Hemithyroidectomy Specimen Research Articles

Primary Cavernous Hemangioma of the Thyroid Gland

Abstract: Hemangioma of the thyroid gland is a rare diagnosis and less than 35 cases have been previously published in the literature. The pathogenesis is unknown but it is suggested to be a developmental anomaly which is associated with an incapability of angioblastic mesenchyma to form canals. On microscopic examination, it should be distinguished from reactive endothelial hyperplasia, angiosarcoma or hemangiosarcoma. We report a case of a primary thyroid hemangioma, with nonspesific US appearance. Cytologic findings were nondiagnostic and final diagnosis was made at pathologic examination of the hemithyroidectomy specimen.

Prevalence and Predictors of Malignancy in Contralateral Thyroid Lobe in Patients Undergoing Completion Thyroidectomy.

(1) To determine prevalence of malignancy in contralateral lobe (CL) in patients undergoing completion thyroidectomy (CT) and to study complications of CT. (2) To analyze clinical, ultrasonography(USG) findings and histopathological features of the tumor in ipsilateral lobe (IL) that could predict malignancy in CL. Retrospective chart review of 40-patients who first underwent hemi-thyroidectomy for fine-needle-aspiration (FNA) diagnosed benign lesions followed by CT between September-2017 and November-2019. Histopathology reports from both surgeries, along with patient characteristics and USGfeatures of initial hemi-thyroid lobe were reviewed. Thirty-two (80%) of the 40 patients were female. Mean age of presentation was 38.2years (Range = 19-61years). Malignancy was found in 22(55%) contralateral-lobes of 40 completion thyroidectomies performed. Multi-focality of tumor in first surgery was only factor with significant association with presence of malignancy in CL (OR = 5.53, 95% CI 1.01-30.35, p = 0.048).In terms of USG-findings, most common suspicious feature in IL was peripheral/rim calcification, with TIRADS ≥ 4 was present in 19 patients but none of features could significantly predict bilateral disease. Three (7.5%) patients developed permanent unilateral recurrent-laryngeal-nerve (RLN) palsy (2-following initial surgery and 1-following CT). Fourteen (35%) patients developed hypoparathyroidism following CT of whom 12 were symptomatic and 4(10%) proceeded to permanent hypoparathyroidism. There were no other major complication following CT. Multifocality in initial hemithyroidectomy specimen was most frequently associated with malignancy in CL. Preoperative TIRADS ≥ 4 of IL may be considered a risk factor for bilateral malignancy. CT may be performed in FNA misdiagnosed thyroid cancers as there is high prevalence(56%) of disease in CL. CT is safe and it eradicates disease in CL.

Primary Thyroid Lymphoma in an Adult Male: A Rare Presentation

Primary Thyroid Lymphoma (PTL) is a rare entity prevalent in middle to old aged females. They are predominantly B-cell Non-Hodgkin’s Lymphoma (NHL), among which Diffuse Large B-Cell Lymphoma (DLBCL) is the most common subtype. Here, the authors have described a case of PTL in a male patient which is extremely rare. The patient presented with a swelling over anterior aspect of neck and dysphagia since two months. Fine Needle Aspiration Cytology (FNAC) of thyroid swelling and following immunocytochemistry showed B-cell NHL. Histopathological and Immunohistochemical (IHC) examination was also done thereafter on right hemithyroidectomy specimen, which revealed a non-germinal centre type of DLBCL. Histopathological examination revealed an antecedent chronic lymphocytic thyroiditis in this patient. With this case, it was evident that early diagnosis of thyroid lymphoma can be possible with FNAC. However, false negative diagnosis can occur on non-representative aspiration sample. Besides this, it is challenging for a pathologist to subtype the lymphoma on cytology smear. Hence, histopathological examination along with Immunohistochemistry (IHC) is imperative for accurate diagnosis of PTL. The patient had received three cycles of chemotherapy and follow-up of 11 months was uneventful.

Completion Thyroidectomy for Differentiated Thyroid Cancers: Predicting Contralateral Disease

About 12% of the Indian population present with a thyroid nodule to the surgeon, who is then faced with a clinical dilemma if the fine needle aspiration cytology (FNAC) is inconclusive or indeterminate, and the ultrasonogram of the neck is also not contributory. The extent of surgery and the need for a second surgery always weighs on the mind of the surgeon and the patient. We attempt, in our study, to identify a few pathological features in a hemithyroidectomy specimen which would predict the occurrence of malignancy in the opposite lobe. To determine the pathologic predictors of malignancy in the contralateral thyroid lobe, in patients of differentiated thyroid cancer (DTC) who underwent hemithyroidectomy. A retrospective review of the case records of all patients who underwent thyroid surgery in our Institute between January 2010 and December 2014 was undertaken. Various pathologic parameters were analyzed with respect to their predictive power regarding the occurrence of malignancy in the opposite lobe. Three hundred eighty-nine patients underwent thyroid surgery during the above period, of which 91 patients underwent completion thyroidectomy, as they were found to have malignancy in the hemithyroidectomy specimen. The effect of age, gender, and tumor size on bilaterality could not be established statistically. Other variables such as perithyroidal spread and perineural invasion also did not demonstrate statistical significance. Multifocality of the tumor in the hemithyroidectomy specimen, lymphovascular invasion, and capsular invasion were the pathologically significant factors determining the presence of malignancy in the contralateral lobe. Multifocality, lymphovascular invasion, and capsular invasion can be used as additional markers to decide on performing a completion thyroidectomy in a patient of differentiated thyroid cancer.

