Abstract :
Introduction: Follicular thyroid carcinoma (FTC) accounts for 10–15% of thyroid tumors, typically affecting women in their 50s–60s. It spreads hematogenously, often to lungs and bones, with distant metastases in 6–20% of cases. FTC is challenging to diagnose via ultrasound and fine needle aspiration (FNA). This presents a rare case of FTC with cervical lymph node metastasis but no distant spread, diagnosed solely through FNA cytology.
Case Details: A 45-year-old female presented with a neck swelling over two years, came to District hospital Vijayapur, now since few days noticed, sudden enlargement and causing swallowing difficulty.
Examination revealed a 7×5 cm thyroid swelling involving both lobes, with a hard 3×4 cm left cervical lymphadenopathy. Thyroid function tests were normal.
Ultrasound showed a hypoechoic, macro-calcified nodule in the left thyroid lobe, multiple colloid nodules in the right lobe, and necrotic left cervical lymph nodes. FNAC of Left lobe and right lobe of Thyroid and left largest lymph node performed in Pathology department.
FNAC of the left thyroid lobe and cervical nodes showed high cellularity, micro and macro follicular clusters, nuclear pleomorphism, high N:C ratio, and scant cytoplasm in a necrotic background. The right lobe revealed similar features with scant colloid. Findings confirmed follicular thyroid carcinoma with lymph node metastasis.
Conclusion: Follicular thyroid carcinoma poses diagnostic challenges due to its similarity to benign lesions. This case highlights the need for a comprehensive approach, integrating clinical, imaging, and cytology, especially with atypical lymph node metastasis, to ensure early diagnosis and optimal surgical management.
Keyword :
Follicular thyroid cancers, FNA, Lymph node and Cytology.