Thyroid Lesions Research Articles

P-20 Primary hyperparathyroidism associated with maltoma of the thyroid gland: imaging challenges

Abstract Introduction Primary hyperparathyroidism (PHP) and malignancies are the most common causes of hypercalcemia. Nevertheless, PHP might be observed in coexisting with malignancies. We aimed to present a patient who underwent surgery for PHP and was diagnosed with thyroid MALToma. Clinical Case A 65-year-old female presented with fatigue for one year. The patient's medical history was unremarkable. On examination, thyroid gland was non-palpable. On laboratory, serum calcium (Ca), phosphorus (P) and parathormone (PTH) levels were 11 mg/dL (R: 8.8-10.6), 2.4 mg/dL (R: 2.5-4.5) and 157 pg/mL, respectively; vitamin-D was 23.63 µg/L and increased urinary Ca (400 mg per-day). She was euthyroid, and thyroid antibody elevated. Ultrasound (US) revealed multiple hypoechoic areas and a lesion (18×14 mm) in the vicinity of inferior right thyroid gland. Parathyroid scintigraphy revealed significant increase of metabolic activity posterior to the right lobe of the thyroid. She underwent right thyroid lobectomy thyroidectomy. Pathology revealed mucosa-associated lymphoid tissue (MALT) lymphoma of the thyroid. No parathyroid lesion noted. Then she was referred to our clinic. US revealed hypoechoic areas at remaining thyroid with no extra finding. We performed tru-cut biopsy from thyroid lesion. On immunochemistry, lymphoid cells were diffusely immunoreactive for CD3, CD5, CD20 and CD43 in the ymphocytes. Ki-67 index was 40%. Hence, the diagnosis of MALT lymphoma of the thyroid gland in the background of Hashimoto's thyroiditis. PTH staining of patient's previous pathology specimen was unremarkable. Pretreatment baseline 18F-flurodeoxyglucose PET/CT (FDG) revealed increased uptake (SUVmax: 5.1) in hypodense nodular structure in the posterior left lobe of the thyroid gland (Figure 1). FDG was suggestive of stage IE. Mild 18F-FCH uptake was observed suspected as parathyroid lesion next to the inferior left lobe. 4D-CT showed similar results. All imaging methods and we examined patient via US that revealed hypoechoic lesion with polar blood supply in the left lobe inferior (parathyroid adenoma). The patient were under rituximab 375 mg/m2 per week for 4 cycles. At the end of treatment, there were no sign of residual disease. Reoperation has not been planned due to the improvement of the patient's symptoms, and lymphoma with indolent course. Conclusion 10% of PHP cases may have a concomitant malignancy, while association with lymphoma is even rarer. MALT lymphoma of the thyroid gland is a rare malignancy with an indolent course. The combination of these two rare conditions hard to orchestrate. As in our case, detection of parathyroid lesions becomes more difficult in the background of a low grade lymphoma. Indolent lymphomas have limited sensitivity with FDG. FCH could be more sensitive for discriminating parathyroid lesions and indolent lymphomas. It may be useful to confirm the localization of the PHP in such cases using multiple techniques involving FCH.Figure 1.Pre-treatment avid FCH uptake (A, B) and mild FDG uptake (C, D) related with thyroid MALToma; post-treatment complete remission shown in FDG (E, F); highly vascular paratracheal lesion at 4D-CT (G, H asterixis), the same lesion with mild FCH uptake (I-N arrows) and the same lesion with hypoechoic sonographic appearance evaluated as parathyroid adenoma (O arrow).

Cytomorphological comparison of ThinPrep and SurePath liquid-based cytology in thyroid fine-needle aspiration.

