Fibrous Variant of Hashimoto’s Thyroiditis as a Diagnostic Pitfall in Thyroid Pathology

Iannaci, G.; Luise, R.; Sapere, Patrizia; Coluccino, V.; Ronchi, A.; Faggiano, Antongiulio; Marotta, Vincenzo; Colao, Annamaria; Spiezia, Stefano

doi:10.1155/2013/308908

Cited by 11 publications

(8 citation statements)

References 13 publications

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“…Since the fibrous variant of clinical HT accounts for up to 10% of cases ( Iannaci et al., 2013 ) we investigated co-occurrence of HT and fibrotic phenotypes in GTEx pathology notes. We found that 9/31 samples with HT phenotypes also had fibrotic phenotypes, which was significantly enriched compared with the background set of non-HT samples (Fisher’s test; P = 0.002, OR = 4.2).…”

Section: Resultsmentioning

confidence: 99%

Histopathological Image QTL Discovery of Immune Infiltration Variants

et al. 2018

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SUMMARY Genotype-to-phenotype association studies typically use macroscopic physiological measurements or molecular readouts as quantitative traits. There are comparatively few suitable quantitative traits available between cell and tissue length scales, a limitation that hinders our ability to identify variants affecting phenotype at many clinically informative levels. Here we show that quantitative image features, automatically extracted from histopathological imaging data, can be used for image quantitative trait loci (iQTLs) mapping and variant discovery. Using thyroid pathology images, clinical metadata, and genomics data from the Genotype-Tissue Expression (GTEx) project, we establish and validate a quantitative imaging biomarker for immune cell infiltration. A total of 100,215 variants were selected for iQTL profiling and tested for genotype-phenotype associations with our quantitative imaging biomarker. Significant associations were found in HDAC9 and TXNDC5. We validated the TXNDC5 association using GTEx cis-expression QTL data and an independent hypothyroidism dataset from the Electronic Medical Records and Genomics network.

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Section: Resultsmentioning

confidence: 99%

Histopathological Image QTL Discovery of Immune Infiltration Variants

et al. 2018

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“…Grade I to grade IV lesions of HT are sufficed with replacement therapy and followup. Few cases of grade IV HT when show increased fibroblasts with clinical presentation of firm diffuse enlargement of the gland with pressure symptoms, underwent surgical excision and proved to be fibrous variant of HT as supported by Lannaci G et al (11) Fibrous variant of HT clinically mimics a malignant lesion. Kanaya H et al (12) reported a case of fibrous variant of HT, its cytology revealed clusters of large multinucleated cells suggestive of anaplastic carcinoma, a misdiagnosis.…”

Section: Discussionmentioning

confidence: 84%

Cytomorphological Grading in Hashimoto’s Thyroiditis - A Pioneer Study

Bajaj¹,

Mohammad²,

Somalwar³

et al. 2016

jebmh

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BACKGROUND Hashimoto's Thyroiditis is a leading cause of hypothyroidism results due to immune mediated destruction of follicles and is characterised by infiltration of lymphoid cells. The aim of the present study is to categorise cytomorphology in to various grades and understand the spectrum of lesion and its complications. MATERIALS AND METHODS Fine needle aspiration cytology was done on patients with diffuse and nodular enlargement of thyroid in the Department of Pathology, Osmania Medical College over a period of one and half year from January 2015 to June 2016. Smears were made and stained by pap staining and H & E and diagnosis is based on characteristic cytomorphology of thyroid lesion. RESULTS A total number of 363 cases were received in the Department of Pathology of which 246 cases presented with diffuse enlargement and rest were nodular with varied cytological features. A total number of 177 cases of Hashimoto's thyroiditis were diagnosed of which 171 cases presented with diffuse enlargement and 6 cases as nodular are the subjects of present study. CONCLUSION Fine needle aspiration is a simple and reliable diagnostic procedure in the evaluation of Hashimoto's thyroiditis. The present study emphasises that cytomorphologic grading of HT is useful in deciding the line of treatment, its followup and complications.

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“…Clinical and pathological features of Riedel’s thyroiditis overlap with those of the fibrous variant of Hashimoto’s thyroiditis [ 9 – 11 ]. High titers of antithyroglobulin and anti-peroxidase antibodies are frequently seen in both entities.…”

Section: Discussionmentioning

confidence: 99%

IgG4-Related Fibrous Thyroiditis (Riedel’s Thyroiditis): A Case Report

et al. 2020

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Patient: Female, 69-year-old Final Diagnosis: Riedel thyroiditis Symptoms: Dysphagia • goiter Medication: — Clinical Procedure: — Specialty: Endocrinology and Metabolic Objective: Rare disease Background: Riedel’s thyroiditis is a rare form of immunoglobulin G (IgG) 4-related invasive fibrosis of the thyroid gland; given its scarce incidence, standardized therapeutic guidelines are unavailable. Although complications are unusual, obstructive symptoms produced by the stony-hard goiter may put patients’ lives at risk. The diagnosis must be biopsy-proven, and treatment consists of thyroid hormone replacement and anti-inflammatory drugs, although sometimes thyroidectomy may be required. Case Report: A 69-year-old woman presented with a 7-month history of progressive hypothyroidism and obstructive dysphagia. On physical examination, she had a large, stony-hard goiter. A Doppler ultrasound study revealed a massive, avascular enlargement of the thyroid gland. A computed tomography scan failed to demonstrate any extrathyroidal extension of the abnormal tissue. A Tru-Cut biopsy of the thyroid was performed. Extensive replacement of thyroid follicles by prominent bands of fibrous tissue was observed, with follicular obliteration and mild focal occlusive phlebitis. A lymphoplasmacytic infiltrate was clearly identified; no oxyphilic nor giant cells were found. On immunohistochemistry, the immunoglobulin G (IgG) 4/IgG ratio in the plasma cell infiltrate was 40%; increased serum IgG4 levels were also found, supporting the diagnosis of Riedel’s thyroiditis. The patient was successfully treated with levothyroxine replacement and tamoxifen with prompt resolution of obstructive symptoms. Conclusions: Fibrous thyroiditis should be considered in the differential diagnosis of primary hypothyroidism in a patient with a stony-hard goiter. Although steroids are often used as a therapeutic strategy for this disease, our patient had an excellent therapeutic response to tamoxifen, avoiding adverse effects associated with steroid therapy, the higher cost of monoclonal antibody therapy, and surgery-associated risks.

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Fibrous Variant of Hashimoto’s Thyroiditis as a Diagnostic Pitfall in Thyroid Pathology

Cited by 11 publications

References 13 publications

Histopathological Image QTL Discovery of Immune Infiltration Variants

Histopathological Image QTL Discovery of Immune Infiltration Variants

Cytomorphological Grading in Hashimoto’s Thyroiditis - A Pioneer Study

IgG4-Related Fibrous Thyroiditis (Riedel’s Thyroiditis): A Case Report

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