Colloid Nodules Research Articles

A study of correlation of pre-operative fine needle aspiration cytology and ultrasonography with post-operative histopathology in thyroid swellings

Background:Diseases of the thyroid gland can be due to inflammatory and neoplastic causes. Many diagnostic tests like ultrasound, thyroid nuclear scan and fine needle aspiration cytology (FNAC) are available for their evaluation. Histopathologically, they can be adenomas, colloid nodules, cysts, infectious nodules, lymphocytic or granulomatous nodules, congenital abnormalities or hyperplasia, or various types of malignancy. It is therefore crucial to have a clear diagnostic approach to ensure patients are managed appropriately and are not over or under-treated. Present study was done to evaluate FNAC and ultrasonography (USG) as a diagnostic method in thyroid swellings and to plan surgery accordingly.Methods: A prospective observational study was conducted among 60 adult patients undergoing thyroid surgery at Victoria and Bowring and Lady Curzon Hospital. They were investigated with FNAC and USG of thyroid, and were subjected to surgery and subsequent histopathological examination. The histopathological examination reports were correlated with the findings of FNAC and USG in order to evaluate their findings by statistical methods.Results:The sensitivity and specificity of FNAC was 87.5% and 98% respectively. All malignant lesions on FNAC were confirmed by histopathology indicating its excellence. Therefore FNAC helps in planning the correct management and avoids second surgery. And the sensitivity and specificity of USG was 75% and 86% respectively. Therefore combination of both FNAC and ultrasonography will improve the diagnostic accuracy to higher level and helps in better management. Conclusions:FNAC has high sensitivity and specificity, so it is closest to ideal test. However, a combination of both FNAC and ultrasound will give desirable results and so that we can avoid mismanagement.

Clinicopathological study of thyroid swellings

<p class="abstract"><strong>Background:</strong> Diseases of the thyroid continue to be a common clinical problem having a prevalence rate of 4 to 7% in the general population.</p><p class="abstract"><strong>Methods:</strong> This retrospective study was conducted in the Department of ENT, Head and Neck Surgery, SMGS Hospital, Jammu from January 2018 to January 2020. A thorough history taking, meticulous clinical examination, routine hematological and biochemical investigations were done in all the patients. General examination of the patient was done and looked for thyroid functional abnormality followed by local examination was carried out to locate and identify the site of the swelling, shape, size and consistency of the thyroid swelling and clinical diagnosis was made. All thyroid swelling cases were subjected to fine needle aspiration cytology (FNAC). The type of thyroidectomy is based on the size and type of thyroid whether neoplastic or non-neoplastic. All the specimens were sent for histopathological examination. </p><p class="abstract"><strong>Results:</strong> Out of 60 patients in the study, 56 were females and only 4 were males. The most common age group was 31 to 40 years seen in 24 (40%) patients. The most common presenting symptom was swelling in the neck seen in 58 (96.67%) patients. The most common diagnosis on FNAC was colloid goiter seen in 40 (66.67%) patients. The most common was benign nodular colloid goiter seen in 35 (58.33%) patients.</p><p class="abstract"><strong>Conclusions:</strong> Fine needle aspiration is a very useful and indispensible test in the diagnosis of thyroid lesions.</p>

A prospective study on post operative complications of thyroid surgery

Background: The various postoperative complications of thyroid surgery have long been known to surgeons embarking on the surgical treatment of goitre. These complications may be severe enough to jeopardise the life of the patient or to create a physical or physiological incapacity which will limit his normal activities. Because of the severity of the complications it becomes necessary to reduce the incidence of these complications to an absolute minimum in this age of modern surgery. Aims & Objectives: Aim of this study is to study the preoperative factors which influence complication rates, complication rates associated with the type of thyroid surgery, type of complications, period of onset of complications, hospital stay of patient with different complications, mode of management of each complications. Materials and Methods: The present study of “Postoperative complications of Thyroid Surgery “has been made over a period of 18 months from January 2017 to July 2019.The study was made in Kamineni institute of Medical Sciences Narkatpally. Prospective analysis of 60 goitres undergoing surgery were taken for the study. These cases were studied in detail clinically and recorded as per the proforma attached. Results: Prospective analysis of 60 goitres undergoing surgery showed the incidence of thyroid diseases is more common in females than in males. The peak age group in which patients presented to the hospital was in 3rd decade. The commonest clinical diagnosis in patients with goitre was Multinodular Goitre in Euthyroid status. The commonest histological diagnosis in those specimens sent for Histopathological examination was Nodular Colloid Goitre. The most common surgery performed in goitre cases was Sub-total thyroidectomy. Wound infection was the most common post- operative complication. Conclusion: In this study the mortality was zero and morbidity was low. Thyroid surgery is safe and can be performed with minimum morbidity and mortality for a wide range of diseases of thyroid, if it is done gently with meticulous attention to achieve adequate hemostasis with identification and preservation of structural details.

