The authors report a case of an unusual inflammatory reaction and multiple Keratinous nodules in a thyroglossal cyst. It consisted of broad papillary intraluminal projections and multiple keratinous nodules. This benign process should not be confused with a carcinoma, branchial cyst and dermoid cyst.

Objective: Oncocytic variant (OV) is an unusual subtype of papillary thyroid cancer whose histopathologic diagnostic criteria, clinicopathologic features and biological behavior are different and have not been comprehensively studied, characterized in literature. Previous studies present conflicting results upon its prognosis. We investigated demographic and clinicopathologic risk factors affecting its prognosis while presenting our clinical experience. Subjects and Methods:This is a retrospective cohort study reviewing 101 patients of OV from an archive of 4500 well-differentiated thyroid cancer patients treated with iodine-131 (I-131) between 1991 and 2017. Predefined parameters of age, gender, tumor size (TS), total I-131 dose, time to recurrent disease, overall survival, extrathyroidal extension, multifocality, vascular invasion, accompanying other variants, capsular status of thyroid gland, initial cervical lymph node (IN) metastases, preablation stimulated thyroglobulin level, background thyroiditis and stage were evaluated by statistical comparison between metastatic and nonmetastatic groups. Results: Seventeen cases (17%) developed metastases/ recurrence, 70% of the recurrences occured before 24 months. Four patients (4%) died during the follow-up. Metastatic sites were usually cervical IN, local recurrence in thyroid bed and lungs. Multivariate analysis revealed stage (IV) and TS were the main parameters impacting recurrence/metastases. In the follow-up, isolated cervical IN metastases were found in 41% of metastatic cases, while 12% had sole recurrence in thyroid bed. Eighty eight percent of the metastatic disease included locoregional (cervical) and/or remote L N. The recurrences were associated with initial thyroid masses greater than 3.5cm in diameter. Conclusion: We found that the prognosis of OV is not poor in our series. Stage (IV) and tumor size are the main risk factors in metastatic development.

Bu calismada, N-asetilsisteinin, kronik pankreatit hayvan modelinde fibrozis, atrofi ve oksidatif stres uzerindeki etkisini degerlendirmeyi amacladik. Kronik pankreatit, ratlarin ana pankreatik kanallarina 0.4 ml, %2’lik trinitrobenzen sulfanik asit (TNBS) enjeksiyonu ile uyarilir. 60 Sprague-Dawley sicani dort gruba randomize edildi; Grup I (n= 15): salin (sham), Grup II (n= 15): fibrozis + N-asetilsistein (NAC), Grup III (n= 15): fibrozis (TNBS), Grup IV: etanol. 8. haftanin sonunda tum ratlar sakrefiye edildi ve pankreatik dokular, oksidatif stres belirtecleri, fibrozis ve atrofi progresyonlari incelendi. NAC grubunda doku malondialdehid (MDA) duzeyleri anlamli olarak dusuk bulunurken (p <0.001); superoksit dismutaz (SOD) ve glutation peroksidaz (GSH-Px) aktiviteleri TNBS grubuna gore anlamli olarak yuksek bulundu (sirasiyla p <0.001 ve p <0.001). Dokulardaki histopatolojik incelemede NAC grubunun histopatolojik skorunun TNBS grubundan anlamli derecede dusuk oldugu izlenirken (p<0.003) oksidatif stres ile histopatolojik skordaki artis arasinda anlamli bir iliski oldugu saptandi (histopatolojik skor/MDA: p<0.03, SOD: p<0.04, GSH-Px: p<0.02). Sonuc olarak, NAC uygulamasi kronik pankreatitte oksidatif stresi azaltmakta olup fibrozis ve atrofi uzerinde yararli etkilere sahiptir.

