Colloid Nodules Research Articles

Detection of BRAF Gene Mutation in Preoperative Diagnostic of Thyroid Gland Cancer

Purpose: To assess the utility of BRAFV600E mutation detection in preoperative thyroid cancer diagnostic. Material and methods: We studied 46 aspirates taken by FNA from patients with thyroid gland nodes. Thyroid tissue aspirates DNA was extracted by sorbent method. BRAF gene mutation was analyzed with primers specific for wild and mutant gen type by RT-PCR. Results: All patients were divided into three groups by cytological conclusions: colloid nodules (9), PTC (19), and suspicious for malignancy (18). In the group of patients with PTC all diagnoses were confirmed by histology, and BRAF gene mutation was detected in 15 (79%) FNAB specimens. In the group with suspicious cytological diagnosis only one patient had follicular cancer by histology and positive BRAF mutation. There were detected no BRAF mutation in 16 patients with histologically proven follicular adenoma, in 9 patients with colloid nodular goiter and in one patient with follicular cancer. Thereby, we received the following criteria valuers of method’s reliability: sensitivity – 76%, specificity – 100%, diagnostic accuracy – 89%. Conclusions: Detection of the BRAFV600E mutation may be a useful adjunct marker for preoperative diagnostic of thyroid gland cancer.

Insulin-Like Growth Factor mRNA Binding Protein 3 (IMP3) is Differentially Expressed in Benign and Malignant Follicular Patterned Thyroid Tumors

Insulin-like growth factor mRNA binding protein 3 (IMP3) is an mRNA-binding protein that regulates transcription of insulin-like growth factor II affecting cell proliferation during embryogenesis. It is highly expressed in carcinomas of the pancreas, stomach, colon, rectum, kidneys, uterine cervix, lung, and ovary. The purpose of our study was to evaluate IMP3 expression in thyroid follicular lesions, to determine whether it has a role in differentiating among these lesions, and to understand their biological relationships. We immunostained 219 thyroid lesions selected from our surgical pathology archives including 14 hyperplastic colloid nodules (CN), 19 Hashimoto's thyroiditis (HT), two Graves disease (GD), ten Hürthle cell adenoma (HCA), 20 follicular adenoma (FA), 37 conventional papillary thyroid carcinoma (PTC), 60 follicular variant of papillary carcinoma (FVPC), 19 Hürthle cell carcinoma (HCC), 32 follicular carcinoma (FC), and six poorly differentiated/anaplastic carcinoma. Immunohistochemistry was performed on formalin-fixed sections using monoclonal antibody to IMP3. Clinicopathological data were also reviewed. In all cases, residual thyroid tissue, CN, HT, GD, HCA, and FA were completely negative for IMP3 staining. Of the 60 FVPC, 23 tumors (38%) were positive for IMP3, with 13 of these (22%) showing very strong staining (3+). Of the 32 FC, 22 tumors (69%) were positive, with seven (22%) showing very strong staining (3+). Furthermore, 33 out of 37 cases (89%) of PTC were negative for IMP3. In all four PTC cases that did stain positive, staining was weak-moderate (1-2+). Similarly, 15 out of 19 cases (79%) of HCC were negative. No significant correlation was found between pathologic tumor characteristics and IMP3 expression in differentiated follicular pattern thyroid carcinoma. With 100% specificity and 69% sensitivity for FC as compared to FA and 100% specificity for FVPC, again compared to FA, IMP3 has the potential to be diagnostically useful in differentiating malignant and benign follicular pattern thyroid lesions. This study also points to a possible common biological relationship between FC and FVPC that requires further investigation.

