkup. Chest X-ray showed an oval shadow in the left hilum. CT scan and tomogram revealed a 7.5×5.5cm well-demarcated and internally heterogeneous tumor adjacent to the aortic arch and protruding into the left lung field. Transcutaneous needle aspiration biopsy disclosed atypical follicle-like cells. Thyroidal scintigraphy revealed an uneven accumulation continuing from the left thyroidal lobe. The extirpation of the tumor was performed on May 20 1991. The tumor was partially adjacent to the normal thyroidal tissue which was mainly nourished by the artery branching from the beginning of the truncus brachiocephalicus, leading to a diagnosis of intrathoracic goiter (complete type). Histologically the tumor was composed of small and large follicles without malignant region. A total of 53 cases of intrathoracic goiter (complete type) has been reported in Japan (including this case), and only 4 cases of them had an abnormal shadow in the right or left hilum on chest X-ray examination for each 2 case.

Transcutaneous needle aspiration of solitary pulmonary masses: how many passes?

In 46 consecutive patients undergoing transcutaneous needle aspiration of the lung, we evaluated the number of passes required to reliably predict the presence of malignancy. A diagnosis of malignancy was made in 38 of the 46 patients (84%), none of whom required more than 6 separate aspirations for a positive cytologic diagnosis to be made. The remaining 8 patients with a nonmalignant cytologic diagnosis on 6 separate aspirations were subsequently shown to have a benign lesion, either by surgical excision (5 patients), fiberoptic bronchoscopy (2 patients), or clinical follow-up (1 patient). Pneumothorax occurred in 12 of 46 patients (26%). We confirm that TCNA is a safe and reliable procedure in the valuation of lung masses and that, when adequate cellular material is obtained, 6 separate aspirations reliably predict the presence of malignancy.

Pancoast's Syndrome and Small Cell Lung Cancer

Four patients with small cell lung cancer (SCC) presenting with Pancoast's syndrome are described. Superior sulcus tumors are usually caused by epidermoid carcinoma or adenocarcinoma of the lung, and are routinely treated with radiotherapy followed by radical surgery. SCC, on the other hand, is widely disseminated at diagnosis and is best treated with chemotherapy. Although not previously reported as a cause of Pancoast's tumor, these four cases of SCC presenting as such clearly indicate the need for pretreatment histologic diagnosis to avoid unnecessary surgical intervention. Transcutaneous needle aspiration biopsy is a means by which the diagnosis can be safely made in patients presenting with apical lung tumors.