The Bethesda System for Reporting Thyroid Cytopathology: Validating at Tribhuvan University Teaching Hospital

Abstract Introduction Fine needle aspiration cytopathology (FNAC) is widely used for the stratification of thyroid nodules. Objective The objective of the present study is to validate FNAC reporting based on The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) at our institution and to calculate the risk of malignancy in each category. Methods This was a descriptive cross-sectional study conducted jointly at the Department of Ear, Nose and Throat and at the Department of Pathology for a period of 1.5 years (May 2018 to November 2018). All cases presenting with thyroid swelling in the outpatient department were investigated with ultrasonography (USG) of the neck, thyroid function test, and FNAC. All FNAC reporting was done according to TBSRTC. Results A total of 134 thyroidectomies were performed during the study period. The female to male ratio was 5.3:1. The age ranged from 11 to 74 years old. with a mean age of 51 years old. The FNAC has a specificity of 84.9%, a sensitivity of 89.4%, a positive predictive value of 86.4%, a negative predictive value of 88.2%, and an accuracy of 87.3% in detecting thyroid cancer. The implied risk of malignancy (ROM) in Bethesda II, III, IV, V and VI is 11.7%, 25%,40%,76.6% & 96%, respectively. Conclusion The four studied categories had a ROM comparable to other studies, except for the Bethesda III category. Further studies with larger sample sizes and with the use of USG guidance for the aspiration from the thyroid swelling may give better results by reducing the number of false negative and false positive cases.

Sinus Histiocytosis with Massive Lymphadenopathy (Rosai-Dorfman Disease): A Case Report and Literature Review

Introduction Rosai-Dorfman disease (RDD) is a rare histiocytic proliferative disorder of unknown etiology. Usually it presents with massive painless cervical lymph node enlargement. Histologically, it shows proliferation of distinctive histiocytic cells that demonstrate emperipolesis in the background of a mixed inflammatory infiltrates. Immunohistochemically, the cells are positive for markers such as CD68 and S100. Objective To report a case of a 12-year-old patient with multiple sites of cervical lymphadenitis, which was diagnosed as RDD histopathologically as well as immunohistologically. Resumed Report A 12-year-old girl presented with multiple painless sites of cervical lymphadenitis without any systemic and other ear, nose, and throat manifestations. The biopsy report of the lymph node showed dilatation of the sinuses, filled with histiocytes having foamy cytoplasm. Many of the histiocytes were engulfing mature lymphocytes. The sinus histiocytes were strongly positive for S-100 protein. Conclusion RDD must be considered in the differential diagnosis of massive or multiple lymphadenopathies...

Foreign body pyriform sinus: an unusual presentation.

This is a case report of a foreign body (chicken bone) on the left pyriform sinus impacted in its lateral wall. Although it could be seen on x-ray soft tissue neck lateral view and on CT scan of the neck, the foreign body could not be found by rigid oesophagoscopy which was done twice. It was detected and removed by lateral pharyngotomy under GA. A brief review of literature is also included.

Kikuchi-Fujimoto disease: a rare cause of cervical lymphadenopathy.

Kikuchi-Fujimoto Disease (KFD) is a self-limiting, necrotizing, histiocytic lymphadenitis (NHL) of unknown etiopathogenesis. So far in Nepal not a single case of this disease in the cervical region leading to progressive inspiratory stridor has been reported till date. Here a case of 26 years old Nepalese house wife suffering from this disease, which is histopathologically proved as KFD with complete recovery is presented.