Malignant melanoma with synchronous thyroid metastases: case report and literature review

SUMMARY Thyroid metastases are rare in clinical practice. We describe the case of an 85-year-old woman who was referred to our department due to a multinodular goiter with compressive symptoms and subclinical hyperthyroidism. The patient was also undergoing evaluation for a polyp in her left nasal cavity, which was then diagnosed as a malignant melanoma of the nasal mucosa. A thoracoabdominal magnetic resonance imaging obtained for cancer staging revealed a > 50% tracheal obstruction caused by the goiter. The patient underwent simultaneous total thyroidectomy and melanoma excision. Histological analysis of the thyroid showed the presence of multiple metastatic foci from the melanoma. Due to the patient’s age, a decision was made to maintain her under surveillance and administer palliative treatment if necessary. Although metastases to the thyroid are rare, they should be considered in the differential diagnosis of thyroid lesions in patients with a known primary tumor. The thyroidectomy, performed in this patient’s case, allowed the diagnosis of the metastases and relief of compressive symptoms caused by the goiter.

Large thyroid cyst in a patient with congenital hypothyroidism / Grande cisto tiroidiano em paciente com hipotireoidismo congênito

Thyroid hormone biosynthetic defects are rare causes of congenital hypothyroidism. Although, initial presentations are usually diffuse goiter and hypothyroidism, subsequently they may develop thyroid nodules and or thyroid cancer. We describe a case of hypothyroidism due to dyshormonogenesis whose one of the previously solid nodules degenerates into a large cyst. A 22-year-old male was referred to our clinic for evaluation of enlarging thyroid nodule. Hypothyroidism was diagnosed in infancy, however due to poor compliance to treatment TSH values were elevated most of the times. When he was fifteen the first nodule was detected which was a solid cold nodule. Fine needle aspiration was in favor of benign follicular nodule. Seven years later we found a large multi nodular thyroid with a predominant large cyst corresponding to the previously detected solid nodule. 21cc straw colored fluid was aspirated. Cytology was reported as benign cystic nodule. The patient underwent thyroidectomy and pathology confirmed a benign thyroid cyst. Although underreported thyroid dyshormonogenesis may progress to cystic degeneration. Taking into account the risk of malignancy and eventually cyst formation, we recommend more frequent evaluation in the face of nodule formation in these patients. Arq Bras Endocrinol Metab. 2014;58(9):958-61.

Os defeitos de biossíntese do hormônio tiroidiano são causas raras de hipotireoidismo congênito. Embora as apresentações iniciais sejam geralmente bócio difuso e hipotireoidismo, nódulos tiroidianos ou câncer de tiroide podem se desenvolver subsequentemente. Descrevemos aqui um caso de hipotireoidismo causado por disormonogênese e no qual um dos nódulos sólidos degenerou em um grande cisto. Um homem de 22 anos de idade foi encaminhado para nossa clínica para avaliação do aumento de um nódulo tiroidiano. O hipotireoidismo foi diagnosticado na infância. Entretanto, em razão da baixa conformidade ao tratamento, os valores de TSH estavam elevados na maior parte do tempo. Quando o paciente tinha 15 anos de idade, um primeiro nódulo sólido e frio foi detectado. A aspiração por agulha fina mostrou um nódulo folicular benigno. Sete anos depois encontramos múltiplos nódulos na tiroide e um grande cisto predominante que correspondia ao nódulo sólido anteriormente detectado. Foram aspirados 21cc de fluido cor de palha. A citologia mostrou um nódulo cístico benigno. O paciente foi submetido à tiroidectomia e o exame histopatológico confirmou um cisto tiroidiano benigno. Embora não seja comumente relatada, a disormonogênese da tiroide pode progredir para a degeneração cística. Ao serem considerados o risco de malignidade e a eventual formação de cistos, recomendamos uma avaliação mais frequente da formação de nódulos nesses pacientes. Arq Bras Endocrinol Metab. 2014;58(9):958-61.

