Ultrasonographic examination of focal thyroid lesions, particularly those in multinodular goiter is helpful in selecting one or more foci for fine-needle aspiration bi- opsy. It is currently believed that the most important cri- teria for the evaluation of malignant potential of a thyroid nodule is not its size but rather its vascularization, the presence of microcalcifications, height/width ratio, struc- ture (solid or solid-fluid), echogenicity and border margins as well as the presence of so called halo. Hence, thyroid nodules most suspected of malignancy are those with the following ultrasonographic features: enhanced central vas- cularization or no flow in power doppler; microcalcifica- tions; nodule height exceeding its width; solid lesions are more suspicious than solid-fluid ones; hypoechogenic le- sions raise more concerns than isoechogenic ones; lesions with rough margins and those without a halo or lesions with irregular, thick halo are more suspicious . Now- adays, ultrasound-guided fine-needle aspiration biopsy is a gold standard in the diagnosis of nodulargoiter. It is tech- nically simple, safe and inexpensive. Cytology assessment of the specimens obtained through fine-needle aspiration biopsy is based on international classification known as the Bethesda System of Reporting Thyroid Cytopathology . According to this classification, the findings of fine- needle aspiration biopsy of thyroid nodule can be divided into 6 groups of diagnostic cytopathology categories: I- non-diagnostic or unsatisfactory, II- benign, III- atypia of undetermined significance or follicular lesion of undeter- mined significance, IV- follicular neoplasm or suspicious for a follicular neoplasm, V- suspicious for malignancy and VI- malignant. Cytopathology diagnoses falling within groups IV, V and VI are indications for surgery. Diagnoses classified as group III and those classified as group I mean that fine-needle aspiration biopsy should be repeated. It is also worth emphasis that even the diagnosis of a benign lesion (group II ) in fine-needle aspiration biopsy carries 3% risk of false negative result . Irrespective of the chosen classification of cytopathology findings, one should assume that approx. 20% of thyroid nodule biopsies pro- duce results that require final diagnosis based on postop- erative histopathology report .
The patient was transferred to the thyroid breast surgery department. Thyroid mass resection was performed to es- tablish a diagnosis and to relieve the symptoms caused by tumor compression. During the operation, the markedly enlarged thyroid was easily observed, and the trachea was pushed to the right. Multiple masses of various sizes were noted in the bilateral thyroid. The largest of these masses (10.0 × 6.0 × 5.0 cm) was noted in the left lobar thyroid, and 2/5 of the mass was behind the sternum with an intact capsule. In addition, a small (1.8 × 1.2 × 1.0 cm) mass with a distinct border was located in the middle of the right lobar thyroid. These masses were completely removed and sent to the pathology department for frozen section exam- ination. Frozen section histological results revealed nodulargoiter of bilateral and focal atypical hyperplasia in the left lobe. The patient then underwent a total thyroidectomy with central neck area lymph node dissection.
Background: Schwannoma is a benign tumor derived from Schwann cells. The most common location was cerebellopontine angle (CPA). Neurilem- moma originated from the thyroid gland is very rare. Purpose: To discuss the diagnosis and treatment of cervical vagal schwannoma and the causes of mis- diagnosis and preventive measures. Case Presentation: A case of cervical vagal schwannoma misdiagnosed as nodulargoiter by ultrasonography was analyzed retrospectively. This patient was found to have pain in the neck for 1 month and then went to our hospital for treatment. After admission, a 5 cm × 4 cm mass was found on the left side of the neck, with a medium texture and clear margin. It could move with swallowing. Initially ultrasound showed a well circumscribed hypoechoic mass in the left thyroid lobe, which is sugges- tive of hemorrhage of thyroid nodule. Biopsy of thyroid nodules after ultra- sound guided biopsy revealed Schwannoma. Surgical treatment and post- operative pathological examination confirmed cervical vagal schwannoma. The patient recovered well and was discharged 9 days after operation. Con- clusion: The location of thyroid schwannoma is rare, the relationship be- tween thyroid schwannoma and surrounding tissues is unclear, and there is no typical ultrasonic manifestation. Moreover, if doctors are not aware of their knowledge, it is easy to cause misdiagnosis. Radiologists should raise awareness of the disease and carefully analyze the results of ultrasonography in combination with the clinical manifestations of the patients so as to reduce or avoid misdiagnosis of cervical schwannoma.
