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 nodular goiter. 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 .
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 nodular goiter 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.
The patient in this case suffered from dyspnea and intermittent headaches for approximately 1 month. A giant non-tender mass in the neck was accidentally dis- covered upon physical examination. A CT scan demon- strated that the remarkably enlarged left lobar thyroid was occupied by a giant mass that suppressed the tra- chea. Thyroid function tests were normal preoperatively, whereas frozen section histological results revealed a nodular goiter with bilateral and focal atypical hyperpla- sia in the left lobe. Taking the increase in serum LDH and the occupied lesion in the cerebellum into consider- ation, we examined the tissue sections carefully. Eventu- ally, we found lesion areas in three of the total 20 paraffin blocks. Thus, it is important to be aware of this entity and to examine the small vessels in biopsies as carefully as possible. In addition, the 18F–FDG PET/CT scan was demonstrated to have diagnostic value in IVLBCL [16, 17].
Background: Thyroid cancer (TC) comprises 1% of all carcinomas and is the most common malignancy of the endocrine system. The disease is more common in women, with its peak morbidity observed in 40–50-year-old patients. The main risk factors include radiation, iodine deficiency, hereditary background, and genetic mutations. Among all diagnosed thyroid nodules, 5%–30% will evolve into cancer. The gold-standard procedure in the preoperative evaluation of a nodular goiter, apart from ultrasonography, is fine needle aspiration (FNA) biopsy. The FNA biopsy is favored for its simplicity, safety, and high specificity and sensitivity rates.
Even though nodular goiter 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 nodular goiter often of long duration was e licited in many series of thyroid cancer. Some authors cited the individual history of patient with quiescent benign nodular goiter, 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)
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Results: Of the 90 patients, 53(59%) were in group 1 with papillary thyroid cancer and 37(%) in group 2 with nodular hyperplasia. Platelet-lymphocyte ratio was significantly higher in group 1 (p=0.015). Mean platelet volume was significantly higher in group 1 patients with a diameter of 1cm or more (p<0.05). Within group 1, lymphocyte count was significantly high in patients with invasion (p<0.05). In correlation analysis, group 1 patients with a tumour diameter of 1cm or more showed a significant correlation in mean platelet volume, tumour multicentricity, lymphocyte count, vascular invasion, thyroglobulin, platelet distribution width, platelet number and tumour multicentricity (p<0.05). Conclusion: Only platelet-lymphocyte ratio could assist in distinguishing benign goiter from thyroid cancer. Also, mean platelet volume, lymphocyte count, and platelet distribution width appeared to be effective prognostic markers for papillary thyroid cancer.
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.
Abstract Material and research methods. The study is based on the results of treatment of 368 patients with thyroid nodular lesions, admitted to the surgical department of the 1st clinic of the Samarkand State Medical Institute from 2005 to 2018. Patients are conditionally divided into two groups. In 2005-2013 operated on 230 patients who made up the comparison group. From 2014 to 2018 under our supervision were 138 patients who entered the main group. The results of the study. Surgical tactics and techniques for performing the main stages of a stumectomy did not differ from the generally recognized. In order to properly carry out the surgical intervention during thyroid nodular lesions and to avoid complications and relapses after the operation, the basic principles of strumectomy were observed. In the main group, the choice of treatment was more differentiated. Factors affecting the choice of treatment were taken into account. As indicated in chapter III in the late postoperative period, the unsatisfactory results in the comparison group were due to the neglect of the cytological conclusion and the choice of surgical tactics. Conclusions. The developed program for the scoring of factors affecting the choice of surgery in patients with thyroid nodular lesions allowed to choose the optimal method of surgery, taking into account the individual characteristics of the body and improved treatment outcomes. To prevent intraoperative complications, one of the innovative solutions in patients in the main group was the use of a modified retractor tool.
uncommon to see patients presenting with symptoms of thyrotoxicosis initially, who had florid morphological features of acromegaly. The prevalence of toxic nodular goiter 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.
Material and Methods. Genetic material from fifteen patients with three of the most common types of thyroid lesions (nodular goiter, follicular thyroid adenoma and papillary thyroid cancer) was investigated. DNA isolated from tumors tissues remaining after performing all necessary routine diagnostic tests was used. As a comparative material, DNA from the blood of the patients where tumor was removed surgically was used. PCR was applied. Results. LOM was observed in 7 (46.7%) patients with papillary thyroid carcinoma, 4 (30.76%) with follicular thy− roid adenoma, and 4 (30.76%) with nodular goiter.
