Das Dilip K, Janardan Chandrashekar, Pathan Shahed K, George Sara S, Sheikh Zaffar A
Department of Pathology, Faculty of Medicine, Kuwait University, Safat, Kuwait.
Acta Cytol. 2009 Sep-Oct;53(5):571-5. doi: 10.1159/000325386.
In case of difficulty in the interpretation of fine needle aspiration (FNA) smears of a thyroid nodule, histopathologic examination is advised to arrive at a definitive diagnosis. On rare occasions, a specific diagnosis may be given based on cytologic examination, but FNA is followed by infarction of the thyroid nodule, with resultant difficulty in interpretation or even misinterpretation of bistopathologic material. We report 2 such cases.
Two cases were diagnosed as papillary thyroid carcinoma (PTC) by FNA cytology, but histopathology reports indicated colloid goiters with infarcted nodules. Review of histopathologic material showed features of PTC in the viable tissue at the periphery of nodules. Immunohistochemical study for galectin-3 and CD44 in 1 of the cases supported the diagnosis of PTC.
We suggest that while reporting on an infarcted nodule in paraffin sections of a thyroidectomy specimen, the histopathologist should be careful to look thoroughly at its periphery for the surviving cells and their detailed morphologic features, especially if there is a prior FNA cytology report of a neoplasm.
若甲状腺结节细针穿刺（FNA）涂片的解读存在困难，建议进行组织病理学检查以得出明确诊断。在极少数情况下，可根据细胞学检查做出特定诊断，但FNA后甲状腺结节会发生梗死，导致组织病理学材料的解读困难甚至错误解读。我们报告2例此类病例。
2例经FNA细胞学诊断为甲状腺乳头状癌（PTC），但组织病理学报告显示为伴有梗死结节的胶样甲状腺肿。对组织病理学材料的复查显示，结节周边存活组织中有PTC的特征。其中1例病例进行的半乳糖凝集素-3和CD44免疫组织化学研究支持PTC的诊断。
我们建议，在报告甲状腺切除标本石蜡切片中的梗死结节时，组织病理学家应仔细全面查看其周边的存活细胞及其详细形态特征，尤其是在之前有FNA细胞学报告提示肿瘤的情况下。
