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Morphological changes in a hyperfunctioning thyroid adenoma after percutaneous ethanol injection: histological,
A Crescenzi1, E Papini, C M Pacella
1Histopatology Service, Ospedale Regina Apostolorum, Albano (RM), Rome, Italy.
Journal of Endocrinological Investigation
|June 1, 1996
Summary
Ultrasound-guided ethanol injection effectively treats autonomously functioning thyroid nodules (AFTN). Histological analysis reveals alcohol induces central necrosis and peripheral damage, leading to hyperthyroidism control.
Area of Science:
- Endocrinology
- Pathology
- Medical Imaging
Background:
- Ultrasound-guided percutaneous ethanol injection (PEI) is a recognized treatment for autonomously functioning thyroid nodules (AFTN).
- The precise tissue-level effects of alcohol injection on AFTN remain incompletely understood.
- Investigating the morphological and ultrastructural changes post-PEI is crucial for understanding treatment efficacy.
Observation:
- A surgically removed AFTN, treated successfully with PEI, was examined histologically.
- The nodule exhibited central coagulative necrosis, hemorrhage, and vascular thrombosis.
- Peripheral adenomatous tissue and surrounding thyroid parenchyma showed minimal inflammation or regressive changes.
Findings:
- Enzyme histochemistry confirmed the nodule's hyperfunctioning state and revealed reduced enzyme activity in viable peripheral tissue.
- Electron microscopy identified submicroscopic alterations in adenomatous cells adjacent to necrotic areas.
- These changes indicate both irreversible central damage and potentially reversible peripheral damage.
Implications:
- PEI achieves hyperthyroidism control through direct, irreversible central tissue damage (necrosis, infarction).
- Peripheral cellular changes, including reduced enzyme activity and ultrastructural alterations, may also contribute to treatment success.
- Understanding these lesion dynamics can refine PEI techniques and patient selection for AFTN management.