The two widely established systems for liquid-based cytology (LBC), ThinPrep and SurePath, employ different principles. The aim of this study was to compare the cytomorphology of thyroid lesions prepared by the two techniques. We retrospectively reviewed 44 thyroid FNA specimens prepared by LBC, including 20 ThinPrep and 22 SurePath. Cytologic diagnoses were made according to the Bethesda system and cytomorphologic parameters were evaluated. Acellular smears were significantly frequent in ThinPrep than SurePath (10% vs. 0%). Both techniques produced a clean background, well cell preservation, and not apparent cell shrinkage. ThinPrep showed significantly lower cellularity than SurePath (25% vs. 4.3%). ThinPrep produced considerable flattening and fragmented clusters, while SurePath contained larger clusters in a three-dimensional configuration. Colloid was significantly reduced in amount and fragmented in ThinPrep, and was easily observed in SurePath. In cases of Hashimoto's thyroiditis, ThinPrep produced much less leukocytes in background than SurePath. Aggregates of fibrin and leukocytes were frequently present in 10/16 cases (62.5%) processed by ThinPrep. Air-dry artifact at periphery of the ring was present in 6/16 cases (37.5%) processed by ThinPrep. The nuclear features of papillary carcinoma were similarly evident in both LBC preparations. SurePath seems to be superior to ThinPrep for diagnosing benign entities based on adequate representation of colloid and lymphocytes. The cell quality of both techniques in thyroid FNA was comparable, while each method introduces its own unique cytologic artifacts related to its methodology. We should recognize the cytomorphologic alterations to avoid misinterpretations.

Fine needle aspiration biopsy of parathyroid; is it meaningful? A cytologic study of 81 cases with histological and clinical correlations.

Recognizing the parathyroid gland and distinguishing the parathyroid from thyroid lesions in fine needle aspiration (FNA) is challenging. This study aimed to identify cytomorphologic features suggestive of parathyroid origin and to assess the utility of cytopathology in conjunction with ancillary tests in the identification of parathyroid glands. Ultrasound (US) guided FNA of parathyroid gland and lesions in 81 patients were reviewed concerning clinical history and correlated to histopathologic findings in available cases. FNA smears were evaluated for cellularity, architectural patterns, cellular and nuclear features, and background of the smears. In 78 cases, FNA was supplemented by a measurement of parathormone (PTH) levels in the needle washout fluid (FNA-PTH assay) and/or GATA3/PTH/chromogranin-A immunostainings. Sixty-four cases were diagnosed cytologically as parathyroid lesions in conjunction with FNA-PTH assay and/or immunocytochemical examinations. In an additional nine cases, a diagnosis of parathyroid lesions was rendered after repeated FNA with FNA-PTH assay. The histolopathologic diagnosis of surgically excised cases (n = 75) included parathyroid adenoma (60 cases), atypical parathyroid adenoma (4 cases), parathyroid hyperplasia (10 cases), and parathyroid carcinoma (1 case). Major cytological findings of parathyroid tissue included high cellularity, scattered naked nuclei, cribriform and three-dimensional clusters, stippled chromatin, and oxyphilic cytoplasm while papillary pattern or colloid-like material was identified in three cases respectively. No nuclear grooves or inclusions were seen in any case. High cellularity scattered naked nuclei, cribriform and three-dimensional patterns, stippled chromatin and oxyphilic cytoplasm are cytomorphologic features that favour parathyroid origin. A combination of these features with FNA-PTH assay and/or GATA3, PTH, and chromogranin-A immunostainings on cytologic specimens aid in the identification of parathyroid glands and the distinguishing of parathyroid from thyroid lesions.

Cytological Analysis of Thyroid lesions According to the Bethesda System for Reporting Thyroid Cytology and their Correlation with Histopathology: A Prospective Study

