Expert: Neha Dahiya MD - 5/28/2009

Question
QUESTION: I was recently diagnosed with one complex thyroid nodule. My endocrinologist did FAN and recommended to watch is every few months since it has one atypical cell group. I got second opinion myself with ENT and he said take it out to be sure so I need your thoughts. Thanks!
Here is report summary:
Rare atypical follicular epithelial cell group present, in a background of nodular hyperplasia.

Description: The smears show abundant hemosiderin laden histicytes along with scattered colloid material. Some of the colloid is watery, but there is more inspissated appearing colloid. The follicular epithelial cells predominantly show no nuclear or architectural atypia, and for the most part, are consistent with nodular hyperplasia. However, focally on one of the smears, there is a single group of epithelial cells with nuclear atypia, including nuclear enlargement, partially obscured by blood. This fragment of atypical epithelium is associated with a structure possibly representing a psammoma body. However, the atypical cells do not show intranuclear grooves or pseudoinclusions, but are enlarged with some Hurthle cell features. The ThinPrep slide shows blood and hemosiderin laden histiocytes only.



ANSWER: Hello Monica:

The FNA report is essentially favoring nodular hyperplasia. The only negative is a single fragment of atypical cells. These cells  are suggestive of cancer but are NOT cancer cells.

The choice to operate and remove the thyroid nodule is  for the concerned doctor to make along with all other findings...ultrasound reports / thyroid function test results etc. If decision is not to operate you will be on follow up scan with a repeat FNA at a later date.

---------- FOLLOW-UP ----------

QUESTION: Thanks! Neha,

Just one more question. My endo and GP both said follow up for now. Is it consider follicular lesion or follicular neoplasm ? or nodular hyperplasia from FNA report. After reading so much on interner I am confuse between my Nodular Hyperplasia and follicular lesion/neoplasm. Appreciate you input.

Answer
Hi:

Based on the report your diagnosis is nodular hyperplasia as of now.
There isnt sufficient follicular pattern to favor a follicular lesion.

If on a followup scan and FNA such a pattern emerges it can be diagnosed as a follicular lesion / neoplasm. Even then a final diagnosis will be upon removal of thyroid gland.