Morphological and immunohistochemical approaches to the diagnosis of Hashimoto thyroiditis and mucosa associated lymphoid tissue lymphomas: An audit.

Most cases of autoimmune hypothyroidism are due to Hashimoto thyroiditis (HT). It is sometimes difficult to distinguish HT from mucosa associated lymphoid tissue (MALT) lymphoma using cytology or histology alone. This has necessitated the use of immunohistochemistry and other molecular techniques. A descriptive study was undertaken to determine the prevalence of MALT lymphoma and other associations of HT using histopathological and immunohistochemical methods. For testing of kappa and lambda antibodies, paraffin sections were prepared for immunohistochemical staining using a peroxidase-antiperoxidase immune complex method. Immunostaining in HT, demonstrated a polyclonal lymphoid population, as evidenced by dual positivity for kappa and lambda staining cells, whereas MALT lymphoma revealed a monoclonal lymphoid population, with strong positivity for kappa immunostaining and lack of lambda light chain expression. The proportion of MALT lymphoma in surgically treated cases of HT in the present study was 3.5% (95% CI: 0%–8.3%). The common malignancy associated with HT was papillary carcinoma of the thyroid (8.8%). Among the benign conditions, nodular colloid goiter (7%) was more commonly associated. Although modern molecular techniques are available for the confirmation of lymphomas, they are more expensive, time consuming and are available only in a few centers. Strict morphological criteria can differentiate HT from MALT lymphoma, but in suspicious cases, paraffin section immunohistochemistry using light chain restriction can offer comparable and reliable results. Since papillary carcinoma and MALT lymphoma have been associated with HT, these patients require careful surveillance.

Study of complications following various thyroidectomy procedures: a tertiary care centre experience in South India

Introduction: Thyroid surgeries comprise one of the more commonly performed procedures by a general surgeon. Today most of the complications of thyroid surgery are related to either metabolic derangements or injury to the recurrent laryngeal nerve injury. Other complications include superior laryngeal nerve injury, infection, airway compromise, and bleeding. At present, mortality for this procedure approaches 0% and overall complication rate is less than 3%. Nonetheless, major complications of thyroidectomy (i.e. compressive hematoma, recurrent laryngeal nerve palsy and hypoparathyroidism) are still fearful complications and account for a significant percentage of medico-legal claims. Patients volume and surgical skill play an important role in reducing the risk of complications. Knowledge about the clinical profiles of thryoidectomy cases and understanding the post thyroidectomy complications are an important milestone in public health. Aims & Objectives: This study intends to identify the incidence of the complications following various thyroidectomy surgeries performed at JSS Hospital, Mysuru and the effect of timely and prompt recognition and intervention in minimizing morbidity. Methodology: This clinical study was conducted between October 2017 and September 2019 and included 70 consecutive patients undergoing various thyroidectomy procedures, at JSS Hospital, Mysuru. All cases were followed up for a period of 6 months. Results: In our prospective observational study 70 cases of patients with thyroid swellings underwent various thyroidectomy procedures. The incidence of thyroid diseases is more common in females than in males.The peak age group in which patients presented to the hospital was in the 4thdecade .The most common histopathological diagnosis was Nodular Colloid Goitre.The most common surgery performed in was Total thyroidectomy in 45 cases out of 70. Transient hypocalcemia was the most common post- operative complication occurring in about 13 out of 70 cases.

