Fine‐needle aspiration of subacute granulomatous thyroiditis (De Quervain's thyroiditis): A clinico‐cytologic review of 36 cases

Abstract

Although subacute granulomatous thyroiditis (SGT) is usually diagnosed clinically, there are other thyroid conditions that must be ruled out. This task is achieved by means of fine-needle aspiration (FNA). In retrospect, the clinical and cytologic findings seen in 36 SGT cases are reassessed with a view to deciding which findings are most reliable for reaching a confident cytologic diagnosis. These are: the simultaneous presence in the same aspirate of the following cells: 1) follicular cells with intravacuolar granules and/or plump transformed follicular cells; 2) epithelioid granulomas; 3) multinucleated giant cells; 4) an acute and chronic inflammatory dirty background; 5) the absence of the following cells: fire-flare cells, hypertrophic follicular cells, oncocytic cells, and transformed lymphocytes. The absence of one or more of these requirements does not exclude SGT but does increase the number of thyroid conditions that come into the differential diagnosis. In these cases, it is essential to review clinical data carefully and to submit the patient to a close clinical and FNA follow-up. Diagn. Cytopathol. 16:214-220, 1997. r 1997

Multinucleated Giant Cells in Fine-Needle Aspiration of Thyroid Nodules: Their Diagnostic Significance

“…FNA cytology is characterized by epithelioid granulomas, MNGCs, and an acute and chronic inflammatory ''dirty'' background. Solano et al 6 reported on the presence of follicular cells with intravacuolar granules and/or plump transformed follicular cells, a finding not appreciated in our cases. MNGCs seen in our cases of subacute thyroiditis tended to be the most numerous, the largest, and with the most number of nuclei.…”

“…They have also been reported in a broad spectrum of diseases ranging from palpation thyroiditis to drug reactions such as fenitoins, postsurgical reactions, postradionucleotide scan, follicular neoplasms, Hashimoto's thyroiditis, and others. [2][3][4][5][6][7][8] Osteoclast-like giant cells have been reported in rare cases of anaplastic carcinomas. 9,10 This study was undertaken to see whether the quantity and/or quality, i.e., the morphologic characteristics of MNGCs as seen on fine-needle aspiration (FNA) of thyroid nodules, can help in the differential diagnosis of these diagnostic possibilities.…”

The presence of multinucleated giant cells: Noninvasive follicular thyroid neoplasm with papillary‐like nuclear features vs the follicular variant of papillary thyroid carcinoma

“…Multinucleated giant cells (MGCs) are reported to occur in both benign and malignant thyroid gland lesions, most commonly including papillary carcinoma, Hashimoto's thyroiditis and granulomatous thyroiditis . Their origin and presence in cases of PTC has been the subject of several studies dating to the 1980s.…”

Causes of misdiagnoses by thyroid fine-needle aspiration cytology (FNAC): our experience and a systematic review

“…The reactive follicular epithelium in chronic lymphocytic thyroiditis is usually adjacent to the inflammatory infiltrate and with focal nuclear atypia showing some but not all features of PTC [53,55]. Identifying the multinucleated giant cells, epithelioid histiocytes, and fibrotic stromal fragments in the complex background created by acute-chronic inflammation and debris can improve the sensitivity for the diagnosis of granulomatous thyroiditis [56][57][58]. However, it should be noted that the presence of multinucleated giant cells does not rule out the diagnosis of thyroid cancer.…”