Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2012 | Month : June | Volume : 6 | Issue : 5 | Page : 811 - 815

Cyto-Histological Correlation of Thyroid Lesions with Estrogen and Progesterone Receptor Status on Neoplastic Lesions

Shilpi Bhargava, Rani Bansal, Poonam Elhence, Sanjay Pandey, Natasha Makkar

1. MD(3rd yr.), Subharti Medical College, Meerut, India. 2. Professor & Head, Subharti Medical College, Meerut, India. 3. Associate Professor, Subharti Medical College, Meerut, India. 4. Associate Professor, Subharti Medical College, Meerut, India. 5. MD (3rd yr.), Subharti Medical College, Meerut, India.

Correspondence Address :
Dr. Shilpi Bhargava
Department of Pathology.
Subharti Medical College, Meerut, India -250003.
Phone: 09760062926
E-mail: drshilpi222@gmail.com

Abstract

Introduction: Thyroid nodules are common clinical findings, they are more common in women and this incidence increases with age, a history of radiation exposure and with a diet which contains goitrogenic material. Fine needle aspiration cytology (FNAC) is an established technique for the investigation of thyroid nodules. The aim of the present study was to establish a correlation between the cytological features and the histomorphology of various neoplastic and non-neoplastic lesions. Secondly, we aimed to analyze the oestrogen receptor (ER) and the progesterone receptor (PR) status in malignant thyroid tumours.

Materials and Methods: The FNAC of 448 thyroid lesions was performed, with the histological correlation being available in 122 cases, over a period of 5 years. Immunohistochemistry was performed on the neoplastic lesions by the peroxidase- anti-peroxidase technique by using a mouse monoclonal antibody clone.

Results: A cyto-histological discrepancy was noted in 8 cases. On considering histological diagnosis as the gold standard, the overall accuracy was found to be 92.9%.The male:female ratio was 1:7.2 and the maximum number of cases belonged to the nodular colloid goiter category (82.36%). An immunohistochemical analysis for ER and PR was performed on 11 cases of thyroid malignancy, with a single case of papillary carcinoma showing focal nuclear positivity for the progesterone receptors.

Conclusion: The focal nuclear PR positivity which was seen in a single case cannot predict the biological behaviour of the tumour and thus, the use of anti-oestrogenic drugs like tamoxifen is questionable for the management of thyroid cancer. This needs to be confirmed further by taking up similar studies with a larger number of cases.

Keywords

Thyroid, FNAC, Cyto-Histological Correlation, Estrogen receptor, Progesterone receptor

How to cite this article :

Shilpi Bhargava, Rani Bansal, Poonam Elhence, Sanjay Pandey, Natasha Makkar. CYTO-HISTOLOGICAL CORRELATION OF THYROID LESIONS WITH ESTROGEN AND PROGESTERONE RECEPTOR STATUS ON NEOPLASTIC LESIONS. Journal of Clinical and Diagnostic Research [serial online] 2012 June [cited: 2019 Oct 17 ]; 6:811-815. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2012&month=June&volume=6&issue=5&page=811-815&id=2200

INTRODUCTION
Thyroid nodules are common clinical findings and they have a reported prevalence of 4% to 7%, whereas about 50% of the general population has incidental nodules on autopsy (1). Thyroid nodules are more common in women and the incidence increases with age, a history of radiation exposure and with a diet which contains goitrogenic material. Though goitre is a common problem, cancer of the thyroid is a rare disease and the annual incidence ranges between 2-3.8 cases in females and 1.2-2.6 cases per 100 cases in males (2).

Fine needle aspiration cytology (FNAC) is an established technique for the investigation of thyroid nodules. It has an important part to play in the pre-operative diagnosis by identifying the disease process in both solitary nodules and in the diffuse enlargement of thyroid gland. Despite many advantages, FNAC has certain limitations, which include the specimen adequacy and the cytological interpretation, as the sampling is variable and not always representative. Thus, a specific diagnosis can only be arrived at after a histological examination (3).

