Hallazgos anatomopatológicos definitivos en pacientes tiroidectomizados con diagnóstico preoperatorio de neoplasia folicular / Definitive anatomopathological findings in thyroidectomized patients with preoperative diagnosis of follicular neoplasm

Background: The finding of follicular neoplasm, using a FNAP, is an indication for partial or total thyroidectomy, to obtain the definitive malignant or benign histology. Frequently, it is possible to identify significant additional histological diagnosis. Aim: To obtain the definitive histological findings in patients with follicular neoplasm by FNAP. Patients and Method: Transversal analysis of 133 patients that underwent to total thyroidectomy between 2003 and 2009, that filled de requirements for adequate histological assessment. Results: In 33.1 percent of the treated patients the final diagnosis was indeed a follicular neoplasm (adenoma in 26.3 percent and cancer in 6.8 percent). In the 51.9 percent the finding was follicular colloidal hyperplasia and other thyroid cancer in 8.3 percent. The total malignant prevalence in the whole gland was 29.3 percent. Conclusions: The thyroidec-tomy is the treatment of choice and the final diagnostic procedure for these patients. The histological findings of cancer different from follicular not only in the punctioned nodule are a secondary and an additional argument for reinforcing the surgical indication.

Introducción: El hallazgo de una neoplasia folicular por PAAF, obliga a realizar una tiroidectomía parcial o total, para definir la naturaleza maligna o benigna definitiva de la lesión tiroidea. Junto a este diagnóstico preoperatorio se identifican finalmente con alta frecuencia lesiones histológicas adicionales. Objetivo: Conocer y describir los hallazgos anatomopatológicos definitivos que se encuentran en tiroidectomías por neoplasias foliculares diagnosticadas por PAAF. Materiales y Métodos: Revisión transversal de las biopsias definitivas de 133 pacientes sometidos a tiroidectomía total entre 2003 y 2009, que cumplieron los requisitos establecidos para evaluar la histología definitiva del nódulo puncionado y de la glándula tiroides completa. Resultados: En el 33,1 por ciento de los pacientes el diagnóstico definitivo del nódulo puncionado fue efectivamente una neoplasia folicular (adenoma en el 26,3 por ciento y cáncer en el 6,8 por ciento). El 51,9 por ciento correspondió a hiperplasia folicular y el 8,3 por ciento otro cáncer. La prevalencia de malignidad final en la glándula completa fue de un 29,3 por ciento. Conclusiones: Siendo la indicación de tiroidectomía en estos pacientes un tratamiento y procedimiento diagnóstico aceptado y necesario, se concluye que la alta prevalencia de lesiones malignas (29,3 por ciento) tanto en el nódulo puncionado como, adicionalmente, en el resto de la glándula, reforzaría la necesidad de este tratamiento quirúrgico.

Fine Needle Aspiration Cytology of Parathyroid Neoplasms: A Review of Three Cases / 대한세포병리학회지

Parathyroid tumors may be difficult to distinguish from thyroid follicular lesions, especially when a tumor is nonfunctioning. We report here two cases of asymptomatic parathyroid carcinoma preoperatively misdiagnosed as thyroid follicular lesions, and one case of parathyroid adenoma showing hyperparathyroidism, and review the cytologic features favoring the diagnosis of parathyroid neoplasm. The cytologic findings that are characterized by clean background, monomorphic small cells, cohesive three-dimensional papillary clusters, small tight clusters with scattered naked nuclei, and well-defined clear cytoplasm favor a diagnosis for the parathyroid lesions. Cytologic findings such as macrofollicular structure, presence of colloid and macrophages, and presence of perivacuolar cytoplasmic granules on May-Grunwald-Giemsa stain support a diagnosis of a thyroid follicular lesion. The cytomorphology of parathyroid tumors is so variable that the distinction from a thyroid lesion cannot be based on the presence or absence of a single feature only but on the cytologic features as a whole.