A correlation study of diagnostic fine‐needle aspiration with histologic diagnosis in cystic neck lesions

The clinical diagnosis of a mass in the neck region encompasses a wide spectrum of differential diagnosis. Fine-needle aspiration is a quick and safe technique, which can provide useful information for initial assessment and further therapeutic measures. The aim of this retrospective study was to evaluate the performance characteristics of the fine-needle aspiration (FNA) in cystic neck lesions. Of 142 patients with FNA for cystic neck masses during 2002-2007, 92 cases were selected with a follow-up histologic diagnosis, excluding the cystic colloid nodule of the thyroid. The cases were divided into salivary gland cystic neck (37 patients) and non-salivary cystic neck (55 patients) mass groups. False-positive and false-negative diagnoses were applied only to the malignant lesions after confirmation by histopathology. In the first group, nine malignant and 28 benign diagnoses were made by FNA; of which three were false-negative. In the second group, there were nine malignant and 46 benign diagnoses with three false negatives. The overall performance of the FNA showed 76% sensitivity and 100% specificity. In conclusion, FNA of the cystic neck lesions offers an invaluable and highly specific initial diagnostic approach for the management of the patients.

Utility of a Liquid-Based, Monolayer Preparation in the Evaluation of Thyroid Lesions by Fine Needle Aspiration Biopsy

To retrospectively compare the diagnostic accuracy and cytomorphologic features of thyroid lesions on ThinPrep (TP) (Cytyc Corporation, Boxborough, Massachusetts, U.S.A.) monolayer preparations with those of the conventional smear (CS) method on fine needle aspiration biopsy (FNAB).Slides of 145 TP and 145 CS consecutive cases of thyroid FNAB were retrospectively reviewed for the following features: amount and architecture of follicular cells, nuclear and cytoplasmic details, amount and quality of colloid, background blood, cyst fluid and macrophages, and lymphocytes and plasma cells. These were semiquantitatively scored 0-4 for each parameter.The TP slides more often had higher cellularity with flat clusters, while CS slides more often had 3-dimentional clusters. The CS slides displayed better morphology and more preserved follicular cells with intact cytoplasm and crisper nuclei, while TP slides revealed shrunken cells with fragmented cytoplasm and dark, often-naked nuclei. The amount of colloid was generally more abundant on the CS slides, while it appeared as small, dense droplets (thick colloid) or as folded tissue paper-like material (thin, watery colloid) on the TP slides. The CS more often had a bloody background obscuring the cells, while the TP slides had a clear background. Simple thyroid cysts were more often detected on TP than CS slides by the presence of cyst fluid and macrophages. The 2 methods had almost similar diagnostic rates for chronic thyroiditis (11% TP vs. 12% CS) and atypical/neoplastic lesions (3.4% each). The 2 methods had similar diagnostic correlation for colloid nodules (49% TP vs. 45.5% CS), but the nondiagnostic rate was lower in TP (24%) than CS slides (31%).Although there are cytomorphologic differences between the TP and CS methods, including better cellular preservation and details on CS, the TP method shows a lower nondiagnostic rate, similar diagnostic rate for chronic thyroiditis and atypical/neoplastic lesions, and slightly better diagnostic rate for colloid nodules. The 2 methods complement each other, and we strongly recommend that they both be performed on all thyroid FNAB cases.

Regional hemodynamic changes in nodular goiter

The goal of the present study was to evaluate the clinical and diagnostic value of regional hemodynamic changes in the thyroid vessels and carotid beds in patients with different forms of nodular goiter in order to optimize further follow-up and treatment. The study covered 120patients aged 25 to 40years (mean age 32.82±0.36 years) who had nodular goiter. A control group comprised 30 women comparable by age (mean age 32. 06±0. 44 years), who had a morphologically and functionally unchanged thyroid. After examined, the patients with nodular goiter were divided into group according to the identified morphological forms. Group 1 consisted of25 (20.8%) women (mean age 34.85±0.89 years) with signs of nodular malignancies; Group 2 included 35 (29.2%) patients (mean age 32.08±0.78years) with detected adenomas; Group 3 comprised 40 (33.3%) patients (mean age 33.6±1.08years) with colloidal nodules, and Group consisted 20 (16.7%) women (mean age 32.87±0.9 years) with signs of cysts. The study and comparison of the linear and volume parameters of arterial ducts to the euthyroid loves in nodular pathology were made, by taking into account the site of an abnormal focus and its morphological structure. The linear and volumetric bloodflow rates in the thyroid arteries ipsilaterally to the abnormal nodular of any morphological structure were found to be significantly higher (p < 0.05). Changes were revealed in blood flow parameters in the carotid bed in relation to the morphological structure of nodules.

