Abstract

Introduction: Hashimoto’s/Lymphocytic thyroiditis is a common autoimmune disorder which has female preponderance. Autoimmune thyroiditis is considered as a complex interaction and interplay between various genetic and non-genetic factors. Molecular basis of Hashimoto’s thyroiditis is not known. Fine needle aspiration cytology being first line of investigation for thyroid lesions is helpful in diagnosing these lesions as well. However, few potential pitfalls in cytology may lead to cytohistologic discordance. Materials and methods: This is a retrospective study of one year where all histologic proven cases of Hashimoto’s/ Lymphocytic thyroiditis with their corresponding fine needle aspiration cytology slides from pathology database were studied. All FNACs were analyzed in depth and reviewed for cytohistologic correlation. The reasons of cytohistologic discrepancies and discordant cases were analyzed. The genetics of autoimmune thyroiditis was also reviewed from literature. Results: Out of total 38 cases of HT/LT analyzed in this study, 89% were females and 11% were males. Mean and median age was found to be 44.4 years and 44 years respectively. Correlation of cytology and histology showed that 50% FNACs’ correlated with their respective histologic diagnosis. Major causes of the discrepancies and discordance are reporting on suboptimal smears, cystic fluid samples, and giving over emphasis on a single cytologic feature in rare cell clusters. Conclusion: Autoimmune thyroiditis is frequently encountered lesion. Fine needle aspiration cytology is useful in deciding the management of thyroid lesions. In order to restrict the discrepancies and cytodiagnostic errors, one must adhere to the adequacy criterion along with primary fixation, quality of the smear and cellularity. Cytopathologists should be aware of the possible pitfalls and differentiating clues when overlapping features between different lesions are encountered. Also an integrated multidisciplinary approach can be used to minimize potential pitfalls. Many a time the condition can be diagnosed after death as seen in case of few sudden deaths. The unexpectedly brought in thyroid dysfunction is expected in such cases. So the forensic pathologist must keep this entity in mind while dealing with cases of sudden death.

Keywords: Autoimmune; Cyto-histologic discordance; Fine needle aspiration cytology; Genetics; Hashimoto’s thyroiditis