EVALUATION OF FINE NEEDLE ASPIRATION CYTOLOGY (FNAC) IN HEAD AND NECK SWELLINGS, PRESENTED IN AKHTAR SAEED MEDICAL AND DENTAL COLLEGE, LAHORE

Objective: To determine the frequency of various Head and Neck swellings at various sites reported at Pathology department Akhter Saeed Medical and Dental College, Lahore. 
 Materials and Methods: The present study evaluates data of all the patients that underwent FNAC for various head and neck swellings from the period of 2012 to 2019 in Akhtar Saeed Medical College, Lahore. A total of 177 patients with swellings in the head and neck regions, on which FNAC was performed are included in this study. After cleaning the area properly, a 23 gauge needle with syringe and needle tip was inserted at convenient angles to the lesions and with the help of multiple hits, an adequate amount of material was aspirated. The needle was then removed with sufficient negative pressure. In order to avoid bleeding or hematoma formation, a cotton gauze was kept pressed over the aspirated area for a few minutes. 
 Results: Out of 177 fine needle aspiration procedures, the maximum number of aspirates were procured from thyroid (35%), 22% from cervical lymph nodes, 16% from salivary glands, 24% from miscellaneous swellings in head and neck region. The highest number of cases were diagnosed as reactive/non-specific inflammatory lesions (19%) followed by benign lesions with hyperplastic colloid nodule (14%).
 Conclusion: The study mainly confirmed the results of various studies previously carried out in different countries. FNA of head and neck lumps proves to be an efficient and useful diagnostic method in segregating inflammatory and neoplastic lesions, thus avoiding unnecessary invasive procedures. The diagnostic accuracy of FNAC makes it a reliable first-line tool in predicting the nature of various head and neck swellings. 

Noninvasive follicular neoplasm with papillary like nuclear features: A comprehensive analysis with a diagnostic algorithm.

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) lacks the carcinoma label, avoiding aggressive therapy, physiological, social and financial impact of cancer diagnosis. Unfortunately, the preoperative diagnosis is still a challenge. Varied incidence of NIFTP has been document with limited data on preoperative cytological, radiological characteristics and the impact on risk of malignancy in each category of the Bethesda system of reporting thyroid cytopathology. Retrospective analysis of 20 NIFTPs with an attempt to provide a preoperative diagnostic algorithm based on the cytological and ultrasound features along with incidence and implication on risk of malignancy in various Bethesda categories with its impact on patient management. Incidence of NIFTP in our study was higher in comparison to that documented from other Asian countries. TIRADS 3 was the most common sonographic diagnosis. NIFTP was commonly preceded by indeterminate or benign Bethesda category. Major impact of excluding NIFTP form malignant category was seen on Bethesda categories II and IV with 20% and 27% reduction in risk of malignancy, respectively. Retrospective analysis should not be confined only to follicular variant of papillary thyroid carcinoma but cases of follicular adenoma and adenomatous colloid nodule should always be included in review to ascertain the true incidence of NIFTP. NIFTPs are less likely to have malignant preoperative cytology. NIFTP shares major cytological and ultrasound features with follicular adenoma, adenomatous colloid nodule and minimally invasive follicular papillary carcinoma. When analyzed together, taking minor findings in consideration, can favor a diagnosis.

