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Old 06-09-2005, 06:14 AM   #1
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Follicular neoplasm/Hashi's/Surgery

Well, I just met with the surgeon yesterday about my nodules (2) that are "follicular lesions". The comment on the path report said Benign consistent with hashi's. I asked the surgeon, who is well versed on the thyroid - thank God! - if it is possible to definitely say a follicular lesion is benign. He said absolutely not. He told me the report should read "benign appearing". My nodule of concern is 1.9 cm and the other small one they didn't biopsy is 7 mm.

He believes I should have the entire thyroid removed. He told me some people in my situation beg to have this done. I set an appt for surgery for July 7th. The main reason being: There is a 10-15% chance that a "follicular lesion" (he called it a follicular neoplasm) is cancer. Also, he said, even if it is not cancer now, there is a chance that later it will develop into it.

He told me the benefits far outweigh the risks at this point. I asked if hashi's was a factor here and he said he has seen a "relationship" between cancerous nodules and hashi's, but not the case all the time. He thoroughly explained why they cannot be 100% sure of benign or malignancy with follicular lesions and drew me a couple of pictures.

I am thrilled to be in the hands of a great surgeon who truly understands the thyroid. He does 200 surgeries/year on thyroids alone, more than anyone in the Greater KC area. He had done one earlier that morning.

He also told me the surgery would be about 1hour and 45 mins long and that he would keep in the hospital for one night. Start me immediately on temporary calcium tabs and check my calcium the next day. If it was fine, I would be released, if not, they would keep me another day or two.

So, here I go,,,,, gonna do the "thyroid yank". They told me to only take tylenol (if I needed it) for 2 weeks prior to the surgery and to take 2 weeks off of work following it. He told me there would be a scar, but that they try to do it on a line that already exists - he thought my natural line was a little high. Hmmmm, bummer. But, that's ok.

Just wanted to give an update to those of you in a similar situation. It's always good to know what other doctors are out there saying.

 
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Old 06-09-2005, 06:52 AM   #2
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Re: Follicular neoplasm/Hashi's/Surgery

Good luck. I worry for you yet envy you for finally getting rid of your problem once and for all. Wish I could get mine yanked already.

 
Old 06-09-2005, 09:34 AM   #3
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Re: Follicular neoplasm/Hashi's/Surgery

Good for you. I wish you luck....and I am envious that you have the closure so many of us do not. That must mean the world to you.

Again....best wishes.

Mimi

 
Old 06-09-2005, 10:17 AM   #4
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Re: Follicular neoplasm/Hashi's/Surgery

Now see, that is what disgusts me the most about all of this! That your dr says "follicular lesion" can never mean for sure that it is benign. All that I have seen say that the term follicular lesion is applied to all nodules because the thyroid produces follicular cells! My biopsy says the exact same thing as yours! I am so sick of this game!

You know what..........I am firing all involved and finding a new dr. I am going to get into someone who will get this thing out of me.

Can I ask.................oh I will do this in another post.......but how many are told this confilciting term!!!!

I am so happy for you and think you are doing the right thing! It is ridiculous how many drs say different say all different things!!!!!!

Karen

 
Old 06-09-2005, 10:59 AM   #5
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Re: Follicular neoplasm/Hashi's/Surgery

Hi Kant,

My endo told me that it was benign, but everything I read said they could never be 100% sure on "follicular", so I saw the surgeon with my endo's recommendation.

The surgeon said, he didn't like the first sentence in the path's comments:
Diagnosos: FNA THyroid, Follicular lesion, see comment:

Comments:
"The smears and ThinPrep contain sheets of uniform benign follicular epithelial cells with some crush artifact in a bloody background." He (the surgeon) said that indicated there were cells in there that were not normal.

My path report went on to say: "Some stromal elements, colloid, and lymphocytes are also present. The findings are consistent with a benign follicular lesion, possibly hashimotot's thyroiditis. Clinical correlation required."

I am not anxious to get my thyroid out at all. I can live with this and would rather not have the surgery, but if there is any chance of it being cancerous, I want it removed, so that's why I'm doing it.

I wish I could get a definitive answer on "follicular lesions". The surgeon kept calling it a follicular neoplasm, which it never says that anywhere on the report. Where did you read that a follicular lesion was what they regarded as a normal nodule? I'd love to see that.

Thanks to you all for your replies!!!

 
Old 06-09-2005, 11:30 AM   #6
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Re: Follicular neoplasm/Hashi's/Surgery

Well, I didn't read that it was a "normal" nodule but that most nodules are called follicular lesions because the thyroid is made up of follicular cells. The path and my dr told me that is a blanket term for them, saying that the thyroid produces those cells so that is not atypical of a nodule being made up of those types of cells.

Here is my path report word for word:Sheets of follicular cells, some with enlarged nuclei, colloid material and macrophages. Many lyphocytes are present. The core biopsy has thyroid parenchyma with large numbers of lymphcytes, foci of follicles with colloid and occasional follicular cells with pleomorphic nuclei.

