Cytohistopathological Correlation Of Thyroid Swellings, A Retrospective Study In A Tertiary Hospital

Global Journal of Pathology & Laboratory Medicine
Volume 2, Issue 1, April, Pages: 1-25

Received: April 5, 2023 Reviewed: April 7, 2023, Accepted: April 9, 2023, Published: April 11, 2023

Unified Citation Journals, Pathology 2023, 2(1) 1-25;
ISSN 2754-0952

Author: Dr. M Naveen Kumar 1, Dr. Vinila Belum Reddy 2, Dr. S Jayabhaskar Reddy 3, Dr. Manimekhala P 4, Dr. Vanajakshi S 5, Dr. Bala Krishna 6

1) Assistant Professor, Department of Pathology, AIMSR Hyderabad
2) Associate Professor, Department of Pathology, AIMSR Hyderabad
3) Professor & HOD, Department of Pathology, AIMSR Hyderabad
4) Professor Department of Pathology, AIMSR Hyderabad
5) Assistant Professor, Department of Pathology, AIMSR Hyderabad
6) Assistant Professor, Department of Statistics, AIMSR Hyderabad

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    The word thyroid originated from thyreos a Greek word meaning shield. It was first used by Thomas Wharton (1614-1673) of London.He named it as Glandular thyroideis in 1656. Enlargement of thyroid gland produced obvious physical changes in the neck. In old times it was called struma (Latin for a swollen gland), bronchocele (a cystic mass in the neck) and goiter (Latin word gutter meaning throat) In 1980, the first global estimate from the WHO on the prevalence of goiter was reported.It is estimated that 20–60% of the world’s population was iodine deficient and or goitrous, with most of the burden in developing countries2. The incidence of clinically apparent thyroid swellings in the general population is 4%–5%3. In India, there are 2,16,000 new cases of thyroid malignancies per year and hence the role of properly evaluating thyroid lesions is significant4. Thyroid cancers account for approximately 1% of all human malignancies.
  • Thyroid nodules are the common clinical findings and have a reported prevalence of 4%-7% of the adult population and occur more commonly in women. Most nodules are non-malignant and the malignancy rate range from 5%-12% in patients with single nodules and 3% in patients with multiple nodules5. Fine needle aspiration (FNA) for cytology evaluation of thyroid cancer was originally used by Martin and Ellis at New York Memorial Hospital in 1930 FNAC, as reported in the literature, is the most accurate, relatively inexpensive and provides rapid diagnosis for thyroid lesions7. Neck masses are usually benign their clinical importance is primarily related to the need to exclude thyroid cancer. Which accounts for 4 to 6.5 percent of all thyroid nodules8. Several different disorders can cause thyroid nodules. Simplicity, diagnostic accuracy and most of all cost effectiveness has given FNAC the status of first line diagnostic test in pre-operative evaluation of thyroid lesions. Its accuracy is higher when applied by experienced and well trained practitioners9. To achieve standardization of diagnostic terminology, morphologic criteria, and risk of malignancy for reporting of thyroid FNA, in 2007, the National Cancer Institute (NCI) organized the NCI thyroid Fine Needle Aspiration State of the Science Conference which proposed a 6-tier system and named it The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) 10.

Categories and their risk of malignancy for
I—Nondiagnostic (1–4%)
II—Benign (0–3%)
III—Atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS) (5–15%)
IV—Follicular neoplasm (FN)/suspicious for follicular neoplasm (SFN) (15–30%)
V—Suspicious for malignancy (SM) (60–75%)
VI—Malignant (97–99%)
The study is done in a Semi Urban Population of Hyderabad to find the diagnostic accuracy of FNAC using Bethesda reporting 2007 and correlated with the histopathological features.

1) To determine the diagnostic accuracy of FNAC in evaluation of thyroid swellings by correlating FNAC results with that of histopathological examination.
2) To characterize the cytological and histological changes identified into various categories.

