Visible Pancreatic Neuroendocrine Tumor after Water Intake and Position Change

Most pancreatic neuroendocrine tumors (NETs) are detected incidentally and arise in the endocrine tissues. NETs can secrete hormones and result in clinical syndromes. However, between 50 and 75 percent of pancreatic NETs are nonfunctioning. Ultrasonography shows a well-circumscribed mass with a smooth margin and round or oval hypoechoic shape. A 38-year-old woman visited our hospital with mild upper abdominal discomfort. We visualized an oval hypoechoic mass with inner hyperechogenicity after water intake in the stomach and position change. The patient underwent surgery, and the mass was diagnosed as pancreatic NET.

Graves’ Disease Following Subacute Thyroiditis

Subacute thyroiditis is an inflammatory thyroid disease caused by viral infection. Graves’ disease is an autoimmune thyroid disease caused by thyrotropin (TSH) receptor antibody (TRAb). Graves’ disease following subacute thyroiditis is rare, and only a few cases have been reported. A 58-year-old woman presented with anterior neck pain and swallowing difficulty. Laboratory tests showed elevated FT4, low TSH, normal TRAb, and elevated erythrocyte sedimentation rate. Thyroid ultrasonography (US) revealed focal, ill-defined hypoechoic areas in both thyroid lobes. The patient was treated with corticosteroid, and symptoms subsided after 1 month. Three months later, she complained of tremor and palpitation. Thyroid function testing showed hyperthyroidism with the positive conversion of TRAb, indicating Graves’ disease. Doppler US showed increased vascular flow in both thyroid lobes. She started treatment for hyperthyroidism with methimazole.

Clinical Application of Automated Breast Ultrasound

Automatic breast ultrasound (ABUS) has been developed to compensate for the shortcomings of hand-held ultrasound (HHUS) and is mainly used for breast cancer screening purposes in women with dense breasts. Since 2021, ABUS has been covered by the Korean National Health Insurance System. It is important to scan the entire breast on ABUS and to identify the poor-quality images requiring re-scanning. In addition, a general understanding of the unique ABUS display mode, distinguishing benign from malignant lesions, the diagnostic performance of breast cancer screening, and the application of computer-aided detection/diagnosis systems is necessary to use ABUS efficiently. This review explores the acquisition method, image quality, and image characteristics of ABUS to improve general understanding of this procedure and its advantages over HHUS, so that ABUS can be applied efficiently in clinical practice.

Calcification and Expression of Bone Morphogenetic Protein-4 in Papillary Thyroid Carcinoma

Background/Aim: The purpose of this study was to investigate whether bone morphogenetic protein (BMP)-4 expression differs according to the presence of calcification in papillary thyroid carcinoma and to investigate if calcification and BMP-4 expression are associated with metastasis of papillary carcinoma.Methods: We performed the study using paraffin-embedded tissues of 55 patients who underwent thyroidectomy in Kosin University Gospel Hospital. Of those 55 cases, 36 were papillary thyroid carcinomas, and 19 were benign tumors. Immunohistochemical staining with BMP4 antibody was performed on the paraffin-embedded tissues.Results: Among the 36 papillary thyroid carcinomas, 20 (55.6%) of extrathyroidal invasion and 21 (58.3%) of lymph node metastasis were observed. The presence of calcification was significantly different according to incidence of extranodal invasion (p = 0.02), lymphovascular invasion (p < 0.001), and lymph node metastasis (p = 0.04). BMP-4 expression was weakly positive in benign tumors and strongly positive in papillary thyroid carcinoma (p < 0.001). BMP-4 expression was significantly different by TNM stage (p < 0.001).Conclusion: In the present study, the presence of calcification in thyroid papillary carcinoma was associated with tumor metastasis. BMP-4 was strongly expressed in papillary thyroid carcinoma and was associated with the stage of papillary thyroid carcinoma.

Metastatic Clear Cell Renal Carcinoma with Benign Ultrasonographic Findings in the Thyroid Gland

Metastasis to the thyroid gland is rare, and the incidence of thyroid metastasis is from 1.4% to 3% for all thyroid malignancies. The most common metastatic malignancy to the thyroid gland is renal cell carcinoma. Ultrasonography is useful to assess the malignancy risk of thyroid nodules, and the ultrasonographic features of metastatic renal cell carcinoma in the thyroid gland are hypoechoic solid nodules with increased vascularity. Here, we report a case of metastatic clear cell renal carcinoma with benign ultrasonographic features and fine-needle aspiration cytology in the thyroid gland. A 76-year-old woman visited our hospital for surgical management of a growing left thyroid mass. Her history comprised previous left nephrectomy for an unknown reason. Thyroid ultrasonography revealed a well-defined, isoechoic, solid mass. Left thyroidectomy was performed, and the final diagnosis was metastatic clear cell renal carcinoma of the thyroid gland.

Role of Vascular Ultrasonography in Patients with Leg Swelling

There are many causes of leg swelling or edema. Leg edema due to systemic condition or disease demonstrates chronic, bilateral features, whereas leg edema caused by vascular disease shows more complex clinical features including secondary skin changes and ulcerative lesion, resulting in more complicated clinical outcomes with less frequent early diagnosis and appropriate management. Definite differential diagnosis might not be possible by medical history, clinical features, and physical findings. Vascular ultrasonography (Duplex ultrasound) can be used easily as a bedside diagnostic procedure and is a recommended diagnostic tool for differentiation of a non-vascular from vascular etiology in patients with leg swelling.

Role of Endoscopic Ultrasonography in Differential Diagnosis of Pancreatic Cystic Lesions

Pancreatic cystic lesions (PCLs) are being identified increasingly because of recent advancements in abdominal imaging technologies, presenting a number of challenges in clinical practice. Although most PCLs are benign, some carry a significant risk of malignant degeneration. Accurate diagnosis of PCLs is important for proper management and follow-up. Endoscopic ultrasound (EUS) is useful for the characterization of PCLs with high sensitivity and accuracy. Additional information can be obtained using EUS for indeterminate lesions on computed tomography or magnetic resonance imaging. In this review, we introduce the relevant EUS findings for the diagnosis of relatively common PCLs.