Introduction: Fine-needle aspiration cytology (FNAC) has a crucial role in differentiating between nonneoplasticand neoplastic lesions of the thyroid. It is a quick outpatient department (OPD) procedure. It greatlyaffects the treatment decision. The current study was done to evaluate the role of FNAC as a diagnostic tool inthyroid lesions and establish a clinico-cytological and histological correlation.Aim: To study efficacy of Bethesda system for reporting (TBSRTC) FNAC of thyroid in view of offering guidancefor patient management, for review of distribution of diagnostic categories and correlation with histopathology.Materials and Methods: It is a prospective study of thyroid lesions carried out at the Department of Pathology, CAIMS,Karimnagar over a period of 3 years (January 2020 to January 2023) A total of 303 patients of neck swelling (thyroid),with satisfactory cases on 290 patients in cytology were undertaken for histopathology. Their clinico-cytological,biochemical, and histological correlation was done only in 133 patients only. Their statistical analysis was done.Results: Majority of cases were non neoplastic. The accuracy of cytodiagnosis was 89.3% and overall malignancyrate on histopathology was 16% (37 cases).Conclusion: FNAC of lesions in thyroid gland has a high accuracy in differentiating between malignant andbenign lesions. It is safe cost effective, minimally invasive, and OPD procedure. Using FNAC as the first line ofinvestigation which streamline the reporting terminologies and the number of surgeries on thyroid lesion hasreduced greatly.

Thyroid neoplasia associated with nutritional deficiency in cultured jade perch in Hong Kong.

Non-neoplastic thyroid hyperplasia is common in terrestrial animals, secondary to nutritional imbalances or other goitrogenic compounds. Thyroid hyperplasia is relatively common in teleost fish; however, malignant thyroid neoplasia is rarely reported. We diagnosed cases of thyroid neoplasia in a population of jade perch (Scortum barcoo). The 3,000 affected fish had grossly apparent, bilateral pharyngeal swellings. Histologic examination confirmed proliferative thyroid lesions ranging from hyperplasia to well-differentiated follicular cell carcinoma. In addition, the younger population of animals on the farm also had bacterial septicemia and mild Dactylogyrus sp. gill infections. Feed analysis revealed a severe deficiency of iodine and vitamin C in the homemade fish diet used on the farm. The concentrations of other minerals, such as zinc, were also on the lower end of the recommended requirements for freshwater fish. The farm was using surface water in its recirculating aquaculture system. We recommended a switch to a commercial aquaculture diet, as well as to use well water rather than surface water to avoid any contaminants, and to treat the younger fish with an antibiotic for bacterial septicemia. Our case provides evidence of progression from nutritional-associated thyroid hyperplasia to neoplasia in farmed teleost fish.

Thyroid Malignancy among Fine Needle Aspiration Cytology of Thyroid Lesions in a Tertiary Care Centre.

The most prevalent endocrine cancer in the world is thyroid cancer, and its incidence is on the rise. The distinction between benign and malignant thyroid nodules must be made, which is why fine needle aspiration cytology of thyroid lesion is necessary and required. This study aimed to find out the prevalence of thyroid malignancy among fine needle aspiration cytology of thyroid lesions in a tertiary care centre. A descriptive cross-sectional study was conducted among fine needle aspiration cytology of thyroid lesions in a tertiary care centre after obtaining ethical approval from the Institutional Review Committee. Data from 13 April 2020 to 13 April 2023 was collected between 19 May 2023 to 19 June 2023. All the patients with complete hospital record data were included in this study. However, repetitive fine needle aspiration cytology of thyroid lesion were excluded from the study. Fine needle aspiration cytology diagnoses were categorized in this study as per the Bethesda system for reporting thyroid cytopathology. The point estimate was calculated at a 95% Confidence Interval. Among 398 fine needle aspiration cytology of thyroid lesions, thyroid malignancy was seen in 12 (3.02%) (1.34-4.70, 95% Confidence Interval) patients. The prevalence of thyroid malignancy was found to be lower than other studies done in similar settings. cytology; malignancy; prevalence; thyroid.

Efficacy of prevention of recurrent laryngeal nerve injury in thyroid surgery

To evaluate the effectiveness of prevention of recurrent laryngeal nerve injury depending on thyroid gland lesion and extent of surgery. There were 2412 thyroid surgeries between 2000 and 2020. Patients were divided into the main group (1689 patients) and the control group (729 patients). Patients with nodular thyroid gland lesions prevailed in both groups (987 (58.4%) and 415 (56.9%), respectively). All ones underwent atraumatic extrafascial desection and thyroid resection (ultrasonic scalpel). He upper laryngeal nerve injury occurred in 35 cases (1.4%). The number of surgeries with thyroid remnant preservation was significantly lower in the main group. The number of procedures with subtotal thyroid resection and thyroidectomy increased by 2.4 times (from 414 to 1010 operations, p<0.05). Improvement of surgical treatment of thyroid gland lesions consisting in new operative technique of recurrent laryngeal nerve isolation using ultrasonic scalpel reduces the incidence of recurrent laryngeal nerve injury from 2.3% to 1%. At the same time, the number of extended procedures in the main group significantly exceeded that in the control group (by 2.5 times).

