[Maitray D. Patel]

Really enjoying all the topics

[Maitray D. Patel]

Wow—never seen this before.  I have seen multiple intratesticular cysts, but often clustered at the mediastinum.  I could not review the mp4 you uploaded on my phone (and don’t have access to my computer right now to see if this is related to viewing on my phone as I’m traveling) but it seems like these cysts are scattered diffusely.

[Maitray D. Patel]

I don’t know of anything more recent, but those guidelines and recommendations are spot on in my opinion.  I particularly endorse the idea that not ALL polyps need intervention, particularly when small and asymptomatic.

The only proviso I would add is to really consider recommending consideration of reevaluation of the endometrium AFTER progestin administration for the asymptomatic perimenopausal woman or asymptomatic early postmenopausal woman (< 10 yrs from FMP) who has incidental endometrial thickness at or over 10 mm rather than simply recommending gynecologic consultation.  These woman are often being sent or seen by their primary care physician who may not be a gynecologist, and this simple maneuver will often result in resolution of the observation because it was related to unsloughed stimulated endometrium.  If the endometrium remains at/over 10 mm after the attempted medical curettage using progestin, then GYN consultation would be useful–but if it resolves, then GYN consultation isn’t really needed.

[Maitray D. Patel]

Attaching a print out of the past evolution of the Forum within the website.

 

 

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[Maitray D. Patel]

I can’t say that I see these daily, and we do a lot of thyroid studies.  In my experience, we see these occasionally. It seems like everyone agrees that these should be ignored as “normal”.  It’s hard to argue with PTH confirmation that the authors of the paper indicate. Having said that, it seems reasonable that SOME of these are normal parathyroid glands and OTHERS are not (but not pathologic).

Jill, you say that they “usually” don’t come back as parathyroid, but it must be difficult if not impossible to know if what your ENT surgeons have taken out are actually the observation made on ultrasound given the small size.  Not that it matters, I think, but it might be interesting to get the take of your parathyroid conference colleagues, so do share when you get some feedback.

[Maitray D. Patel]

thanks David, this is really helpful information IMO…the paper has FNA washout confirmation that the observation was parathyroid, so looks legit to me…I love having this as a label for these occasional echogenic observations

[Maitray D. Patel]

Hi Cheryl–great question. In my current practice, I no longer see these patients, so I’ll be interested in the replies of any of our colleagues with OB experience/expertise.  I will reach out to some to get their opinions!

[Maitray D. Patel]

I’m not sure I would always ascribe the observation to some pathologic cause. I think it can just be a normal variant of sorts. It’s clearly associated with spermatoceles (that’s been published) and we don’t think of spermatoceles being “caused” by anything (at least I don’t).

• This reply was modified 1 year, 3 months ago by Maitray D. Patel.

[Maitray D. Patel]

Does it matter? 

[Maitray D. Patel]

This was an esophageal diverticulum–no biopsy!

[Maitray D. Patel]

Additional maneuver we did

click to show video

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