Thyroid disorders have a predilection for the female sex. Hyperthyroidism, hypothyroidism and thyroid neoplasms predominantly affect women. A history of one or more pregnancies, the use of lactation suppressants and oral contraceptives, increased body weight and irregular menstruation are all associated with an increased risk of thyroid cancer, thus suggesting the role of sex steroids (4). Epidemiological studies suggest that oestrogen and progesterone may contribute to the pathogenesis of goitre, as well as thyroid tumours.

The aim of this study was to find out the pattern of the thyroid lesions which presented to our institute, with correlation between the cytological and histological features of various neoplastic and non-neoplastic thyroid lesions, wherever available. Secondly, we aimed to analyze the oestrogen receptor (ER) and progesterone receptor (PR) status in carcinomas and anaplastic tumours. A strong positivity could be of help in equivocal cases and it could be of immense use in the treatment of thyroid carcinomas by non steroidal antioestrogens like Tamoxifen.

Material and Methods

This study was conducted in the Department of Pathology over a period of 5 years. FNAC of 448 thyroid lesions was performed. A histological diagnosis was available for 122 of these cases and a cyto-histological correlation was made. An immunohistochemical analysis for ER and PR was performed on 11 histopathologically confirmed cases of thyroid malignancies.

Depending on the aspirate which was obtained, a minimum of 2 smears were air dried and stained with Leishman-Giemsa stain and 2 smears were wet fixed (ethyl alcohol) and stained with the Papanicolaou and Hematoxylin and Eosin stains.

Lesions were divided into three categories which were as follows: • Inflammatory/others • Neoplasm and • Inconclusive

A minimum of 2-3 smears were prepared from separate passes with the presence of at least 6-10 clusters, each with a minimum 10 follicular epithelial cells on 2 or more slides and this was considered to be adequate.

Smears which contained excess of blood, deficient or absent follicular epithelial cells, or only colloid were considered as inadequate and they were excluded from the study. A repeat FNAC was advised in such cases.

For the histological analysis, formalin fixed, paraffin embedded and H and E stained sections were studied and the cytological features were correlated with the histology sections, wherever they were available.

Suspected cases of medullary carcinoma of the thyroid were stained by Congo Red to check for amyloid and they were examined under polarized microscopy.

For immunohistochemical analysis, the sections were taken on poly-L lysine coated slides and they were incubated overnight at 37ºC. Immunohistochemistry was performed by the peroxidase antiperoxidase (PAP) technique. A mouse monoclonal antibody clone ER/PR from Biogenix was used to demonstrate the ER and PR status. The established ER/PR positive breast carcinoma tissues served as the positive controls and sections from the normal parenchyma of the thyroid were taken as negative controls (5).

The nuclear and cytoplasmic staining was recorded and the assessment of staining intensity was done by using the Leader’s category score (negative, weak, moderate and strong) (6).

Results

A total of 488 thyroid lesions were studied. This included 448 FNACs (Table/Fig 1), whereas 40 cases had only a histopathological diagnosis. A cyto-histological correlation was available in 122 of the 448 cases.

The age of the patients ranged from 8 years to 80 years. There was a female predominance, with our study population consisting of 87.7% (429/488 cases) females and 12.3% (59/488.cases) males. The male : female ratio was 1:7.2.

Thyroid function tests were available in 140 cases. The maximum number of cases – [93(66.4%)] were found to be euthyroid, followed by an almost equal preponderance in the hypothyroid and the hyperthyroid category. In the euthyroid category, the commonest diagnosis on FNAC was nodular colloid goitre.

A cytohistological correlation was available in 122 cases, with the FNAC findings correlating with the histological diagnosis in most of the cases. 8 of the cases showed a discrepancy (Table/Fig 2). On considering histopathology as the gold standard for the diagnosis, the ‘p’ value (Chi-square test) for the cyto-histological correlation was found to be significant (P=.003) and the accuracy of the test was found to be 92.9% in diagnosing the thyroid lesions.

12 cases were placed in the category of follicular neoplasms on the basis of cytology. Among these, the histopathology report was available in 3 cases (25%). 2 cases proved to be of a benign nature, which were diagnosed as nodular goitre with a hyperplastic change and as marked nodular hyperplasia in a background of granulomatous thyroiditis respectively. A single case was diagnosed as follicular carcinoma with prominent capsular (Table/Fig 3) and vascular invasion.

