FNA of Bilateral Thyroid Nodules in 31-Year-Old Pregnant Woman

by Brent J. Huddleston, M.D

Editor: Brian T. Collins, MD, Professor of Pathology,University of Utah, and Medical Director, Cytopathology, ARUP Laboratories

The patient is a 31-year-old female who is 11 weeks pregnant. She went to see her Ob/Gyn physician who felt a swelling in her neck. She was sent for a neck ultrasound which revealed bilateral thyroid nodules. She denies any pain in her neck. She has not had any thyroid problems in the past. Her past medical history is unremarkable. There is no family history of thyroid malignancy.

Fine needle aspiration was performed on both the left and right thyroid nodules. Modified Wright-Giemsa and Papanicolaou stained smears were prepared.

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Pathologic Findings

Cytomorphology Features:

  • The smears from both the left and right thyroid nodules are morphologically similar and show a moderate cellular smear arrange mostly in sheets with a background of abundant watery colloid. (fig. 1).
  • Some papillary-like structures are present(fig. 2,fig. 3).
  • The cells are follicular in nature with abundant cytoplasm and mildly enlarged but monomorphic round nuclei (fig. 2,fig. 3,fig. 4,fig. 5,fig. 6.
  • The nuclei have somewhat open chromatin but lack prominent nucleoli (fig. 6).
  • Nuclear grooves are not prominent and there are no pseudonuclear inclusions (fig. 6).
  • There are also abundant flame cells present on the modified Wright-Giemsa stained slides (fig. 4,fig. 5).
  • The flame cells are seen as follicular cells with translucent pink homogenous material that stains darker at the periphery which is seen within large cytoplasmic vacuoles.(fig. 5).

Final Diagnosis & Discussion

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