Based on your query and attached reports (attachment removed to protect patient identity), my opinion is as follows. Yes, the report does say suspicious for malignancy. When sometimes, we are not 100% sure or if there is overlap with benign or normal findings, we do report it as suspicious for malignancy. In these circumstances, we advise biopsy or surgery for confirmation as we do not want any cancer to be missed. Looking at the findings, it most likely appears to be papillary carcinoma of the thyroid. If it is the case, it has the best prognosis amongst all thyroid cancer and is usually curable. The cytology study is not always 100%, and we always try to be careful as not to miss anything important. Diagnosis appears to be well done. I would also suggest surgery or biopsy for confirmation. Do meet your treating surgeon for a further opinion.
Thank you doctor,
I would like to understand more, please. You are telling that there is a high chance to be cancer. In which stage it is? Why the report not shown as cancer? Is there any possibility that it could be benign?
Yes, there is a very low possibility that it could be benign. However, a biopsy is necessary for confirmation. If we diagnose it as cancer and as there is no lymph nodes involvement as seen now (otherwise they would have tested it also if present), it should be early stage and excision or removal of thyroid alone might be adequate. Staging cannot be done without confirmation of diagnosis. First, get the biopsy or surgery done. Once pathologist report confirms it, then the next decision can be made. If nothing is there, then not to worry. If it is papillary carcinoma of thyroid, then still nothing to worry as it is easily curable. Going by the report, it is probably cancer. Do meet your doctor at the earliest.
I had three ultrasounds in the last 18 months but different hospitals. All show thyroid goiter, except the last ultrasound, which I sent to you. If I do have thyroid goiter, will that reflect on the biopsy findings?
Based on your query, my opinion is as follows. Goiter by definition is enlargement of the thyroid. Over time, the degenerative changes or progression to cancer may occur. This is one of the reason, the reporting pathologist is not confident enough to confirm it as malignancy (positive for malignancy) and has called it as suspicious. The degenerative change can mimic cancer at times. Hard to comment and hence, the biopsy is necessary. Yes, it might be just colloid goiter with degenerative changes. However, if it were to be cancer, then early identification is helpful. Yes, if surgery is done, it might be a colloid goiter. Depends on the amount of degeneration, which could be mimicking cancer. Do get the biopsy done. Hopefully, it is goiter.
Thank you for the reply. Are overlapping clusters and enlargement of nucleus indications of goiter? Does goiter have the same specifications? How wil they differentiate after surgery? Kindly help.
Overlapping cells in a cluster and nuclear enlargement are not the usual features of goiter. It is called a honeycomb pattern, just sheets without nuclear size or cell size variation and with some colloid. The absence of colloid is usually viewed seriously, and especially with nuclear features classical of possible carcinoma, a biopsy is advised. It is not easy to think of possible cancer when it mostly appears benign goiter in the past one and half years. I suggest you get a biopsy done.
Please go through the attachments and please explain me further. Can it be cauterized with iodine?
I had gone through the reports (attachments were removed to protect the patient's identity). According to reports, it is multifocal papillary thyroid carcinoma. Four focuses have been found, and the largest of 0.5 cm has been ablated. Radioiodine therapy is rarely necessary for these situations as it is decided on a case-to-case basis. As there is no lymphatic spread, it is not risky. Multifocal papillary thyroid carcinoma of the size of 0.5 cm sometimes requires radioiodine therapy. However, it will vary in each case depending on the treating doctor. If your doctor insists, there might be a reason for it as the conditions are present at borderline - below 0.5 cm and single focus, no radioiodine therapy necessary. Above 0.5 cm or multifocal (>5 foci), radioiodine therapy is necessary. As I told you earlier, this carcinoma has best prognosis, as there is no spread beyond the thyroid. Follow-up is needed for a year or two to rule out recurrence.
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