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What Does This Thyroid Biopsy Report Indicate?

Posted on Thu, 24 Sep 2015

Question: I have just received the results of a biopsy on my thyroid. I have yet to speak to the endocrinologist, but I have been told that there are granulations and some evidence of a hemorrhage.
I am concerned and do not understand the results.
Can I have some assistance, please????

I have been told is that there was evidence of previous a hemorrhaging. Some cells are showing granulation

does this mean that I have hurthle cell thyroid cancer?

or should I be worried about ATC? honestly, I'll be so much happier once I get your reply--regardless of what you think. Doctors need to know that this is not the way to treat people--they can't just leave people hanging without knowing their results. It's awful and it's cruel.

Answered by Dr. Shehzad Topiwala (2 hours later)

Brief Answer:
Thyroid biopsy

Detailed Answer:
The report mentions two words granulations and haemorrhage.

Granulations is not a standard term in thyroid biopsy samples and so it is not something typically found in the description.

So I would not read too much into that, nor worry about it as such.

Hemorrhage is encountered occasionally, especially when the needle used to perform the biopsy causes unintentional bleeding inside the thyroid/nodule area. The biopsy/cytology slide examined under the microscope shows evidence of red blood cells due to the presence of blood.

This is not of concern either, if the source of blood is inadvertent trauma from the procedure.

Hemorrhage can occur though in nodules that have other causes as spontaneous bleeding in a non-cancer type nodule or sometimes in a cancerous nodule.

There is nothing specific in your preliminary report that suggest hurtle cell cancer.

Kindly seek a more detailed description

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (4 minutes later)

Thank you Dr Topiwala
Are either of these descriptions associated with Hurthle cell cancer?
So, is hemorrhaging common with this type of cancer?
As for granulations in cells, what exactly does that mean?

I appreciate your response.

Answered by Dr. Shehzad Topiwala (16 minutes later)

Brief Answer:
Follow up

Detailed Answer:
1 None of these are descriptions typically associated with hurtle call cancer. There are certain words used specifically to refer to this such as
'large, polyclonal cells with abundant oxyphilic cytoplasm'

This is not mentioned anywhere in the limited report you have shared with me

2 Hemorrhaging can occur with benign and cancerous nodules in thyroid, but it is much more common due to inadvertent trauma from the needle procedure

3 Granulations is very unusual term in this context. As I said earlier, I have never come across it in a conventional Thyroid Fine Needle Aspiration (FNA) biopsy/cytology report so I am not particularly worried about this term.

Cancer type nodules' FNA report has different words describing it. I will give you an example of ATC (Anaplastic Thyroid Cancer):

'marked pleomorphism, bizarre giant cells, and spindle cells'

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (0 minute later)

I probably should also add that I have had this lesion biopsied 4 years ago. It was 3cm originally, with a large portion of it being a cyst. There were two other portions that were biopsied: one was non-malignant, the other was inconclusive due to the paucity of cells.

My apologies, sir. I only have limited information and the nurse almost refused to give me any idea of the results. As I said, I feel this is a particularly cruel practice.

I appreciate your patience and time.

Answered by Dr. Shehzad Topiwala (38 minutes later)

Brief Answer:
Second follow up

Detailed Answer:
I follow what you are saying. So at least one biopsy previously has not shown cancer and that is reassuring.
I do understand you must feel anxious with a cursory report.
If it was an indeed an emergent matter the doctor would have set up an immediate meeting.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (2 minutes later)

Well he has set up a meeting for tomorrow. Oh dear....
So, I suspect things are not right.
Just for clarification, is it common for US to yield different sizes of lesions? The radiologist said it was 9mm, the endocrinologist's US read 11mm.

The endo's US was 4 weeks prior to the radiologists US

Answered by Dr. Shehzad Topiwala (3 hours later)

Brief Answer:
Third follow up

Detailed Answer:
Ultrasound is very well known to be operator-dependent so yes it can be expected to have some variations between readings taken by two individuals.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (2 hours later)

Thank you Dr Topiwala
I am presuming that given the endo wants to see me tomorrow, and the nurse was not forthcoming about anything except granulations and hemorraging, then the biopsy has returned with a cancer result.

I suppose I do not have any further questions, as such. However, I shall return to discuss what the description of "cells showing granulations" meant.

Answered by Dr. Shehzad Topiwala (6 hours later)

Brief Answer:
Fourth follow up

Detailed Answer:
All the best

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar