Benign Thyroid Lesions Research Articles

The cytological diagnosis of a 'benign thyroid lesion': is it a real safe diagnosis for the patient?

In fine needle aspiration cytology (FNAC), the category of benign thyroid lesions (BTL), which constitutes 65-70% of all thyroid FNAC, and can be correctly diagnosed by morphology alone, is an important entity. A diagnosis of BTL denotes a lesion managed with follow-up unless found in conjunction with compressive symptoms. Although this diagnosis can be quite simple, there are cases in which the scant cellular or colloid component may pose diagnostic issues. Herein, we describe the experiences of evaluating BTL at two large academic institutions. We evaluated the clinical importance of a correct diagnosis of BTL to define the exact inherent risk of a false-negative result (FNR). From January 2008 through to June 2013, 506 (3.6%) out of 15 850 patients with BTL underwent surgery. All nodules were sampled under sonographic guidance (US) and processed either with liquid-based cytology (LBC), Diff-Quik® smears or alcohol-Papanicolaou staining methods. The histological follow-up of 506 BTL series included 493 benign and 13 malignant lesions. The latter group included four follicular carcinomas (FC), two classic variants of papillary thyroid carcinoma (PTC), one macrofollicular PTC and six follicular variants of PTC (FVPC). The malignancy rate for the BTL category was 2.5%. When diagnosed by expert cytopathologists, BTL represents a robust diagnosis and might reduce the number of FNR. Additional diagnostic experience and a large case series could enable cytopathologists to recognise all the morphological entities of BTL. An important additional aid is the extensive sampling of the lesions to reduce issues related to a low cellularity.

Thyroiditis: a Clinico-cytomorphological Study with a Reference to the Ethnic Groups of Northeast Regions of India.

Definite clinico-cytological criterion is outlined for thyroid lesions. Fine needle aspiration cytology (FNAC) makes it easier to segregate cases of thyroiditis (Chronic lymphocytic thyroiditis/Hashimoto's thyroiditis-CLT/HT, and subacute thyroiditis-SAT) from other benign and malignant lesions of thyroid. The study was done for a period of 5½ years at a diagnostic centre in Guwahati. Patients underwent FNAC and smears were studied for cytomorphology. A correlation with clinical features and thyroid function, including antithyroid antibody estimation, was done, wherever possible. 792 thyroid lesions were encountered during the study, of which 213 (26.89%) were cases of thyroiditis (70.43% CLT/HT, 24.9% SAT and 3.76% having overlapping features of CLT/HT and SAT); 2 cases (0.9%) of CLT showed suspicion of Non-Hodgkin's Lymphoma (NHL), which was confirmed on histopathology. 24 cases (11.26%) belonged to different ethnic tribal groups of Northeast India. CLT/HT presented predominantly with diffuse thyroid enlargement, but 12 cases (8% of CLT/HT cases) had nodular enlargement. Patients presented with predominantly hypothyroidism; however occasional hyperthyroid cases were also seen. SAT showed signs of inflammation and presented with hyperthyroidism. Overlap cases of CLT/HT and SAT showed combined clinico-cytomorphological features of both lesions. 37.5% cases with overlapping features belonged to tribal communities. A rise in incidence of thyroiditis, particularly CLT/HT, was seen. Overlap features of CLT/HT and SAT was noticed in significant percentage. No bias was noticed amongst any specific tribal community. FNAC, coupled with clinico-serological study, helps to diagnose thyroiditis at early stage.

Retrospective analysis of TGF-β 1 expression in patients with thyroidectomy.

To investigate the relationship between the expression of transforming growth factor β1 (TGF-β1) and thyroid lesions by retrospective analysis in patients with thyroidectomy. Immunohistochemical analyses of TGF-β1 were performed with 120 archived formalin-fixed and paraffin-embedded thyroid resection tissue samples that included 60 cases of thyroid cancers (papillary thyroid carcinoma, follicular thyroid carcinoma), 14 cases of nodular goiter (NG), 16 cases of thyroid adenoma, 15 cases of Graves disease, 15 cases of Hashimoto's thyroiditis. The pathological analysis of resection thyroid showed a high coincidence with that diagnosed by preoperative fine needle aspiration biopsy (FNAB), with coincidence rate of 84.48%. The results showed that the expressions of TGF-β1 in the thyroid cancers were significantly higher than in other benign thyroid lesions and normal thyroid tissues (P < 0.05). Moreover, high expression of TGFβ1 was found to closely related with the occurrence of thyroid cancers, while there was no significant difference of TGFβ 1 expression between different thyroid cancers. The overexpression of TGF-β1 is associated with the occurrence of thyroid cancer, which can be used as a candidate for the diagnosis and prognosis of thyroid cancer.

