BACKGROUND AND OBJECTIVES: To classify the metastases to the thyroid gland arising from non-thyroidal malignancies on ultrasound (US). MATERIALS AND METHODS: We enrolled 45 consecutive patients with metastases to the thyroid gland from 2005 to 2012. We classified metastases into 4 types; type I: diffuse non-mass forming lesion, type II: a solitary suspicious nodule, type III: multiple suspicious nodules, and type IV: nodule(s) with no suspicion. We subcategorized type I into two subtypes; type IA: diffusely infiltrative lesion, type IB: diffuse micronodulation. RESULTS: The most frequent primary malignancy of thyroid metastases was lung cancer. The patients with thyroid metastases were 26 (57.8%) in type I; type IA: 16 (35.6%), type IB: 10 (22.2%), 14 (31.1%) in type II, 3 (6.7%) in type III and 2 (4.4%) in type IV. Type I metastasis included 18 of 25 patients with lung cancer and all 3 patients with stomach cancer. Thirty patients (73.3%) having type IA, II or III revealed malignant findings on US, in contrast, 12 (26.7%) patients having type IB or IV revealed no suspicious findings. CONCLUSION: Type I (diffuse non-mass forming lesion) was the most common in thyroid metastases. A quarter of thyroid metastases revealed no suspicious findings on US. Thyroid metastases can be considered as a differential diagnosis, when diffuse non-mass forming lesions or nodules with no suspicion are revealed on thyroid US.
Classification* ; Diagnosis, Differential ; Humans ; Lung Neoplasms ; Neoplasm Metastasis* ; Stomach Neoplasms ; Thyroid Gland* ; Ultrasonography

PURPOSE: The purpose of this study was to evaluate the usefulness of convex probe endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for detecting malignancy in parenchymal pulmonary lesions located adjacent to the central airways. MATERIALS AND METHODS: We retrospectively reviewed the diagnostic performance of EBUS-TBNA in consecutive patients with high clinical suspicion of a centrally located primary lung cancer who had undergone EBUS-TBNA at the Samsung Medical Center between May 2009 and June 2011. RESULTS: Thirty-seven patients underwent EBUS-TBNA for intrapulmonary lesions adjacent to the central airways. Seven lesions were located adjacent to the trachea and 30 lesions were located adjacent to the bronchi. Cytologic and histologic samples obtained via EBUS-TBNA were diagnostic in 32 of 37 (86.4%) of patients. The final diagnosis was lung cancer in 30 patients (7 small cell lung cancer, 23 non-small cell lung cancer), lymphoma in one and malignant fibrous histiocytoma in one patient. The diagnostic sensitivity of EBUS-TBNA in detecting malignancy and detecting both malignancy and benignity was 91.4% and 86.5%, respectively. Two patients experienced minor complications. CONCLUSION: EBUS-TBNA is an effective and safe method for tissue diagnosis of parenchymal lesions that lie centrally close to the airways. EBUS-TBNA should be considered the procedure of choice for patients with centrally located lesions without endobronchial involvement.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung/diagnosis/ultrasonography ; Diagnosis, Differential ; Endoscopic Ultrasound-Guided Fine Needle Aspiration/*methods ; Female ; Histiocytoma, Malignant Fibrous/diagnosis/ultrasonography ; Humans ; Lung Neoplasms/*diagnosis/ultrasonography ; Lymphoma/diagnosis/ultrasonography ; Lymphoproliferative Disorders/diagnosis/microbiology ; Male ; Middle Aged ; Retrospective Studies ; Sensitivity and Specificity ; Small Cell Lung Carcinoma/diagnosis/ultrasonography ; Tomography, X-Ray Computed

Cytologic diagnosis of the metastatic tumors to the thyroid is important in the management of the patients. There have been rare reports analyzing fine-needle aspiration (FNA) cytology of metastatic tumors to the thyroid. This study examines comprehensive cytologic findings of metastatic tumors to the thyroid with radiologic findings. The FNA cytology slides obtained from 12 cases with metastatic tumors of the thyroid; lung cancer (n=5), tongue and tonsil cancer (n=3), esophageal cancer (n=2), and breast cancer (n=2) were reviewed. Radiological study showed single mass with heterogeneous texture or multiple masses without calcification. Metastatic tumor was easily considered in a differential diagnosis of FNA cytology because they had peculiar cytological features which were not seen in primary thyroid tumor. The smear background varied from predominantly necrotic, bloody, and inflammatory to colloid. The aspirates exhibited a mixture of benign follicular cells and malignant cells in 6 cases. The characteristic cytoplasmic features of the tumor cells, such as keratin, mucin and melanin, were found in 9 cases. Although some cases mimic primary thyroid neoplasm, a careful examination of the cytological characteristics may help cytopathologists to recognize a metastatic tumor in the thyroid by FNA, and may help the clinicians to establish a proper treatment plan.
Biopsy, Fine-Needle* ; Breast Neoplasms ; Colloids ; Cytoplasm ; Diagnosis ; Diagnosis, Differential ; Esophageal Neoplasms ; Humans ; Lung Neoplasms ; Melanins ; Mucins ; Thyroid Gland* ; Thyroid Neoplasms ; Tongue ; Tonsillar Neoplasms ; Ultrasonography*