Study Sample Design:
This is a retrospective cohort study design.

Study Sample Size:
Assuming 5% level of significance with 92% sensitivity, 97% specificity, prevalence of thyroid lesions is 10%.
Acceptance of precision is 8% and required sample size is 445 cases.

Method of Analysis:
Mean, SD, proportions will be calculated for all variables.
Sensitivity, specificity, Positive predictive value, Negative predictive value and accuracy will be calculated for FNAC and histopathology examination
Chi Square test will be used to study the association.
Level of significance will be taken as 0.05. SPSS version 24 will be used for all statistical analysis.

Methodology and recruitment of patients or subjects
A pre-designed proforma was used to collect relevant information patient data, clinical findings and investigation reports from patients selected. A detailed general examination and thorough local examination like the site, size, shape, extent, number, consistency, margins, its mobility with deglutition, tenderness were noted down in all patients who presented with thyroid swelling from case sheets.  All patients underwent routine investigations including complete hemogram, HIV, HBsAg, Renal function tests, Chest X ray, lateral neck X ray, serum calcium estimation, thyroid function tests and ultrasound neck. Consent taken from all the patients prior to performing fine needle aspiration cytology documents were revived and noted. Fine needle aspiration cytology report was obtained after microscopic examination of the aspirate There are different classification systems for thyroid FNAC reporting.  Systems range from 1-6 diagnostic categories.  In our present study we have used these criteria for the diagnosis.
The Bethesda System, most commonly and currently used distinguishes 6 subcategories non-diagnostic, benign, atypia of undetermined significance, follicular neoplasm, suspicious for malignancy (follicular neoplasm) and malignant. “Follicular neoplasm or suspicious for a follicular neoplasm” refers to a cellular aspirate comprised of follicular cells. Most of which are arranged in an altered architectural pattern characterized by significant cell crowding and/or microfollicle formation; “follicular neoplasm, Hurthle cell type” refers to a cellular aspirate consisting exclusively (or nearly exclusively) of Hurthle cells.  Thyroidectomy specimens which were collected and fixed in 10% neutral buffered formalin and fixed for 24 to 48 hours following which gross description of all the specimens were done will be documented. Detailed histomorphological study of the sections were revived and documented according to the category. The result of fine needle aspiration cytology was correlated with results of histopathological examination of the thyroidectomy specimen.

The study included 445 patients with complaints of thyroid swelling evaluated by FNAC and 105 patients who underwent thyroidectomy.

Distribution of Cases according to the age and gender:
The age group of the patients ranged from 14 to 70 years with a mean of 31.09 years.
Majority of the patients were females accounting for 402 cases (92.83%) of the total 445 patients, with male to female ratio of 1:10.

Age in years Female Male Total
No % No % No
11-20 27 6.06 2 0.4 29
21-30 93 20.89 5 1.12 98
31-40 197 44.26 11 2.47 208
41-50 54 12.13 04 0.89 58
51-60 28 6.29 06 1.34 34
61-70 14 3.14 04 0.89 18
TOTAL 413 92.81 32 7.19 445
Inference Approximately 69% of the female patients referred are in age group of 21-40 years.

Distribution of Cases according to the Bethesda System
Out of 445 cases, 74.8% were benign of which 56.5% was nodular goitre. Scant cellularity contributed with 3.8% of the nondiagnostic category. The distributions of AUS/FLUS (III) and FN/SFN (IV) were 4.0% and 7.1%, respectively. Category-V constituted 3.8% cases suspicious for papillary carcinoma. Papillary carcinoma (2.6%) was the most common malignancy in category-VI

Bethesda Category FNAC Diagnosis No. of Cases Percentage of Cases
I Non Diagnostic Cyst fluid, Scant cellularity

Obscuring blood

28 6.2%
II Benign Nodular goiter, Colloid nodule, Hashimotos/Lymphocytic thyroiditis

Grave’s Disease, Adenomatoid nodule

333 74.8%
V Suspicious for Malignancy Suspicious for Papillary Carcinoma

Suspicious for Medullary Carcinoma

18 4.0%
VI Malignant Papillary Carcinoma, Medullary Carcinoma, Poorly differentiated Carcinoma 16 3.5%

Distribution of Cases based on histopathological features
Out of 105 cases, 76.2% were benign of which 50% was nodular goitre. 23.8% were malignant of which 84% was papillary carcinoma.

