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Thyroid paraganglioma: A diagnostic pitfall in thyroid FNA
Swati P Satturwar1, Esther D Rossi2, Zahra Maleki3
1Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania.
Cancer Cytopathology
|November 24, 2020
Summary
Thyroid paragangliomas are rare and often misdiagnosed by fine-needle aspiration (FNA). Key cytologic clues like absent colloid and naked nuclei can aid in correct diagnosis.
Area of Science:
- Endocrinology
- Cytopathology
- Surgical Pathology
Background:
- Thyroid paragangliomas are exceptionally rare neuroendocrine tumors.
- Preoperative diagnosis is challenging due to overlapping cytologic features with common thyroid neoplasms.
- Fine-needle aspiration (FNA) frequently leads to misdiagnosis.
Purpose of the Study:
- To review the cytomorphology of thyroid paragangliomas.
- To correlate FNA findings with histopathological diagnoses.
- To identify diagnostic clues for thyroid paragangliomas on FNA.
Main Methods:
- Retrospective review of five thyroid paraganglioma cases diagnosed via FNA.
- Analysis of clinical presentation, radiological features, cytomorphology, and ancillary tests.
- Correlation of FNA findings with final histopathology and immunohistochemistry.
Main Results:
- All five patients were women presenting with asymptomatic solitary thyroid nodules.
- Radiologically, nodules were well-circumscribed, hypoechoic, and hypervascular.
- FNA smears showed epithelioid cells with specific nuclear and cytoplasmic features; all cases were misdiagnosed as follicular neoplasms.
Conclusions:
- Thyroid paragangliomas are frequently misdiagnosed on FNA due to rarity and overlapping features.
- Absence of colloid, presence of naked nuclei, marked anisonucleosis, and sustentacular cells are critical diagnostic clues.
- Accurate preoperative diagnosis requires careful evaluation of these cytologic features.
