[ABC of thyroid diseases and their treatment]

Thyroid diseases are caused by a disturbance of thyroid hormone secretion, inflammations or tumors of the thyroid or combinations thereof. Most important causes for hyperthyroidism are Graves' disease and toxic nodular goiters (including toxic adenomas). Hypothyroidism is often caused by Hashimoto's chronic thyroiditis and can occur in patients after thyroidectomy. Chronic hashimoto's thyroiditis and subacute de Quervain's thyroiditis are the thyroid inflammations most frequently seen. Graves' disease and Hashimoto's thyroiditis are autoimmune thyroid diseases. Thyroid tumors encompass benign solitary nodules, diffuse and nodular goiters, papillary, follicular, medullary and anaplastic carcinomas.

Solitary small- to medium-sized pleomorphic T-cell nodules of undetermined significance: clinical, histopathological, immunohistochemical and molecular analysis of 26 cases

BACKGROUND: Solitary skin nodules composed of pleomorphic T lymphocytes are often the source of diagnostic problems. OBJECTIVE: To characterize the clinicopathological features, prognosis and optimal treatment modalities of patients with solitary lymphoid nodules of small- to medium-sized pleomorphic T lymphocytes. METHODS: Twenty-six patients were analysed for clinical, histopathological, immunophenotypical, molecular and follow-up data. Results: Lesions were located mainly on the head and neck (n = 16; 61.5%) or trunk (n = 8; 30.8%). Histopathology showed non-epidermotropic nodular or diffuse infiltrates of small- to medium-sized pleomorphic T lymphocytes. Monoclonality was found by PCR in 54.2% of cases (n = 13/24). After a mean follow-up of 79.7 months, a local recurrence could be observed only in 1 patient. CONCLUSIONS: Our patients have a specific cutaneous lymphoproliferative disorder characterized by reproducible clinicopathological features. The incongruity between the indolent clinical course and the worrying histopathological features poses difficulties in classifying these cases unambiguously as benign or malignant. We suggest to describe these lesions as 'solitary small- to medium-sized pleomorphic T-cell nodules of undetermined significance'. Irrespective of the name given to these equivocal cutaneous lymphoid proliferations, follow-up data support a non-aggressive therapeutic strategy.

Occurrence of spontaneous tumours of the renal proximal tubules in oscars Astronotus ocellatus

This report describes the occurrence of renal papillary cystic adenomas and adenocarcinomas in oscars Astronotus ocellatus Cuvier, 1829. Samples from 5 oscars with abdominal swelling were collected between 1996 and 2004 and compared to a published case from the USA. Macroscopically, all cases revealed a large, well-demarcated, greyish-brown nodular mass in a retroperitoneal position within the body cavity, and originating from the posterior kidney. Histologically, these neoplasms were composed of epithelial cells, which were arranged in papillary cystic tubular structures and partly covered by cilia. In this study, microscopic and ultrastructural examination confirmed that the origin of the neoplasm was the proximal tubules of the kidney.

Ataxia due to vertebral hemangiosarcoma with evidence of disseminated disease in a 20-year old Swiss Warmblood mare

A 20-year old Swiss Warmblood mare was referred to the Swiss Institute of Equine Medicine with a history of poor performance, coughing and ataxia and hindlimb weakness which progressed to recumbency. Lung auscultation revealed pronounced wheezing, blood work showed signs of chronic inflammation and increased bone turnover and thoracic ultrasound indicated patchy pulmonary consolidation. Cerebrospinal fluid revealed only mild, unspecific changes allowing exclusion of meningoencephalomyelitis and clinically relevant bleeding. Despite medical treatment and support in a sling the mare did not improve and was euthanized. Necropsy revealed a poorly demarcated, non-encapsulated and invasively growing mass dorsally in the musculature at the level of the forth cervical vertebra (C4) infiltrating the vertebral body and the spinal canal at the level of C1–C2. Multiple nodular, firm masses were present in all lobes of the lung and appeared to be mainly located in vessels. Histologically the masses were composed of spindle cells with marked anisocytosis, anisocaryosis, a high mitotic activity and showed invasive growth. These neoplastic cells stained positive for CD31, an endothelial cell marker, which confirmed diagnosis of a hemangiosarcoma. Definite ante mortem diagnosis of hemangiosarcoma, which is rare in horses, is challenging. Besides the vertebral localization, disseminated, locally invasive and cutaneous forms of hemangiosarcoma exist and can be either acquired or congenital. Prognosis for equine hemangiosarcoma and response to treatment are usually poor and progression of clinical signs is rapid. Vertebral hemangiosarcoma is an uncommon cause of spinal ataxia in horses.

