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A case report and review of oncocytic variant of papillary thyroid carcinoma
ABSTRACTS
incidence. We determined to examine the incidence of chronic deciduitis, based on the agreed definition of decidual plasma cells, in the setting of acute chorioamnionitis in a series of placental specimens: and to determine the inter-observer reliability between pathologists and trainees at all levels of training in the diagnosis of chronic deciduitis. Ninety placentas with acute chorioamnionitis were reviewed by three pathologists and three registrars for the presence of chronic deciduitis. The criteria for analysis of deciduitis included the presence and pattern of distribution of plasma cells within the decidua basalis and decidua parietalis. Our preliminary results show a much higher rate of chronic deciduitis than initially reported, particularly involving the decidua basalis, detected by both pathologists and registrars. Chronic deciduitis is underdiagnosed at our institution. The lack of recognition of chronic deciduitis impairs attempts to determine its clinical significance in the setting of co-existing acute chorioamnionitis.
A CASE REPORT AND REVIEW OF ONCOCYTIC VARIANT OF PAPILLARY THYROID CARCINOMA Stephen Wong and Andrew Parker Department of Anatomical Pathology, Sydpath, St Vincent’s Hospital, Darlinghurst, NSW, Australia Aim: To present a case of oncocytic variant of papillary thyroid carcinoma and review the literature on this uncommon variant. Case report: A 60-year-old male underwent a total thyroidectomy and right cervical level six lymph node dissection for a suspected papillary thyroid carcinoma based on FNA. The thyroid gland contained two nodules in the right lobe, 10 mm and 23 mm, both with a tan lobulated cut surface. Histologically, the smaller nodule was an adenomatoid nodule and the larger was an oncocytic variant of papillary thyroid carcinoma. The carcinoma cells possessed classic oncocytic morphology, positivity for succinate dehydrogenase complex subunit B (SDHB) and the characteristic nuclear features of papillary thyroid carcinoma – enlarged nuclei with pale chromatin, nuclear membrane grooves and irregularities, and intranuclear pseudoinclusions. Somewhat unusually, the cells were negative for Galectin-3 and HBME-1. There was lymphovascular invasion and three lymph node metastases were found. Discussion: The oncocytic variant of papillary thyroid carcinoma can provide a diagnostic challenge, with possible differentials including oncocytic variants of follicular adenoma and carcinoma, medullary thyroid carcinoma and hyalinising trabecular tumour. With varying reports on its immunohistochemical profile, the nuclear features of papillary thyroid carcinoma remain the most useful diagnostic criteria for this tumour.
NICORANDIL USE AND COMPLICATED DIVERTICULAR DISEASE A. Young, A. Hoyle and F. Duthie Southern General Hospital Pathology Department, Glasgow, United Kingdom Introduction: Nicorandil has been increasingly used for ischaemic heart disease with proven cardioprotective benefit. However
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there is an increasing body of literature reporting the association between gastrointestinal ulceration and nicorandil use. In the setting of diverticulosis/diverticulitis, any superimposed ulceration may lead to significant complications, but data on whether or not nicorandil contributes to this is scanty. It was our aim to identify if any potential association between complicated diverticulitis and nicorandil exists. Methods: 339 reports of colonic resections with diverticular disease received over 19 months (May 2012 to January 2014) were reviewed and divided into those with complicated diverticulitis and those with uncomplicated diverticulitis or uninflamed diverticulosis. Age, sex, surgical indication and nicorandil-use were recorded. Results: 303 cases were included, 186 patients with complicated diverticulitis and 117 with uncomplicated diverticulitis/diverticular disease. Twenty-three patients (12.4%) were on nicorandil in the complicated group, compared to 0 in the other group, a significant difference ( p < 0.001, Fisher’s exact Test). A nicorandil history was never provided and it was raised as a possible contributing factor in one pathology report. Conclusion: We have shown an association between nicorandil use and complicated diverticulitis and demonstrated that nicorandil-associated perforation, fistulation and abscess formation in diverticular disease is under-recognized/underreported.