CLINICAL EVALUATION AND MANAGEMENT OF SOLITARY NODULE OF THYROID IN EUTHYROID PATIENTS

BACKGROUND: Solitary nodules of the thyroid have been the area of focus in research since Warren Colein 1949. It is an area of research with much potential because of its diverse clinicalpresentation and its wide-ranging etiology and often the risk of malignancy. But the studiesassessing the prevalence and clinical prole of solitary thyroid nodules are relatively scarcefrom India. Hence the current study was conducted with the objective of determining theprevalence of solitary nodule of thyroid in general Population and to determine the proportion of a solitary nodule of thyroid turning out to be multinodular goitre on subsequentevaluation. The study has also assessed the role of FNAC in the management of solitarynodule of the thyroid and estimatedincidence of carcinoma as a cause of solitary Noduleof the thyroid to determine the underlying cause of Solitary nodule of thyroid (SNT) by theHPE. MATERIALS & METHODS:This study was a prospective study conducted in the Department of General surgery inKATURI MEDICAL COLLEGE fromNovember 2016 to May 2018 for a period of 1.5years.The study population included Solitary Nodule of Thyroid admitted to theDepartment of General surgery at Katuri medical collegewere considered as thestudy population. The prevalence was computed against all the OPD attendees in thedened study period. The ndings of ultrasonography, FNAC and HPE were comparedusing cross tabulation. Since the study did not attempt to test any hypothesis, No statisticaltest of signicance was used. IBM SPSS statistical software version 21 was used for data/analysis. RESULTS: During the study period, the total number of subjects attending the Outpatient departmentwere 6485.Among all the outpatient attendees, the prevalence of solitary thyroid nodulewas 1.23% with 95% CI ranging from 0.96% to 1.5%.Out of 80 clinically diagnosed solitarythyroid nodule cases multi nodular goitrewas found in 7 (8.8%) subjects on subsequentevaluation. In USG, 51.3% had Hyper Echogenic Nodule while 23.8% had MixedEchogenic Nodule. In 8.8%, the nodule turned out to be a part of Multi Nodular Goiter while7.5% had Suspicious Multi Nodular Goiter. In FNAC, 86.2% of the nodules were benign onFNAC. The majority (32.50%) were Benign Colloid Nodules. 26% were colloid nodules inFNAC. 13.8% of the nodules were malignant in FNAC. Papillary thyroid carcinoma wasseen in 12.5% in FNCAC. In HPE, the majority (78.5%) were benign nodules. Only 21.5%were malignant. In HPE, 32.5% were a benign follicular adenoma. The proportion of Colloid Nodule was 31.3%, and nodular goitre was 5%. The proportion of Papillary Thyroid Carcinoma, Hashimoto's thyroiditis, Well-Differentiated PTC, Anaplastic ca. of Thyroid was 13.80%, 3.80%, 2.50% and 1.3% respectively. CONCLUSIONS: The current study had assessed the burden and clinic pathologicprole of solitary thyroid nodulecases. The study ndings is an important addition to the existing evidence and guide the clinicians at various levels in evidence based evaluation and management of the patients with solitary thyroid nodule.

Vagal nerve Schwannoma- An interesting case presenting as lateral neck swelling

A Schwannoma is a benign nerve sheath tumor composed of Schwann cells. Schwannoma arising from the vagus nerve is an uncommon (2–5%) benign nerve tumor. Less than 1% becomes malignant. Definitive pre-operative diagnosis may be difficult and investigations such as FNAC have low specificity. Surgical removal of tumor is the treatment of choice for vagal schwannomas with nerve preservation. Surgical removal can be done either by intra capsular enucleation or extra capsular excision of tumor. Definitive diagnosis is obtained by means of surgical pathology. Here we present a case of 40 year old male presented with swelling over anterio -lateral aspect of left lower neck region for last four years with mild change in his voice for few months. CECT of the neck was suggestive of left neck cystic necrotic lesion. On FNAC the swelling was misdiagnosed as colloid nodule. The mass was excised. Grossly a single encapsulated globular cystic tissue piece measuring 8.5x7x6 cm was received in histopathology lab, which on cut section show a unilocular cyst filled with blood mixed mucoid material. On Histopathology, a diagnosis of Schwannoma was rendered. Keywords: Benign tumor, Neck swelling, Schwannoma, Vagal nerve.

Case Report: Nodular colloid degeneration of the skin

In this report, we described a 58-year-old man, presenting with multiple plaques and nodules over the nose and forehead resembling sarcoidosis or lepromatous leprosy. The histologic study revealed deposition of the mass of amorphous, eosinophilic-cleaved, colloid materials in the papillary dermis and deep dermis. The periodic acid-Schiff (PAS) stain was positive, whereas the Congo red stain was negative. Based on the clinical and pathologic findings, the patient was diagnosed with nodular colloid degeneration(NCD). To treat the patient, lesions were flattened using a Co2 laser. The patient did not return for follow-up. NCD is a rare disease, with only 12 cases having been previously reported. Here, we present a case of NCD that occurred on the face and discuss the topic of how to discriminate between NCD and other similar entities, emphasizing that nodular colloid degeneration should be considered in the differential diagnosis of asymptomatic facial plaques and nodules.