Even though nodulargoiter may be benign at the time of detection, it is likely to become malignant later and sho uld therefore be removed as cancer prophylaxis. Lahey stated that prophylaxis removal of all discrete nodules would do much to lower, if not abolish the occurrence of thyroid cancer. This history of pre-existing nodulargoiter often of long duration was e licited in many series of thyroid cancer. Some authors cited the individual history of patient with quiescent benign nodulargoiter, which began to grow rapidly, and proved to be thyroid carcinoma. Sokal states (49) that some nodules might be malignant from the start for which series of histopathological studies during every stage of evolution of the goiter may be helpful to come near to conclusion and to find out that the histopathological abnormality is the earlier stages to predict malignancy later. (50)
This retrospective study involved patients diagnosed with multi-, single- or retrosternal nodulargoiter, including Graves–Basedow disease. Data were collected from case histories along with postoperative specimen histopathology results and preoperative FNA biopsies. Patients were referred for surgery after a set of laboratory and imag- ing tests, FNA, and ear–nose–throat assessment. The following surgery extent pattern was developed in our department: single nodule – lobectomy and isthmusectomy; multinodular goiter – total thyroidectomy; preoperative TC diagnosis – total thyroidectomy and central neck dissection. One hundred and eight patients who had been operated on in
Currently, one of the most urgent is the problem of surgical treatment of patients with nodulargoiter. This is primarily due to the development of relapses in the postoperative period. There are supporters of radical and organ-preserving operations. When conducting organ-preserving operations, researchers indicate the need to preserve part of the gland tissue to prevent postoperative hypothyroidism, which will avoid taking thyroid drugs . Supporters of radical surgeries consider organ-preserving surgeries unreasonable, since this increases the risk of a relapse of the disease up to 25-40% [1,4].
Methods: The retrospective comparative study was conducted at Van Training and Research Regional Hospital, Van, Turkey, and comprised data of patients who underwent thyroidectomy from 2011 to 2015. The data was compared between patients with papillary thyroid cancer (group 1) and those with nodular hyperplasia (group 2) in terms of age, gender and thyroid stimulating hormone level as well as haemogram parameters, neutrophil-lymphocyte ratio and platelet-lymphocyte ratio. SPSS 20 was used for statistical analysis.
clinical manifestations related to the corresponding functions. Different types of human proteins have been identified as possible causative agents of amyloidosis , including amyloid light chain, SAA, b amyloid/APP and transthyretin . Despite the different etiologies, organs involved, clinical manifestations and variety of proteins that can cause amyloidosis, a common feature is the accumulation of insoluble proteins arranged in cross- b -pleated sheet structures regardless of their source, primary structure or function . Amyloid goiter (AG) is a rare condition characterized by thyroid infil- tration of amyloid material, which causes thyroid gland enlargement and atrophy of thyroid follicles [15-18]. The most commonly reported clinical features of these patients are rapid, painless thyroid gland enlargement that may be associated with dysphagia, dyspnea, or hoar- seness [15,16]. AG has been infrequently described [16,18] and most of the reported cases mainly refers to patients suffering from systemic amyloid A (AA) amyloi- dosis or long-standing predisposing diseases [19,20]. Palpable neck masses are not a rare occurrence, some time representing a challenging diagnostic dilemma with unusual extrathyroidal masses [21,22]. Fine-needle cytol- ogy (FNC) is a primary diagnostic tool in preoperative diagnosis of thyroid nodules [23-28]. Cellular biomar- kers, such as endothelial progenitor cells, whose fre- quency increase in peripheral blood of cancer patients and decrease in those suffering from cardiovascular dis- eases [29-31], are unfortunately lacking. However, the application of immunocytochemistry (ICC), flow cyto- metry (FC) and molecular techniques to FNC has dra- matically increased the sensitivity of the method [28,32-38]. The identification of chromosomal aberra- tions or differences in the expression profiles of suitable membrane ion channels, such as ion channels, whose expression may be up-regulated under pathological con- ditions [39-43], might favour amyloidosis recognition. These advantages are enhanced in case of AG, which does not require surgical treatment, and even more in elderly patients, for whom surgery is generally more bur- densome, complex and expensive than younger patients [44-46]. A case of nodular AG diagnosed by FNC is here described; differential diagnosis and clinical implication of the FNC diagnosis are described accordingly.
