scholarly journals Excessive Leukocytosis Leading to a Diagnosis of Aggressive Thyroid Anaplastic Carcinoma: A Case Report and Relevant Review

2020 ◽  
Vol 9 (3) ◽  
pp. 162-168 ◽  
Author(s):  
Antonis Polymeris ◽  
Christina Kogia ◽  
Dimitrios Ioannidis ◽  
Dimitrios Lilis ◽  
Maria Drakou ◽  
...  
Keyword(s):  
Paraneoplastic Syndrome ◽  
Myeloproliferative Neoplasms ◽  
Acute Infection ◽  
White Blood Cells ◽  
Needle Aspiration ◽  
Respiratory Arrest ◽  
Anaplastic Thyroid Carcinoma ◽  
Anaplastic Carcinoma ◽  
Tender Mass ◽  
The Right

Introduction: Leukocytosis and particularly neutrophilia are usually caused by acute infection, inflammation, and myeloproliferative neoplasms. However, leukocytosis can also occur in patients with malignancy either due to bone marrow metastases or in the context of a paraneoplastic syndrome. Case Presentation: An 86-year-old female was admitted to our hospital due to marked leukocytosis (white blood cells [WBC] >40,000/μL), neutrophilia, and monocytosis. She was afebrile and reported hoarseness and mild difficulty swallowing. Upon physical examination, lung auscultation revealed inspiratory wheezing and a non-tender mass was observed in the anterior midline of the neck. Blasts and immature WBC were not found, and polymerase chain reaction for the detection of BCR/ABL gene was negative. A mass (5.4 cm in diameter) of abnormal parenchymal composition with calcifications occupying the right lobe, was seen on thyroid ultrasound. Cytology, after fine-needle aspiration, showed an anaplastic thyroid carcinoma (ATC). The cervical and chest computed tomography scan revealed a low-density lesion with calcifications that shifts and presses the trachea and multiple lung nodular lesions bilaterally. Since the case was inoperable and the airway was severely obstructed, a DUMON stent was placed. Biopsy of specimens from the trachea lesion revealed a tumor with significant atypical cells and focal squamoid features. The patient’s WBC increased to 72,470/μL. Additionally, interleukin-6 (IL-6) was markedly elevated (20.2 pg/mL). The patient passed away due to respiratory arrest 55 days after her initial admission. Discussion: Excessive leukocytosis in a patient, having excluded infectious disease and myelodysplastic syndrome, could represent a manifestation of a paraneoplastic syndrome due to various cytokines secretion from the tumor. In our case, ATC synthesized and secreted IL-6, which seems to be the cause of severe leukocytosis.

Cytomorphologic findings of thyroid carcinoma showing thymus-like (CASTLE) differentiation: A case report

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S42-S42
Author(s):  
A K Abu-Salah ◽  
S Segura ◽  
H Mesa ◽  
H M Cramer
Keyword(s):  
Case Report ◽  
Thyroid Carcinoma ◽  
Thymic Carcinoma ◽  
Needle Aspiration ◽  
Central Neck Dissection ◽  
Anaplastic Carcinoma ◽  
Thyroid Neoplasm ◽  
Squamous Differentiation ◽  
Thymic Tissue ◽  
The Right

Abstract Introduction/Objective Thyroid carcinoma showing thymus-like differentiation also known as intrathyroidal thymic carcinoma is a rare thyroid neoplasm arising from either an ectopic intrathyroidal thymic tissue or from remnants of thymobranchial pouches. On fine needle aspiration (FNA) its diagnosis can be challenging due to overlapping morphologic features with other aggressive thyroid carcinomas. Methods/Case Report A 31-year-old female consulted for 6-month history of neck swelling and tenderness. Thyroid ultrasound demonstrated a 2.6 x 2.5 x 2.1 cm nodule in the right lobe with punctate calcifications. FNA showed cellular smears composed of loosely cohesive and single basaloid neoplastic cells exhibiting significant cellular and nuclear pleomorphism. Focal squamous differentiation with keratinization was noted on the cell block sections. Immunocytochemical stains showed that the tumor was positive for cytokeratin AE1/AE3, p40, p63, CD117 and CD5 consistent with intrathyroidal thymic carcinoma. The Ki67 proliferative index was approximately 40%. A right thyroidectomy with central neck dissection confirmed the diagnosis and showed a 3.0 cm tumor with invasion into skeletal muscle, lymphovascular invasion and positive lymph nodes. The patient completed adjuvant radiotherapy and remain in remission at 3-months follow-up. Results (if a Case Study enter NA) NA Conclusion Intrathyroidal thymic carcinoma is a rare thyroid neoplasm that frequently shows squamous differentiation and therefore overlaps with papillary thyroid carcinoma with squamous morulae, squamous cell carcinoma and anaplastic carcinoma. The coexpression of squamous markers together with CD5 and CD117 allows the recognition of CASTLE on FNA samples.

