Résumé
Background: Thyroid gland is an endocrine organ. The non-neoplastic and neoplastic conditions affecting the gland can manifest as the swelling of the gland with thyroid dysfunction. Based on cytology, the diseases can be categorized into non-neoplastic, benign neoplastic, and malignant neoplastic conditions and according to hormone status, the lesions of thyroid can be categorized in hypothyroid, euthyroid, or hyperthyroid condition. Aims and Objectives: Our study was done to find out the various cytomorphological spectrum of thyroid diseases and to record their common clinical presentation along with hormonal status in a tertiary care hospital in Northern Odisha. Materials and Methods: A total of 220 cases of thyroid disorder were taken for analysis over a period of 2 years. Patients demographic data, brief clinical features, finding on FNAC (cytomorphology), and thyroid function status were analyzed with appropriate statistical method. Results: The predominant age group affected was 21–40 years and total female to male patient ratio was 5.5:1. Most common presentations were heat intolerance (22.27%), cold intolerance (28.63%), and tachycardia (27.72%) apart from thyroid enlargement. Most common non-neoplastic lesion were multinodular and colloid goiter constituting 38.18% of total cases and most common neoplastic lesion was papillary carcinoma constituting 14.55% of total cases. Thyroid function test showed predominantly euthyroid states for all conditions. Conclusion: As the rest part of India, this part of Odisha also showed that thyroid disorders are more common in females and the most affected age group is 21–40 years. Multinodular and colloid goiter are the most common thyroid lesions. Most of the cases present with euthyroid state.
Résumé
Background: Solitary thyroid lesions are a common presentation in the surgical OPD. The signi?cance of solitary nodule is its malignant potential. Thyroid nodule is an elusive clinical problem. Surgeons and Physicians are often required to make a diagnostic or management decision in its treatment. To study the Aim and Objectives: correlation between Clinical, Radiological, Cytological and Histopathological ?nding in patients who presented with “solitary thyroid nodule”. A prospective observational study, Ramakrishna Mission Materials and Methods:Study design: Study area: Seva Pratishthan Hospital, Kolkata, July 2019 to June 2022(3 years), 40 patients, Inclusion criteria: Study period: Sample size: Patients presenting with solitary thyroid nodule, Patients with multinodular goitre, patients with carcinoma Exclusion criteria: thyroid with distant metastasis, paediatric patients and those unwilling. Thorough history, clinical examination, Methodology: investigation (FNAC/USG/Isotope Scan, TSH), appropriate surgical intervention and HPE of excised specimen was done. Results: In our study of 40 cases, 28(70.0%) were colloid goiter, 7(17.5%) were papillary carcinoma, 2(5%) were follicular adenoma, 1(2.5%) was follicular carcinoma, 1(2.5%) was adenomatoid hyperplasia and 1(2.5%) was Hashimoto thyroiditis. 28(70%) cases underwent hemithyroidectomy, 11(27.5%) underwent total thyroidectomy and 1(2.5%) underwent hemithyroidectomy followed by revision total thyroidectomy. 2 cases of papillary carcinoma with enlarged neck nodes underwent total thyroidectomy with neck node dissection. Solitary nodule is most common in woman and in third Conclusion: and fourth decade of life, more common in the right lobe. USG and FNAC are common modalities of investigations with high speci?city and sensitivity. Isotope scan is only indicated to con?rm the toxic nodule. Malignancy reported in my study was 20%. Early diagnosis and prompt treatment will cure the disease since carcinoma thyroid is more curable amongst all cancers.
Résumé
Background: Lymph node metastasis (LNM) is evident in about 20–50% of cases at presentation in papillary carcinoma thyroid (PTC). There are no clear recommendations for the need and extent of lateral and central compartment dissection in PTC. Methods: A total of 83 patients who underwent total thyroidectomy and bilateral selective neck dissection for diagnosed PTC from September 2011 to October 2017 were retrospectively analyzed. Results: Tumor site was bilobar or involving isthmus in 40 patients. Contralateral LNM was seen in 42 patients. Both radiological (median size 2.6 cm, P = 0.051) and pathological (median size 3.65 cm, P = 0.015) size of tumor, tumor involving isthmus or bilateral lobes (P = 0.006), and lymphovascular invasion (LVI) (P = 0.026) had significant correlation with contralateral LNM. Conclusion: Size and site of tumor, ipsilateral lateral compartment nodes involvement, and LVI status of tumor significantly increases the probability of contralateral LNM in patients of PTC.
