Profile Of Thyroid Neoplasms With Special Focus On Interesting Cases: A Hospital Based 12 Year Longitudinal Study

Abstract

Introduction: The incidence of thyroid nodules increases throughout life. Benign neoplasms outnumber thyroid carcinomas by a ratio of nearly 10:1. The microscopic features of thyroid neoplasms have been described in world literature, together with their behavior and molecular biology. However, this retrospective longitudinal study aims to report a 12 year data about thyroid neoplasms encountered in a Medical college in a rural area of Andhra Pradesh, India. This study analyses the sociodemographic profile (age and sex data) associated with various types of benign and malignant tumors. Study also depicts few interesting, rare cases and cases posing diagnostic dilemma. Highlighting features of this study are few collision tumors and association of neoplasms with non-neoplastic lesions. Materials and methods: The Hospital based longitudinal study includes cases gathered over a period of 12 years. During this period, 246 patients were diagnosed on histopathology as having thyroid neoplasms of different types either benign or malignant. In all the cases, thyroidectomy specimens were fixed in 10% neutral buffered formalin and stained with hematoxylin and eosin. For some cases special stain like Congo red was done for the confirmation of diagnosis. In few cases wherein there was a diagnostic dilemma, immunohistochemistry was performed. Results: In our study a total of 246 thyroid neoplasms (n) were observed over a period of 12 years. The mean age was 35.50 years with (s.d.) of ± 13.608 years. Benign tumors were 176 (71.5%) and the malignant were 70 (28.5%). Out of total 246 cases, the highest number of cases 85 (34.6%) belonged to the age group of 21-30 years; of this 63 (74.11%) were benign and 22 (25.88%) malignant neoplasms, with female preponderance of 74 (87.05%) cases. Considering gender 205 (83.3%) occurred in the females and 41 (16.7%) in the males. Amongst benign tumors, 154 (87.5%) were females and 22 (12.5%) were the males. Amongst the malignant tumors, 51 (72.85%) were females and 19 (27.14%) were the males. Considering the benign tumor follicular adenoma and from malignant tumor papillary thyroid carcinoma (PTC) were the most common tumors. Conclusion: Thyroid neoplasms though being very common neoplasms in routine practice can pose a diagnostic dilemma. Thorough observation and analysis of both gross and microscopic findings, deeper sections, cytochemistry, and the right use of immunohistochemistry are required in such cases. Awareness about Worrisome histologic alterations following Fine needle aspiration thyroid (WHAFFT) is needed to avoid misinterpretation. The technique of non-aspiration Fine needle aspiration (FNA) is significantly less traumatic. The association of thyroid neoplasms with the non-neoplastic lesions complicates still more if the Fine needle aspiration cytology (FNAC) is not suggestive of neoplasms.