Search Results (71)

Background/Objectives: Thyroid nodules are commonly found through sensitive imaging methods like ultrasonography. While most nodules are benign and asymptomatic, certain characteristics may indicate malignancy, prompting fine needle aspiration biopsy. Factors like age and gender affect cancer risk, complicating ultrasound-based risk systems. We aimed to determine whether the cytological malignancy rate of thyroid nodules could be adjusted for several clinical parameters. Methods: Data from patients aged 18 and above with thyroid nodules assessed via fine needle aspiration (FNA) were retrospectively reviewed. Malignancy classification was based on cytopathology and histopathology results. The study examined how various clinical parameters, adjusted for the ACR TI-RADS category, affected thyroid nodule malignancy rates, including age, sex, Body Mass Index (BMI), nodule size, presence of autoimmunity, and thyroxine therapy. Additionally, we analyzed the performance of ACR TI-RADS in predicting malignant cytology across different age subgroups of thyroid nodules. Results: The study included 1128 thyroid nodules from 1001 adult patients, with a median age of 48 years and predominantly female (76.68%). Malignancy rates varied across ACR TI-RADS categories, with higher rates associated with larger nodules and younger age groups. Age emerged as a significant predictor of malignancy, with a consistent decrease in the odds ratio for malignant cytology with advancing age across all ACR TI-RADS categories, indicating its potential utility in risk assessment alongside nodule size and sex. Conclusions: Raising the size threshold for recommending FNA of TR3-3 nodules and incorporating patients’ age and gender into the evaluation process could enhance the system’s accuracy in assessing thyroid nodules and guiding clinical management decisions. Full article

A 10-year-old intact female Bichon Frise presented with multiple firm skin nodules on all four limbs. The nodules progressively increased in number and size over seven months. Diagnostic tests included cytology of fine-needle aspirates, histopathology of skin biopsies, radiography, and abdominal ultrasonography. Cytology revealed spindle-shaped mesenchymal cells and extracellular matrix components, and histopathology confirmed ND characterized by mature collagen deposition without evidence of malignancy. Ultrasonography detected multiple kidney cysts bilaterally, although their exact nature (benign or malignant) could not be confirmed histologically. Genetic analysis was performed, revealing no mutation in the traditionally implicated FLCN gene but multiple nonsynonymous mutations in the BRCA2 gene. This case suggests a potential association between BRCA2 gene mutations and the development of ND with renal cystic lesions, broadening the known genetic causes beyond the commonly reported FLCN mutation. Regular genetic screening and close monitoring of dermatological and renal conditions in atypical breeds are recommended. To the best of current knowledge, this is the first case report demonstrating ND and renal cysts associated with BRCA2 mutations in a Bichon Frise. Full article

Background and Objectives: Endoscopic ultrasonography (EUS)-guided fine-needle aspiration/biopsy (FNA/B) is widely used for solid pancreatic lesions; however, the optimal number of needle punctures required to achieve high diagnostic accuracy remains unclear. This study aimed to identify the ideal number of punctures required for solid pancreatic lesions using EUS-FNA/B. Methods: This single-center retrospective study included 598 patients who underwent EUS-FNA/B for solid pancreatic lesions. We analyzed the cumulative tissue acquisition rates and diagnostic accuracy rates for cytology and histology, and identified the factors associated with diagnostic accuracy using univariate and multivariate analyses. Rapid on-site cytological evaluation was performed in all cases. Results: Cumulative tissue acquisition rates were 95.6% and 92.5% for cytology and histology, respectively. The diagnostic accuracy for cytology increased from 72.6% in the first puncture to 78.8% in the second puncture (p = 0.0233). In contrast, the diagnostic accuracy of histology increased from 72.0% at the first puncture to 83.2% at the third puncture (p = 0.0412). Statistically significant differences were noted between the first and second punctures for cytology, and between the first, second, and third punctures for histology. Univariate and multivariate analyses were conducted to identify factors associated with diagnostic accuracy. In cytology, sex was identified as a significant contributing factor, whereas no independent predictors were found in histology. Conclusions: These findings suggest that two-needle punctures are optimal for cytology, and three-needle punctures are optimal for the histological diagnosis of solid pancreatic lesions using EUS-FNA/B. Full article