A Pilot Study of Galectin-3, HBME-1, and p27 Triple Immunostaining Pattern for Diagnosis of Indeterminate Thyroid Nodules in Cytology With Correlation to Histology.

Indeterminate thyroid nodules form a heterogenous group of lesions that constitute 5% to 30% of thyroid cytology diagnoses. We introduce a triple immunostaining protocol for subtyping. Galectin-3, HBME-1, and p27 triple immunostaining, performed on destained cytology slides and formalin-fixed paraffin-embedded tissue, was developed and applied to 51 patients retrospectively with preoperative cytologic diagnoses of follicular lesion of undetermined significance (n=40), atypia of undetermined significance (n=6), and suspicious for follicular neoplasm (n=5). The malignant rate in this series was 43.1% (22/51). A hierarchal evaluation algorithm was generated based on digital image quantitation of triple-stained histologic sections, and applied to both cytology and histology specimens. Fifty of 51 cytology cases have triple staining validated by internal controls. In cytology specimens, the individual sensitivities and specificities of p27, Galectin3, and HBME1 for cancer with 95% confidence interval are: 86.2% (0.674, 0.955)/66.7% (0.431, 0.845); 77.3% (0.542, 0.913)/72.4% (0.525, 0.866); and 72.7% (0.496, 0.884)/93.1% (0.758, 0.988), respectively. Sensitivity is increased to 95.5% (0.751, 0.998), but specificity is decreased to 69.0% (0.490, 0.840), if Galectin3 and HBME1 are both used in combination as markers for malignancy. However, the level of specificity is increased to 86.2% (0.674, 0.955) and sensitivity remains high 100% (0.808, 1) if in addition, using the Galectin3/HBME1:p27 ratio (ratio ≥2 indicating malignancy) for 2 or 3 markers positive cases. Thus, the triple staining method on cytology slides and histology sections shows a similar sensitivity/specificity/positive predictive value/negative predictive value of 100.0%/86.2%/84.0%/100.0% and 95.5%/86.2%/84.0%/96.2%, respectively (P=0.92). Overall, p27 is the most frequent single positive marker (19/50, 38% in cytology), consistent with benign nature of most indeterminate thyroid nodules. Galectin-3 and HBME-1 colocalization (positive in the same cell) was demonstrated in thyroid cancer in 45.5% (10/22) of histology sections, but in none of the normal thyroid tissues and benign thyroid lesions. This supports the notion that synchronous activation of Galectin-3 and HBME-1 occurs in thyroid malignancy and is highly specific for malignancy. We have demonstrated the performance and pattern of triple immunostaining for subtyping indeterminate thyroid nodules. Further studies and validation in different larger populations are warranted.

Application value of fine needle aspiration and cell block in preoperative diagnosis of thyroid cancer and discrimination of follicular tumor

