- Email: [email protected]
Aspiration cytology in the differential diagnosis of non-toxic goitre
62
THE ROYAL COLLEGE O F PATHOLOGISTS O F AUSTRALIA
SPECIFIC MACROGLOBULIN ESTIMATIONS I N THE DIAGNOSIS OF SOME VIRAL DISEASES
MURPHY,A. M. Instirute of Clinical Pathology and Mcdical Research, Li dcabe, N w South Wales The demonstration of rubella specific IgM is now an accepted method for the diagnosis of maternal rubella when rising antibody levels cannot be shown. However, all available techniques are time consuming and/or expensive. The sucrose density gradient method has been modified to allow reduced centrifuging time and during the past 3 yr 121 cases of rubella have been confirmed using this modified method. A study has also been made of the significance of this test in the diagnosis of congenital rubella. Of 56 infants born to mothers with serologically confirmed rubella or with a rubella-like rash during pregnancy, 18 show-ed congenital abnormalities at birth. Rubella specific IgM globulin was demonstrated in the cord blood of 16 (89'") of this latter group and one of the remaining 2 gave a positive result at 3 mth of age. Thus in only one infant with congenital abnormalities was specific IgM not demonstrable. Of the remaining 38 apparently normal infants 14 had demonstrable IgM and 24 did not. Similarly studies of the IgM response in mumps meningo-encephalitis show it to be a useful diagnostic criterion, frequently providing a more rapid result than virus isolation, and preliminary studies of COXsackie B myo-pericarditis suggest that specific IgM estimations will provide a satisfactory answer to a difficultlaboratory diagnostic problem. ACTINIC GRANULOMA: A CONNECTIVE TISSUE DISORDER AFFECTING SUN AND HEAT-DAMAGED (ELASTOTIC) SKIN
O'BRIEN,J. P. Maroubra, New South Wales
Ring-shaped inflammatory lesions sometimes develop in the abnormal, 'elastotic' connective tissues of sun and heat-damaged skin. The lesions, which commence as papules and nodules, enlarge very slowly and may persist for years. On microscopic section h e y show an infiltrate composed mainly of foreign-body giant cells engaged in digesting and absorbing the abnormal elastotic fibres. The disorder, which occurs on several continents, should probably be regarded as a phenomenon of repair within damaged connective tissue. The name Actinic granuloma indicates its external or environmental origin and distinguishes it from other granulomas with which it is constantly being confused. Actinic granuloma tends to be misdiagnosed as granuloma annulare, necrobiosis lipoidica and sarcoidosis. ASPIRATION CYTOLOGY I N THE DIFFERENTIAL DIAGNOSIS OF NON-TOXIC GOITRE
ORELL,S. R. and GUTTERIDGE, D. H. Fremanrlc Hospital and the Sir Charles Gairdner Hospital, Western Australia
Over a period of 16 mth aspiration biopsy of the thyroid gland for cytological examination was carried out on 104patients. Half of these had solitary thyroid nodules, carcinoma or thyrotoxicosis or when reviewed were considered to have thyroids of normal size. The remainder were regarded as having non-toxic goitre. On the basis of the cytological pattern, the 52 cases of non-toxic goitre were subdivided into simple colloid goitre (15), subacute thyroiditis of de Quervain's type (5) and lymphocytic thyroiditis (30). In 2 cases, clinically thought to have thyroiditis, cytology did not permit a definite diagnosis. Two main cytological subtypes were seen in cases of lymphocytic thyroiditis. One was characterized by a predominance of lymphoid cells, the other by the presence of pleomorphic oxyphilic follicular epithelium usually with fewer lymphocytes. One of the simple colloid goitres has been histologically confirmed, none of the other cases have been subjected to surgery. Clinical presentation and anti-thyroid antibody tests were in good agreement with the cytological diagnosis. A few patients who at the time of aspiration had negative antithyroid antibodies later developed positive titres. Aspiration cytology is a simple, quick and painless examination which is of great value in the differential diagnosis of non-toxic goitre and in the diagnosis of thyroiditis. It is particularly suitable for screening for thyroiditis in a goitre population.
