Primary thyroid lymphomas account for less than 5% of all thyroid malignancies and the majority of cases concern non- Hodgkin's lymphoma of B and T-cell origin as well as Hodgkin's lymphoma. Mucosa-associated lymphoid tissue (MALT) lymphoma are a relatively recently described subset of low grade B-cell non-Hodgkin's lymphoma representing between 6 and 27% of the patients with thyroid lymphomas. These cases occur usually in patients with Hashimoto's thyroiditis having a long indolent course and delayed diagnosis, actually benefit from several therapeutic opportunities among them even surgery and a favorable prognostic. Herein we present a 42-year-old female admitted in our unit for a right firm sensitive thyroid swelling, nonhomogeneous on ultrasound images. FNAB showed cellular smears of mixed follicular cells on a background of mature lymphocytes displaying some nuclear atypia and scanty cytoplasm but no definite malignant elements. Intraoperatively, in addition to the "banal" goiter that was found, some subcentimeter cervical lymph nodes were evidenced. Frozen section showed no evidence of malignant or even suspected cellular elements. However a total right lobectomy and lymph node excision was performed. Microscopy revealed a diffuse lymphoproliferative infiltrate in a background of lymphocytic thyroiditis suggesting a diagnosis of B-cell lymphoma of MALT type and the patient was referred to chemotherapy. She was currently under follow-up without recurrences or metastases after two years from surgery.
Manifestãri clinice aei tratamentul chirurgical al patologiei tiroidiene la pacienåii peste 65 ani Introducere: Creaeterea semnificativã a duratei de viaåã a populaåiei a condus la o semnificativã sporire a prevalenåei condiåiilor tiroidiene benigne aei maligne aei în egalã mãsurã a intervenåiilor chirurgicale pentru aceastã patologie. Pacienåi aei metodã: Într-o serie personalã de 464 tireopatii tratate chirurgical într-un interval de douã decade am înregistrat 51 cazuri (10.9%) peste 65 ani dintre care 11 (2.4%) depãaeind 75 ani. Sunt analizate caracteristicele demografice, clinice aei diagnostice împreunã cu indicaåiile, tehnicile chirurgicale aei rezultatele acestora în timp. Cercetarea statisticã retrospectivã analizând raportul de risc aei intervalul de încredere (95%) nu a identificat factori suplimentari de risc ai complicaåiilor postchirurgicale la aceastã grupã de vârstã. Rezultate: Am consemnat 33 femei aei 18 bãrbaåi (raport 1,8/1) confirmaåi clinic, paraclinic aei histologic cu guaeã (multi)nodularã 24 cazuri (47.0%), tirotoxicoze 18 cazuri (35.2%) aei respectiv carcinoame tiroidiene 9 cazuri (17.6%). Au fost practicate 34 tiroidectomii totale sau subtotale aei 17 exereze conservatoare. Nu am înregistrat decese postoperatorii dar am notat câte trei cazuri de hipocalcemie prelungitã aei respectiv câte douã paralizii recurenåiale aei recidive lezionale. În toate cazurile benigne am realizat vindecãri stabile în timp ce în cancere am obåinut supravieåuiri la 3-5 ani în 4 tumori papilare. Concluzii: În pofida unor dificultãåi de diagnostic aei riscurilor suplimentare legate de comorbiditãåi, patologia tiroidianã benignã aei malignã instalatã la bolnavi peste 65 ani poate beneficia de toate tipurile de exereze glandulare conservatoare sau radicale în condiåiile unei selecåii riguroase a cazurilor.
The normal vaginal flora is complex and includes various organisms, many of them conditioned pathogens. The vaginal microbiome is controlled by estrogens that is why a major difference it encountered between pre-menopausal and menopausal women. Bacterial vaginosis was associated with inflammatory changes on Papanicolaou (PAP) smears and chronic inflammation may eventually tead to potentially precancerous and cancerous processes of the cervix. We asses the importance of PAP test and early discovery of vaginal infections because bacterial vaginosis has been associated with inflammatory changes on PAP smears. Materials and metods: Were analysed 50 patients with bacteriologic exam and PAP smear, from ambulatory (Polyclinic Constanța). Bacteriological exam was performed on smears stained Gram from vaginal secretion, collected during the same ginecological examination when PAP smears were collected. The PAP smear was conventional PAP. Samples were obtained by cervical brushing. Results and discussions: These patients were aged between 21 and 64 year and were examined for various symptoms. The patients were classified in pre-menopausal 35% and post-menopausal 65%.The result of the bacteriologic exam showed normal flora (absence of infection) in 44% of cases and abnormal vaginal flora in 56% of the cases. The predominant pathology was bacterial vaginosis with non-specific flora (Gram positive coci and Gram negative bacilli, absence of lactobacilli) in 38% of cases. Candida infection was present in 12% of the cases and Trichomonas vaginalis and Actynomices in 3% of the cases each. Conclusions The majority of patients with bacterial vaginosis (Candida, Trichomonas,Actinomyces) had Pap tests negative for intraepithelial lesion or malignancies NILM or NILM and cellular changes associated with inflammation. There may be infectious causes of abnormal Pap tests other than HPV.
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