Diagnostic utility of thyroglobulin measurement in the fine needle aspirates from cervical lymph nodes: a case report

Baldini, Enke and Sorrenti, Salvatore and Catania, Antonio and Guaitoli, Eleonora and Pinzi, Natalie and Mocini, Renzo and Nardi, F. and D'armiento, Eleonora and Bianchini, M. and Favoriti, P. and Di Matteo, F.M. and Ruggieri, M. and De Antoni, E. and Ulisse, Salvatore (2012) Diagnostic utility of thyroglobulin measurement in the fine needle aspirates from cervical lymph nodes: a case report. Il giornale di chirurgia, 33 (11/12). pp. 387-391. ISSN 1971-145X

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Fine needle aspiration cytology (FNAC) is the more accurate diagnostic method for cervical lymph node (CLN) metastasis from differentiated thyroid cancers (DTC). However, FNAC diagnosis of cystic CLN is, in most cases, uninformative due to inadequate cellularity. Recently, thyroglobulin (Tg) detection in FNAC needle washout fluid has been shown to improve the diagnostic accuracy of FNAC, and its routine association with cytology is recommended. We here describe the case of a 20 yr old girl complaining of the recent appearance of palpable non-painful laterocervical nodes in the neck. Ultrasound examination revealed the presence of 3 cystic CLNs and 2 mixed thyroid nodules, with the larger one showing irregular margins. On the latter, and on 2 larger CLNs, FNAC was performed, and both Tg protein and mRNA were determined in the needle washout. The cytological analysis was not diagnostic for the two CLNs, while that of the thyroid nodule reported the presence of colloid and groups of thyrocytes with normal morphology. Both CLNs showed, however, high levels of Tg protein and were positive for Tg mRNA, suggestive of metastatic DTC. Based on these findings, the FNAC analysis was performed on the second smaller thyroid nodule suggesting (Tir4) the presence of PTC. The patient was then subjected to total thyroidectomy with lymph nodes resection of the central and homolateral compartments. The histological diagnosis confirmed the presence of a PTC in the small nodule and metastatic lymph nodes. In conclusion, this case confirms that the cytological diagnosis of cystic lymph nodes is challenging, and that the measurement of Tg protein and/or mRNA in the needle washout may overcome this limitation.

Item Type: Article
Uncontrolled Keywords: Thyroid cancer - Lymph node - Metastasis - Diagnosis - Thyroglobulin - Fine-needle aspiration cytology - Follow-up
Subjects: 600 Tecnologia - Scienze applicate > 610 Medicina e salute (Classificare qui la tecnologia dei servizi medici) > 617 Rami vari della medicina; Chirurgia > 617.4 Chirurgia secondo il Sistema e Regioni
Depositing User: Nadia Del Gobbo
Date Deposited: 03 Aug 2016 15:59
Last Modified: 03 Aug 2016 15:59
URI: http://eprints.bice.rm.cnr.it/id/eprint/8244

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