English

BACKGROUND: Hyalinising trabecular tumors of thyroid is an interesting but uncommon neoplasm of thyroid. This is presented because of its peculiar morphologic features, including encapsulation, trabecular pattern and marked hyalinization. OBJECTIVES: To know the morphologic feature and its histological behavior. METHOD: Hemithyroidectomy specimen was received with fixative. The specimen was grossed, bits were taken from appropriate areas & processed in Histokinette, embedded in paraffin and the serial sections were stained with Hematoxylin & Eosin. RESULTS: Histologically, showed encapsulated cellular growth, composed of follicular cells arranged in trabecular and follicular pattern. They are separated by fibrous bands and areas of abundant hyalinization seen. The nuclei of the cells were vesicular with indistinct nucleoli, having pale vacuolated cytoplasm. CONCLUSION: Hyalinizing trabecular tumor is an uncommon neoplasm with its peculiar morphologic features. It is sometimes mistaken for other neoplasm like- Papillary carcinoma, insular carcinoma & paraganglioma.. Hence histologic evaluation of cytomorphologic features is important for definitive diagnosis.

Head and neck manifestations of 22q11.2 deletion syndromes

The allelic loss of 22q11.2 results in various developmental failures of pharyngeal pouch derivatives ("22q11.2 deletion syndromes", 22q.11DS), consequently affecting the anatomy and physiology of head and neck (H&N) organs. The objective of this paper was to describe those manifestations. Two 22q11.2DS patients with H&N manifestations were studied along with a comprehensive review of the English literature, from 1975 to 2010 regarding the associated H&N malformations among 22q11.2DS. A 24-year-old mentally disabled 22q11.2DS male presented with right hemithyroid enlargement, causing significant compressive signs. Sonography revealed a homogeneous 8 × 3 cm lesion, replacing almost the entire thyroid lobe. Fine needle aspiration revealed colloid material and abundant eosinophils. The hemithyroidectomy specimen confirmed follicular adenoma. A 19-year-old mentally disabled 22q11.2DS female underwent CT-angiography due to an upper GI bleeding. The study revealed a vascular malformation in the infratemporal fossa. Reviewing the reported data regarding 22q11.2DS-associated H&N malformations revealed abnormalities and malfunctions of the thyroid gland, parathyroid glands, thymus agenesis, cleft palate, carotid artery aberrations, malformations of the larynx and trachea and esophageal dysmotility. 22q11.DS patients may present with H&N anatomical abnormalities, along with hormonal dysfunctions, which require special awareness once treatment is offered, especially when concerning anesthetic and surgical aspects. In addition, hSNF5/INI1, a tumor suppressor gene, detected at location 22q11.2 was described to be "knocked out" in some patients. This may be associated with H&N tumors reported in these patients.

Fine‐needle aspiration biopsy of monophasic variant of spindle epithelial tumor with thymus‐like differentiation of the thyroid: Report of one case and review of the literature

Spindle epithelial tumor with thymus-like differentiation (SETTLE) is a rare biphasic tumor of the thyroid with approximately 20 well-documented cases reported in the English literature. Although a monophasic variant of SETTLE is conceivable, the majority of the reported cases were truly biphasic tumors. A minimal amount of epithelial component was present in the reported cases of so-called spindle-cell predominant SETTLE. Here, we report an apparently monophasic case of SETTLE in a 16-yr-old girl, in which no epithelial cells were identified in either fine-needle aspiration biopsy (FNAB) or the subsequent hemithyroidectomy specimen. The FNAB smears were moderately cellular and composed of single and loosely grouped spindle cells with homogenous metachromatic material, which could be mistaken as amyloid, erroneously suggesting medullary thyroid carcinoma. The compact nodules of uniform spindle cells in histology sections raised the possibility of monophasic synovial sarcoma. The spindle cells stained positive for both cytokeratin and vimentin, but were negative for thyroglobulin and calcitonin as well as neuroendocrine markers, confirming the diagnosis of SETTLE.

ONCOCYTES OF THE THYROID: A NEUTRAL RED DYE UPTAKE STUDY

Oncocytosis and oncocytomas have attracted attention because on the one hand there have been reports of the favourable prognosis and generally benign nature of oncocytic tumours, while on the other hand, Hurthle cell change in thyroid neoplasms have been reported to be correlated with aggressive biological behaviour and a significantly worse clinical course. Presently, there appear to be two schools of thought on the significance of oncocytosis: (i) a process where there is redifferentiation of cells with involvement in the pathogenesis of cancer; and (ii) a compensatory process for 'functional exhaustion' of the cell. Many aspects of oncocytosis seem unclear. In this study, transmission electron microscopy is used to demonstrate the presence of thyroid oncocytes in the hemithyroidectomy specimen of a patient with focal lymphocytic thyroiditis. Tissue sections from this specimen did not display preferential uptake of neutral red dye, a distinctive characteristic of M-phase cancer cells which was previously reported. The findings seem to suggest that oncocytes are not cells with distinctive proliferative potentials. If that were the case, then oncogenesis or cancer cell progression and oncocytosis may not be convergent processes.