Hemosiderin laden macrophages and hemosiderin within follicular cells distinguish benign follicular lesions from follicular neoplasms

Background:Published criteria to distinguish benign colloid nodules from follicular neoplasms emphasize only three interdependent features: size of follicles, amount of colloid, and cellularity. There is a need for the validation of other independent criteria.Methods:This study quantified the significance of cystic change, defined as presence of macrophages, and the presence of hemosiderin in either the macrophages or follicular cells. The cohort consisted of 165 patients with fine needle aspiration (FNA) and histologic follow-up of either goiter (101), follicular adenoma (47), or follicular carcinoma (17). Papillary thyroid carcinomas and Hürthle cell neoplasms were excluded from the cohort, because these categories are known to show cystic change and hemosiderin. FNAs were reviewed blindly with the most cellular slide scored for the presence of macrophages and/or hemosiderin.Results:Hemosiderin within macrophages were seen in 67% (68 of 101) of the goiters and only 6% (four of 64) of follicular neoplasms (P<.0001). All four follicular neoplasms with hemosiderin in macrophages were adenomas. Three of these four had equivocal features of a benign colloid nodule histologically. None of the 17 follicular carcinomas had hemosiderin in macrophages (P<.12). Macrophages without hemosiderin also strongly distinguished goiters from neoplasms (83% vs 17%) but appears less useful as a criterion since macrophages were present within 3 of 17 follicular carcinomas. Hemosiderin within follicular epithelial cells was present in 18% (18 of 101) of goiters, whereas none of the 64 follicular neoplasms had intraepithelial hemosiderin (P<.0003).Conclusions:If papillary thyroid carcinoma and Hürthle cell neoplasm are ruled out, our findings indicate that the presence of hemosiderin virtually excludes a clinically significant follicular neoplasm.

One in Four Patients with Follicular Thyroid Cytology (THY3) Has a Thyroid Carcinoma

Fine-needle aspiration (FNA) biopsy is the cornerstone of assessment of thyroid nodules. Cytological criteria for benign (THY2) and malignant (THY5) aspirates are well established and reliable. When cytology suggests a follicular neoplasm (THY3), only formal histological assessment can differentiate between benign and malignant lesions. The objective of this study was to determine the factors predictive of malignancy in thyroid nodules when cytological assessment is restricted to euthyroid patients living in an area without endemic goiter who undergo routine diagnostic lobectomy once the FNA raises the suspicion of a follicular neoplasm. Retrospective review of histological and clinical data in a cohort of patients with a palpable thyroid nodule and THY3 cytology. Between January 2000 and December 2007, 1981 patients (346 males and 1635 females) underwent 2809 thyroid FNAs. There were 201 THY3 reports (9%). Histology demonstrated thyroid carcinomas in 57 patients (31 follicular carcinomas, 11 Hurthle cell carcinomas, 11 papillary carcinomas, 1 medullary thyroid carcinoma, 1 poorly differentiated thyroid cancer, 1 lymphoma, and 1 metastatic renal carcinoma). Benign tumors were found in 144 patients with follicular adenomas (n = 76), Hurthle cell adenomas (n = 33), multinodular goiter (n = 13), adenomatoid nodules (n = 15), colloid nodules (n = 4), and thyroiditis (n = 3). THY3 cytology was more predictive of malignancy in men (13/34 male symbol vs. 44/167 female symbol, p < 0.001, chi(2) test). The risk for malignancy was 1:4 for the entire group and 1:3 for patients under 30 years and over 60 years. About 17/46 nodules over 40 mm in diameter were carcinomas, compared with only 35/140 in nodules under 40 mm (p < 0.01, chi2 test). One in four patients with cytological features of a follicular neoplasm has a thyroid carcinoma. A large nodule (>4 cm) with THY3 cytology has a high likelihood of being a cancer, and arguably such patients could be offered total thyroidectomy rather than diagnostic lobectomy.