To study the application value of fine needle aspiration and cell block combined with molecular markers in early diagnosis of thyroid cancer and discriminate follicular tumor before operation. Fine needle biopsy of thyroid nodules was guided by color ultrasound, then the sample acquired was used to make smear and the rest to make cell block. The pathological diagnosis on smear, cell block or combination of both was made respectively. Then, the Envision immunohistochemical method was employed to detect the expressions of CK19, Galectin-3 in cell block samples, which had been used for the diagnosis of papillary thyroid carcinoma or thyroid nodules from benign lesions after operation and to detect the expressions of DDIT3, ki-67 of cell block that had been used for the diagnosis of follicular tumor nodules. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of cytopathology for the diagnosis of malignancy were 95.3%, 94.7%, 92.7%, 96.6% and 95.0% respectively; and the sensitivity, specificity and accuracy of the diagnosis used cell block alone or combined with smear were 88.1%, 95.3%, 92.3% and 95.3%, 94.7%, 95.0% respectively, which were higher than 53.8%, 83.7%, 71.3% from smear correspondingly. The positive expression rate of CK19 and Galectin-3 of papillary thyroid carcinoma cell block were 100% and 98.0% respectively, higher than the value 17.7% and 23.3% of thyroid benign lesions (P < 0.01); the positive expression rate of DDIT3 of thyroid follicular cancer cell block was 84.6%, higher than the value 35.1% of follicular adenoma (P < 0.01), there was no statistical significance of Positive expression rate of Ki-67 between thyroid follicular carcinoma and follicular adenoma cell block (P > 0.05). It was conducive to early diagnose thyroid cancer with detection of CK19, Galection-3 of cell block made by ultrasound-guided fine needle biopsy of thyroid nodules. And it was also significant for DDIT3 detection to early discriminate follicular neoplasm before operation.

Clinical Significance of EphB4 and EphB6 Expression in Human Malignant and Benign Thyroid Lesions.

Ephrin receptors (Ephs) are frequently overexpressed in a wide variety of human malignant tumors, being associated with tumor growth, invasion, angiogenesis and metastasis. The present study aimed to evaluate the clinical significance of EphB4 and EphB6 protein expression in human malignant and benign thyroid lesions. EphB4 and EphB6 protein expression was assessed immunohistochemically on paraffin-embedded thyroid tissues obtained from 127 patients with benign (n = 71) and malignant (n = 56) thyroid lesions. Enhanced EphB4 and EphB6 expression was more frequently observed in malignant compared to benign thyroid lesions (p = 0.0508 and p = 0.0006, respectively). EphB4 and EphB6 expression also provided a distinct discrimination between papillary carcinoma and hyperplastic nodules (p = 0.0302 and p = 0.0013, respectively). In malignant thyroid lesions, enhanced EphB4 expression was significantly associated with larger tumor size (p = 0.0366). Enhanced EphB6 expression was significantly associated with larger tumor size (p = 0.0366), the presence of lymph node metastases (p = 0.0023), the presence of capsular (p = 0.0038), lymphatic (p = 0.0053) and vascular invasion (p = 0.0018) and increased risk of recurrence rate (p = 0.0038). The present study supported evidence that EphB4 and mainly EphB6 may participate in the malignant thyroid transformation, reinforcing their utility as useful biomarkers and possible therapeutic targets in this type of neoplasia.

MicroRNA-106b-mediated down-regulation of C1orf24 expression induces apoptosis and suppresses invasion of thyroid cancer.

We previously showed that C1orf24 expression is increased in thyroid carcinomas. Nonetheless, the mechanism underlying C1orf24 deregulation is not fully understood. It has been widely demonstrated that microRNAs are involved in post-transcriptional gene regulation in several diseases, including cancer. Using in silico prediction approach, five microRNAs that bind to the 3'-untranslated region (3'-UTR) of C1orf24 were identified. The expression of two selected microRNAs (miR-17-5p, miR-106b) and the expression of C1orf24 were tested in 48 benign and malignant thyroid lesions and in five thyroid carcinoma cell lines. miR-106b was down-regulated in thyroid cancer specimens and thyroid carcinoma cell lines, while C1orf24 expression was markedly increased. To demonstrate that miR-106b reduces C1orf24 expression, follicular (WRO) and papillary (TPC1) thyroid carcinoma cell lines were transiently transfected with miR-106b mimic. Ectopic expression of the miR-106b mimic significantly inhibits C1orf24 mRNA and protein expression in both WRO and TPC1 cells. Dual-luciferase report assays demonstrated that miR-106b directly targets C1orf24 by binding its 3'-UTR. Moreover, miR-106b-mediated down-regulation of C1orf24 expression increased apoptosis and inhibited migration. We additionally demonstrated that siRNA against C1orf24 significantly decreased its expression, inhibited cell migration and cell cycle progression while induced apoptosis. In summary, our findings not only provide new insights into molecular mechanism associated with C1orf24 overexpression in thyroid carcinomas but also show that C1orf24 might increase proliferation and cell migration. Thus, decreasing C1orf24 levels, by restoring miR-106b function, may have therapeutic implications.