Diagnostic Role of The Bethesda System of Reporting Thyroid Cytopathology and Immunohistochemistry as an Adjunct to Fine Needle Aspiration Cytology in Differentiating Benign and Malignant Thyroid Lesions: A Cross-sectional Study

Introduction: Fine Needle Aspiration Cytology (FNAC) plays a crucial role in the preoperative assessment of thyroid nodules. The Bethesda System of Reporting Thyroid Cytopathology (TBSRTC; 2023) is a standardised system for reporting thyroid FNAC. However, diagnostic challenges can occur in each category of TBSRTC. Aim: To categorise thyroid FNAC according to TBSRTC and revisit the challenges of cytological diagnosis in each category. Materials and Methods: A cross-sectional, observational study was conducted from November 2018 to April 2020 (18 months) in the Department of Pathology at ABVIMS and Dr. RML Hospital in New Delhi, India. The study included all 470 thyroid FNA cases received in the department from patients presenting with palpable thyroid nodules or ultrasonographically detected solid thyroid lesions, regardless of their age or sex. The cases were classified according to TBSRTC. Diagnostic tests were used to calculate sensitivity, specificity, Negative Predictive Value (NPV), Positive Predictive Value (PPV), and diagnostic accuracy of TBSRTC. Immunoexpression for Human Bone Marrow Endothelium marker-1 (HBME-1) and p63 was studied in Bethesda III to VI category cases, i.e., atypia of undetermined significance (AUS), Suspicious for Malignancy (SFM) and malignant cases only, and not in categories I and II. Results: The study included 470 thyroid FNA cases with a mean age of 39.72 years. Cytohistological follow-up was available for 50 cases, of which six cases were discordant and the remaining 44 cases were concordant. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy of TBSRTC were calculated as 50%, 97.06%, 32%, 80.49%, and 82%, respectively. Three cases with diagnostic challenges were revisited and discussed. Immunohistochemistry was performed on a total of 33 FNAC cases. However, histological follow-up was available for only 18 cases, of which seven cases were diagnosed as Papillary Thyroid Carcinoma (PTC) on histological follow-up. HBME-1 and p63 were positive in 57.14% and 42.86% of these cases, respectively. Conclusion: The TBSRTC, 2023, is an excellent reporting system for thyroid FNA and serves as an initial investigative tool for thyroid lesions. Present study findings reveal that it has high specificity and diagnostic accuracy. The Risk of Malignancy (ROM) was comparable to other studies, except for the Bethesda II category. Immunoexpression of HBME-1 and p63 was useful in isolated cases; however, it is not sufficient for cytological diagnosis.

Differentiating Malignant and Benign Lesion in Thyroid, Is There Any New Marker?

The most common malignancy of the endocrine gland is papillary thyroid carcinoma (90% of endocrine malignancy). In many cases, the tumor showed borderline morphology between benign lesions and characteristics of papillary thyroid carcinoma. To determine malignancy, we propose new markers to assist with these difficulties and challenges. This research aims to determine the sensitivity and specificity of CD44 and CDK4 immunostaining in diagnosing papillary thyroid carcinoma. Samples of paraffin blocks with histopathology diagnosis of papillary thyroid carcinoma and components of benign thyroid follicular cells from January 2019 to December 2022 were collected. Immunohistochemical staining was done using CD44 and CDK4 antibodies. The staining in papillary thyroid carcinoma cells and benign thyroid follicular cells were compared. Conclusions: All papillary thyroid carcinoma cells expressed CD44 and CDK4 antibodies (100%), whereas 78.9% of benign thyroid follicular cells did not express CD44 and 81.57% did not express CDK4. CD44 and CDK4 could be useful in diagnosing papillary thyroid carcinoma with a sensitivity of 100% and specificity of 78.9% and 81.57% respectively.