Case Report: Cellular Medullary Carcinoma as Cervical Metastases of Undetermined Origin

1979 ◽  
Vol 87 (5) ◽  
pp. 640-644
Author(s):  
Bruce W. Pearson ◽  
Krishnan K. Unni ◽  
Glen W. Sizemore ◽  
Stanley G. Norman
Keyword(s):  
Thyroid Carcinoma ◽  
Radical Neck Dissection ◽  
Medullary Carcinoma ◽  
Final Diagnosis ◽  
Anaplastic Thyroid Carcinoma ◽  
Amelanotic Melanoma ◽  
Anaplastic Carcinoma ◽  
Tumor Focus ◽  
The Right ◽  
Tracheoesophageal Groove

A healthy 27-year-old man with a lump in the lateral midneck was examined. Results of a recent biopsy performed elsewhere indicated amelanotic melanoma. A careful search for a primary integumentary or upper respiratory site of origin, including appropriate roentgenograms and a thyroid scan, was negative. At right radical neck dissection, the pathologic diagnosis was expanded to include anaplastic carcinoma. Subsequent examinations of the head and neck were negative. The neck and upper aerodigestive system were subjected to a full course of radiotherapy. Pathologic study of this tumor was continued. Electron microscopy indicated the tumor was epithelial, possibly of glandular epithelial origin. A tumor nodule reappeared in the right tracheoesophageal groove. Surgery was performed and the nodule was removed. The right thyroid lobe was removed also and submitted for histopathologic study. A solitary microscopic tumor focus, presumably anaplastic thyroid carcinoma, was found within the thyroid. Further pathologic studies were undertaken. Eventually, amyloid deposits were discovered, and a final diagnosis of cellular medullary thyroid carcinoma was established. Further studies of this patient and his family for multiple endocrine adenoma have been negative.

Renal Infarction and Pulmonary Embolism in Patient with Myelodysplastic

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Mounia Bendari ◽  
Nouama Bouanani ◽  
Mohamed Amine Khalfaoui ◽  
Maryam Ahnach ◽  
Aziza Laaraj ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Myeloproliferative Neoplasms ◽  
Bone Biopsy ◽  
Bone Marrow Aspiration ◽  
Myeloproliferative Disorders ◽  
Acute Onset ◽  
International Prognostic Scoring System ◽  
Renal Infarction ◽  
The Right ◽  
Enhanced Computed Tomography

The myelodysplastic syndrome-myeloproliferative neoplasms (MDS/MPNs) are defined by a group of heterogeneous hematological malignancies resulting from stem cell−driven clonal growth of pathological hematopoietic progenitors and ineffective hematopoiesis, they are characterized concomitant myelodysplastic and myeloproliferative signs. Myelodysplastic/myeloproliferative disorders have been considered to have a higher risk of thrombus formation.We report a rare case about a 64 years old Moroccan woman, experienced renal infarction (RI) associated with pulmonary embolism as a complication of a myelodysplastic/myeloproliferative disorder.The patient complained of acute-onset severe left flank pain, a contrast-enhanced computed tomography (CT) of the chest and abdomen revealed RI by a large wedge-shaped defect in the right kidney with pulmonary embolism.Biological exam showed deep anemia, the bone marrow aspiration found myelodysplasia.the bone biopsy showed signs of myeloproliferatif disease. The karyotype was normal, BCR-ABL, JAK2, CALR mutations were absents, and MPL mutation was positive. The International Prognostic Scoring System (IPSS-R) was 0, and the patient was included to the low risk group.Anticoagulation therapy was initiated with heparin to treat RI and pulmonary embolism. Three months later, pulmonary embolism had resolved without the appearance of additional peripheral infarction.This case emphasizes the need to consider myelodysplastic/myeloproliferative disorders as a cause of infraction renal and pulmonary embolism.

