Thyroid Paraganglioma Diagnosed by Fine‐Needle Aspiration Biopsy, Correlated With Histopathological Findings: Report of a Case

Abstract

Thyroid paragangliomas are rare neuroendocrine tumors. They are difficult to diagnosis by fine-needle aspiration biopsy (FNAB) and can be misdiagnosed as other types of thyroid disease. Here, we present an unusual case of primary thyroid paraganglioma diagnosed by FNAB. A 66-year-old woman presented with multinodular goiter. Ultrasound (US)-guided FNAB of the 3 cm nodule in the superior portion of the right lobe of the thyroid was performed. The cytological smears showed single cells or loose clusters of round to ovoid cells with oval granular nuclei. To differentiate between thyroid paraganglioma and other thyroid neoplasms, cell block material from the FNAB specimen was immunohistochemically stained with antibodies to thyroglobulin, calcitonin (CT), AE1-AE3, carcinoembryonic antigen (CEA), synaptophysin, chromogranin A (CH-A), neuron-specific enolase (NSE), thyroid transcription factor-1 (TTF-1), parathyroid hormone (PTH), and S-100. Immunohistochemical staining was positive for synaptophysin, CH-A, NSE, and S-100, and negative for thyroglobulin, CT, AE1-AE3, PTH, CEA, and TTF-1. Congo red staining was also negative. Paraganglioma and other neuroendocrine neoplasms were considered in the differential diagnosis. A total thyroidectomy was performed, and a final diagnosis of paraganglioma was made. Paraganglioma is a rare neuroendocrine tumor of the thyroid and should be considered in the differential diagnosis based on cytology of thyroid neuroendocrine tumors. Immunohistochemistry should be performed when making a diagnosis of thyroid paraganglioma, particularly when evaluating fine-needle aspiration smears. Diagn. Cytopathol. 2016;44:643-647. © 2016 Wiley Periodicals, Inc.

Thyroid paraganglioma accompanied by lymph node metastasis or trachea invasion: A case report

“…The cell block method made it possible to investigate the pathological characteristic of the ‘zellballen’ pattern in FNAB specimen preoperatively. Additionally, it could be evaluated by immunohistochemistry, which was consistent with the characteristics of paraganglioma described previously ( 16 , 21 ). The diagnosis of TP can be successfully achieved, and these observations suggest that the method comprising FNAB and immunohistochemistry is promising for the differentiation between TP and other thyroid neoplasms.…”

“…However, as reported in the present study and previous literature ( 4 – 6 ), the levels of catecholamine were not increased in TP, which can be differentiated from other paragangliomas. Similarly, a correct diagnosis could not be established preoperatively by FNAB, except for by immunohistochemistry, until the introduction of the novel method using cell block material ( 21 ). The cell block method made it possible to investigate the pathological characteristic of the ‘zellballen’ pattern in FNAB specimen preoperatively.…”

Cytologic and histological features of rare nonepithelial and nonlymphoid tumors of the thyroid

“…The cytological diagnosis of paraganglioma is challenging and, not surprisingly, might lead to misdiagnoses. FNA smears are cellular and contain single cells or loose clusters of medium to large cells 37,41‐43 . The neoplastic cells have epithelioid, plasmacytoid, and spindle features.…”

“…Of note, a paraganglioma‐like medullary thyroid carcinoma has been described 50 . The presence of intracytoplasmic eosinophilic granules and amyloid are helpful clues for diagnosis of medullary thyroid carcinoma 37‐40 . Furthermore, medullary thyroid carcinomas show immunopositivity for TTF‐1, calcitonin, and CEA.…”

A case report of a concomitant total thyroidectomy and carotid body tumor resection in a 43 year old female

“…Carotid body tumors are rare neuroendocrine tumors originating from the sympathoadrenal and parasympathetic paraganglia of the autonomic nervous system. The incidence of this tumors is estimated to be of 1:30,000 to 100,000 in the general population [ 1 ].…”