Follicular lesion with degeneration suggestive of an adenoma. Lymphocytic thyroiditis

This is where I was told that the term "follicular" is applied to nodules because they are going to contain those types of cells because that is what the thyroid produces.

I am very confused now.

I didn't mean to imply that there was a "normal" nodule persay, sorry for the confusion, but that they ( drs ) weren't inhibited by the word follicular. Does that make sense?

Hey, I know you are apprehensive about the surgery and I didn't mean I would be gung-ho for it either, by all means if this is benign I want my thyroid because I have too many in my family without theirs and they have had a hard time getting meds adjusted and all of that.........I am just one who would like peace of mind. I guess dr;s are very blase about the whole issue because they see them all the time. While having the biopsy ( and I was a nervous wreck ) the dr said to me, I wouldn't waste my weekend worrying about this..........I do these everyday and I can't tell you the last time one was cancerous attitude.

I guess what bothers me is when there can still be some concern of cancer and you and I are the ones that have to worry, not them. I just would love to know for sure and then I could forget about it, ya know?

Karen

Last edited by merrillin; 06-09-2005 at 11:34 AM.

 
Old 06-09-2005, 12:41 PM   #7
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Re: Follicular neoplasm/Hashi's/Surgery

Oh Kant,

I hear ya! I can't understand for the life of me why doctors aren't on the same page.

One simple question to anyone out there, and ALL doctors... Plain and simple, Can a diagnosis of a follicular lesion be 100% sure or even 99% (false negatives ) sure that it is either benign or not?

When I do a search on the net for "follicular lesion", I find several very reliable sources. I will just paste a few sentences from each of them:

1)A cytologist could experience difficulty in distinguishing some benign cellular adenomas from their malignant counterparts (ie, follicular and Hürthle cell adenomas from carcinomas).

2)What are the types of follicular lesions?
Follicular lesions may be benign or malignant (1-3).
Lesions with follicular patterns are
diagnostic problems on FNA smears (1) and in histologic sections as well (2).

3)A particular problem is posed when cytology discloses a follicular proliferation or a Hurthle celll proliferation. FNA cannot differentiate follicular adenoma from follicular carcinoma, since this distinction can only be based on the presence of capsular or vascular invasion, which cannot be detected on a cytologic smear. In these cases, the histological verification of the lesion is mandatory, even though only 10-20% of nodules with follicular histology are proven to be malignant.

4)However, for follicular and Hurthle lesions of the thyroid,
FNA serves only as a screening test. The reason for this is
that differentiation between cellular foci within a
hyperplastic nodule (a.k.a. colloid nodule), follicular
adenoma and follicular carcinoma requires histologic
evaluation for the presence of a fibrous capsule as well as
the presence of invasion of the capsule and vascular
invasion. Evaluation of these diagnostic criteria is not
possible by FNA. “Differentiation” of these follicular
entities by cytology is based on the relationship between
colloid and follicular epithelium. More colloid favors a
benign hyperplastic nodule, while greater amounts of
follicular epithelium favors a possible neoplastic process.
Because differentiation of these follicular entities is not
possible by FNA, diagnosis of follicular processes yields the
following diagnoses: hyperplastic nodule, follicular lesion
and an indeterminent category. The term follicular lesion
encompasses follicular adenoma and possible follicular
carcinoma

5) Most follicular adenomas are benign; however, some may share features of follicular carcinoma.

6) There is a large body of literature discussing the relative merits of fine-needle aspiration biopsy (FNA) for the preoperative identification of malignancy.3–13 Although FNA is a cost-effective and specific first test, up to 30% of patients with nodular thyroid disease will receive an FNA report that reads "follicular lesion" or "suspicious." Most of these patients will require surgical management, and the extent of resection will need to be planned without a preoperative diagnosis of malignancy.
A report listed as "benign," "cyst," "goiter," "nodule," "adenoma," or "no evidence of malignancy" was recorded as benign. Diagnoses of "Hürthle cell," "possible" or "suspicious" for any malignancy, "neoplasm," or "lesion" were recorded as suspicious.

7) Diagnosis

Unlike papillary thyroid cancer, it can be difficult to diagnose without performing surgery. A fine needle aspiration (FNA) biopsy often can not distinguish among the precursor to follicular cancer (called a follicular adenoma), follicular cancer and a completely benign condition called nontoxic nodular goiter. Even a coarse needle biopsy, which is typically more accurate than an FNA, can not always provide an answer since it is only able to distinguish a follicular neoplasm (which includes both adenoma and cancer) versus nontoxic nodular goiter about 40% of the time. This difficulty in diagnosis is one of the most frustrating areas for physicians who study thyroid disease, because it means that surgery is often the only way of definitively diagnosing a thyroid nodule
"New York Thyroid Cancer Center"

I guess I could go on forever. I have several pages book marked that I believe are reliable sources. I site 7 DIFFERENT websites.

I guess when I look at it like this, it's pretty clear.

Take Care. Let's keep in touch. I hope I don't get in trouble for posting these sentences. I think it's really important!

 
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