结节病易误诊,据王洪武等~([1])收集国内18篇关于此病误诊的文献,误诊率高达63.2%,当然有误诊就会有误治,如孙永昌等~([2])报道26例结节病在影像学检查诊断的第一印象中拟诊结核5例,其中就有2例完成规范的抗结核治疗,为此应引起临床对本病诊治的重视。

Sarcoidosis

The National Cancer Institute (NCI) sponsored the NCI Thyroid Fine-needle Aspiration (FNA) State of the Science Conference on October 22-23, 2007 in Bethesda, MD. The two-day meeting was accompanied by a permanent informational website and several on-line discussion periods between May 1 and December 15, 2007 (http://thyroidfna.cancer.gov). This document summarizes matters regarding diagnostic terminology/classification scheme for thyroid FNA interpretation and cytomorphologic criteria for the diagnosis of various benign and malignant thyroid lesions. (http://thyroidfna.cancer.gov/pages/info/agenda/).

Diagnostic terminology and morphologic criteria for cytologic diagnosis of thyroid lesions: a synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference.

On October 22 and 23, 2007, the National Cancer Institute (NCI) hosted "The NCI Thyroid Fine Needle Aspiration (FNA) State of the Science Conference," a two-day gathering in Bethesda, Maryland. Its mission was to establish a comprehensive interdisciplinary informational dialogue dedicated to thyroid FNA. Preparations for the conference began 18 months earlier with the designation of a steering committee, the appointment of nine working committees, coordination with co-sponsoring organizations, and the establishment of a dedicated permanent web site. The function of the website was to serve as a permanent educational tool for health care practitioners and patients alike, as well as to foster on-line dialogue.

Six committees were charged with preparing summary documents based on literature reviews on the following subjects: 1. Indications/Pre-FNA requirements; 2. Training and Credentialing; 3. Technique; 4. Terminology and Morphologic Criteria; 5. Ancillary Studies; and 6. Post-FNA Options for Testing and Treatment. Three additional committees were formed, one each to oversee the website, publications ensuing from the conference and the establishment of an on-line educational cytopathology atlas.

Literature reviews were limited to English language publications dating back to 1995, using PubMed as the search engine, with key words determined by the committee members. The first draft of the committees' summary documents ("Review and Conclusions") was posted on the web site and open for on-line forum discussion from May 1-June 30, 2007. There were several subsequent drafts and on-line discussion periods (Aug 15 – Sept. 30, 2007 and Nov. 30-Dec. 15, 2007). The documents underwent revision after each comment period prior to re-posting on the web. The two-day "live" conference in October, attended by 154 registrants, comprised of pathologists, endocrinologists, surgeons, and radiologists, gave the committees an in-depth opportunity to present their conclusions and debate controversial areas.

This is an abridged version of the topics reviewed at the conference and the website. This is not a "standards of practice" guideline, nor is it endorsed as such by the National Cancer Institute.

/pdf/the-national-cancer-institute-thyroid-fine-needle-aspiration-1kywd0i8uv.pdf

The National Cancer Institute Thyroid fine needle aspiration state of the science conference: a summation

Cystic neoplasms of the pancreas are increasingly diagnosed in the modern era. More frequent use of radiography and advances in imaging techniques have led to larger numbers of cystic lesions being identified.1–4 For decades, it has been clear that correctly differentiating between a cystic neoplasm and a pseudocyst is vital to avoid incorrect treatment.5 More recently, as the divergent natural histories and malignant potentials of different cystic neoplasms have been elucidated, differentiating between mucinous cystic neoplasms (MCNs), intraductal papillary mucinous neoplasms (IPMNs), serous cystadenomas, and other less common tumors has become increasingly important.6–9

As opposed to pancreatic pseudocysts, serous and mucinous cystic tumors have an epithelial lining. The epithelium of IPMNs and MCNs is made up of columnar mucin-producing epithelium. However, MCNs, which occur almost exclusively in women, are devoid of communication with the ductal system and are supported by ovarian-type stroma, whereas IPMNs arise in the main pancreatic duct or its major branches. In contrast, serous cystic tumors are lined by an inconspicuous single layer of either cuboidal or flattened cells. The cytoplasm of the cells is either clear or eosinophilic and the nuclei are usually centrally located, small, and hyperchromatic. Mitoses are conspicuously absent.

