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Old 01-13-2013, 07:15 AM   #1
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Exclamation Help for proceeding further --Single Thyroid Nodule

I had a lump on right side below the Adam Apple. I am 61 years old. On examination Doctor advised to go for a FNA and Thyroid scan
The FNAC report is as under :
" FNAC upper pole of right lobe of thyroid shows moderately cellular smears. Some of the folicular epithelial cells are arranged in microfollicular and occasional macrofollicular structures. Some of the cells are in clusters with nuclear overlapping and crowding .
Many cells are adhered to stromal material. Singly scattered follicular cells are also seen in the background .
No Colloid is seen. No Papillary structure seen.
Impression:

Possibibilty of follicular neoplasm can not be excluded

Thyroid Scan performed following intravenous administration of 5 mCi TC 99 m pertechnetate.
Overall thyroid uptake is fair with normal background activity and salivary gland concentration. The right lobe of the thyroid is enlarged with a hypo functional area noted in upper pole corresponding tothe palpable neck swelling with equivvocal vascularity. The left lobe is of normal size with uniform radionuclide distribution. No focal hot area seen . There is no functioning retrostrernal thyroid extension and no evidence of pyramidal lobe/ectopic thyroid tissue.
The eo- minute TC-99m thyroid uptake is 1.7 % ( normal 1-4%)
Impression :
Cold thyroid nodule involving the upper pole of right lobe with equivocal vascularity.
the lef lobe is of normal size with uniform radionuclide distribution.
Suggested FNAC correlations

Subsequently on 5/1/13 further ultrasound and FNAC was repeated :
which reads as follows :
Microscopic Examination:
SMEARS SHOW FOLLICULAR EPITHLIAL CELLS ARRANGED IN MONOLAYER & FORMING MICROFOLLICLES. THICK SCANTY COLLID IS SEEN IN THE BACKGROUND. FEW SINGLY SCATTERED CYST MACROPHAGES ARE SEEN. AN OCCASSIONAL STROMAL FRAGMENT IS ALSO NOTED.
OVERSALL FEATURES ARE OF FOLLICULAR LESION WITH FOLLOWING DIFFERENTIAL IN DESCENDING ORDER.
OPINION: 1 ADENOMATOUS HYPERPLASIA IN A NODULAR GOITRE
2. FOLLICULAR NEOPLASM.
ADVISE: HISTO PATHOLOGICAL CORRELATION TO DIFFERENTIATE THE SAME.

THE Ultrasound report reads as under :
The thyroid gland is normal in position and moves well with degulitition.
A well defined oval heterogeneous mass lesion with a predominantly homogeneous hypo-echoic solid nodule and a small anechoic cystic peripheral compnent is seen arising along the superomedial margin of the right lobe extending alon the anterolateral aspect of the isthmus. it measures 1.9x1.7x1.0 cms . A thin hypoechoic peripheral rim measuring 1.00 mm in thichness is seen. No calcifications are seen. On color Doppler imaging peripheral vascularity is well visualized .

Rest of right lobe istmus and left lobe are norma lin echo texture .
The right lobe of the thyroid measures 3.8x1.3x1.0 cms
The left lobe of the thyroid measures 3.2x1.5x1.1 cms
Both sides neck were also examined and there is no evidence of any nodal enlargement.
All the visualized salivary glands are normal in apprearanc.

Impression : ABOVE DESCRIBED ULTRASOUND FEATURES OF THE SOLID NODULE ARE HIGHLY SUGGESTIVE OF A BENIGN MASS LESION, MOST LIKELY TO BE AN ADENOMATOUS NODULE.


Wish to know in layman's words, what is meant by above... shall be grateful if one can suggest what should be done now ... surgery or observe and go for the checkup ie FNA or detailed examination say every 6 months ...
Please assist

 
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