Histological review of skin cancers in African Albinos: a 10-year retrospective review.

BACKGROUND Skin cancer is rare among Africans and albinism is an established risk for skin cancer in this population. Ultraviolet radiation is highest at the equator and African albinos living close to the equator have the highest risk of developing skin cancers. METHODS This was a retrospective study that involved histological review of all specimens with skin cancers from African albinos submitted to The Regional Dermatology Training Center in Moshi, Tanzania from 2002 to 2011. RESULTS A total of 134 biopsies from 86 patients with a male to female ratio of 1:1 were reviewed. Head and neck was the commonest (n = 75, 56.0%) site affected by skin cancers. Squamous cell carcinoma (SCC) was more common than basal cell carcinoma (BCC) with a ratio of 1.2:1. Only one Acral lentiginous melanoma was reported. Majority (55.6%) of SCC were well differentiated while nodular BCC (75%) was the most common type of BCC. CONCLUSIONS Squamous cell carcinoma is more common than basal cell carcinoma in African albinos.

Malignant nail tumors

Because of the large number of different tissues making up the distal phalanx of fingers and toes, a large variety of malignant tumors can be found in and around the nail apparatus. Bowen disease is probably the most frequent nail malignancy. It is usually seen as a verrucous plaque of the nail fold and nail bed in persons above the age of 40 years. It slowly grows over a period of years or even decades before degenerating to an invasive squamous cell carcinoma. The latter may also occur primarily often as a weeping onycholysis. The next most frequent nail malignancy is ungual melanoma. Those arising from the matrix are usually pigmented and often start with a longitudinal melanonychia whereas those originating from the nail bed remain amelanotic, are often nodular and mistaken for an ingrown nail in an elderly person. The treatment of choice for in situ and early invasive subungual melanomas is generous extirpation of the nail apparatus whereas distal amputation is only indicated for advanced melanomas. In addition to these frequent nail malignancies, nail-specific carcinomas, malignant vascular and osseous tumors, other sarcomas, nail involvement in malignant systemic disorders and metastases may occur. In most cases, they cannot be diagnosed accurately on clinical grounds. Therefore, a high degree of suspicion is necessary in all isolated or single-digit proliferations that do not respond to conservative treatment.

Experimental infection of the pig with Mycobacterium ulcerans: a novel model for studying the pathogenesis of Buruli ulcer disease.

BACKGROUND Buruli ulcer (BU) is a slowly progressing, necrotising disease of the skin caused by infection with Mycobacterium ulcerans. Non-ulcerative manifestations are nodules, plaques and oedema, which may progress to ulceration of large parts of the skin. Histopathologically, BU is characterized by coagulative necrosis, fat cell ghosts, epidermal hyperplasia, clusters of extracellular acid fast bacilli (AFB) in the subcutaneous tissue and lack of major inflammatory infiltration. The mode of transmission of BU is not clear and there is only limited information on the early pathogenesis of the disease available. METHODOLOGY/PRINCIPAL FINDINGS For evaluating the potential of the pig as experimental infection model for BU, we infected pigs subcutaneously with different doses of M. ulcerans. The infected skin sites were excised 2.5 or 6.5 weeks after infection and processed for histopathological analysis. With doses of 2 × 10(7) and 2 × 10(6) colony forming units (CFU) we observed the development of nodular lesions that subsequently progressed to ulcerative or plaque-like lesions. At lower inoculation doses signs of infection found after 2.5 weeks had spontaneously resolved at 6.5 weeks. The observed macroscopic and histopathological changes closely resembled those found in M. ulcerans disease in humans. CONCLUSION/SIGNIFICANCE Our results demonstrate that the pig can be infected with M. ulcerans. Productive infection leads to the development of lesions that closely resemble human BU lesions. The pig infection model therefore has great potential for studying the early pathogenesis of BU and for the development of new therapeutic and prophylactic interventions.