Evaluation of percutaneous ethanol injections in benign thyroid nodules / Avaliação do tratamento com injeção percutânea com etanol em nódulos benignos de tireoide

Objective The objective of this study was to evaluate the efficacy and safety of percutaneous ethanol injection (PEI) in the treatment of benign thyroid nodules. Subjects and methods We evaluated 120 patients with benign thyroid nodules. Patients underwent evaluation of serum TSH and free T4, cervical ultrasound, and thyroid scintigraphy (in those with suppressed TSH levels). The application of sterile ethanol 99% was guided by ultrasound, with the injected volume amounting to one-third of the nodule volume. Response was considered complete (reduction of 90%); partial (reduction between 50 and 90%); or none (reduction of < 50%). Autonomous nodules were evaluated for normalization of TSH levels. Results Among the nodules studied, 30.8% were solid, 56.7% were mixed, 12.5% were cystic, and 21.6% were hyperfunctioning. The initial volume of the treated nodules ranged from 0.9 to 74.8 mL (mean 13.1 ± 12.4 mL). We performed 1-8 sessions of PEI, applying an average of 6.2 mL of ethanol for patient. After 2 years of follow-up, 17% of patients achieved a complete response (94% reduction); 53%, a partial response (70% reduction); and 30%, no response. A reduction in the volume of autonomous nodules was noted in 70% of cases, and 54% had a normalized value of TSH. The main side effect is local pain, lasting less than 24 hours in most cases. Conclusion This study showed that PEI is a safe and effective procedure for treatment of benign, solid or mixed thyroid nodules. Most cases resulted in significant reduction in nodule volume, with normalization of thyroid function. Arq Bras Endocrinol Metab. 2014;58(9):912-7 .

Objetivo O objetivo deste estudo foi avaliar a eficácia e segurança da injeção percutânea de etanol (IPE) no tratamento de nódulos tireoidianos benignos. Sujeitos e métodos Foram avaliados 120 pacientes com nódulos benignos de tireoide. Todos realizaram dosagens de TSH, T4 livre, ecografia cervical (US) e cintilografia de tireoide (em pacientes com TSH suprimido). A aplicação de etanol estéril a 99% foi guiada por US e o volume de etanol injetado correspondeu a um terço do volume nodular calculado. A resposta foi considerada completa (redução de 90%); parcial (redução entre 50 e 90%) ou ausência de resposta (redução menor que 50%). Nos nódulos autônomos, foi avaliada a normalização do TSH. Resultados Entre os nódulos estudados, 30,8% eram sólidos, 56,7% eram mistos, 12,5% eram císticos e 21,6%, nódulos hiperfuncionantes. O volume inicial dos nódulos tratados variou de 0,9 a 74,8 mL (média 13,1 ± 12,4 mL). Foram realizadas de 1 a 8 sessões de IPE (média 2,8), com aplicação média de 6,2 mL de etanol por paciente. Após dois anos de seguimento, 17% dos pacientes obtiveram resposta completa (redução de 94%), 53% obtiveram resposta parcial (redução de 70%) e 30% não responderam. Houve redução de volume nos nódulos autônomos em 70% dos casos, e 54% normalizaram o valor do TSH. Os efeitos colaterais registrados foram decorrentes apenas do desconforto no local de aplicação. Conclusão Este trabalho mostrou que a IPE é um procedimento seguro e eficaz para tratamento de nódulos benignos, sólidos ou mistos de tireoide. ...

Evaluation of cytopathological findings in thyroid nodules with macrocalcification: macrocalcification is not innocent as it seems / Avaliação dos achados citopatológicos em nódulos tiroidianos com macrocalcificações: elas não são tão inocentes como parecem

Objective Microcalcification is strongly correlated with papillary thyroid cancer. It is not clear whether macrocalcification is associated with malignancy. In this study, we aimed to assess the result of fine needle aspiration biopsies (FNAB) of thyroid nodules with macrocalcifications. Subjects and methods We retrospectively evaluated 269 patients (907 nodules). Macrocalcifications were classified as eggshell and parenchymal macrocalcification. FNAB results were divided into four groups: benign, malignant, suspicious for malignancy, and non-diagnostic. Results There were 79.9% female and 20.1% male and mean age was 56.9 years. Macrocalcification was detected in 46.3% nodules and 53.7% nodules had no macrocalcification. Parenchymal and eggshell macrocalcification were observed in 40.5% and 5.8% nodules, respectively. Cytologically, malignant and suspicious for malignancy rates were higher in nodules with macrocalcification compared to nodules without macrocalcification (p = 0.004 and p = 0.003, respectively). Benign and non-diagnostic cytology results were similar in two groups (p > 0.05). Nodules with eggshell calcification had higher rate of suspicious for malignancy and nodules with parenchymal macrocalcification had higher rates of malignant and suspicious for malignancy compared to those without macrocalcification (p = 0.01, p = 0.003 and p = 0.007, respectively). Conclusions Our findings suggest that macrocalcifications are not always benign and are not associated with increased nondiagnostic FNAB results. Macrocalcification, particularly the parenchymal type should be taken into consideration. Arq Bras ...

