Adrenoleukodystrophy.
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Adrenoleukodystrophy↗
Biomedical subjects
Ronald A DeLellis
Publications and source records attributed to Ronald A DeLellis.
Interpretative problems and preparative technique influence reliability of intraoperative parathyroid touch imprints.
CONTEXT: Identification of parathyroid tissue (PT) is crucial during parathyroid and thyroid surgery. Touch imprint preparation (TIP) examination is potentially a more time-effective and less labor-intensive approach than frozen section examination for identification of PT during intraoperative consultation. However, the reliability of PT-TIP remains controversial, and this fact has hindered its adoption as a replacement for frozen section examination. OBJECTIVE: To assess the factors contributing to the relative lack of reliability of TIP in a retrospective study. METHODS: Fifty randomly selected, alcohol-fixed, hematoxylin-eosin- and/or Diff-Quik-stained TIPs of specimens that had been submitted to confirm PT during intraoperative consultation were retrospectively reviewed by 5 observers. The observers were blinded to the final interpretation (based on hematoxylin-eosin-stained permanent sections), which included PT in 39 (78%) of the 50 specimens, thyroid in 9 (18%), lymph node in 1 (2%), and adipose tissue 1 (2%). Cases in which a unanimous diagnosis was not attained were re-reviewed by 3 observers. RESULTS: Of 50 TIPs reviewed, a unanimous diagnosis was rendered in 33 cases (66%), including 27 (69%) of 39 PT cases, 5 (56%) of 9 thyroid cases, and the 1 lymph node case. Cytologic features observed in the TIPs that were unanimously accepted as being diagnostic of PT included the presence of small uniform cells in isolation or in small groups, round to oval nuclei, salt-and-pepper chromatin, occasional naked nuclei, and delicate vacuoles both within the cytoplasm and in the background. Re-review of the 17 remaining TIPs cases, in which diagnostic unanimity was not achieved, demonstrated that factors hindering assessment of the TIPs included hypocellularity (n = 5 cases), air-drying effect (n = 4), hemorrhagic background (n = 4), and presence of PT cells in follicular (thyroid-like) arrangements (n = 4). CONCLUSIONS: The major factors influencing reliability of TIP of PT during intraoperative consultation are related primarily to interpretative problems and preparative technique. Awareness of interpretative problems and attention to preparation of TIPs may further enhance the accuracy of TIP during intraoperative consultation.
Cytodiagnosis↗
Pathologic quiz case: a 66-year-old man with thyrotoxicosis.
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Aged↗
Aspiration cytology of elastofibroma dorsi: case report with ultrastructural and immunohistochemical findings.
Elastofibroma is a well-recognized tumor-like process which typically occurs in the soft tissue of the shoulder. Although fine-needle aspiration (FNA) represents a quick and simple method for definitive diagnosis, the possibility of a false-negative diagnosis is high due to the hypocellularity of the smears. However, a high index of suspicion based on the clinical presentation of a firm mass in a typical location in an elderly person, usually female, aids in the diagnosis. We describe the FNA findings of elastofibroma dorsi in an 89-yr-old woman which, although hypocellular, contained diagnostic aggregates of petaloid globules within a collagenous matrix. The cytologic material showed a green-yellow autofluorescence of the altered elastic fibers with ultraviolet light. Transmission electron microscopy revealed an elongated beaded appearance with small electron densities and obliteration of the central elastin core. The presence of a hypocellular aspirate with autofluorescent elastic fibers should suggest the possibility of elastofibroma dorsi.
Aged↗
Observer variation of encapsulated follicular lesions of the thyroid gland.
Although histologic definition of follicular thyroid lesions is readily available, application of the diagnostic criteria and personal experience may lead to disagreement among pathologists. To investigate interobserver variation in assessment of encapsulated follicular lesions, eight pathologists (four American and four Japanese) reviewed the same hematoxylin and eosin-stained slide of each of 21 cases of thyroid lesions showing encapsulation and follicular growth pattern. In 10% of the cases, there was complete agreement. At least seven pathologists agreed on the diagnosis in 29% of the cases, and at least six in 76% of the cases. American and Japanese pathologists agreed among themselves in 33% and 52% of cases, respectively. The frequency of diagnosis of adenomatous goiter among Japanese pathologists (31%) was considerably higher than that among American pathologists (6%). In contrast, the frequency of diagnosis (25%) of papillary carcinoma among American pathologists was considerably higher than that (4%) among Japanese pathologists. Our analysis revealed three main factors affecting observer variation: 1) interpretation of the significance of microfollicles intimately related to capillaries within the tumor capsule, 2) evaluation of what constituted the type of nuclear clearing indicative of papillary carcinoma, and 3) absence of clear morphologic criteria for separation of adenomatous goiter and follicular adenoma. To reduce observer variation of encapsulated follicular lesions, it will be necessary to provide more explicit criteria for diagnosis.
Adenoma↗
Thyroid gland: international case conference.
The cases of five thyroid tumors were presented and discussed at an international case conference held during the 5th Annual Meeting of the Japanese Endocrine Pathology Society. There was significant disagreement among six pathologists who studied the cases. In this article, we present two of the cases, attempt to explain the reason for disagreement in their diagnoses, and propose what should be done to obtain better consensus in diagnosis.
Adenocarcinoma, Follicular↗
Parathyroid carcinomas: can clinical outcomes for parathyroid carcinomas be determined by histologic evaluation alone?
The Fifth Annual Meeting of the Japan Endocrine Pathology Society was held in September 2001. A highlight of the meeting was the participation of Japanese and American endocrine pathologists in a conference to consider the topic "The Determination of Clinical Outcomes for Parathyroid Carcinomas by Histological Evaluation of Invasive Growth." The discussion was centered around three cases of parathyroid carcinomas selected by the coordinator, Dr. Kameyama, and discussed by Drs. Ronald DeLellis, Ricardo Lloyd, and Kennichi Kakudo. In this article, we summarize their diagnoses and comments.
Adult↗
Prediction of malignant behavior of pheochromocytomas and paragangliomas using immunohistochemical techniques.
Pheochromocytomas and paragangliomas arise from the adrenal glands and extraadrenal paraganglia, respectively. Malignant behavior of these tumors is uncommon and is, in part, dependent on their sites of origin, such as extraadrenal location. Morphologic criteria for malignancy of pheochromocytoma and paragangliomas have not been clearly defined. In this study, to clarify the histologic features that distinguish the benign from malignant pheochromocytomas and paragangliomas, we examined metastatic and nonmetastatic tumors using immunohistochemical techniques. A total of eight cases, five pheochromocytomas from the adrenal glands (four benign and one malignant tumor) and three paragangliomas with invasion or metastasis, were studied. The markers used in this study were chromogranin A, synaptophysin, NCAM (CD56), SNAP25, neuron-specific enolase, S-100 protein, and MIB-1. Our results suggest that MIB-1 immunostaining is a useful adjunct marker to predict malignant behavior in these tumors.
Adolescent↗
Tumors of thyroid follicular epithelium: where have we been and where are we going?.
In a time that was much simpler but not so long ago, we believed there were two main types of differentiated thyroid cancer, papillary and follicular, and diagnostic criteria were relatively straightforward. Papillary carcinomas were characterized by papillary architecture, local invasiveness, and a relatively indolent course, while follicular carcinomas had a follicular architecture, were most often encapsulated, and were more prone to distant metastasis.
Adenocarcinoma, Follicular↗