Vascular flow on doppler sonography may not be a valid characteristic to distinguish colloid nodules from papillary thyroid carcinoma even when accounting for nodular size.

The purpose of this study was to test the hypothesis that there is no significant difference in vascular flow patterns between cytopathologically-proven colloid nodules and papillary thyroid carcinoma (PTC) even when adjusting for nodule size. Doppler vascular flow patterns in 200 colloid nodules and 166 nodules with PTC were retrospective reviewed independently by 2 neuroradiologists blinded to the cytopathological results. Absence of vascular flow, perinodular and/or intranodular flow, and diffuse vascular flow were recorded. The vascular flow patterns were compared without (Fisher exact test) and with (Kruskal-Wallis test) an adjustment for nodular size. Using the most common flow pattern as the reference group, multiple logistic regression was used to compare the flow patterns. Sample skewness was calculated to determine degree of symmetry of the size distribution for each vascular flow category. No significant difference was found in the tested vascular flow patterns between colloid nodules and PTC both without and with an adjustment for nodular size (P>0.05). Intranodular flow only was the largest group (n=111/366) and used as the reference for multiple logistic regression. No significant difference was noted between the vascular flow patterns (P>0.05). Sample skewness showed that nodules were generally smaller in size with outliers of larger size on the opposite end of the spectrum. Independent of nodule size the absence or presence of vascular flow is not significantly different between colloid nodules and PTC. Therefore, vascular flow may not be useful in distinguishing between colloid nodules and PTC.

The role Of thyroid autotransplantation in patients with benign thyroid disorders

Abstract Background: The heterotropic thyroid autotransolantation is to leave thyroid tissue in the body that might be able survive, gain blood supply and become functioning to avoid or reduce the severity of post thyroidectomy hypothyroidism in noncompliant patients. In the meantime, if recurrence occurs it would not be in the neck, thus avoiding the compression of the trachea and avoid dangerous re-operation deeply in the neck Methods: Form 1/11/2017 till 1/7/2018. Patients with benign thyroid disorders were selected for heterotropic thyroid autotransolantation followed up for 12 months by duplex us , free T3, T4 , TSH and 99mTc to detect survival of the graft maintaining the patient euthyroid after total thyroidectomy for benign thyroid disorders. Results: ninety percent were males and 40 % females with mean age 36.2 years. The most common presentation was compressive symptoms (51.6%). Mean operative time was 124.4 min, 71% were benign follicular lesion and 29% colloid nodular goitre , 71% without early postoperative complications. Transient hypocalcaemia reported in 29% 0f cases .one month postoperative duplex was positive in 93.5%. Postoperative radio-isotopic scanning was positive in 93.1% after 6 months and 96.5% after 12 months.90% of the patient reached euthyroid state.Conclusions: Autotransplantation of heterotrophic thyroid tissue following total thyroidectomy for patients with benign thyroid disorders is a safe , easy and applicable technique that provides survival and function of thyroid graft achieving a postoperative euthyroid state in majority of selected patients without the need for further replacement therapy.

Evaluation of thyroid nodules classified as Bethesda category III on cytology and their malignancy rate: An institutional experience.