Objetivo A microcalcificação está fortemente correlacionada com o câncer papilar de tiroide. Não está claro se a macrocalcificação também está associada com malignidade. Neste estudo, nosso objetivo foi avaliar o resultado da biópsia de aspiração por agulha fina (FNAB) de nódulos tiroidianos com macrocalcificações. Sujeitos e métodos Avaliamos retrospectivamente 269 pacientes (907 nódulos). As macrocalcificações foram classificadas como periféricas (casca de ovo) ou parenquimatosas (interna). Os resultados da FNAB foram divididos em quatro grupos citológicos: benignos, com malignidade, suspeita de malignidade e não diagnósticos. Resultados Das amostras, 79,9% foram coletadas de mulheres e 20,1% de homens, e a idade média foi de 56,9 anos. A macrocalcificação foi detectada em 46,3% dos nódulos, e em 53,7% dos nódulos não havia macrocalcificação. A macrocalcificação parenquimatosa e periférica foi observada em 40,5% e 5,8% dos nódulos, respectivamente. Em termos citológicos, a malignidade e suspeita de malignidade foram mais comuns em nódulos com macrocalcificação em comparação com nódulos sem macrocalcificação (p = 0,004 e p = 0,003, respectivamente). Resultados benignos e não diagnósticos da citologia foram similares em ambos os grupos (p > 0,05). Os nódulos com calcificações periféricas apresentaram uma taxa maior de suspeita de malignidade e os nódulos com macrocalcificação parenquimatosa apresentaram ...

Bocio endotorácico / Endothoracic goiter

Se informa el caso de una paciente de 71 años de edad, con antecedentes de hipertensión arterial, que acude a consulta externa pues hace unos 5 años presenta aumento de volumen de la región inferior y lateral del cuello que se acompaña de decaimientos, palpitaciones y disfagia ocasional. Se realizaron los estudios de laboratorio para la valoración preoperatoria, además de los estudios de la función tiroidea, radiografías de tórax (vista anteroposterior), tomografía de tórax, ecografía de la tiroides y biopsia de aspiración con aguja fina. Se encontró un bocio endotorácico eutiroideo y se realizó tratamiento quirúrgico que consistió en hemitiroidectomía izquierda con istmectomía. El transoperatorio y el posoperatorio transcurrieron sin complicaciones, y el informe anatomopatológico reveló la presencia de un bocio coloide nodular(AU)

This is the case of a female patient aged 71 with a history of high blood pressure seen in external consultation since five years ago she presents a volume increase of lower and lateral region of the neck accompanied of weakness, palpitations and occasional dysphagia. Laboratory studies were conducted to preoperative assessment in addition to thyroid function studies, thorax X-rays (anteroposterior view), thorax tomography, thyroid gland echography and fine needle aspiration biopsy (FNAB). A euthyroid endothoracic goiter was present; surgical treatment was done consisting of left hemithyroidectomy with isthmectomy. In transoperative and postoperative periods there were not complications and the anatomic and pathologic report revealed the presence of nodular colloid goiter(AU)

Role of Ki-67 as a proliferative marker in lesions of thyroid.

Background: Specific criteria are used to diagnose thyroid neoplasms; however, the distinction between certain neoplasms, such as follicular adenoma and carcinoma, could be difficult. Thus, additional diagnostic features that can assist in this distinction would have great clinical usefulness. Aims: To evaluate the role of the proliferative marker Ki-67 in nonneoplastic and neoplastic lesions of the thyroid, with a special emphasis on the distinction between follicular adenoma and follicular carcinoma. Settings and Design: A retrospective study from a tertiary care center. Materials and Methods: One hundred cases of thyroid lesions, including 50 nonneoplastic and 50 neoplastic lesions, were retrieved from the archives of the Department of Pathology, Pt. BD Sharma PGIMS, Rohtak, Ki-67 immunostaining was performed by peroxidase-antiperoxidase method and compared with mitotic counts. Results: Ki-67 labeling index (LI) showed a progressive rise from multinodular goiter to benign to malignant neoplasms. A statistically significant difference was observed in Ki-67 counts between multinodular goiter vs papillary carcinoma (P < 0.05) and follicular adenoma vs follicular carcinoma (P < 0.05). The correlation between mitotic counts and Ki-67 LI was found to be significant. Conclusions: In the present study, Ki-67 was found to be useful in differentiating between follicular adenoma and follicular carcinoma, but since the sample size of our study was small, larger studies are needed to confirm this observation as well as to assign a cutoff value for differentiating benign from malignant tumors.

