Introduction: Despite the fact that the fine needle aspiration biopsy (FNA) is commonly used in the initial evaluation and distinction of benign and malignant lesions of thyroid nodules, it may yield variable results, inasmuch as it is contingent on the pathologist's analysis and expertise in collecting appropriate samples. Objective: To check the diagnostic accuracy between FNA and pathological examination of thyroid nodules, both performed in a diagnostic pathology service. Methods: Retrospective study carried out in a diagnostic pathology service in Chapecó, Santa Catarina, Brazil. All patients who underwent FNA and pathological examination in the period from January 1 st 2005 to December 31 2010 were included in this study. Results: 1,172 FNA were conducted during this period and 265 patients underwent both FNA and pathological examination. Most patients were female (85%), with mean age 47.75 years (standard deviation [SD] = 14.93 years). Cytopathological examinations yielded the following results: benignity (43.77 %), suspected malignancy (23.77%), follicular neoplasm (5.28%), atypical follicular lesion of undetermined significance (1.51%) and unsatisfactory sample (1.51%). In the pathological examination, the most predominant diagnoses were colloid goiter (38.87%), follicular adenoma (22.64%) and classic papillary carcinoma (18.87%). In satisfactory samples (n = 261), the following results were obtained: diagnostic accuracy (89.66%), sensitivity (82.14%), specificity (93.22%), negative predictive value (91.67%) and positive predictive value (75.19%). Conclusion: We concluded that FNA provides a good predictive value for benign thyroid, constituting a reliable and effective tool for diagnosis and surgical indication.
ResumoOBJETIVO: apresentar uma série de casos de dismenorreia membranosa. MÉTODOS: todas as pacientes foram selecionadas a partir da suspeição diagnóstica, após atendimento clínico em consultório privado por relato de dismenorreia dolorosa associada à eliminação espontânea de material elástico com formato semelhante a útero. Apenas fatos relevantes foram descritos do quadro álgico, história médica atual e pregressa e hábitos de vida. O material eliminado foi encaminhado para laboratório de patologia no qual ocorreu a análise macro e microscópica. Os casos em que não se pode provar a eliminação de material com característica membranácea não foram selecionados. Após a confirmação diagnóstica, realizou-se uma revisão da literatura até o ano de 2008 utilizando o método MeSH com o termo "membranous dysmenorrhea". RESULTADOS: três casos clínicos de dismenorreia foram transcritos. Todos os casos, além do quadro característico de dor e eliminação vaginal de material elástico, foram associados ao uso de métodos anticoncepcionais hormonais. CONCLUSÕES: embora haja apenas escassos relatos de caso de dismenorreia membranosa na literatura científica, sua etiologia deve ser suspeita em casos de dor associada a sangramento vaginal com eliminação de material elástico ou firme. O diagnóstico final é dependente do exame anatomopatológico que nunca deve ser dispensado. Observamos necessidade de mais discussões sobre esta patologia com o objetivo de manter o profissional atualizado para exercer diagnóstico e terapêutica adequados. AbstractPURPOSE: to present a series of cases of membranous dysmenorrhea. METHODS: all the patients selected were under diagnostic suspicion, after being clinically attended in a private medical office due to the report of painful dysmenorrhea associated with spontaneous elimination of elastic material with uterine shape. Only relevant facts about the pain condition have been described, together with the present and previous medical history and life habits. The material eliminated was forwarded to the pathology laboratory, where the macro and microscopic analyses were done. Cases with no confirmation of membranous material elimination were not selected. After the diagnostic confirmation, literature up to 2008 was carried out using the MeSH method, with the words "membranous dysmenorrheal". RESULTS: three cases of dysmenorrhea were transcribed. Besides the characteristic picture of pain and vaginal elimination of elastic material, all the cases were associated with the use of hormonal contraceptive methods. CONCLUSIONS: despite the fact that there are only sporadic reports of cases of membranous dysmenorrhea in the scientific literature, this etiology must be considered in cases of pain associated with vaginal bleeding plus elimination of elastic or solid material. The final diagnosis depends on anatomopathological exam, which should not be dismissed. We highlight the need for more discussion about this pathology, to keep the professionals updated with the aim of exerting adequate diagnosis and therapeutics.
Breast squamous cell carcinoma are rare, occurring in less than 0.1% of all breast carcinomas. This report describes the oncological conduct performed on a patient with a triple negative squamous cell carcinoma in the upper outer quadrant of the right breast. The same patient presented a lobular carcinoma in situ within a fibroadenoma of the contralateral breast, during the follow up period. The association of these two diseases in the same patient has not yet been described in the literature.
Introdução: Sarcomas cutâneos são neoplasias malignas incomuns, e compõem um grupo heterogêneo de doenças. Apesar de serem pouco frequentes, devem ser incluídos como diagnósticos diferenciais em lesões cutâneas que possuem apresentação clínica não habitual e/ou histopatologia inconclusiva. Relato do caso: Foram descritos dados clínicos, histológicos, e imuno-histoquímicos, forma de tratamento e de seguimento oncológico de três pacientes com diagnóstico de sarcoma cutâneo de linhagem celular muscular. Os pacientes tinham idade entre 63 e 74 anos; sendo que dois deles possuíam queixa de recidiva local da neoplasia após tratamento cirúrgico prévio. Foram submetidos à avaliação clínica, e, na sequência, à ressecção alargada com margens de 2cm. Nenhum deles apresentou recidiva regional, ou à distância, durante o seguimento oncológico. Conclusão: Tanto o leiomiossarcoma como o rabdomiossarcoma cutâneos, possuem melhor prognóstico quando comparados às neoplasias mesenquimais malignas de linhagem muscular que surgem em outros sítios anatômicos. No entanto, a definição do diagnóstico e, consequentemente, o tratamento cirúrgico de forma precoce são fundamentais para o controle locorregional da doença.
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