Background:Thyroid gland nodules are common and fine-needle aspiration (FNA) is the gold standard for screening those nodules. The Bethesda system for reporting thyroid cytolopathology standardized reporting thyroid nodules aspirations, but atypia of undetermined significance or follicular lesion of undetermined significance (Bethesda category III) was the most controversial category. The aim of our study is to review our institutional experience and analyze the clinical implications of making a diagnosis of AUS/FLUS (Bethesda category III).Methods:This is a retrospective study of an 889 thyroid FNAs from 825 patients in Salmaniya Medical Complex, during (January 2013–December 2017).Results:The most common cause for designating cases as AUS/FLUS (Bethesda category III) was the presence of features suggestive of papillary thyroid carcinoma, but not quite fulfilling the criteria for such diagnosis. Ninety-six cases were diagnosed as AUS/FLUS (10.7%), in which 26 (27%) patients underwent surgery without repeating the FNA, 25 (26%) underwent a second FNA and 43 (44.7%) patients were followed up by ultrasound. On repeating the FNA, 1 (4%) was unsatisfactory, 13 (52%) were benign, 10 (40%) were AUS/FLUS, and only 1 (4%) was categorized as malignant. Thirty cases were surgically excised, in which 4 (13.3%) were diagnosed as follicular adenoma, 2 (6.6%) as Hurthle cell adenoma, 9 (30%) as multinodular goiter, 5 (16.6%) as multinodular goiter with Hashimoto thyroiditis, 1 (3.3%) as colloid nodule with Hashimoto thyroiditis, and 9 (30%) as papillary thyroid carcinoma. Among all the cases diagnosed initially as AUS/FLUS (Bethesda category III), 9 (9.3%) cases were diagnosed as papillary thyroid carcinoma.Conclusion:Diagnostically, we almost meet the international standards of designating cases with AUS/FLUS (Bethesda category III) and approximate the risk of malignancy. However, the clinical management's guidelines should be followed to decrease the risk of unnecessary surgeries and their complications. There is a statistically significant correlation between the age and gender with the final histopathology report, respectively.

The Frequency of Malignancy in Nodular Thyroid Disease

The thyroid nodules occur quite frequent but, thyroid carcinoma is a relatively infrequent malignancy. Thyroid carcinoma is generally regarded as a condition of modest oncologic importance because it accounts for less than 0.5% of cancer deaths (less than 2% of all cancers). A sample of 196 patients with nodular thyroid enlargements who underwent thyroidectomies were included in this cross-sectional study. The diagnosis of thyroid carcinoma was confirmed in 18(9.2%) patients in this series. Most of the patients were presented with benign goiters, mainly nontoxic multinodular goiter. Cervical lymphadenopathy was present in 4(22.2%) at presentation. In ten patients out of the 18 patients (55.5%) diagnosed with carcinoma, it was possible to make a correct diagnosis of thyroid carcinoma before and at operation time. While in the remaining eight patients (44.5%) the diagnosis of carcinoma was made at a histopathological examination of the surgical specimens. In conclusion goiter affect female more than male. Nodular colloid goiter was the main pathology. Thyroid carcinoma reported in 9.18% of the sample with goiters. Papillary carcinoma was the commonest histopathological type among patients with carcinomas. Keywords: Goiter, multinodular goiter, carcinoma, ANF DOI : 10.7176/JHMN/66-04 Publication date :September 30 th 2019

Primary Thyroid Schwannoma with Papillary Carcinoma and Hurtle Cell Adenoma in a Background of Hashimoto’s Thyroiditis

Schwannomas are common benign neurogenic tumours that arise from Schwann cells of nerve roots; up to 45% arise in head and neck. However primary thyroid schwannomas are extremely rare. Among thyroid tumours papillary carcinoma of thyroid (PCT) are the most common. Hurthle cell neoplasms are also rare. In addition occurrence of all the three neoplasms in the same patient is extremely rare. In this report we discuss a case of left lobe intrathryroidal schwannoma with papillary carcinoma of thryroid (PCT), Hurthle cell adenoma and background Hashimoto thyroiditis in a 25 year old female. On FNAC it was diagnosed as colloid nodule with cystic change, total thyroidectomy was done and histopathological examination showed that the largest well circumscribed nodule was a benign neurogenic tumour, schwannoma (left lobe of thryroid gland). There were other smaller thyroid nodules; one showing papillary carcinoma with lymph node metastasis and other showing hurthle cell adenoma with background Hashimoto’s thyroiditis.

Somatic mutation testing: the role in differential diagnosis of thyroid neoplasms

