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Figure 1. Fine-needle aspiration smear, showing loosely arranged spindled cells intermingled with abundant histiocytic cells and inflammatory cells (Papanicolau, ·10).

Background and aim: Omentin-1 is suggested to affect inversely atherosclerosis (AS). Data about omentin-1 is limited to chronic kidney disease (CKD). Our aim was to examine omentin-1 in non-diabetic CKD patients who are not dialyzed and investigate its relationships with inflammation and carotid AS. Materials and Methods: We performed a cross-sectional study in 55 non-diabetic CKD patients and 30 healthy controls. Baseline clinical and laboratory data were obtained for all participants. Serum omentin-1 and interleukin-6 (IL-6) levels were measured according to the manufacturer's instructions. Carotic plaque and intima-media thickness (IMT) were assessed by carotid ultrasonography. The homeostasis model assessment of insulin resistance index (HOMA-IR) was used to assess IR. Results: Omentin-1 and IL-6 levels in the patient group were found to be higher than the control group; the differences were statistically significant (p ¼ 0.01 and p ¼ 0.04, respectively). Carotid IMT(mean) was significantly higher in the patient group (p ¼ 0.01). Omentin-1 did not correlate with IL-6 and IMT in the patient group (p ¼ 0.51 and p ¼ 0.76, respectively). In subgroup analysis, omentin-1 levels in patients with carotid plaque were lower than those without carotid plaque (179.5 AE 88.1 ng/ml and 185.9 AE 67.8 ng/ml, respectively). However, the difference was not statistically significant (p ¼ 0.47). Conclusion: We conclude that omentin-1 is higher in not dialyzed non-diabetic CKD and there is no correlation between omentin-1 and IL-6 or carotid IMT(mean).

Background:We evaluated the differential diagnosis of solitary pulmonary lesions on magnetic resonance imaging. Aims: To investigate the value of diffusion weighted imaging on the differential diagnosis of solitary pulmonary lesions. Study Design: Randomized prospective study. Methods: This prospective study included 48 solitary pulmonary nodules and masses (18 benign, 30 malignant). Single shot echo planar spin echo diffusion weighted imaging (DWI) was performed with two b factors (0 and 1000 s/mm 2 ). Apparent diffusion coefficients (ADCs) were calculated. On diffusion weighted (DW) trace images, the signal intensities (SI) of the lesions were visually compared to the SI of the thoracic spinal cord using a 5-point scale: 1: hypointense, 2: moderately hypointense, 3: isointense, 4: moderately hyperintense, 5: significantly hyperintense. For the quantitative evaluation, the lesion to thoracic spinal signal intensity ratios and the ADCs of the lesions were compared between groups.Results: On visual evaluation, taking the density of the spinal cord as a reference, most benign lesions were found to be hypointense, while most of the malignant lesions were evaluated as hyperintense on DWI with a b factor of 1000 s/mm

460C ontrast-enhanced magnetic resonance imaging (MRI) is a complementary imaging technique that is increasingly used in the surgical treatment planning of breast cancer. Contrast-enhanced MRI has a sensitivity of 40%-100% in detecting ductal carcinoma in situ (DCIS) and up to 100% sensitivity in detecting invasive breast cancer (1, 2). In many studies, MRI had a higher accuracy than mammography (MMG) and ultrasonography (US) in detecting multiple malignant foci, in defining the actual size and spread of a solitary tumor, and in diagnosing contralateral synchronous breast cancer (3-5).Many studies have indicated various detection rates of MRI (16%-37%) for occult multiple lesions. The detection rate for a larger spread of the cancer is as high as 34% (1,5,6).Larger extension of local disease affects not only the surgical and systemic treatment but also the axillary lymph node approach for staging leading to a direct full axillary dissection instead of sentinel node excision (5, 7).Our objective in this prospective study was to investigate 1) the rate at which additional evidence is obtained with a pre-operative MRI and 2) how often the MRI findings change the surgical plan in patients for whom physical examination, MMG, and US findings make them candidates for breast-conserving surgery. Materials and methodsThe study was approved by the Ethics Committee of the Ege University School of Medicine. Retrospective analyses were performed on the prospectively obtained information. All of the patients were asked to read and sign informed consent prior to the MRI examination.Contrast-enhanced breast MRIs were performed on 69 female patients undergoing physical examination, MMG, and US between August 2006 and December 2008. These patients exhibited evidence of breast cancer based on clinical and radiologic findings and were candidates for breastconserving surgery.Inclusion criteria were as follows: 1) Cytologically or histopathologically (fine-needle aspiration biopsy, Tru-cut excisional or incisional biopsy) proven breast cancer, 2) In accordance with the TNM classification used for malignant tu- All of the enrolled patients were believed to be candidates for breast conservation on the basis of physical examination, mammography, and ultrasonography. The patients were reevaluated with the MRI examination as to whether they were still candidates for breast conservation therapy. RESULTSThe MRI findings changed the previous management plans in 19.1% of the 68 patients. With respect to the surgical approach, no statistically significant difference was observed between the histopathology groups (P = 0.403). In terms of the breast parenchymal pattern, however, surgical planning was changed in 53.8% of the patients who exhibited a dense pattern, which was significantly different from the rates of the other groups (P = 0.006). The sensitivity, specificity, positive predictive value, and negative predictive value of the MRI for additional malignant lesion detection and identification were 85%, 98%, 92%, and 96%, respectively. The...

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SummaryBackgroundRenal cell carcinoma is an interesting tumor due to its unpredictable behavior. Common metastatic sites of renal cell carcinoma are the lungs, lymph nodes, bones and liver. Concurrent thyroid metastasis of clear cell carcinoma is uncommon but it can appear as a rapidly growing cervical, painless nodular mass.Case ReportWe report a case of a 56-year-old male patient with clear cell renal carcinoma confirmed on a histopathological examination. The patient noticed a rapidly growing mass in the thyroid region when receiving medical anticancer therapy. Because of that, gray-scale thyroid ultrasonography and a fine-needle aspiration biopsy were performed. The histopathological examinationof the biopsy specimen revealed a lesion composed of malignant epithelial cells compatible with metastasis of renal carcinoma.ConclusionsIn patients with with a history of RCC, both past and present, a thyroid mass, especially co-existing with an adenomatous goiter, should prompt a work-up for thyroid metastasis.

Adrenocorticotropin (ACTH) producing macroadenomas and pituitary apoplexy are unusual in Cushing' s disease. A 20-year-old man who had been diagnosed Cushing' s disease 2 months ago, presented with sudden headache, nausea, and vomiting. His serum cortisol level was 0.4 μg/dl and ACTH level was 23.9 pg/ml. Magnetic resonance imaging of the pituitary gland disclosed a hemorrhage in the pituitary macroadenoma (22×19 mm). He was treated with IV methylprednisolone immediately and then the symptoms were relieved within the first day of the treatment. The hemorrhagic lesion was resected by transsphenoidal surgery successfully. Impaired secretion of pituitary hormones may be seen after the pituitary apoplexy. We communicate a case with pituitary apoplexy of an ACTH secreting pituitary macroadenoma, causing acute glucocorticoid insufficiency.