Multiple thyroid cysts as an extra-renal manifestation of ADPKD.

A 44-year-old female with autosomal dominant polycystic kidney disease (ADPKD) developed end-stage renal failure by 36 years of age and had been successfully transplanted 6 years ago. Renal transplant function was stable and current immunosuppression was with prednisolone, azathioprine and ciclosporin. Her past medical history included treatment of a middle cerebral artery berry aneurysm. The patient was presented to the A&E department with the sudden onset of painful swelling on the left-sided neck. Clinical examination revealed a 3-cm left-sided thyroid swelling. There was no associated local or regional lymphadenopathy. Clinically, she was euthyroid, and thyroid function tests were normal. A flexible nasendoscopy was normal whilst a USS of her neck revealed multiple cystic nodules affecting both thyroid lobes (Figure ​(Figure1).1). A cyst in the upper pole of the left lobe of thyroid appeared collapsed and contained debris, suggesting recent haemorrhage. Fig. 1 Ultrasound images of right (above) and left (below) thyroid gland showing cystic changes and debris within cysts. Measured cyst diameters are shown. Fine needle aspiration of the cyst revealed features of cystic change in a colloid nodule. There was no evidence of malignancy. A USS of the abdomen confirmed enlarged native polycystic kidneys and a large polycystic liver (Figure ​(Figure22). Fig. 2 Ultrasound images of liver demonstrating polycystic changes. Thyroid cysts are associated with ADPKD, although literature reports are scarce. In one series, the clinical manifestations of ADPKD were studied in a Korean population, with thyroid cysts occurring in 2 out of 30 patients studied [3]. Extra-renal cystic changes have also been described in the pancreas, lung, spleen, oesophagus, ovary, testis, epididymis, bladder, uterus and cerebral arteries in the form of berry aneurysms [1,2]. Thyroid nodules are common in women of this age and therefore we should consider whether this reported association is merely coincidental. In a working age population, thyroid nodules were detected by ultrasound scanning in 34% of women [4], with large thyroid nodules (>1.0 cm) seen in 12% of this population [4]. Cystic thyroid lesions represent approximately one-fifth of all thyroid nodules; thus, the likelihood of incidental large cystic thyroid nodules would be ∼2.5%. The incidence of ADPKD is 0.1–0.25%; thus, we conclude that the reported association of ADPKD with thyroid cysts is more than coincidental. This patient with ADPKD has a propensity for extra-renal cystic disease, with a cystic change in the liver and thyroid gland as well as intracranial aneurysm formation. Awareness of thyroid cysts, which may haemorrhage, as an extra-renal manifestation of ADPKD is therefore important. Conflict of interest statement. None declared.

A Thyroglossal Duct Cyst Presenting as a Thyroid Nodule in the Lateral Neck

The patient is a 55-year-old female with a history of multinodular goiter. She was followed for several years for a dominant left-sided superior pole thyroid nodule. Several prior fine needle aspiration biopsies had been performed. All were consistent with the diagnosis of degenerative colloid nodule. Eventually she developed symptoms of intermittent choking and shortness of breath and presented for surgical evaluation. On physical examination, including ultrasound, a left-sided superior thyroid nodule was noted. At operation, the nodule was found to be completely separate from the thyroid. Dissection revealed a thyroglossal duct cyst (TDC) located lateral to the superior pole of the thyroid gland, attached to the mid portion of the hyoid bone by a pedicle. The standard Sistrunk procedure was performed. Here we describe an unusual late presentation of a TDC located lateral to a multinodular goiter and producing compressive symptoms.

