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Old 11-16-2002, 02:02 PM   #1
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DebbiBrooks HB User
Post FNA Biopsy Results - What's this mean?

You suggested I posted my FNA biopsy results. I have no clue as to what this means and won't see the doctor for another month. I realize you aren't physicians (or are you?) but can ANYONE help decipher what this means?

Impression: Abundant follicular epithelium with microfollicle formation in a background of abundant colloid and hemosiderin-laden macrophages (see comment)

Comment: The specimen consists of follicular epithelium composed of cells with relatively small nuclei. Numerous microfollicles present. These features are most suggestive of a follicular lesion (hyperplastic vs. neoplastic) possibly in a background of nuclear goiter.

Clinical correlation and further evaluation are recommended.

Thank you!!
Debbi

 
Old 11-16-2002, 05:54 PM   #2
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ArtfulD HB UserArtfulD HB User
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Hi Debbi. I can't believe your doctor won't be seeing you for a month! He or she should at least have a phone conference with you to explain your results and the treatment options (as necessary).

We're not doctors, but some folks here are trained in science or medical fields. And we know where to look to find answers. Let's see if I can translate some of this gobbledygook. I've gleaned this information from a variety of medical websites so, unfortunately, it's still pretty technical. Hopefully, I've interpreted them properly. (Scroll down to the very bottom for suggestions of what to ask your doctor):


Quote:
Impression: Abundant follicular epithelium with microfollicle formation in a background of abundant colloid and hemosiderin-laden macrophages (see comment)

Comment: The specimen consists of follicular epithelium composed of cells with relatively small nuclei. Numerous microfollicles present. These features are most suggestive of a follicular lesion (hyperplastic vs. neoplastic) possibly in a background of nuclear goiter.

Epithelium or Epithelial Cells - Epithelium is the type of glandular tissue that is sampled in an FNA Biopsy.

Follicular Epithelium - Follicles are the type of cells (with nuclei) that compose the thyroid gland. "Normal" thyroid tissue would have follicles that are evenly dispersed; An FNA of normal tissue would reveal low columnar follicular cells surrounding pink colloid (containing thyroglobulin produced by follicular cells).

Colloid - Colloid is a a gelatinous or mucinous substance found in tissues that naturally surrounds the follicular epithelial cells. In a normal thyroid gland, colloid should predominate with clusters or sheets of follicular cells with wispy cytoplasm (cellular fluid) and indistinct cell borders. Abnormal FNA results may identify nodules or cysts filled with colloid.

Thyroglobulin - an iodine-containing protein of the thyroid gland that is the precursor of thyroxine (T4 hormone) and triiodothyronine (T3 hormone). The body uses Thyroglobulin to produce thyroid hormone.

Nuclei Size – Follicular Cells typically have large nuclei. Cells with small nuclei may suggest an abnormal degeneration in the cells.

Hemosiderin - a yellowish brown granular pigment that is formed in some phagocytic cells by the breakdown of hemoglobin and is probably essentially a denatured form of ferritin (a form of iron found in the blood).

Phagocyte or Phagocytic Cells – see “Macrophage.”

Macrophages - a cell (typically a white blood cell) that engulfs and consumes foreign material (as microorganisms) and debris. Phagocytes are macrophages.

Neoplasm or Neoplastic - a new growth of tissue serving no physiological function (such as a nodule)

Macrofollicle – a type of clustered follicular cells. Colloid nodules contain macrofollicles.

Microfollicle - a type of clustered follicular cells. Hurthle cells contain microfollicles.

Hyperplasia, Hyperplasm, Hyperplastic - an abnormal or unusual increase in the cells composing a tissue.

------------------------------------

I found a really technical website that described something similar to the impression you posted:


Various Types of Euthyroid (healthy thyroid) non-neoplastic conditions:

1. Indications of a Hematoma/Hemorrhage into the Thyroid - The sampled fluid includes Brownish fluid "chocolate" (old blood) that disappears with aspiration but may reaccumulate over time. FNA shows Red cells predominate with numerous macrophages. Results may show ingested debris and/or hemosiderin should lack ciliated or columnar epithelium; may have sparse degenerative follicular cells.

-------------------------------

This is the closest thing I found to your FNA diagnosis. I'm not certain, but it sounds as if you may have a nodule with some hemorrhage. Your results did not mention "capsule infiltration" (an indication of malignancy), so I'm glad for that. But I think your results suggest follicular and Hurthle cell abnormalities.

Is it possible to call your doctor and ask him/her to explain these results in layperson's terms? You may also want to ask for follow-up tests, such as an Iodine Uptake Scan to determine if your nodule is hot (producing more thyroid hormone than normal), warm (producing the same amount of thyroid hormone as normal thyroid tissue), or cold (not producing thyroid hormone). Cold nodules require a closer watch.


[This message has been edited by ArtfulD (edited 11-16-2002).]

 
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Old 11-16-2002, 06:21 PM   #3
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DebbiBrooks HB User
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Thanks so much for your reply. As you can imagine, I've been all over the internet searching for clues, you info certainly helped with much of the terminology. I am going to call the doctor on Monday AND give the results to my GP as I can always count on him for translation, options, etc.

If you're interested, I'll post the highlights of my conversations - hopefully to help someone else in the future.

Thanks again and God bless,
Debbi

 
Old 12-08-2002, 12:41 PM   #4
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DebbiBrooks HB User
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So, I FINALLY got to talk to a doctor about my lab/fnab results (new endo). He explained alot, but I left without a clear direction on what to do next. In a nutshell:

My test results are inconclusive for cancer or benign tumors. One treatment option is to try suppression therapy - except my TSH awfully too low so suppression may not be a viable choice. Also, there are certain things about my tumors that are either 'suspicious'for cancer or at least give greater weight to the surgery option; having a tumor many times greater than 2 other found, ultrasound showing both solid and fluid elements; the presence of lymph nodes, my elavated thyroglobulin level and the size of the largest tumor (2 cm). Or I could do nothing and they could monitor me for the next 6 months.

I'm leaning toward surgery for many reasons but worry about the possibility that it may have been unnecessary in the long run. Then I read the posts of all of you that have stories where cancer was all but ruled out, then was discovered at the last minute.

Any thoughts to share? Thanks so much for your support!!!

 
Old 12-09-2002, 07:11 AM   #5
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ringbearer HB User
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Basically this is a very personal decision. What is your comfort level living with a 2 cm tumor in you neck? Even if it is not cancer, benign tumors can grow and become a problem. Multiple nodules are not as suspicious for cancer, but yours is what they call a “complex nodule” and does have suspicious elements. Furthermore, suppression rarely works, even with benign tumors, and FNA are not perfect.

I’m one of those people who did have a cancerous tumor after all was said and done. But even if it hadn’t been, I don’t think I would regret having it removed. It was not normal, even without the cancer (I had Hashi’s), and now I can clearly focus on balancing my levels and getting back to good health. This seems to be happening pretty well, even under these very undesirable circumstances.

I’m just giving my own personal point of view – what is working for me. Talk to your loved ones, get lots of support, make a plan you can feel comfortable with, and go for it! And please keep us posted! I wish you well!

 
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