The Esophageal Detector Device: Accuracy and Reliability in Difficult Airway Settings

1996 ◽  
Vol 11 (1) ◽  
pp. 60-62 ◽  
Author(s):  
Christopher E. Kapsner ◽  
David C. Seaberg ◽  
Charles Stengel ◽  
Kaveh Ilkhanipour ◽  
James Menegazzi
Keyword(s):  
Emergency Medicine ◽  
Pulmonary Edema ◽  
Difficult Airway ◽  
Laboratory Investigation ◽  
Respiratory Arrest ◽  
Tube Placement ◽  
Mainstem Bronchus ◽  
Anatomic Location ◽  
The Right ◽  
Attending Physician

AbstractIntroduction:The esophageal detector device (EDD) recently has been found to assess endotracheal (ET) tube placement accurately. This study describes the reliability of the EDD in determining the position of the ET tube in clinical airway situations that are difficult.Methods:This was a prospective, randomized, single-blinded, controlled laboratory investigation. Two airway managers (an emergency-medicine attending physician and a resident) determined ET-tube placement using the EDD in five swine in respiratory arrest. The ET tube was placed in the following clinical airway situations: 1) esophagus; 2) esophagus with 1 liter of air instilled; 3) trachea; 4) trachea with 5 ml/kg water instilled; and 5) right mainstem bronchus. Anatomic location of the tube was verified by thoracotomy of the left side of the chest.Results:There was 100% correlation between the resident and attending physician's use of the EDD. The EDD was 100% accurate in determining tube placement in the esophagus, in the esophagus with 1 liter of air instilled, in the trachea, and in the right mainstem bronchus. The airway managers were only 80% accurate in detecting tracheal intubations when fluid was present.Conclusions:The EDD is an accurate and reliable device for detecting ET-tube placement in most clinical situations. Tube placement in fluid-filled trachea, lungs, or both, which occurs in pulmonary edema and drowning, may not be detected using this device.

scholarly journals Thyroid Carcinoma on the Side of the Absent Lobe in a Patient with Thyroid Hemiagenesis

2017 ◽  
Vol 2017 ◽  
pp. 1-5
Author(s):  
Hiroki Sato ◽  
Kiyoaki Tsukahara ◽  
Ray Motohashi ◽  
Midori Wakiya ◽  
Hiromi Serizawa ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Papillary Carcinoma ◽  
Thyroid Tissue ◽  
Needle Aspiration ◽  
Left Lobe ◽  
Thyroid Hemiagenesis ◽  
Poorly Differentiated ◽  
Node Metastases ◽  
Right Lobe ◽  
The Right

Background. Thyroid carcinoma complicated by hemiagenesis is very rare, and previous reports have not described this cancer on the side of the absent lobe. Methods and Results. We report the case of a 64-year-old woman in whom left thyroid hemiagenesis was discovered incidentally during investigations of abnormal sensation during swallowing. A tumorous 1.4 cm lesion was also found on the side of the absent lobe, left of the isthmus. Fine-needle aspiration biopsy revealed class V papillary carcinoma, but no lymph node metastases. Total thyroidectomy was performed for stage cT1bN0M0 carcinoma. Histopathology revealed normal thyroid tissues in the right lobe and isthmus, while the left lobe was absent. The mostly papillary carcinoma was adjacent to the truncated thyroid tissue, with a portion histologically consistent with poorly differentiated carcinoma. Conclusions. All previously reported cases of thyroid cancer complicated by hemiagenesis have represented carcinoma occurring within the present lobe. This case is extremely rare.

Chalastospora gossypii in a Maine Coon cat: case report and literature review

2021 ◽  
pp. 104063872110222
Author(s):  
Samantha M. Norris ◽  
Paula A. Schaffer ◽  
Noah B. Bander
Keyword(s):  
Soft Tissue ◽  
Needle Aspiration ◽  
Tissue Mass ◽  
Large Numbers ◽  
Formalin Fixed Paraffin ◽  
Formalin Fixed Paraffin Embedded ◽  
Soft Tissue Masses ◽  
Subcutaneous Mass ◽  
The Right ◽  
A Minor