Résumé
Background: Multinodular goiter (MNG) occurs due to repeated hyperstimulation of thyroid gland due to iodine deficiency, goitrogens, antithyroid drugs and genetic defects. MNG can have different complications which include treacheal compression, retrosternal extension, malignancy and secondary thyrotoxicosis. The aim of the work was to study the clinical features and histopathology of MN in patients admitted for thyroidectomy in surgical wards of a tertiary care hospital in north Kerala.Methods: A prospective hospital based observational study in the patients in surgical wards of a tertiary care hospital in north Kerala from April 2011 to March 2012. The clinical data of patients who are subjected to thyroidectomy for MNG (clinical and fine needle aspiration cytology diagnosis) were included in this study. Patients undergoing completion thyroidectomy for recurrence or malignancy were excluded from this study.Results: MNG is more common in females. Female to male ratio 24:1 Majority are in the age group of 30-50 years (64%) with a mean age of 41 years. 38% (38 cases) had pressure symptoms in the form of dysphagia or dyspnea. Secondary thyrotoxicosis seen in 17% (17 cases). Fine needle aspiration cytology (FNAC) is not an error-proof investigation in MNG. 14 % of our patients had malignancy inspite of being reported as benign in FNAC. Among the malignancies papillary carcinoma thyroid was found to be most common accounting for 12% of cases (12/100) followed by follicular carcinoma.Conclusions: FNAC is not an error proof investigation in MNG. Incidental thyroid cancer in MNG is about 14 % with papillary carcinoma thyroid being the commonest.
Résumé
Background: Diseases of the thyroid gland are one of the most common endocrine disorders in India and the world, many of these diseases require surgery for their treatment. The incidence of thyroid diseases differs from one geographical area to another. This study was aimed at finding out the thyroid pathologies for which thyroid surgeries were performed in D. Y. Patil Hospital, Nerul, Navi Mumbai.Methods: It is a retrospective analysis of all the patients who have undergone thyroid surgeries (lobectomy, hemithyroidectomy, subtotal or near total thyroidectomy or total thyroidectomy) in D. Y. Patil hospital, Nerul, Navi Mumbai from 1st January 2018 to 31st December 2019 (2 years duration).Results: Most common pathology for which thyroidectomy was performed was colloid goitre (41.33%). Benign diseases of the thyroid was much more common (76%) than malignant diseases (24%). Most common malignancy was papillary carcinoma thyroid. Thyroid surgeries were most commonly performed on women in their 5th decade of life.Conclusions: Colloid goitre was the most common pathology for which thyroid surgeries were performed and females in their 5th decade of life were the most common patients undergoing thyroidectomy.
Résumé
Papillary carcinoma of thyroid accounts for 80% of all thyroid malignancies. They tend to have a female preponderance and present in the 4th to 5th decade of life, as a slow growing midline mass. Cervical metastases are common, blood borne being rare. We present a case of a 29 years old who presented with cervical lymphadenopathy that was secondary to an occult papillary carcinoma of thyroid. Patient underwent total thyroidectomy with bilateral neck node dissection for the same.