Radiofrequency ablation for thyroid nodules: which indications? The first Italian opinion statement.

Nodular thyroid disease is a very common finding in clinical practice, discovered by ultrasound (US) in about 50 % of the general population, with higher prevalence in women and in the elderly [1–4]. Whereas therapeutic flowchart is quite established and shared for malignant lesions, multiple options are now available for patients presenting with benign thyroid nodules, ranging from simple clinical and US follow-up to thyroid surgery. The majority of thyroid nodules, benign by fine-needle aspiration, are asymptomatic, stable, or slow-growing over time and require no treatment. Nevertheless, large thyroid nodules may become responsible for pressure symptoms, resulting in neck discomfort, cosmetic complaints, and decreased quality of life. Partial/total thyroid surgery has so far constituted the only therapeutic approach for these. Although surgery is widely available, highly effective, and safe in skilled centers, complications (both temporary and permanent) still occur in 2–10 % of cases [5, 6]. Hypothyroidism is an unavoidable effect after total thyroidectomy, requiring lifelong l-thyroxine replacement therapy. Besides, surgery is expensive and may be not recommended for high-risk patients or refused by others. Radioiodine (131I) therapy has been proven to be effective to treat toxic multinodular goiters and autonomously functioning thyroid nodules (AFTN) [7], although they are usually more radioresistant than toxic diffuse goiters [8]. Radioiodine therapy normalizes thyroid function and significantly reduces thyroid volume. However, hypothyroidism often occurs, in up to 60 % of patients, several years after treatment [9]. Otherwise, radioiodine therapy shows only incomplete, weak effects in nonfunctioning cold thyroid nodules. Pretreatment with recombinant human TSH may improve goiter volume reduction by causing a more homogeneous distribution of radioiodine within the gland, especially increasing the uptake of 131I in scintigraphically relatively cold areas [10]. TSH-suppression therapy withl-thyroxine was widely used to achieve nodule shrinkage and to prevent nodule growth and formation, producing, however, controversial results and exposing patients to heart and bone side effects. Therefore, current guidelines do not recommend its routine use in clinical practice, suggesting its usefulness in some cases only [3, 4]. Over the last two decades, nonsurgical, minimally invasive, US-guided techniques have been proposed for the treatment of thyroid nodules [11–16]. Percutaneous ethanol injection (PEI) is recommended for the treatment of relapsing cysts and dominantly cystic thyroid nodules [17]. Because of the limitations of PEI in the management of solid thyroid nodules, hyperthermic methods (laser ablation and radiofrequency ablation) have been introduced afterward for the treatment of solid, benign thyroid lesions [18], achieving marked nodule size reduction and clinical improvement in nodule-related symptoms, in several series from skilled centers, especially in Korea and Italy. Other nonsurgical therapies, such as high-intensity focused-ultrasound (HIFU), microwaves, cryotherapy, and electroporation, are presently under investigation.

Differential protein expression profiles of cyst fluid from papillary thyroid carcinoma and benign thyroid lesions.

Cystic papillary thyroid carcinoma (cPTC) is a subgroup of PTC presenting a diagnostic challenge at fine needle aspiration biopsy (FNAB). To further investigate this entity we aimed to characterize protein profiles of cyst fluids from cPTC and benign thyroid cystic lesions. In total, 20 cPTCs and 56 benign thyroid cystic lesions were studied. Profiling by liquid chromatography tandem mass spectrometry (LC-MS/MS) was performed on cyst fluids from a subset of cases after depletion, and selected proteins were further analyzed by Western blot (WB), immunohistochemistry (IHC) and enzyme-linked immunosorbent assay (ELISA). A total of 1,581 proteins were detected in cyst fluids, of which 841 were quantified in all samples using LC-MS/MS. Proteins with different expression levels between cPTCs and benign lesions were identified by univariate analysis (41 proteins) and multivariate analysis (59 proteins in an orthogonal partial least squares model). WB analyses of cyst fluid and IHC on corresponding tissue samples confirmed a significant up-regulation of cytokeratin 19 (CK-19/CYFRA 21-1) and S100A13 in cPTC vs. benign lesions. These findings were further confirmed by ELISA in an extended material of non-depleted cyst fluids from cPTCs (n = 17) and benign lesions (n = 55) (p<0.05). Applying a cut-off at >55 ng/ml for CK-19 resulted in 82% specificity and sensitivity. For S100A13 a cut-off at >230 pg/ml revealed a 94% sensitivity, but only 35% specificity. This is the first comprehensive catalogue of the protein content in fluid from thyroid cysts. The up-regulations of CK-19 and S100A13 suggest their possible use in FNAB based preoperative diagnostics of cystic thyroid lesions.

