Thyroid Lesions Research Articles

ENDOCRINE TOXICITY OF IMMUNE CHECKPOINT INHIBITORS IN CLINICAL PRACTICE

Relevance: Immunological control points significantly changed cancer therapy worldwide after a new class of inhibitor drugs was registered. Based on clinical studies, this type of treatment was associated with better survival in sensitive patients than cytostatic therapy. Checkpoint inhibitors exert their effect by regulating the immune response to malignant cells, blocking the usual inhibitory pathways of T-cell regulation. The receptors of cytotoxic T-lymphocytic antigen-4 (CTLA-4) and programmed cell death protein (PD-1) or its associated ligand (PD-L-1) are the target of inhibitors. CTLA-4 acts at an early stage of triggering an antigenic response, and PD-1 and PD-L-1 act by modulating interaction with peripheral tissue
 However, treatment with checkpoint inhibitors (ICTs) is accompanied by a wide range of immune mediated adverse events associated with the activation of the immune system. Despite the positive effect on survival, side effects with endocrine effects were noted in about 10% of patients.
 The study aimed to assess the incidence of immune mediated adverse events from the thyroid gland in clinical practice in patients with different localization of malignant tumors in the first and subsequent lines of therapy with checkpoint inhibitors.
 Methods: The study utilized anamnestic, laboratory, and instrumental tests. Laboratory analysis included determining the blood levels of TSH, T3, T4, ACTH, and cortisol. Data analysis was carried out using the Microsoft Excel program.
 Results: The frequency of development of immune mediated thyroiditis against the background of therapy with blockers of control points of the immune pathway in our observation was 29%. The debut of thyroid disorders was diagnosed in the first 12-16 weeks of therapy, beginning with hyperthyroidism against the background of thyroid destruction, followed by a transition to persistent hypothyroidism after 1-3 months.
 Conclusion: When analyzing the safety profile of ICTs in patients in our study, immune mediated adverse reactions did not differ in frequency and spectrum from world practice. The spectrum of toxicity did not depend on the localization of the tumor. Early diagnosis of thyroid lesions necessary for optimal and effective treatment can be carried out using laboratory tests. Knowing the timing of the development of adverse events during ICT therapy allows timely diagnosing and correcting complications from the thyroid to continue effective therapy.

Comparative study of fine needle aspiration cytology and histopathology correlation of various thyroid lesions

Patients with anterior neck swelling constitute common problems encountered in the clinical practice. In all age groups, including children, thyroid cancer is the most prevalent endocrine system cancer. Initial diagnostic testing using fine needle aspiration cytology (FNAC) has been found to be quick and cost effective. Therefore, it is widely accepted and more thyroid cases are diagnosed at an early stage, but it is associated with pitfalls due to difference in correlations between FNAC and Histopathological Examination (HPE). The purpose of the study is to compare the results of FNAC with histopathological findings in order to evaluate the diagnostic efficacy of FNAC.The present study was performed over a period of two years in a tertiary care center. Included in the study were 100 cases of thyroid nodule, which underwent FNAC and the post-operative specimens of whom were subjected to histopathological examination. The results obtained by FNAC were compared with histopathological findings.Out of the 100 cases taken for the purpose of the study, 92 were benign whereas 8 were malignant. The cytological and histopathological diagnosis correlated with each-other in 89 cases. A partial correlation between the cytological and histopathological diagnoses was found in 5 cases. In 6 cases the FNAC diagnosis was not correlating with histopathological diagnosis. FNAC revealed a sensitivity of 62.50%, a specificity of 97.83%, an accuracy of 95%, a positive predictive value of 71.43% and a negative predictive value of 96.77%.FNAC of thyroid lesions is thus proved to be a simple, cost effective and accurate method to diagnose and to guide the management of palpable thyroid lesions Thus, we can see that the diagnostic accuracy of FNAC procedure is very high making it a very useful investigation in the work-up of thyroid patients. However final diagnosis and treatment pattern should be based upon histopathology.