Résumé
The incidence of papillary carcinoma of thyroid has shown an increase in the last few decades. One contributing factor is the identification of Papillary Microcarcinoma of thyroid. Papillary Microcarcinoma is defined as a papillary carcinoma which is ≤ 10 mm in size in the greatest dimension. Though it is associated with excellent prognosis, controversies still exist regarding the treatment and follow up of these patients.METHODSThis study is a retrospective study done in a tertiary care hospital in South India over a period of one year from July 2016 to June 2017. All surgically removed thyroid specimens submitted to the Pathology Department of the hospital were studied. The demographic details, clinical features, ultrasound and other imaging studies were obtained from the medical records. The FNAC findings, gross features of surgically removed thyroid and histopathological findings of these thyroid specimens were recorded and analysed. The records of the follow up of these patients were obtained from the corresponding clinical department.RESULTSAmong the 486 thyroid samples received, 59 (12.13%) were malignant tumours of the thyroid, out of which Papillary carcinoma was seen in 50 cases (84.7%) including 11 cases of Papillary Microcarcinoma constituting 18.6% of all thyroid malignancies and 2.26% of thyroidectomies during the study period. Mean age of patients with PMC was 43.9 with a female: male ratio of 10:1. 10 cases were incidental PMC, while one was suspected to be papillary carcinoma on ultrasound examination and FNAC. Only one patient showed high risk features of multifocality, extrathyroidal extension and lymph node metastases. Hence she was given RAI. All patients were followed up. No recurrence has been noted in the two year period of follow up.CONCLUSIONSPapillary Microcarcinoma is being increasingly diagnosed, most of them being incidental. Hence thorough histopathological examination is mandatory to identify these lesions. Though PMC has an excellent prognosis, aggressive treatment may be required in patients with high risk features including nonincidental, lymph node metastasis, multifocality, and extra-thyroid extension.
Résumé
Background: Blood supply to the thyroid is relatively high when compared to that of liver. Despite this documented metastatic deposit in thyroid remains a rarity. Synchronous nonthyroidal metastatic deposit in thyroid from a lung primary is relatively rare. Metastasis to thyroid portends to poor prognosis, and hence a metastatic deposit has to be excluded in any suspicious lesion of thyroid. Materials and Methods: Details of a rare presentation of a malignant thyroid lesion, a secondary deposit from an asymptomatic primary papillary adenocarcinoma of lung, who had presented to this tertiary care center was retrieved and analyzed. Results: Patient with an initial diagnosis of papillary carcinoma on FNA was taken up for total thyroidectomy and cervical lmphadenectomy. HPR was mucinous carcinoma of thyroid with high lymph nodal metastasis. In view of the exrathyroidal disease an adjuvant external beam radiotherapy was considered for him. Unfortunately, the radiotherapy planning CT scan revealed left sided lung lesions with pleural effusion which was proved to be papillary adenocarcinoma of lung on biopsy, with metastases to thyroid. He was treated with chemotherapy but he succumbed to his illness 9 months from the date of diagnosis. Conclusion: Although encountered rarely, metastatic lesions in thyroid from nonthyroidal primaries need to be excluded while evaluating thyroid lesions
Résumé
A 36-year-old female presented with lump in the left breast of 2 months duration. Fine-needle aspiration cytology (FNAC) and trucut biopsy confirmed the diagnosis of carcinoma. Clinically, it was T3N1Mx disease. Computed tomography (CT) of the chest detected bilateral lung metastasis. CT head and neck detected a nodule in the thyroid which on FNAC was suspicious of papillary carcinoma. The patient was started on chemotherapy for breast disease with a good initial response; however, while on-follow up, there was progression of disease at primary site. The patient was taken up for surgery. Radical mastectomy along with total thyroidectomy was performed. Histopathological examination showed infiltrating duct carcinoma, not otherwise specified type and papillary carcinoma thyroid. There was a 0.4 cm × 0.4 cm metastatic focus, from breast carcinoma within the papillary carcinoma thyroid. The metastasis was confirmed by immunohistochemistry. Metastasis to thyroid is rare. However, tumor-to-tumor metastasis with papillary carcinoma serving as recipient to breast carcinoma is exceedingly rare with very few case reports in the literature. We report this case for its rarity and also for highlighting the fact that pathologists should keep in mind the possibility of metastasis also when coming across unusual morphology in thyroid lesions.
Résumé
Background: Fine needle aspiration of thyroid neoplasm is cost effective procedure to differentiate between benign and malignant lesions in most of the cases. Aim: To evaluate the accuracy of FNAC in diagnosis of different thyroid lesions, particularly differentiation of malignant and non malignant lesions. Materials and methods: Study comprised of 220 cases of thyroid FNAC’s which were followed by excision biopsy. Their FNAC’s diagnosis was compared with histopathological diagnosis. Results: Among 220 cases of FNAC’s 151 was diagnosed as benign (68.63%), 58 cases as malignant (26.36%) and 11 case as follicular neoplasms (5.0%). Colloid goitre represented the majority of benign cases while papillary carcinoma was the most frequent malignant lesion. Cytological findings were compared with their corresponding histopathological findings. Conclusion: Benign and malignant thyroid lesions can be differentiate accurately by FNAC however certain pitfalls should be kept in mind.
