Solitary Nodular Goiter

OBJECTIVE To study the cytomorphologic features of solitary nodular goiters (SNG). STUDY DESIGN May-Grunwald-Giemsa-stained smears in 441 SNG diagnosed by ultrasonography and fine needle aspiration (FNA) and found to have optimum cellular material at review were subjected to detailed cytologic assessment. The age of the patients ranged from 11 to 75 years, with a median of 35. Male: female ratio was 69:372. The parameters for cytologic assessment included cellularity, colloid content, acinar formation, papillary formation, intranuclear cytoplasmic inclusions, nuclear grooves, marginal vacuoles, Hurthle cells and various inflammatory cells. Histopathology reports on thyroidectomy specimens were available in 27 cases from two Delhi hospitals. RESULTS Hyperplastic nodules (68 cases) differed significantly from colloid goiters (269 cases) by having more cases with excessive cellularity, acinar formation and marginal vacuoles (P < .001). There was also a significant difference with respect to papillary formation and moderate-to-excessive colloid content (P < .001). As compared to hyperplastic nodules, neoplasms (60 cases) had a significantly higher number of cases with papillary formation, intranuclear inclusions and nuclear grooves but lower number of cases with marginal vacuoles (P < .01-.001). Among neoplasms, usual papillary carcinoma (19 cases) differed from follicular neoplasms (20 cases) with respect to acinar formation, papillary formation and nuclear grooves (P < .001). A significant difference was also observed with respect to colloid content and nuclear inclusions. Follicular variant of papillary carcinomas (FVPC) (10 cases) emerged as a distinct cytologic entity following review and differed from usual papillary carcinomas in having a higher number of cases with acinar formation, tubular formation and marginal vacuoles (P < .01-.001) and lower number of cases with nuclear grooves (P = .05). FVPC also differed from follicular neoplasms with respect to papillary formation, tubular formation, intranuclear inclusions and nuclear grooves (P < .01-.001). Overall cytohistologic agreement was achieved in 24 of 27 (88.9%) cases. CONCLUSION Detailed cytologic assessment of FNA smears-in SNG was helpful in highlighting parameters that differentiate between various types of goiters.

[1]  K. Kapila,et al.  Follicular neoplasms of the thyroid. Decision tree approach using morphologic and morphometric parameters. , 1997, Acta cytologica.

[2]  H. Gharib,et al.  Fine-needle aspiration biopsy of thyroid nodules: advantages, limitations, and effect. , 1994, Mayo Clinic proceedings.

[3]  Y. Oertel,et al.  “Cellular adenomatoid nodules” of the thyroid: Review of 219 fine‐needle aspirates , 1993, Diagnostic cytopathology.

[4]  R. Hartwick,et al.  Correlation of cytologic and histologic features in variants of papillary carcinoma of the thyroid. , 1993, Acta cytologica.

[5]  H. Gharib,et al.  Fine-Needle Aspiration Biopsy of the Thyroid: An Appraisal , 1993, Annals of Internal Medicine.

[6]  P. D. Lewis.  Surgical Pathology of the Thyroid , 1993 .

[7]  J. Safneck,et al.  Fine needle aspirates of follicular lesions of the thyroid gland. The intermediate-type smear. , 1990, Acta cytologica.

[8]  R. Narasimhan,et al.  Problems and limitations with fine needle aspiration cytology of solitary thyroid nodules. , 1990, The Australian and New Zealand journal of surgery.

[9]  J. Safneck,et al.  Differentiation of Hashimoto's thyroiditis from thyroid neoplasms in fine needle aspirates. , 1988, Acta cytologica.

[10]  K. Suen.  How does one separate cellular follicular lesions of the thyroid by fine‐needle aspiration biopsy? , 1988, Diagnostic cytopathology.

[11]  H. Deligeorgi‐Politi.  Nuclear crease as a cytodiagnostic feature of papillary thyroid carcinoma in fine‐needle aspiration biopsies , 1987, Diagnostic cytopathology.

[12]  H. Gharib,et al.  Fine needle aspiration cytology of the thyroid, 1980 to 1986. , 1987, Acta cytologica.

[13]  D. Fitz-Patrick,et al.  Fine-needle aspiration biopsy of thyroid nodules. A diagnostic method that minimizes the need for surgery. , 1986, Postgraduate medicine.

[14]  J. Rosai,et al.  Papillary carcinoma of the thyroid. A discussion of its several morphologic expressions, with particular emphasis on the follicular variant. , 1983, The American journal of surgical pathology.

[15]  W. Frable,et al.  Fine needle aspiration biopsy of the thyroid. Differential diagnosis by videoplan image analysis. , 1982, Acta cytologica.

[16]  R. Ward.  CARCINOMA OF THE THYROID GLAND: A Clinical and Pathologic Study of 293 Patients at the University of California Hospital. , 1960 .