A 15-y-old castrated male Maine Coon cat was evaluated for an ulcerated soft tissue mass on the right hindlimb that had been observed for 4 mo and had grown rapidly. A 3 × 3 cm soft, raised, amorphous, and ulcerated subcutaneous mass was observed on the lateral right metatarsus. In-house cytology via fine-needle aspiration was nondiagnostic. Incisional biopsy of the mass and further staging was declined, and amputation was elected. The amputated limb was submitted for histopathology, which revealed severe chronic nodular granulomatous dermatitis and multifocal granulomatous popliteal lymphadenitis with large numbers of intralesional fungal hyphae. Fungal PCR and sequencing on formalin-fixed, paraffin-embedded tissue identified Chalastospora gossypii. No adjunctive therapy was elected at the time. The patient has done well clinically 1 y post-operatively. C. gossypii is a rare microfungus found worldwide and is considered a minor pathogen of several plants. To our knowledge, infection by this fungus has not been reported previously in veterinary species. Features in our case are comparable to other mycotic infections. Nodular granulomatous mycotic dermatitis and cellulitis, although uncommon, should be a differential for soft tissue masses in veterinary species; C. gossypii is a novel isolate.

scholarly journals Angiogenic parameters and the risk factors for thrombosis in polycythemia vera

2018 ◽  
Vol 72 ◽  
pp. 627-633
Author(s):  
Joanna Boinska ◽  
Grażyna Gadomska ◽  
Katarzyna Ziołkowska ◽  
Karolina Woźniak ◽  
Alicja Bartoszewska-Kubiak ◽  
...  
Keyword(s):  
Risk Factors ◽  
Polycythemia Vera ◽  
Myeloproliferative Neoplasms ◽  
White Blood Cells ◽  
Reference Value ◽  
Control Group ◽  
Vascular Endothelial ◽  
Clinical Issue ◽  
Thrombotic Complications ◽  
Endothelial Growth Factor

Aim: The assessment of angiogenic parameters in so-called “liquid tumors”, such as myeloproliferative neoplasms, remains an open clinical issue. The aim of the study is to evaluate the concentration of vascular endothelial growth factor (VEGF-A) and soluble receptors sVEGFR-1 and sVEGFR-2 in relations to risk factors of thrombosis in patients with polycythemia vera (PV). Material/Methods: A total of 45 patients suffering from newly diagnosed PV and 30 healthy volunteers were enrolled into the study. Polycythemia vera was diagnosed according to the WHO (2008) criteria. In the citrated plasma samples VEGF-A, sVEGFR-1 and sVEGFR-2 were measured using ELISA tests. Results: VEGF-A concentration was three-fold higher and sVEGFR-2 significantly lower in PV patients as compared to the control group. VEGF-A concentration was significantly higher in PV patients with JAK2V617F mutation, as compared to patients without this mutation. SVEGFR-1 and sVEGFR-2 concentrations were similar in the analyzed subgroups. In PV patients with an increased number of white blood cells (WBCs), the above upper reference value (≥10 G/l), VEGF-A concentration was two-fold higher than in patients with WBCs number <10 G/l. However, sVEGFR-1 and sVEGFR-2 concentrations did not differ between the analyzed subgroups. Analysis of correlations revealed only one relation between VEGF-A and WBCs number. Conclusions: Increased VEGF-A and decreased sVEGFR-2 concentrations in polycythemia vera patients as compared to the control group indicate an intensification of the process of angiogenesis. A higher concentration of VEGF-A in PV patients with leukocytosis and a positive correlation between WBCs number and VEGF-A reflect the potential role of VEGF-A in the pathogenesis of thrombotic complications in hypercoagulable state in PV patients.

scholarly journals SUN-934 A Rare Case of Hyperparathyroidism - Parathyroid Carcinoma, Atypical Adenoma, or Both?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Petra Krutilova ◽  
Harjyot Sandhu ◽  
Michael Salim ◽  
Janice L Gilden ◽  
Paula Butler
Keyword(s):  
Parathyroid Carcinoma ◽  
Rare Case ◽  
Parathyroid Tissue ◽  
Needle Aspiration ◽  
Mitotic Rate ◽  
Fluid Replacement ◽  
Cancer Center ◽  
Subtotal Parathyroidectomy ◽  
History Of ◽  
The Right

