Profile and pattern of histology specimen of thyroidectomy patients operated in Mankweng hospital, Limpopo province, South Africa

Object of study: To evaluate the histopathologic pattern of the thyroidectomy specimen in patients with goitre who underwent thyroidectomy operation at Mankweng Hospital and to review the profile of thyroid disease in relation to the age, gender & Distribution of thyroid disease which are referred to Mankweng hospital from the districts of Limpopo Province. The problem to be solved: The demographic profile of thyroidectomy patients in this hospital is identified. Hence outreach program can be initiated according to demographic profile. Main scientific results: Total of 62 patients analyzed: Male 2, female 60. Age range 15-70: District: Capricorn 23, Sekhukhune 33, Mopani 6. Histology: 62: Multinodular goitre 47, Papillary carcinoma 5: Hurtle cell carcinoma 3, colloid goitre 2, Diffuse colloid goitre 1, Cavernous haemangioma 1, follicular neoplasm 1, Hashimoto`s Thyroiditis 1, benign thyroid parenchyma with cyst 1 The area of practical use of research results: General surgery department in Regional & Tertiary hospital An innovative technological product: Patient demographic profile for health outreach program. Scope of application of an innovative technological product: General surgery department

Patterns of surgically treated thyroid disease in Lusaka, Zambia

Background: Thyroid gland disease is a common disorder of the endocrine system worldwide.This disease varies according to the environment. The aim of this study is to determine demographic and histopathologic patterns of thyroid disease at the University Teaching Hospital, Lusaka, Zambia.Methods: This was a retrospective review of patients records (n=239) over a ten year period (2001-2010) at the University teaching Hospital, Lusaka, Zambia. Rate of thyroidectomies, demographic characteristics (age and gender), histologic types and regions where patient came from (for clustering) were analysed.Results: A total of 3475 general surgical operations were done in a 10-year period. Of these 252(7.25%) were for thyroid surgery. 239 thyroid specimen results were found. They were from 212 females and 27 males with female: male ratio of 7.8:1. There were172 cases (71.96%) of colloid goitre (the most common thyroid disease) followed by 33 cases of thyroid neoplasms (n=33, 13.8%). Benign tumour i.e., adenoma were seen in eight (3.3%) cases and thyroid carcinoma in 26 (10.8%) cases. Thyroiditis constituted three (1.2%) of the cases Thyroid cyst accounted 19(8.1%) and Toxic goitre nine(3.8%) cases.Age range for colloid goitre was 19-89, malignancy 19-69, thyroid adenoma 19-69 and toxic goitre 20- 69 Colloid goitre had a peak at age group 31-49years. Follicular carcinoma was the commonest malignant thyroid tumour (15 cases).Peak age for thyroid malignancy 30-59. Most patients were from Lusaka (n=103) followed by Eastern province (29 patients).Conclusion: This study showed that thyroid surgery constituted a significant proportion of major surgical operations. Colloid goiter (a preventable disease), was the commonest thyroid disease in this study. Thus, public health measures such as iodination of salt and health education could play a role reducing the occurrence of this disease and of related surgery. Females mostly affected. A thyroid carcinoma pattern differs from other parts of world. Follicular carcinoma is common in sub-Saharan Africa. In the Western world papillary carcinoma is more common. A further prospective study is expected to bring more statistical data

Clinicopathological spectrum of operated thyroid lesions in a tertiary care centre : a cross sectional study