THE ROYAL COLLEGE O F PATHOLOGISTS O F AUSTRALIA
SPECIFIC MACROGLOBULIN ESTIMATIONS I N THE DIAGNOSIS OF SOME VIRAL DISEASES
MURPHY,A. M. Instirute of Clinical Pathology and Mcdical Research, Li dcabe, N w South Wales The demonstration of rubella specific IgM is now an accepted method for the diagnosis of maternal rubella when rising antibody levels cannot be shown. However, all available techniques are time consuming and/or expensive. The sucrose density gradient method has been modified to allow reduced centrifuging time and during the past 3 yr 121 cases of rubella have been confirmed using this modified method. A study has also been made of the significance of this test in the diagnosis of congenital rubella. Of 56 infants born to mothers with serologically confirmed rubella or with a rubella-like rash during pregnancy, 18 show-ed congenital abnormalities at birth. Rubella specific IgM globulin was demonstrated in the cord blood of 16 (89'") of this latter group and one of the remaining 2 gave a positive result at 3 mth of age. Thus in only one infant with congenital abnormalities was specific IgM not demonstrable. Of the remaining 38 apparently normal infants 14 had demonstrable IgM and 24 did not. Similarly studies of the IgM response in mumps meningo-encephalitis show it to be a useful diagnostic criterion, frequently providing a more rapid result than virus isolation, and preliminary studies of COXsackie B myo-pericarditis suggest that specific IgM estimations will provide a satisfactory answer to a difficultlaboratory diagnostic problem. ACTINIC GRANULOMA: A CONNECTIVE TISSUE DISORDER AFFECTING SUN AND HEAT-DAMAGED (ELASTOTIC) SKIN
O'BRIEN,J. P. Maroubra, New South Wales
Ring-shaped inflammatory lesions sometimes develop in the abnormal, 'elastotic' connective tissues of sun and heat-damaged skin. The lesions, which commence as papules and nodules, enlarge very slowly and may persist for years. On microscopic section h e y show an infiltrate composed mainly of foreign-body giant cells engaged in digesting and absorbing the abnormal elastotic fibres. The disorder, which occurs on several continents, should probably be regarded as a phenomenon of repair within damaged connective tissue. The name Actinic granuloma indicates its external or environmental origin and distinguishes it from other granulomas with which it is constantly being confused. Actinic granuloma tends to be misdiagnosed as granuloma annulare, necrobiosis lipoidica and sarcoidosis. ASPIRATION CYTOLOGY I N THE DIFFERENTIAL DIAGNOSIS OF NON-TOXIC GOITRE
ORELL,S. R. and GUTTERIDGE, D. H. Fremanrlc Hospital and the Sir Charles Gairdner Hospital, Western Australia
Over a period of 16 mth aspiration biopsy of the thyroid gland for cytological examination was carried out on 104patients. Half of these had solitary thyroid nodules, carcinoma or thyrotoxicosis or when reviewed were considered to have thyroids of normal size. The remainder were regarded as having non-toxic goitre. On the basis of the cytological pattern, the 52 cases of non-toxic goitre were subdivided into simple colloid goitre (15), subacute thyroiditis of de Quervain's type (5) and lymphocytic thyroiditis (30). In 2 cases, clinically thought to have thyroiditis, cytology did not permit a definite diagnosis. Two main cytological subtypes were seen in cases of lymphocytic thyroiditis. One was characterized by a predominance of lymphoid cells, the other by the presence of pleomorphic oxyphilic follicular epithelium usually with fewer lymphocytes. One of the simple colloid goitres has been histologically confirmed, none of the other cases have been subjected to surgery. Clinical presentation and anti-thyroid antibody tests were in good agreement with the cytological diagnosis. A few patients who at the time of aspiration had negative antithyroid antibodies later developed positive titres. Aspiration cytology is a simple, quick and painless examination which is of great value in the differential diagnosis of non-toxic goitre and in the diagnosis of thyroiditis. It is particularly suitable for screening for thyroiditis in a goitre population.