Eosinophilia in Dermatologic Disorders

Eosinophil infiltration can be observed in skin disorders, such as allergic/immunologic, autoimmune, infectious, and neoplastic diseases. Clinical presentations are variable and include eczematous, papular, urticarial, bullous, nodular, and fibrotic lesions; pruritus is a common symptom in all. In this review, we present representative eosinophilic skin diseases according to their clinical pattern, together with histologic findings and diagnostic procedures. We also discuss the potential roles of eosinophils in the pathogenesis of dermatologic disorder. Current pathogenesis-based diagnostic and therapeutic approaches are outlined.

European Dermatology Forum Guidelines on topical photodynamic therapy

Topical photodynamic therapy (PDT) is a widely approved therapy for actinic keratoses, squamous cell carcinoma in-situ, superficial and certain thin basal cell carcinomas. Recurrence rates are typically equivalent to existing therapies, although inferior to surgery for nodular basal cell carcinoma. PDT can be used both as a lesional or as a field therapy and has the potential to delay/reduce the development of new lesions. PDT has also been studied for its place in the treatment of, as well as its potential to prevent, superficial skin cancers in immune-suppressed patients, although sustained clearance rates are lower than for immunocompetent individuals. Many additional indications have been evaluated, including photo-rejuvenation and inflammatory and infective dermatoses. This S2 guideline considers all current and emerging indications for the use of topical photodynamic therapy in Dermatology, prepared by the PDT subgroup of the European Dermatology Forum guidelines committee. It presents consensual expert recommendations reflecting current published evidence. An unabridged version of this guideline is available online at: http://www.euroderm.org/edf/index.php/edf-guidelines.

Mineral resources in Lower Brule Indian Reservation

On the Lower Brule Indian Reservation in South Dakota, about 3 million tons of metallic manganese are in low-grade deposits in the DeGrey Member of the Pierre Shale on the reservation. The geology and methods of mining and processing this sub-economic mineral resource have been studied extensively; technologically, extraction of manganese is possible. However, an efficient, economical method to separate manganese-bearing nodules from the shale host rocks has yet to be found. The manganiferous nodules occur in the Oacoma zone of the Sully shale member (De-Grey Member) which is a subdivision of the South Dakota Pierre Shale formation. These nodular deposits have an interesting similarity in stratigraphical position, lithology and manganese content to those of the Porcupine Mountain area in Manitoba.

Description and chemical and mineral composition of iron oxide samples from two Finnish lakes

Fifteen iron oxide accumulations from the bottoms of two Finnish lakes ("lake ores") were found to contain as much as 50% Fe. Differential X-ray powder diffraction and selective dissolution by oxalate showed that the samples consisted of poorly crystallized goethite and ferrihydrite. The crust ores of one lake had higher ferrihydrite to goethite ratios than the nodular ores of the other lake. The higher ferrihydrite proportion was attributed to a higher rate of Fe2+ supply from the ground water and/or a higher rate of oxidation as a function of water depth and bottom-sediment permeability. Values of Al-for-Fe substitution of the goethites determined from unit-cell dimensions agreed with those obtained from chemical extraction if the unit-cell volume rather than the c dimension was used. In very small goethite crystals a slight expansion of the a unit-cell dimension is probaby compensated by a corresponding contraction of the c dimension, so that a contraction of the c dimension need not necessarily be caused by Al substitution. The goethites of the two lakes differed significantly in their Al-for-Fe substitutions and hence in their unit-cell sizes, OH-bending characteristics, dehydroxylation temperatures, dissolution kinetics, and Mössbauer parameters. The difference in Al substitution (0 vs. 7 mole %) is attributed to the Al-supplying power of the bottom sediments: the silty-clayey sediments in one lake appear to have supplied A1 during goethite formation, whereas the gravelly-sandy sediments in the other lake did not. The compositions of the goethites thus reflect their environments of formation.

