CASE 1: FNA OF A LARGE GOITRE Roberto Dina, MD Cytology Dept of Histopathology Hammersmith Hospital...

CASE 1: FNA OF A LARGE CASE 1: FNA OF A LARGE GOITREGOITRE

Roberto Dina, MDRoberto Dina, MD

CytologyCytology

Dept of HistopathologyDept of Histopathology

Hammersmith HospitalHammersmith Hospital

London (U.K.)London (U.K.)

CASE HISTORYCASE HISTORY

• A 77 yr old Female with a history of long A 77 yr old Female with a history of long standing goitrestanding goitre

• Presents with a recently enlarged thyroidPresents with a recently enlarged thyroid

• SmokerSmoker

ImagingImaging

• Large heterogeneous mass within the neck Large heterogeneous mass within the neck consistent with the patients goitre. The trachea consistent with the patients goitre. The trachea is markedly deviated to the right and narrowed is markedly deviated to the right and narrowed in the coronal dimension to 6 mm. The goitre in the coronal dimension to 6 mm. The goitre extends to the superior aspect of the sternum. extends to the superior aspect of the sternum. Within the anterior segment of the LUL there Within the anterior segment of the LUL there is a spiculated 11 mm diameter nodule which is a spiculated 11 mm diameter nodule which appears to be cavitating anteriorly.appears to be cavitating anteriorly.

BronchoscopyBronchoscopy

• Bronchoscopy normalBronchoscopy normal

• Bronchial washing and brushing Bronchial washing and brushing Negative for malignant cellsNegative for malignant cells

FNA PERFORMEDFNA PERFORMED

• 4 Passes (27 G needle)4 Passes (27 G needle)

• Scanty MaterialScanty Material

Isolated atypical nuclei

lymphocytes

CYTOLOGYCYTOLOGY

• Necrotic BackgroundNecrotic Background

• Multinucleated Giant CellsMultinucleated Giant Cells

• Histiocyte like cellsHistiocyte like cells

• Atypical CellsAtypical Cells

• Aggregates of LymphocytesAggregates of Lymphocytes