Presentation
Right neck swellling.
Patient Data
The right thyroid lobe appears enlarged, occupied by a well-defined isoechoic nodule with cystic changes, macrocalcification, and a peripheral halo sign.
No cervical lymphadenopathy noted.
Case Discussion
Gross: specimen fixed and labeled with the patient's name, consists of 22.5 gm, 4.5 x 4 x 2.5 cm right thyroid lobe, and isthmus 2 x 1 cm "section: A". Sectioning of the right lobe shows a 3.5 x 3.5 x 3 cm well-defined cystic hemorrhagic nodule and solid areas. Submitted in 6 cassettes, left tissue.
Microscopic: sections of the right thyroid lobe show a thinly encapsulated nodule, composed of a large number of microfollicles, mixed with normofollicles and few macrofollicles, with cystic degeneration and recent and old hemorrhage with numerous hemosidren- laden macrophages. The capsule shows areas of thickening with adjacent hemorrhage and follicles extending into the capsule. These may be secondary to previous F.N.A rather than capsular invasion. No evidence of a vascular invasion was seen. The above features are most in keeping with follicular adenoma with secondary degenerative changes. The other differential is a hyperplastic nodule with secondary degenerative changes. The isthmus is unremarkable.
Diagnosis: right thyroid lobe; hemithyroidectomy: features most in keeping with follicular adenoma with secondary degenerative changes.
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