FDG-PET Intra-tratamiento como valor pronóstico en el tratamiento del linfoma Hodgkin

Introducción: La utilización de regímenes de tratamiento más individualizados requiere de mejores sistemas de estratificación temprana en Linfoma Hodgkin (LH). El estudio Tomografía por Emisión de Positrones utilizando 2-[18F] fluoro-2-deoxi-Dglucosa (FDG-PET) intra-tratamiento podría jugar un rol muy importante en esta evaluación. Objetivo: Determinar el valor pronóstico del FDG-PET intra-tratamiento en pacientes con LH para predecir sobrevida libre de progresión y sobrevida global. Material y método: El estudio fue llevado a cabo en el Servicio de Hematología del Hospital Central de Mendoza incluyendo pacientes con diagnóstico de LH confirmados por histología. De acuerdo al estadio y sitio de presentación, los pacientes recibieron quimioterapia sola o la combinación de radioterapia y quimioterapia, con el uso del esquema ABVD (adriamicina, bleomicina, vinblastina y dacarbazina) como protocolo estándar. Los estudios FDG-PET fueron practicados como parte de la evaluación intra-tratamiento y a la finalización. Resultados: En total fueron evaluados 8 pacientes, Sexo: F/M: 4/4, Edad: 18-58 años (Mediana: 29 años), Estadios: IIB:1, IIIA:2, IIIB:1, IVA:1, IVB:3, regiones nodales: 2-10 (Mediana:4), compromiso extranodal: 4/8, síntomas B: 5/8, enfermedad bulky 2/8 . Subtipos: Escleronodular: 6/8, Celularidad mixta: 1/8, Depleción linfocítica: 1/8. IPS: 1: 3/8 2: 3/8 3: 1/8 4: 0/8 ≥ 5: 1/8. Tratamientos: ABVD x 6: 6/8, ABVD x 6 + Radioterapia: 2/8. PET intermedio: 8/8 negativos (6/8 PET 3, 2/8 PET 2). PET final: 7/8 PET negativo, 1/8 PET positivo. Recaída: 1/8 (10° mes). Seguimiento: 11-37 meses (mediana de 24 meses). Discusión y Conclusiones: Al momento actual el FDG-PET intra-tratamiento demostró tener un importante valor predictivo negativo dado que todos los pacientes, menos uno, se encuentran en remisión completa sin progresión de enfermedad. Resta aún determinar el rol que esta herramienta pueda tener en el futuro en la terapia adaptada al riesgo de pacientes con LH.

Late Cenozoic silicoflagellate biostratigraphy, relative paleotemperature, and distribution of various genera and morphologic subgroups with remarks on noteworthy occurrences at DSDP Leg 86 Holes

A quantitative study of late Cenozoic silicoflagellates from the northwestern Pacific sites of Deep Sea Drilling Project Leg 86 shows a relative paleotemperature (Ts) gradient with lowest values (Ts = 30) in the north. Some new ecostratigraphic relations for the region are indicated, such as the last common occurrence of Dictyocha brevispina at 2.6 - 3.0 m.y. ago during a cool interval. Elements of North Pacific and low-latitude biostratigraphic zonations can be identified, but the mixing of cool- and warm-indicator taxa prompted the definition of the new Miocene Mesocena hexalitha Subzone and Pliocene Distephanus jimlingii Subzone. Scanning-electron microscope study of Leg 86 silicoflagellates was done to determine whether various types of skeletal surface texture are temperature dependent. To conduct the study we organized a new surface-texture descriptive code, which characterizes the apical structure/basal ring/spine sequence using new definitions of the terms crenulate (C), linear (L), nodular (N), reticulate (R), and smooth (S). One new silicoflagellate genus, Caryocha Bukry et Monechi, n. gen., is described and several new combinations are made.

