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At least 415 records · Page 23Linked to original sources
PubMed1987

Circulating autoantibodies to thyroid hormones: a diagnostic pitfall.

Circulating autoantibodies to thyroid hormones are occasionally detected and may cause confusion, because symptoms and signs are inconsistent with the measured thyroid hormone values. We present a 5 1/2 year old girl with Hashimoto's thyroiditis and false high concentrations of free thyroxine and total triiodothyronine.

Autoantibodies↗
PubMed1998

Papillary squamous cell carcinoma of the uterine cervix: diagnostic pitfalls.

A case of papillary squamous cell carcinoma (PSCC) of the uterine cervix is reported. The patient was a 73-year-old Japanese woman with acute renal failure and bilateral hydronephrosis. A cauliflower-like mass was found in the uterine cervix. A uterine cervical biopsy specimen revealed PSCC in situ, while clinically it was an invasive carcinoma. Uterine cervical biopsy was performed a second time to confirm its stromal invasion. However, only small fragments were obtained because of heavy bleeding from the tumor and they showed PSCC in situ again. Following this, computed tomography of the pelvis revealed a 5 cm mass in the uterine cervix, invading the vagina and urinary bladder. Though deep-wedge biopsy, loop electrosurgical excision, or cone biopsy is recommended to evaluate PSCC, it may be impossible to perform any of these procedures because of bleeding such as that seen in our case. In these circumstances, good communication between pathologists and clinicians is important since lack of communication may cause PSCC to be microscopically misinterpreted as in situ carcinoma rather than invasive carcinoma.

Aged↗
PubMed1998

Diagnostic pitfalls in sports related laryngeal injury.

The serious nature of laryngeal trauma sustained during sporting activity can be easily overlooked. Concomitant injury should not distract from the diagnosis of potential airway problems. The effects of head and neck trauma on the airway may be delayed. The assessment and management of a patient with suspected laryngeal injury should be carried out by experienced medical practitioners.

Adult↗
PubMed2001

Thyroglobulin immunoreactivity in lymph node histiocytes: a potential diagnostic pitfall.

AIMS: Strong thyroglobulin immunoreactivity within sinus histiocytes in a lymph node draining a papillary thyroid carcinoma was observed in a recent case. This prompted the investigation of whether thyroglobulin immunoreactivity is common in regional lymph nodes in cases of thyroid malignancy. METHODS: Eighty seven lymph nodes were studied from 21 cases of thyroid malignancy. These comprised papillary carcinoma (n = 12), follicular carcinoma (n = 4), medullary carcinoma (n = 3), and one case each of squamous and anaplastic carcinoma. Eleven cervical lymph nodes from patients with no evidence of thyroid disease were included as controls. Sections were stained with a monoclonal antibody against thyroglobulin. RESULTS: In the cases of thyroid malignancy, 32 of 87 lymph nodes showed positive staining for thyroglobulin of histiocytes within the subcapsular and medullary sinuses. In an additional four cases, there was positive staining of lymph within lymphatic channels. Positivity was present in at least one node in 15 of 21 cases. There was no positivity in the control cases. There was no correlation between the size of the primary tumour and the presence of thyroglobulin positivity. CONCLUSIONS: Positive staining with antithyroglobulin occurs not uncommonly in sinus histiocytes in lymph nodes draining thyroid tumours. This positivity could be the result of the destruction of normal thyroid follicles, with the release of thyroglobulin, which is taken up by histiocytes, which subsequently drain to local lymph nodes. Pathologists should be aware of this phenomenon and should be careful not to interpret this as metastatic tumour.

Biomarkers↗
PubMed1999

Detection of clonal B cells in microdissected reactive lymphoproliferations: possible diagnostic pitfalls in PCR analysis of immunoglobulin heavy chain gene rearrangement.

AIMS: To evaluate the specificity of standard and fluorescence based (Genescan) polymerase chain reaction (PCR) immunoglobulin heavy chain (IgH) gene rearrangement analysis in complete and microdissected paraffin wax embedded sections from lymphoid proliferations. METHODS: PCR IgH gene rearrangement analysis of whole sections and microdissected fragments (n = 62) from paraffin wax embedded reactive lymph nodes (n = 6) and tonsils (n = 3). Amplificant analysis used both standard methods and automated high resolution fluorescence based quantification and size determination using GENESCAN software. RESULTS: Whole tissue sections were consistently polyclonal in control experiments. IgH gene amplification was successful in 59 of 62 microdissected fragments; only two of 59 showed a polyclonal rearrangement pattern, the remainder being oligoclonal or monoclonal. Reanalysis was possible in 33 samples; six showed reproducible bands on gel analysis and satisfied accepted criteria for monoclonality. Use of high resolution gels with Genescan analysis improved sensitivity and band definition; however, three samples still appeared to be monoclonal. CONCLUSIONS: These results confirm that PCR based IgH gene rearrangement analysis is a sensitive and specific method for demonstrating B cell clonality in whole paraffin wax embedded sections. However, oligoclonal and monoclonal rearrangement patterns are regularly encountered in small tissue fragments from otherwise unremarkable reactive lymphoproliferations, possibly because of preferential priming or detection of local B cell clones. Data from clonal analysis of small, microdissected or lymphocyte poor samples must be evaluated critically. It is recommended that analyses should be run in parallel on at least two tissue specimens. Only reproducible bands present in more than one sample should be considered to be suggestive of neoplasia.

