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Objective To assess outcomes of thyroid nodules analyzed with the AFIRMA gene expression classifier (GEC) and to perform a comprehensive literature review. Study Design Retrospective analysis of patients with thyroid nodules who underwent AFIRMA GEC testing at our institution. Settings A tertiary care academic institution. Subjects and Methods We collected clinical outcomes for 416 thyroid nodules that were analyzed with AFIRMA GEC between 2011 and 2015, including long-term follow-up through 2019. We performed a comprehensive literature review. Results The resection rate for nodules with “suspicious” GEC results was 85% with a positive predictive value of 37%. The resection rate for nodules with “benign” GEC results was 24% with a negative predictive value of 90%. The prevalence of thyroid malignancy in patients with thyroid nodules with indeterminate cytology at our institution during this timeframe was 41%, thus lowering our negative predictive value. Mean follow-up duration for unresected nodules was 27.8 months. Our resection rates for nodules with “benign” GEC were among the highest reported in the literature. Conclusions Molecular marker testing of thyroid nodules with indeterminate cytology can aid in the surgical decision making by obviating the need for diagnostic surgery and/or guiding extent of resection. Patients with other indications for surgery may not benefit from such costly testing.

Background: Diseases involving thyroid gland are myriad-they span from functional to goiterous which again can be non-neoplastic or neoplastic. The pattern and prevalence of these disorders depend on various factors like age, sex, ethnicity and geographic location of residence. The aim of the present study was to determine the pattern of thyroid lesions in surgically resected thyroid specimens.Methods: This retrospective study was conducted at Department of Histopathology of Armed Forces Institute of Pathology (AFIP), Dhaka, Bangladesh. All thyroidectomy specimens received in the Department of Histopathology over the period from 1 st January 2018 to 30 th June 2019 were included in the study. Data including age, sex and histopathological diagnosis were collected from the records and histopathology slides of all cases were reviewed to verify diagnosis. Data were then analyzed by standard statistical methods. Results:A total of 377 specimens were collected, 301 specimens were from females and 76 from males (female to male ratio 4.01:1). The age ranged from 13 years to 82 years (mean 38.44±12.89 years). Nodular goiter (274, 72.62%) was the commonest thyroid lesion; other benign lesions included follicular adenoma (18) and Hashimoto thyroiditis (17). Overall malignancy was 18.03% (68). Papillary carcinoma (61, 89.70%) constituted majority of the malignant neoplasms. Other malignant neoplasms included follicular carcinoma (3 cases including 1 case of Hurthle cell carcinoma), anaplastic carcinoma (2) and medullary carcinoma and non-Hodgkin lymphoma 1 each. Conclusion:Our study revealed that the prevalent form of thyroid diseases is nodular goiter that mostly affects females. Papillary carcinoma is the commonest malignancy of thyroid gland which also predominantly affects females.

Background: Fine needle aspiration cytology (FNAC) is now a days the initial investigation in most cases of superficial lymphadenopathy. In clinical practice both clinicians and cytopathologists are not commonly suspecting of Toxoplasma lymphadenitis (TL), though it may constitute a significant proportion of unexplained lymphadenitis. Careful cognizance of cytological findings can give valuable clue to the diagnosis of toxoplasmosis which can be confirmed by serological evidence.Methods: This cross-sectional study was conducted in Department of Histopathology of Armed Forces Institute of Pathology (AFIP), Bangladesh from 01 July 2017 to 31 March 2018. FNAC smears of the patients with lymphadenopathy who reported for FNAC were examined and suspicion of toxoplasmosis was made on coexistence of abundance of ‘tingible body macrophages’ (TBM) and follicular center cells (FCC), small collections of epithelioid histiocytes and absence of necrosis and/or more than occasional giant cells. Serum enzyme linked immunosorbent sorbent assay (ELISA) for Toxoplasma IgM and IgG antibody was then performed in all cases that deemed suspicious for toxoplasmosis for confirmation of the diagnosis.Results: Total 925 patients were examined by FNAC of lymph node. Among them 574 were categorized as reactive hyperplasia (RH). Thirty two patients (5.74%) of RH were suspected as TL and included in the study. Serum ELISA confirmed toxoplasmosis in 22 (68.75%, twelve male and ten female) of these 32 cases. One among the positive cases revealed bradyzoites of Toxoplasma in the smear. The age of the patients diagnosed finally as TL spanned between 5 to 47 years (mean 28.59±11.51 years) though most frequent age group was 26 Yr to 35 Yr (7 cases- 31.8%).Conclusion: A high index of suspicion of TL can be made on careful study of smears of FNAC of enlarged lymph node, diagnosis of which can then be confirmed by ELISA.Birdem Med J 2018; 8(2): 103-107

Introduction: Lymphadenitis is the most common extrapulmonary manifestation of tuberculosis. It remains both diagnostic and therapeutic challenge as not only mimics other diseases but also inconsistent physical and laboratory findings. Diagnosis is difficult often requiring biopsy. Aim: Aim of the study was to evaluate the role of surgical dissection of tuberculous cervicle lymphadenopathy for diagnosis as well as therapeutic purpose. Methods: This observational study was conducted during the time period of 01 july 2015 to 30 june 2017 in ENT & Pulmonology department, combined military hospital Dhaka on 100 patients who have undergone surgical neck dissection. Result: In our study total 100 patients were biopsied. Among them 56 patient was diagnosed as tubercular lymphadenitis after lymphnode excision biopsy. Among them 47 tubercular lymphadenitis patient responded to ATT (CAT-1), only 2 patient developed cold abscess which required further surgery. Six patient showed relapse during follow-up and 9 patient did not respond to CAT-1 treatment (treatment failure). Surgical intervention along with CAT-2 treatment showed cure in all of them. 2nd surgical interventions were done in total 17 patients, 2 TB abscess during ATT (CAT-1 HRZE), 9 treatment failure patients and 6 relapse patients along with ATT (CAT-2 SHRZE) and all these patients had no relapse or treatment failure during further follow up. Bangladesh J Otorhinolaryngol; October 2017; 23(2): 127-132