Mo1496 Endoscopic Ultrasound Guided (EUS) Fiducial Marker Placement Without Fluoroscopy - Safety and Technical Feasibility

Mo1496 Endoscopic Ultrasound Guided (EUS) Fiducial Marker Placement Without Fluoroscopy - Safety and Technical Feasibility

High Diagnostic Accuracy Based on CLDN10, HMGA2, and LAMB3 Transcripts in Papillary Thyroid Carcinoma.

Thyroid nodules are common in adult population and papillary thyroid carcinoma (PTC) is the most frequent malignant finding. The natural history of PTC remains poorly understood and current diagnostic methods limitations are responsible for a significant number of potentially avoidable surgeries. This study aimed to identify molecular markers to improve the diagnosis of thyroid lesions. Gene expression profiling was performed using microarray in 61 PTC and 13 surrounding normal tissues (NT). A reliable gene list was established using cross-study validation (138 matched PTC/NT from external databases). Results were collectively interpreted by in silico analysis. A panel of 28 transcripts was evaluated by RT-qPCR, including benign thyroid lesions (BTL) and other follicular cell-derived thyroid carcinomas (OFDTC). A diagnostic algorithm was developed (training set: 23 NT, 8 BTL, and 86 PTC), validated (independent set: 10 NT, 140 BTL, 120 PTC, and 12 OFDTC) and associated with clinical features. GABRB2 was ranked as the most frequently up-regulated gene in PTC (cross-study validation). Altered genes in PTC suggested a loss of T4 responsiveness and dysregulation of retinoic acid metabolism, highlighting the putative activation of EZH2 and histone deacetylases (predicted in silico). An algorithm combining CLDN10, HMGA2, and LAMB3 transcripts was able to discriminate tumors from BTL samples (94% sensitivity and 96% specificity in validation set). High algorithm scores were associated with regional lymph node metastases. A promising tool with high performance for PTC diagnosis based on three transcripts was designed with the potential to predict lymph node metastasis risk.

Utility of FNAC in the Clinicopathologic Evaluation of Benign Thyroid Lesions

Background: Thyroid swellings are common clinical presentations in the male and females, majority of them are benign in nature and do not require surgery. Fine needle aspiration cytology in the diagnosis of thyroid lesions is an easy and cost-effective method. Aim of this study was to assess the effectiveness of FNAC in the evaluation of benign thyroid lesions by clinical, histopathologic analysis and compare the consistency of the results with the literature. Materials and Methods: Over a period of 3 years prospective study done from January 2001 to December 2003 in the cytopathology department, Sri Venkateswara Medical College, Tirupati, Andhra Pradesh. Two hundred and fifty (250) cases of palpable and clinically benign thyroid lesions were analyzed by fine needle aspiration, preceded by thorough clinical evaluation. Out of these 250 cases only 65 patients under went surgical excision and these were available for histopathological correlation. Staining techniques used are Haematoxylin and Eosin and May-Grun Wald Giemsa stain. Results: out of 250 cases, 65 were available for histopathological correlation. Among which 10 had malignant, which were excluded from the present study. Out of 55 benign thyroid lesions 20(36.3%) cases were Multinodular goiter, 17(30.9%) were Follicular adenoma, 10(18.1%) were Hashimoto’s thyroiditis. Sensitivity, specificity, positive predictive value, negative predictive values were 90,100,100 & 98.21 % respectively. Finally accuracy rate was 98.46%. Conclusion: Fine needle aspiration cytology is a simple, cost effective, rapid to perform procedure with high degree of accuracy and is recommended as first line investigation for the diagnosis of thyroid lesions.

