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  • Title: [Ultrasonography, with Doppler color, and cytologic correlations in Plummer's disease].
    Author: Gimondo P, Pizzi C, Gimondo S, Messina G.
    Journal: Radiol Med; 1998 Mar; 95(3):193-8. PubMed ID: 9638165.
    Abstract:
    PURPOSE: We carried out a retrospective study to assess the different B-mode and color Doppler features of Plummer's disease and to compare them with cytologic findings. MATERIAL AND METHODS: One hundred and eighty autonomous nodules were studied with B-mode US. Mean patient age was 55 years for women and 56 years for men. Twenty-seven patients were also submitted to color Doppler US. Forty-nine autonomous nodules were also submitted to cytologic examination by fine needle aspiration (FNA). RESULTS: The most frequent US pattern was a hypoechoic solid nodular lesion (59.8%), while 45.6% of the nodules exhibited a mixed US pattern. No mixed areas were found in 100% of the nodules in the patients under 20 and over 60. In contrast, various degrees of mixed areas were found in the patients 20-59 years old, with the highest rate (24.9%) in the 40-49 age range and the lowest rate (6.2%) in the 20-29 age range. The mixed areas were most frequently correlated with bigger nodules and the toxic phase. Calcifications were found in 4.3% of the partially autonomous nodules in 4.1% of the pretoxic nodules and in 8.6% of the toxic nodules. Color Doppler US showed rich internal and peripheral vascularization (pattern A) in 74.1% of the nodules and a mostly perilesional flow (pattern B) in 25.9% of the cases. Pattern A prevailed in the toxic phase (75%), while pattern B in the partially autonomous nodules (85.7%). Simple hyperplasia was the most frequent (63.3%) cytologic feature in the solid nodular lesions, while bleeding (10.2%) was typical of the mixed anechoic nodular lesions. Cytologically undifferentiated lesions were found in the toxic phase of Plummer's disease (50%). DISCUSSION: Solid lesions in Plummer's disease are characterized by hyperplasia, while the diagnosis of hemorrhagic pseudocyst is typical of mixed lesions. CONCLUSIONS: Color Doppler US provides data on the functional phase of Plummer's disease and is a very useful tool to monitor medical treatment results; moreover, it permits to characterize the lesions with the richest vascularization, avoiding inadequate cytologic sampling.
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