Cases that underwent Surgery

Total number

Benign non neoplastic

Total number (66)

Benign neoplastic

Total number (14)


Total number (25)

105 Colloid nodule (8)

Nodular goiter (43)

Adenomatoid hyperplasia (6)

Hashimotos/ Lymphocytic thyroiditis  (9)

Follicular adenoma (10)

Hurthle cell adenoma (04)

Papillary carcinoma (21)

Follicular carcinoma (03)

Medullary carcinoma (01)

Cytohistological Correlation
Cytohistological correlation was done for 105 patients with surgical follow-up.
On histopathology, 78 cases were confirmed to be benign of which the most common was 50% cases nodular goitre.  Out of 105 cases, 25 cases were malignant. Papillary carcinoma (84%) was the most common malignancy followed by follicular carcinoma (12%).
Cytohistological Correlation with Assessment of Risk of Malignancy and Risk of Neoplasm
Risk of malignancy was assessed for 105 cases with surgical follow-up.  To calculate the risk of neoplasm the surgical resections were divided into three groups:
Benign nonneoplastic lesions, benign neoplasms, and malignant lesions.

Cytology Histopathology
Bethesda category No. of cases: 445 Cases that underwent surgery : 105 Benign non neoplastic Benign neoplastic Malignant lesions Risk of neoplasm
I 28 02 02 0 0 0
II 333 69 60 06 03 4.3%
III 18 06 0 04 02 33.3%
IV 32 14 04 04 06 42.8%
V 18 06 0 0 06 100%
VI 16 08 0 0 08 100%

Determination of Diagnostic Values
The total of 105 cases was divided into two groups.
One group comprised of Bethesda categories II and III for which surgery is not recommended due to low malignancy risk. The  other group consisted of Bethesda categories IV, V, and VI for which surgery is recommended due to high malignancy risk.
Cytological diagnosis was correlated with histopathological diagnosis and efficacy of FNAC was estimated by using methodology of Galen and Gambino.
Sensitivity = TP/TP + FN X100
Specificity = TN/TN + FP ×100
Positive predictive value = TP/TP + FP X 100
Negative predictive value = TN/TN + FN X 100
Diagnostic accuracy = TP + TN/ total number of cases
TP = True positiveFP = False positive
TN = True negativeFN=False negative
TP = is a positive result for neoplasm on cytology with subsequent final histopathological confirmation.
FP = is a positive result for neoplasm on cytology with a benign lesion on histopathology.
TN = is a negative result for neoplasm with subsequent final histopathological confirmation.
FN = is a negative result for neoplasm on cytology with a neoplastic lesion on histopathology.
Sensitivity- 77.7%
Specificity- 98.8%
Positive predictive value- 93.3%
Negative predictive value- 95.4%
Diagnostic accuracy- 97.7%

FNAC of thyroid is a well established reliable, minimally invasive and cost effective diagnostic procedure with high sensitivity and specificity for the evaluation of thyroid disorders.  It has a central role in the management of thyroid lesions and should be used as an initial diagnostic test.  It is mainly relied upon distinguishing neoplastic from non-neoplastic lesions, thus influencing therapeutic decisions. The important steps in FNA thyroid are sample adequacy and accurate interpretation by cytopathologist. It also contributes significantly to the preoperative investigation of patients with thyroid swellings.
In the present study the cytological diagnosis of thyroid neoplastic lesions were compared with histopathological diagnosis as gold standard. This study was undertaken to evaluate the accuracy of thyroid FNA and determine the reasons for cyto-histological discrepancies. In the present study, the age of the patients ranged from 11-70 years with a median age of 31.90 ± 12.10.  Age distribution and median age of the present study was comparable to SekhriT etal but the median age was lower when compared to Silverman et al 10, 11,12,13,14,15.

