Need help understanding pathology report

[worriedinmd]

Can someone help me to sort through the jargon of my pathology report? I know that no one here is a doctor, (I'm meeting with mine on Monday) but I don't want to go through another weekend not knowing if I have cancer. I'm not the type to freak out, so please don't hold back any comments. I already expect it to be malignant. Here's what the report says:

"Slides show scattered groups of bland uniform follicle cells and background including abundant lymphocytes, more than can be accounted for by just peripheral blood. There are also some lymphoid tangles with streaming chromatin. Scattered groups of follicle cells show some more abundant granular cytoplasm for Hurthle cell changes. Focally, three dimentional almost microbiopsy fragments are noted. The study is fairly cellular for follicle cells and the groups range from loose monolayer groups to having rosette type follicle structure. There is some thin colloid in the background."

It goes on to say "cellular follicular nodule with a background of Hashimoto's thyroiditis. Although there is some colloid present, it is not a marked feature, and given the cellularity for follicle cells, cannot rule out follicular neoplasm."

What does it mean?!

[worriedinmd]

Thank you so much! I know that my thyroid has to be taken out either way, since the nodule is so large (6.4 cm), but it helps to know there isn't an obvious malignancy.

[Fernando Roque, MD]

Hi.  The presence of lots of lymphocytes in your thyroid gland, may indicate inflammation of the thyroid gland (thyroiditis) and not malignancy.  That's why the primary consideration of your pathologist is Hashimoto's thyroiditis.  This is an "autoimmune" condition where your thyroid gland is attacked by your own body's immune system (e.g. your lymphocytes), causing the thyroid gland to become inflamed.  The pathologist, however, cannot totally rule out the possibility of follicular thyroid carcinoma.  This type of carcinoma can present with an increased amount of follicular cells (thyroid gland cells which produce the hormone) and a relative decrease in colloid material (colloid is the protein which contains the thyroid hormone).  The increased amount of follicular cells is what the pathologist has termed as an increase in "cellularity".  The pathologist has not found any cancer-like cells or "atypical" cells among the follicle cells.  They all seem to look normal, except for the increase in number.  This is why the pathologist has not committed to a diagnosis of cancer, and why he is thinking that thyroiditis is a more plausible diagnosis in your case.

I hope the explanations help.