FNAC (Fine needle aspiration cytology) and histopathological correlation and reclassification of thyroid neoplasm in accordance with WHO classification 2022

While assessing whether a patient requires surgery or conservative treatment, the thyroid FNAC is crucial. “The Bethesda System of Reporting Thyroid Cytopathology” was introduced to resolve the problem of standardising terminology in Thyroid FNA diagnosis. This study aims to evaluate the histopathological correlation and to also assess the diagnostic accuracy of TBSRTC at an institutional level with respect to histopathology. Additionally, reclassification of these cases in accordance with new Update of WHO Classification of Thyroid tumors 2022.This is a 3-year retrospective study of thyroid lesions from August 2019 to August 2022 comprising of 160 cases. Data was retrieved from institutional database and analysed. Fine needle aspiration Cytology- Histopathological correlation followed by determination of diagnostic accuracy of TBSRTC was done using Sensitivity, Specificity, PPV, NPV and accuracy. Reclassification was done on the 160 histopathological diagnosis based on the new updated classification.Study showed female predominance and largest cohort belonged to the age group of 21–40 years. Cytohistopathological correlation was done and 4 discordant cases were identified. The Sensitivity, Specificity, PPV, NPV and Accuracy was found to be 95.77, 98.87, 98.55%, 96.7% and 97.5% respectively. On reclassification, the tumors were now classified based on cell of origin and maximum no. of cases were identified under the category of Follicular- cell derived.FNAC is a sensitive and specific method of evaluating thyroid lesions. TBSRTC shows excellent diagnostic accuracy in detecting malignant lesions and can be used for screening neoplasm. The new classification demonstrates classification based on tumour cell of origin. It is crucial for Clinicians and Pathologists to be informed of new terminologies and classification schemes to aid more therapeutic options for patients.

DIAGNOSTIC ROLE OF GALECTIN-3 EXPRESSION IN BENIGN FOLLICULAR PATTERNED THYROID LESIONS, NON-INVASIVE FOLLICULAR THYROID NEOPLASM WITH PAPILLARY-LIKE NUCLEAR FEATURES (NIFTP), AND INFILTRATIVE FOLLICULAR VARIANT PAPILLARY THYROID CARCINOMA (IFVPTC)

Objectives: The objective of the study was to determine the role of Galectin-3 expression in distinguishing Benign follicular patterned thyroid lesions, non- Invasive follicular thyroid neoplasm with papillary-like nuclear Features (NIFTP), and invasive follicular variant of papillary thyroid carcinoma (IFVPTC). Methods: The Institutional Human Ethics Committee reference number is 271/pathology/09/2022. A total of 85 cases were included in the study after the histopathological evaluations based on strictly defined inclusion and exclusion criteria. Study groups were created as nodular hyperplasia, follicular adenoma, follicular carcinoma, NIFTP, invasive EFVPTCs, and classical papillary thyroid carcinomas. Cytoplasmic Galectin-3 Immunohistochemistry (IHC) expression was evaluated in these cases. Galectin-3 IHC scores data were analyzed using IBM SPSS statistics. The Chi-square test was used to determine the association between the variables. p<0.05 was considered statistically significant. Results: Cytoplasmic galectin-3 IHC expression was significantly increased in malignant follicular patterned thyroid lesions compared to benign lesions with p<0.00001. Similarly, cytoplasmic galectin-3 IHC expression was significantly increased in IFVPTC when compared to NIFTP with a p-value of 0.01358. The Odds Ratio showed the positive cytoplasmic Galectin-3 expression in IFVPTC with a 7.5 times higher risk of having adverse outcome when compared to NIFTP. Conclusion: Cytoplasmic Galectin-3 IHC expression may serve as a useful biomarker in predicting the invasiveness of FVPTC and distinguishing NIFTP from infiltrative FVPTC.

Correlation between Ultrasound TI-RADS and Bethesda FNAC Scoring in Thyroid Lesions: A Retrospective Analysis

