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Spontaneous disappearance of a Hürthle cell tumor of the thyroid following fine needle aspiration

Upon routine examination, a 41-year-old female was noted to have a thyroid nodule. Ultrasonography (USG) revealed normal sized bilobed thyroid gland with a tiny nodule (5 mm in greatest diameter) in the lower part of a right lobe. Hormone analysis showed euthyreosis, and no further diagnostic nor therapeutic procedures were indicated at that time. A year and a half later, USG showed increase in size of the nodule, now measuring 15 mm in diameter, and routine percutaneous USG-guided fine needle aspiration biopsy (FNAB) was performed using a 23-gauge needle. No fluid was obtained. The nodule did not change in size during the process of aspiration. The aspirate was smeared and stained routinely. The aspirate was cellular and, apart from some contaminating blood, consisted of monomorphic population of Hürthle cells in clusters and singly. No colloid was present. The cells were large, polyhedral, or oval, with typical red granular cytoplasm and with prominent nuclei with prominent nuclear membrane and distinct nucleoli. There was no admixture of lymphocytes or plasma cells. Apart from the Hürthle cells, no other thyroid epithelium was present so that a diagnosis of a Hürthle cell tumor was made. Two months later, the patient returned for reevaluation before surgical excision. The patient stated that following FNAB, there was no swelling of the nodule and only minimal pain was present shortly after the biopsy. There were no clinical nor biochemical signs of hyperthyroidism or hypothyroidism. USG showed no changes in size of the thyroid. Instead of the previously described solid nodule in the lower pole of the right lobe, only a small cyst (3 mm in diameter) was discovered. FNAB of this area was performed and revealed only colloid with few degenerated follicular cells singly and in small clusters. The most logical explanation for the disappearance of the nodule following FNAB appears to be necrosis due to compromised vascular supply, although some other mechanisms may be involved.

Spontaneous disappearance of a Hürthle cell tumor of the thyroid following fine needle aspiration

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