1/18. Multicystic autoimmune thyroiditis-like disease associated with hiv infection. A case report.BACKGROUND: Human immunodeficiency virus (hiv) infection and resulting acquired immunodeficiency syndrome (AIDS) may involve virtually every organ system, including the endocrine glands. Thyroid dysfunction most commonly reflects advanced disease and generally resembles euthyroid sick syndrome. Rarely do opportunistic infections, hemorrhage, neoplasms and drugs account for alterations in thyroid tissue. Multiple lymphoepithelial cysts of parotid gland and thymus have been identified, but similar findings in thyroid gland have not been reported. CASE: A 41-year-old, hiv-seropositive woman, asymptomatic for seven years, developed a squamous cell carcinoma of the cervix with local-regional extension. At the same time, bilateral complex thyroid cysts and high titers of antimicrosomal antibodies (1/6,400) were detected. Ultrasound-guided fine needle aspiration biopsy of the thyroid showed a heterogeneous lymphocytic population with a reactive appearance and occasional groups of epithelial cells with an immature squamous pattern, along with cytologic features of autoimmune thyroiditis. Immunocytochemistry was positive for CD20, CD3 and CD5. Immunoglobulin heavy chain gene rearrangement by polymerase chain reaction from cytologic material showed a polyclonal lymphoid population. External radiotherapy resulted in a significant reduction in the pelvic lesion. Four months after diagnosis, abdominal ultrasound displayed multiple hepatic metastasis, the patient's condition rapidly deteriorated, and she died about a month later. CONCLUSION: This case had unique features and probably represented an AIDS-related lesion and distinct entity.- - - - - - - - - - ranking = 1keywords = neoplasm, complex (Clic here for more details about this article) |
2/18. hypopigmentation of a papillary carcinoma arising in a black thyroid.We report a case of an unpigmented papillary carcinoma arising in a black thyroid induced by minocycline. Black thyroid syndrome is an unusual pigmented change seen almost exclusively in patients on minocycline, apparently resulting from an oxidative interaction between thyroid peroxidase and the drug. Twenty-six cases have previously been reported in the English literature, nine of which described an associated thyroid neoplasm. Four of these nine neoplasms were described as pale or hypopigmented. The nature of the lesion against the background of pigmentation suggests diminished function of the thyroid peroxidase in this clonal population.- - - - - - - - - - ranking = 1.8668607547868keywords = neoplasm (Clic here for more details about this article) |
3/18. Autoimmune thyroid dysfunction induced by interferon-alpha treatment for chronic hepatitis c: screening and monitoring recommendations.OBJECTIVE: To analyze the proposed mechanisms of action of recombinant interferon-alpha (IFN-a) in causing autoimmune thyroid dysfunction, to identify pretreatment risk factors, and to provide recommendations for screening and monitoring of thyroid dysfunction during IFN-a therapy for chronic hepatitis c. methods: Selected publications were reviewed to analyze the proposed mechanisms of autoimmune thyroid disorders. In addition, we examined the interrelationship of the thyroid and the liver, the occurrence of thyroid dysfunction in patients with chronic hepatitis c before and after IFN-a therapy, and the presence or absence of antithyroid antibodies in association with thyroid disease. case reports were selected to demonstrate various IFN-a-induced thyroid dysfunction. RESULTS: IFN-a induces thyroid dysfunction in 3 to 14% of all treated patients with chronic hepatitis c, leading to hypothyroidism, hyperthyroidism, or thyroiditis. In a few patients, thyroid disease will develop in the absence of antithyroid antibodies, a scenario that suggests a nonimmune-mediated mechanism. More frequently, patients develop antithyroid antibodies, which may progress to overt thyroid dysfunction. Through its immunomodulatory properties, IFN-a seems to act through major histocompatibility complex class I antigens to produce antithyroid antibodies and thyroid disease. CONCLUSION: In patients receiving IFN-a therapy for chronic hepatitis c infection, identifiable risk factors for developing autoimmune thyroid dysfunction are preexisting overt thyroid or autoimmune disease, subclinical thyroid or autoimmune thyroid disease, and female gender. Pretreatment screening is recommended for all patients in whom IFN-a therapy is being considered, and periodic monitoring should be performed during such therapy. Thyroid disease need not be a contraindication to IFN-a therapy; early detection of subclinical or overt thyroid disease may allow uninterrupted continuation of IFN-a treatment.- - - - - - - - - - ranking = 0.066569622606576keywords = complex (Clic here for more details about this article) |
4/18. Homozygosity for a dominant negative thyroid hormone receptor gene responsible for generalized resistance to thyroid hormone.Generalized resistance to thyroid hormones (GRTH) commonly results from mutations in the T3-binding domain of the c-erbA beta thyroid hormone receptor gene. We have reported on a novel deletion mutation in c-erbA beta in a kindred, S, with GRTH. One patient from this kindred was the product of a consanguineous union from two affected members and was homozygous for the beta-receptor defect. This patient at 3.5 weeks of age had unprecedented elevations of TSH, free T4, and free T3 (TSH, 389 mU/L; free T4, 330.8 pmol/L; free T3, 82,719 fmol/L). He displayed a complex mixture of tissue-specific hyperthyroidism and hypothyroidism. He had delayed growth (height age, 1 3/12 yr at chronological age 2 9/12 yr) and skeletal maturation (bone age, 4 months), and developmental delay (developmental age, 8 months), but he was quite tachycardic. The homozygous patient of kindred S is markedly different from a recently reported patient with no c-erbA beta-receptor. This difference indicates that a dominant negative form of c-erbA beta in man can inhibit at least some thyroid hormone action mediated by the c-erbA alpha-receptors.- - - - - - - - - - ranking = 0.066569622606576keywords = complex (Clic here for more details about this article) |
