Incidental findings

Clinically significant pituitary disease is rare, although small functionless pituitary adenomas are commonly seen as incidental findings at autopsy or on magnetic resonance brain scans. The main issues for clinical pharmacology concern replacement therapy for hypopituitarism, and treatment of hormone-producing pituitary adenomas. 

Each treatment-related clinical sign should be described. Any frequently-noted signs that are not related to the test item (e.g., caused by the method of administration) should also be explained. There is no need, however, to detail each incidental finding (e.g., localized areas of hairloss). Diagnostic terms, e.g., jaundice, are best avoided. Medical terms should be defined the first time they are used in the text, e.g., " Paresis (weakness) of the limbs and ptosis (half-closed eyes) were observed starting one hour after dosing. 

There is no need to mention incidental findings in the summary that were not related to treatment with the test item. For a teratology study, however, it is customary to specify the incidence and types of all malformations found, along with an explanation of their relation to treatment (or not). 

Fig. 18.12. Circumscript filling defects within a dural sinus, a Incidental finding in contrast-enhanced CT. The bilateral well-defined filling defects in the lateral sinuses (arrows) most probably represent Pacchioni granulations, b Contrast-enhanced Tl-weighted image with incidentally demonstrated hypointense, round and circumscript structures within the lateral sinus (arrow). They most likely represent hypertrophic Pacchioni granulations and not thrombus, c In the T2-weighted images of the same patient the structures appear strongly hyperintense (arrow)...

Mitral leaflet prolapse is a common incidental finding. It can be complicated by gross mitral regurgitation, infective endocarditis, atrial fibrillation and left atrial thrombus and thus embolism to the brain. However, there is no excess risk of first or recurrent stroke in patients with uncomplicated mitral leaflet prolapse (Orencia et al. 1995a, b). 

Thrombophilias and other causes of hypercoagulability are rare causes of stroke (Matijevic and Wu 2006). Antithrombin III deficiency, protein C deficiency, activated protein C resistance owing to factor V Leiden mutation, protein S deficiency and plasminogen abnormality or deficiency can all cause peripheral and intracranial venous thrombosis. Thrombosis is usually recurrent and there is often a family history. Thrombophilia may cause arterial thrombosis, although the alternative diagnosis of paradoxical embolism should always be considered in patients with these disorders. It should be noted that deficiencies in any one of the factors associated with thrombophilia may be an incidental finding and cannot necessarily be assumed to be the cause of stroke. 

Benign hepatic focal lesions are usually detected as an incidental finding in sonography. As a rule, there are no subjective or characteristic complaints, no identified neoplastic disease and no objective clinical findings. 

Kayexalate (sodium polystjrene sulfonate) in sorbitol is commonly used to treat hjrperkalemia in patients with renal insufficiency. Case reports have documented intestinal necrosis after the administration of kayexalate in sorbitol (26,27). In one study, there was an incidence of 1.8%, and the authors concluded that sorbitol-associated complications may not be uncommon postoperatively (28). Furthermore, it has been suggested that some cases of idiopathic colonic ulcers in patients with renal failure are due to the effects of sorbitol. While kayexalate crystals, which are purple, irregular, and jagged, can be an incidental finding and are not known to cause injury, they are a helpful histological clue to the possibility that sorbitol has been administered (29). 

The classic symptoms of metabolic disturbance are rare in Type-II diabetes and more insidious than in Type-I. Hyperglycaemia, thirst, polyuria and fatigue are the classic symptoms, but weight loss is infrequent and diagnosis is often made after intercurrent infections or as an incidental finding (Table 2). 

Among all human cancers, DAs have the highest frequency of KRAS alterations, the oncogene being constitutively activated in approximately 90% of DAs. 07,136-139,141-145 However, it is important to point out that KRAS mutations are seen even in earliest forms of neoplastic transformation (namely PanIN-lA) they are a common incidental finding in pancreas, as well as in patients with chronic pancreatitis lacking invasive carcinoma thus they are by no means specific for cancer. Other oncogenes that are found to be activated in pancreatic cancer include AIBl, BRAF, c-MYC, and... 

Hemangioma is the most common primary hepatic tumor, usually an incidental finding at autopsy. Microscopically, most lesions are of cavernous type (see other chapters for details). 

Dysembryoplastic neuroepithelial tumor (DNT) may be the hamartomatous counterpart of a gangliogli-oma. It is multinodular within the cerebral cortex, most often in the temporal lobe cortex. Some DNTs are cystic (Fig. 20.35A). Some are incidental findings, but many others are associated with long-standing partial complex seizure disorders in children and young adults.i ... 

Pathological criteria for classifying thyroid cancer may show discrepancies in the differentiation between foUicu-lar adenoma and minimally invasive follicular carcinoma, and between follicular neoplasia and the folficular variant of papillary carcinoma (Lloyd et al., 2004 Saxen et ai, 1978). The inclusion of papillary microcarcinomas (1.0 cm or less in diameter), which are usually incidental findings or detected by the use of ultrasound-guided thyroid fine-needle aspiration cytology (Lin et al., 1997), the existence of radioactive fallout, which may lead to an increase of differentiated thyroid carcinoma and a rise in population age with time, should also be taken into account when analyzing the epidemiology of thyroid cancer. 

Histological autoimmune thyroiditis related to iodine intake are generally referred to in the literature as focal or Hashimotos in type, regardless of their clinical features as these are almost always an incidental finding in thyroidectomies or at autopsy. In this review, we will focus... 

Congenital anomalies of the pancreas are typically incidental findings. In few patients are these anomalies associated with important clinical symptoms. 

Fig.2.1. Ultrasonographic appearance of normal lymph nodes as an incidental finding in a 23-year-old female patient with constipation...

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