BACKGROUND: Fine needle aspiration biopsy (FNAB) of the thyroid is a simple and safe investigation. Dissemination of malignant cells during FNA for papillary thyroid carcinoma is extremely uncommon. CASE: We report a 49-year-old woman who presented with a multicystic goiter and palpable cervical lymph nodes. Three sessions of FNAB (a total of 12 needle passes) from a complex cyst overlying the thyroid isthmus using a 22-gauge needle failed to reveal malignant cells. Following the FNAs she developed a persistent discharging sinus at the needle insertion site. Exploration of the neck and histopathologic examination confirmed a well-differentiated papillary thyroid carcinoma infiltrating the skin and strap muscles at a single focus. Debulking surgery with adjuvant radiotherapy had a satisfactory outcome in our patient. CONCLUSION: Skin sinus formation might have been prevented in our case by using a needle with a caliber < 22 gauge and avoiding multiple sessions of aspiration of the same thyroid nodule.
BACKGROUND: Fine needle aspiration biopsy (FNAB) of the thyroid is a simple and safe investigation. Dissemination of malignant cells during FNA for papillary thyroid carcinoma is extremely uncommon. CASE: We report a 49-year-old woman who presented with a multicystic goiter and palpable cervical lymph nodes. Three sessions of FNAB (a total of 12 needle passes) from a complex cyst overlying the thyroid isthmus using a 22-gauge needle failed to reveal malignant cells. Following the FNAs she developed a persistent discharging sinus at the needle insertion site. Exploration of the neck and histopathologic examination confirmed a well-differentiated papillary thyroid carcinoma infiltrating the skin and strap muscles at a single focus. Debulking surgery with adjuvant radiotherapy had a satisfactory outcome in our patient. CONCLUSION: Skin sinus formation might have been prevented in our case by using a needle with a caliber < 22 gauge and avoiding multiple sessions of aspiration of the same thyroid nodule.
Authors: Peter P Truran; Sarah J Johnson; Richard D Bliss; Thomas W J Lennard; Sebastian R Aspinall Journal: World J Surg Date: 2014-11 Impact factor: 3.352