Résumé
The medullary thyroid carcinomas (MTC) comprise 5-10% of all thyroid carcinomas. It is known to show many cyto-architectural variations. The WHO classification of thyroid tumors includes an entity called mixed medullary-papillary carcinoma, a rare malignancy known to represent <1% of all thyroid malignancies. Fewer than 40 such cases have been reported so far and include tumors showing morphological features of both medullary carcinoma and papillary carcinoma with immunoreactivity for calcitonin and CK19 &thyroglobulin respectively. We report a case of a 27-year-old female with complaints of gradually increasing neck swelling for 2 years, with difficulty in swallowing in the last 2 months. The swelling was more localized towards left. Ultrasound neck revealed a nodule in the left lobe of thyroid with benign features most likely nodular colloid goiter. Thyroid profile of the patient was normal. FNA revealed sheets and follicles lined by both hyperplastic and involutional follicular cells. Few micro follicles showed pleomorphic cells having hyperchromatic nuclei and mild anisonucleosis. A diagnosis of colloid goiter was given on cytology; however, on grounds of suspicion of a neoplastic process, histopathology was advised. The patient underwent total thyroidectomy. Hematoxylin & Eosin stained sections showed features of mixed medullary-papillary carcinoma of the thyroid which was further confirmed on Immunohistochemistry and raised serum calcitonin levels. It is important to know about this entity due to its prognostic implications, association with other endocrine disorders and to prevent any diagnostic dilemmas.
Résumé
Thyroid carcinoma occuring as a second primary associated with head and neck squamous cell carcinoma (SCC) is unusual. This report presents a synchronous thyroid carcinoma and squamous cell carcinoma in the anterior palate region of a 41-year-old man. The clinical, radiologic, and histologic features are described. At 10-month follow-up after operation, no evidence of recurrence and metastasis was present.
Sujets)
Adulte , Humains , Carcinome épidermoïde , Études de suivi , Tête , Cou , Métastase tumorale , Palais , Récidive , Glande thyroide , Tumeurs de la thyroïdeRésumé
Objective To analyze the clinical characteristics,diagnosis and treatment of thyroid micro-carcinoma.Methods The clinical data of 52 cases of thyroid micro-carcinoma operated from 2003 to 2008 were analyzed retrospectively.Results All of the 52 cases were confirmed as thyroid micro-carcinoma by postoperative pathologic exam;30 cases(57.7%) were discovered by intraoperative frozen section and 22 cases were not.Micro-calcification ratio on ultrasound was 35.19%.11 cases were diagnosed as malignant tumor on ultrasound scan preoperatively.Lobectomy of involved lobe with subtotal thyroidectomy of contra-lateral lobe was performed in 38 cases,3 cases of bilateral total thyroidectomy,3 cases of unilateral lobectomy and isthmectomy,5 cases of ipsilateral subtotal lobectomy and 3 cases of ipsilateral lobectomy with isthmectomy were performed.Combined central region lymph nodes dissection was adopted in 27 cases(positive 11/27,40.74%).Follow-up rate was 96.2%,with time ranging from 3 months to 5 years.No recurrence or mortality was discovered.Conclusions(1)B type ultrasound is the first choice for preoperative screening.(2) lpsilateral thyroid lobectomy with contralateral subtotal thyroidectomy combined with central region lymph node dissection is advocated.
Résumé
Objective To study the treatment of differentiated thyroid carcinoma. Method The clinical data and, in partricular, the treatment modalities of 173 cases of differentiated thyroid carcinoma were retrospectively analyzed.Results All of the 173 patients were treated by resection and subsequent endocrine therapy.Different types of operations were selected in accordance with the clinical stages.No perioperative deaths occurred.There were altogether 30 operative complications including nerve injury.Ninety-one patients were followed up for over 5 years and no deaths occurred.Jugular lymphatic metastases occurred in 4 patients, sternum metastases in 2 and lung metastasis in 1.Conclusion Surgical resection and endocrine therapy are highly effective for the treatment of differentiated thyroid carcinoma.