Fine Needle Aspiration Cytodiagnosis of Subacute (De Quervain's) Thyroiditis In an Endemic Goitre Area

Abstract

Between 1977 and 1989 252 fine needle aspirates (FNAs) of the thyroid from patients with a clinical suspicion of subacute granulomatous (de Quervain's) thyroiditis were examined in the Department of Pathology of the University of Innsbruck, Austria. In the same period 31 cases with preoperative FNA were diagnosed histologically as subacute thyroiditis. Only in three of these cases were the cytological features of de Quervain's thyroiditis found in the preoperative FNA. However, in 13 of these 31 cases a cytological suspicion of malignancy was obtained. Subsequent histological examination revealed an acute phase inflammation of de Quervain's thyroiditis in most of these cases. We conclude that an accurate FNA diagnosis of de Quervain's thyroiditis, particularly in the acute stage, may cause difficulties due to a lack of typical features and the appearance of atypical thyroid follicular cells. For the cytopathologist, accurate clinical information relating to the possibility of de Quervain's thyroiditis is essential if unnecessary surgery is to be avoided.

Subacute thyroiditis: Fine-needle aspiration cytology of 14 cases presenting with thyroid nodules

“…In another series by Ofner et al 15 where 31 cases of SAT in an endemic goiter area are described, 13 were interpreted as suspicious for malignancy. These aspirates exhibited an increased number of follicular cells, some with significant cytologic atypia with complete lack of mngcs.…”

Clinical and cytomorphological study of Dequervains thyroiditis

“…The typical cytological findings of SGT are of numerous multinucleate giant cells together with mixed inflammatory cells composed of epithelioid cells forming gr anulomas, neutrophils and lymphocytes. 11,15,16 The follicular cells may show degenerative features and contain dark-blue (golden in PAP-stained smears) cytoplasmic 'paravacuolar' granules representing lipofuscin or lysosomal debris. These granules are not a specific feature of this condition and may be seen in involutional follicular cells of nodular goiter, in Grave's disease and occasionally in papillary carcinomas and follicular neoplasms.…”

“…The presence of apparent necrosis and degenerative atypia in follicular cells may lead to an inappropriate suspicion of malignancy. 16,17 Granulomatous changes may also arise in the thyroid as a histiocytic response to hemorrhage, as a reaction to spilled colloid adjacent to a neoplasm following clinical examination (p alpation thyroiditis) or with mycobacterial infections. 18,22 Giant cells are not very specific for this condition; the y can be observed in other forms of thyroiditis (Hashimoto's thyroiditis, Graves's disease, and palpation thyroiditis) and carcinomas (papillary carcinoma and anaplastic carcinoma).…”

Correlation of Cytologic and Histologic Findings in Fibrosing Thyroiditis

“…5 Cytologic descriptions of the more common types of thyroiditis are available. [6][7][8] However, fibrosing, or Riedel's, thyroiditis is a very rare entity, and, as a result, experience with its cytologic appearance is limited.…”