Fine-needle aspiration cytology in thyroid lesions: A diagnostic evaluation study

Fine-needle aspiration cytology in thyroid lesions: A diagnostic evaluation study

Expression of RASSF1A, DIRAS3, and AKAP9 Genes in Thyroid Lesions: Implications for Differential Diagnosis and Prognosis of Thyroid Carcinomas.

Thyroid carcinoma is the primary endocrine malignancy worldwide. The preoperative examination of thyroid tissue lesion is often unclear. Approximately 25% of thyroid cancers cannot be diagnosed definitively without post-surgery histopathological examination. The assessment of diagnostic and differential markers of thyroid cancers is needed to improve preoperative diagnosis and reduce unnecessary treatments. Here, we assessed the expression of RASSF1A, DIRAS3, and AKAP9 genes, and the presence of BRAF V600E point mutation in benign and malignant thyroid lesions in a Polish cohort (120 patients). We have also performed a comparative analysis of gene expression using data obtained from the Gene Expression Omnibus (GEO) database (307 samples). The expression of RASSF1A and DIRAS3 was decreased, whereas AKAP9's was increased in pathologically changed thyroid compared with normal thyroid tissue, and significantly correlated with e.g., histopathological type of lesion papillary thyroid cancer (PTC) vs follicular thyroid cancer (FTC), patient's age, tumour stage, or its encapsulation. The receiver operating characteristic (ROC) analysis for the more aggressive FTC subtype differential marker suggests value in estimating RASSF1A and AKAP9 expression, with their area under curve (AUC), specificity, and sensitivity at 0.743 (95% CI: 0.548-0.938), 82.2%, and 66.7%; for RASSF1A, and 0.848 (95% CI: 0.698-0.998), 54.8%, and 100%, for AKAP9. Our research gives new insight into the basis of the aggressiveness and progression of thyroid cancers, and provides information on potential differential markers that may improve preoperative diagnosis.

The role of CK19 and CD56 immunohistochemical staining in differentiating papillary thyroid carcinoma from other thyroid lesions

The role of CK19 and CD56 immunohistochemical staining in differentiating papillary thyroid carcinoma from other thyroid lesions

Comparison of diagnostic accuracy of conventional method and Bethesda system for reporting thyroid cytopathology in the diagnosis of various lesions of the thyroid: Experience from a tertiary care center of northeastern India

Background: Fine-Needle Aspiration Cytology (FNAC) is a valuable, minimally invasive diagnostic tool for discerning benign and malignant thyroid lesions. In the realm of thyroid cytopathology, both the traditional approach and the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) are widely utilized for diagnosing and categorizing these lesions. Aims and Objectives: This study aims to classify thyroid cytology smears using both the conventional method and the Bethesda system and to compare their findings with histopathological diagnoses. Method and Materials: A hospital-based cross-sectional study was conducted over one year, spanning from February 1, 2022, to January 31, 2023. We included 191 cases of FNAC thyroid lesions and categorized them following the guidelines of both the conventional system and the Bethesda system for reporting thyroid cytopathology. Sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy for both systems were calculated, with histopathology serving as the gold standard for comparison. Furthermore, we calculated the Risk of Malignancy (ROM) for each category within the Bethesda system. Results: The Bethesda system exhibited a notably high sensitivity of 83.33%, surpassing the conventional method's sensitivity of 50%, while both systems shared the same specificity of 90%. The diagnostic accuracy of the Bethesda system, at 89.13%, outperformed that of the conventional method, which stood at 84.78%. Conclusion: This study demonstrates a strong positive correlation with histopathology, indicating high sensitivity, specificity, and accuracy when employing TBSRTC, in contrast to the conventional method.