La gammagrafía paratiroidea (GP) puede ser negativa o equívoca (N/E) en un número considerable de casos con alta sospecha clínica y bioquímica de adenoma de paratiroides (AP). Los objetivos de este estudio fueron investigar el papel complementario de la determinación de paratohormona en punción con aguja fina (PTH en PAAF) con la GP en pacientes con hiperparatiroidismo primario (HPTP) y evaluar los aspectos histopatológicos de los AP en comparación con los resultados de GP. Fueron incluidos en el estudio 38 pacientes con HPTP remitidos para realizar GP. Diecisiete pacientes tuvieron resultados gammagráficos y ecográficos concordantes con AP (grupo A). Veintiún pacientes con GP N/E pero sospecha de AP en la ecografía formaron el grupo B. Se realizó PTH en PAAF en todos los pacientes y todos fueron operados. Se extirpó un adenoma en cada uno de ellos y en todos los casos se establecieron las características histopatológicas. El tamaño del tumor en la ecografía fue mayor en aquellos pacientes cuyos adenomas se vieron en la GP (p < 0,001). Los porcentajes de células principales, oxífilas y claras en AP no fueron estadísticamente diferentes entre los grupos. El nivel de paratohormona sérica y PTH en PAAF no fueron estadísticamente significativos entre los grupos A y B (p = 0,095 y p = 0,04, respectivamente). Aunque no existe un valor umbral definitivo, la sensibilidad de la GP aumenta con el tamaño de la lesión. Mientras que el contenido de células principales y oxífilas tiende a reducirse en los AP con GP N/E EP, la tasa de células claras aumenta sustancialmente. La combinación de GP con la ecografía y la PTH en PAAF aumenta la sensibilidad de detección y localización de los AP. Parathyroid scintigraphy (PS) can be negative or equivocal (N/E) in a considerable number of cases with highly suspicious clinical findings and biochemical results for parathyroid adenoma (PA). The aims of this study were to investigate the complementary role of parathormone washout test (PWT) to PS in patients with primary hyperparathyroidism (PHPT) and evaluate histopathologic aspects of PAs in comparison with PS results. Thirty-eight patients with PHPT referred for PS were included in the study. Seventeen patients had both scintigraphic and ultrasonographic findings concordant with PA (Group A). Twenty-one patients having N/E PS, but suspected lesions for PA on ultrasonography (US) formed Group B. PWT was performed for all patients and they underwent the surgical intervention. An adenoma was removed in all patients and the histopathologic cell characteristics were established. The tumor size on US was larger in those patients whose adenomas were seen on the PS (P < .001). The percentages of chief (or principal), oxyphilic and clear cells in PAs were not statistically different between the groups. Serum parathormone level and PWT were not statistically significant between Group A and Group B (P = .095 and P = .04, respectively). Although there is not a definitive threshold value, the sensitivity of PS increases with lesion size. While chief cell and oxyphilic cell content of PAs tend to deplete in N/E PS, clear cell rate increases substantially. Combining PS with both US and PWT increases the sensitivity of detection and localization of PAs.

Objective: Parathyroid scintigraphy (PS) can be negative or equivocal (N/E) in a considerable number of cases with highly suspicious clinical findings and biochemical results for parathyroid adenoma (PA). The aims of this study were to investigate the complementary role of parathormone washout test (PWT) to PS in patients with primary hyperparathyroidism (PHPT) and evaluate histopathologic aspects of PAS in comparison with PS results. Material and methods: Thirty-eight patients with PHPT referred for PS were included in the study. Seventeen patients had both scintigraphic and ultrasonographic findings concordant with PA (Group A). Twenty-one patients having N/E PS, but suspected lesions for PA on ultrasonography (US) formed Group B. PWT was performed for all patients and they underwent the surgical intervention. An adenoma was removed in all patients and the histopathologic cell characteristics were established. Results: The tumor size on US was larger in those patients whose adenomas were seen on the PS (P < .001). The percentages of chief (or principal), oxyphilic and clear cells in PAs were not statistically different between the groups. Serum parathormone level and PWT were not statistically significant between Group A and Group B (P = .095 and P = .04, respectively). Conclusion: Although there is not a definitive threshold value, the sensitivity of PS increases with lesion size. While chief cell and oxyphilic cell content of PAs tend to deplete in N/E PS, clear cell rate increases substantially. Combining PS with both US and PWT increases the sensitivity of detection and localization of PAs. (C) 2018 Published by Elsevier Espana, S.L.U.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Thyroid-stimulating hormone-secreting pituitary adenoma (TSHoma) is a rare benign endocrinological tumor which produces TSH in the pituitary gland. Herein, we presented a female patient having TSHoma with Graves' disease during and just after pregnancy that we found by indium-111 octreotide scintigraphy while investigating the patient for hyperthyroidism symptoms.