Background: Thyroid diseases are one of the most common endocrine disorders affecting the general population worldwide.They comprise a spectrum of entities causing systemic disease (Grave’s disease) or a localised abnormality in the thyroid gland such as nodular enlargement (goitre) or a tumour mass.The prevalence and pattern of these disorders depend on various factors including sex, age, ethnic and geographical patterns.Aim: To study the clinicopathological spectrum of thyroid lesions and the treatment outcome among the operated cases of thyroid. Variables in the spectrum includes age and sex distribution, mode of presentation, pre-operative  thyroid function, evaluation by  ultrasound, FNAC and final histopathology, postoperative complications and duration of hospital stay.Materials and Methods:This was a cross sectional study which included all patients who underwent surgery for  thyroid pathologies in the department of general surgery, at our teaching hospital from January 2016 to December 2017.150 patients were included in the study. Patients who underwent thyroid surgery but whose records were not complete for thyroid function tests, USG findings and FNA findings were excluded from the study. Results:The highest incidences (38.6%) of thyroid lesionswere found in age group of 46-60 years with female predominance (87.3%). Out of total 150 cases, 30 were malignant and 120 were benign lesions. Thyroid function test was carried out for all cases and out of them 84 were euthyroid. Most common clinical symptom was swelling in the neck which was present in all cases. Multinodular goitre was the most common radiological finding seen in 76.7% cases. Benign follicular nodule was the most common diagnosis in FNAC (80%).The most common surgery performed was Total thyroidectomy (71%).Papillary carcinoma was the most common malignant lesion in this study (29 cases) and it was associated with MNG in 55% of cases. The incidence of clinical hypocalcemia was 10.6% and RLN injury was 5%.The mean duration of hospital stay was 4 days.Conclusions: Multinodulargoitre was found to be the most common thyroid lesion in this study. Thyroid diseases showed definite female predominance, with most of them occurring in an age group of 36 - 60 years. Papillary carcinoma was the most common malignant lesion in this study.In our study USG neck showed a moderate agreement with final histopathology compared to FNAC in diagnosing malignant lesions preoperatively. USG guided FNAC may improve the diagnostic accuracy. Combined approach based on history, clinical examination, FNAC and ultrasound is required to make an accurate diagnosis

Role of fine needle aspiration cytology and cytohistopathological co-relation in thyroid lesions: experience at a tertiary care centre of North India

Background: Fine needle aspiration cytology is considered to be simple and cost effective technique for diagnosis of thyroid lesions. However the common limitations which may be encountered in FNAC may be associated with sampling error, dual pathology, cystic change or misinterpretation of morphology. The present study was therefore conducted to study the role of FNAC in diagnosis of thyroid lesions and to study the diagnostic pitfalls which may be encountered that limit the diagnosis of thyroid lesions.Methods: A retrospective study was conducted which included all the cases of thyroid lesions in which FNAC was done either directly or under image guidance over a period of five years. The cytomorphological diagnosis was correlated with histopathology to assess the diagnostic accuracy of FNAC in diagnosis of thyroid lesions.Results: Colloid goitre was the most common benign thyroid lesion while papillary carcinoma was the most common carcinoma constituting 50.2% and 5.2% of total cases. The maximum cyto-histopathological discordance was observed in cases of autoimmune thyroiditis (38%) and papillary carcinoma was most common lesion which was underdiagnosed on FNAC.Conclusions: The study concludes that although FNAC is safe, cost effective and sensitive technique for diagnosis of thyroid lesions but vigilant cyto-morphological interpretation in association with skilful aspiration and clinic-radiological co-relation is essential to avoid diagnostic pitfalls. This is even more important in cases showing focal neoplastic pathology or presence of dual pathology. Repeat image guided FNAC with clinical follow up is recommended in cases with strong clinical suspicion of malignancy

Spectrum of thyroid diseases in the surgical department of a tertiary centre in South-south, Nigeria

