Occult papillary microcarcinoma of the thyroid - a potential pitfall of fine needle aspiration cytology?

Article Abstract:

One technique used to diagnose disease of the thyroid gland is fine needle aspiration (FNA) cytology, in which a needle is inserted into the gland to remove cells for analysis. FNA offers important advantages over other methods of diagnosis, because it often allows surgery to be avoided (thereby reducing both risk to the patient and costs). The cases of two women diagnosed by FNA are discussed. Both patients had a lump in the neck which was found to be due to goiter, in which the thyroid gland is enlarged because of dietary iodine deficiency, infection, or other causes. In addition, the FNA technique revealed that each patient also had a tiny cancerous tumor known as papillary microcarcinoma. Because the tumors were found, surgery was performed to remove them, but the authors argue that the surgery was ''virtually unnecessary.'' The reason they question the need for surgery in these cases is that papillary microcarcinomas grow slowly and rarely lead to metastasis, or spreading of the cancer. Even tumors of this type that do metastasize are not considered life-threatening. Thus the authors conclude that it was unfortunate that these tumors were found inadvertently by the FNA procedure, and they suggest that the patients would have been better off had the tumors remained hidden and untreated. The unintentional diagnosis of papillary microcarcinoma by FNA is a disadvantage of the technique, but since this rarely occurs and the technique is accurate and useful in diagnosing thyroid disease, FNA should continue to be used. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Identification and classification, Cancer cells, Cytodiagnosis, Endocrine gland tumors

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Cholesterol absorption by the gall bladder

Article Abstract:

Cholesterol absorption by the small intestine and the gall bladder is generally a passive process. That is, the concentration of cholesterol in the bile and in the small intestine is sufficiently high that much of it will pass into the organs naturally, without the expenditure of energy. However, when these tissues are poisoned with cyanide, which cripples the energy production of cells, there is a reduction in the amount of cholesterol absorbed. In the case of the gall bladder, cholesterol absorption is reduced by 30 percent, indicating that this portion of cholesterol absorption relies upon the expenditure of energy by the lining of the gall bladder. Utilizing human gall bladders, which had been surgically removed for medical purposes, researchers used an artificial concoction resembling bile to investigate the factors affecting cholesterol absorption. Their results indicate that the composition of bile salts affected the uptake of cholesterol. In particular, substances like chenodeoxycholic acid may increase the uptake of cholesterol, but inhibit its transport through the cell. Consequently, such substances might result in the accumulation of cholesterol. Since chenodeoxycholic acid is used therapeutically to dissolve gallstones, the possibility exists that extended treatment with this drug may result in the accumulation of cholesterol in the mucosa of the gall bladder. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Lipids, Cholesterol, Gallbladder

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Paraganglial cells of urinary bladder and prostate: potential diagnostic problem

Article Abstract:

Chromaffin cells are found in the abdomen, adrenal medulla, and in extra-adrenal aggregates called paraganglia. Chromaffin cells interact with potassium dichromate producing a brown coloration in the solution. This report discusses a rare case in which a 73-year old male patient had paraganglial cells in the urinary bladder and prostate. A pathological review of a tissue section obtained after a prostatic resection was performed. A cluster of richly capillarized clear cells were found closely associated with smooth muscle of the prostate. Three cases with similar cellular aggregates in association with bladder muscle and mucosa were also discussed and results were compared. Extensive immunohistochemical analyses and staining were performed on each of the specimens, which confirmed the identity of these aggregates in the bladder wall and prostate gland as paraganglial cells. This case demonstrates the potential for errors in diagnosis because of the close association of these cells to nerves. These cells may be mistaken as malignant. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Prostate diseases, Prostatic diseases, Bladder

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