Background: Interdigitating dendritic cell sarcoma (IDCS) is a very rare haematologic malignant tumour that arises from antigen-presenting cells. While it primarily affects the lymph nodes, extranodal manifestations have been observed, and there is a slight male predominance. Due to its rarity, diagnosing IDCS can be challenging, as illustrated in our case report of a 61-year-old woman. Methods: In this case presentation, the oncological management of a patient suspected of having malignant melanoma metastasis in the neck lymph nodes is discussed. This includes otorhinolaryngological examinations, fine needle aspiration biopsy, PET CT imaging, and histological analysis with immunohistochemistry. Results: The patient’s medical history included the excision of a pigmented lesion from the left ala of her nose, which was diagnosed as malignant melanoma. After surgical treatment, she experienced a tumour-free period of one year; however, during a follow-up ultrasonography three pathological lymph nodes were detected on the left side of her neck. Initially, a nodal metastasis of melanoma was suspected. Yet, fine needle aspiration cytology revealed myofibroblastic tumour invasion, and a re-biopsy showed no signs of malignancy. To further investigate, PET-CT scans were conducted, and a modified radical neck dissection was performed based on the findings. The histological analysis of the lymph nodes revealed an IDCS, a second independent tumour distinct from the initially diagnosed malignant melanoma, originating from the submandibular, upper jugular, and mid-jugular lymph nodes. Conclusions: This case highlights the diagnostic difficulties associated with IDCS. Initially, the clinical suspicion of malignant melanoma was considered, necessitating further examinations and a multidisciplinary approach to reach a final diagnosis and provide the patient with appropriate treatment. Full article

Background and Objectives: Many diagnostic methods exist for identifying thyroid malignancy, but most of them resemble an odyssey, as the journey from palpating a nodule to receiving a definitive diagnose is often long and costly. The aim of the present study is to investigate the role of Sestamibi scintigraphy in the characterization of cytological indeterminate thyroid nodules. Materials and Methods: A focused literature review was conducted, emphasizing the comparison between Fine Needle Aspiration Biopsy (FNAB), the main diagnostic method for thyroid cancer, and Sestamibi. Results: It is widely accepted that Sestamibi is the primary alternative for patients with non-diagnostic FNAB. As shown in the literature, Sestamibi has a high negative predictive value in excluding thyroid malignancy. Conclusions: Much like Odysseus’ adventurous 10-year journey returning to Ithaca, the path to diagnosing thyroid cancer is not straightforward. Molecular imaging with 99mTc-Sestamibi may serve as a valuable adjunct in evaluating thyroid nodules with inconclusive cytological findings. Full article

Background/Objectives: This study aims to evaluate whether fine-needle aspiration biopsy (FNAB) of melanocytic uveal tumors (MUTs) using 27-gauge (27G) needles yields aspirates like those obtained using 25-gauge (25G) needles for cytology. Methods: A retrospective review was conducted on 32 primary uveal melanomas (PUMs). Tumors were sampled at three adjacent sites, first using a 27G needle for gene expression profile (GEP) testing, second and third with 27G and 25G needles for cytology. The endpoints evaluated were the sufficiency of aspirates for cytopathology and GEP. Results: Among the 32 patients, 17 tumors were choroidal, 6 ciliochoroidal, 7 iridociliochoroidal, and 2 exclusively iridic. Tumor diameter ranged from 3.3 mm to 23 mm (mean 13.2 mm), and thickness ranged from 0.5 mm to 12 mm (mean 6.4 mm). Aspirates from both needle sizes were sufficient for cytopathological diagnosis and GEP in 31 of 32 cases (96.9%). The single insufficient aspirate was insufficient with both the 27G and 25G needles. The cytopathology was identical in all other cases. The tumors were Class 1 in 22 cases (71.0%) and Class 2 in 9 cases (29.0%). Conclusions: FNAB aspirates of MUTs using 27G needles appear sufficient for cytology and GEP in most cases, showing a similar diagnostic yield compared to 25G needles. Full article