COMPARISON OF INTERFERENCE IN 4 JAFFE CREATININE ASSAYS USING ACUTE DIABETIC KETOACIDOSIS SAMPLES Azni Abdul-Wahab1, Angela Chiriano2, Chen Lim3, Que Lam3, Kay Weng Choy4, David Mitchell5, Nilika Wijeratne5, Malcolm Mohr1,2 and Cherie Chiang1 1Department of Pathology, Royal Melbourne Hospital, Parkville, 2Department of Pathology, Royal Children Hospital, Parkville, 3Department of Pathology, Austin Hospital, Heidelberg, 4Department of Pathology, Monash Medical Centre, Clayton, and 5Dorevitch Pathology, Heidelberg, Vic, Australia Background and aim: Creatinine assays are now standardised, however the effect of elevated glucose and ketoacids during acute diabetic ketoacidosis (DKA) on different Jaffe creatinine assays is unknown. We aim to assess this interference on different platforms using the Vitros enzymatic creatinine method as the gold standard. Methods: Samples were collected from patients presenting to Emergency Department with DKA and analysed using 4 Jaffe assays (Architect, Roche, Beckman Coulter and Siemens) and 1 enzymatic assay (Vitros). Results: Of the eighteen patients (12 M, 6F, age 32.1 12.4 years), admission pH was 7.12 0.16, HCO3 was 8.2 4 mmol/L, glucose was 36.2 13.8 mmol/L and capillary ketone was 5.7 1.2 mmol/L. The average enzymatic creatinine value was 115.3 64.2 mmol/L. All Jaffe creatinine results were significantly higher ( p < 0.001), in order of magnitude: Architect (156.5 64.7), Beckman (147.2 69.1), Siemens (131.4 57.7) and Roche (127.2 57.5). Discussion: Falsely elevated plasma creatinine results might delay the administration of intravenous potassium in DKA patients and clinicians need to be aware of this potential interference which appeared most marked on the Abbott platform.
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.
incidence. We determined to examine the incidence of chronic deciduitis, based on the agreed definition of decidual plasma cells, in the setting of acute chorioamnionitis in a series of placental specimens: and to determine the inter-observer reliability between pathologists and trainees at all levels of training in the diagnosis of chronic deciduitis. Ninety placentas with acute chorioamnionitis were reviewed by three pathologists and three registrars for the presence of chronic deciduitis. The criteria for analysis of deciduitis included the presence and pattern of distribution of plasma cells within the decidua basalis and decidua parietalis. Our preliminary results show a much higher rate of chronic deciduitis than initially reported, particularly involving the decidua basalis, detected by both pathologists and registrars. Chronic deciduitis is underdiagnosed at our institution. The lack of recognition of chronic deciduitis impairs attempts to determine its clinical significance in the setting of co-existing acute chorioamnionitis.
A CASE REPORT AND REVIEW OF ONCOCYTIC VARIANT OF PAPILLARY THYROID CARCINOMA Stephen Wong and Andrew Parker Department of Anatomical Pathology, Sydpath, St Vincent’s Hospital, Darlinghurst, NSW, Australia Aim: To present a case of oncocytic variant of papillary thyroid carcinoma and review the literature on this uncommon variant. Case report: A 60-year-old male underwent a total thyroidectomy and right cervical level six lymph node dissection for a suspected papillary thyroid carcinoma based on FNA. The thyroid gland contained two nodules in the right lobe, 10 mm and 23 mm, both with a tan lobulated cut surface. Histologically, the smaller nodule was an adenomatoid nodule and the larger was an oncocytic variant of papillary thyroid carcinoma. The carcinoma cells possessed classic oncocytic morphology, positivity for succinate dehydrogenase complex subunit B (SDHB) and the characteristic nuclear features of papillary thyroid carcinoma – enlarged nuclei with pale chromatin, nuclear membrane grooves and irregularities, and intranuclear pseudoinclusions. Somewhat unusually, the cells were negative for Galectin-3 and HBME-1. There was lymphovascular invasion and three lymph node metastases were found. Discussion: The oncocytic variant of papillary thyroid carcinoma can provide a diagnostic challenge, with possible differentials including oncocytic variants of follicular adenoma and carcinoma, medullary thyroid carcinoma and hyalinising trabecular tumour. With varying reports on its immunohistochemical profile, the nuclear features of papillary thyroid carcinoma remain the most useful diagnostic criteria for this tumour.
