BACKGROUND: In hepatology, the clinical use of endoscopic ultrasound (EUS) has experienced a notable increase in recent times. These applications range from the diagnosis to the treatment of various liver diseases. Therefore, this systematic review summarizes the evidence for the diagnostic and therapeutic roles of EUS in liver diseases.
OBJECTIVE: To examine and summarize the current available evidence of the possible roles of the EUS in making a suitable diagnosis in liver diseases as well as the therapeutic accuracy and efficacy.
METHODS: PubMed, Medline, Cochrane Library, Web of Science, and Google Scholar databases were extensively searched until October 2023. The methodological quality of the eligible articles was assessed using the Newcastle-Ottawa scale or Cochrane Risk of Bias tool. In addition, statistical analyses were performed using the Comprehensive Meta-Analysis software.
RESULTS: Overall, 45 articles on EUS were included (28 on diagnostic role and 17 on therapeutic role). Pooled analysis demonstrated that EUS diagnostic tests had an accuracy of 92.4% for focal liver lesions (FLL) and 96.6% for parenchymal liver diseases. EUS-guided liver biopsies with either fine needle aspiration or fine needle biopsy had low complication rates when sampling FLL and parenchymal liver diseases (3.1% and 8.7%, respectively). Analysis of data from four studies showed that EUS-guided liver abscess had high clinical (90.7%) and technical success (90.7%) without significant complications. Similarly, EUS-guided interventions for the treatment of gastric varices (GV) have high technical success (98%) and GV obliteration rate (84%) with few complications (15%) and rebleeding events (17%).
CONCLUSIONS: EUS in liver diseases is a promising technique with the potential to be considered a first-line therapeutic and diagnostic option in selected cases.

This study presents two cases of lipid-rich pancreatic neuroendocrine tumors (PanNETs), a rare variant posing significant diagnostic challenges in fine needle aspiration (FNA) cytology and small biopsies. The first case involves an elderly male with a pancreatic tumor, displaying distinct cytoplasmic vacuoles, while the second case is a middle-aged male present with a pancreatic tail mass exhibiting foamy cytoplasm and eccentric nuclei, infiltrating in the stroma. Both cases did not exhibit typical morphologic features of PanNET but demonstrated cytomorphologic features and infiltrative growth patterns that mimicked adenocarcinoma. Further work-up demonstrated that both tumors were immunoreactive for synaptophysin and chromogranin, and were interpreted as well-differentiated, PanNET, lipid-rich variant. The study highlights the overlapping morphological features between lipid-rich PanNETs and other pancreatic neoplasms and underscores the importance of comprehensive cytological and immunohistochemical analysis for accurately diagnosing this variant, particularly due to the risk of misinterpreting it as pancreatic adenocarcinoma. Recognizing lipid-rich PanNETs is crucial for appropriate clinical management, as their identification can significantly impact treatment decisions and patient outcomes.

Pleomorphic adenomas (PA) are the most common type of salivary gland tumors. These slow-growing benign tumors most commonly involve the parotid gland, but can sometimes occur at atypical sites such as the submandibular or minor salivary glands. We describe an atypical case of pleomorphic adenoma with multicentric involvement of the parotid, the submandibular gland, and the parapharyngeal space in a 35-year-old male which mimicked a slow-flow malformation on magnetic resonance imaging (MRI). Diagnosis was confirmed on fine needle aspiration cytology, and conservative approach was opted for the patient in view of perioperative risks. This case highlights the uncommon multicentricity and atypical presentation of PA, challenging the initial differential diagnosis based on MRI features. It also underscores the importance of considering atypical presentations and utilizing accurate diagnostic tools like cytology for managing complex salivary gland tumors.

OBJECTIVE: Despite advancements in imaging techniques and cytological analysis, plunging ranula remains a challenging surgical, radiologic, and pathologic phenomenon. Of the 18 patients we evaluated at our institution, we highlight three cases that illustrate the high rate of misleading imaging and cytological results when assessing plunging ranula.
METHODS: Imaging results, biopsy findings, operative techniques, and pathological reports were reviewed from patients who had either a preoperative or postoperative diagnosis of ranula and underwent surgery by a single head and neck surgeon at a tertiary care center.
RESULTS: Of the 18 identified patients, computed tomography was correct on preoperative imaging 73% of the time and magnetic resonance imaging was correct on preoperative imaging 71% of the time. Two patients underwent preoperative ultrasound and their ultrasound reports did not accurately diagnose the presence of a ranula. Two patients underwent preoperative fine needle aspiration biopsy due to inconclusive preoperative imaging, in which results suggested either a ranula or epidermal cyst. Both ultimately did not match the final pathology. Three of eighteen patients (17%) underwent an inappropriate initial surgery due to incorrect imaging diagnoses and/or biopsy findings.
CONCLUSIONS: Despite use of preoperative modalities to distinguish plunging ranula from other cystic floor of mouth lesions, surgeons must be aware that no workup modality is fully precise. The potential for revision surgery must be included in all preoperative discussions for presumed plunging ranula.
METHODS: 4 Laryngoscope, 134:2689-2696, 2024.