Most serous cystadenomas are microcystic, forming an honeycomb-like appearance, but macrocystic variants have been described.10–12 The overwhelming majority of these tumors are benign, with only a handful of case reports of serous cystadenocarcinomas.13–18 Resection is generally carried out for symptoms, large size, or the inability to distinguish a serous cystic neoplasm from a mucinous lesion, which has greater malignant potential. Some authors have recommended resection for all cystic neoplasms of the pancreas,14,15,19 whereas others (including our group) advocate a more selective approach.4,20

Our study had three specific aims: to describe a large single-center experience with serous cystadenoma of the pancreas, including presenting signs and symptoms and methods of diagnosis; to analyze serial radiography in available patients to determine the rate of growth; and to make recommendations for the accurate diagnosis and optimal treatment of patients with this neoplasm.

Serous cystadenoma of the pancreas: tumor growth rates and recommendations for treatment

We report a retrospective clinicopathologic study of 108 primary thyroid gland lymphomas (PTLs), classified using the REAL and proposed WHO classification schemes. The patients included 79 women and 29 men, with an average age of 64.3 years. All patients presented with a thyroid mass. The PTLs were classified as marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) or MZBL (n = 30), diffuse large B-cell lymphoma (DLBCL) with MZBL (n = 36), DLBCL without MZBL (n = 41), and follicle center lymphoma (FCL; n = 1). Excluding the FCL, features of lymphomas of MALT-type were identified in all groups, despite a follicular architecture in 23% of cases. Lymphocytic thyroiditis (LT) was identified in 94%. Ninety-one percent of patients presented with stage IE or IIE disease, whereas 69% had perithyroidal soft tissue infiltration. All patients were treated with surgical excision followed by adjuvant therapy (76%): chemotherapy (15%), radiation (19%), or a combination of radiation and chemotherapy (42%). Disease-specific survival was 82% at last follow up (mean, 82.8 mos) and 79% at 5 years. Statistically, stages greater than IE, presence of DLBCL, rapid clinical growth, abundant apoptosis, presence of vascular invasion, high mitotic rate, and infiltration of the perithyroidal soft tissue were significantly associated with death with disease. No patients with MZBL or stage IE disease died with disease. In summary, PTLs typically occur in middle- to older-aged individuals as a thyroid mass, with a predilection for females. Despite their histologic heterogeneity and frequent simulation of other lymphoma subtypes, virtually all PTLs are lymphomas of MALT-type arising in the setting of LT. Mixed DLBCL and MZBL are common. Overall, PTLs have a favorable outcome with appropriate therapy, but prognosis depends on both clinical stage and histology. MZBL and stage IE tumors have an excellent prognosis, whereas tumors with a large cell component or DLBCL or stage greater than IE have the greatest potential for a poor outcome.

Malignant lymphoma of the thyroid gland: a clinicopathologic study of 108 cases.

A 57-year-old woman developed pulmonary sarcoidosis during therapy with interferon β for advanced renal cell carcinoma metastatic to mediastinal lymph nodes. The possible role of interferon β in the pathogenesis of sarcoidosis in this patient is discussed. Cancer 59:896-900, 1987.

Pulmonary Sarcoidosis Following Interferon Therapy for Advanced Renal Cell Carcinoma

Thyroid nodules (TN) are a common clinical problem. Fine needle aspiration (FNA) of the thyroid now is practiced worldwide and proves to be the most economical and reliable diagnostic procedure to identify TNs that need surgical excision and TNs that can be managed conservatively. The key for the success of thyroid FNA consists of an adequate or representative cell sample and the expertise in thyroid cytology. The FNA cytologic manifestations of TNs may be classified into seven working cytodiagnostic groups consisting of a few heterogenous lesions each to facilitate the differential diagnosis. Recent application of diagnostic molecular techniques to aspirated thyroid cells proved to be useful in separating benign from malignant TNs in several cases of indeterminate lesions.