CK19 (Keratin 19) is a member of the keratin family. The keratins are intermediate filament proteins responsible for the structural integrity of epithelial cells. CK-19 is strongly and diffusely expressed in papillary carcinoma, whereas it is usually absent or focally expressed in benign follicular nodules [29-31]. CK19 positive rate in these four groups was 26.80% (nodular goiter), 24.08% (follicu- lar adenoma), 99.20% (papillary thyroid carcinoma with- out lymphatic metastasis) and 92.74% (papillary thyroid carcinoma with lymphatic metastasis), respectively. The role of CK-19 in the diagnosis of thyroid carcinoma is controversial . Schelfhout et al. have found CK-19 expression in all tumor cells of papillary carcinomas, but it was absent or only focally present in follicular carcino- mas and follicular adenomas . In the current study, although we found CK-19 expression in follicular adeno- mas or nodular goiter but the CK-19 was the most sensi- tive (96.37%) and specific (74.17%) marker in papillary carcinomas. Diagnostic efficiency of CK19 (90.71%) was slightly higher than that of Galectin-3(84.63%) and the specificity and false positive rate (misdiagnosis rate) CK19 was better than Galectin-3.
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. Nodular goiter 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. Nodular goiter is highly prevalent in iodine-de ﬁ cient areas. 7 A higher percentage of nodular goiter 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.
This retrospective study included 760 patients who re- ceived kidney transplantation between January 2000 and October 2017. All ESRD patients, to be included in the waiting list, underwent ultrasonography of the neck and complete assessment of thyroid function according to serum levels of FT3, FT4, and TSH, as previously de- scribed . In brief, all patients with a benign thyroid disease (nodular goiter or thyroiditis) were considered eligible for kidney transplantation after treatment of the disease, while patients with a diagnosis of thyroid cancer were considered eligible for kidney transplantation after at least 2 years of negative follow-up .
been described: type I AIT develops in an abnormal thy- roid gland (nodular goiter, 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
In the present study out of 56 histopathology reported, three neoplastic lesions i.e. two cases of nodular goiter were diagnosed as Neoplastic lesions i.e., follicular adenoma on histopathology and one case Colloid goiter was diagnosed as Papillary Carcinoma on histopathology. False negative diagnosis was given in FNAC for three cases. Hence false negative error rate was 5.36%. Two cases diagnosed as follicular adenoma cytologically, were diagnosed as ar goiter on histopathology, hence false positive diagnosis by FNAC is given in 2 cases with false positive error rate of 3.57%. On cytology many features of Follicular Adenoma and Multinodular goiter are similar which resulted in her cases of Non-neoplastic lesion available for correlation were confirmed on histopathology. Out of four cases of Papillary carcinoma which were diagnosed by FNAC were confirmed histopathologically but 1 case of colloid goiter given on FNAC was diagnosed as Papillary carcinoma on histopathology with diagnostic accuracy of 80%. ar adenoma was diagnosed as Follicular carcinoma on histopathology, since diagnosis of carcinoma needs histopathological evidence of capsular/vascular invasion of the tumor hence this was taken as a positive correlation only. One case of Hurthle cell Adenoma available for correlation was confirmed on histopathology with diagnostic accuracy of Our study findings are similar to the findings of et al. In our study sensitivity was 78.50%, specificity 95.20%, Positive predictive value 84.61% and Negative Predictive value 93.02% which nearly correlates with the findings suggested by Afroze et al. Bagga et al. 1986), Hawkins et al. (1987) and Gulia et al.
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 nodular goiter.
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 nodular goiter 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).
Fine Needle Aspiration Cytology is the important investigation in the evaluation of solitary nodule of thyroid. All 77 cases were subjected to FNAC during the course of evaluation. FNAC reports are mainly categorized into 6 entities- Colloid goitre, follicular adenoma, Hyperplastic goiter, suspicious (of malignancy), malignant- Papillary and Follicular carcinoma, Hashimoto’s thyroiditis, and cysts. In our study, out of 23 follicular neoplasms, 19 cases turned out to be follicular adenoma, 2 cases each were Hyperplastic nodule and Hashimoto’s thyroiditis. One suspicious (of papillary carcinoma) case confirmed Follicular carcinoma on histopathological examination. Out of 5 cases 4 cases of papillary carcinoma were diagnosed preoperatively by FNAC alone and 3 cases were Lymph node positive. One case diagnosed as cysts by FNAC confirmed to be simple cysts on histopathological examination.
Our findings of the continued reduction of IDD in China are consistent with previous studies [14, 34]. There was no significant association between iodized salt intake and the three endemic diseases, which revealed that the current nutrition level of iodized salt did not cause the high goiter prevalence. Even when considering the confounders of goiter, such as genetic, metabolism, drugs, etc., the most important factor remains the lack of iodine. Therefore, in accordance with these results, the controversy that iodized salt increased the risk of thyroid disorders in China in the past decade is begin- ning to be cleared. We demonstrated no differences in the daily iodized salt intake across the provinces in three years using one-way ANOVA, which suggests that the daily iodized salt intake levels of residents in the three consecutive years remained stable. The results of our data demonstrated that the daily iodine salt intake values of a reference male were 12.63 g, 12.64 g and 12.23 g in 2011, 2012 and 2013, respectively. The current standard for salt iodization in China is 20-30 mg/kg according to the fourth adjustment of the iodine content of edible salt in 2010 . Taking 2012 as an example, the daily iodine intake of a reference male ranged from 252.8 to 379.2 μ g. The recommended dietary allowance of iodine for an adult male is 150 μg/d according to the WHO/