Background: Diseases of the thyroid gland are common endocrine disorders encountered globally and the incidence varies from one geographical region to another. The aim of this study is to determine the demographic, clinical and histopathological pattern of thyroid diseases as seen in University of Port Harcourt Teaching Hospital (UPTH).Methodology: This is a 6 year retrospective study of all patients with thyroid diseases that were managed in the surgical department of the University of Port Harcourt Teaching Hospital between January 2006 and December 2011. Relevant data were retrieved from the case notes and analysed using the Statistical Package for Social Sciences (SPSS) version 17.Results: A total of 80 patients with thyroid diseases were evaluated. They included 11 (13.7%) males and 69 (86.3%) females with a male to female ratio of 1: 6.3. Their ages ranged from 18 to 70 years with a mean of 40.3±4.4 years and peak age at 31-40 years. Colloid goitre was the commonest lesion encountered, seen in 21.3% of the patients with an average age of 37.4±3.1 years and peak age of 21-30 years. Cosmetic disfigurement was found to be the major indication for surgery and respiratory obstruction the commonest post-operative complication seen.Conclusion: Diseases of the thyroid gland are common in Port Harcourt and seen in both genders with a female preponderance. Colloid goitre was the commonest lesion encountered and respiratory obstruction the commonest surgical complication.Keywords: Thyroid diseases, clinical features, histopathology, Port Harcourt, Nigeri

Cytomorphological alterations of thyroid gland consequent upon fluorosis

Background: Study aimed at assessing the impact of elevated fluoride from drinking water on thyroid gland structure and function in fluorosis prone areas. Iodine is incorporated in the thyroid synthesis by thyroid gland but in the presence of low Iodine levels fluoride is likely to interfere with the concentrating capacity of thyroid of iodine in thyroid production, consequently reflecting changes in thyroid parameters and also cytomorphological features manifesting hypothyroidism in association with different pathological entities.Methods: Prakasam district in Andhra Pradesh is fluorosis prone zone and subjects are picked up from highly vulnerable zone in this district and their specimens are collected to study cytomorphological changes of the thyroid gland and biochemical parameters of blood samples for thyroid function test were considered. Cytological study by way of Fine Needle Aspiration Cytology (FNAC) of thyroid gland, biochemical parameters pertaining to function of thyroid gland namely Free triiodothyronine (FT3), Free Thyroxine (FT4) and Thyroid stimulating hormone (TSH) were assessed in the subjects from fluorosis prone zone.Results: The results were statistically significant with concurrent association of different cytological alterations of thyroid gland in these subjects like Hashimoto’s thyroiditis of hypothyroidism, adenomatous goitre, colloid goitre and few of follicular adenoma/neoplasm. FNAC makes cytological changes evident showing different morphological features that comprise different pathological entities largely with an evidence of hypothyroidism in most of the cases in the given study.Conclusions: The results of the study strongly suggest assessing the magnitude of the problem of fluorosis and also magnitude of its influence on thyroid structure and function that warrants assessment of the thyroid function by biochemical and cytological studies

EVALUATION OF DIAGNOSTIC PERFORMANCE OF USG GUIDED FNAC OF THYROID SWELLINGS: A PROSPECTIVE STUDY

  Background: USG-guided FNAC is a good preoperative screening technique when compared to FNAC and USG done separately for the diagnosis of a thyroid lesion. However, there is little evidence in the literature that emphasizes the importance of USG-guided FNAC as the first step in the investigation of thyroid lesions. Aim: Our study aims to see the sensitivity and specificity, adequacy, and diagnostic accuracy of USG-guided FNAC taking histopathology as a gold standard. Methods: This Hospital-based prospective observational study was carried out on patients who attended the OPD and/or IPD and underwent surgery in the Department of Otorhinolaryngology. Results: The sensitivity, specificity, and diagnostic accuracy of ultrasound-guided FNAC for thyroid lesions were 58.82%, 98.18%, and 88.89% respectively taking Bethesda categories 1 to 3 as benign and categories 4 to 6 as malignant. The positive likelihood ratio and negative likelihood ratio are 32.32 and 0.42 respectively. Positive predictive value and negative predictive value were 90.91% and 88.52%. The diagnostic accuracy of USG-guided FNAC for thyroid lesions in the present study is 88.89% and adequacy is 93.05%. Conclusion: Further study of a larger number of cases is desirable. US-FNAC is an expensive procedure as compared to palpable FNAC. Recommendation: We recommend the application of USG guide FNAC as the first step in the investigation of thyroid lesions along with a detailed interdepartmental correlation to make the diagnosis before surgery