Fine-needle aspiration of the thyroid: an overview

We report a case of a solitary plasmacytoma arising from a thyroid with longstanding Hashimoto's disease, and diagnosed by fine-needle aspiration cytology. Serum protein electrophoresis revealed an M-spike in the γ-globulin region due to monoclonal IgG-λ immunoglobulin. The thyroid tumor was treated with near-total thyroidectomy and irradiation, and the patient was well 6 years after surgery without evidence of multiple myeloma. The serum M-spike disappeared after the tumor resection and radiation therapy. Plasma cell lesions of the thyroid reported in the world literature are extensively reviewed. Solitary plasmacytomas occur most commonly in patients with Hashimoto's disease, and must be distinguished from plasma cell granulomas and involvement of the thyroid in multiple myeloma. Plasmacytomas should be considered in the differential diagnosis of a rapidly enlarging thyroid mass in a patient with known Hashimoto's disease.

Plasma Cell Lesions of the Thyroid: Report of a Case of Solitary Plasmacytoma and a Review of the Literature

Three men and 2 women with ages ranging from 37 to 70 years, clinically and histologically confirmed solitary, palpable metastatic cancers to the thyroid (SMCT) and preoperative cytologic investigation of their thyroid lesions by fine-needle aspiration (FNA), were reviewed. Four patients were known to have a solid cancer treated by radical surgery 1 to 4 years prior [1 bronchogenic squamous cell carcinoma, 1 parotid adenoid cystic carcinoma, 1 renal cell carcinoma (RCC) and 1 cutaneous melanoma], and 1 patient had no past history of cancer. Direct smears prepared from the patients' thyroid FNAs were fixed in 95% ethanol and stained with the Papanicolaou method. In 3 cases, immunostaining of the aspirated tumor cells with thyroglobulin antibody was performed, and in 1 case an aspiration smear was stained with commercial HMB-45 antibody. A correct cytodiagnosis of metastatic cancer to the thyroid was made in all 5 cases. In 1 patient the thyroid FNA revealed a metastatic RCC that led to the discovery of a clinically occult RCC. All 5 patients died of metastatic disease 27 to 40 months after surgical resection of their SMCTs.

Solitary metastatic cancer to the thyroid: a report of five cases with fine-needle aspiration cytology

Macrocystic serous adenoma of the pancreas (MSAP) is a rare neoplasm. Its preoperative diagnosis by physical examination and imaging studies is challenging, if not impossible. In recent years, a few cases of MSAP with correct cytodiagnosis by transabdominal fine-needle aspiration (TFNA) have been documented. This paper reports two cases of MSAP that were successfully diagnosed by TFNA cytology. Two adult women presented with epigastric discomfort. Abdominal imaging studies revealed a large pancreatic cystic lesion in both cases. TFNAs of the pancreatic lesions were subsequently performed and revealed a clear serous fluid containing small monolayered sheets of benign cuboidal epithelial cells with scant, clear or granular cytoplasm, vesicular nuclei and micronucleoli. The cell cytoplasm stained positively with periodic acid-Schiff (PAS) and negatively with PAS with prior digestion with diastase (PASD). The cytological findings in both cases were similar and suggested a serous cystadenoma. The two pancreatic lesions were removed by Whipple's operation. They showed features of a macrocystic serous adenoma of the pancreas that were characterized by a small number of large cystic cavities lined by a single layer of non-mucus secreting, PAS-positive and PASD-negative cuboidal epithelial cells. By electron microscopy, the epithelial lining cells showed short and aborted apical microvilli, well-formed desmosomes and a large amount of intracytoplasmic glycogen, suggesting a centroacinar ductal cell origin.

Gia-Khanh Nguyen

Papers

Pulmonary Sarcoidosis Following Interferon Therapy for Advanced Renal Cell Carcinoma

Fine-needle aspiration of the thyroid: an overview

Plasma Cell Lesions of the Thyroid: Report of a Case of Solitary Plasmacytoma and a Review of the Literature

Solitary metastatic cancer to the thyroid: a report of five cases with fine-needle aspiration cytology

Macrocystic serous adenoma of the pancreas.