Background/Objectives: Mucoepidermoid carcinoma (MEC) is the most common malignant tumor of the minor salivary glands, often affecting the hard palate. Preoperative diagnosis and surgical planning are challenging due to anatomical complexity and limitations in sampling, generally obtained by fine-needle aspiration (FNA). This study retrospectively evaluated the diagnostic and therapeutic performance of a high-definition ultrasound (HDUS)-guided fine-needle aspiration cytology/biopsy (FNAC/FNAB) protocol in diagnosing intraoral MEC, based on the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC), with the relative clinical outcomes. Methods: A cohort of 64 patients with histologically confirmed MEC of the minor salivary glands, treated between 2000 and 2022, was retrospectively analyzed. All patients underwent HDUS-guided FNAC/FNAB, imaging (CT, MRI, and panoramic X-ray), and subsequent surgical treatment. The cytological specimens were classified using the MSRSGC. Surgical margins, histopathological findings, lymph node status, and follow-up outcomes were recorded. Results: Of 64 MECs, 42 cases were finally diagnosed as low-grade (LG)/intermediate grade (IG) and 22 as high-grade (HG) carcinomas, using a two-tier histological classification system. HDUS accurately delineated the lesion size, infiltration depth, and bone proximity, with excellent correlation with surgical specimens (difference ≤ 0.6 mm). MSRSGC classification distributed the cases across all categories, with 28 classified as malignant (category VI). Repeat FNAC improved the diagnostic yield in non-diagnostic and atypical cases. FNAB confirmed the cytological findings in all cases, with immunohistochemistry investigation with Ki-67 supporting tumor grading. Surgical margins were clear in all resections. Lymph node metastases were identified in all patients who underwent neck dissection (n = 18), all with HG-MEC. No recurrences occurred among the LG/IG-MEC patients during a median 2-year follow-up. Conclusions: The combined use of HDUS and FNAC/FNAB, interpreted through the MSRSGC framework, offers a highly accurate, minimally invasive approach for preoperative diagnosis and surgical planning in intraoral MEC. HDUS-guided cytology significantly improves diagnostic reliability, particularly in LG/IG and cystic variants, facilitating tailored surgical management. Also, the clinical outcomes may support the possibility of using a simplified grading classification for two histopathological types. Full article

Background: Kuttner’s tumour refers to chronic sclerosing sialadenitis commonly affecting the submandibular gland. It clinically mimics submandibular gland neoplasms and has a possible association with IgG4-related disease. The literature on standardised diagnostic and management pathways is limited. This paper presents a case series and narrative literature review to support a proposed diagnostic and management approach for Kuttner’s tumour. Methods: Twelve cases of patients with a Kuttner’s tumour aged between 55 and 87, identified from 2018 to 2025 through hospital records, were reviewed. All patients underwent ultrasound assessment using standardised diagnostic criteria and were followed up clinically and radiologically every six months. In parallel, we performed a narrative review of studies published between 2005 and 2025, identifying nine relevant articles to contextualise our findings. Results: Our 12-patient case series highlights the potential for Kuttner’s tumour to progress to bilateral involvement and IgG4-related disease. Most cases resolved spontaneously with ultrasound-led monitoring. One progressed to IgG4-RD and responded to glucocorticoids. Our findings support the selective use of invasive tests, baseline serum IgG4 testing, and a six-monthly follow-up strategy. Despite similarities within the existing literature, international variation highlights the need for standardised diagnostic and management protocols. Conclusions: We recommend a conservative, structured approach to managing Kuttner’s tumour, with six-monthly clinical and radiological follow-ups. Based on one case progressing to multi-organ IgG4-related disease, we now recommend routinely measuring serum IgG4 concentrations at diagnosis. The role of magnetic resonance imaging, fine-needle aspiration cytology, and biopsy should be considered on a case-by-case basis. Further research is needed to validate this approach and assess long-term outcomes. Full article

Background/Objectives: Thyroid nodules are commonly observed in neck ultrasonography. Most nodules are benign; hence, several nodules require biopsy to accurately identify the malignant ones. Numerous risk classification guidelines have been developed for thyroid nodules, varying in their indications for fine-needle aspiration biopsy (FNAB). The aim of this study is to evaluate the performances of three internationally recognized thyroid imaging reporting and data systems (TIRADS) for risk stratification of malignancy in comparison to one another. Methods: A total of 225 thyroid nodules with definitive FNAB cytology or histopathological diagnoses were included in this study. Various ultrasound (US) features were classified into categories based on three TIRADS editions. The guidelines were assessed regarding sensitivity, specificity, predictive values, and diagnostic accuracy to compare diagnostic value. Results: The American College of Radiology (ACR)-TIRADS demonstrated the best diagnostic accuracy (63.1%), the highest specificity (58.7%) and positive predictive value (36.3%), among three different TIRADS systems. Korean (K)-TIRADS exhibited the highest sensitivity (94.2%), negative predictive value (96.1%), and the most favorable negative likelihood ratio (0.13). The European (EU)-TIRADS had a sensitivity of 90.4%, specificity of 48.6%, and diagnostic accuracy of 58.2%, ranking between the other two guidelines across most parameters. Conclusions: The rigorous use of the guidelines established by each of the three TIRADS systems would have markedly reduced the number of FNABs performed. The comparison of the three guidelines in our study indicated that they are effective screening methods for identifying malignant thyroid nodules. Among them, K-TIRADS showed the most effective diagnostic performance in sensitivity, while ACR-TIRADS yielded the best specificity. Full article