Lithofacies, chronostratigraphy, minerals and diagenetic silica facies at DSDP Leg 80 Holes

X-ray powder diffraction and optical and scanning-electron microscope analyses of sediment samples taken from four sites drilled in the Goban Spur area of the northeast Atlantic show variable diagenetic silicification of sediments at several stratigraphic horizons. The results are as follows: 1. The silicified sediments are middle Eocene at Site 548, Paleocene to lower Albian at Site 549, upper to lower Paleocene at Site 550, and lower Turanian at Site 551. 2. There are three types of these silicified sediments: nodular type in carbonate-rich host sediments, bedded type in clayey host sediments, and a type transitional between the other two. 3. Silica diagenesis is considered to progress as follows: dissolution of siliceous fossils; precipitation of opal CT in pore spaces and transformation of biogenic silica (opal A) to opal CT, development of opal CT cement; chalcedonic quartz precipitation in pore spaces and replacement of foraminiferal tests by chalcedonic quartz; and finally, transformation of opal CT to quartz, and cementation. But the strong influence of host-sediment types on diagenetic silica fades is recognized. Bedded-type silicified sediments in a clayey environment indicate a lower grade of silica diagenesis. Only very weak chalcedonic quartz formation is recognized, and there is no opal CT cementation, even in Lower Cretaceous bedded-type clayey silicified sediments. 4. The rf(101) spacing of opal CT shows two distinct trends of ordering or decrease with burial depth; one is a rapid change, in the case of nodular silicified sediments, and the other is a more gentle shift, found in bedded silicified sediments. 5. Diagenetic silica facies of the nodular type develop as irregular concentric zones around some nodule nuclei. Also, quartz-chert nodule formation occurs at rather shallower horizons, and is discordant with the trend of decreasing d(101) spacing in opal CT. 6. Silicified sediments at Site 551 are shallower than at the other sites. The diagenetic silica facies suggest the probable erosion of 300 m or more of sediment at this site. 7. The zeolites clinoptilolite and phillipsite were found in the sediment samples recovered on Leg 80. Clinoptilolite occurs from the shallower levels to the deepest horizons of diagenetically silicified zones, suggesting that clinoptilolite formation is related to diagenesis of biogenic silica. Phillipsite at Site 551 (Section 551-5-2) may originate from volcanogenie material.

Miozene larger foraminifera in ODP Leg 133 holes

The Marion Plateau is a large carbonate platform off northeastern Queensland. Three sites (815, 816, and 826) were drilled on this platform and form the basis for this study. Larger benthic foraminifers, together with rare planktonic forms from the shallow-water carbonates that form the main part of the platform sequence, were studied to establish a biostratigraphy. The presence of Lepidocyclina (Nephrolepidiná) howchini sensu lato and Ladoronia vermicularis, together with Globorotalia (Globorotalia) praemenardii and Orbulina, indicate an early middle Miocene (N9-N12) age (i.e., lower Tf stage) for these carbonates. Dolomitization has destroyed much of the original fabric of these carbonates, making study of the larger foraminifers difficult. Sites 815 (forereef location) and 826 (backreef, lagoonal setting) provide the best faunas. However, at all sites nodular coralline algae and Halimeda are the major bioclasts; coral fragments form a major component at Sites 816 and 826. The middle Miocene neritic sequence is separated from the overlying hemipelagic sequence by an unconformity that spans much of the middle and late Miocene. At Site 815, which is in a forereef situation, the overlying hemipelagic sequence contains a Zone N17A fauna, but at Site 816, higher on the platform, a similar sequence contains a Zone N19 fauna. The faunas indicate that the platform was built up during the early middle Miocene and remained at fairly constant water depths and temperatures during this period. It was then exposed prior to subsiding rapidly during the late Miocene and Pliocene to depths similar to those of the present day.