BACKGROUND: Radial probe endobronchial ultrasound (R-EBUS), is effective for tissue diagnosis of lung lesions. We evaluated the diagnostic performance of R-EBUS both a guide-sheath and fluoroscopy and identified factors associated with accurate diagnosis. The feasibility of molecular and genetic testing, using specimens obtained by R-EBUS, was also investigated. METHODS: The study retrospectively reviewed 211 patients undergoing R-EBUS without a guide-sheath and fluoroscopy, June 2016-May 2017. After excluding 27 patients of which the target lesion was not reached, 184 were finally included. Multivariate logistic regression was used, to identify factors associated with accurate diagnosis. RESULTS: Among 184 patients, R-EBUS-guided biopsy diagnosed malignancy in 109 patients (59%). The remaining 75 patients (41%) with non-malignant results underwent additional work-ups, and 34 were diagnosed with malignancy. Based on final diagnosis, diagnostic accuracy was 80% (136/170), and sensitivity and specificity for malignancy were 76% (109/143) and 100% (27/27), respectively. In multivariate analysis, peripheral location (adjusted odds ratio [aOR], 3.925; 95% confidence interval [CI], 1.203–12.811; p=0.023), and central position of the probe (aOR, 2.435; 95% CI, 1.424–7.013; p=0.035), were associated with accurate diagnosis of malignancy. Molecular and genetic analyses were successful, in all but one case, with inadequate specimens. CONCLUSION: R-EBUS-guided biopsy without equipment, is effective for tissue diagnosis. Peripheral location and central position of the radial probe, were crucial for accurate diagnosis. Performance of molecular and genetic testing, using samples obtained by R-EBUS, was satisfactory.
Biopsy ; Bronchoscopy ; Diagnosis ; Fluoroscopy ; Genetic Testing ; Humans ; Logistic Models ; Lung ; Lung Neoplasms ; Multivariate Analysis ; Odds Ratio ; Retrospective Studies ; Sensitivity and Specificity ; Ultrasonics ; Ultrasonography

BACKGROUND: In lung cancer patients, the presence of metastatic neck nodes is a crucial indicator of inoperabilty. So thorough physical examination of neck is always mandatory, but sometimes those are hardly palpable even by the skillful hand. Ultrasonography is a useful diagnostic method in detection of small impalpable lymph nodes and in guidance of fine needle aspiration biopsy. In this study we evaluated the clinical usefulness of ultrasonography(USG) and ultrasound-guided fine needle aspiration cytology(US-FNA) in lung cancer patients without palpable neck nodes. METHODS AND MATERIALS: From Sep 2002 to Sep 2003, 36 non-small cell lung cancer patients (20 adenocarcinoma, 16 squamous cell cancer) and 10 small cell lung cancer patients without palpable neck nodes on physical examiation were enrolled. patients who had contralateral mediastinal nodal enlargement(>1cm) on chest CT were excluded. After the routine check of USG on the neck, US-FNA was done in cases with enlarged neck nodes (> or =5 mm in the short axis). The presence of enlarged lymph node on USG, and of malignant cells on cytology were evaluated by the histological type and the patients' clinical stage of lung cancer. RESULTS: Among 36 non-small lung cell cancer patients, 14 (38.8%) had enlarged neck nodes on USG, and 5 of 10 small cell lung carcinoma patients. The mean diameter of the neck nodes was 9.8 mm (range, 7-12 mm). US-FNA of 14 non-small cell lung cancer patients revealed tumor cells in eight patients (57.1%). In 5 small cell lung cancer pateints, tumor cells were found in all cases. By the result of US-FNA, the clinical stage of 8 out of 36 (22.2%) non-small cell lung cancer patients had changed, including two cases of shift from the operable IIIa to the inoperable IIIb. In small cell lung cancer patients their clinical stage was not changed after US-FNA, but their pathological diagnosis was easily done in two cases, in whom endobronchial lesions were not found on bronchoscopy. CONCLUSIONS: USG and US-FNA of neck node seem to be safe, sensitive and cost-effective diagnostic tools in the evaluation of lung cancer patients without palpable neck nodes.
Adenocarcinoma ; Biopsy ; Biopsy, Fine-Needle* ; Bronchoscopy ; Carcinoma, Non-Small-Cell Lung ; Diagnosis ; Hand ; Humans ; Lung Neoplasms* ; Lung* ; Lymph Nodes ; Neck* ; Physical Examination ; Small Cell Lung Carcinoma ; Tomography, X-Ray Computed ; Ultrasonography