NICORANDIL USE AND COMPLICATED DIVERTICULAR DISEASE A. Young, A. Hoyle and F. Duthie Southern General Hospital Pathology Department, Glasgow, United Kingdom Introduction: Nicorandil has been increasingly used for ischaemic heart disease with proven cardioprotective benefit. However
S81
there is an increasing body of literature reporting the association between gastrointestinal ulceration and nicorandil use. In the setting of diverticulosis/diverticulitis, any superimposed ulceration may lead to significant complications, but data on whether or not nicorandil contributes to this is scanty. It was our aim to identify if any potential association between complicated diverticulitis and nicorandil exists. Methods: 339 reports of colonic resections with diverticular disease received over 19 months (May 2012 to January 2014) were reviewed and divided into those with complicated diverticulitis and those with uncomplicated diverticulitis or uninflamed diverticulosis. Age, sex, surgical indication and nicorandil-use were recorded. Results: 303 cases were included, 186 patients with complicated diverticulitis and 117 with uncomplicated diverticulitis/diverticular disease. Twenty-three patients (12.4%) were on nicorandil in the complicated group, compared to 0 in the other group, a significant difference ( p < 0.001, Fisher’s exact Test). A nicorandil history was never provided and it was raised as a possible contributing factor in one pathology report. Conclusion: We have shown an association between nicorandil use and complicated diverticulitis and demonstrated that nicorandil-associated perforation, fistulation and abscess formation in diverticular disease is under-recognized/underreported.
COMPARISON OF INTERFERENCE IN 4 JAFFE CREATININE ASSAYS USING ACUTE DIABETIC KETOACIDOSIS SAMPLES Azni Abdul-Wahab1, Angela Chiriano2, Chen Lim3, Que Lam3, Kay Weng Choy4, David Mitchell5, Nilika Wijeratne5, Malcolm Mohr1,2 and Cherie Chiang1 1Department of Pathology, Royal Melbourne Hospital, Parkville, 2Department of Pathology, Royal Children Hospital, Parkville, 3Department of Pathology, Austin Hospital, Heidelberg, 4Department of Pathology, Monash Medical Centre, Clayton, and 5Dorevitch Pathology, Heidelberg, Vic, Australia Background and aim: Creatinine assays are now standardised, however the effect of elevated glucose and ketoacids during acute diabetic ketoacidosis (DKA) on different Jaffe creatinine assays is unknown. We aim to assess this interference on different platforms using the Vitros enzymatic creatinine method as the gold standard. Methods: Samples were collected from patients presenting to Emergency Department with DKA and analysed using 4 Jaffe assays (Architect, Roche, Beckman Coulter and Siemens) and 1 enzymatic assay (Vitros). Results: Of the eighteen patients (12 M, 6F, age 32.1 12.4 years), admission pH was 7.12 0.16, HCO3 was 8.2 4 mmol/L, glucose was 36.2 13.8 mmol/L and capillary ketone was 5.7 1.2 mmol/L. The average enzymatic creatinine value was 115.3 64.2 mmol/L. All Jaffe creatinine results were significantly higher ( p < 0.001), in order of magnitude: Architect (156.5 64.7), Beckman (147.2 69.1), Siemens (131.4 57.7) and Roche (127.2 57.5). Discussion: Falsely elevated plasma creatinine results might delay the administration of intravenous potassium in DKA patients and clinicians need to be aware of this potential interference which appeared most marked on the Abbott platform.
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.