Thyroid nodule

Submandibular solid-cystic mass as the first and sole manifestation of occult thyroid papillary carcinoma: A case report

BACKGROUND

Occult thyroid papillary carcinoma (OTPC) is typically characterized by initial presentation with cervical lymph node metastasis and can be detected through ultrasound. However, the initial and sole manifestation was a submandibular solid-cystic mass. High-frequency ultrasound, enhanced multislice computed tomography (CT) scan, and thyroid function tests revealed no abnormalities, which is relatively uncommon.

CASE SUMMARY

A 24-year-old Chinese female, who studied at a university in Shandong Province, presented to the clinic in June 2019 with a right submandibular mass that she had noticed 2 mo earlier. Clinical examination revealed a 2-cm, nontender, movable solid-cystic mass in the submandibular region, with no palpable thyroid mass observed. Ultrasonography revealed a 2.0 cm × 1.1 cm solid-cystic mass in the right submandibular region, and the thyroid gland showed no abnormalities. CT scan and 131I whole body follow-up scan showed that there were no abnormalities in the thyroid. However, cytology and pathology showed papillary tumor cell clusters, consistent with papillary thyroid carcinoma. Thus, we performed total thyroidectomy and right neck lymph node dissection. The pathology revealed the thyroid was detected as classical thyroid micropapillary carcinoma, and lymph nodes of levels VI central and levels II, III, IV, V on the right side showed no tumor metastasis. The patient was followed up for 2 years without significant recurrence.

CONCLUSION

The presentation of a submandibular solid-cystic mass as the primary and solitary indication of OTPC is relatively uncommon. Fine needle aspiration is advised for evaluating neck masses.

Ultrasound-guided fine-needle aspiration biopsy of the thyroid: methods to decrease the rate of unsatisfactory biopsies in the absence of an on-site pathologist

PURPOSE

The rate of unsatisfactory samples from ultrasound-guided fine-needle aspirations of thyroid nodules varies widely in the literature. We aimed to evaluate our thyroid ultrasound-guided fine-needle aspiration biopsy technique in the absence of on-site microscopic examination by a pathologist; determine factors that affect the adequacy rate, such as the number of needle passes and needle size; compare our results with the literature; and establish an optimal technique.

MATERIALS AND METHODS

We performed a retrospective review of cytopathology reports from 252 consecutive thyroid ultrasound-guided fine-needle aspiration biopsies performed by a radiologist between 2005 and 2010 in our hospital's radiology department. Sample adequacy, the number of needle passes, and needle size were determined. There was an on-site cytologist who prepared slides immediately after fine-needle aspiration but no on-site microscopic assessment of sample adequacy to guide the number of needle passes that should be performed. Cytopathology biopsy reports were classified as either unsatisfactory or satisfactory samples for diagnosis; the latter consisted of benign, malignant, and undetermined diagnoses.

RESULTS

Seventy-seven biopsies were performed with 1 needle pass, 124 with 2 needle passes, and 51 with 3 needle passes. The rates of unsatisfactory biopsies were 33.8%, 23.4% (odds ratio [OR] 0.599 [95% confidence interval {CI}, 0.319-1.123]; P = .110), and 13.7% (OR 0.312 [95% CI, 0.124-0.788]; P = .014), respectively.

CONCLUSION

In a hospital in which there is no on-site pathologist, a 3-pass method increases the specimen satisfactory rate by 20% compared with 1 pass, achieves similar rates to the literature, and provides a basis for further improvement of our practice.

Association of insulin-like growth factor-1 with thyroid nodules

The aim of the present study was to investigate the relationship between insulin-like growth factor-1 (IGF-1) and thyroid nodules. A total of 56 patients with thyroid nodules confirmed by physical examination and ultrasound screening were randomly selected. The patients were divided into three groups by radionuclide scan: the hot nodule group (group 1, n=18); the cold and solid nodule group (group 2, n=18); and the cold and cystic nodule group (group 3, n=20). Cystic fluid samples from patients with cystic cold thyroid nodules were defined as group 4. A control group of 18 healthy adults matched for age, gender and body mass index (group 0) was also included. For all participants, levels of the thyroid hormones, TT3, TT4, TSH and IGF-1, were determined by radioimmunoassay. The measurement data were expressed as the mean ± standard deviation (SD). The analysis of variance was performed by the t-test and the correlation analysis was performed by linear regression. The serum levels of IGF-1 in the solid cold nodule group were significantly higher than those in the hot nodule group (P<0.05). Serum levels of IGF-1 in the cystic cold nodule group were significantly lower than those in the control group (P<0.05). The serum IGF-1 levels in the cystic fluid were significantly lower than those in the cystic cold nodule (P<0.05) and the control groups (P<0.05). Additionally, the mean serum IGF-1 level in patients with thyroid adenoma was significantly higher than that in the control group (P<0.05). The serum IGF-1 level may not be involved in the pathogenesis of hot thyroid nodules and cold and cystic thyroid nodules; however, it may play a significant role in the pathogenesis of certain solid cold thyroid nodules.

Evaluation and management of incidentally discovered thyroid nodules

Thyroid nodules are present in 4-10% of the adult population. However, less than 1% of all cancers occur in the thyroid gland. Thyroid nodules are usually an incidental finding in a routine clinical or an ultrasound examination of the neck performed for some other reason. Differentiating a benign nodule, which may require no specific treatment, from a malignant nodule presents a diagnostic dilemma. An individualized approach to a patient with history, risk factors and fine needle cytology is warranted. Molecular markers and immunohistochemical studies done on thyroid nodule cytology may help in differentiating benign from malignant. This article presents a review of the literature for the diagnosis and management of the thyroid nodule.