Top

Diagnostic Pathology

Published in:

Open Access 01-12-2021 | Foreign Body Aspiration | Case Report

Diagnostic pitfall of thyroid fine-needle aspiration induced fibrosis: follicular adenoma mimicking medullary thyroid carcinoma in frozen section

Authors: Woo Sung Moon, Myoung Jae Kang, Hyun Jo Youn, Kyoung Min Kim

Published in: Diagnostic Pathology | Issue 1/2021

Abstract

Background

Fine-needle aspiration (FNA) is a frequently utilized method for the diagnosis of thyroid nodules. Although the technique has clear advantages, the injury caused by the aspiration needle can induce various histological alterations. Herein, we report a case of follicular adenoma showing histological alterations possibly caused by FNA biopsy. Furthermore, the histological appearance of the lesion mimicked those of medullary thyroid carcinoma, particularly in the frozen section.

Case presentation

Ultrasonography of a thyroid nodule in a 39-year-old man revealed a mass (2.2 cm in diameter) in the right thyroid lobe. FNA was performed three times on the mass, and the results of the cytology were atypia of undetermined significance. Thereafter, the patient underwent right hemithyroidectomy. The histological findings of the operative frozen section analysis indicated medullary thyroid carcinoma. However, after evaluation and immunohistochemical staining of the permanent section, the mass was diagnosed as follicular adenoma with extensive fibrosis.

Conclusion

The histological alterations observed in the follicular adenoma are believed to have been caused by injury during the repeated FNA procedures.

Gharib H, Papini E, Paschke R, et al. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract. 2010;16(Supplement 1):1–43.CrossRef

Cooper D, Doherty G, Haugen B, et al. American Thyroid Association (ATA) guidelines taskforce on thyroid nodules and differentiated thyroid cancer. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19(11):1167–214. https://doi.org/10.1089/thy.2009.0110.CrossRefPubMed

Baloch ZW, LiVolsi VA. Post fine-needle aspiration histologic alterations of thyroid revisited. Am J Clin Pathol. 1999;112(3):311–6. https://doi.org/10.1093/ajcp/112.3.311.CrossRefPubMed

Polyzos SA, Anastasilakis AD. Clinical complications following thyroid fine-needle biopsy: a systematic review. Clin Endocrinol. 2009;71(2):157–65. https://doi.org/10.1111/j.1365-2265.2009.03522.x.CrossRef

Recavarren RA, Houser PM, Yang J. Potential pitfalls of needle tract effects on repeat thyroid fine-needle aspiration. Cancer Cytopathol. 2013;121(3):155–61. https://doi.org/10.1002/cncy.21220.CrossRefPubMed

Cibas ES, Ali SZ. The Bethesda system for reporting thyroid cytopathology. Am J Clin Pathol. 2009;132(5):658–65. https://doi.org/10.1309/AJCPPHLWMI3JV4LA.CrossRefPubMed

LiVolsi VA, Merino MJ. Worrisome histologic alterations following fine-needle aspiration of the thyroid (WHAFFT). Pathol Annu. 1994;29:99–120.PubMed

Bolat F, Kayaselcuk F, Nursal TZ, Reyhan M, Bal N, Yildirim S, Tuncer I. Histopathological changes in thyroid tissue after fine needle aspiration biopsy. Pathol Res Pract. 2007;203(9):641–5. https://doi.org/10.1016/j.prp.2007.05.004.CrossRefPubMed

Lloyd RV, Kovacs K, Young W Jr, et al. World Health Organisation classification of tumours; 2004. p. 10–3.

10.

Najah H, Tresallet C. Role of frozen section in the surgical management of indeterminate thyroid nodules. Gland surgery. 2019;8(Suppl 2):S112–7. https://doi.org/10.21037/gs.2019.04.07.CrossRefPubMedPubMedCentral

11.

Chang H-Y, Lin J-D, Chen J-F, Huang BY, Hsueh C, Jeng LB, Tsai JS. Correlation of fine needle aspiration cytology and frozen section biopsies in the diagnosis of thyroid nodules. J Clin Pathol. 1997;50(12):1005–9. https://doi.org/10.1136/jcp.50.12.1005.CrossRefPubMedPubMedCentral

12.

Huber GF, Dziegielewski P, Matthews TW, Warshawski SJ, Kmet LM, Faris P, Khalil M, Dort JC. Intraoperative frozen-section analysis for thyroid nodules: a step toward clarity or confusion? Arch Otolaryngol Head Neck Surg. 2007;133(9):874–81. https://doi.org/10.1001/archotol.133.9.874.CrossRefPubMed

13.

Basolo F, Ugolini C, Proietti A, Iacconi P, Berti P, Miccoli P. Role of frozen section associated with intraoperative cytology in comparison to FNA and FS alone in the management of thyroid nodules. Eur J Surg Oncol (EJSO). 2007;33(6):769–75. https://doi.org/10.1016/j.ejso.2006.12.004.CrossRef

14.

Kahmke R, Lee WT, Puscas L, Scher RL, Shealy MJ, Burch WM, Esclamado RM. Utility of intraoperative frozen sections during thyroid surgery. Int J Otolaryngol. 2013;2013:1–4. https://doi.org/10.1155/2013/496138.CrossRef

15.

Cohen MA, Patel KR, Gromis J, Kutler DI, Kuhel WI, Stater BJ, Schulman A, Hoda RS, Scognamiglio T. Retrospective evaluation of frozen section use for thyroid nodules with a prior fine needle aspiration diagnosis of Bethesda II–VI: the Weill Cornell Medical College experience. World J Otorhinolaryngol Head Neck Surg. 2015;1(1):5–10. https://doi.org/10.1016/j.wjorl.2015.09.002.CrossRefPubMedPubMedCentral

Title: Diagnostic pitfall of thyroid fine-needle aspiration induced fibrosis: follicular adenoma mimicking medullary thyroid carcinoma in frozen section
Authors: Woo Sung Moon
Myoung Jae Kang
Hyun Jo Youn
Kyoung Min Kim
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Foreign Body Aspiration
Foreign Body Aspiration
Aspiration
Published in: Diagnostic Pathology / Issue 1/2021
Electronic ISSN: 1746-1596
DOI: https://doi.org/10.1186/s13000-021-01087-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Diagnostic pitfall of thyroid fine-needle aspiration induced fibrosis: follicular adenoma mimicking medullary thyroid carcinoma in frozen section

Abstract

Background

Case presentation

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Case presentation

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2021

CpG islands in MyD88 and ASC/PYCARD/TMS1 promoter regions are differentially methylated in head and neck squamous cell carcinoma and primary lung squamous cell carcinoma

Succinate dehydrogenase deficient gastrointestinal stromal tumor in a three month old boy with a fatal clinical course: a case report and review of literature

Gastric mucin phenotype indicates aggressive biological behaviour in early differentiated gastric adenocarcinomas following endoscopic treatment

Acute fibrinous and organizing pneumonia: two case reports and literature review

Whole-exome sequencing reveals the etiology of the rare primary hepatic mucoepidermoid carcinoma

Significance of mesothelin and CA125 expression in endometrial carcinoma: a retrospective analysis