On histopathology, a total of 11 cases of malignancy were diagnosed, which included 5 cases of papillary carcinoma, 3 cases of medullary carcinoma and 3 cases of follicular carcinoma. In 5 cases of papillary carcinoma which were diagnosed by histopathology, the cytological findings were available in 2 cases . Both the cases were missed during cytology and were diagnosed as nodular colloid goitre with hyperplastic change and colloid goitre with a cystic change. Thyroiditis was observed in the surrounding parenchyma in 4 out of 5 cases of papillary carcinoma (Table/Fig 4). Psammoma bodies were observed in 3 out of 5 cases, which included 1 case of a follicular variant of papillary carcinoma.

All 3 cases of medullary carcinoma of the thyroid showed the presence of amyloid, which were positive for Congo red and they showed an apple green birefringence on polarizing microscopy. (Table/Fig 5).

Some of the noteworthy cases which were encountered during the study period were:

In an FNAC aspirate of the thyroid from a 35-year old female, gametocytes of Plasmodium Falciparum were seen, with associated hyperplastic changes in colloid goitre. Another case showed a follicular variant of papillary carcinoma with osseous metaplasia on histopathology (Table/Fig 6).

Immunohistochemistry was performed on 11 cases of the thyroid malignancies. Stained slides were analyzed for the following features:

1. Intensity of the staining, which was graded by using the “Leaders Category score” (6), into negative, weak, moderate or strong. A moderate and strong staining could be seen under the low power (10X) objective. Weak staining was focal and it was evident only at a higher magnification.
2. Nuclear or cytoplasmic staining:

Out of the 5 cases of papillary carcinomas ,1 case showed a focal (weak) nuclear positivity for PR (Table/Fig 7). 2 cases of papillary carcinomas, which included FVPC, showed cytosolic positivity for both ER and PR . The rest of the cases did not show any positivity.

In all the sections, a large amount of nonspecific staining was seen in the red blood cells and colloid for both ER and PR. A cytoplasmic positivity was seen in few cases and this could have been artifactual due to absence of blockade of the non specific binding by the power block.

Discussion

Thyroid disorders are common in India and the most common ones are goitrous enlargement and nodularity of the thyroid. FNAC and histopathology, along with clinical findings, is used to reliably distinguish benign from the malignant thyroid nodules. In our study, an overall female predominance was observed, with our study population consisting of 87.7% females and 12.3% males. This was in accordance with that which was seen in the study of Ghulam Rasool Memon et al., (7) where the thyroid disorders were found to occur more commonly in females (2.5 times) of the reproductive age group, which could have been due to the effect of oral contraceptive pills, pregnancy, lactation and other hormonal effects.

In our study, FNAC had 92.9% accuracy, 95.4% sensitivity and a specificity of 93.9% in diagnosing various disorders of the thyroid. (Table/Fig 8) illustrates and compares the results of the diagnostic accuracy of various studies with respect to the role of FNAC in the management of thyroid nodules (8),(9),(10),(11),(12).

(Table/Fig 9) compares the FNAC results of the thyroid lesions in the present study with those of other studies (12),(13). In contrast to the comparative studies in [Table/Fig-9], Haggi M (14) observed an equal proportion of benign and malignant disorders, with only 31% cases being benign, 37% being malignant and 32% cases being reported as follicular neoplasms.

In the present study, a histopathological correlation was present in 122 cases of these, 8 cases showed a discordance between cytology and histopathology.

The pitfalls on FNAC which were encountered in this study were mainly with cystic lesions. Two cases of papillary carcinomas, diagnosed by histopathology, were missed on cytological evaluation, as the aspirate showed an extensive cystic change and the absence of the characteristic nuclear features. Cystic changes are known to occur in papillary carcinomas of the thyroid. Two studies which were done by Rosen IB et al., (15) and Sarda AK et al., (16) have shown that the sensitivity of FNAC in cystic neoplasms may be as low as 40% and that all the cystic lesions should be managed cautiously. Other cases in which a discrepancy was noted were follicular neoplasms as were diagnosed by FNAC vs colloid goitre with a hyperplastic nodule and thyroiditis. Settakorn (9), in 2001, reported similar discrepant findings in a few cases of adenomatous goitre vs follicular neoplasm and papillary carcinoma. The main reason behind this was that the follicular patterned lesions of the thyroid could present with a varied morphology as a hyperplastic nodule, a follicular adenoma or carcinoma and a follicular variant of papillary carcinoma which contained an admixture of the microfollicular, normofollicular and the macrofollicular patterns (17).Thyroid nodules which are diagnosed as follicular neoplasms on FNAC pose a diagnostic dilemma and they have been put into the grey zone category (18). A study which was done by Kung IT (19) suggested certain distinguishing features on cytology which could help in differentiating the hyperplastic nodules from the follicular neoplasms. These included the cells which showed larger nuclei with prominent nucleoli and overlapping nuclei as the features of follicular neoplasms and which showed hyalinized stroma as a feature of colloid nodules.