ABSTRACT Objectives: Primary objective of the study was to determine the association between the TI-RADS system of thyroid lesion evaluation on ultrasound and the cytological findings of thyroid lesions by FNAC (graded as per the Bethesda system). The secondary objective was to study the outcome of high TI-RADS and high Bethesda grades in terms of malignant potential determined by histopathological examination. Materials and Methods: A multi-centric retrospective hospital-based study was done for all patients who underwent sonography for evaluation of thyroid lesions and subsequently fine needle aspiration cytology (FNAC) from 2018 to 2021 at two hospitals in two different states of India. Clinical and radiological data were obtained from hospital records. The data hence obtained was subjected to statistical analysis. The outcome of high-grade TIRADS and Bethesda scores in terms of malignant potential (confirmed by histopathology) was also evaluated. Results: A total of 249 patients fulfilled the inclusion criteria. 129 patients (51.8%) were in 36-55 year age group with female predominance. The majority of cases in the study belonged to TI-RADS 3 category (33.73%) on sonography and Bethesda Grade III (28.91%) after cytological analysis. Out of 72 Bethesda grade III cases, 59 (81.9%) had TI-RADS 3 score. Similarly, out of 67 Bethesda Grade IV cases, 55 (82%) had TI-RADS 4 scores showing maximum concordance. The accuracy of TIRADS 4 and 5 lesions and Bethesda grade 4-6 lesions in detecting malignancy confirmed on HPE was 67.9 and 73.6%. Discussion: Our study done on 249 patients from varying demographic profiles showed that the correlation between sonography and cytological findings of thyroid lesions was statistically significant. Both diagnostic modalities helped to correctly determine the severity of the lesions, and malignant potential and enabled grading into clinically relevant groups that decided the further management as per laid down guidelines. Conclusion: The concurrent use of ACR-TIRADS on sonography coupled with the Bethesda system of cytological evaluation for thyroid nodules is clinically appropriate in ascertaining the RoM (Risk of malignancy) in a thyroid nodule.

Patterns of thyroid tumors in Northern Saudi Arabia with a specific focus on CK19, CD56, and Galectin-3 tumor markers.

The goal of this study was to look at the patterns of thyroid tumors and how thyroid cancer markers showed up in immunohistochemistry in Northern Saudi Arabia. This study investigated retrospectively 190 patients who attended with thyroid complaints. About 140 thyroid biopsies were diagnosed in the Department of Pathology at King Salman Hospital, Ha'il, from November 2019 to November 2020. Out of the 190 patients who attended with thyroid complaints, 140/190 (73.7%) were detected with thyroid lesions (58 malignant and 82 benign). Benign lesions included goiter 49/82 (60%), follicular adenoma 17/82 (21%), Hashimoto's thyroiditis 13/82 (16%), and toxic goiter 3/82 (3%). 5/6 (83.3%) of males with benign lesions had goiters. CK19 was positive in 68.5% of the cases; 71.8% were papillary, 66.7% were follicular, and 100% were undifferentiated carcinomas. Out of the 26/54 (48%) CD56-positive cases, 18/39 (46%) were papillary, 7/12 (58.3%) were follicular, and 3/3 (100%) were undifferentiated carcinomas. Out of the 35/54 (64.8%) Galectin-3-positive cases, 69.2% were papillary, 7/12 (58.3%) were follicular, and 3/3 (100%) were undifferentiated carcinomas. Thyroid cancer is prevalent in northern Saudi Arabia, with the predominant type being papillary thyroid carcinoma. Most patients are female and younger. The combined use of CK19, CD56, and Galectin-3 tumor markers assists in the accurate differential diagnosis of thyroid neoplasms.

Demographic study of endocrine tumours in northwestern India: a five-year retrospective chart review analysis of 3081 thyroid and other endocrine lesions from Jaipur, Rajasthan

Endocrine tumours are commonly encountered in clinical practice. The demographic data in a specific part of the country can be harnessed only from a tertiary care referral center. We aimed to analyze the epidemiological pattern of various histopathological subtypes of four major endocrine glands in the body in Northwestern India. In this retrospective chart review analysis, we reviewed three lakh records of histopathologically proven tumours coming to four major pathology departments and laboratories in Jaipur, Rajasthan over five years; of which 3081 were from patients with endocrine tumours. We included these endocrine tumours in our study and the results were obtained. The collected data were analyzed and results were obtained using Microsoft Excel 2019 Version 2107. Thyroid tumours were the most common tumours (96.8%) with adrenal, parathyroid and pituitary in order. Percentage of malignant cases among the thyroid disorders was 20.55%. Multinodular goitre (50.3%) and papillary carcinoma thyroid (77.67%) topped the benign and malignant thyroid tumours respectively. Females in 21 to 40 years age group were most affected in thyroid tumours. Pheochromocytoma was the most common adrenal tumour (60%) most commonly affecting females in the age group pf 21 to 40 years of age. Parathyroid adenoma constituted the majorchunk of parathyroid tumours (86.9%) with no sex predilection and affecting patients mostly in the age group of 31 to 45 years. Pituitary adenoma was found in 34 of 35 cases with a female preponderance and a wide range of affected age groups (21 to 50 years). Different histopathological subtypes of endocrine gland tumours have a varied epidemiological profile in NorthwesternIndia and incorporation of this knowledge will help improve the clinical acumen of the treating personnel in this part of the country.