Frequency of thyroid carcinoma in multinodular goitre

To determine the frequency of carcinoma in thyroidectomies for multinodular goitre [MNG]. This was a prospective descriptive study, conducted in department of general surgery, Nishtar Medical College, Multan [NMC] from July 1998 to December 2004. Only 255 patients with confirmed multinodular goitre were considered in the study. All were from either sex and above the age of 12 years. Out of 255 patients, 213 were female and 42 males with female to male ratio of 5:1. The patients with swelling in front of neck were 180 [70.58%], with symptoms of thyrotoxicosis 30 [11.76%], with dysphagia 21 [8.23%], with dyspnoea 15 [5.88%] and with hoarseness of voice 9 [3.52%]. Thyroid carcinoma was reported in 21 patients [8.23%]. Papillary carcinoma was the most common 57.14% and Follicular carcinoma was 28.57%. Papillary to follicular ratio was 2:1. Risk of malignancy in Multinodular goitre should not be underestimated. It should be considered for surgery, especially if it has very hard nodules and / or dominant nodules are present in multinodular goitre

Marcadores de riesgo de neoplasia folicular en nódulos tiroideos / Risk markers of follicular neoplasms in thyroid nodules

Los nódulos tiroideos de origen folicular abarcan procesos no neoplásicos y neoplásicos. No existen métodos de diagnóstico ni rasgos citológicos por punción con aguja fina (PAF) que los delimiten, constituyendo un dilema su diagnóstico diferencial. Analizamos la asociación existente entre variables clínicas y métodos de diagnóstico prequirúrgicos en nódulos tiroideos de estirpe folicular, con el objetivo de definir riesgo de neoplasia.Se estudiaron 92 pacientes con bocios nodulares de estirpe folicular por citología, tratados con tiroidectomía. Las variables analizadas fueron: sexo, edad, tamaño del nódulo, características ecográficas, diagnóstico citológico, nivel de TSH y resultados del centellograma. De los 92 casos, 74 fueron neoplásicos (56 adenomas y 18 carcinomas diferenciados) y 18 nódulos no neoplásicos, hiperplásicos o adenomatosos. Los marcadores que se relacionaron con alto riesgo de neoplasia folicular correspondieron al diagnóstico citológico de proliferación folicular de alto grado, en nódulos iso o hipoecogénicos, e hipocaptantes con I131. Los carcinomas presentaron citología de proliferación folicular de alto grado en nódulos hipoecogénicos, de bordes irregulares con microcalcificaciones e hipocaptantes, en pacientes varones o menores de 20 años. La presencia de macrocalcificaciones e hipercaptación estarían a favor de nódulo de origen benigno.La correlación de los métodos de diagnóstico y variables clínicas en nódulos tiroideos de estirpe folicular nos permitirían delimitar el riesgo de neoplasia y carcinoma para planificar un tratamiento quirúrgico selectivo.

Thyroid nodules of follicular origin include neoplastic and non neoplastic processes. No methods of diagnosis or cytological features (obtained by fine-needle aspiration, FNA) may differentiate both types, and therefore differential diagnosis still constitutes a dilemma.We analyzed the existing association between clinical variables and methods of diagnosis in thyroid nodules of follicular type with the aim of defining risk of neoplasm. Ninety two patients with nodular goiters, of follicular origin by cytology, previously submitted to surgical treatment were analyzed. The studied variables were: sex, age, size of the nodule, ultrasound characteristics, cytological diagnosis, TSH level and results of the scintigraphy. Of 92 cases, 74 were neoplastic nodules (56 adenomas and 18 differentiated thyroid cancer) and 18 were non neoplastic nodules. Markers, that were related to high risk of follicular neoplasm corresponded to the cytological diagnosis of proliferation of high follicular degree, in iso or hypoechoic, and hypofunctioning nodules with I131. The carcinomas presented cytology of follicular proliferation of high degree, in hipoechoic nodules, of irregular edges with microcalcifications and hypofunctioning, in male patients or patients younger than 20 years. The presence of macrocalcifications and hypercaptation would be in favor of nodules of benign origin.The correlation of diagnostic methods and clinical variables in thyroid nodules of follicular type would allow us to differentiate the risk of neoplasm or carcinoma, and plan surgical selective treatments.

