Histopathological Results of Suspicious Nodules in the Patients with Hashimoto Thyroiditis

Year 2020, Volume: 3 Issue: 1, 8 - 11, 01.01.2020

Sevilay Ozmen Havva Tugba Kiper Yılmaz İlknur Calık Yusuf Can Özge Timur Şenay Arıkan Durmaz Eşref Kabalar Ayşe Çarlıoğlu Kenan Çadırcı Aykut Turhan

Abstract

The most endocrinologists in routine practice are used to Bethesda classification for evaluation of thyroid nodule in fine needle aspiration biopsy (FNA). It is accepted that FNA biopsy is an accurate diagnostic and gold standard test. However, false-positive diagnosis may sometimes occur as a patient with a ‘malign’ lesion is found incorrectly rather than an actually benign lesion on histological examination. Hashimoto’s thyroiditis probably is the most common cause of false-positive cytology. The aims of present study evaluate retrospectively postoperatively biopsy results in patients with Hashimoto disease have a thyroidectomy. Results of totally 29 patients with Hashimoto thyroiditis achieved from our hospital records. All of the patients had undergone totally or subtotals thyroidectomy. We are-evaluated retrospectively biopsy results postoperatively. We compared their preoperative FNA results. We detected 24.1% papillary thyroid cancer in seven patients (mean age 45.5±11.9 year), 44.8% nodular goitre in 13 patients (mean age 45.8±4.9 year), 13.7% adenomatous nodule in four patients (mean age 43.5±14.4 year), 3.4% hurtle cell adenoma in one patient with 56 years old. But, 14% in four patients with Hashimoto thyroiditis (mean age 41.5±13.1 year) were redundantly operated due to atypia of undetermined significance in FNA. Although Hashimoto disease is a benign diagnosis, its misclassification as atypia of undetermined significance in FNA accounts for some false-positive errors. The cytopathologists can frequently be interpreted as atypia of undetermined significance instead of Hashimoto’s thyroiditis. Therefore, result of atypia of undetermined significance in FNA may lead unnecessarily concern among with the endocrinologists. More importantly, our results demonstrated that high papillary thyroid cancer rate was found postoperatively in suspicious nodules evolved background Hashimoto thyroiditis.

Keywords

Hashimoto thyroiditis, Nodules, Fine needle aspiration biopsy, Papillary thyroid cancer