5/18. Fine needle aspiration cytology of cystic parathyroid lesions. A cytomorphologic overlap with cystic lesions of the thyroid.Three cases of palpable cystic parathyroid nodules examined by fine needle aspiration (FNA) cytology are reported. Two of the three aspirates were incorrectly identified as thyroid neoplasms due to the presence of papillary clusters or microfollicles and grossly golden-brown cyst fluid. Histologic examination of these two nodules revealed partially cystic parathyroid adenomas. Aspirated material from the third patient yielded clear watery fluid, which was correctly identified as consistent with a parathyroid cyst. The diagnostic difficulties in the differentiation of parathyroid adenoma from thyroid carcinoma or adenoma are discussed, as is the utilization of assays for parathyroid hormone in making the FNA diagnosis of parathyroid lesions.- - - - - - - - - - ranking = 0.93343037739342keywords = neoplasm (Clic here for more details about this article) |
6/18. malacoplakia of the thyroid gland.A case of malacoplakia of the thyroid gland is described in a 50-year-old Japanese woman. This lesion clinically mimicked a malignant neoplasm, and the true diagnosis of malacoplakia was made only after histologic examination; light microscopy revealed a granulomatous nodule with an accumulation of von Hansemann's histiocytes containing PAS-positive and von Kossa's-positive intracytoplasmic and extracytoplasmic inclusions known as Michaelis-Gutmann bodies. There were some foci consisting of neoplasm-like or hyperplastic residual follicles within the lesion. Electron microscopically, a small number of bacilliform organisms were demonstrated within the lesion. X-ray microanalysis of Michaelis-Gutmann bodies was performed and revealed the presence of phosphorus, calcium, iron, and chloride. It is suggested that the malacoplakic lesion may be associated with the hyperplastic or neoplastic follicular lesion, and bacterial infection could be important in the causation of malacoplakia of the thyroid gland.- - - - - - - - - - ranking = 1.8668607547868keywords = neoplasm (Clic here for more details about this article) |
7/18. Cowden's disease: a case report and review of the literature.Cowden's disease is one of the rare genodermatoses. The most characteristic findings in this disease are cutaneous and oral lesions that are widespread papillomas and verrucous papules. On the palms the lesions are keratoses. Aside from these findings, this syndrome complex is sooner or later associated with various internal abnormalities involving the mammary, thyroid, gastrointestinal, reproductive and skeletal systems. In the 28 reported cases, 13 cancers have been found, most of the breasts. Because of the characteristic cutaneous and oral lesions, it is possible to recognize this disease early and then to follow afflicted patients closely for the possibility of development of cancers or other abnormalities of other organs.- - - - - - - - - - ranking = 0.066569622606576keywords = complex (Clic here for more details about this article) |
8/18. Clear cell follicular adenoma of the thyroid.A rare case of follicular adenoma of the thyroid gland composed exclusively of clear cells is described. This case differs from most of the previously reported cases of clear cell thyroid neoplasm in that it was clinically and histologically benign.- - - - - - - - - - ranking = 0.93343037739342keywords = neoplasm (Clic here for more details about this article) |
9/18. Upper eyelid retraction from inferior rectus restriction in dysthyroid orbit disease.Findings from orbital computed tomography scans have shown inflammatory enlargement of the levator palpebralis superioris complex to be a likely cause of eyelid retraction in dysthyroid (Graves's) ophthalmopathy. We have studied a subgroup of nine dysthyroid patients in whom the eyelid retraction occurs as a relative malposition of the globe and eyelid due to inferior rectus restriction. Our explanation of this phenomenon in nine patients is based on Hering's law. Increased innervation required for a fixating superior rectus muscle to overcome a severely restricted inferior rectus muscle causes an unrestricted levator muscle to open the eyelid abnormally wide relative to the globe. The retraction is best demonstrated with fixation of the involved eye. We have performed inferior rectus recession to correct this type of eyelid retraction in three of our patients.- - - - - - - - - - ranking = 0.066569622606576keywords = complex (Clic here for more details about this article) |
10/18. Differential diagnosis of anterior upper mediastinal expansions by contrast-enhanced computed tomography.This study investigated the potential of contrast-enhanced CT in the differential diagnosis of the most common anterior upper mediastinal expansions. CT examinations of 29 patients with an upper anterior mediastinal mass lesion of unknown origin were reviewed retrospectively and compared with the clinical data obtained. The density, contrast enhancement and invasive nature of the tumors were recorded. Thyroid tissue was enhanced most and lymphomas least. Contrast medium injection helped to distinguish great vessels and cystic lesions from surrounding areas. Thyroid tissue was most heterogeneous and lymphomas most homogeneous. All except one of the malignant neoplasms (a lymphoid mass lesion) were infiltratory in nature. Contrast-enhanced CT gives clues as to the origin of a neoplasm and whether it is benign or malignant.- - - - - - - - - - ranking = 1.8668607547868keywords = neoplasm (Clic here for more details about this article) |
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