Prostate cancer is the most common cancer in the male population in the world. In cancer-related deaths after lung cancer it ranks as second. Approximately 95% of prostate neoplasms are adenocarcinomas. Small cell carcinoma of the prostate is a rare and highly aggressive subtype. Subtype of small cell carcinoma of the prostate constitute about 0.5-2% of all prostate cancers. It can occur alone as primary while it can also occur in association with advanced adenocarcinoma. Most common type of small cell carcinoma of the prostate is neuroendocrine differentiation type which is associated with prostate adenocarcinomas. Cases of small cell carcinomas of the prostate are highly metastasis at diagnosis. The prognosis of small cell carcinomas of the prostate is very poor, unlike adenocarcinoma. These tumors do not have androgen receptors to unlike prostate adenocarcinomas. Therefore these tumors fail to respond to hormonal therapy. We presented a 57-year-old man who was admitted to our clinic with lower urinary tract symptoms, fatigue, and low back pain. There was an elevated prostate-specific antigen (PSA) level in the patient. Therefore, transrectal prostate biopsy was performed. As a result of the biopsy, small cell carcinoma of the prostate which was present in acinar adenocarcinoma component (3040%) was detected.

The innate immune network is responsible for coordinating the initial defense against potentially noxious stimuli. This complex system includes anatomical, physical and chemical barriers, effector cells and circulating molecules that direct component and system interactions. Besides the direct effects of breaching pulmonary protective barriers, cyclic stretch generated during mechanical ventilation (MV) has been implicated in the modulation of the innate immunity. Evidence from recent human trials suggests that controlling MV-forces may significantly impact outcome in acute respiratory distress syndrome. In this paper, we explore the pertinent evidence implicating biotrauma caused by cyclic MV and its effect on innate immune responses. Introduction The natural or innate immune system is present in some form in most living organisms and consists of mechanisms for defending the host against foreign invaders and for healing injured tissues. We now know that many of the mechanisms of resistance to infection are also involved in the individual’s response to noninfectious foreign substances and environmental stresses, including mechanical stretch. Furthermore, mechanisms that normally protect individuals and eliminate foreign substances are themselves capable of causing tissue injury and disease. This inherent defense network includes anatomical, physical and chemical barriers, circulating molecules, cells with specific phagocytic or lytic abilities, and soluble mediators that orchestrate the activities of each component and their interactions with the acquired immune system. Normally, this is a well integrated system of host defense and preservation of self-integrity, in which numerous cells and molecules function cooperatively. However, dysregulation of the fine balance between proinflammatory and anti-inflammatory stimuli may explain the pathophysiologic processes that underlie syndromes such as sepsis and acute lung injury (ALI) [1]. Although patients undergoing positive pressure mechanical ventilation may have impaired lung function, and possibly impaired systemic immune defenses by virtue of their underlying lung pathology, further dysregulation of natural defenses occurs in these patients. The presence of an endotracheal tube bypassing natural upper airway defenses, decrease or loss of coughing, paralysis of bronchial ciliae, alterations in surfactant and phagocyte and epithelial defensins – a critical first line antibacterial defense mechanism – all contribute to impairment in host defense [2–4]. Apart from the direct effects of breaching pulmonary protective barriers, cyclic stretch generated during mechanical ventilation has been implicated in the modulation of the innate immune system. In this short review we revisit some of the pertinent evidence exploring the relationship between biotrauma caused by cyclic mechanical ventilation and its effect on innate immune responses. This is not intended to be a comprehensive and structured review of the Review Bench-to-bedside review: Biotrauma and modulation of the innate immune response Claudia C dos Santos1, Haibo Zhang2, Mingyao Liu3 and Arthur S Slutsky4 1Clinical Associate and Post Doctoral Fellow, Departments of Medicine and Critical Care Medicine, St. Michael’s Hospital, and Inter-Departmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada 2Assistant Professor, Departments of Medicine and Critical Care Medicine, St. Michael’s Hospital, and Inter-Departmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada 3Professor, Departments of Medicine and Critical Care Medicine, St. Michael’s Hospital, and Inter-Departmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada 4Vice President of Research, Departments of Medicine and Critical Care Medicine, St. Michael’s Hospital, and Inter-Departmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada Corresponding author: Arthur S Slutsky, arthur.slutsky@utoronto.ca Published online: 5 January 2005 Critical Care 2005, 9:280-286 (DOI 10.1186/cc3022) This article is online at http://ccforum.com/content/9/3/280 © 2005 BioMed Central Ltd