Utility of malignancy markers in fine-needle aspiration cytology of thyroid nodules: comparison of Hector Battifora mesothelial antigen-1, thyroid peroxidase and dipeptidyl aminopeptidase IV

The purpose of this study was to compare the diagnostic interest of Hector Battifora mesothelial antigen-1 (HBME-1), thyroid peroxidase (TPO), and dipeptidyl aminopeptidase IV (DPP4) in thyroid fine-needle aspirates obtained from 200 resected thyroid lesions (55 colloid nodules, 54 follicular adenomas, 59 papillary cancers, and 32 follicular carcinomas). Hector Battifora mesothelial antigen-1 or TPO expression (% positive cells) and DPP4 staining score (12-point scale) were evaluated. Receiver operating characteristic (ROC) curves were plotted and optimal cutoff values for diagnosing malignancy were determined. The TPO ROC curve was consistently higher than the HBME-1 ROC curve. The TPO curve was also higher than the DPP4 curve with regard to sensitivity, but dipped below the DPP4 curve with regard to specificity. Using a cutoff value of <80% positive cells for TPO, >10% positive cells for HBME-1, and staining score ⩾1 for DPP4, sensitivity to specificity ratios were 98–83% for TPO, 90–60% for HBME-1, and 88–80% for DPP4. Two particularly interesting findings of this study were the low negative likelihood ratio of TPO (0.02) allowing highly reliable exclusion of malignancy and the 100% specificity of DPP4 staining scores=12. Due to poor performance on follicular lesions, HBME-1 showed no advantage over TPO or DPP4.

Comparison of Thin-Prep and cell block preparation for the evaluation of Thyroid epithelial lesions on fine needle aspiration biopsy

BackgroundThe objective of this study was to compare the utility of Thin-Prep (TP) cytologic preparation with that of Cell Block (CB) preparation in the diagnosis of thyroid lesions, mainly follicular epithelial lesions, by fine needle aspiration biopsy (FNAB). Feasibility of using the TP slides for immunocytochemical stains is also discussed.MethodsA total of 126 consecutive cases of thyroid FNAB with TP slides and 128 consecutive cases of thyroid FNAB with CB slides were reviewed blindly by two cytopathologists. The presence of colloid, follicular cells, macrophages and lymphocytes/plasma cells were recorded and scored 0–4 on each case based on TP or CB slide review. The cytologic diagnoses were grouped as follows: cyst, colloid nodule, colloid nodule with cystic change, chronic thyroiditis, atypical/neoplastic and non-diagnostic.ResultsThe TP slides had higher diagnostic rate than CB slides. The diagnostic yield was 68% of the TP slides whereas only 24% of the CB slides were diagnostic. Also, only 4 atypical/neoplastic lesions were diagnosed on the TP slides and the corresponding direct smears, while 5 cases of atypical/neoplastic lesions were diagnosed on the smears but could not be diagnosed on the corresponding CB slides. Additionally, the TP slides revealed cytologic features that were not observed on the direct traditional smears of the same case.ConclusionIn thyroid FNAB cases, TP slide preparation is superior to CB slide preparation and is more likely to have greater cellularity for diagnosis and detect atypical/neoplastic thyroid lesions, particularly those of follicular cell origin. Furthermore, TP slides appear to detect helpful diagnostic cytologic features and should be considered complementary to, rather than replacing, direct smears.

¿EXISTEN NODULOS COLOIDEOS TIROIDEOS QUE NO REQUIEREN PUNCIÓN DIAGNOSTICA?