B-Lymphocytes↗
PubMed1990

Subungual amelanotic melanoma: a diagnostic pitfall.

A 35 year old female presented with a persistent amelanotic lesion of the nail bed of the left great toe for 1 year, associated with destruction of the overlying nail. Incision biopsy revealed a nodular malignant melanoma and the toe was amputated. There is no sign of recurrence at 18 month follow-up. As prognosis is related to local disease extent, any persistent nail bed lesion should be biopsied to exclude the possibility of malignant melanoma.

Adult↗
PubMedDate not supplied

Pelvic endometriosis: MR imaging spectrum with laparoscopic correlation and diagnostic pitfalls.

Endometriosis is a common multifocal disease involving a number of anatomic sites in the pelvis. Although laparoscopy is the standard of reference for diagnosis, magnetic resonance (MR) imaging is a noninvasive method for evaluating areas inaccessible to laparoscopy. A large endometrioma (> or = 1 cm in diameter) appears as a homogeneously hyperintense mass on T1-weighted MR images and as a low-signal-intensity mass with areas of high signal intensity on T2-weighted images. A small endometrioma may be indicated when a pelvic mass less than 1 cm in diameter is hyperintense on T1-weighted images irrespective of its appearance on T2-weighted images. Endometriosis may also manifest as multiple, homogeneously hyperintense cysts on T1-weighted images. Involvement of the alimentary tract or bladder can appear as areas of high signal intensity. Although MR imaging is limited in its ability to depict small endometrial implants and adhesions, the advantages of MR imaging over laparoscopy include the ability to characterize endometriotic lesions and to evaluate extraperitoneal sites of involvement, contents of a pelvic mass, or lesions hidden by dense adhesions. The roles of the two modalities are therefore complementary. Knowledge of the variety of MR imaging appearances of endometriosis and organ involvement within the pelvis is important for guiding a subsequent laparoscopic examination.

Adult↗
PubMedDate not supplied

FDG PET of the retroperitoneum: normal anatomy, variants, pathologic conditions, and strategies to avoid diagnostic pitfalls.

Evaluation of the retroperitoneum is important to assess the extent of retroperitoneal malignancies and because the retroperitoneum is a route of nodal spread for other malignancies. Positron emission tomography (PET) with 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG) allows detection of small malignant nodes not identified or not meeting size criteria for malignancy with computed tomography (CT) and tumor recurrences in surgical beds that are otherwise difficult to assess. However, evaluation of retroperitoneal malignancies or adenopathy with FDG PET can be complicated by urinary and colonic activity or anatomic variants. Urinary artifacts are avoided with intravenous hydration, administration of furosemide, and catheterization and retrograde filling of the bladder with saline solution. Colonic artifacts are avoided by cleansing the bowel with an isosmotic solution. FDG PET is useful in assessing the retroperitoneum for adenopathy in malignancies such as testicular cancer; lymphoma; and rectal ovarian, or cervical cancer that spread along retroperitoneal lymphatics. FDG PET is especially useful for detection of malignant nodes that do not meet size criteria at CT or when lack of retroperitoneal fat makes it difficult to identify retroperitoneal nodes with CT. FDG PET has an important role in evaluation of postoperative beds, where CT has limited useful because of altered anatomy, surgical clip artifacts, and scar issue.

Artifacts↗
PubMedDate not supplied

Hepatofugal flow in the portal venous system: pathophysiology, imaging findings, and diagnostic pitfalls.

Hepatofugal flow (ie, flow directed away from the liver) is abnormal in any segment of the portal venous system and is more common than previously believed. Hepatofugal flow can be demonstrated at angiography, Doppler ultrasonography (US), magnetic resonance imaging, and computed tomography (CT). The current understanding of hepatofugal flow recognizes the role of the hepatic artery and the complementary phenomena of arterioportal and portosystemic venovenous shunting. Detection of hepatofugal flow is clinically important for diagnosis of portal hypertension, for determination of portosystemic shunt patency and overall prognosis in patients with cirrhosis, as a potential pitfall at invasive arteriography performed to evaluate the patency of the portal vein, and as a contraindication to specialized imaging procedures (ie, transarterial hepatic chemoembolization and CT during arterial portography). Hepatofugal flow is generally diagnosed at Doppler US without much difficulty, but radiologists should beware of pitfalls that can impede correct determination of flow direction in the portal venous system.

Arteriovenous Fistula↗