• 1.   Ekambaram M, Kumar B, Chowdhary N, et al. Significance of eosinophils in diagnosing Hashimoto’s thyroiditis on fine needle aspiration cytology. Indian J Pathol Microbiol. 2010;53(3):476–9.
• 2.   Zaletel K, Gaber S. Hashimoto’s thyroiditis: from genes to the disease. Curr Genomics. 2011;12(8):576–88.
• 3.   Harvey AM, Truong LD, Mody DR. Diagnostic pitfalls of Hashimoto’s/lymphocytic thyroiditis on fine-needle aspirations and strategies to avoid overdiagnosis. Acta Cytol. 2012;56(4):352–60.
• 4.   Haberal AN, Toru S, Ozen O, et al. Diagnostic pitfalls in the evaluation of fine needle aspiration cytology of the thyroid: correlation with histopathology in 260 cases. Cytopathology. 2009;20(2):103–8.
• 5.   MacDonald L, Yazdi HM. Fine needle aspiration biopsy of Hashimoto’s thyroiditis: sources of diagnostic error. Acta Cytol. 1999;43:400–6.
• 6.   Kocjan G. Lymphoid infiltrate. In: Schroder G, editor. Fine needle aspiration cytology: diagnostic principles and dilemmas. 1st ed. Berlin: Springer; 2006. p. 99–101.
• 7.   Gayathri BN, Kalyani R, Harendra Kumar ML, et al. Fine needle aspiration cytology of Hashimoto’s thyroiditis—a diagnostic pitfall with review of literature. J Cytol. 2011;28:210–3.
• 8.   Bhatia A, Rajwanshi A, Dash RJ, et al. Lymphocytic thyroiditis—is cytological grading significant? A correlation of grades with clinical, biochemical, ultrasonographic and radionuclide parameters. Cytojournal. 2007;4:10.
• 9.   Nguyen GK, Ginsberg J, Crockford PM, et al. Hashimoto’s thyroiditis: cytodiagnostic accuracy and pitfalls. Diagn Cytopathol. 1997;16(6):531–6.
• 10.   Vaidya B, Kendall-Taylor P, Pearce SHS. Genetics of endocrine disease: the genetics of autoimmune thyroid disease. J Clin Endocrinol Metab. 2002;87(12):5385–97.
• 11.   Marwaha RK, Tandon N, Karak AK, et al. Hashimoto’s thyroiditis: countrywide screening of goitrous healthy young girls in postiodization phase of India. J Clin Endocrinol Metab. 2000;85(10):3798–802.
• 12.   Benvenga S, Trimarchi F. Changed presentation of Hashimoto’s thyroiditis in North-Eastern Sicily and Calabria (Southern Italy) based on a 31-year experience. Thyroid. 2008;18(4):429–41.
• 13.   Guhamallick M, Sengupta S, Bhattacharya NK, et al. Cytodiagnosis of thyroid lesions-usefulness and pitfalls: a study of 288 cases. J Cytol. 2008;25(1):1–9.
• 14.   Orell SR, Sterrett GF, Walters MN, Whitaker D. Manual and atlas of fine needle aspiration cytology. 4th ed. New Delhi: Churchill-Livingstone; 2005. p. 125–64.
• 15.   Kini SR, Miller JM, Hamburger JI. Problems in the cytologic diagnosis of the ‘cold’ thyroid nodule in patients with lymphocytic thyroiditis. Acta Cytol. 1981;25(5):506–12.
• 16.   Ohmori N, Miyakawa M, Ohmori K, et al. Ultrasonographic findings of papillary thyroid carcinoma with Hashimoto’s thyroiditis. Intern Med. 2007;46:547–50.
• 17.   Carson HJ, Castelli MJ, Gattuso P. Incidence of neoplasia in Hashimoto’s thyroiditis: a fine-needle aspiration study. Diagn Cytopathol. 1996;14(1):38–42.
• 18.   Ravinsky E, Safneck JR. Differentiation of Hashimoto’s thyroiditis from thyroid neoplasms in fine needle aspirates. Acta Cytol. 1988;32(6):854–61.
• 19.   Pandey P, Dixit A, Mahajan NC. Fine-needle aspiration of the thyroid: a cytohistologic correlation with critical evaluation of discordant cases. Thyroid Res Pract. 2012;9:32–9.
• 20.   Kumarasinghe MP, De Silva S. Pitfalls in the cytological diagnosis of autoimmune thyroiditis. Pathology. 1999;31(1):1–7.
• 21.   Cobin RH, Gharib H, Bergman DA, et al. AACE/AAES medical/surgical guidelines for clinical practice: management of thyroid carcinoma. Endocr Pract. 2001;7(3):202–20.
• 22.   Hall TL, Layfield LJ, Philippe A, Rosenthal DL. Sources of diagnostic error in fine needle aspiration of thyroid. Cancer. 1989;63(4):718–25.
• 23.   The Papanicolaou Society of Cytopathology Task Force on Standards of Practice. Guidelines of the Papanicolaou Society of Cytopathology for fine needle aspiration procedure and reporting. Diagn Cytopathol. 1997;17(4):239–47.
• 24.   Nggada HA, Musa AB, Gali BM, et al. Fine needle aspiration cytology of thyroid nodule(s): a Nigerian tertiary hospital experience. Internet J Pathol. 2006;5:1.
• 25.   Ashcraft MW, Van Herle AJ. Management of thyroid nodules II: scanning techniques, thyroid suppressive therapy and fine needle aspiration. Head Neck Surg. 1981;3(4):297–322.
• 26.   Campbell JP, Pillsbury HC 3rd. Management of the thyroid nodule. Head Neck. 1989;11:414–25.
• 27.   The Papanicolaou Society of Cytopathology Task Force on Standards of Practice. Guidelines of the Papanicolaou Society of Cytopathology for the examination of fine-needle aspiration specimens from thyroid nodules. Mod Pathol. 1996;9:710–5.
• 28.   Zeppa P, Cozzolino I, Peluso AL, et al. Cytologic, flow cytometry, and molecular assessment of lymphoid infiltrate in fine-needle cytology samples of Hashimoto's thyroiditis. Cancer Cytopathol. 2009;117:174–84.
• 29.   Jogai S, Al-Jassar A, Temmim L, et al. Fine needle aspiration cytology of the thyroid: a cytohistologic study with evaluation of discordant cases. Acta Cytol. 2005;49:483–8.
• 30.   Bongiovanni M, Triponez F, McKee TA, et al. Fine-needle aspiration of the diffuse sclerosing variant of papillary thyroid carcinoma masked by florid lymphocytic thyroiditis; a potential pitfall: a case report and review of the literature. Diagn Cytopathol. 2009;37(9):671–5.
• 31.   Clark DP, Faquin WC. Thyroid cytopathology. In: Rosenthal DL, editor. Essentials in cytopathology, series 1. New York: Springer; 2005.
• 32.   Lerma E, Arguelles R, Rigla M, et al. Comparative findings of lymphocytic thyroiditis and thyroid lymphoma. Acta Cytol. 2003;47(4):575–80.
• 33.   Radojevic N, Medenica S, Vujosevic S, Savic S. Sudden unexpected death associated with Hashimoto’s thyroiditis and thymic hyperplasia. Med Leg J. 2017;85(2):111–2.
• 34.   Lorin de la Grandmaison G, Izembart M, Fornes P, Paraire F. Myocarditis associated with Hashimoto’s disease: a case report. Int J Legal Med. 2003;117(6):361–4.
• 35.   Liang H, Congjie X, Tao L, et al. Spontaneous intracranial hypotension in Hashimoto’s thyroiditis—a case report. Medicine (Baltimore). 2019;98(18):1–3.

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