Depending on age, sex, and geographic area, 19 to 67% of the general population is found to have thyroid nodules when submitted to ultrasonica- lly-guided diagnostic puncture. Being benign in more than a 80%, most of them corresponds to colloid nodules. Indiscriminate fine-needle aspiration not only increases health costs but also generates anxiety in patients. The echographic-histological correlation of thyroid nodules made it possible to define five typical patterns (colloid patterns 1, 2, 3; neoplastic type, and malignant pattern). Thirty three percent of colloid nodules may appear as follicular neoplasms or malign nodules, being puncture the only means for recognizing and establishing the difference between them. Nevertheless, 67% of nodules presents a typical appearance that corresponds to colloid patterns 1, 2, and 3, which show a weak association to cancer risk (0%, 0% and 1,5%, respectively). On this basis, ultrasound follow-up is advised to recognize them in order to significantly diminish unnecessary diagnostic histological punctures.

Lingual thyroid with coexisting normal thyroid (one lobe) in neck

Ectopic thyroid tissue not located anterolaterally to the second and fourth tracheal cartilage is rare. In majority of the cases, it is located in the midline between foramen cecum and the usual location of thyroid gland in the neck. Most often, it is found in the base of the tongue. We present a case of lingual thyroid with hemi-agenesis of right lobe and colloid nodule in left lobe presenting with difficulty in breathing and swallowing with choking episodes since the last 9 months. The patient was operated upon under general anesthesia, and the lingual mass was removed intraorally leaving a minimal part and sent for histopathological examination, which ultimately confirmed the diagnosis of lingual thyroid tissue. We are presenting this case for its rarity in general practice and because of its unusual presentation.

Afterhistory of surgical treatment of nodular goiter

Long-term results of surgical treatment of 649 patients with different morphological forms of nodular goiter in terms of 15 to 3 years are analyzed. Postsurgical recurrent goiter was diagnosed in 26.8% (174 people). The most part of relapses falls on operations characterized by the large part of TG tissue rest (resection of TG lobe and node enucleation): 69.1% (139 patients of 201). No one relapse was diagnosed after thyreoidectomy. After extremely subtotal resection, relapses were observed in 2.2% (7 people of 312) and after hemithyroidectomy in 20.6% (26 people of 136). This study indicates inadequacy of operations such as node enucleation and resection of the lobe with a node, especially, if the node belongs to nodular colloid goiter, because in such operations the pathologically changed TG tissue is often rest and there is high probability of relapse.

Thyroid cysts: a new extra‐adrenal site of aldosterone synthase expression and increased aldosterone content

The rapid re-accumulation of fluid following aspiration of thyroid cystic lesions suggests that active transport of sodium and water may be involved in volume regulation of these lesions. In this study we address the possibility that aldosterone may take part in this process. Thirty-one patients (29 women and two men), with a mean age of 52.7 +/- 13.2 years (range: 27-77 years) underwent evaluation for thyroid nodules that had a sonographic cystic component. Cystic fluid obtained by FNA biopsy was sent for cytological examination and biochemical measurements. In 10 patients, material was collected for RNA extraction and determination of aldosterone synthase expression by RT-PCR amplification. All lesions were benign, cystic, colloid nodules. Cyst fluid aldosterone levels as measured by routine radioimmunoassay (RIA) were elevated above the normal plasma levels in all but five patients. Mean aldosterone levels were 27.1 +/- 22.9 ng/dl (SD) (range: 5.9-117.5 ng/dl). In contrast, cyst cortisol values were in the low, low normal serum range (6.2 +/- 2.9 microg/dl, range: 0.2-10.2 microg/dl). Sodium, chloride and potassium levels were 137 +/- 4.7 mEq/l, 98 +/- 5 mEq/l and 4.9 +/- 1.4 mEq/l, respectively. Plasma aldosterone levels were normal in all patients tested. To confirm these results, 12 samples were assayed after extraction and chromatography using a highly specific antibody. Cyst aldosterone levels in this group were elevated above the normal serum range in all but one patient (mean concentration: 24.5 +/- 14.6 ng/dl, range: 8.72-40.1 ng/dl). In this group, 18(OH)B levels were within the normal plasma range (12-55 ng/dl) in all but one patient (34.9 +/- 17 ng/dl). Furthermore, aldosterone synthase mRNA expression was found in aspirates of four of 10 patients. The increased aldosterone concentration and the presence of aldosterone synthase expression suggest that aldosterone may be locally produced and secreted in thyroid tissue. The pathophysiological implications of this finding remain to be established.