Background: In the preoperative diagnosis of thyroid tumors the cytological examination of the material of fine needle aspiration biopsy is the gold standard and serves as the basis for planning of treatment strategy. However, in 10–30% of cases, it cannot be clearly established by cytology whether the nature of thyroid neoplasm benign or malignant, which leads to the inability to choose the optimal treatment strategy in advance. For such cases, it is extremely important to search for methods of clarifying differential diagnosis, among which mutation testing is currently considered the most promising.
 Aims: To evaluate the possibility of using mutation tests for clarifying differential diagnosis of thyroid neoplasms at the preoperative stage.
 Materials and methods: We performed the prospective single center study, which included patients with the thyroid neoplasms, who had been treated in the Endocrinology Research Center, Moscow, Russia from 2012 to 2014. Samples of histological material, cytological material and blood plasma of these patients were tested for the presence of somatic mutations in hot spots of the genes BRAF, KRAS, NRAS, TERT, and EIF1AX.
 Results: The study included 75 patients, 29 of them with low-risk papillary thyroid cancer, 29 with follicular neoplasm NA of the thyroid gland and 17 with colloid nodular goiter. Mutations in the “hot spots” of the BRAF gene (exon 15, codon area 600–601) were found in 29 patients, mutations in the “hot spots” of the NRAS gene (exon 3, codon 61) – in 8 patients; mutations in the hot spots of the KRAS, TERT and EIF1AX genes were not detected. Correlation of the results of mutational testing of cytological and histological material was 91.7%. Mutations of tumor origin in circulating blood plasma DNA were found in only 1 cases. The prognostic value of the positive result (PPV) of the mutation test on cytological material in relation to the malignant nature of the thyroid tumor was 100% for the BRAF gene and 0% for the NRAS gene.
 Conclusions: The mutation test in the “hot spots” of the BRAF gene on cytological material can be used as an additional marker to clarify the nature of thyroid tumors, when the result of cytological examination are uncertain. Either in similar situations for mutation tests in the “hot spots” of genes KRAS, NRAS, EIF1AX and TERT on cytological material, or mutation testing of circulating DNA of blood plasma can’t be used as an additional marker.

Petrov Thyroid Cancer Score (PTCS): evaluation of practical significance on the basis of postsurgical morphological analysis

The study objective is to evaluate the results of using the Petrov Thyroid Cancer Score (PTCS) in 2018 and assess the diagnostic value of the original PTCS and modified PTCS. Materials and methods. PTCS, proposed in the N.N. Petrov National Medical Research Center of Oncology in early 2018, was tested in this institution in 310 patients, 99 of whom underwent surgery, mainly due to suspected malignancy of thyroid nodules or at the request of patients. Results. According to the standard histological evaluation, in 35 cases the process was considered benign (group Д ), while in 61 cases — after exclusion of 3 medullary carcinomas — regarded as highly differentiated (according to previous classification) thyroid cancer (group Р ). The average values of such components of PCTS as BethesdaScore, TI-RADSScore, ElastoScore and body mass index (BMI) in group Р were significantly higher than in group Д . The sum of the scores of the used four parameters was not only higher in group Р , but also at a magnitude of ≥ 5.0 (62.3 % of observations in this group) it always corresponded to the diagnosis of thyroid carcinoma. At the same time, a similar histological conclusion was made, in particular, in respect of 14 patients (23 % of the group Р contingent) with the value of the mentioned sum <3.5. Of note, according to the preoperative cytological study, among these 14 cases 11 follicular neoplasms and 3 colloid nodules were found. Conclusion. A high value ( ≥ 5.0) of the sum of four selected parameters (3 from PTCS + BMI_Score) indicates an extremely high probability of detecting a tumor process, while in other cases (and not only under the assumption of follicular neoplasia presence), an additional diagnostic methods of research are needed.

SUN-562 Hurthle Cell Carcinoma Presenting as Hyperfunctioning Nodule

Background: Hurthle cell carcinoma (HCC) is a rare type of aggressive follicular carcinoma comprising a small percentage of all thyroid cancers. It is associated with high metastasis and mortality rates with 20-30% of this type of cancer having metastatic extension at the time of treatment. HCC may be asymptomatic until a lump is noticed on the anterior neck. The inability to establish a preoperative diagnosis of HCC creates a dilemma with hyperfunctioning thyroid nodules which are commonly managed as benign. Clinical Case: This is a case of a 48-year old female, who presented with a multinodular thyroid gland on initial imaging associated with palpitations and chest discomfort. Further workup revealed subclinical hyperthyroidism and a thyroid scan showing hyperfunctioning nodules on both lobes. She underwent fine needle aspiration (FNA) biopsy which revealed benign colloid nodule on the right thyroid and cellular findings consistent with follicular neoplasm with oncocytic features on the left thyroid nodule prompting surgery. Surgical specimen histopathology eventually revealed Hurthle cell carcinoma with lymphovascular invasion of the left thyroid nodule. Conclusion: Hurthle cell carcinoma is a relatively uncommon thyroid neoplasm. Though toxic nodules are rarely malignant, HCC is more commonly seen in hyperfunctioning nodules compared with general thyroid nodules. This case supports further evaluation of toxic nodules for possible risk of thyroid cancer. Reference: (1) Mirfakhraee, Sasan & Mathews, Dana & Peng, Lan & Woodruff, Stacey & M Zigman, Jeffrey. (2013). A solitary hyperfunctioning thyroid nodule harboring thyroid carcinoma: Review of the literature. Thyroid research. 6. 7. 10.1186/1756-6614-6-7.