Diagnostic criteria of well differentiated thyroid tumor of uncertain malignant potential; a histomorphological and immunohistochemical appraisal

BackgroundWell differentiated thyroid tumor of uncertain malignant potential (WDT-UMP) represents a true “gray zone” of “follicular patterned” thyroid lesions, that needs to be characterized in order to outright the diagnosis of carcinoma and avoid unnecessary aggressive treatment. AimTo emphasize on the histomorphological criteria for more accurate diagnosis of WDT-UMP. Also to compare the immunohistochemical expression of CK19 of WDT-UMP versus adenoma and papillary thyroid carcinoma (PTC). Materials and methodsThe study included 60 thyroid specimens; 18 WDT-UMPs, 24 PTC (18 classic variant and 6 follicular variants) and 18 benign thyroid lesions (8 adenoma, 6 Hashimoto’s thyroiditis and 4 hyperplastic nodules). H&E stained sections were assessed according to the published major and minor criteria of malignancy in the thyroid. CK 19 immunostaining was examined and evaluated according to the proportion and intensity scores. ResultsWe could detect the absence of nuclear inclusions, presence of characteristic nuclear groove, nuclear clearing, ovoid nuclei, nuclear crowdness, nuclear enlargement and pleomorphism as important reliable features for diagnosis of WDT-UMP with p value (<0.0001 for each). WDT-UMP showed moderate to strong CK 19 immunostaining with proportion scores 3 and 4; an intermediate expression profile; higher than adenoma and less than papillary carcinoma (p<0.0001). ConclusionThe constellations of both major and minor criteria of malignancy are important clues for WDT-UMP diagnosis which could be ascertained by CK 19 immunostaining.

Expression of follicle stimulating hormone receptors (FSHR) in thyroid tumours - a marker of malignancy?

BackgroundIn normal conditions FSHR are expressed in granulosa cells of the ovary and Sertoli cells of the testis. They can be expressed also in gonadal tumours. However, recently the expression of FSHR was found in tumoral cells and intra-tumoral blood vessels of many other tumours, including thyroid tumours. Aim of this study was to see whether the expression of FSHR can be useful in the differentiation of benign and malignant thyroid lesions.Methods44 samples of surgically excised thyroids were immunostained with anti- FSHR antibody raised against 1–190 amino acid sequence from the human FSHR.ResultsNon-neoplastic thyroid follicles (i.e. the follicles situated outside the tumour) do not show the immunostaining for FSHR. The same concerns the majority of follicular adenomas. In contrast, 87.5% of follicular cancers, the same percentage of papillary cancers and all the examined undifferentiated cancers showed the FSHR immunopositivity of tumoral cells. A tendency towards the higher frequency of FSHR – positive blood vessels also concerns malignant thyroid tumours.ConclusionsThe ectopic FSHR immunostaining seems to be useful to differentiate malignant from benign lesions, especially follicular cancers from follicular adenomas. However, the further studies on larger material are needed.

Clinical significance of HMGA1 and HMGA2 expression in papillary thyroid carcinoma

Objective To study the relationship of high mobility group A(HMGA)1 and HMGA2 expressions with the occurrence, development, and metastasis of papillary thyroid carcinoma. Methods Fresh and paraffin-embedded 35 cases of papillary thyroid carcinoma tissues(PTC)and corresponding paracancerous thyroid tissues(PT), and 10 cases of normal tissues(NT)from adjacent thyroid benign lesions were collected.The mRNA and protein expressions of HMGA1 and HMGA2 were detected by realtime PCR and immunohistochemistry respectively. Results The mRNA expressions of HMGA1 and HMGA2 showed nearly no expression in the NT group, no significant difference between PT group and NT group(P>0.05), and significantly higher expression in PTC group compared with NT group(173.5 folds and 5.9 folds, both P 0.05). The mRNA and protein expressions of HMGA1 were significantly higher than those of HMGA2 in PTC group(P<0.05 or P<0.01). Conclusions The overexpressions of HMGA1 and HMGA2 were related to development and metastasis of papillary thyroid carcinoma. Compared with HMGA2, HMGA1 was a better molecular marker in identifying benign and malignant thyroid tumors. (Chin J Endocrinol Metab, 2015, 31: 18-22) Key words: Thyroid cancer, papillary; High mobility group A

Ultrasound sonoelastography in the evaluation of thyroiditis and autoimmune thyroid disease.