Detection of RET/PTC, TRK and BRAF mutations in preoperative diagnosis of thyroid nodules with indeterminate cytological findings

Fine-needle aspiration biopsy (FNAB) is the primary means to distinguish benign from malignant nodules and select patients for surgery. However, adjunctive diagnostic tests are needed because in 20-40% of cases the FNAB result is uncertain. We investigated whether a search for the oncogenes RET/PTC, TRK and BRAF(V600E) in thyroid aspirates could refine an uncertain diagnosis. A total of 132 thyroid aspirates, including colloid nodules, inadequate samplings, indeterminate and suspicious for malignancy were analysed by reverse transcription polymerase chain reaction (RT-PCR) and mutant allele-specific amplification techniques for the presence of oncogenes. No oncogenes were detected in 48 colloid nodules, 46 inadequate and 19 indeterminate FNABs, then confirmed to be benign at histology. No oncogenes were detected in one follicular thyroid cancer (FTC) with indeterminate cytology. Five out of six papillary thyroid cancers (83%) with FNAB suspicious for malignancy were correctly diagnosed by the presence of oncogenes. Among these, four (67%) contained the BRAF mutation and one (17%) contained RET/PTC-3. On final analysis, no false-positive results were reported in 131 samples and five out of seven carcinomas (71%) were correctly diagnosed. The finding of oncogenes in FNAB specimens suspicious for malignancy guided the extent of surgical resection, changing the surgery from diagnostic to therapeutic in five cases. Detection of RET/PTC, TRK and BRAF(V600E) in FNAB specimens is proposed as a diagnostic adjunctive tool in the evaluation of thyroid nodules with suspicious cytological findings.

Morfology of Focal Lesious of the Thiroid Gland

To evaluate focal changes morphology the authors carried out a retrospective analysis in 297 patients who had earlier underwent surgery for different forms (multinodular/nodular) of goiter. In all cases preoperative US examination revealed thyroid nodules and focal lesions under 1 cm in the surrounding thyroid tissue. The results after US study taken part in the preoperative period were compared with histological examination data. Average patients age was 47.4 ± 11.9; median was 48 [17; 81]. For evaluation expression of a proliferation marker (Ki 67) and a development of a functional independence (TSH receptor) in the focuses of goiterous transformation at an immunnohistochemical study was formed a group of 25 cases (14 — focal hyperplasia and 11 — focal hypertrophy). 78.8% of focal changes were morphologically represented with goiterous or dystrophic origin (focuses of sclerosis, lymphoid infiltration and atrophy). Amongst them 56.6% were focal goiterous hypertrophy and hyperplasia. Evidently and moderately marked Ki 67 expression and negative expression of TSH-receptor in the focuses of goiterous hyperplasia proved the tendency to their growth with further transformation into colloid nodules and functional independence development.

Inter‐ and intraobserver reproducibility of thyroid fine needle aspiration cytology: an analysis of discrepant cases

To determine the inter- and intraobserver reproducibility and analyse the discrepant cases of fine needle aspiration cytology (FNAC) of the thyroid. Cases of thyroid FNAC with a corresponding histological diagnosis were reviewed regarding the original cytological diagnoses by two observers. The final cytological diagnoses (FCD) included both concordant and consensus diagnoses. The inter- and intraobserver reproducibility and efficacy of thyroid FNAC were calculated based on the FCD. A total of 97 FNAC cases with corresponding histopathological specimens were analysed. Although inter- and intraobserver disagreement in the cytological diagnoses occurred in about one-quarter of the cases analysed (24.7% and 23.7%, respectively), a substantial level of diagnostic interobserver (kappa = 0.71) and intraobserver (kappa = 0.66) reproducibility was observed. The efficacy of the method was 94.4%. Disagreement in the diagnosis was detected in 24 cases (24.7%), most of them (41.7%) for follicular lesions. Discordant cytological diagnoses between the two observers were represented by six (16.2%) of the 37 cases with an FCD of colloid nodule, five (41.7%) of the 12 cases of cellular follicular lesion, all three cases of follicular neoplasm, in two (6.3%) of the 32 cases of PTC, one (16.7%) of six cases of follicular neoplasm with a predominance of Hürthle cells and in one case of poorly differentiated neoplasia. Similarly, major disagreement in intraobserver cytological diagnoses was observed for the diagnosis of follicular lesions: 18 (78.3%) of a total of 23 discordant cases. As discrepancies in the cytopathological diagnosis can have repercussions in the management of patients, all cases with a cytological diagnosis of follicular lesions/neoplams should be reviewed in multidisciplinary meetings thus minimizing interobserver variability.