Detection of Thyroid Nodule Prevalence and Associated Risk Factors in Southwest China: A Study of 45,023 Individuals Undergoing Physical Examinations.

Thyroid nodules (TNs) are among the most common thyroid lesions, and rates of these nodules have risen over the past three decades. As the majority of TN patients remain asymptomatic when these nodules are in the early stages of development, malignant nodules may continue to develop into thyroid cancer when not detected. As such, early screening and diagnosis-based strategies represent the most promising means of preventing or treating TNs and associated cancers. The present study was thus developed to explore TN prevalence among individuals in Luzhou, China. Here, thyroid ultrasonography and metabolic-related indicators from 45,023 adults undergoing routine physical examinations in the Health Management Center of a large Grade A hospital in Luzhou over the last three years were retrospectively reviewed in an effort to identify factors associated with TN risk and the detection of these nodules through univariate and multivariate logistic regression analyses. In total, 13,437 TNs were detected in these 45,023 healthy adults for an overall 29.8% detection rate. This TN detection rate rose with age, and multivariate logistic regression analyses revealed that independent risk factors associated with TNs included greater age (≥31 years old), female (OR = 2.283, 95% CI: 2.177-2.393), central obesity (OR = 1.115, 95% CI: 1.051-1.183), impaired fasting glucose (OR = 1.203, 95% CI: 1.063-1.360), overweight status (OR = 1.085, 95% CI: 1.026-1.147), and obesity (OR = 1.156, 95% CI: 1.054-1.268), while low BMI was a protective factor associated with lower rates of TN incidence (OR = 0.789, 95% CI: 0.706-0.882). When results were stratified by gender, impaired fasting glucose was not an independent predictor of TN risk among males, while high LDL levels were an independent predictor of TNs among females, and other risk factors were not significantly changed. TN detection rates were high among adults in Southwestern China. Female, elderly individuals, individuals exhibiting central obesity, and those with high levels of fasting plasma glucose are more likely to develop TN.

Elevated Plasma Levels of MT4-MMP and MT6-MMP; A New Observation in Patients with Thyroid Nodules.

Based on the critical role of MT4-MMP and MT6-MMP in carcinogenesis, we focused on MT4-MMP and MT6-MMP circulating levels in patients with thyroid nodules. Plasma samples were collected from three groups, including papillary thyroid cancer (PTC; n=30), multinodular goiter (MNG; n=30), and healthy subjects (n=22). Enzyme-linked immunosorbent assay (ELISA) was used to obtain the concentration of MT4-MMP and MT6-MMP in the three groups. Analysis of data demonstrated increased levels of MT4-MMP (PTC: 4.90±1.35, MNG: 4.89±1.37, and healthy: 3.13±1.42) and MT6-MMP (PTC: 8.29±2.50, MNG: 7.34±2.09, and healthy:5.01±2.13) in thyroid nodules by comparison with healthy subjects (P<0.05). There were no significant differences in the levels of the two MT-MMPs between PTC and MNG (P>0.05). Increased plasma levels of MT4-MMP (odds ratio=2.48; 95% CI: 1.46-4.19; P=0.001) or MT6-MMP (odds ratio=1.81; 95% CI: 1.29-2.53; P=0.001) were associated with increased risk of PTC tumorigenesis. Interestingly, a strong positive association was observed between MT4-MMP and MT6-MMP in the three groups (PTC: r=0.766**, P=0.000; MNG: r=0.856**, P=0.000; healthy r=0.947**, P=0.000). Areas under the ROC curve for MT4-MMP and MT6-MMP were 0.82 and 0.96, respectively. At the cutoff value>4.7 (ng/mL), MT4-MMP and MT6-MMP showed a sensitivity of 63.3% and 90.0%, respectively, with 100% specificity. Our work has led us to imply that the higher levels of MT4-MMP and MT6-MMP are closely linked with both PTC and MNG tumorigenesis. They may probably promote the development of thyroid lesions; however, more research is needed to further clarify the current findings.