Sonoelastography (USE) is a constantly evolving imaging technique used for the noninvasive and objective estimation of tissue stiffness. Several USE methods have been developed, including Quasi-Static or Strain Elastography and Shear Wave Elastography. The utility of USE has been demonstrated in differentiating between malignant and benign thyroid lesions. Recently, USE has been applied in the evaluation of thyroiditis and autoimmune thyroid disease (AITD).Thyroid inflammatory illnesses constitute a diverse group of diseases and may manifest various symptoms. These conditions may share some parallel clinical, biochemical, and ultrasonographic features, which can lead to diagnostic difficulties. USE may be an additional tool, supporting other methods in the diagnosis and treatment monitoring of thyroid diseases, other than thyroid nodular disease.The aim of this article was to analyse and summarise the available literature on the applicability of different elastographic techniques in the diagnosis, differentiation and monitoring of various types of thyroiditis and AITD. Advantages and limitations of this technique are also discussed.

Clinical Significance of Cannabinoid Receptors CB1 and CB2 Expression in Human Malignant and Benign Thyroid Lesions.

The endocannabinoid system is comprised of cannabinoid receptors (CB1 and CB2), their endogenous ligands (endocannabinoids), and proteins responsible for their metabolism participate in many different functions indispensable to homeostatic regulation in several tissues, exerting also antitumorigenic effects. The present study aimed to evaluate the clinical significance of CB1 and CB2 expression in human benign and malignant thyroid lesions. CB1 and CB2 proteins' expression was assessed immunohistochemically on paraffin-embedded thyroid tissues obtained from 87 patients with benign (n = 43) and malignant (n = 44) lesions and was statistically analyzed with clinicopathological parameters, follicular cells' proliferative capacity, and risk of recurrence rate estimated according to the American Thyroid Association (ATA) staging system. Enhanced CB1 and CB2 expression was significantly more frequently observed in malignant compared to benign thyroid lesions (p = 0.0010 and p = 0.0005, resp.). Enhanced CB1 and CB2 expression was also significantly more frequently observed in papillary carcinomas compared to hyperplastic nodules (p = 0.0097 and p = 0.0110, resp.). In malignant thyroid lesions, elevated CB2 expression was significantly associated with the presence of lymph node metastases (p = 0.0301). Enhanced CB2 expression was also more frequently observed in malignant thyroid cases with presence of capsular (p = 0.1165), lymphatic (p = 0.1989), and vascular invasion (p = 0.0555), as well as in those with increased risk of recurrence rate (p = 0.1165), at a nonsignificant level though, whereas CB1 expression was not associated with any of the clinicopathological parameters examined. Our data suggest that CB receptors may be involved in malignant thyroid transformation and especially CB2 receptor could serve as useful biomarker and potential therapeutic target in thyroid neoplasia.

Pattern and frequency of thyroid pathologies among thyroid cytology specimen in rural part of central India: A retrospective secondary data analysis