Mammography is an essential tool in breast screening, often revealing lesions that appear as microcalcifications with or without an associated mass. Decisions about biopsy requirements are guided by the BI-RADS system, aiming to confirm the histopathology of suspicious lesions while avoiding unnecessary procedures. A vacuum-assisted breast biopsy (VABB) is a minimally invasive procedure for diagnosing breast abnormalities. Precise lesion targeting is ensured under stereotactic guidance, reducing the need for repeated procedures. Compared to traditional core needle biopsy (CNB) and fine-needle aspiration cytology (FNAC), it differs in using vacuum assistance to gather more tissue volume, increasing diagnostic accuracy and reducing the likelihood of histological underestimation. This is particularly crucial in cases where microcalcifications are the primary finding, as they are often the earliest signs of ductal carcinoma in situ (DCIS). Managing such findings requires precise diagnostic tools to differentiate benign from malignant lesions without subjecting patients to unnecessary surgical interventions. Building on several years of experience in our department, we have assembled a selection of ten interesting cases encountered in our clinical practice. Each case is documented with paired mammographic images and their corresponding image of histopathological findings, offering a comprehensive view of the diagnostic journey. These cases were selected for their educational value, highlighting the integration of imaging modalities, histopathological evaluation, and clinical decision-making. All cases underwent an extensive diagnostic workup at our facility. This compilation aims to provide valuable insights for both clinicians and researchers, offering a deeper understanding of advanced diagnostic techniques and their role in improving patient outcomes. Full article

Background: The objective of this study was to compare the value of ultrasound (US), magnetic resonance imaging (MRI), and US-guided fine-needle aspiration biopsy (FNAB) in the preoperative evaluation of parotid tumors. Methods: A three-year prospective study, including 35 patients, was conducted. Preoperative ultrasound, MRI, and US-guided FNAB were performed on each patient, after which an imaging and cytological diagnosis was obtained. Each patient underwent surgical treatment. The imaging and cytological diagnoses were compared with the histopathological reports. Results: Ultrasound and MRI showed the same diagnostic performance in discriminating benign from malignant parotid tumors: sensitivity—80%, specificity—97%, and accuracy—94%. In this regard, FNAB registered a sensitivity, specificity, and accuracy of 100%, 97%, and 97%, respectively. US, MRI, and FNAB were recorded as having high diagnostic accuracy in the detection of pleomorphic adenoma and Warthin tumors. Conclusions: Ultrasound and US-guided FNAB allow for the preoperative differential diagnosis of parotid tumors located in the superficial lobe. When US and FNAB results are inconclusive, MRI becomes mandatory. Full article

Background/Objectives: A modern classification distinguishes between two nosological entities posing an intermediate risk between differentiated and anaplastic carcinoma: poorly differentiated thyroid carcinoma and differentiated high-grade thyroid carcinoma. There are currently few studies searching for the preoperative molecular genetic markers of high-grade papillary thyroid carcinoma (PTC HG), primarily because of a recent WHO reclassification and singling out of a separate entity: high-grade follicular cell-derived nonanaplastic thyroid carcinoma. Therefore, this work was aimed at identifying PTC HG-specific microRNAs and mRNAs that reliably distinguish them from differentiated papillary thyroid carcinoma in preoperative cytology specimens (fine-needle aspiration biopsies). Methods: A molecular genetic profile (expression levels of 14 genes and eight microRNAs) was studied in 110 cytology specimens from patients with PTC: 13 PTCs HG and 97 PTCs without features of HG. Results: Of the examined eight microRNAs and 14 genes, significant differences in the expression levels between the PTC and PTC HG groups were revealed for genes SLC26A7, TFF3, and TPO. Only one gene (SLC26A7) proved to be crucial for detecting PTC HG. It showed the largest area under the ROC curve (0.816) in differentiation between the PTC and PTC HG groups and was the key element of the decision tree by ensuring 54% sensitivity and 87.6% specificity. Conclusions: Early preoperative diagnosis of PTC HG in patients with early stages of this cancer type will allow clinicians to modify a treatment strategy toward a larger surgery volume and lymph node dissection and may provide indications for subsequent radioactive iodine therapy. Full article