Деякі особливості ендокринного статусу у реконвалесцентів після COVID-19 та його зміни під впливом відновлювального лікування

Abstract. The aim — to study the thyroid hormones and cortisol levels in convalescents after COVID-19, including patients with chronic obstructive pulmonary disease (COPD) and their possible changes under the influence of recovery treatment. Materials and methods. 83 convalescents after COVID-19 (with manifestations of COVID pneumonia in the acute period) aged 32–67 years, who had no history of thyroid or adrenal glands lesions’ manifestations were examined. 29 of them had COPD (GOLD II-III). Patients began the course of rehabilitation within 1–3 weeks after inpatient treatment. Тhe levels of thyroid-stimulating hormone (TSH), total fractions of thyroid hormones (thyroxine — T4 , triiodothyronine — T3 ), cortisol as well as the level of interleukin-8 (IL-8) were determined in blood serum. Assessment was carried out by immunoenzymatic method at the beginning of recovery treatment and after it (within 21–22 days). Recovery treatment included the necessary basic anti-inflammatory and broncholytic therapy (for patients with COPD) and a physiotherapeutic complex, which included the use of haloaerosoltherapy (HAT) — dry aerosol media with certain concentration and dispersion (18-20 sessions per course) and singlet oxygen therapy (12 procedures per course). Results. Before treatment significantly higher levels of all studied indices compared to control were found in both groups of patients (without history of COPD and patients with COPD). Certain change of the inverse relationship between the values of TSH and T4 , T3 was noted, which probably indicates the presence of maladaptive thyroid syndrome. The obtained results can be interpreted as a consequence of systemic immune activation caused by SARS-CoV 2 infection and as a result of intensive treatment in the acute period. These changes took place on the background of a significant IL-8 level increase. A correlation between the levels of IL-8 and TSH (r=0.43) was revealed, which indicates a certain dependence between stimulation of thyroid gland function and the severity of the inflammatory process. Thyroid hormone levels in convalescents after COVID-19 without COPD (1st group) and convalescents after COVID-19 with COPD history (2nd group) were compared. Direction of changes in the thyroid hormones levels in both groups was similar, but the increase of TSH and T4 levels in the 2nd group was significantly higher and took place on the background of a higher IL-8 level. Studies of cortisol secretion in the examined groups showed a moderate, but reliable increase in its levels compared to the control by 1.2 and 1.4 times respectively. This may be related to both activation of the adrenal cortex during the convalescence and the consequences of therapy in the acute period of COVID-19. Taking into account received data, as well as the analysis of individual deviations of the studied indices, these changes should be considered as a non-thyroidal illness syndrome (NTIS) and dysfunctional adrenal disorders. The applied recovery treatment had a corrective effect on the thyroid and adrenal functions. Thus, by the end of treatment, the levels of cortisol and T3 reached the control level on the background of a significant decrease of IL-8 level in both groups of patients. Positive changes in thyroid function in convalescents after COVID-19 without COPD history were more pronounced. Conclusions. In convalescents after COVID-19 thyroid and adrenal dysfunctional disorders were observed, they were more pronounced in patients with COPD and directly correlated with an increase of pro-inflammatory IL-8 level. Rehabilitation treatment based on haloaerosoltherapy, which is aimed at bronchopulmonary system sanation and reduction of inflammatory process, contributes to the recovery of thyroid and adrenal function. Positive effect is more pronounced in patients without a history of chronic bronchopulmonary pathology.

Assessment of diagnostic accuracy of Bethesda reporting system with fine needle aspiration cytology of thyroid lesions and its histological correlation

Assessment of diagnostic accuracy of Bethesda reporting system with fine needle aspiration cytology of thyroid lesions and its histological correlation

Progress in research on ablation of thyroid nodules.