Showing Age range and Median Age of different studies and Present study

S.No Authors Age Range (Years) Median age (Years)
1. Silverman JF et al (1987) 11 16-79 44.80
2. Afroze et al (2000) 12 16-78 40.20
3. Sekri T et al (2001) 13  9-70 33.90 ± 11.70
4. Mitra et al (2002) 14 16-70 39.60
5. Safirullah et al (2004) 15 17-80 45.50
6. Present study 14-70 31.90 ± 12.10

In our study, in 445 cases 413 patients were females and 32 patients were males.
Female: Male ratio in our study was 9.2:1.
This was comparable to most of the studies done earlier.
Sex distribution was comparable.
It was closest to Tabaq Chali et al  in which the Female: Male ratio was 9:1.
It is a well known fact that thyroid diseases affect females more commonly than males 11,13,16,17,18.

Sex distribution and Male to Female Ratio of Different Studies and Present Study

S.No Authors Total Cases Male Female M:F
1 Pandit A A and Kinare SG

(1986) 16

64  26  58  1 : 2
2 Silverman JF et al (1987) 11 295 25 270 1 : 10.80
3 Tabaq Chali et al (2000) 17  239 26 211 1 :9
4 Sekhri T et al (2001) 13 300  44 256 1 : 6
5 Kamal et al (2002) 18 200  27 173 1 : 9
6 Present Study 445 32 413 1:9
  • Handa U et al (2008) 19 stated in their study that the major presenting symptom was diffuse swelling and/or nodular swelling of the thyroid.
  • Other less frequent symptoms included pain in the swelling, dysphagia, hoarseness of voice and cough.
  • Sushant Mohite et al. 20 reported the most common complaint was swelling in front of the neck.
  • In present study, most of the patients came with common complaint of swelling in front of the neck and dysphagia which was also observed with other studies.
  • Aspiration was done from 2 – 3 sites.
  • Afroze et al suggests repeated aspiration 2 – 3 times from different areas of gland in case of major nodules 38.
  • Gharib et al suggests upto 6 aspirations and an average of 2-4 aspiration 39.
  • Complications after FNAC of thyroid was usually not seen. All patients were co-operative.In the present study a technique of non aspiration fine needle cytology was also used for few cases and yielded with satisfactory results. Santos JE and Lieman collected the material for cytology in 50 cases by non aspiration technique and showed that quality of the material studied was significantly superior in the non-aspiration technique 21. The specimens that are labelled unsatisfactory owe to factors like obscuring blood, air drying of alcohol-fixed smears, or an inadequate number of follicular cells. There are several different criteria for adequacy or to be satisfactory for evaluation in thyroid aspirates.
  • For lesions that lack abundant colloid, at least 6 groups of benign follicular cells are required, each group composed of at least 10 cells or 10 groups each with 20 or more cells. There are several exceptions to the numeric requirement of benign follicular cells.
  • Any specimen that contains abundant colloid is considered adequate (and benign), even if few follicular cells are identified. The present study had 28 (6.29%) cases in ND/UNS category. Other recent studies had 1.2% to 10.6% cases in this group. The guidelines for this category are very clear in TBSRTC. TBSRTC does not provide the implied risk of malignancy for this category. But in recent classification has mentioned 1-4% risk of neoplasm.
