Necessity for craniospinal irradiation of germinoma with positive cytology without spinal lesion on MR imaging-A controversy

Necessity for craniospinal irradiation of germinoma with positive cytology without spinal lesion on MR imaging-A controversy

 Cerebrospinal fluid (CSF) cytology and spinal MR imaging are routinely carried out for staging earlier than therapy of intracranial germinoma. Nonetheless, the interpretation of the outcomes of CSF cytology poses 2 unresolved scientific questions: (1) Does constructive CSF cytology correlate with the presence of spinal lesion earlier than therapy? and (2) Is craniospinal irradiation (CSI) mandatory for sufferers with constructive CSF cytology within the absence of spinal lesion?
Multicenter retrospective analyses had been carried out primarily based on a questionnaire on scientific options, spinal MR imaging discovering, outcomes of CSF cytology, therapies, and outcomes which was despatched to 86 neurosurgical and 35 pediatrics departments in Japan. Pretreatment frequencies of spinal lesion on MR imaging had been in contrast between the sufferers with constructive and detrimental cytology. Development-free survival (PFS) charges had been in contrast between sufferers with constructive CSF cytology with out spinal lesion on MR imaging handled with CSI and with entire mind or entire ventricular irradiation (non-CSI).
 A complete of 92 germinoma sufferers from 45 institutes had been evaluated by each CSF cytology and spinal MR pictures, however 26 sufferers had been excluded due to tumor markers, the timing of CSF sampling or incomplete estimation of spinal lesion. Of the remaining 66 germinoma sufferers, spinal lesions had been equally recognized in sufferers with detrimental CSF cytology and constructive cytology (4.9% and eight.0%, respectively). Eleven sufferers handled with non-CSI had glorious PFS similar to 11 sufferers handled with CSI.

Puncture feeling is of nice worth throughout US-FNAC. “Onerous” and “laborious with grittiness” had been indicators for malignancy, whereas “comfortable” indicated that the thyroid nodule was more likely to be benign. The diagnostic worth of US-FNAC mixed with puncture feeling for thyroid nodules is larger than US-FNAC alone, particularly when nodule measurement is ≤1 cm. Puncture feeling is of nice worth in predicting the character of Bethesda III thyroid nodules.

Follicular Dendritic Cell Sarcoma of the Cervical Lymph Node Recognized on High quality Needle Aspiration Cytology

Follicular Dendritic Cell Sarcomas (FDCS) are uncommon tumors of lymph nodes and extranodal tissues that are grouped with the histiocytic and dendritic cell neoplasms. The prognosis is normally made after thorough scientific and pathological examination with immunohistochemical evaluation. Difficulties persist in diagnosing FDCS on cytologic preparations. We report herein a case of a 57-year-old feminine who offered with a proper neck mass of 5 months length. Computed Tomography (CT) imaging of neck reported a necrotic proper stage IIb lymph node and uneven fullness of the proper palatine tonsil.

High quality needle aspiration biopsy (FNA) revealed quite a few spindle, oval and stellate neoplastic cells, organized singly and in syncytia with reasonable nuclear pleomorphism, vesicular chromatin sample, and distinguished nucleoli, sprinkled with small lymphocytes. The tumor cells had been strongly diffusely constructive for CD21, CD23, and D2-40 immunostaining on cell bock sections, whereas detrimental for CD1a and CD34, supporting the prognosis of FDCS. Comply with-up surgical pathology on the resection confirmed histopathological options and immunohistochemical profile in keeping with FDCS.

There was a major correlation between puncture feeling and postoperative pathology (p < 0.001). The sensitivity, detrimental predictive worth, and whole coincidence charge of US-FNAC mixed with puncture feeling for the prognosis of thyroid nodules had been larger than these of US-FNAC alone (96.1, 83.6, and 94.7% vs. 89.0, 65.5, and 89.7%, respectively). Thyroid nodule measurement was the influencing issue for puncture feeling, FNAC, and FNAC mixed with puncture feeling (p < 0.05 for all). The world below the curve for puncture feeling, FNAC, and FNAC mixed with puncture feeling for thyroid nodules of measurement ≤1 cm was better than for modules of measurement >1 cm. Puncture feeling was of nice worth in diagnosing Bethesda III thyroid nodules (p < 0.001), and all Bethesda IV thyroid nodules had puncture feeling of sentimental.

Necessity for craniospinal irradiation of germinoma with positive cytology without spinal lesion on MR imaging-A controversy

Do Ultrasound Patterns and Medical Parameters Inform the Likelihood of Thyroid Most cancers Predicted by Molecular Testing in Nodules with Indeterminate Cytology?

Molecular testing (MT) is usually used to refine most cancers chance in thyroid nodules with indeterminate cytology. Whether or not or not ultrasound (US) patterns and scientific parameters can additional inform the danger of thyroid most cancers in nodules predicted to be constructive or detrimental by MT stays unknown. Intention: To check if scientific parameters, together with affected person age, gender, nodule measurement (by US), Bethesda class (III, IV, V), US sample (American Thyroid Affiliation [ATA] vs American School of Radiology TI-RADS methods), radiation publicity, or household historical past of thyroid most cancers can modify the chance of thyroid most cancers or NIFTP predicted by MT.

We studied 257 thyroid nodules in 232 sufferers from 10 examine facilities with indeterminate effective needle aspiration cytology and informative MT outcomes utilizing the ThyroSeq v3 genomic classifier (TSv3). Univariate and multivariate logistic regression had been used for knowledge evaluation. The presence of most cancers/NIFTP was related to constructive TSv3 outcomes. On univariate regression, affected person gender, age, and Bethesda class had been related to most cancers/NIFTP chance. Though ATA and TI-RADS US classes demonstrated constructive developments, neither had been considerably related to most cancers/NIFTP chance. A multivariate regression mannequin incorporating the 4 most informative non-MT covariates yielded a C index of 0.653; R2=0.108.

When TSv3 was added to Mannequin #1, the C index elevated to 0.888; R2=0.572. Nonetheless, age (P=0.341), Bethesda class, and ATA US patternwere nonsignificant, and apart from TSv3 (P<0.0001), male gender was the one non-MT parameter that doubtlessly contributed to most cancers/NIFTP danger (P=0.095). The only and best scientific mannequin (#3) integrated TSv3 and gender (C index=0.889; R2=0.588).  On this multicenter examine of thyroid nodules with indeterminate cytology and molecular testing, neither the ATA nor TI-RADS US scoring methods additional knowledgeable the danger of most cancers/NIFTP past that predicted by TSv3.

Though age and Bethesda class had been related to most cancers/NIFTP chance on univariate evaluation, in sequential nomograms they offered restricted incremental worth above the excessive predictive potential of TSv3. Affected person gender could contribute to most cancers/NIFTP danger in thyroid nodules with indeterminate cytology.

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