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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5794_Библиотеки_им_академика_М_И_Перельмана.pdf
4.1 Nodular Hyperplasia (Adenomatous Goiter)
Fig. 4.2 B-mode
ultrasonogram showing
isoechoic partially cystic
4.74 cm right nodule
with round margin
Fig. 4.3 Color Doppler
showed moderately
increased internal blood
ow within the nodule
13
Fig. 4.4 Shear wave
elastogram showing
traversing pattern of
high elasticity and E
76.6 kPa
Max
14
Fig. 4.5 Core needle
biopsy suggested
nodular hyperplasia
with thick brous
tissue (arrows)
Fig. 4.6 Core needle
biopsy suggested
nodular hyperplasia
with thick brous
tissue showing similar
patterned follicles in
both sides (arrows)
4 Dierential Diagnosis ofThyroid Nodules
Fig. 4.7 Surgical
histopathology was
nodular hyperplasia
showing thick interstitial
brosis (arrow)
4.1.2 Case 2
65-year-old man was found to have a 1.39cm
right nodule on routine check. B-mode ultrasonogram showed a hypoechoic nodule with round
margin (Figs.4.8, 4.9 and 4.10).
Shear wave elastogram showed a traversing
pattern of high elasticity and E
was 74.0kPa
Max
(Fig.4.11). FNA showed a benign follicular nodule (Figs.4.12 and 4.13) and CNB showed nodular hyperplasia (Figs.4.14 and 4.15).
4.1 Nodular Hyperplasia (Adenomatous Goiter)
Fig. 4.8 B-mode
ultrasonogram showed
hypoechoic nodule with
round margin
Fig. 4.9 B-mode
ultrasonogram showed
hypoechoic nodule with
round margin
15
Fig. 4.10 Color
Doppler showed little
internal blood ow
within the nodule
16
Fig. 4.11 Shear wave
elastogram showed
traversing pattern of
high elasticity and E
was 74.0 kPa
Max
4 Dierential Diagnosis ofThyroid Nodules
Fig. 4.12 FNA showed
benign follicular
nodule
4.1.3 Case 3
A 37-year-old woman was referred to have a
thyroid nodule on routine check. B-mode ultrasonogram showed a 3.55 cm isoechoic right
nodule with round margin with little internal
vascularity (Figs. 4.16, 4.17, and 4.18). Shear
wave elastogram showed a traversing pattern of
high elasticity and E
was 60.1kPa (Fig.4.19).
Max
Core needle biopsy suggested nodular hyperplasia (Fig. 4.20) showing dilated involutional
follicles.
4.1 Nodular Hyperplasia (Adenomatous Goiter)
Fig. 4.13 FNA showed
benign follicular nodule
Fig. 4.14 CNB result
was nodular hyperplasia
17
Fig. 4.15 CNB result
was nodular
hyperplasia
18
Fig. 4.16 B-mode
ultrasonogram showed
3.55 cm isoechoic right
nodule with round
margin
Fig. 4.17 B-mode
ultrasonogram showed
3.55 cm isoechoic right
nodule with round
4 Dierential Diagnosis ofThyroid Nodules
Fig. 4.18 Color
Doppler showed little
internal blood ow
within the nodule
4.1 Nodular Hyperplasia (Adenomatous Goiter)
19
Fig. 4.19 Shear wave elastogram showed traversing pattern of high elasticity and E
Fig. 4.20 Core needle
biopsy suggested
nodular hyperplasia
showing dilated
involutional follicles
4.1.4 Case 4
Shear wave elastogram showed a traversing
pattern of high elasticity (E
A 51-year-old woman was found to have a
1.03cm left nodule that was growing to 1.58cm
during regular follow-up. B-mode ultrasonogram showed a partially cystic 1.58cm solid
nodule with round margin (Figs.4.21 and 4.22),
and FNA showed a benign follicular nodule.
Figs.4.23 and 4.24). She underwent thyroidectomy and histopathology revealed nodular
hyperplasia (Figs. 4.25 and 4.26) showing
incomplete formation of the surrounding capsule and interstitial brosis (arrow, Figs.4.25,
4.26 and 4.27).
was 60.1 kPa
Max
50.1 kPa,
Max
20
Fig. 4.21 B-mode
ultrasonogram showed
partially cystic 1.58 cm
solid nodule with round
margin in the left
middle lobe
Fig. 4.22 B-mode
ultrasonogram showed
partially cystic 1.58 cm
solid nodule with round
margin in the left
middle lobe
4 Dierential Diagnosis ofThyroid Nodules
Fig. 4.23 Shear wave
elastogram showed
traversing pattern of
high elasticity. E
Max
was
50.1 kPa
4.1 Nodular Hyperplasia (Adenomatous Goiter)
Fig. 4.24 Shear wave
elastogram showed
traversing pattern of
high elasticity. E
Max
was
50.1 kPa
Fig. 4.25 Surgical
histopathology revealed
nodular hyperplasia.
showing incomplete
formation of
surrounding capsule and
interstitial brosis
(arrow)
21
Fig. 4.26 Surgical
histopathology
revealed nodular
hyperplasia.showing
incomplete formation
of surrounding
capsule and interstitial
brosis (arrow)
22
Fig. 4.27 Surgical
histopathology revealed
nodular hyperplasia.
showing interstitial
brosis (arrow)
Fig. 4.28 B-mode
ultrasonogram
showed partially
cystic 4.31 cm nodule
in the left lobe
4 Dierential Diagnosis ofThyroid Nodules
4.1.5 Case 5
33-year-old woman was referred to have a growing thyroid nodule during regular follow-up.
B-mode ultrasonogram showed a partially cystic
4.31cm left nodule with moderate internal vascularity (Figs.4.28, 4.29, and 4.30). Shear wave
elastogram showed a traversing pattern of high
elasticity and E
Core needle biopsy suggested nodular hyperplasia showing dilated follicles and interstitial
inltration of inammatory cells (arrow,
Fig.4.32) and brotic change.
was 150.8 kPa (Fig. 4.31).
Max
4.1.6 Case 6
A 48-year-old woman presented a right neck mass
found recently. She had been diagnosed as a thyroid nodule (right, 0.8cm) nine years ago and FNA
at that time had revealed follicular lesion, but follow-up evaluation was lost. B-mode USG revealed
a 5.25cm mixed solid and cystic nodule with little
internal vascularity in the right lobe (Figs. 4.33,
4.34 and 4.35). SWE showed scattered increased
elasticity along the solid portions of the nodule
(E
140.4kPa, Fig.4.36). CNB was performed in
Max
the solid portion of the nodule and showed thick