One of the limitations of fine-needle aspiration (FNA) of the thyroid is difficulty in distinguishing the follicular variant (FV) of papillary thyroid carcinomas (PTC) from follicular neoplasms. By highlighting the "Orphan Annie-eyed" clear nuclei of the former, the Ultrafast Papanicolaou stain (UFP) easily separates these two entities. One thousand one hundred thirty-five ultrasound-guided FNAs of the thyroid were assessed by UFP with immediate biopsy results reported to the patients in a busy radiology office in Manhattan from November 1994 to December 1998. Of the 77 thyroid cancers resected, 22 were FVPTC and 17 were microcarcinomas (1 medullary carcinoma, 16 PTC). The rates of "unsatisfactory," "cancer," "suspicious for cancer," "follicular neoplasm," and "benign" cytology were 0.7%, 4.4%, 2.6%, 10.2%, and 82.1%, respectively and the cancer yields at surgery were 98%, 81.8%, 15.8%, and 0% respectively. Of the 1127 satisfactory FNAs in the series with a 2- to -6 years of clinical follow-up, a false-negative rate of 0% and a false-positive rate of 1.5% were obtained. Of the 169 surgical follow-ups with satisfactory FNAs, a sensitivity of 100%, specificity of 66.7%, positive predictive value of 87.4%, negative predictive value of 100%, and global accuracy of 89.9% were achieved. The paradoxical combination of low unsatisfactory rate and low false-negative rate is attributed to (1) the use of needle puncture without syringe to obtain enough microfollicles from the exceedingly bloody aspirates from follicular neoplasms for a diagnosis, (2) eliciting history of neck trauma to confirm hematomas, (3) using UFP to highlight the grape-like watery clear nuclei of FVPTC evident with a 4x objective, and (4) the precise guidance by ultrasound in sampling microcarcinomas.

Fifteen patients with simultaneous presentation of meningiomas with other intracranial tumours are reviewed. The associated tumours included a brain metastasis in six cases, glioma in three, pituitary adenoma in two, craniopharyngioma in one,acoustic schwannoma in two and brain lymphoma in one. A correct preoperative radiological diagnosis was made in 12 patients; in three others the associated tumour was discovered at operation and by histological studies. A one-stage removal of both tumours through the same approach was performed in nine patients, whereas six others underwent two-stage operations with an interval of 1 - 13 months. The literature relating to meningiomas associated with other intracranial tumours is reviewed and the possible pathogenetic correlations are discussed. A diagnostic pitfall may occur for metastasis into a meningioma, glioma surrounding a meningioma and different suprasellar lesions. The surgical indication and management of meningiomas may be significantly influenced by the presence of another different intracranial tumour.

BACKGROUND As the consequence of the decreasing incidence of follicular thyroid carcinoma (FC), one wonders whether cytopathologists should stop reporting follicular neoplasms in fine‐needle aspiration (FNA) of the thyroid to minimize unnecessary thyroidectomies, if the follicular variant of papillary carcinoma (FVPC) has been excluded. METHODS Over a 6‐year‐period, 2667 ultrasound‐guided FNAs of the thyroid were performed at our practice. A total of 246 nodules (9.2%) were reported as follicular neoplasms, using abundant blood as the diagnostic clue. All FNA specimens were prepared and reported by one cytopathologist and the final pathology was reported by surgical pathologists in various hospitals in New York City. RESULTS The histologic follow‐up was available for 147 cases and showed 5 cases of widely invasive FC (3.4%), 10 cases of minimally invasive FC (6.8%), 8 cases of FVPC (5.4%), 92 cases of follicular adenoma (62.6%), and 32 cases of nonneoplastic nodules (21.8%). CONCLUSIONS FVPC cannot be excluded completely from follicular neoplasms by FNA because of the patchy distribution of papillary carcinoma nuclei in the encapsulated variant. Widely invasive FC still exists and may cause considerable morbidity in patients as young as the third decade of life. It is the opinion of the authors that cytopathologists should continue reporting follicular neoplasms in FNA of the thyroid. Cancer (Cancer Cytopathol) 2003;99:69–74. © 2003 American Cancer Society.

Objective Severe inflammation and astrocyte loss with profound demyelination in spinal cord and optic nerves are typical pathological features of neuromyelitis optica (NMO). A diagnostic hallmark of this disease is the presence of serum autoantibodies against the water channel aquaporin‐4 (AQP‐4) on astrocytes. Methods We induced acute T‐cell–mediated experimental autoimmune encephalomyelitis in Lewis rats and confronted the animals with an additional application of immunoglobulins from AQP‐4 antibody–positive and –negative NMO patients, multiple sclerosis patients, and control subjects. Results The immunoglobulins from AQP‐4 antibody–positive NMO patients are pathogenic. When they reach serum titers in experimental animals comparable with those seen in NMO patients, they augment clinical disease and induce lesions in the central nervous system that are similar in structure and distribution to those seen in NMO patients, consisting of AQP‐4 and astrocyte loss, granulocytic infiltrates, T cells and activated macrophages/microglia cells, and an extensive immunoglobulin and complement deposition on astrocyte processes of the perivascular and superficial glia limitans. AQP‐4 antibody containing NMO immunoglobulin injected into naïve rats, young rats with leaky blood–brain barrier, or after transfer of a nonencephalitogenic T‐cell line did not induce disease or neuropathological alterations in the central nervous system. Absorption of NMO immunoglobulins with AQP‐4–transfected cells, but not with mock‐transfected control cells, reduced the AQP‐4 antibody titers and was associated with a reduction of astrocyte pathology after transfer. Interpretation Human anti–AQP‐4 antibodies are not only important in the diagnosis of NMO but also augment disease and induce NMO‐like lesions in animals with T‐cell–mediated brain inflammation. Ann Neurol 2009;66:630–643

This study audits the reliability of ultrasound-guided fine needle aspiration (FNA) in excluding papillary thyroid carcinoma (PTC) in thyroid cysts containing mural nodules, and investigates the histological counterpart of cystic PTC diagnosed on FNA. Using a 10-5 MHz ultrasound probe and a 27-gauge needle, solid portions of thyroid nodules were sampled and assessed immediately using both Diff-Quik and Ultrafast Papanicolaou stains. Unlike usual PTCs that demonstrate hypercellularity, the aspirates of cystic PTC showed low cellularity and consisted of papillae with atypical nuclei scattered in abundant thin colloid. Over a period of 13 years, histological follow-up was obtained from 11 women and 6 men in whom cystic PTC was reported on FNA. This represented 4.4% of 383 cases of PTC reported and 0.25% of all thyroid FNAs performed. In all 17 cases, histopathology showed encapsulated PTC in various stages of cystic degeneration. Sonography correlated well with histopathology, where findings ranged from cysts with small mural nodules to solid nodules with pockets of thin colloid. In 87 patients with thyroid cysts containing mural nodules, FNA findings were benign, as was clinical follow-up that ranged from 1 to 12 years. In conclusion, ultrasound-guided FNA, if performed in the manner described, can reliably distinguish cystic PTC from a benign cyst with a mural nodule. Cystic PTC on FNA in this series correlates to a subset of the encapsulated variant of PTC, an entity described in the 1988 WHO Histological Typing of Thyroid Tumours in the good prognostic category.