BACKGROUND: Sclerosing Mucoepidermoid Carcinoma with Eosinophilia (SMECE) of the thyroid is an extremely rare tumor that exhibits unique histologic characteristics and is nearly always associated with lymphocytic thyroiditis (LT). However, the cytomorphologic and clinicopathologic characteristics of SMECE have only been described in rare case reports.
METHODS: Authors\' institution laboratory information systems were searched for records of SMECE between 2012 and 2023. Literature review was performed using keywords \"Sclerosing mucoepidermoid carcinoma with eosinophilia\", \"thyroid\", and \"cytopathology\" to search through institution electronic library databases for relevant articles.
RESULTS: A total of 19 cases were identified, 3 unpublished in the authors\' archives and 16 in the literature which had fine needle aspiration (FNA) material or cytologic features available for review, and were comprised of 3 males and 16 females. The common cytomorphologic characteristics of SMECE included fragments or loose clusters of intermediate-type epidermoid cells in a background of prominent LT and eosinophils. Overt keratinization, mucinous cells, and extracellular mucin were not commonly encountered, resulting in diagnostic challenges, especially if eosinophils associated with epithelial cell clusters were rare. The cases were reported as \"Nondiagnostic\" (1 case), \"Atypia of Undetermined Significance\" (4 cases), \"Suspicious for Malignancy\" (3 case), or \"Malignant\" (11 cases).
CONCLUSIONS: The clinical course of SMECE of the thyroid varied and distinct cytomorphologic characteristics in a subset of patients who experienced aggressive disease raises the possibility of different prognostic grades. Cases with keratinized squamous cells and necrosis mimic anaplastic (undifferentiated) thyroid carcinoma, but the clinical history and radiologic findings can be helpful to exclude this diagnosis.

Metastatic thyroid cancer is rare. Here, the case of a patient with colon cancer that metastasized to the thyroid is described. The patient underwent radical rectal cancer surgery in August 2017 and received six cycles of chemotherapy with oxaliplatin and capecitabine postoperatively. On August 4, 2018, the patient was admitted to the hospital due to the discovery of thyroid nodules on ultrasound and carcinoembryonic antigen levels within the normal range. The biopsy from the fine needle aspiration suggested a malignant tumor. The patient underwent radical thyroid cancer surgery. Using intraoperative rapid frozen pathology, medullary carcinoma was diagnosed. Using postoperative routine pathology combined with immunohistochemistry results, thyroid metastasis from colorectal adenocarcinoma was diagnosed. After surgery, the patient regularly visited the outpatient clinic for chemotherapy with capecitabine. As of May 2023, the patient is still alive with no recurrence.

BACKGROUND: Mesenchymal tumors of the thyroid gland are extremely rare. We report the cytomorphologic characteristics of 12 mesenchymal tumors occurring in the thyroid gland and highlight the diagnostic difficulties encountered in their cytologic evaluation.
METHODS: The cytopathology and surgical pathology archives from 5 large institutions were searched for thyroid mesenchymal tumors that had an FNA available for review. Clinicopathologic and cytomorphologic characteristics for each case were evaluated.
RESULTS: Twelve cases of mesenchymal tumors occurring in the thyroid were identified in our search. Patient age ranged from 28 to 84 years (median, 60 years). The cases occurred in 7 women and 5 men. The tumor size ranged from 1.4 to 14 cm (median, 3.3 cm). The tumors were as follows: hemangioma (n = 4; 33.3%), angiosarcoma (n = 2; 16.7%), schwannoma (n = 2; 16.7%), solitary fibrous tumor (n = 2, 16.7%), metastatic synovial sarcoma (n = 1, 8.3%) and metastatic pleomorphic rhabdomyosarcoma (n = 1, 8.3%). The cytomorphologic features of the tumors were similar to those of their counterparts occurring in different sites. An accurate diagnosis was achieved in six primary thyroid mesenchymal cases (60%). Five patients (41.7%) underwent total thyroidectomy, and 3 patients received partial thyroidectomy (25%). Three patients (25%) did not receive a thyroidectomy and subsequent surgical information was not available in 1 case (8.3%).
CONCLUSIONS: Mesenchymal tumors of the thyroid are extremely uncommon. Cytologic diagnosis of these tumors is often challenging due to the morphologic overlap with diverse epithelial and non-epithelial thyroid lesions. Ancillary studies such as immunohistochemistry and molecular studies are essential for accurate diagnosis.

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BACKGROUND: Primary thyroid lymphoma (PTL) is a rare cancer accounting for approximately 5% of thyroid malignancies. Historically, incisional biopsy has been the gold standard for definitive diagnosis of PTL, however, the use of cell block as an adjunct to fine needle aspiration (FNA) provides a high sensitivity and specificity for diagnosis and classification.
METHODS: Three patients presented with a symptomatic enlarging thyroid mass. Patient 1 underwent incisional biopsy under general anesthesia, Patient 2 underwent core needle biopsy to avoid high risk intubation, and Patient 3 underwent fine needle aspiration alone with the use of cell block.
RESULTS: All patients were diagnosed with a fully classified non-Hodgkin\'s lymphoma using immunohistochemistry, flow cytometry, and fluorescence in situ hybridization (FISH) analysis.
CONCLUSIONS: FNA for diagnosis of some subtypes of PTL is feasible and preferred in cases that are particularly high risk for general anesthesia. This minimally invasive technique is safe and cost effective as it avoids expenses associated with operative intervention.

Although actinomycosis is frequently seen in the cervicofacial region, it is very rare in the parotid gland. Furthermore, it can be confused with salivary gland malignancies in imaging. The most important underlying causes are cervicofacial trauma, tooth extraction history and poor oral hygiene. A 43-year-old male patient was admitted to otorhinolaryngology department with a complaint of progressive swelling on his cheek. The histopathological examination of fine-needle aspiration (FNA) biopsy showed acute suppurative polymorphous leukocytes and actinomycese hyphae balls within histiocytes. The patient was started on amoxicillin 2 gm per day for two months. With antibiotherapy, the swelling in the patient\'s parotid gland decreased and completely healed at the end of six months. Primary parotid actinomycosis has been rarely reported in the literature, differential diagnosis is usually problematic as both clinical and radiological findings may mimic parotid tumour; however, it can be useful to apply FNA cytology for a quick diagnosis and treatment.