Thyroid Cancer / Nodules & Hyperthyroidism Expert Forum
Biopsy Report
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Questions in the Thyroid forum are answered by Mark Lupo, MD. Topics covered include Goiter, Graves Disease, Hyperthyroid, Parathyroid/Calcium Problems, Thyroid Cancer, Thyroid Nodules/Cysts, Thyroiditis, Thyroid & Pregnancy, Thyroid Stimulating Hormone (TSH), Thyroid Tests, and Thyroid Surgery.

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Biopsy Report

Dear Dr. Lupo,

Could you please decifer this report for me?  Any insight would be appreciated.  

MICROSCOPIC DESCRIPTION:
A. Most of the smears and the cell block are either acellular or markedly hypocellular. The best material is one of the Pap stained slides. This demonstrates small tissue fragments composed of fibrous stroma and adherent cells with relatively abundant and granular cytoplasm typical of Hurthle cells, along with individually dispersed Hurthle cells in the background. The background is bloody and with the exception of some thick colloid on one the air-dried slides, there is no obvious colloid backgound. There is no prominent lymphocytic background which would suggest lymphocytic thyroiditis. No features of papillary carcinoma are identified.
B. The cell block shows blood and macrophages. The smears are similar but also include rare atypical cells. This could represent Hurthle cell change and could be a degenerative or reactive change in response to the cystic degeneration. Other than these rare cells, no other definite epithelial cells are seen. Therefore the exact type of cyst cannot be determined.
FINAL DIAGNOSIS:
A. Fine needle aspiration, Right thyroid:  A few Hurthle cells and scant thick colloid (see comment).
B. Fine needle aspiration, Left thyroid cyst: Hemorrhagic cyst fluid with microphages and a few atypical cells (see comment).
COMMENT: The Right biopsy "A" raises the possibility of a microfollicular lesion with Hurthle cell features. Although the Hurthle cells could represent a reactive change, no background thyroiditis is recognized. The material is hypocellular and a definitive diagnosis cannot be made.
The Left thyroid cyst shows mosly degenerative cyst contents with macrophages. Rare atypical cells are present, which could be reactive changes. However, if any residual solid area of the lesion remains, this should be evaluated.

Thank you,
Sandy
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Would repeat the FNA biopsies but could wait 4-6 weeks at least and make sure it is done under ultrasound guidance.  This sounds like hashimoto's on the R and cystic degeneration on the L -- both benign, but this report is not conclusive.  The other option is to send the slides for second opinion to a university center.
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Dear Dr. Lupo,

I forgot to mention, that all the endo told me about this report is that I need a repeat biopsy because there are "worrisome terms" in this report.  

Is this something urgent, or can I wait a while to have another biopsy?

Thanks again,
Sandy
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Dear Dr. Lupo,

Thank you for answering my questions.  I actually did have this FNA biopsy done with ultrasound, but I guess the endo didn't get very good specimens from it.  My cyst on the L was aspirated 3 times (28cc's of fluid removed) and the nodule on the R was stuck 5 times for samples.  

When the endo called me about this biopsy, I asked her if there was any signs of Hashimoto's, and she said "no, no Hashimoto's".  She scared me with the way she spoke about the report.

I am curious how she doesn't see Hashimoto's and you do?  The Hashimoto diagnosis makes more sense to me since my dad had hypothyroidism.  My TSH are within normal range though.  

I am waiting to see a thyroid specialist at UCLA next month (found an endo that only sees thyroid patients!).  

Thank you so much for your help!

Sincerely,
Sandy  
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