Abstract Introduction: Parathyroid carcinoma (PC) is a rare endocrine malignancy. It accounts for &lt;1% cases of primary hyperparathyroidism (PHPT). We present a rare case of concurrent PC and atypical parathyroid adenoma (PA). Case presentation: A 72-year-old woman presented with 1-week history of generalized weakness, confusion, and auditory hallucinations. Her medical history was significant for PHPT known for 5 years, CAD and CHF. The patient appeared mildly volume depleted and was tachycardic (105/min). The rest of her physical exam was unremarkable. Calcium (Ca) was 15.1 mg/dL (8.4–10.2 mg/dL) and intact PTH 451.9 pg/mL (12–88 pg/mL). Her condition improved with aggressive fluid replacement, pamidronate, and cinacalcet. A sestamibi scan revealed increased uptake of bilateral parathyroid tissue. Fine needle aspiration (FNA) revealed PA. Surgical treatment was postponed for control of cardiac comorbidities. One month later, she presented again with symptomatic hypercalcemia. Her Ca was 16.1 md/dL and PTH 761.5 pg/mL. Initial medical management was followed by subtotal parathyroidectomy – three masses were removed (one on the right and two on the left). Final pathology revealed PC within the left parathyroid, the others were consistent with hypercellular parathyroid tissue. One month later, the patient underwent left hemithyroidectomy, right parathyroidectomy, and central neck dissection. PTH level dropped to 2.4 pg/mL and Ca level was 7.6 mg/dL after surgery. She was discharged home on Ca and vitamin D supplements. Pathology was sent to a referral cancer center and revealed PC vs. atypical PA within the right parathyroid. Discussion: PC is a rare endocrine malignancy. Further, there are not many cases of synchronous PC and PA or multifocal PC. Diagnosing PC preoperatively is challenging since it shares overlapping characteristics with PA. Patients with malignancy commonly present with larger tumor size, higher level of Ca (&gt;14.6 mg/dL), and PTH (5-fold higher than the upper limit of normal). Our patient had a history of multiple admissions due to symptomatic HC. She had no palpable neck masses on exam. Her initial FNA was consistent with PA. Hence, we presumed that her hypercalcemia was caused by PA. Establishing a definitive diagnosis of PC by frozen sections intraoperatively is difficult. Histopathologic findings of atypical cells, high mitotic rate, and cellular invasions can suggest the diagnosis, though they are often negative. Even postoperatively, pathologists often disagree on cytologic interpretation. However, differentiating PA and PC is important since earlier and more aggressive treatment is needed to reduce the morbidity and mortality in case of malignancy.

scholarly journals Anaplastic carcinoma of the thyroid - clinicomorphological spectrum and review of literature

1970 ◽  
Vol 1 (1) ◽  
pp. 45-48 ◽  
Author(s):  
A Ghosh ◽  
N Nepal ◽  
MD Gharti ◽  
S Basnet ◽  
M Baxi ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Spindle Cell ◽  
Neck Mass ◽  
Anaplastic Thyroid Carcinoma ◽  
Anaplastic Carcinoma ◽  
High Power Field ◽  
The Mean ◽  
Cell Variant ◽  
Thyroid Malignancies ◽  
Atypical Mitosis

Background: Thyroid cancer is fairly common. The worldwide annual incidence ranges from 0.5 to 10 cases per 100,000 people. Anaplastic thyroid carcinoma, comprising less than 10% of all thyroid carcinomas, remains one of the most virulent of all cancers in humans with a 10 year survival rate of only 0.1 %. In the present study we looked into the clinical, cytological and histological spectrum of anaplastic carcinoma and compared our experience with recent literature. Materials and Methods: This was a hospital based retrospective study from January 2000 to November 2010. Clinical, cytological and histopathological data of all the diagnosed anaplastic thyroid carcinoma cases were reviewed and analyzed. Results: Of the 59 thyroid malignancies diagnosed in the same period, 7 cases were anaplastic carcinoma. The mean age was 63 years and was predominantly found in females. All of the cases presented with a neck mass that lasted for a mean of 5.7 months. The mean tumor size was 14.9 cm and the most common sub-type was the spindle cell type. Atypical mitosis of more than 5 per high power field and necrosis was noted in all cases. Conclusion: Due to the markedly aggressive nature of this tumor and its association with areas of endemic thyroid disease, early diagnosis and aggressive therapy is essential, especially in the Himalayan and Sub-Himalayan belt. Keywords: Anaplastic carcinoma; Thyroid carcinoma; Spindle cell variant DOI: 10.3126/jpn.v1i1.4451 Journal of Pathology of Nepal (2011) Vol.1, 45-48

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