We present a case of metastasis of the external auditory canal (EAC) from a primary breast carcinoma in a 53-year-old female with a review of the literature. The patient had been diagnosed with a primary carcinoma 4 years previously. The metastasis had developed recently in her left EAC and presented as a bulky, fleshy, bleeding mass. The mass was causing hearing loss on the left due to complete obstruction in the left EAC. The mass was incompletely removed with a surgical operation and histopathologically metastasis was proven. Although there are few case reports in the literature of various cancers metastasizing to the EAC, metastasis in the EAC from the breast carcinoma is exceedingly rare and only one case has been reported in the literature so far.

The opioid and non-opioid types of stress-induced analgesia have been well defined. One of the non-opioid type involve the endocannabinoid system. We previously reported that the spinal serotonin 7 receptor (5-HT7) blockers inhibit both morphine and cannabinoid-induced analgesia, thus we hypothesized that descending serotonergic pathways-spinal 5-HT7 receptor loop might contribute to stress-induced analgesia. Stress-induced analgesia was induced with warm (32 °C) or cold (20 °C) water swim stress in male Balb-C mice. The effects of intrathecal injection of a selective 5-HT7 receptor antagonist, SB 269970, of the denervation of serotonergic neurons by intrathecal administration of 5,7-dihydroxytryptamine (5,7-DHT) and of lesions of the dorsolateral funiculus on opioid and non-opioid type stress-induced analgesia were evaluated with the tail-flick and hot plate tests. The expression of 5-HT7 receptors mRNA in the dorsal lumbar region of spinal cord were analyzed by RT-PCR following spinal serotonin depletion or dorsolateral funiculus lesion. The effects of the selective 5-HT7 receptor agonists LP 44 and AS 19 were tested on nociception. Intrathecal SB 269970 blocked both opioid and non-opioid type stress-induced analgesia. Dorsolateral funiculus lesion or denervation of the spinal serotonergic neurons resulted in a marked decrease in 5-HT7 receptor expression in the dorsal lumbar spinal cord, accompanied by inhibition of opioid and non-opioid type stress-induced analgesia. However, the systemic or intrathecal LP 44 and AS 19 alone did not produce analgesia in unstressed mice. These results indicate that descending serotonergic pathways and the spinal 5-HT7 receptor loop play a crucial role in mediating both opioid and non-opioid type stress-induced analgesia.