molecular markers of cytotoxicity were used. The reduction of total iodine (by 19.5%), increase of in- organic iodine fraction (by 82.4%) and total copper content (twice) in paranodular and nodular tissues compared with contrlateral part have been estab- lished. Excess of copper in goitrous-changes tissue was partially accumulated in the metallothioneins. The level of metal-binding form of metallothio- neins and reserve of free thiols of these proteins was higher two-three times and lower content of reduced glutathione in node-affected tissue compared to the contralateral part. Signs of cytotoxicity among them: higher cathepsine D free activity (up to 84.6% and 134.4% in paranodular tissue and node respectively) and higher level of DNA strand breaks in the node (up to 22.6%) were observed. In paranodular tissue the range of indices variability compared with pa- renchyma of contralateral part is shorter than in the node. Thus, under low level of iodine organification and high copper level in goitrous-modified tissue of thyroid gland metallothionein may provide a partial compensatory effect on prooxidative processes.
Genetic material from fifteen patients with the three most common types of thyroid lesions (nodulargoiter, follicular thyroid adenoma, and papillary thyroid cancer) was investigated. These were obtained from the Institute of Oncology in Gliwice and from the Department of General, Gastrointestinal, and Endocrinological Surgery of Silesian Piasts University of Medicine in Wro− cław. In these studies, DNA isolated from tumors tissues remaining after performing all necessary routine diagnostic tests was used. DNA from the blood of patients where tumor was removed surgi− cally was used as a comparative material. The types of thyroid tumors are listed in Table 1 (see previous page).
Galectin-3 is a protein of the lectin family that has been associated with neoplastic processes in various tissues . In the thyroid, expression of this protein has been described in differentiated follicular cancer, suggesting that the immunohistochemical study of galectin-3 may be a potential marker of malignancy in thyroid neo- plasms [3,12,22,24-27]. Galectin-3 positive rate in these four groups was 52.58% (nodulargoiter), 48.15% (folli- cular adenoma), 97.17% (papillary thyroid carcinoma without lymphatic metastasis) and 96.37% (papillary thyroid carcinoma with lymphatic metastasis), respec- tively. In a study by Bartolazzi et al., the sensitivity and specificity of galectin-3 in thyroid carcinomas were 99% and 98%, respectively . In the present study, our finding about the expression of galectin-3 in thyroid car- cinomas was less specificity (49.01%). This may be par- tially due to the subjective criteria used in assessing positive expression or genetic heterogeneity of PTC in different ethnic group.
A total no of 119 cases of thyroid lesions were subjected to FNAC and were analyzed. Most of the cases occurred in females 113 (94.96%) and 6 cases were noticed in males (5.04%). Maximum number of lesions was seen in age group 21 to 30 years(39 cases). Cytological diagnosis was given in 119 cases. Benign lesions constituted 108 cases where as malignant lesions were 11. Nodulargoiter was the commonest benign lesion and papillary carcinoma of thyroid was commonest malignant lesion. AgNOR scoring was given in 100 cases and in 19 cases AgNOR scoring was not given due to poor cellularity of smears. The number of benign lesions was 90 and malignant lesions were 10. In the present study malignant thyroid lesions (papillary carcinoma)showed AgNOR scoring 3.15 ± 0.64(SD) & and benign thyroid lesion(lymphocytic thyroiditis) showed AgNOR scoring of 1.69 ± 0.10(SD). Comparative study by other workers alsoshowed significant difference between benign and malignant lesions. There was no significant variation in AgNOR score among the various benign lesions; whereas there was a significantly higher AgNOR score in malignant lesions of thyroid.