A COMPARATIVE STUDY OF FINE NEEDLE ASPIRATION CYTOLOGY VS FINE NEEDLE NON ASPIRATION CYTOLOGY VS ULTRASOUND GUIDED FINE NEEDLE ASPIRATION CYTOLOGY IN THE CYTOLOGICAL EVALUATION OF THYROID LESIONS

Introduction: FNAC is mainly used in differentiating malignant thyroid nodules from benign nodules as the later can be followed up clinically. A modified sampling technique called fine needle non-aspiration cytology (FNNAC), has come into clinical use in recent times. To evaluate the efficacy of fine-needle non-aspiration cytology (FNNAC) with that of standard fine-needle aspiration cytology (FNAC) and USG guided FNAC of thyroid lesions as regards to cellular and hemorrhagic yield. Methodology: Patients attending Out patient and In patient Department of General Surgery with clinically palpable thyroid swelling for a period of one year are included in this study. Patients were randomised into 3 groups_ 25 patients in each group. After a thorough clinical examination, all the patients in group 1 were subjected to FNAC. Patients in group 2 were subjected to FNNAC .Patients in group 3 were subjected to USG guided FNAC. The details of the technique of Fine needle cytology were explained to the patient and an appropriate consent was obtained from each case before performing the procedure. After subjecting patients to FNNAC and FNAC using 23 gauge needle,the samples were smeared and air dried and sent to the pathologist. Cytological evaluation and reporting was done by pathologist. Results: Out of 50 patients, 25 patients were subjected to FNNAC &amp; 25 patients were subjected to USG guided FNAC from thyroid lesions. The smears was scored and graded accordingly. Based on the results, it was found that superior quality smears were more in FNNAC technique, but diagnostically adequate samples are more in USG guided FNAC than FNNAC. Conclusion: For highly vascular organs like thyroid , FNNAC is the preferred technique as there is better material with less admixture of blood. The number of superior quality smears without admixture of blood is more from FNNAC. FNAC smears although equally diagnostic, mostly produced diagnostically adequate rather than superior quality smears.

Cowden Syndrome Complicated with Thyroid Lesion: A Pediatric Case Report.

Cowden Syndrome Complicated with Thyroid Lesion: A Pediatric Case Report.

Aliens in the thyroid gland: The secondary lesions.

A secondary lesion in the thyroid gland is a rare clinical scenario diagnosed preoperatively during the evaluation of a neck mass, postoperatively in a thyroidectomy specimen or in autopsy studies. Even though the thyroid gland is highly vascular, secondary malignant lesions are rare accounting for 0.2% of all thyroid malignancies. Thyroid gland secondary lesions are often metachronous in presentation as they are seldom evaluated in the initial diagnostic workup of the primary lesion. Fine-needle aspiration cytology (FNAC) is a useful modality for the diagnosis of secondary thyroid lesions. A 6-year retrospective review (2016-2021) was carried out to assess the secondary lesions in the thyroid gland. Papanicolaou and field-stained FNAC smears of secondary thyroid lesions were reviewed. Ancillary techniques were performed on the cell block for differentiating from the primary thyroid gland lesions. There were 383 patients in our archives. There were only 18 cases (4.7%) that presented with secondary neoplastic lesions in the thyroid gland either by direct extension, metastases or as a hematolymphoid malignancy. There were 14 (77.7%) cases that presented with non-hematolymphoid secondary lesions while 4 (22.3%) cases presented with hematolymphoid malignancies. Thyroid secondaries were predominantly seen in female patients (female: male ratio of 1.5:1). Most of the cases presented with a synchronous secondary lesion (n = 14, 77.7%) and few metachronous secondary lesions were also noted (n = 4, 22.3%). Although exceedingly rare, the detection of secondary thyroid gland lesions is important for staging and planning treatment.

B-mode Ultrasound Characteristics of Thyroid Nodules With High-Benign Probability and Nodules With Risk of Malignancy.