    Unsatisfactory percentage of Present study and different study
S.No Authors Total Satisfactory Unsatisfactory %
1 Diosado MA et al (1997) 22 289 252 37 12.8 %
2 Afroze et al (2000) 13 170 166 4 2.35 %
3 Kamal et al (2002) 18  250 181 19 7.6 %
4 Hyang-Mi Ko et al(2003) 23 1613  1532 81 5.0 %
5 Present study 445 417 28 6.2%
  • Majority (417) of the aspirates done by routine FNAC were satisfactory for cytological evaluation with satisfactory to unsatisfactory percentage is 6.2%.
  • Among the remaining inconclusive aspirates, USG guided FNAC was done which yielded sufficient material for the cytological study.
  • The ratio in our present study was comparable to Kamal et al & better than Hyang-Mi Ko et al 13,18,22,23.
  • Out of 445 cases, the benign category had 74.8%.
  • Nodular goitre161 cases being the predominant group followed by lymphocytic thyroiditis 78 cases.
  • The “benign” category had a range of 60% to 87.5% in recent studies.
  • Atypia of undetermined significance” (AUS) or “follicular lesion of undetermined significance.”
  • We had 18 (7.14%) cases in group AUS/FLUS.
  • AUS result has been reported in 1–18% of thyroid cases in other studies.
  • TBSRTC suggests that the frequency of AUS interpretations should be in the range of approximately 7% of all thyroid FNA interpretations.
  • Follicular neoplasms 32 cases, Suspicious for malignancy 18 cases and malignancy 16 cases.
S.No Authors Non-neoplastic Neoplastic Ratio
1  Silverman JF et al (1986) 11 193  80 2.41:1
2  Hsu and Boey J (1987) 24 316 239  1.32:1
3  Hall TL et al (1989) 25 509  156  3.26:1
4 Sekhri et al (2001) 13  266 22 12.09:1
5 Present Study (Cyto) 411 34 12.01:1.
  • In the present study, 411 were non-neoplastic and 34 were neoplastic lesions with non-neoplastic ratio of 01:1.
  • The ratio in our present study was almost same with the results of studies done by Sekhri et al 11,13,24,25.
S.No Authors Non-neoplastic Neoplastic Ratio
1  Silverman JF et al (1986) 11 193  80 2.41:1
2  Hsu and Boey J (1987) 24 316 239  1.32:1
3 Hall TL et al (1989) 25  509  156  3.26:1
4 Sekhri et al (2001) 13 266 22 12.09:1
5 Present Study (Histo) 81 24 3.38:1.
  • In the present study, 81 were non-neoplastic and 24 were neoplastic lesions with non-neoplastic ratio of 38:1.
  • The ratio in our present study was almost same with the results of studies done by Hall TL et al 11,13,24,25.
  • In the present study, the most common lesion was nodular and colloid goitre accounting for 225 cases followed by Hashimoto’s/ Lymphocytic thyroiditis 78 cases, follicular neoplasm 32 cases, Papillary carcinoma 29 cases, Adenomatoid nodule 28 cases, Hyperplastic colloid goitre (6 cases), poorly differentiated carcinoma 5 cases, Graves disease 2 cases, Anaplastic carcinoma 2 cases  and Thyroglossal duct cyst 1 case.
  • The results of present study were compared to results of Silverman JF et al11. in case of colloid goitre and the results were comparable with Suen KC, Quenvilla NF26,27 in case of Hashimoto thyroiditis.Thyroglossal duct cyst