The incidence of thyroid nodules is rising annually. Surgical treatment is effective, but often results in significant trauma, recurrent laryngeal nerve injury, hypoparathyroidism, and other complications. Recent years have seen significant breakthroughs in thyroid nodule ablation for treating thyroid diseases, although its application remains controversial. The objective was to review the development history and current research status of thyroid nodule ablation to provide a reference for future studies. The literature on thyroid nodule ablation was reviewed, analysing its advantages and disadvantages. The therapeutic effect of thyroid nodule ablation in treating benign thyroid lesions is noteworthy, but issues such as lax treatment indications and excessive medical treatment persist. Initial success has been achieved in treating thyroid malignant lesions, particularly papillary thyroid microcarcinoma (PTMC). However, the curative effect requires further follow-up verification.

Varied Lineage Thyroid Malignancies in Longstanding Thyroid Swellings: A Series of Three Cases

Long-standing thyroid swellings can present therapeutic and diagnostic challenges. Although benign, these nodules can harbour malignancies of diverse lineages ranging from those of follicular cell origin to rare malignancies such as lymphomas and paragangliomas. Here, the authors are sharing their three clinical experiences with thyroid neoplasms of long duration. The first case is a 42-year-old male patient who presented with an anterior neck swelling of 12 years’ duration. Postoperatively, a diagnosis of Mucosa-associated Lymphoid Tissue (MALT) lymphoma was made based on histopathology and immunohistochemistry. In the second case, a 43-yearold male presented with a neck swelling with eight years of history. Intraoperatively, the lesion was found to be locally aggressive with infiltration into the strap muscles and trachea. A tissue diagnosis of paraganglioma of the thyroid gland was made postoperatively. The third case involves a 72-year-old female who had undergone a left thyroidectomy 10 years back and presented to the Outpatient Department (OPD) with a history of right-sided neck swelling associated with dysphagia and a change in voice. The patient was diagnosed with anaplastic carcinoma, specifically squamous cell carcinoma. Thyroid lesions of abnormally large size create intraoperative problems concerning securing an adequate airway, locating anatomical structures, especially the Recurrent Laryngeal Nerve (RLN), parathyroids, and great vessels of the neck. Postoperatively, the tissue features may be very uncharacteristic, making reaching a proper diagnosis difficult. The use of immunohistochemistry helps in determining the cell lineage and type of malignancy

Correlative Study of Ultrasound Scan, Fine-needle Aspiration Cytology and Histopathology of Thyroid Swellings

Abstract Introduction: Thyroid swellings are common clinical entities with a reported prevalence of about 10% of the adult population. As ultrasound technology is advancing, so is the detection of thyroid lesions, even if they are as small as a few millimetres in size. While fine-needle aspiration cytology (FNAC) is the standard procedure for thyroid nodule diagnosis; it involves risks and unnecessary costs. However, histopathological examination (HPE) is the gold standard for the classification of thyroid swellings. While individual characteristics of USS which increase the suspiciousness of malignancy, have been studied repeatedly but are inconclusive, we therefore need a comprehensive system of stratifying thyroid nodules and characterising them with confidence so that we can reduce the number of needless painful aspiration and biopsy procedures. Aim: This study aims to determine the diagnostic accuracy of ultrasound scans and FNAC in thyroid swellings by comparing them with HPE results. Materials and Methods: It was a prospective observational study conducted in a tertiary care centre over a period of 2 years. During this period, a total of 200 patients presented with palpable thyroid nodules in the surgery outpatient department out of which 160 patients were included in our study. All the patients underwent a triple assessment (clinical examination, sonogram and FNAC) and were later posted for surgery, the specimen obtained was sent for HPE. Data were collected and the results were analysed and compared. Results: One hundred and sixty cases with thyroid swellings were studied. Out of the 160 cases, 136 were female and 24 were male with female-to-male ratio of 5.6:1. Based on various ultrasound characteristics of thyroid nodules, each thyroid nodule was classified into ACR-TIRADS categories and then FNAC was done. On HPE diagnosis of 160 cases, 98 (61.3%) patients were benign and 62 (38.8%) patients were malignant. The results of histopathology were correlated with ultrasound features and statistical analysis was done calculating sensitivity, specificity, positive predictive value and negative predictive value for each feature. The sensitivity and specificity for irregular margin were 38.7% and 93.9%, for taller-than-wide were 21% and 100%, for punctate echogenic foci/microcalcification were 8.1% and 100%, for hypoechogenicity were 91.9% and 64.3% and for solid consistency were 69.4% and 76.5%. The risk of malignancy for TIRADS categories 2, 3, 4 and 5 in our study was 2.5%, 21%, 64% and 94%, respectively. In comparison with FNAC diagnosis and HPE, FNAC is 98.0% sensitive and 54.8% specificity in detecting benign lesions while 4.84% sensitivity and 97.96% specificity in detecting malignant lesions. Conclusion: ACR-TIRADS is a good predictor of malignancy. Individual characteristics such as solid composition, hypoechogenicity, irregular borders, taller-than-wide shape and microcalcifications were highly predictive of malignancy. FNAC is of greater help in the pre-operative diagnosis and should be treated as a first-line diagnostic test for thyroid swellings to guide the management though it is not a substitute for HPE.