Thyroid nodules are commonly found on clinical examination or diagnostic imaging of the neck. Malignant thyroid nodules are increasing worldwide, making thyroid cancer one of the most common endocrine malignancies worldwide. The aim of this study was to determine B-mode ultrasound characteristics of benign thyroid nodules and nodules with risk of malignancy. Material and methods: This retrospective study was conducted on subjects (n=99) who underwent thyroid ultrasound. Data were retrieved from the Thyroid Digital Image Database of Universidad Nacional de Colombia, a published open-access dataset, in which B-mode ultrasound images were interpreted by expert radiologists providing a complete diagnostic description of thyroid lesions using the Thyroid Imaging Reporting and Data System. Sponge-like appearance (Pearson Chi-Square 4.6, p=0.02), cystic (Pearson Chi-Square 27.3, p<0.001), isoechoic (Pearson Chi-Square 26, p<0.001), and well-defined (Pearson Chi-Square 13.7, p<0.001) thyroid nodules were more likely to be observed in benign nodules (risk of malignancy <5%). On the other hand, predominately solid (Pearson Chi-Square 5.9, p=0.01), microcalcifications (Pearson Chi-Square 50.7, p<0.001), hypoechoic (Pearson Chi-Square 27.7, p<0.001), irregular shape (Pearson Chi-Square 6.6, p=0.01), and ill-defined (Pearson Chi-Square 8.8, p=0.003) thyroid nodules were more likely to be observed in nodules with risk of malignancy (>5%). Ultrasound characteristics could be used to determine thyroid nodules with risk of malignancy and avoid over-diagnosing nodules with benign features. Further research evaluating the use of multiparametric ultrasound to distinguish between benign thyroid nodules and thyroid nodules with risk of malignancy is required.

The Accurate Interpretation and Clinical Significance of Morphological Features of Fine Needle Aspiration Cells in Papillary Thyroid Carcinoma.

Papillary thyroid carcinoma (PTC) is the most common malignant neoplasm of the thyroid gland; fine needle aspiration cytology is the most basic and reliable diagnostic method before PTC operation. However, it is not clear which cell morphological changes can be used as a reliable standard for the diagnosis of PTC. A retrospective analysis was performed on 337 patients with PTC confirmed by postoperative histology. An additional 197 randomly selected patients with benign thyroid lesions were included in the study and used as a control group. True papillary arrangements, swirl arrangements, and escape arrangements had high specificity, all of which were 100%, but only swirl arrangements had ideal sensitivity (77.61%). The nuclear volume characteristics had a high sensitivity of more than 90%, but the specificities of both nuclear crowding and nuclear overlap were too low, only 16.34% and 23.35%. The sensitivities of five nuclear structural characteristics were more than 90%, but only the specificity of intranuclear cytoplasmic pseudoinclusions (INCIs) reached 100%, nuclear contour irregularity and pale nuclei with powdery chromatin also had ideal interpretation value except for grooves and marginally placed micronucleoli. Although the sensitivity of psammoma bodies (PBs) was low, the specificity was 100%. In terms of preparation methods, the method of liquid-based preparation (LBP) is obviously better than that of conventional smears. The diagnostic efficiency by the combined detection method of parallel tests showed that without reducing the specificity, the sensitivity increased with the increase of the number of morphological characteristics and finally reached 98.81%. The INCIs and swirl arrangements are the most common and important indicators for the diagnosis of PTC, whereas papillary-like arrangements, the crowding and overlap of nuclear, grooves, marginally placed micronucleoli, and multinucleated giant cells are of little significance for the diagnosis of PTC.

Possibilities and priority of ultrasound in thyroid lesions covid-19

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Pre-operative features of borderline thyroid lesions - outcomes of the sonographic and cytopathological analysis

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

A STUDY ON THYROID NODULES CORRELATION OF TIRADS WITH BETHESDA SYSTEM

Thyroid nodules are very common in clinical practice and the incidence ranges from 4-7% on palpation whereas on ultrasonographic examination the prevalence ranges from 50-60%. Ultrasound has considerably increased the number of cases identied; The USG features of thyroid nodules do not always coincide with the cytological results, leading to discrepancies and confusion in management protocols. This study aims to correlations between USG and cytological ndings in the diagnosis of thyroid nodules. Ultrasonogram of neck done in 100 cases in these 75 of them having thyroid nodules. More common in females. In my study observed a good correlation between ultra sound guided diagnosis made by TIRADS and ne needle aspiration diagnosis by Bethesda classication. By stratifying the thyroid lesions according to TIRADS, FNAC can be performed only on suspicious lesions which can avoid unnecessary aspiration on thyroid lesions &amp; the identication of patients at higher risk of cancer

Abstract #1384628: An Incidental Thyroid Lesion on FDG-PET Scan in a Patient with Long History of Hypothyroidism and Radiation Exposure