A 47-year-old Korean woman with right middle lobe lung adenocarcinoma, malignant pleural effusion, and multiple lymph node and bone metastases, after three months of lung cancer diagnosis, presented with a palpable right breast mass. Images of the right breast demonstrated architectural distortion that strongly suggested primary breast cancer. Breast biopsy revealed metastatic lung cancer with a negative result for estrogen receptor (ER), progesterone receptor (PR) and mammaglobin, and a positive result for thyroid transcription factor-1 (TTF-1). We present a case of breast metastasis from a case of lung cancer with an extensive micropapillary component, which was initially misinterpreted as a primary breast cancer due to unusual image findings with architectural distortion.
Adenocarcinoma/drug therapy/*secondary ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Biopsy, Needle ; Bone Neoplasms/secondary ; Breast Neoplasms/drug therapy/*secondary ; Diagnosis, Differential ; Female ; Humans ; Lung Neoplasms/*pathology ; Lymphatic Metastasis ; Mammography ; Middle Aged ; Neoplasm Staging ; Tomography, X-Ray Computed ; Ultrasonography, Mammary

Pericardial tamponade is a life-threatening condition, as accumulated fluid in the pericardial sac can ultimately lead to fatal shock. The clinical identification of cardiac tamponade can be difficult to determine. Accurate diagnosis and prompt intervention are important to prevent adverse outcomes. Unexplained hypotension, enlarged cardiac silhouette, chest pain or dyspnea in a patient with underlying comorbidities, such as cancer, uremia or trauma history, constitute a high-risk population for pericardial effusions. The identifying cause of pericardial effusion and the understanding of the disease process are also important to prevent recurrent pericardial effusions. We report a case of malignant pericardial effusion with tamponade as an initial presentation in a patient with lung adenocarcinoma. The patient had typical features of tamponade such as neck vein distension, hypotension, tachycardia, tachypnea, muffled heart sound and cardiomegaly on chest X-ray. The pericardial effusion was confirmed by bedside echocardiography. Subsequently, ultrasound guided pericardiocentesis was performed and malignant cells were detected in the effusion by cytology. Eventually, lung adenocarcinoma was detected by CT-guided tissue biopsy. Hemodynamic changes, associated underlying causes, clinical presentations, radiologic findings, and the emergency management of cardiac tamponade were reviewed with the current literature.
Adenocarcinoma* ; Biopsy ; Cardiac Tamponade ; Cardiomegaly ; Chest Pain ; Comorbidity ; Diagnosis ; Dyspnea ; Echocardiography ; Emergencies ; Heart Sounds ; Hemodynamics ; Humans ; Hypotension ; Lung Neoplasms ; Lung* ; Neck ; Pericardial Effusion* ; Pericardiocentesis ; Shock ; Tachycardia ; Tachypnea ; Thorax ; Ultrasonography ; Uremia ; Veins

OBJECTIVE: To analyze the contrast-enhancement patterns obtained at pulseinversion harmonic imaging (PIHI) of focal hepatic lesions, and to thus determine tumor vascularity and the acoustic emission effect. MATERIALS AND METHODS: We reviewed pulse-inversion images in 90 consecutive patients with focal hepatic lesions, namely hepatocellular carcinoma (HCC) (n=43), metastases (n=30), and hemangioma (n=17). Vascular and delayed phase images were obtained immediately and five minutes following the injection of a microbubble contrast agent. Tumoral vascularity at vascular phase imaging and the acoustic emission effect at delayed phase imaging were each classified as one of four patterns. RESULTS: Vascular phase images depicted internal vessels in 93% of HCCs, marginal vessels in 83% of metastases, and peripheral nodular enhancement in 71% of hemangiomas. Delayed phase images showed inhomogeneous enhancement in 86% of HCCs; hypoechoic, decreased enhancement in 93% of metastases; and hypoechoic and reversed echogenicity in 65% of hemangiomas. Vascular and delayed phase enhancement patterns were associated with a specificity of 91% or greater, and 92% or greater, respectively, and with positive predictive values of 71% or greater, and 85% or greater, respectively. CONCLUSION: Contrast-enhancement patterns depicting tumoral vascularity and the acoustic emission effect at PIHI can help differentiate focal hepatic lesions.
Adult ; Aged ; Carcinoma, Hepatocellular/blood supply/*ultrasonography ; Colon/pathology ; Contrast Media/*administration & dosage ; Diagnosis, Differential ; Female ; Hemangioma/blood supply/*ultrasonography ; Human ; Image Enhancement/*methods ; Liver/pathology/ultrasonography ; Liver Neoplasms/blood supply/secondary/*ultrasonography ; Lung/pathology ; Male ; *Microbubbles ; Middle Aged ; Pancreas/pathology ; Polysaccharides/administration & dosage/diagnostic use ; Reproducibility of Results ; Retrospective Studies ; Sensitivity and Specificity ; Stomach/pathology ; Support, Non-U.S. Gov't