Scanning Electron Microscopy of the Human Thyroid Gland and its Disorders

The characteristic scanning electron microscopic features of the normal thyroid gland, benign thyroid lesions such as nodular (adenomatous) and colloid goitre, adenomas and thyroiditis, and malignant tumors such as papillary carcinoma, follicular carcinoma, anaplastic carcinoma and medullary carcinoma are described. One or more cilia are present in the center of the follicular surface of almost every epithelial cell in the normal thyroid gland as well as in most goitres. Their number is reduced in adenomas and differentiated carcinomas. Medullary carcinomas and anaplastic carcinomas usually lack cilia. Variation in distribution and appearance of microvilli seems to be related to functional differences in the normal thyroid and goitres. In neoplastic conditions the abundance of microvilli steadily decreases from ordinary papillary carcinomas to follicular variants of papillary carcinoma and to follicular carcinoma. Most of the cells in medullary carcinoma and anaplastic carcinoma have few or no microvilli. Benign and neoplastic Hürthle cells have a very characteristic appearance. Distinct, smooth-surfaced cells are interspersed among cells rich in microvilli. The literature is reviewed. Our own experience from examinations of 264 thyroid specimens is included

Cytology of Paediatric lesions: a tertiary care centre experience during COVID-19

Background: Paediatric lesions are worrisome and need immediate attention with early diagnosis. Fine needle aspiration cytology (FNAC) is safe, cost effective, minimally invasive method which helps in diagnosis and guides for treatment of various paediatric lesions.Methods: This was an observational study done during the pandemic of COVID-19 at department of pathology in Andhra Medical College, Visakhapatnam from March 2020 to October 2020 .The total number of cases were 91 who underwent fine needle aspiration (FNA) during this period. USG guided aspiration and fluids are also included in the study. Slides were fixed in 95% isopropyl alcohol and stained with Haematoxylin and Eosin. May Grunwald Giemsa stain, CBNAAT for acid fast bacilli and correlation with histopathology was done wherever required and results were tabulated.Results: In the present study the lesions were more common in female children (68.13%) and in the age group of 11-15 years (35.16%).Benign lesions (80.91%) were more common than malignant lesions. Majority of benign lesions were reactive lymphadenitis (32.5%) followed by tuberculous lymphadenitis (23.75%). The common malignant lesions were lymphoblastic and Hodgkin’s lymphoma, metastatic nasopharyngeal carcinoma, malignant peripheral nerve sheath tumour (MPNST), Langerhans cell Histiocytosis and Ewing’s sarcoma.Conclusions: Extra pulmonary tuberculosis in children is highly variable in severity and rate of progression with long term sequelae. The spectrum of malignancies in children is variable and region based. FNAC helped in early diagnosis and management of these cases

Diagnostic utility of fine needle aspiration cytology in thyroid lesions

Background: Thyroid fine needle aspiration cytology (FNAC) is an important screening tool and thereby dictates clinical management. The exclusion of non-invasive follicular variant of papillary carcinoma (NIFVPTC) from thyroid malignancies and its reclassification as non-malignant entity i.e., non-invasive follicular thyroid neoplasm with papillary like nuclear features (NIFTP) has added a new dimension. Aim of this study was to study the role of fine needle aspiration cytology in screening thyroid lesions by correlation with histopathological examination and to calculate diagnostic accuracy of FNAC considering NIFTP as non-malignant and compare it with pre NIFTP era.Methods: It was an observational study done over a period of 2 years (2017-2018). It included the cases where FNAC was followed subsequently by histopathology. FNAC results were correlated with histopathological diagnosis established thereof.Results: A total of 107 patients were included in this study. Considering NIFTP as non-malignant, sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 92.97%, 100%, 100%, 92.73% and 96.23% respectively, that is significantly higher if authors considered NIFTP as malignant.Conclusions: FNAC plays an indispensable role in making preliminary diagnosis in thyroid lesions. There is a notable increase in diagnostic accuracy of FNAC in thyroid lesions and significant decrease in risk of malignancy by considering NIFTP as non-malignant