Papillary carcinoma arising in a throglosal cyst with no associated thyroid lesion: An unusual case

ABSTRACT Introduction: Thyroglossal cyst is the most common development anomaly of thyroid gland as well as it represents the most common congenital neck mass. Thyroglossal duct associated malignancy is very rare, and majority is papillary carcinoma. Case: A 21-year-old female presented with a painless midline neck swelling. There are no complaints of difficulty in swallowing, breathing, or voice changes. Ultrasonography revealed a multiloculated cystic lesion in midline neck region. The patient underwent Sistrunk procedure. Histopathology revealed foci of papillary carcinoma in association with thyroglossal duct cyst. Discussion: Thyroglossal duct cyst remains the most common anomaly of thyroid development. It is also the most common congenital neck swelling. The malignancy associated with thyroglossal duct cyst is very rare. Suspicion of malignancy may arise when the cyst appears irregular, hard, and fixed. Conclusion: In our case, the presence of papillary structures in thyroglossal duct support the diagnosis of papillary carcinoma arising from thyroglossal duct rather than a secondary tumor or metastasis from other organs such as thyroid gland. A diagnosis of papillary carcinoma in a thyroglossal duct cyst requires comprehensive surgical management and vigilant follow-up.

Clinical value of contrast-enhanced ultrasound quantitative analysis for differentiating thyroid lesions in Hashimoto's thyroiditis patients.

The role of quantitative contrast-enhanced ultrasound (CEUS) in the evaluation of thyroid nodules with Hashimoto's thyroiditis (HT) has received little attention. This was a retrospective cohort study. We consecutively enrolled 242 patients (49 males, 193 females, average age 52 years) with a combined total of 248 thyroid nodules coexisting with HT who underwent biopsy/resection-proven pathology from December 2016 to June 2021. All patients underwent preoperative ultrasound (US) and CEUS examinations performed by 2 radiologists independently. Quantitative analysis of CEUS using time-intensity curves (TIC) was measured by an expert radiologist from the thyroid intra-nodule and the surrounding parenchyma and their ratios. Receiver operating characteristic (ROC) analysis was performed to evaluate their diagnostic performance. The patients were divided into the nodular HT (NHT) group (n=42), the papillary thyroid carcinoma (PTC) group (n=154), and the primary thyroid lymphoma (PTL) group (n=52) according to their pathological results. TIC parameters revealed that PTC and PTL showed faster time to peak (TTP) (P=0.044, P=0.049), lower peak intensity (PI) (both P<0.001), and smaller areas under the curve (both P<0.001) than those of NHT. The intra nodule of PTL showed an obviously slower perfusion (ratio =0.90, P<0.001) and lower PI (ratio =0.84, P<0.001) compared with the thyroid parenchyma. TIC improved performance in distinguishing PTL from NHT [area under the curve (AUC): 0.947, 95% confidence interval (CI): 0.903-0.991], but inferior performance in differentiating PTC and NHT (AUC: 0.838, 95% CI: 0.759-0.917). CEUS quantitative analysis could be valuable in differentiating thyroid malignancies in patients with HT.