Session: SAT 449-497-Thyroid Neoplasia & Case Reports
Poster Board SAT-460
Clinical case: 27 year old healthy Caucasian female presented in 2011 to Endocrinology clinic with a soft, palpable 3.9X2.4x1.9 cm nodule. USI revealed heterogenous nodule with no signs of calcifications, though some nodular vascularity was present; rate of growth on US was slow (less than 10% increase over 12 months period 4.3x2.4x1.8 cm). US-guided FNA biopsy of the most concerning area of the nodule was performed at the first encounter and results revealed benign adenomatous nodule with no concerning features ("macrofollicular clusters and flat sheets of cytologically bland follicular cells and back ground colloid"). Patient continued to be followed in the office with no changes in clinical status, thyroid function tests or USI. About 6 months ago patient decided to pursue removal of the nodule for cosmetic reasons and ENT consult was sought. Uneventful hemithyridectomy was performed and pathology report had unexpectedly shown tall-cell variant of papillary thyroid carcinoma (TC-PTC) confirmed on immunostain with no signs of vascular invasion. She is doing well clinically and is awaiting whole body RAI scan testing.
Conclusion: this case demonstrates challenges identifying thyroid cancer which might present with less defined pathological features and misdiagnosed as a benign nodule based on FNA alone with potentially serious consequences. While more common challenge is misdaignosing benign nodules as malignant ones, especially PTC, the other way around is encountered less often, yet might be much more consequential. Further studies to identify ways of reducing rates of misdiagnosis are needed and have to include detailed clinical history, presentation, USI apperance and potentially more extensive use of immunocytochemistry. Certain factors, like vascularity, have to be re-evaluated and in certain cases might indicate need for re-biopsy.
Nothing to Disclose: NRG, AKG
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