CYTO PATH CASE IMAGE WEB
INDIAN ACADEMY Of CYTOLOGISTS
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Case #3: Case contributed by Maj. Rohit Tewari, MD(Path); Ambala.
India. A thirty year old lady presented with a swelling in the front of the neck associated with pain and fever for the past two weeks. She gave history of an upper respiratory infection 3 weeks prior to the development of these symptoms. On examination, she had a diffuse swelling in the front of the neck which was moving with deglutition. Tenderness was present. A nodule was also palpable on the right side (Fig. 1). Her hemoglobin was 11.5 gm/dl, TLC 9900/cmm and ESR was 32 mm fall at the end of one hour (Wintrobe). Her Thyroid function tests revealed T3 - 2.91 ng/ml (0.8-2.0 ng/ml), T4 - 22.65 mgm/dl (4.5-12.0 mgm/dl) and TSH - 0.01 µIU/ml (0.3-5.0 µIU/ml). USS of the thyroid showed thyromegaly with coarse echotexture and a 2.0 x 1.7 cm nodule on the right side. She was referred for FNAC.
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Fig.1: Clinical photograph - Diffuse tender thyroid swelling with a nodule 2 x 1.7 cm in the right lobe. |
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Fig. 2: Good cellularity, dirty background (Leishman, x100). |
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Fig.3:
A mixed
infiltrate of lymphocytes, histiocytes, epithelioid cells and large number
of multinucleate giant cells was seen in addition to the degenerated
follicular epithelium (Leishman,
x 200).
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Fig.4: Multinucleated giant cell with numerous nuclei at higher magnification (Leishman, x 400). |
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Fig. 5: Coarse blue ‘paravacuolar’ granules were seen in the cytoplasm of the epithelial cells (Leishman, x 200). |
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Fig.6: Abundant colloid was seen (Leishman, x 400). |
