Presentation
Thyroid ultrasound follow-up.
Patient Data
There is a right thyroid lobe mid third 1,0 cm hypoechogenic nodule with microcalcifications and increased peripheral and central vascularity. Also, two adjacent hypoechogenic nodules in the lower third of the same lobe, measuring up to 0.8 cm each. Left lobe echogenic nodule has benign features and appears unchanged compared to ultrasound back three years ago.
Case Discussion
FNA has been performed in the suspicious mid third nodule in the right lobe: The smears scant atypical follicular cells, forming clusters and in groups. The follicular cells are atypical. They have ovoid nuclei with pale chromatin, few nuclear grooves and some intranuclear pseudoinclusions. There are sparse globules of colloid in the background. The features are suspicious for papillary carcinoma. DIAGNOSIS: FNA Thyroid - Right Lobe: Atypical. Features are suspicious but not diagnostic for a papillary carcinoma.
Tha patient was submitted then to a hemithyroidectomy:
MACROSCOPIC DESCRIPTION: 1. "Right thyroid stitch upper pole": Right hemithyroidectomy 3.9g, 38x19x16mm. The specimen is inked: isthmus green, anterior blue and posterior black and cut into 12 sections from superior to inferior. In the mid section there is a firm off-white moderately well delineated nodule 6x5x4mm lying 1.5mm from the anterolateral margin. Within the inferior pole of the specimen there is a second less well defined pale nodule 8mm abutting the anteromedial surface.
MICROSCOPIC DESCRIPTION: 1. The above-mentioned nodule is confirmed to be a papillary carcinoma. It consists mostly of papillary structures but there are a few areas with a more follicular pattern. There are no psammoma bodies. The nuclei are open and vesicular with occasional very small nucleoli, some nuclear grooves, and intranuclear inclusions. The nearest margin is anterolateral and 1.2 mm. The adjacent thyroid shows a few lymphoid germinal centers but there are no other special features. The inferior lobe nodule is non-encapsulated but well demarcated and consists of variably-sized follicles with some mild nuclear atypia but the features are not those of papillary carcinoma. 2. Three lymph nodes are identified and none show evidence of metastatic tumor. 3. One lymph node is identified which appears unremarkable.
DIAGNOSIS: 1. "Right thyroid stitch upper pole": Papillary thyroid carcinoma sized 6mm and clear of margins. 2. "Right central node": Three normal lymph nodes. 3. "Delphian node": One normal lymph node.
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