  • In the present study, cytological diagnosis of thyroglossal duct cyst was made in 1 case.
  • Smears from the aspirate were sparsely cellular showing squamous epithelial cells, anucleate squamous, foamy macrophages, occasional neutrophils and few degenerated epithelial cells.
  • Shaffer M, Oertel Y, Oertel J studied the cytology of 11 thyroglossal cysts and concluded that cellular elements are non specific28.
  • Has a cytological appearance of that of a benign paucicellular aspirate comprising histiocytes, polymorphonuclear leucocytes and relatively scanty epithelial cells in a mucoid or proteinaceous background.
  • They also showed that it is the scanty cellularity of the smears and the ratio of the inflammatory to the epithelial cells are the greatest aids in making the diagnosis.
  • Histopathology confirmed the cytodiagnosis in this case.Nodular and Colloid Goitre
  • In the present study nodular and simple goitre was the commonest thyroid lesion accounting for 225 cases out of 445 cases.
  • Our results are comparable to Silverman JF et al11 in which out of 309 cases 186 (60.20%) were nodular or colloid goitre.
  • Cytomorphological features between simple colloid goitre and nodular goitre were overlapping.
  • Therefore, they are taken together in our present study.
  • Histopathology confirmed the cytodiagnosis nodular goitre for 43 cases.
  • There was some difference in 8 cases.
  • 2 cases were follicular adenoma, 2 cases was Hashimoto’s/ lymphocytic thyroiditis, 2 were nodular goitre with follicular adenoma and 2 cases were colloid goitre with micro papillary carcinoma.
  • Amrikachi said false negative results were due to not using ultrasonography29.
  • In doubtful cases it is advisable to aspirate from multiple sites and USG guided.
  • The reasons for making the cytologic diagnosis of nodular goitre in a histopathologically proved follicular adenoma are mainly suboptimal material, admixture with colloid and absence of a recognizable acinar pattern.
  • In Silverman JF, et al study, out of 309 cases, 156 were nodular nodular goitre of which histopathological study was possible in 11 cases (follicular adenoma in 6 cases and nodular goitre in 5 cases) 11.
  • Cytological presentation in nodular goitre is as varied as its histology.
  • Colloid goitre may show colloid rich follicles lined by flattened inactive epithelium as well as areas with follicles lined by crowded columnar cells which may pile up and form projection similar to those seen in Graves disease.
  • Areas of lymphoid aggregates, hemorrhage, fibrosis, calcification are seen.
  • Cytologic features vary depending on the area aspirated.
  • Therefore, not only size but also consistency of the nodules is also helpful the making the clinical diagnosis.
  • Therefore, USG is helpful to see whether nodule is solid, cystic or mixed.
  • Zeppa P et al studied association of different pathologic processes of thyroid gland in FNA samples and observed association of goitre and Hurthle cell tumour in 12 cases and goitre and papillary carcinoma in 14 cases 30.
  • This indicates that every case of nodular goitre should be sampled from multiple sites to avoid missing of the other neoplastic lesions.