Importance of fine needle aspiration in evaluation of single nodular goiter

Improvements in the sensitivity and specificity of biochemical thyroid tests, as well as the development of fine needle aspiration biopsy [FNA] and improved cytological techniques, have dramatically impacted clinical strategies for detecting and treating thyroid disorders. Fine needle aspiration is a safe and relatively painless procedure where a hypodermic needle passed into the lump and samples of tissue taken out. This procedure will provide us with more information about the nature of the lump, and especially differentiate between a benign and malignant mass. The current prospective study designed to evaluate the sensitivity, specificity and accuracy of FNA. The study was performed in the regional major hospital, Khartoum, Sudan. A thousand and three hundred thirty one patients who underwent thyroid surgery between January 2004 to June 2007 were enrolled. 247 [18.3%] had single nodular goiter. The incidence of benign and malignant lesions in single nodular goiter were 204 [87.6%] and 29 [12.4%] respectively. The overall sensitivity, specificity and accuracy of FNA were 95.5%, 99.5% and 99.4% respectively. Also there is correlation between the nodule size and the result of FNA, as the nodular size increase there is increase of the probability of malignant changes. So, solitary or dominant nodules 1cm in diameter might be evaluated by FNA

Thyroid cancer in toxic and non-toxic multinodular goiter.

BACKGROUND: Many authors have claimed that hyperthyroidism protects against thyroid cancer and believed that the incidence of malignancy is lower in patients with toxic multinodular goiter (TMG) than in those with non-toxic multinodular goiter. But in recent studies, it was reported that the incidence of malignancy with TMG is not as low as previously thought. AIM: To compare the thyroid cancer incidence in patients with toxic and non-toxic multinodular goiter. SETTINGS AND DESIGN: Histology reports of patients treated surgically with a preoperative diagnosis of toxic and non-toxic multinodular goiter were reviewed to identify the thyroid cancer incidence. Patients having a history of neck irradiation or radioactive iodine therapy were excluded from the study. MATERIALS AND METHODS: We reviewed 294 patients operated between 2001-2005 from toxic and non-toxic multinodular goiter. One hundred and twenty-four of them were toxic and 170 were non-toxic. Hyperthyroidism was diagnosed by elevated tri-iodothyroinine / thyroxine ratios and low thyroid-stimulating hormone with clinical signs and symptoms. All patients were evaluated with ultrasonography and scintigraphy and fine needle aspiration biopsy. STATISTICAL ANALYSIS USED: Significance of the various parameters was calculated by using ANOVA test. RESULTS: The incidence of malignancy was 9% in the toxic and 10.58% in the non-toxic multinodular goiter group. Any significant difference in the incidence of cancer and tumor size between the two groups could not be detected. CONCLUSIONS: The incidence of malignancy in toxic multinodular goiter is not very low as thought earlier and is nearly the same in non-toxic multinodular goiter.

A thyroid nodule with adipose metaplasia in a nodular goitre: a case report.

Fat containing lesions of the thyroid gland are a rarity with very few cases reported in the literature. We report a case ofa thyroid nodule with adipose metaplasia in a nodular goiter in a 67-year-old female.

Cáncer de tiroides: estudio descriptivo retrospectivo / Thyroid carcinoma: a descriptive retrospective study

