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Nodular goiter with amyloid deposition in an elderly patient: fine-needle cytology diagnosis and review of the literature

BACKGROUND: Amyloidosis is a systemic disease characterized by the extracellular deposition of amyloid fibrils in different organs and tissues. The thyroid gland may be affected by diffuse or nodular amyloid deposits, along with multiple myeloma (MM) (Amyloid Light-Chain Amyloidosis, AL amyloidosis)...

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Autores principales: Di Crescenzo, Vincenzo, Garzi, Alfredo, Petruzziello, Fara, Cinelli, Mariapia, Catalano, Lucio, Zeppa, Pio, Vitale, Mario
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3851267/
https://www.ncbi.nlm.nih.gov/pubmed/24267036
http://dx.doi.org/10.1186/1471-2482-13-S2-S43
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author Di Crescenzo, Vincenzo
Garzi, Alfredo
Petruzziello, Fara
Cinelli, Mariapia
Catalano, Lucio
Zeppa, Pio
Vitale, Mario
author_facet Di Crescenzo, Vincenzo
Garzi, Alfredo
Petruzziello, Fara
Cinelli, Mariapia
Catalano, Lucio
Zeppa, Pio
Vitale, Mario
author_sort Di Crescenzo, Vincenzo
collection PubMed
description BACKGROUND: Amyloidosis is a systemic disease characterized by the extracellular deposition of amyloid fibrils in different organs and tissues. The thyroid gland may be affected by diffuse or nodular amyloid deposits, along with multiple myeloma (MM) (Amyloid Light-Chain Amyloidosis, AL amyloidosis) or chronic inflammatory diseases (Amyloid A Amyloidosis, AA amyloidosis), but thyroid gland involvement rarely appears as the first clinical manifestation in both conditions. The present study reports a case of primary thyroidal nodular amyloid goiter diagnosed by fine-needle cytology (FNC) in an elderly patient. CASE REPORT: A 66-year-old female patient presented with dysphagia and hoarseness; the patient suffered from rheumatoid arthritis but did not have kidney failure or altered thyroid function. Ultrasound examination (US) showed a 30 mm irregular, hypoechoic area in the left thyroid lobe. FNC showed abundant, dense and amorphous material similar to the one stained in purple at Diff-Quik stain and pinkish at the Papanicolaou. Spindle cells with thin, bland and bent nuclei were scattered in this material; few thyroid follicular cells were also present. An alcohol-fixed smear was stained with Congo red: the amyloid material appeared cherry red and it also showed apple-green birefringence when observed with a polarizing microscope. A differential diagnosis between different thyroid pathologies was considered and the cytological diagnosis of nodular amyloid goiter was pointed out. The patient underwent thyroid lobectomy and the subsequent histological examination confirmed the cytological diagnosis. CONCLUSIONS: FNC is a safe and effective procedure for the diagnosis of thyroid amyloidosis. Congo red-stained smears can be used to demonstrate the presence of amyloid material, showing the typical green birefringence under polarized light. An early and accurate cytological diagnosis may suggest an hematological screening and the appropriate treatment for the thyroid nodule.
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spelling pubmed-38512672013-12-13 Nodular goiter with amyloid deposition in an elderly patient: fine-needle cytology diagnosis and review of the literature Di Crescenzo, Vincenzo Garzi, Alfredo Petruzziello, Fara Cinelli, Mariapia Catalano, Lucio Zeppa, Pio Vitale, Mario BMC Surg Research Article BACKGROUND: Amyloidosis is a systemic disease characterized by the extracellular deposition of amyloid fibrils in different organs and tissues. The thyroid gland may be affected by diffuse or nodular amyloid deposits, along with multiple myeloma (MM) (Amyloid Light-Chain Amyloidosis, AL amyloidosis) or chronic inflammatory diseases (Amyloid A Amyloidosis, AA amyloidosis), but thyroid gland involvement rarely appears as the first clinical manifestation in both conditions. The present study reports a case of primary thyroidal nodular amyloid goiter diagnosed by fine-needle cytology (FNC) in an elderly patient. CASE REPORT: A 66-year-old female patient presented with dysphagia and hoarseness; the patient suffered from rheumatoid arthritis but did not have kidney failure or altered thyroid function. Ultrasound examination (US) showed a 30 mm irregular, hypoechoic area in the left thyroid lobe. FNC showed abundant, dense and amorphous material similar to the one stained in purple at Diff-Quik stain and pinkish at the Papanicolaou. Spindle cells with thin, bland and bent nuclei were scattered in this material; few thyroid follicular cells were also present. An alcohol-fixed smear was stained with Congo red: the amyloid material appeared cherry red and it also showed apple-green birefringence when observed with a polarizing microscope. A differential diagnosis between different thyroid pathologies was considered and the cytological diagnosis of nodular amyloid goiter was pointed out. The patient underwent thyroid lobectomy and the subsequent histological examination confirmed the cytological diagnosis. CONCLUSIONS: FNC is a safe and effective procedure for the diagnosis of thyroid amyloidosis. Congo red-stained smears can be used to demonstrate the presence of amyloid material, showing the typical green birefringence under polarized light. An early and accurate cytological diagnosis may suggest an hematological screening and the appropriate treatment for the thyroid nodule. BioMed Central 2013-10-08 /pmc/articles/PMC3851267/ /pubmed/24267036 http://dx.doi.org/10.1186/1471-2482-13-S2-S43 Text en Copyright © 2013 Di Crescenzo et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Di Crescenzo, Vincenzo
Garzi, Alfredo
Petruzziello, Fara
Cinelli, Mariapia
Catalano, Lucio
Zeppa, Pio
Vitale, Mario
Nodular goiter with amyloid deposition in an elderly patient: fine-needle cytology diagnosis and review of the literature
title Nodular goiter with amyloid deposition in an elderly patient: fine-needle cytology diagnosis and review of the literature
title_full Nodular goiter with amyloid deposition in an elderly patient: fine-needle cytology diagnosis and review of the literature
title_fullStr Nodular goiter with amyloid deposition in an elderly patient: fine-needle cytology diagnosis and review of the literature
title_full_unstemmed Nodular goiter with amyloid deposition in an elderly patient: fine-needle cytology diagnosis and review of the literature
title_short Nodular goiter with amyloid deposition in an elderly patient: fine-needle cytology diagnosis and review of the literature
title_sort nodular goiter with amyloid deposition in an elderly patient: fine-needle cytology diagnosis and review of the literature
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3851267/
https://www.ncbi.nlm.nih.gov/pubmed/24267036
http://dx.doi.org/10.1186/1471-2482-13-S2-S43
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