Hashimoto’s Thyroiditis

  • In the present study, cytological diagnosis of Hashimoto’s/ lymphocytic thyrodiitis was made in 78 cases.
  • Histopathological study confirmed as Hashimoto’s/ lymphocytic thyrodiitis in 9 cases, it differed in 4 cases with 1 colloid goitre with cystic change, 2 follicular adenoma, 1 papillary carcinoma with Hashimoto’s Thyroiditis.
  • Lowhagen described Hashimoto’s thyroditis as a clinical entity consisting of diffuse lymphocytic thyroiditis accompanied by hypothyroidism 31.
  • Lowhagen said stressed the need for re-aspiration of thyroid nodules to establish the cause of lymphocytic infiltrate.
  • This is helpful in differential diagnosis between focal lymphocytic thyroiditis and the lymphocytic infiltrate accompanying carcinoma.
  • Orel et al showed increased lymphocytic infiltrate in Hashimoto’s thyroiditis & mixed inflammatory cells with giant cells, epithelioid cells in subacute thyroiditis 28.

Nodular Goitre with Hyperplasia

  • In the present study 08 cases of nodular goitre with hyperplasia were diagnosed cytologically and 32 cases was diagnosed as follicular adenoma.
  • It is difficult to differentiate follicular neoplasm and hyperplastic colloid nodule cytologically.
  • Histopathological study confirmed as follicular adenoma in 10 cases, it differed in 6 cases with 1 colloid goitre with cystic change, 2 Hurthle cell adenoma and  3 papillary carcinoma.
  • Sidawy M et al mentioned the limitations of fine needle aspiration cytology in distinguishing these follicular lesions due to overlapping of the cytologic criteria.
  • They stressed the need for adequate cellular smears, minimal cellular damage and preservation of the pattern of cell distribution 32.
  • Ravinsky E, in his study, diagnosed colloid nodule and follicular neoplasm based on the arrangement of cells 33.
  • Some authors describe hyperplastic nodules as sheets of cells with a honeycomb pattern with well spaced nuclei maintaining their polarity.
  • Aspirate from follicular neoplasms were described as having syncitial type of tissue fragments with crowding and overlapping of the nuclei.
  • The nuclei were normal to slightly enlarged in hyperplastic nodules whereas nuclei in follicular adenomas are uniform and comparatively much larger.

Neoplastic Lesions

  • Neoplastic lesions accounted for 34 cases out of 445 cases in the present study.
  • Most common neoplastic lesions was papillary carcinoma accounting for 22 cases followed by follicular neoplasm (including Hurthle cell neoplasm) accounting for 6 cases, followed by 4 cases of poorly differentiated carcinoma and 2 cases of Anaplastic carcinoma.
  • Distribution of different neoplastic lesions when compared to Hall et al was lower in case of Follicular neoplasm than Papillary carcinoma 25.
  • In the present study cytological diagnosis of papillary carcinoma was made in 22
  • Histopathological study confirmed all 22 cases.
  • In the present study Psammoma bodies were seen in 2 cases.
  • Kini SR et al showed that the psammoma bodies were present only a small percentage of aspirates.
  • He diagnosed lymphocytic thyroiditis 7 cases out of 87 cases of papillary carcinoma 34.
  • In the present study Tall cell variant of papillary carcinoma thyroid was seen in 2 cases.
  • Ko et al have reported the predictive value of cytological diagnosis as 100% for papillary carcinoma of thyroid 35.

Follicular Neoplasm

  • Follicular neoplasm was the next commonest neoplastic lesions that was encountered in the present study in 6 cases.
  • Histopathological study conformed the cytodiagnosis in 6 cases and differed in 4 cases.
  • In which 1 were colloid goitre, 1 Hashimoto’s thyroiditis, 1 colloid goitre with hyperplasia and 1 Hurthel cell adenoma.
  • Smears from Hurthle cell adenoma showed cellular monomorphic population of oval to polygonal cells with abundant granular cytoplasm small round to oval eccentric nucleus with finely granular chromatin and prominent macro nucleoli.
  • 2 cases histopathologically diagnosed as MNG / colloid goitre were cytologically diagnosed as follicular neoplasms due to high cellularity with microacinar pattern.
  • All these cases histopathologically showed nodular hyperplasia with focal crowding of the epithelium.
  • Similarly, Hsu C and Boey J reported 128 cytologically diagnosed follicular adenomas of which 58 were nodular goitre on histopathology 24.
  • 1 case histopathologically diagnosed as Hashimoto’s thyroiditis were cytologically diagnosed as follicular neoplasm.
  • Ravinsky E showed the difficulties in differentiation of Hashimoto’s thyroiditis from thyroid neoplasms in fine needle aspirates.
  • He stressed on two most consistent distinguishing criteria identified in their study to cell arrangement and nuclear chromatin.
  • Aspirates from the neoplasms were characterized by three dimensional tissue fragments with loosely cohesive cells and many isolated single cells.
  • The tissue fragment had syncytial pattern, with crowded overlapping nuclei and poorly oriented to each other .
  • The nuclear chromatin of the neoplastic cells was crisp and well defined.
  • The smears from hashimoto’s thyroiditis on the other hand were characterized by flat cell sheets, thin cell clusters and scattered isolated cells.
  • They showed bland nuclear chromatin with the regressive atypia considered to be indicative of non neoplastic conditions 33.

