ACTA ENDOCRINOLOGICA (BUC)

Context/Objective. The standard approach is to perform repeat FNAB (rFNAB) in thyroid nodules with nondiagnostic (ND) / insufficient (UNS) cytology. However, due to the nature of these nodules, recurrent FNABs may also be insufficient. Therefore, by comparing the clinicalradiological- pathological parameters of nodules with a definite diagnosis of excision, we questioned the possibility of patient management without rFNAB. Methods. Clinical-radiological parameters of 275 nodules belonging to 264 patients in the ND/UNS aspiration group with definite pathological diagnosis after surgery were determined. Under the guidance of these parameters, those with and without rFNAB were compared. Results. The incidence of malignancy was found to be significantly higher in nodules without rFNAB compared to nodules with rFNAB (p = 0.036). In addition, the incidence of malignancy in BC-1 nodules without rFNAB was significantly higher than in nodules with rFNAB result also BC-1 (p = 0.009). In all cases, nodule size smaller than 10 mm and border irregularity were found to be statistically significant for malignancy (p <0.020, p <0.002). When looking at the distribution of rFNAB results, a significant correlation was observed with female gender, solid component, hypoechogenicity, border irregularity and halo loss around the nodule in patients with BC-4,5,6 cytology results (respectively, 0.005 / 0.031 / 0.001 / 0.012 / 0.004). Conclusion. rFNAB did not show the expected effect in ND / UNS nodules. We recommend direct surgical excision without rFNAB for nodules with border irregularity, solid structure, halo loss and hypoechogenicity, which should be considered more important in female patients.

Background. Adrenocortical oncocytoma (ACO) is exceedingly rare. To date, only 81 cases are reported in the English literature. Most of ACOs are nonfunctioning and benign.\r\nCase report. We describe a case of ACO incidentally diagnosed in a 54-yearold male patient. Physical examination, routine laboratory studies and hormonal tests were within normal ranges. Abdominal computed tomography (CT) and magnetic resonance imaging showed a large and\r\nheterogeneous tumor (9x7x6 cm) in the left adrenal gland with borderline malignant characteristics. Left adrenalectomy was performed for treatment purposes. The cut\r\nsurface of the resected tumor was heterogeneous with tan brown color with areas of extensive hemorrhage and necrosis.\r\nMicroscopically, the tumor consisted predominantly of large polygonal cells containing eosinophilic granular cytoplasm\r\narranged in a solid pattern with abundant hemorrhage and necrosis. The tumor showed a compressed remnant of adrenal\r\ncortex in the outer the capsule of the mass. No vascular and capsular invasion was noted, and mitotic figures were not\r\nconspicuous. Immunohistochemically, the tumor cells were diffusely and strongly positive for melan-A, vimentin, alphainhibin, weakly positive for synaptophysin and calretinin. The tumor was focal and erratively positive for pancytokeratin. No immunoreactivity was observed form\r\nchromogranin-A, CD10 or p53. The histological diagnosis was ACO with uncertain malignant potential.\r\nConclusions. ACO occurs rarely in adults and preoperative diagnosis is difficult, especially in asymptomatic cases.\r\nIt needs careful evaluation and surgical treatment. According to our knowledge, this is the 2th case of ACO in an adult patient from Turkey in English literature. We\r\ndiscuss this case and review the literature on this unusual entity.

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Background. Thyroid nodules are a common pathology worldwide. Fine needle aspiration biopsy (FNAB) is an important diagnostic method for the investigation of malignancy in thyroid nodules. However, according to the Bethesda System used to classify the results, patients with atypia of undetermined significance/follicular lesion of undetermined significance (AUS / FLUS) may not be classified as benign or malignant. Therefore, it may be necessary to determine some clinical risk factors to apply the best treatment in these patients. Aim. To determine the factors that increase the risk of malignancy in this patient group. Methods. A retrospective study including 138 patients with an FNAB categorized as AUS/FLUS and operated between June 2015–September 2018. Demographical, Laboratory (TSH) and Ultrasound variables (number, size and characteristics of nodules) of the patients were compared among postoperative histopathological results. Results. Hypo-echoic structure, microcalcification and irregular margin of the nodules were detected to be associated with malignancy in patients with FNAB results of AUS/FLUS (p <0.001). Conclusion. We suggest that surgical treatment should be considered if the patients have nodules with the hypo-echoic structure, microcalcification and irregular margin with an FNAB histopathological result of AUS / FLUS.