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