Objectives: This study was designed to evaluate effects of hyperbaric oxygen (HBO) plus 3-aminobenzamide (3-AB) cotreatment on tissue oxidative stress parameters (TOSp), tissue histopathology scores (THSc), and bacterial translocations (Bact-Trans) in an experimental model of severe acute pancreatitis (AP).Methods: Seventy-five Sprague-Dawley rats were randomized into 5 groups. Group 1 received sham. Severe AP was induced by intraductal taurocholate infusion and then group 2 received saline, group 3 received 3-AB, group 4 received 3-AB plus HBO, and group 5 received HBO. 3-Aminobenzamide (10 mg/kg per day, once daily, intraperitoneal) and saline (1 mL/kg) were started right after the induction, whereas HBO (2,8 atm pressure, BID, 90 minutes each) was started at the sixth hour. The rats were euthanized at the 54th hour, and TOSp, THSc, and Bact-Trans were studied.Results: In treatment groups 3 and 5, Bact-Trans (P < 0.05, P < 0.05), TOSp (P < 0.05, P < 0.05), and THSc (P < 0.001, P < 0.001) were significantly lower than controls. In addition to these findings, group 4 (cotreatment) showed the most significant effect on Bact-Trans and THSc (P < 0.001, P < 0.001) and also better in TOSp (P < 0.02).Conclusions: Poly(ADP-ribose) polymerase inhibition by 3-AB and HBO treatment alone was effective in the course of severe AP, and favorable with cotreatment because of the improved cascades of inflammatory process by different aspects.

A subepidermal calcified nodule is an uncommon variant of calcinosis cutis and only a limited number of cases have been reported about the eyelid nodules in the literature. A 20-year-old male was referred to our department with symmetrical nodules on both upper eyelids enlarging over 3 years. Both nodules were removed by excisional biopsy. After the histopathologic evaluation, the diagnosis was subepidermal calcified nodule. He had a complete recovery with no recurrence and acceptable aesthetic appearance. As a rare entity, subepidermal calcified nodule should be thought in differential diagnosis of eyelid nodular lesions and symmetrical appearance may be seen.

A 41-year-old man who had otherwise asymptomatic right scrotal swelling presented to our urology clinic. He had been diagnosed with T cell precursor lymphoblastic leukemia/lymphoma 2 years previously. On examination, his right epididymis was enlarged. A regular, homogeneous, slightly hypoechoic solid mass was observed at the right caput epididymis. This testicular mass measured approximately 7×11×12 mm. Leukemia and lymphoma appear in a variety of locations throughout the body, but an isolated relapse involving the epididymis is rare. Epididymectomy was performed which naturally removed the patient's right-sided sperm duct system. Especially in the younger age group epididymal masses can lead to fertility problems.

The coincidence of trisomy 21 and a structural rearrangement is very rare, and even it has not been reported as a prenatal diagnosis yet. In this article, we present an autosomal translocation carrier fetus with trisomy 21: 47,XX,+21, t(3;8)(p21;q24). Although the coincidence of reciprocal translocation and trisomy may be seen in reciprocal translocation carrier families, de novo cases are extremely rare. The presented case is diagnosed by amniocentesis, which was performed because of abnormal fetal ultrasonographic findings and increased trisomy 21 risk at maternal serum screening test. The postmortem pathologic examination of the fetus revealed that the findings of hypertelorism and right lung with two lobes are interesting novel findings of our cases associated with the breakpoints 3p21 and 8q24.

