Cytological diagnosis of thyroid nodules in Hashimoto thyroiditis in elderly patients

Abstract

BackgroundLong standing Hashimoto Thyroiditis (HT) causes shrinking and atrophy of the thyroid, but may also lead to diffuse enlargement of the gland and/or formation of nodules. These nodules should be differentiated from papillary thyroid carcinoma (PTC) and primary thyroidal non-Hodgkin lymphoma (PTL), which are possible complications of HT, and require pre-surgical diagnoses and different treatments.This study focuses on the role of fine-needle cytology (FNC) in the clinical surveillance and pre-surgical diagnosis of HT with diffuse and nodular enlargement of the gland in elderly patients.MethodsThirty-four elderly patients (≥ 65 yrs) with HT and diffuse or nodular enlargement of the thyroid underwent ultrasound (US)-guided FNC. Smears were routinely stained and evaluated; additional passes were used for flow cytometry (FC) assessment of lymphoid infiltrate in 6 cases.ResultsThe cytological diagnosis was HT in 12 cases with prevalence of Hurtle cells in 2 cases, PTC in 1 case and PTL in 2 cases. FC assessed the reactive, non-lymphomatous nature of the lymphoid infiltrate in 5 cases and demonstrated light chain restriction, hence the lymphomatous nature of the lymphoid infiltrate in 2 cases of PTL.ConclusionsFNC plays a key role in the clinical surveillance and pre-surgical diagnosis of diffuse enlargement and nodular presentation of HT in elderly patients. FNC can correctly diagnose HT, PTC and PTL indicating the need for surgery and its extension in suspicious or neoplastic cases, leaving other cases to the medical treatment and clinical surveillance.

Potential relationship between Hashimoto's thyroiditis and BRAFV600E mutation status in papillary thyroid cancer

“…Patients with Hashimoto's thyroiditis(−) and BRAF V600E mutation(+) were more likely to develop poor prognosis. Fine‐needle aspiration biopsy is recommended to evaluate the condition of thyroid nodules preoperatively; results of several studies have shown that Hashimoto's thyroiditis and BRAF V600E mutation have relatively high sensitivity and specificity . Therefore, preoperative information of Hashimoto's thyroiditis and BRAF V600E mutation by fine‐needle aspiration biopsy can be utilized in practice and help surgeons predict clinical outcome.…”

A Clinical Framework to Facilitate Risk Stratification When Considering an Active Surveillance Alternative to Immediate Biopsy and Surgery in Papillary Microcarcinoma

“…The nonspecific ultrasonographic findings seen in HT complicate follow-up by making it more difficult to assess tumor size or identify other areas of concern within the thyroid both at presentation and during follow-up (28,29). Furthermore, HT often leads to atypical cervical lymphadenopathy (30), which makes it more difficult to exclude locoregional metastasis confidently.…”

Pulmonary arterovenous malformation causing hemothorax in a pregnant woman without Osler- Weber-Rendu syndrome

“…These AVMs increase in size during pregnancy [3]. The differential diagnosis was for: abnormal systemic vessels, highly vascular parenchymal mass, other congenital or acquired pulmonary arterial or venous lesions (e.g pulmonary varix), retroperitoneal varices [11,16,21–32]. …”