Presentation
Present with anterior neck pain and odynophagia.
Patient Data
Age: 50
Gender: Male
{"current_user":null,"step_through_annotations":true,"access":{"can_edit":false,"can_download":true,"can_toggle_annotations":true,"can_feature":false,"can_examine_pipeline_reports":false,"can_pin":false},"extraPropsURL":"/studies/16748/annotated_viewer_json?iframe=true\u0026lang=us"}
Ultrasound of the right lobe of the thyroid demonstrates an ill-defined irregular region of heterogeneous hypoechogenicity without elevation of flow on color Doppler examination.
Images courtesy of Dr Anthony Upton.
{"current_user":null,"step_through_annotations":true,"access":{"can_edit":false,"can_download":true,"can_toggle_annotations":true,"can_feature":false,"can_examine_pipeline_reports":false,"can_pin":false},"extraPropsURL":"/studies/16749/annotated_viewer_json?iframe=true\u0026lang=us"}
The FNA smears show an inflammatory process with features consistent with subacute (de Quervain's) thyroiditis:
- scattered benign reactive follicular epithelial cells
- prominent inflammatory background including multinucleate giant cells
- clusters of epithelioid histiocytes, consistent with granulomatous inflammation
Multinucleate giant cells and granulomas can be difficult to differentiate morphologically (see third image) but should not be confused theoretically:
- multinucleate giant cells are single cells with multiple nuclei, formed by the fusion of numerous macrophages (histiocytes)
- granulomas are aggregates of numerous 'epitheloid histiocytes' (activated macrophages).
Case Discussion
This case illustrates imaging and cytological features consistent with subacute granulomatous thyroiditis.