Abstract Cancer is considered to be an important public health problem throughout the world. Early diagnosis of cancer and recurrent tumors are extremely important for reducing mortality rates and also for following up the response to treatment. The increased need of oxygen leads to new vascular structures in and around the tumor. The most important components of this angiogenic process are vascular endothelial growth factor (VEGF) and its receptors which are overexpressed in tumor cells. The aim of this study is to develop soluble VEGF receptor-1 (sVEGFR-1) functionalized iron oxide nanoparticles for diagnosis of early stages of tumors or metastases by MRI. A single dose of N-nitroso-N-methylurea (NMU) at a concentration of 50 mg/kg was injected to inbred rats intraperitoneally on the 21st day of their birth to create breast cancer. In this study, in vivo characteristics of functionalized nanoparticles were studied by comparing rats with tumors and the healthy controls. Approximately 70 days later, tumor formed rats were administered with nanoparticles functionalized with sVEGFR-1, intravenously and scanned with MRI. MR images were taken before the treatment with nanoparticles (0 minute), and at 30th and 60th minutes after treatment. The evaluation of MRI data revealed that the images of metastases were hypointense at 30th minute with respect to the 0 minute and 60th minute images (p<0.05). Nanoparticles were observed to localize at the tumoral regions and there were significant contrast intensity differences in rats with tumor. These results showed that our sVEGFR-1 functionalized nanoparticles were localized at tumoral regions including metastasis. This method can be useful in diagnosis of early tumors, metastasis, and recurrencies. Further molecular and histological studies are necessary to explain the efficacy of these nanoparticles for tumor diagnosis. Citation Information: Mol Cancer Ther 2013;12(11 Suppl):B153. Citation Format: Taner Ozgurtas, Fatih Yesildal, Fevzi Nuri Aydin, Melis Sardan, Gozde Uzunalli, Murat Kocaoglu, Ayse Begum Tekinay, Mustafa Ozgur Guler, Rukan Genc, Salih Deveci. sVEGFR-1 functionalized nanoparticles for diagnosis of cancer using magnetic resonance imaging. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2013 Oct 19-23; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2013;12(11 Suppl):Abstract nr B153.

Heterotopic brain tissue (HBT) most commonly occurs in the nasal region and it is often referred to as a nasal glioma. Nonnasal locations for ectopic brain tissue are less commonly described. In English literature, only six cases have been reported that share some features (face or neck location) of this case. The presented case is the fourth case, located in both face and neck, and the one, which is the most extensive with its dimensions. According to location of heterotopic brain may lead to dystocia. We reported HBT of the face and neck in a neonate and the differential diagnosis, etiopathogenic mechanisms and clinical courses are reviewed and discussed.

Heterotopic brain tissue (HBT) most commonly occurs in the nasal region and it is often referred to as a nasal glioma. Nonnasal locations for ectopic brain tissue are less commonly described. In English literature, only six cases have been reported that share some features (face or neck location) of this case. The presented case is the fourth case, located in both face and neck, and the one, which is the most extensive with its dimensions. According to location of heterotopic brain may lead to dystocia. We reported HBT of the face and neck in a neonate and the differential diagnosis, etiopathogenic mechanisms and clinical courses are reviewed and discussed.

It has been shown that BRAFV600E mutation in papillary thyroid carcinomas (PTC) is associated both with pathogenesis and poor prognosis. In this study, we aimed to investigate the relationship of the BRAFV600E mutation and the established prognostic factors in a cohort of Turkish patients with PTC. Forty-six cases of papillary thyroid carcinoma have been evaluated for the presence of BRAFV600E mutation. BRAFV600E has been examined by restriction fragment length polymorphism. BRAFV600E mutation status has been compared with well-known histopathological and clinical prognostic parameters such as invasion of thyroid capsule, extrathyroidal extension, and the presence of lymph node and/or distant metastasis. We have found that BRAFV600E mutation was present in the majority of our cases (40/46). Considering the stage of the disease, five of the negative cases were in stage 1 while the remaining one was in stage 2. Only one BRAFV600E negative case has shown extrathyroidal extension and lymph node metastasis. All four patients with distant metastasis had BRAFV600E mutation. Statistical analyses revealed that there are no significant relationship between the BRAFV600E mutation and the established prognostic factors. We found a relatively higher BRAFV600E mutation rate in classical type PTC than in other similar studies. We think that the limited number of our cases may either weaken or mask some potentially important relationship between BRAFV600E mutation and the established prognostic factors.