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

Although it is an extremely rare complication, remote cerebellar hemorrhage should be kept in mind as a possible complication of spinal surgery, especially in operations complicated by dural tears.

Ewing sarcoma is an undifferentiated small-round-cell sarcoma. Although molecular detection of pathognomonic EWSR1-ETS fusions such as EWSR1-FLI1 enables definitive diagnosis, substantial confusion can arise if molecular diagnostics are unavailable. Diagnosis based on the conventional immunohistochemical marker CD99 is unreliable due to its abundant expression in morphological mimics.To identify novel diagnostic immunohistochemical markers for Ewing sarcoma, we performed comparative expression analyses in 768 tumors representing 21 entities including Ewing-like sarcomas, which confirmed that CIC-DUX4-, BCOR-CCNB3-, EWSR1-NFATc2-, and EWSR1-ETS-translocated sarcomas are distinct entities, and revealed that ATP1A1, BCL11B, and GLG1 constitute specific markers for Ewing sarcoma. Their high expression was validated by immunohistochemistry and proved to depend on EWSR1-FLI1-binding to highly active proximal super-enhancers. Automated cut-off-finding and combination-testing in a tissue-microarray comprising 174 samples demonstrated that detection of high BCL11B and/or GLG1 expression is sufficient to reach 96% specificity for Ewing sarcoma. While 88% of tested Ewing-like sarcomas displayed strong CD99-immunoreactivity, none displayed combined strong BCL11B- and GLG1-immunoreactivity.Collectively, we show that ATP1A1, BCL11B, and GLG1 are EWSR1-FLI1 targets, of which BCL11B and GLG1 offer a fast, simple, and cost-efficient way to diagnose Ewing sarcoma by immunohistochemistry. These markers may significantly reduce the number of misdiagnosed patients, and thus improve patient care.

In this rat model study we evaluated whether pretreatment with simvastatin affects the severity of acute lung injury caused by intestinal ischemia-reperfusion (I/R). Twenty-four animals were randomly allocated to three equal groups (sham, control, simvastatin). The simvastatin group was pretreated with simvastatin 10 mg x kg(-1) x day(-1) for 3 days, whereas the other groups received placebo. The simvastatin and control groups underwent 60 min of superior mesenteric artery occlusion and 90 min of reperfusion. Compared with the simvastatin group, the control group exhibited significantly more severe intestinal I/R-induced acute lung injury, as indicated by lower Pao2 and oxygen saturation (P = 0.01 and P = 0.005, respectively) and higher mean values for neutrophil infiltration of the lungs (P = 0.003), total lung histopathologic injury score (P = 0.003), lung wet-to-dry weight ratio (P = 0.009), and lung-tissue malondialdehyde levels (P = 0.016). The control and simvastatin groups had similar serum levels and similar bronchoalveolar lavage fluid levels of cytokines (interleukin-1, interleukin-6, and tumor necrosis factor-alpha) and P-selectin at all measurements, except for a significantly higher level of bronchoalveolar lavage fluid P-selectin in the control group (P = 0.006). Pretreatment with simvastatin reduces the severity of acute lung injury induced by intestinal I/R in rats.

TRAIL and a TRAIL receptor expression profile might be useful to follow-up disease progression by virtue of its connection with clinical staging and pathologic grading in patients with laryngeal SCC.