Poorly differentiated thyroid carcinoma (PDTC)

  • Was first proposed as a distinct subtype of thyroid malignancy by Carcangiu et al.
  • These authors reinterpreted the original observation made in 1907 by Langhans.
  • Who described a locally aggressive tumor with a peculiar architecture: tumor cells arranged in large, round to oval formations, the so-called insulae .
  • Currently, there are two recognized subtypes of PDTC – insular and non-insular.
  • PDTC is a rare malignancy, accounting for 0.3–6.7% of all thyroid cancers 36.
  • The age at presentation is between 18 and 63 years with a slight female predilection.
  • It has an aggressive clinical behavior intermediate between that of the well-differentiated thyroid carcinomas (papillary carcinoma, follicular carcinoma, and Hürthle cell carcinoma) and undifferentiated (anaplastic) thyroid carcinoma.
  • 4 cases of poorly differentiated carcinoma was diagnosed on cytopathology.
  • Out of these 3 cases was received for histopathology .
  • 2 cases was diagnosed as poorly differentiated carcinoma and 1 case was diagnosed as Papillary carcinoma.
  • Component showing typical microscopic features of papillary or follicular carcinoma variably admixed with poorly differentiated cells.
  • The presence of oncocytic (Hürthle cell) features does not exclude a diagnosis of PDTC.

Undifferentiated (anaplastic) thyroid carcinoma (UTC)

  • Also called “giant- and spindle-cell carcinoma,” is an extremely aggressive thyroid malignancy.
  • Accounting for less than 5% of thyroid cancers.
  • Patients present with a hard, nodular thyroid gland, and most have a rapidly growing mass.
  • Neck enlargement is due to marked tumor growth, with or without reactive fibrosis, which infiltrates into surrounding extra thyroidal soft tissues 37.
  • 2 cases was reported on cytopathology and 1 case received for histopathology and was diagnosed as Anaplastic carcinoma.
  • Aspirates showed moderately to markedly cellular.
  • Neoplastic cells are arranged singly and few in clusters with variably sized groups.
  • Cells are epithelioid, round to polygonal and few are spindle-shaped.
  • “Plasmacytoid” and “rhabdoid” cell shapes are seen.
  • Nuclei is enlarged with irregular borders, highly pleomorphism, clumping of chromatin with parachromatin clearing, prominent irregular nucleoli, intranuclear pseudoinclusions, eccentric nuclear placement, and multinucleation.
  • Necrosis with extensive inflammation seen.


  • Fine needle aspiration has essential role in the evaluation of euthyroid patients with a thyroid nodule.
  • It is simple, safe, minimally invasive and cost effective procedure for preoperative assessment of patients with thyroid lesions.
  • It not only facilitates the communication among cytopathologists, surgeons, radiologists, endocrinologists but also facilitate research into the epidemiology, molecular biology, pathology and diagnosis of thyroid diseases.
  • FNAC of cystic thyroid lesions helps to reduce the pressure symptoms and
  • the anxiety of the patients.
  • Cystic fluid should be aspirated and FNAC should also be done from residual mass.
  • If no palpable mass is present patient should be followed up with USG examination.
  • USG guided FNAC should be done whenever necessary thereby eliminating the false negative cases.
  • Low rate of false positive and false negative case can be achieved by applying strict criteria for specimen adequacy.
  • Non aspiration technique makes interpretation easier.
  • Patients with benign thyroid lesions have increased risk of developing malignant lesions.
  • Therefore, FNAC is a valuable investigation in identifying occult neoplasms.


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To citation of this article: .Dr. M Naveen Kumar 1, Dr. Vinila Belum Reddy 2, Dr. S Jayabhaskar Reddy 3, Dr. Manimekhala P 4, Dr. Vanajakshi S 5, Dr. Bala Krishna 6, Cytohistopathological Correlation Of Thyroid Swellings, A Retrospective Study In A Tertiary Hospital, Global Journal of Pathology & Laboratory Medicine

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