Background: Thyroid nodules are very frequent, with an annual incidence rate of 4-8%. Thyroid fine needle aspiration cytology (FNAC) is more than 50 years old and is the principal method of preoperative diagnosis in both children and adults. Aims: (1) To assess the pattern and frequency of thyroid lesions in cytology, (2) To study the correlation of thyroid lesions with different age groups (3) To identify the frequency benign and malignant thyroid lesions in cytology, (4) To report the thyroid lesions in Bethesda system of reporting pattern on cytology. Settings and Design: Rural Institute of Medical Science and research is a 750 bedded tertiary care institute. This is a retrospective study. Materials and Methods: 300 thyroid lesion (from December 2012 to May 2014) who attended the pathology department of Rural Institute of Medical Science and research was taken and association between variables and thyroid lesions were observed. Thyroid lesions were also classified according to Bethesda system of reporting. Statistical Analysis Used: SPSS. Results: Male to female ratio was 1:9. Frequency of benign thyroid lesions is 78% with the most common diagnosis being colloid nodule and colloid cyst. Thyroid malignancies were diagnosed in 5% cases. Bethesda category I included 11%, category II 78%, category III (AUS/FLUS) 2%, category IV (Follicular Neoplasm) 3%, category V (Suspicious of malignancy) 1%, category VI (malignant) 5%. Conclusions: Thyroid lesions can be efficiently classified on cytology.The Bethesda system has proved useful and helped improving communication between cytopathologists and clinicians leading to consistent management.

Cytological patterns of thyroid lesions at Gondar University Hospital, Northwest Ethiopia: A retrospective study

Background: Thyroid lesion is a common disorder of endocrine system worldwide. Characterizing varies type of the lesions in a given setup has paramount importance to design effective strategy. As a result, the purpose of this study was to find out the frequency of various cytological thyroid lesions in Gondar University Hospital. Method: A retrospective data of 1010 thyroid lesions, which were registered from 2009-2013 on fine needle aspirate cytology log book, were included in the study. Descriptive statistics were done to determine the proportion of the thyroid lesions. Results: Of the total patients underwent thyroid cytological examination, 768(76%) were females. More than half of thyroid lesions were observed in patients who were under 30 years old. Benign thyroid lesions (916(90.7%)) were the commonest followed by malignant and neoplastic lesions which account 41(4.1%) and 38(3.76%) respectively. Colloid goiter (862/919(93.8%)), follicular neoplasm (30/38(78.9%)) and papillary carcinoma (25/41(61%)) were the major subtype of benign, neoplasm and malignant lesions respectively. Thyroid tuberculosis was also found in 3 (0.29%) cases of benign lesions. Conclusion: Benign lesions were the predominant thyroid lesion; of which the proportion of colloid goiter was higher compared to other subtype of benign thyroid lesions. Unusual benign lesions like thyroid tuberculosis were also observed. Malignant thyroid lesions had also contributed significant amount. Future research with histological technique, detail socio-demographic information and clinical feature is crucial to determine the patterns of thyroid lesions and associated factors.

Use of supravital toluidine blue staining to improve the efficiency of fine-needle aspiration cytology reporting in comparison to papanicolaou stain.

Objective:To see the efficiency, adequacy and accuracy of toluidine blue stained smears of FNAC of Breast thyroid and salivary glands swelling with comparison to conventional stained FNAC smears with Papanicolaou.Methods:A total of 114 aspirates from various sites were included in the study. The smears were stained with toluidine blue and conventional Papanicolaou stain and the cytomorphology of both the smears were compared. The values were tabulated and statistical tests of significance was applied.Results:Of the 114 aspirates included in our study the diagnostic accuracy by using papanicolaou was 78%, while it was upto 100% with supravital toluidine blue stained smears. The percentage of inadequacy was reduced to just 25%. The observations were statistically significant. Breast 37/48 (77%) and Salivary glands 11/48 (23%) respectively. The most commonly used categorization of a five-tier system was used for reporting of breast cytology, with categories ranging from insufficient materials (C1), benign (C2), atypical (C3), suspicious of malignancy (C4), or (C5) frankly malignant. Most of breast lesions were benign 25 (67.56%). There were only 9 (24.32%) malignant cases followed by 2 cases of C-4 and one case of C-3. Benign thyroid lesion were more frequent comprising of 51 (72.27%) cases. One case (1.5%) of papillary carcinoma was found while 13 case were follicular lesions. There were 4 (36.4%) cases of pleomorphic adenoma and 3 (27.3) cases of non-specific sialadenitis. There was one case (9%) of each lesion for mucoepidermoid carcinoma, adenoidcytic carcinoma and benign cyst.Conclusion:Toluidine blue stained study of FNAC improves the diagnostic accuracy by minimizing the smearing and drying artifact, loss of cell sample during fixation and staining which influences the diagnostic accuracy.