An 81-year-old woman with history of lung cancer and hypothyroidism with an incidental thyroid lesion on (FDG)-positron emission tomography (PET) scan is subsequently diagnosed with primary thyroid lymphoma (PTL) using flow cytometry. An 81-year-old woman with a history of lung cancer and hypothyroidism presented to the endocrinology office for evaluation of a thyroid lesion. Primary hypothyroidism was diagnosed 30 years prior to presentation and was controlled with levothyroxine 88 mcg daily. Lung cancer was diagnosed 8 years prior, and treated with radiation therapy. Patient had an FDG-PET scan obtained for the evaluation of lung nodules, and a hypermetabolic focus was noted in the left thyroid region with a max SUV of 18. On thyroid ultrasound, the left thyroid lobe appeared heterogenous with solid nodular areas. The physical exam revealed a smooth but firm thyroid gland, without cervical lymphadenopathy. Laboratory workup showed thyroid stimulating hormone and free thyroxine in the normal range. Microsomal antibody was 4.2 IU/mL (< 5.6 IU/mL), and thyroglobulin antibody was 356.4 IU/mL (< 14.4 IU/mL). Fine needle aspiration (FNA) biopsy showed a polymorphous lymphoid sample. Given the high SUV on PET-scan and longstanding history of Hashimoto’s thyroiditis, repeat FNA biopsy with flow cytometry was subsequently performed and showed a lymphoid population consistent with a non-Hodgkin lymphoma (NHL). The patient was referred to oncology and diagnosed with indolent NHL. Further staging revealed interval growth in lung nodules, with biopsy showing recurrence of adenocarcinoma, but no other metastatic disease. The patient underwent radiation therapy for both her lung adenocarcinoma and primary thyroid lymphoma (PTL). Primary thyroid lymphoma accounts for less than 5% of thyroid cancers. It presents with a female predominance in the 7th decade of life, with Hashimoto’s thyroiditis as the main risk factor. Patients may present with an enlarging neck mass, with or without compressive symptoms, and cervical lymphadenopathy. Diagnosis of PTL can be made through FNA biopsy, core biopsy, or open surgical biopsy. It is important to note that because these lesions have few pathognomonic features, diagnosis with FNA biopsy alone can be difficult, and sensitivity is increased to 97% with the use of flow cytometry, as was demonstrated in our case. Treatment is with radiation therapy or combined chemoradiotherapy. Surgery has a role limited to the management of airway compromise, as surgical resection has not proven to improve overall survival. This case highlights the utility of including flow cytometry with FNA sample when diagnosing PTL.

Genomic Landscape of Three Groups of Patterned Follicular Thyroid Lesions

Clinical ThyroidologyVol. 35, No. 5 Thyroid CancerGenomic Landscape of Three Groups of Patterned Follicular Thyroid LesionsSara AhmadiSara AhmadiDivision of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.Search for more papers by this authorPublished Online:12 May 2023https://doi.org/10.1089/ct.2023;35.195-198AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetails Volume 35Issue 5May 2023 Information© Copyright 2023, Mary Ann Liebert, Inc.To cite this article:Sara Ahmadi.Genomic Landscape of Three Groups of Patterned Follicular Thyroid Lesions.Clinical Thyroidology.May 2023.195-198.http://doi.org/10.1089/ct.2023;35.195-198Published in Volume: 35 Issue 5: May 12, 2023PDF download

CLINICO-CYTOLOGICAL CORRELATION OF THYROID SWELLINGS AT KARWAR INSTITUTE OF MEDICAL SCIENCES.

Aim(s) To elucidate the clinical presentation of thyroid swelling and to assess the Clinico – cytological correlation of thyroid swellings Objective(s) 1. To assess the efcacy of FNAC in thyroid diseases. 2. To study the clinical presentations of thyroid lesions with its cytological correlation Material and method :The present study was a prospective study carried out in the Department of Pathology, karwar institute of medical sciences, karwar, karnataka (India), on both indoor and outdoor patient requiring FNAC of the thyroid lesions between May 2022 to October 2022 with 60 sample size. Results 1) Swelling in front of neck was the most common symptoms followed by pain 2) Swelling40(66.6%), cases were goiter under evaluation/ multinodular goiter 3) Colloid goiter was diagnosed in 35cases (58.3%). Conclusion FNAC is a safe and simple technique of preoperative diagnosis with a sensitivity rate was 96.6% with a specicity rate of 98.3%. Our results also showed a PPV of 98.3% anda NPV of 96.6%.