Thyroid fine needle aspiration — follicular lesion
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Clinical history
46-year-old with a 28 mm solitary thyroid nodule.
Specimen
Ultrasound-guided fine needle aspiration · Stain: Papanicolaou
Microscopic description
Cellular smears with microfollicular architecture, scant colloid and mild nuclear enlargement without papillary nuclear features.
Diagnostic question
How should this be categorised and what is the implied management?
Reveal differential diagnosis
Adenomatoid nodule
Papillary thyroid carcinoma, follicular variant
Hyperplastic nodule
Reveal final diagnosis
Follicular neoplasm (Bethesda category IV)
Learning points
Bethesda IV implies a defined risk of malignancy
Cytology cannot distinguish follicular adenoma from carcinoma
Molecular testing may refine risk
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