There are no accurate data on the relationship between nodal station and diagnostic performance of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). We evaluated the impact of nodal station and size on the diagnostic performance of EBUS-TBNA in patients with non-small cell lung cancer (NSCLC). Consecutive patients who underwent EBUS-TBNA of mediastinal or hilar lymph nodes for staging or diagnosis of NSCLC were included in this retrospective study. Between May 2009 and February 2010, EBUS-TBNA was performed in 373 mediastinal and hilar lymph nodes in 151 patients. The overall diagnostic sensitivity, specificity, accuracy and negative predictive value (NPV) of EBUS-TBNA were 91.6%, 98.6%, 93.8%, and 84.3%, respectively. NPV of the left side nodal group was significantly lower than those of the other groups (P = 0.047) and sensitivity of the left side nodal group tended to decrease (P = 0.096) compared with those of the other groups. Diagnostic sensitivity and NPV of 4L lymph node were 83.3% and 66.7%, respectively. However, diagnostic performances of EBUS-TBNA did not differ according to nodal size. Bronchoscopists should consider the impact of nodal stations on diagnostic performances of EBUS-TBNA.
Adult ; Aged ; Aged, 80 and over ; Biopsy, Needle ; Bronchoscopy ; Carcinoma, Non-Small-Cell Lung/*diagnosis/pathology/ultrasonography ; Endosonography ; Female ; Humans ; Lung Neoplasms/*diagnosis/pathology/ultrasonography ; Lymph Nodes/pathology ; Lymphatic Metastasis ; Male ; Mediastinum/pathology ; Middle Aged ; Neoplasm Staging ; Positron-Emission Tomography and Computed Tomography ; Predictive Value of Tests ; Retrospective Studies ; Sensitivity and Specificity

Fever of unknown origin (FUO) is caused by infections (30-40%), neoplasms (20-30%), collagen vascular diseases (10-20%), and numerous miscellaneous diseases (15-20%). The literatures also reveal that 5-15% of FUO cases defy diagnosis, despite extensive studies. Diagnostic advances continuously modify the spectrum of FUO-causing diseases. Modern imaging techniques (e.g., ultrasound, CT scan, MRI) enable early detection of abscesses and solid tumors that used to be difficult to diagnose. But the correct diagnosis can be delayed because the tumor, such as rare hematologic malignancy, is difficult to be detected by various imaging studies. Intravascular lymphomatosis (IVL) is a rare form of non-Hodgkin's lymphoma and generally fatal disease characterized by extensive proliferation of neoplastic mononuclear cells within the lumina of blood vessels. The prognosis is usually extremely poor, with rapid death despite chemotherapy. The diagnosis is most frequently made after biopsy of skin or brain but is often established post mortem. Most patients with IVL present with FUO and nonspecific cutaneous and neurologic manifestations. Peripheral nerve system or pulmonary involvements are not common as initial menifestations. We report a case of intravascular lymphomatosis, presenting as FUO with peripheral polyneuropathy. We made early diagnosis of IVL by video-assisted thoracoscopic lung biopsy. She is improving with good performance after the 4th cycle of chemotherapy till now.
Abscess ; Biopsy ; Blood Vessels ; Brain ; Collagen ; Diagnosis ; Drug Therapy ; Early Diagnosis ; Fever of Unknown Origin* ; Fever* ; Hematologic Neoplasms ; Humans ; Lung ; Lymphoma ; Lymphoma, Non-Hodgkin ; Neurologic Manifestations ; Peripheral Nerves ; Polyneuropathies* ; Prognosis ; Skin ; Tomography, X-Ray Computed ; Ultrasonography ; Vascular Diseases