Background: Detecting pathological lymph nodes (LNs) is crucial for establishing the proper clinical approach in patients with head and neck cancer (HNC). Positron emission tomography with [¹⁸F] fluorodeoxyglucose (FDG PET) has high diagnostic value, although it can yield false positives since FDG-avid LNs can also occur from non-cancerous diseases. Objectives: To explore if radiomics features from FDG PET can enhance the identification of pathological lymph nodes in head and neck cancer. Materials and methods: This study was carried out on $n=51$ cervical lymph nodes (26 negative, 25 positive) from a cohort of $n=27$ subjects, and the standard of reference was fine needle aspiration cytology or excisional biopsy. An initial set of 54 IBSI-compliant radiomics features, which was subsequently reduced to 31 after redundancy elimination, was considered for the analysis. Mann–Whitney U tests were performed to compare each feature between positive and negative LNs. Classification models based on two sets of features, PETBase (SUVmax, MTV and TLG) and PETRad (radiomics features), respectively, were trained using logistic regression, support vector machines and Gaussian naïve Bayes, and their performance was compared. Accuracy was estimated via leave-one-out cross-validation. Results: We identified via univariate analysis 21 features that were statistically different between positive and negative LNs. In particular, dispersion features indicated that positive LNs had higher uptake non-uniformity than the negative ones. AUC, sensitivity, specificity and accuracy obtained with logistic regression were, respectively, 0.840, 68.0%, 89.5% and 80.4% for PETBase and 0.880, 72.0%, 90.0% and 82.4% for PETRad. The other classification models showed the same trend. Conclusions: Radiomics features from FDG PET can improve the diagnostic accuracy of LN status in HNC. Full article

Differentiated thyroid carcinoma (DTC) is among the most prevalent endocrine cancers. The diagnosis of DTC has witnessed tremendous progress in terms of technological advancement and clinical operational guidelines. DTC diagnostics have evolved significantly over centuries, from early clinical examinations to modern molecular testing and imaging modalities. The diagnosis and management of DTC are currently dependent on the international histological classification and identification of specific genetic abnormalities in tumor tissue, as well as the prognostic implications that can inform treatment decisions. This study goes down the memory lanes of various diagnostic methods for DTCs, highlighting recent advancements in molecular testing and point-of-care (POC) technology. Beginning with conventional methods like fine needle aspiration biopsy (FNAB), fine needle aspiration cytology (FNAC), and ultrasound (US) and moving to contemporary innovative approaches such as POC-thyroglobulin (POC-Tg) and liquid biopsy, this review showcases the current trends in DTC diagnostics. Although considerable progress has been achieved in early malignancy detection, patient stratification, prognosis, and personalized treatment, there is a need to refine the mainstay diagnostic procedures. Finally, future perspectives were provided, and emerging roles of artificial intelligence in DTC diagnostics were explored. Full article

Schwannomas are benign nerve sheath tumours that exhibit a slow rate of growth. In the vast majority of cases, schwannomas manifest as asymptomatic masses. The presence of symptomatic lesions may necessitate surgical removal. The incidence of schwannomas ranges from 4.4 to 5.23 cases per 100,000 population, accounting for approximately 7% of all primary tumours in the central nervous system. There is a limited number of case reports describing schwannomas outside the central nervous system. In rare instances, schwannomas may originate at the level of the thyroid gland. In such cases, incidental neck schwannomas may be mistaken for thyroid or parathyroid tumours. The increasing incidence of thyroid cancer draws more attention to all thyroid nodules, both benign and malignant. Thyroid nodules are detected in up to 65% of autopsies, with only 4–6.5% being malignant. Thyroid tumours are typically diagnosed by USG; however, they are often revealed incidentally during neck CT or MRI for other conditions. To rule out malignancy, tumour verification is required. The modern diagnosis of thyroid cancer is based on fine-needle aspiration (FNA) biopsy and cytology, which is classified according to the Bethesda classification system. However, not all FNAs are informative, and the differential diagnosis and treatment strategies in cases of unsatisfactory results are not standardized, leading to potential intraoperative challenges. We present a case study of a patient with a thyroid nodule that was ultimately diagnosed with a schwannoma of the neck according to core-needle biopsy. Full article