Entre todos los tumores, el carcinoma tiroideo (CT) es poco frecuente, se caracteriza por su lenta evolución y elevado porcentaje de curación. Nuestro objetivo es estudiar las características de los pacientes con CT. Analizamos retrospectivamente a 171 pacientes, edad media al diagnóstico 41.1( ± 14.6 años), que consultaron entre los años 2000-04 por CT. Se evaluaron datos de anamnesis, métodos de diagnóstico, anatomía patológica y evolución. Agrupamos a los tumores por el tamaño y según TNM (tumor-adenopatía-metástasis) en estadios (E). La presencia de tiroglobulina estimulada (Tg) > 2 ng/ml e imagen positiva (con 131I u otro radiotrazador) fueron consideradas como positivas para CT residual. De la población total el 88% fue sexo femenino, el 62% menores de 45 años, y el 77.1% tuvo función tiroidea normal. La punción con aguja fina (PAAF) fue diagnóstica en 78%. El 96% fue carcinoma papilar (CTP), 63% presentaban E I; 14% E II; 19% E III y 4% E IV. Se detectó CT residual en el 90% de los pacientes con Tg entre 2 y 10, y en el 100% con Tg > 10 ng/ml, mientras que con Tg < 2 el 18% mostró imagen positiva. No encontramos correlación significativa con antecedentes patológicos ni con ningún signo relevante en imágenes. En conclusión, en nuestra población el CTP fue predominante. Más frecuente en mujeres, en menores de 45 años y en eutiroideos. El nivel de Tg estimulada es un buen indicador de CT residual, pero no es una prueba suficiente para seleccionar pacientes libres de enfermedad

The thyroid carcinoma (TC) is not very frequent among all cancers. Its course is slow and is high potentially curable. Our aim was to analyse the characteristics in patients with TC. A retrospective analysis on 171 patients, with an average age of 41.1 (±14,6), who asked for TC to our service between the years 2000-04, was performed. From case histories it was evaluated: anamnesis, diagnostic image, histopathology and evolution. Tumours were grouped for size and TNM (tumour-nodule-metastasis) in stages (S). A stimulated serum thyroglobulin level > 2 ng/ml and positive image with 131I or another nuclear marker were considered as positive for residual TC. In the totality of the analyzed patients 88% were female, 62% below 45 years old, and in 77% the thyroid function was normal. The fine needle aspiration (FNA) was diagnostic in 78%. Papillary thyroid carcinoma (PTC) in 96%. The 63% was SI; 14% SII; 19% SIII and 4% SIV. During follow-up, we observed that 90% of patients with Tg between 2 and 10 had evidence of residual TC, and 100% with Tg > 10 ng/ml, whereas 18% of those whose stimulated Tg < 2 presented positive image. There was not found significative correlation with pathologic antecedents or relevant image signs. In conclusion: TCP was the most frequent carcinoma in women, in patients younger than 45 years and in those who have euthyroid function. A stimulated serum thyroglobulin level was a good indicator for residual TC, but failed to select those patients who were disease free

Malignancy in nodular goitre

To highlight diagnostic difficulties and evaluate the outcome of malignancy in nodular goiter. Case series. This study was conducted in the Surgical Unit-III and Unit-IV at Liaquat University Hospital Jamshoro, from January 2001 to December 2004. Nodular goiter patients admitted for treatment were studied with the help of a pre-designed proforma for recording the personal history, blood chemistry and FNAC results. The results of FNACs were further compared with the tissue histology postoperatively. During the four year study period 14 patients had malignancy out of total 149 cases of nodular goiter admitted. Twelve patients were diagnosed on FNAC. These patients were operated and near total thyroidectomy was done. Two patients diagnosed to have carcinoma on tissue biopsy [FNAC did not pick the malignancy] were re-admitted and had near total thyroidectomy. One patient with lymphoma was referred to Department of Oncology for radiotherapy. All patients with neoplasm postoperatively were referred to oncology department for further management to suppress the TSH. Near total thyroidectomy is the surgery of choice to decrease the recurrence rate in thyroid malignancies

Relative efficacy of fine needle aspiration cytology in diagnosis of nodular goitre

To evaluate the diagnostic accuracy and limitation of Fine Needle Aspiration Cytology [FNAC] in nodular goiter. The study was carried out at Military Hospital Rawalpindi and the department of Pathology, Army Medical College Rawalpindi from March 2000 to March 2001. It was a comparative study. 145 patients with nodular goiter who reported to outpatient department were selected for FNAC after taking informed written consent; FNAC was done in department of Pathology of Army Medical College. They were again asked for diagnostic surgery but only 54 patients consented for it. The specimens were studied for histopathology. The data was collected and analyzed by comparison of both procedures by using Gallen and Gambino method. FNAC revealed 44 out of 54 [88.1%] cases as benign and 3 [5.55%] as malignant, while 7 [13%] had indeterminate cytology. All benign lesions were confirmed on histopathology except 01 which turned out to be papillary carcinoma. So FNAC has 98.1% accuracy rate with 92% negative predictive and 100% positive predictive value. FNAC has significant efficacy in differentiating malignant lesions from benign lesions of thyroid. However caution is mandatory in a negative report with strong clinical suspicion of malignancy

Squamous metaplasia in a multinodular goiter: a case report.

