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Diagnostic pitfalls in the evaluation of fine needle aspiration cytology of the thyroid: correlation with histopathology in 260 cases Objectives: Fine needle aspiration cytology (FNAC) of the thyroid is a non-invasive, cost-effective screening procedure that is valuable for distinguishing neoplastic lesions from non-neoplastic nodules. The aim of this study was to determine the diagnostic accuracy of FNACs performed at our institution by correlating FNAC results with histopathological diagnoses. Methods: Two hundred and seventy-one aspiration cytology specimens followed by thyroidectomy were included in the study, and the results of 260 adequate FNACs were compared with their histological diagnoses. Results: The sensitivity and specificity of thyroid FNAC for detecting neoplasia were 92.6% and 91.6%, respectively. There were 15 (5.7%) false positives and six (2.3%) false negatives. Conclusions:The results showed that follicular cells that exhibit some of the features of papillary carcinoma could be observed in a cytology slide of HashimotoÕs thyroiditis, leading to a diagnostic pitfall. In addition, cellularity and overlapping cytological criteria in hyperplasia might lead to a false diagnosis.Keywords: diagnostic pitfalls, fine needle aspiration cytology, thyroid gland, cytodiagnosis, sensitivity, specificity Clinically detectable thyroid nodules occur in approximately 4-10% of the population; however, only 5-30% of the nodules are malignant, and a distinction between benign and malignant lesions is not easy to make on clinical presentation alone.1,2 The main goal of thyroid fine needle aspiration cytology (FNAC) is to identify the nodules that require surgery and decrease the overall incidence of thyroidectomy in patients with benign disease. However, there are some difficulties and limitations of diagnosis with FNAC, in that both false-negative and false-positive results can occur. 3 The most significant difficulty in making a diagnosis is the overlapping features of different lesions such as nodular goitre and follicular neoplasms. 1The current study was undertaken to evaluate the correlation between thryoid FNAC and histology and to determine the sources of diagnostic errors. MethodsBetween 1996 and 2005, 4352 thyroid FNACs were evaluated at Bas¸kent University and were subsequently reviewed. A total of 271 aspirations followed by thyroidectomy were evaluated and the cytology compared with the final histological diagnoses. Histological sections were evaluated in a multidisciplinary setting together with the review of the previous FNAC results. FNACs of thyroid were reported by only four pathologists, whereas seven pathologists, including these four, reported surgical specimens in our institute. All of the thyroid FNACs performed at Bas¸kent University were carried out under ultrasound (US) guidance [Hitachi, EUB 6500; Hitachi Medical Systems (S) Pte Ltd, Singapore] by a radiologist. Linear transducers, ‡ 7.5 MHz in frequency, were

Food allergy has been increasingly reported in children who had orthotopic liver transplantation (OLT). We aimed to conduct a prospective study to investigate the prevalence of sensitizations and food allergy in pediatric OLT recipients. We also aimed to identify potential risk factors. The study group consisted of 28 children (14 male, 14 female, mean age 4.96 +/- 0.76 yrs) who had OLT. Total eosinophil count (TEC), total IgE, and specific IgEs were studied before and 3, 6, 12 months after OLT. Six patients (21%) developed multiple food allergies. Mean age of six patients at OLT who developed food allergy was younger compared to the non-food allergy group (10.2 months vs. 68.9 months, p < 0.05). Food allergy has been developed within 1 yr in 5, and in 20 months in one patient after OLT. All six patients had cow's milk and egg allergy after OLT. Five children developed wheat, one children developed lentil and another one developed peach allergy in addition to cow's milk and egg allergy. Out of six food-allergic patients after OLT, four children developed Epstein-Barr virus (EBV) infection prior to food allergy. Before OLT, TECs and total IgE levels were not differed among food allergic and non-food allergic patients (p > 0.05). Mean of TECs were significantly higher in food allergic group compared to non-food allergic group at each time point after OLT (p < 0.05). Though statistically insignificant, mean of total IgE levels were also higher in the food allergic group (p > 0.05). These findings suggest that food allergy should be considered after OLT in patients who are younger than 1 yr of age, who developed hypereosinophilia, high total IgE levels or EBV viremia.

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Reports on Noonan syndrome (NS) have documented multiple types of coagulation defects and bleeding diathesis, and a wide range of clinical presentations. Early studies suggested that a large proportion of NS patients have coagulation defects, whereas more recent reports indicate low rates of coagulopathy. The aim of this study was to evaluate phenotypic characteristics, PTPN11 gene mutations, and hematological and coagulation parameters in 30 clinically diagnosed cases of NS. One of the NS patients had a history of easy bruising; however, his hematological and coagulation tests were normal. None of the other patients had clinical coagulation problems. In the NS group, values for platelet count, activity of factors XI, XII, and protein C were significantly lower than the corresponding means for the control group. However, the results of coagulation tests in the NS group were diagnostically inconclusive and only one patient had clinical signs of coagulopathy. Interestingly, two NS patients had low protein C activity. One of these children had an A1517C mutation and transient myelodysplasia. The other patient had a C1528G mutation in exon 13 that has not been reported previously. Neither of these individuals experienced a thrombotic event or any complication during approximately 3 years of follow-up. For all patients clinically diagnosed with NS, a thorough history of coagulation issues should be taken and first-line coagulation testing should be done to evaluate for bleeding diathesis. However, if these assessments reveal nothing abnormal, complications related to coagulation are unlikely and extensive testing is unnecessary.

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Selenium accumulates in gastric tissue when it is needed, as is the case in HP-related antral inflammation. This reactive increase in gastric mucosal selenium seems to disappear in the presence of precancerous gastric lesions in the setting of HP-associated gastritis.

Decreased adiponectin levels are associated with impaired CFR in women with normal epicardial coronary arteries and hypoadiponectinemia may be a risk factor for impaired CFR in women.