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Open Access 25-04-2024 | Thyroid Sonography | Image–Breast & Thyroid

Calcium oxalate crystals as a cause of multiple punctate echogenic foci in benign thyroid lesions

Authors: Ayana Suzuki, Mitsuyoshi Hirokawa, Izumi Otsuka, Akira Miyauchi, Takashi Akamizu

Published in: Journal of Medical Ultrasonics

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Abstract

Purpose

Multiple punctate echogenic foci (MPEF) on thyroid ultrasonography reflects psammoma bodies in papillary thyroid carcinomas. However, MPEF is also observed in benign thyroid lesions. The aim of this study was to determine the origin of MPEF in patients with benign thyroid lesions.

Methods

We enrolled 26 patients with Graves’ disease (GD) and 24 with follicular nodular disease (FND) who exhibited MPEF and underwent surgery. As controls, we enrolled 40 patients with GD and 32 with FND, but without MPEF, who underwent surgery.

Results

MPEF was observed in both lobes in 80.8% of GDs with MPEF, but was limited to a single lobe in the remaining cases. MPEF was diffusely distributed in 72.3% of the cases and focally distributed in the remaining cases. On ultrasonography, most (92.3%) FNDs with MPEF were solid lesions, and seven nodules (26.9%) were interpreted as intermediate suspicion and their frequencies were higher than in those without MPEF (p < 0.01). Microscopically, calcium oxalate (CaOx) crystals were observed more frequently in GDs and FNDs with MPEF (100% and 88.5%, respectively) than in those without MPEF (p < 0.001). These differences were particularly significant for CaOx crystals > 100 μm. In GD cases, large CaOx crystals were observed more frequently in the lobes with MPEF than in those without (p < 0.05). No psammoma bodies were present in any of the cases.

Conclusion

Appearance of MPEF in GDs and FNDs is not because of psammoma bodies; it is attributable to CaOx crystals larger than 100 μm. Therefore, MPEF is not an indicator of malignancy.
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Metadata
Title
Calcium oxalate crystals as a cause of multiple punctate echogenic foci in benign thyroid lesions
Authors
Ayana Suzuki
Mitsuyoshi Hirokawa
Izumi Otsuka
Akira Miyauchi
Takashi Akamizu
Publication date
25-04-2024
Publisher
Springer Nature Singapore
Published in
Journal of Medical Ultrasonics
Print ISSN: 1346-4523
Electronic ISSN: 1613-2254
DOI
https://doi.org/10.1007/s10396-024-01448-6