Histopathological and Cytological Efficacy in The Diagnosis of Solitary Thyroid Nodules

Background: thyroid nodules are found in 4-7% of the population, the preferred diagnostic approach is avoidance of numerous radiologic evaluations, and early performance fine-needle aspiration. Objectives: the aim of this study was to evaluate the efficacy of fine needle aspiration cytology (FNAC) and histopathological assessment in diagnosis of solitary thyroid nodules. Methods: this study was done on twenty patients diagnosed as solitary thyroid nodule. All the patients’ FNAC and histopathological results were reviewed, confirmed, correlated and evaluated. Results: there were 4(20%) men and 16(80%) women, with a male-to-female ratio of 1: 4. The patients studied ranged in age from 17 to 65 years, with the majority ranging in age between 25 and 40 years (30%). According to FNAC findings, 65% were benign/non-neoplastic and 35% were malignant aspirates. The most common benign lesion diagnosed by FNAC was a colloid nodule (25%), whereas the most common malignant lesion was papillary carcinoma (30%). There were no false-positive cases (0%). A false-negative result was found in only two cases (10%). According to the histopathological findings, 60% were benign/non-neoplastic lesions and 40% were malignant. The most common benign/non-neoplastic lesions were colloid goiter (25%) and follicular adenoma (15%), whereas the most common malignant lesion was papillary carcinoma (35%). Conclusion: FNAC is a useful diagnostic method, but it has some limitations in the diagnosis of subtypes of solitary thyroid nodules such as follicular lesion. Histopathological study provides a more accurate diagnosis and overcomes these limitations.

Comparison of surgeon-performed ultrasound-guided fine needle aspiration cytology with histopathological diagnosis of thyroid nodules.

Objective:To assess the Solitary thyroid nodules by surgeon- performed ultrasound-guided FNAC and evaluate with the histopathological findings.Methods:This study includes 100 Consecutive patients of a solitary thyroid nodule which were presented to the Outpatients Department of Surgery during the period of two years from September 2016 to August 2018. Exclusion criteria were patients with extra-thyroid swelling, diffuse goiter and multinodular goiter. All patients with a solitary thyroid nodule underwent Surgeon –performed ultrasound-guided FNAC in the department of Radiology. After thyroid surgery, thyroid specimens were sent for histopathology and evaluate with FNAC findings.Results:The study included hundred patients with solitary thyroid nodule, 75(75%) female and 25 (25%) male with a ratio of F 3:1M. The age of the patients ranged from 15-75 years with a mean age of 35 years. The result of 100 cases of Surgeon –performed Ultrasound –guide FNAC of a solitary thyroid nodule were inconclusive in 10 cases (10%), Non-neoplastic in 60 cases (60%) and Neoplastic lesions in 30 cases (30%). After evaluation of findings from FNAC and histopathology, four cases with benign FNAC (adenomatous/colloid Goiter) turnout as neoplastic (papillary carcinoma) on histopathology and six cases with neoplastic FNAC (papillary carcinoma), just two cases turnout as benign (nodular colloid goiter with cystic degeneration) on histopathology. In present study Surgeon – performed Us FNAC has found to be 87.5% sensitive, 95.3% specific and 92.0% diagnostic accuracy.Conclusion:Surgeon – performed Ultrasound-guided FNAC is a safe, simple and accurate technique in the diagnosis of solitary thyroid nodule.