Squamous epithelium in thyroid is an unusual finding. It is seen in a variety of inflammatory and neoplastic conditions. It's presence has been attributed to metaplastic change of follicular epithelium by some authors and to the persistence of ultimobranchial body by others. We encountered a case of multinodular goiter with groups of squamous cells lining a cystic cavity. We report it because of it's rarity with a brief review of literature.

Extensive squamous metaplasia in nodular goiter--a diagnostic dilemma in the fine needle aspiration (FNA) cytology--a case report.

Metaplastic changes are commonly found at widespread locations occurring in both reactive and neoplastic conditions. They can simulate tumors histologically. Squamous metaplasia is rarely seen in areas of fibrosis and inflammation secondary to hemorrhage in nodular goiters. If it is extensive with associated degenerative changes and present clinically in the form of a nodule, cytopathologist must take care to differentiate this from primary or metastatic squamous cell carcinoma or even anaplastic carcinoma.

Patología nodular del tiroides: citología por aspiración con aguja fina guiada por ecografía / Nodular pathology of the thyroid: cithology for aspiration with fine needle guided by ultrasound

Determinar la utilidad de la citología por aspiración con aguja fina guiada por ecografía en la patología del tiroides. Estudio prospectivo, en 30 pacientes, femeninas, portadoras de patología nodular del tiroides, a quienes se les realizó citología por aspiración con aguja fina guiada por ecografía. Los extendidos obtenidos (mínimo 3), fueron revisados por un experto en patología endocrina. Se correlacionaron los hallazgos ecográficos con los citológicos y estos a su vez con los histológicos (en aquellos casos que pudieron operarse). Hospital Universitario de Caracas Venezuela. Por azar, todas las pacientes correspondieron al sexo femenino, edad promedio 44,23 años ñ 14,27 años. Síntoma más frecuente: nódulo visible por el paciente (60 por ciento). Al examen físico: 93,33 por ciento nódulos palpables. 60 por ciento nódulos únicos. Los nódulos que ecográficamente reportaron: halo periférico, ausencia de calcificaciones, con más del 50 por ciento de contenido quístico, patrón homogéneo, isoecóico, fueron los que se asociaron a mayor numero de citologías adecuadas. Sensibilidad de la citología por aspiración con aguja fina guiada por ecografía 76,66 por ciento. Especificidad de la ecografía para el diagnóstico de nódulos tiroideos: 100 por ciento. La citología por aspiración con aguja fina guiada por ecografía es un método sencillo, eficaz, no invasivo, económico, con buena certeza diagnóstica, por lo cual debe usarse como herramienta de primera línea en el estudio de la patología nodular del tiroides

Solitary nodular goiter: Role of ultrasonography in fine-needle aspiration cytology diagnosis

Purpose: To assess the contribution of ultrasonography to the fine-needle aspiration cytology diagnosis of solitary nodular goiters [SNG]. 759 cases of SNG detected by ultrasonography were subjected to fine-needle aspiration. The age of the patients ranged from 9 to 92 years with a median of 35 years. Male:female ratio was 135:624. May-Gr'nwald-Giemsa-stained smears were reviewed and the cytodiagnosis was correlated with clinical and ultrasonographic findings. The right lobe of the thyroid was more frequently involved [52.3% cases] by solitary nodules compared to the left lobe [33.9% cases] and isthmus [13.8% cases]. 27% of SNG cases missed at clinical examination could be detected because of ultrasonography. The frequency of solid echotexture in colloid goiter without cytologic evidence of cystic degeneration [60.3%] was significantly higher than that observed in colloid goiter with cystic degeneration [32.6%, p < 0.001]. The difference of solid echotexture between hyperplastic nodules [55.4%] and colloid goiter [38.5%] was also statistically significant [p < 0.02]. The frequency of solid echotexture and homogeneous hypoechoic pattern in neoplastic goiter [65.4 and 21.2%, respectively] was significantly higher than that in nonneoplastic lesions [43.3 and 8.6%, respectively, p < 0.01]. Ultrasonography, besides its use in the detection of solitary nodules and selection of appropriate areas for aspiration, correlated with cytological interpretation in the majority of cases. However, ultrasonography cannot replace cytologic diagnosis as the specificity and positive predictive values are not sufficiently accurate