Thyroid isthmusectomy: a critical appraisal

Thyroid lobectomy with isthmusectomy is the standard surgical technique for removal of unilateral thyroid nodules, and it involves the exposure of the tracheoesophageal grooves. Thyroid isthmusectomy is a surgical procedure that excises only the thyroid isthmus. It allows excision of a lesion without the exposure of the tracheoesophageal grooves. We aimed to demonstrate that isthmusectomy could be a safe alternative to thyroid lobectomy with isthmusectomy in patients with nodules confined to the isthmus or the pyramidal lobe. This was a prospective study performed over a five year period from 1999 to 2004. Inclusion criteria for thyroid isthmusectomy were: patients with a single lesion located in the region of the thyroid isthmus or the pyramidal lobe; maximum lesion diameter of 30 mm; and cytological reports of non-diagnostic appearance, follicular cells or suspicion of malignancy. Nine patients were identified with these criteria. Histology included two colloid nodules, three benign follicular adenomas, two Hurthle cell adenomas and two papillary thyroid carcinomas. There were no recorded complications. Thyroid isthmusectomy is a safe alternative to thyroid lobectomy with isthmusectomy in patients who have nodules confined to the isthmus and pyramidal lobe. Leaving a cuff of normal thyroid tissue has the advantage of not exposing the tracheoesophageal grooves, thus minimising potential damage to the recurrent laryngeal nerves and parathyroids. Surgeons performing isthmusectomies should be experienced in more complex thyroid surgical procedures.

Thyroid disorders. Part III: neoplastic thyroid disease

This paper is part III of the series on thyroid disorders. Thyroid tumors are the most common endocrine neoplasms. Most of these tumors are benign hyperplastic or colloid nodules or benign follicular adenomas. However, 5% to 10% of the lesions that come to medical attention are carcinomas. A major clinical challenge is establishing which nodules are hyperplastic, benign, or malignant. History, clinical findings, ultrasonography, and fine-needle aspiration biopsy are the mainstays for diagnosis. There are 3 main histologic types of thyroid cancer: differentiated, medullary, and anaplastic. Differentiated lesions are subdivided into papillary, follicular, and Hurthle cell carcinomas. In addition, primary lymphoma may occur in the thyroid gland and other cancers may metastasize to the thyroid. An important neoplastic syndrome, multiple endocrine neoplasia type 2 (MEN2), involves medullary carcinoma of the thyroid gland. In 2002 there were 10 cases of thyroid cancer per 100 000 population. During the past 10 years the rate of thyroid cancer has been increasing 5% per year. The overall 10-year survival for papillary carcinoma is 80% to 90%, follicular carcinoma 65% to 75%, and medullary carcinoma 60% to 70%. The prognosis for anaplastic carcinoma is very poor and 5-year survival is rare. The dentist by inspection and palpation of the neck in the area of the thyroid gland may detect single or multiple lesions that may be benign or malignant. Patients with identified nodules or enlarged thyroid glands should be referred for diagnosis and treatment. Patients with thyroid cancer will benefit from the early detection and treatment of their lesions as early detection can lead to a cure or prolongation of their life.