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Benign nodular hyperplasia - Case 39.

Nodular goiter

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Clinical presentation: a 38-year-old woman requested a second opinion. A nodule was discovered on screening. FNAC in another institute resulted in "follicular neoplasm with significant atypia" from the largest nodule in the right lobe. Total thyroidectomy was advised.

Palpation: a firm nodule in the left lobe.

Functional state: euthyroidism with TSH-level 2.94 mIU/L, anti-TPO 0,3 U/mL.

Ultrasonography. The thyroid was echonormal. There were multiple moderately hypoechogenic and more hypoechogenic nodules in both lobes. The largest one in the central part of the right lobe presented halo sign and perinodular blood flow. There was a smaller lesion in the lower part of the right thyroid which presented irregularly increased type 3 vascularization.

Cytology was performed from the above described both of the above described nodules in the right lobe and resulted in benign follicular proliferation and benign lesion with degenerative atypia, nodule in the middle third and in the lower third, respectively. (The images of the latter are presented.)

We told the patient that we have found no signs of malignancy. Considering all circumstances including the patient great anxiety caused by the previous cytological report, a right lobectomy was advised.

Right lobectomy was performed. Histopathology: benign hyperplastic nodules with degenerative changes and focal lymphocytic thyroiditis.

Comments.

  1. The risk of malignancy in a cytologically diagnosed or suspected follicular tumor in Hungary is around 3 to 5%. Therefore the choice of therapy is lobectomy except for those patients whose contralateral lobe is also diseased.

  2. The cytology is remarkable. If we meet atypical cells on a thyroid smear, than the first question is: to which type of carcinoma might correspond cytological atypia. In this case it corresponded neither to a papillary carcinoma nor to a medullary carcinoma. Oxyphilic tumor had to considered. Nevertheless, the lesion did not present halo sign and no nuclear atypia was found. The former stand against a follicular tumor, the latter against a papillary carcinoma.


 

 

 

 

 

 

 

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