References

• Anderson L, Middleton WD, Teefey SA, Reading CC, Langer JE, Desser T, Szabunio MM, Mandel SJ, Hildebolt CF, Cronan JJ. 2010. Hashimoto thyroiditis: Part 2, sonographic analysis of benign and malignant nodules in patients with diffuse Hashimoto thyroiditis. AJR Am J Roentgenol, 195(1): 216-222.
• Anil C, Goksel S, Gursoy A. 2010. Hashimoto's thyroiditis is not associated with increased risk of thyroid cancer in patients with thyroid nodules: a single-center prospective study. Thyroid, 20(6): 601-606.
• Bagnasco M1, Venuti D, Paolieri F, Torre G, Ferrini S, Canonica GW. 1989. Phenotypic and functional analysis at the clonal level of infiltrating T lymphocytes in papillary carcinoma of the thyroid: prevalence of cytolytic T cells with natural killer-like or lymphokine-activated killer activity. J Clin Endocrinol Metab, 69(4): 832-836.
• Bildik N, Altıntaş MM, Aslan E, Çevik A, Ekinci H, Dalkılıç G, Altıntaş H. 2009. Tiroid hastalıklarında postoperatif histopatolojik inceleme ile preoperatif testler arasındaki ilişki. Kartal Eğit Araş Hastanesi Tıp Derg, XX(1):29-36.
• Chehade JM, Lim W, Silverberg AB, Mooradian AD. 2010. The incidence of Hashimoto's disease in nodular goitre: the concordance in serological and cytological findings C Int J Clin Pract, 64(1): 29-33.
• Chen JC, Pace SC, Chen BA, Khiyami A, McHenry CR. 2012. Yield of repeat fine-needle aspiration biopsy and rate of malignancy in patients with atypia or follicular lesion of undetermined significance: the impact of the Bethesda System for Reporting Thyroid Cytopathology. Surgery 152(6): 1037-1044.
• Cipolla C1, Sandonato L, Graceffa G, Fricano S, Torcivia A, Vieni S, Latteri S, Latteri MA .2005. Hashimoto thyroiditis coexistent with papillary thyroid carcinoma. Am Surg, 71(10): 874-878.
• Cohen S, Rose NR, Brown RC. 1974. The appearance of eosinophils during the development of experimental autoimmune thyroiditis in the guinea pig. Clin Immunol Immunopathol, 2(2): 256-265.
• Cunha LL, Ferreira RC, Marcello MA, Vassallo J, Ward LS. 2011. Clinical and pathological implications of concurrent autoimmune thyroid disorders and papillary thyroid cancer. J Thyroid Res, 2011:387062.
• Dailey ME, Lindsay S, Skahen R. 1955. Relation of thyroid neoplasms to Hashimoto disease of the thyroid gland. AMA Arch Surg, 70(2): 291-297.
• Davies L, Welch HG. 2006. Increasing incidence of thyroid cancer in the United States, 1973-2002. JAMA, 295(18): 2164-2167.
• Ekambaram M1, Kumar B, Chowdhary N, Siddaraju N, Kumar S. 2010. Significance of eosinophils in diagnosing Hashimoto's thyroiditis on fine-needle aspiration cytology. Indian J Pathol Microbiol, 53(3): 476-479.
• Erdogan M1, Erdem N, Cetinkalp S, Ozgen AG, Saygılı F, Yilmaz C, Tuzun M, Kabalak T. 2009. Demographic, clinical, laboratory, ultrasonographic, and cytological features of patients with Hashimoto's thyroiditis: results of a university hospital of 769 patients in Turkey. Endocrine, 36(3):486-90.
• Ersoy R, Gul K, Korukluoglu B, Ersoy P, Aydın R, Aydın C. 2007. Coexistent thyroid papillary carcinoma with chronic lymphocytic thyroiditis. Turk Med J Sci, 1(3): 119-122. Fisher DA. 2008. Thyroid disorders in childhood and adolescence. Pediat Endocrinol, 3: 240-241.
• Gayathri B, Kalyani R, Harendra KM, Krishna PK. 2011. Fine needle aspiration cytology of Hashimoto's thyroiditis–A diagnostic pitfall with review of literature. J Cytol, 28(4): 210.
• Gharib H , Goellner JR, Johnson DA. 1993. Fine-needle aspiration cytology of the thyroid. A 12-year experience with 11,000 biopsies. Clin Lab Med, 13(3): 699-709.
• Gul K, Dirikoc A, Kiyak G, Ersoy PE, Ugras NS, Ersoy R, Cakir B. 2010. The association between thyroid carcinoma and Hashimoto's thyroiditis: the ultrasonographic and histopathologic characteristics of malignant nodules. Thyroid, 20(8): 873-878.
• Haberal AN, Toru S, Ozen O, Arat Z, Bilezikçi B. 2009. Diagnostic pitfalls in the evaluation of fine needle aspiration cytology of the thyroid: correlation with histopathology in 260 cases. Cytopathology, 20(2): 103-108.
• Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, Braverman LE. 2002. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab, 87(2): 489-499.
• Mazokopakis EE, Tzortzinis AA, Dalieraki-Ott EI, Tsartsalis AN, Syros PK, Karefilakis CM, Papadomanolaki MG, Starakis IK. 2010. Coexistence of Hashimoto's thyroiditis with papillary thyroid carcinoma. A retrospective study. Hormones (Athens), 9(4): 312-317.
• Mukasa K, Noh JY, Kunii Y, Matsumoto M, Sato S, Yasuda S, Suzuki M, Ito K, Ito K. 2011. Prevalence of malignant tumors and adenomatous lesions detected by ultrasonographic screening in patients with autoimmune thyroid diseases. Thyroid, 21(1): 37-41.
• Poropatich C, Marcus D, Oertel YC. 1994. Hashimoto's thyroiditis: fine-needle aspirations of 50 asymptomatic cases. Diagn Cytopathol, 11(2): 141-145.
• Uhliarova B, Hajtman A. 2018. Hashimoto's thyroiditis - an independent risk factor for papillary carcinoma. Braz J Otorhinolaryngol, 84(6): 729-735.
• Yoon YH, Kim HJ, Lee JW, Kim JM, Koo BS. 2012. The clinicopathologic differences in papillary thyroid carcinoma with or without co-existing chronic lymphocytic thyroiditis. Eur Arch Otorhinolaryngol, 269(3): 1013-1017.