Diseases of the thyroid gland are a major health problem in our country, and the incidence and prevalence of these thyroid diseases in a community depend on various fac- tors. Tsegaye and associations in 2013 evaluated the his- topathologic pattern of thyroid diseases and concluded that Nodular colloid goiter was the most prevalent thyroid disease. 1 In the same manner, our study showed that Nodular colloid goiter (NCG) is the most prevalent thyroid disease. Previous reports from the west suggest that simple goiter be the most common thyroid disorder that particu- larly occurs in young women in their childhood and 20s. Nodulargoiter is highly prevalent in iodine-de ﬁ cient areas. 7 A higher percentage of nodulargoiter in the current study may suggest the possibility of iodine de ﬁ ciency in representative areas in our study. Further investigations may be required to ﬁ nd causes and pathogenesis in our population.
been described: type I AIT develops in an abnormal thy- roid gland (nodulargoiter, latent Graves' disease) due to iodine-induced true hyperthyroidism; type II AIT occurs in an apparently normal thyroid gland and is due to iodine-induced (or amiodarone -induced) destructive thyroiditis [1,7] In the first case, iodine load is responsible for excessive thyroid hormone synthesis and its preva- lence is higher in mildly iodine deficient areas, suggesting that patients with preexisting thyroid abnormalities are unable to adapt normally to an excessive iodine intake . In the second case, patients usually have no underly- ing thyroid abnormalities, whereas a markedly increased serum interleukin 6 (IL-6) concentration, along with his- topathologic findings demonstrating moderate to severe follicular damage, support the destructive nature of AIT type II, which seems to result from discharge of preformed The fluctuations of thyroid hormones during patient's ICU stay
Case presentation: A 55 year-old, caucasian man presented with overt hyperthyroidism (thyrotropin (TSH) <0.01 μ IU/L; free thyroxine (FT4) 3.03 ng/dL), negative thyroid peroxidase and thyroglobulin autoantibodies, but elevated thyroid stimulating hormone receptor antibodies (TSH-RAb 2.6 IU/L). Ultrasound showed a highly vascularized hypoechoic nodule (1.1 × 0.9 × 2 cm) in the right lobe, which projected onto a hot area detected in the 99m technetium thyroid nuclear scan. Overall uptake was increased (4.29%), while the left lobe showed lower tracer uptake with no visible background-activity, supporting the notion that both Graves ’ disease and a toxic adenoma were present. After normal thyroid function was reinstalled with methimazole, the patient underwent thyroidectomy. Histological work up revealed a unifocal papillary microcarcinoma (9 mm, pT1a, R0), positively tested for the BRAF V600E mutation, embedded into the hyperfunctional nodulargoiter.
may show a repetitive pattern of microfollciles or rosettes similar to a neoplasm if only such a focus is sampled. MacDonald L and Yazdi HM study showed the cytodiagnostic sensitivity of Hashimoto’s thyroiditis as 69%. Study revealed male to female ratio ratio of 1:14.5 and the age group ranged from 30-84 years with mean age 46 years. In their study, 3 cases of Hashimoto’s thyroiditis with nodulargoiter, 1 case of Papillary carcinoma with Hashimoto’s thyroiditis and 1 case of Hürthle cell adenoma with Hashimoto’s thyroiditis revealed both cytopathological and histopathological correlation. 10
uncommon to see patients presenting with symptoms of thyrotoxicosis initially, who had florid morphological features of acromegaly. The prevalence of toxic nodulargoiter to the tune of 14.3% in acromegaly. Goiters seen in acromegaly were euthyroid or autonomous, are due to the elevated growth hormone levels independent of TSH action. In about 13 to 17%, thyroidectomies were performed before acromegaly was diagnosed. When patients with acromegaly presents with a weight loss should arouse the possibilities of thyroid cancer or hyperthyroidism.
cells in 3 patients (follicular epithelium of the papillary atypical hyperplasia in 1 and deno- mas in 2 patients). Of 71 patients with cytologi- cal negative results, 28 patients underwent surgery during the follow-up period, of whom malignant nodules were found in 14 patients (false-negative results were noted in these patients [Table 2]) and benign nodules in 14 (subacute granulomatous thyroiditis in 3, Has- himoto’s thyroiditis in 3, toxic goiter in 1, and nodulargoiter in 7 patients); remaining 43 pati- ents received follow-up by ultrasound examina- tion for more than 1 year and no significant change was observed (thyroid nodules were regarded as being benign). Thus, a total of 55 patients were diagnosed with malignant thyroid nodules, of whom postoperative pathology con- firmed thyroid papillary carcinoma in 50, thy- roid lymphoma in 4 and thyroid follicular adeno- ma with local malignant transformation in 1 patient (Table 3).