Papillary carcinoma was found to be the most common malignancy in our study spectrum. A zonal study which was done in Greece (20)showed an increase in the detection rates for papillary carcinoma in a given time period. A study which was done by Leung CS et al (21) on the variants of papillary carcinoma, showed that colloid was present in all the variants, but that it was seen most frequently in the follicular variant, which was statistically significant. Both thick and thin colloid were present in all the cases of papillary carcinomas in this study. Psammoma bodies were found in 3 out of 5 cases of papillary carcinomas. A study which was done by Hunt et al (22) included 29 patients who had psammoma bodies on thyroid FNAC and all these patients had a focus of papillary carcinoma on histopathology subsequently. The papillary carcinomas shared a strong association with Hashimoto’s (23) and lymphocytic thyroiditis, which may be due to the RET/PTC gene rearrangement (24). In the present study, 4 out of 5 cases of papillary carcinoma showed coexisting chronic lymphocytic thyroiditis on histopathology.

All the 3 cases of medullary carcinoma showed a positive staining for amyloid with Congo red and an apple green birefringence on polarizing microscopy. Uribe M (25) reported a positive histochemical staining in 2/2 cases in their study. A case report on the fine needle aspirates of 4 cases of amyloid goitre showed an abundant violet to pink amorphous material with the staining characteristics of amyloid in all the cases. This material was morphologically distinct from colloid. Hence, pathologists should pay close attention to the morphology of the cells which accompany amyloid, which will allow the exclusion of medullary carcinoma of the thyroid (26).

In this study, mild PR nuclear positivity was seen in one case of papillary carcinoma and two cases of papillary carcinoma showed an artifactual cytoplasmic positivity for both ER and PR .The normal thyroid parenchyma did not show any positivity for either marker and hence, it served as a negative control. A study which was done by Lewy Trenda (27) demonstrated the presence of ER on normal, benign and malignant tissues of the thyroid, with the maximum incidence of ER positivity being seen in papillary carcinoma of thyroid. No immunostaining was seen in the cases of nodular colloid goitre.

Chaudhary et al studied the presence of ER/PR in normal and neoplastic thyroid tissues by the protamine sulphate precipitation technique and they showed that carcinomas and adenomas had higher receptor content than goitre (28).

(Table/Fig 10) has compared the ER/PR positive cases of other studies which were studied by using the same immunohistochemical assay method (7),(28).

Multiple factors could affect the interpretation of ER and PR immunoreactivity in the histological sections:
1. An artifactual cytoplasmic positivity may be due to the absence of a blockade of the non specific binding by the power block.
2. Thyroid sections show haemorrhage and colloid. So, despite treatment with hydrogen peroxide, a large number of red blood cells show non-specific background staining.

Conclusion

In this study, thyroid lesions were found to be predominant in females and nodular colloid goitres comprised the largest group of thyroid disorders which were diagnosed on FNAC. Papillary carcinoma was the most common thyroid malignancy which was seen. Focal nuclear PR positivity which was seen in a single case of papillary carcinoma, could not predict the biological behaviour of the tumour and thus, the use of antioestrogenic drugs like tamoxifen is questionable in the management of thyroid cancer. This needs to be further confirmed by doing similar studies on a larger number of cases.

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Date of Submission: Feb 28, 2012
Date of Peer Review: Apr 07, 2012
Date of Acceptance: Apr 15, 2012
Date of Publishing: Jun 22, 2012

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