The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has provided a set of uniform diagnostic terminology including benign (B), atypia of undetermined significance (AUS), follicular neoplasm (FN), suspicious for malignancy (SM), malignancy (M), and nondiagnostic (ND) for the interpretation of thyroid fine-needle aspiration (FNA). We applied this terminology on our 1,382 thyroid aspirates in a community practice setting, which included 539 cases of B (39%), 376 cases of AUS (27.2%), 116 cases of FN (8.4%), 37 cases of malignant (2.7%), 36 cases of SM (2.6%), and 278 cases of ND (20.1%). Two hundred twenty-one cases (16%) of thyroid FNA had corresponding follow-up thyroidectomies. Each diagnostic category represented a unique association with risk of malignancy and risk of neoplasm. Based on histologic follow-up, the risk of neoplasm (including benign and malignant neoplasm) was B 14%, AUS 44%, FN 67%, SM 77%, and M 100% and the risk of malignancy was B 3%, AUS 6%, FN 22%, SM 56%, and M 100%. The classification and follow-up recommendation of TBSRTC are appropriate for each category. Both B and AUS are low-risk lesions with low probability of malignancy. FN predicts a higher rate for neoplasm but an intermediate rate for malignancy while SM carries a high risk for malignancy.

Gouty panniculitis is a rare manifestation of gout. Clinically, it is characterized by indurated subcutaneous nodules in nonjoint areas. Pathologically, typical characteristic gouty tophi can be seen in subcutaneous tissue. It is postulated that gouty panniculitis develops as a consequence of uric acid accumulation in the body and localized inflammatory changes in subcutaneous tissue. We report a case of a 46-year-old man with 20-year history of gout, who developed multiple subcutaneous nodules over the abdomen and right groin/thigh area over a 2-year period. After a recent episode of congestive heart failure and acute renal failure, the nodules increased in size and the overlying skin became erythematous and ulcerated. Pathologic examination demonstrated typical tophi in the dermis and subcutaneous tissue. A review of the literature yielded fifteen similar cases that had been previously reported. We conclude that gouty panniculitis may be a manifestation of undertreated gout and may be exacerbated by the deterioration of other systemic functions.

The histopathologic distinction between benign and malignant cutaneous keratinocytic proliferations can pose a difficult diagnostic challenge - often with important clinical implications. Activating transcription factor 3 (ATF3) has emerged as a potential biomarker which may aid in the segregation of these lesions, and we hypothesize that ATF3 expression may be a specific marker of cutaneous squamous cell carcinoma (SCC). Using immunohistochemistry, we characterized ATF3 expression in a series of 126 cutaneous epithelial proliferations, including SCC (n = 27), basal cell carcinomas (BCC, n = 59), seborrheic keratoses with atypia (SK, n = 16), hyperplastic actinic keratoses (AK, n = 12) and prurigo nodularis cases (PN, n = 12). We showed strong, nuclear and/or nucleolar expression of ATF3 in a statistically significant number of cases of SCC compared to BCC, SK and PN. We conclude that ATF3 expression is a surrogate of malignancy (or pre-malignancy) in keratinocytic epithelial proliferations and thus helps distinguish SCC from other cutaneous epithelial neoplasms.

Objectives To examine if waist circumference mediated the relationship between 1, 7-dimethylxanthine (a caffeine metabolite) and serum LDL level, adjusting for age, gender, race/ethnicity, smoking, and alcohol consumption. Methods A secondary data analysis study was conducted using data from the National Health and Examination Survey (NHANES) 2009–2010 data collection wave. The final sample included 1976 weighted respondents. Structural equation modeling was used to examine the objectives of this study. Results Structural equation modeling found that levels of 1, 7-dimethylxanthine were not associated with levels of LDL, and that WC was not a mediator of the relationship, adjusting for the covariates. None of the covariates were associated with LDL level, controlling for WC. Conclusions Further longitudinal studies are needed to more thoroughly examine the role of central obesity on the relationship between caffeine and LDL level. Funding Sources None.

Objectives To examine the mediating effect of central obesity (measured by waist circumference [WC]) on the relationship between caffeine metabolite (1, 7-dimethylxanthine) and glycohemoglobin level, adjusting for covariates of age, gender, race/ethnicity, smoking, and alcohol intake. Methods Design: Publicly available data from the 2009–2010 National Health and Examination Surveys (NHANES) were used to conduct this secondary data analysis. NHANES collected data from respondents using in-home surveys and mobile examination centers. Subjects: For the current study, 1976 respondents were included. Respondents were included if they participated in data collection for caffeine consumption and ≥20 years of age. Respondents were excluded if a proxy was required for data collection or had pregnancy confirmation during the physical examination portion of data collection. Outcome Measures: Original NHANES variables, 1, 7-dimethylxanthine level, glycohemoglobin level, WC, age and gender, were used. Race/ethnicity, smoking, and alcohol were recoded to better address the aim of this study. Results Structural equation modeling showed that WC mediated the relationship between 1, 7-dimethylxanthine and glycohemoglobin level, adjusting for covariates. The total effect of 1, 7-dimethylxanthine on glycohemoglobin level was -.001 (indirect effect [.029 x .013] + direct effect [–.001]), adjusting for covariates, which suggests that the total effect was minimal. Age (β = .014, P < .001), non-White race (non-Hispanic Blacks: β = .28, P < .001; Hispanics: β = .29, P < .001, other ethnicities: β = .41, P = .003), smoking (β = .10, P = .014, ), and heavy drinking (β = –.24, P < .001, ) had significant effects on the relationship between 1, 7-dimethylxanthine and glycohemoglobin level. Conclusions Although WC mediated the relationship between 1, 7-dimethlyxanthine and glycohemoglobin level, minimal effects suggest that caffeine consumption should only be considered as part of a treatment regimen in combination with other interventions to reduce glycohemoglobin levels. Funding Sources None.