Centeno B A, Szyfelbein W M, Daniels G H, Vickery A L
Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
Acta Cytol. 1996 Nov-Dec;40(6):1189-97. doi: 10.1159/000333979.
To evaluate the morphologic findings and their potential pitfalls in fine needle aspiration biopsies (FNAB) of thyroid glands obtained following radioactive iodine (RaI) (131I) treatment for Graves' disease.
Study of thyroid FNAB specimens from six patients with prior Graves' disease treated with RaI who developed palpable nodules and had subsequent thyroid resections.
The cytologic changes attributed to radiation were quite variable among the six cases and were so pronounced in one case that a false positive diagnosis of papillary carcinoma was made even though a history of RaI had been provided. The FNAB specimen from the second case, submitted without a history of RaI treatment, was diagnosed as suspicious for papillary carcinoma. The smears from patient 3 were signed out descriptively because the pertinent clinical history had not been provided. The FNAB specimens from the last three patients were correctly interpreted because of the history of RaI therapy provided. All six thyroid surgical specimens showed changes consistent with radiation injury, and none contained evidence of malignancy.
The study's findings demonstrate that the atypia produced by RaI may be severe, leading to an erroneous diagnosis of malignancy. Provision of the appropriate clinical history of Graves' disease treated with RaI may prevent this pitfall.
评估在接受放射性碘（RaI）（131I）治疗格雷夫斯病后获取的甲状腺细针穿刺活检（FNAB）中的形态学发现及其潜在陷阱。
对6例曾接受RaI治疗的格雷夫斯病患者的甲状腺FNAB标本进行研究，这些患者出现了可触及的结节并随后接受了甲状腺切除术。
6例病例中归因于辐射的细胞学变化差异很大，其中1例变化非常明显，尽管提供了RaI治疗史，但仍做出了乳头状癌的假阳性诊断。第二例病例的FNAB标本在未提供RaI治疗史的情况下送检，被诊断为可疑乳头状癌。由于未提供相关临床病史，第3例患者的涂片仅进行了描述性报告。由于提供了RaI治疗史，最后3例患者的FNAB标本得到了正确解读。所有6例甲状腺手术标本均显示出与辐射损伤一致的变化，且均未发现恶性证据。
该研究结果表明，RaI产生的异型性可能很严重，导致对恶性肿瘤的错误诊断。提供接受RaI治疗的格雷夫斯病的适当临床病史可避免这一陷阱。
