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Differential Diagnosis In Internal Medicine : F...


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Differential Diagnosis In Internal Medicine : F...


The differential diagnosis of fever is large as it can occur in many diseases but its occurrence with other symptoms including chills, sweating, cough or sore throats can help narrow down the differential, and the majority of the time its cause is due to everyday diseases, including Influenza or Pharyngitis, which can be treated with self-care for a few days with a follow up to see if symptoms improve. If symptoms continue to worsen or other symptoms like stiff neck, photophobia or abdominal pain develop then immediate medical help should be sought.


In a retrospective cohort study, data from patients referred to the Behçet clinic of the Rheumatology Research Center (RRC) at Tehran University of Medical Sciences were reviewed from November 2018 to August 2019. RRC is the only national referral center for BD and is the national authority on guidelines for prevention, diagnosis, and treatment of Behçet disease. A remarkably high percentage of patients suspected for the diagnosis are referred to RRC from all over the country, and as such, would provide a nationally representative sample of patients suspected for, and diagnosed with BD. Inclusion criteria included first-time referral from doctors of medicine, and complete follow-up records, at least until the diagnosis was proved or ruled out. Patients with a known diagnosis of BD, and those with incomplete records or follow-ups, were excluded.


Rheumatology was the most common specialty of the referring physicians (91 patients, 38.2%), followed by internal medicine (63 patients, 26.5%) and ophthalmology (26 patients, 10.9%). Referring physicians were most commonly practicing in a non-academic center (87 physicians, 36%).


Atypical parathyroid adenomas represent a group of intermediate form of parathyroid neoplasms of uncertain malignant potential which show some atypical histological features that represent a challenge for the differential diagnosis with parathyroid carcinomas. They may occur as sporadic or as a part of hereditary syndromes. The molecular signature of these neoplasms is still unknown and the germline CDC73 mutations appears to be the most common anomaly in this setting suggesting that these cases might represent variants of the hyperparathyroidism-jaw tumor syndrome. The identification of markers predicting the outcome is of great importance to guide an adequate postoperative monitoring and, the same time, relieve of the anxiety of relatively strict monitoring patients not at risk. This review will summarize the current knowledge of the clinical, biochemical, molecular and histological profile of atypical parathyroid adenomas.


Atypical parathyroid adenomas represent a group of intermediate form of parathyroid neoplasms of uncertain malignant potential which show some atypical histological features (i.e. solid growth pattern, fibrous bands and cellular atypia), which represent a challenge for the differential diagnosis with parathyroid carcinomas. In this regard, it should be reminded that, at variance with parathyroid carcinoma, atypical parathyroid adenoma lacks evident signs of local invasion and/or metastasis. In some cases, the initial diagnosis of atypical adenoma needs to be revised to carcinoma because of the occurrence of local or distant metastasis during the follow-up (Sandelin et al. 1994). The reverse, even less frequently, may also occur when the initial diagnosis of parathyroid carcinoma is not confirmed by an expert endocrine pathologist (Ippolito et al. 2007, Cetani et al. 2008, Kumari et al. 2016, Ryhänen et al. 2017). Finally, there are cases in which the differential diagnosis between atypical parathyroid adenoma and carcinoma may be a major challenge also for an experienced pathologist. The macroscopic appearance at surgery is of limited help since in both cases the parathyroid lesions may appear firm and adherent to the adjacent structures, features that in the suspicion for malignancy m




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