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First report of a case with needle track sinus after aspiration biopsy of a benign thyroid nodule resulted in an unexpected postoperative complication.

Dogan L, Karaman N, Kucuk A, Ozaslan C, Atalay C, Celebioglu S - J Thyroid Res (2010)

Bottom Line: In this paper, a 71-year-old man presenting with a swelling and discharge on the anterior neck wall was reported.Similar complaints were present 15 to 20 days after fine needle aspiration biopsy of thyroid gland four years ago.In patients with needle biopsy-related inflammation, surgery may be delayed until the inflammation subsides.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Ankara Oncology Training and Research Hospital, 06340 Ankara, Turkey.

ABSTRACT
Fine needle aspiration biopsy is the most feasible, safe, and accurate diagnostic tool for thyroid nodule diagnosis. The development of a sinus tract between thyroid gland and the skin through needle tract after fine needle aspiration biopsy is an extremely uncommon phenomenon. In this paper, a 71-year-old man presenting with a swelling and discharge on the anterior neck wall was reported. Similar complaints were present 15 to 20 days after fine needle aspiration biopsy of thyroid gland four years ago. Bilateral total thyroidectomy was performed considering a thyroid malignancy infiltrating the skin. Histopathologic examination confirmed a sinus tract between the thyroid gland and skin and thyroid nodule was benign in nature. It must be kept in mind that inflammatory reactions might also occur after fine needle aspiration biopsy of benign thyroid nodules. In patients with needle biopsy-related inflammation, surgery may be delayed until the inflammation subsides.

No MeSH data available.


Related in: MedlinePlus

Fistulography showing contrast material passing to thyroid gland and confined to the left lobe (three arrows).
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fig2: Fistulography showing contrast material passing to thyroid gland and confined to the left lobe (three arrows).

Mentions: Swab culture of the wound revealed no microorganisms. The contrast material given through the opening of the sinus passed neither to trachea nor to esophagus and the sinus was completely intrathyroidal (Figure 2). USG-guided FNAB with 25 Gauge needle was performed for the nodule located in the left lobe of thyroid gland. The cells, with prominent nucleus and elongated cytoplasm, fragmented connective tissue elements and polimorphonuclear cells were noted at cytological evaluation. The result of the FNAB was suspicious for malignancy. PET-CT was also performed with the suspicion of undifferentiated thyroid malignancy infiltrating the skin. Moderate 18-FDG uptake seen on the left side of the neck from epiglottic level to cephalad direction was interpreted as an inflammatory process. However, 18-FDG uptake by thyroid nodule was reported to be suspicious for malignancy. With these radiological and clinical findings, bilateral total thyroidectomy was performed. Methylene-blue dye was injected through the opening of sinus tract at the beginning of surgery. Although the dye was totally intrathyroidal, the sinus tractus, prethyroidal muscles, and the skin were resected with the specimen. The sinus tract was continous with the left lobe of thyroid gland and there were severe inflammatory adhesions around the ligament of Berry at this region. The dissection of the left lobe was quite difficult, and central lymph node dissection was also performed.


First report of a case with needle track sinus after aspiration biopsy of a benign thyroid nodule resulted in an unexpected postoperative complication.

Dogan L, Karaman N, Kucuk A, Ozaslan C, Atalay C, Celebioglu S - J Thyroid Res (2010)

Fistulography showing contrast material passing to thyroid gland and confined to the left lobe (three arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2957759&req=5

fig2: Fistulography showing contrast material passing to thyroid gland and confined to the left lobe (three arrows).
Mentions: Swab culture of the wound revealed no microorganisms. The contrast material given through the opening of the sinus passed neither to trachea nor to esophagus and the sinus was completely intrathyroidal (Figure 2). USG-guided FNAB with 25 Gauge needle was performed for the nodule located in the left lobe of thyroid gland. The cells, with prominent nucleus and elongated cytoplasm, fragmented connective tissue elements and polimorphonuclear cells were noted at cytological evaluation. The result of the FNAB was suspicious for malignancy. PET-CT was also performed with the suspicion of undifferentiated thyroid malignancy infiltrating the skin. Moderate 18-FDG uptake seen on the left side of the neck from epiglottic level to cephalad direction was interpreted as an inflammatory process. However, 18-FDG uptake by thyroid nodule was reported to be suspicious for malignancy. With these radiological and clinical findings, bilateral total thyroidectomy was performed. Methylene-blue dye was injected through the opening of sinus tract at the beginning of surgery. Although the dye was totally intrathyroidal, the sinus tractus, prethyroidal muscles, and the skin were resected with the specimen. The sinus tract was continous with the left lobe of thyroid gland and there were severe inflammatory adhesions around the ligament of Berry at this region. The dissection of the left lobe was quite difficult, and central lymph node dissection was also performed.

Bottom Line: In this paper, a 71-year-old man presenting with a swelling and discharge on the anterior neck wall was reported.Similar complaints were present 15 to 20 days after fine needle aspiration biopsy of thyroid gland four years ago.In patients with needle biopsy-related inflammation, surgery may be delayed until the inflammation subsides.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Ankara Oncology Training and Research Hospital, 06340 Ankara, Turkey.

ABSTRACT
Fine needle aspiration biopsy is the most feasible, safe, and accurate diagnostic tool for thyroid nodule diagnosis. The development of a sinus tract between thyroid gland and the skin through needle tract after fine needle aspiration biopsy is an extremely uncommon phenomenon. In this paper, a 71-year-old man presenting with a swelling and discharge on the anterior neck wall was reported. Similar complaints were present 15 to 20 days after fine needle aspiration biopsy of thyroid gland four years ago. Bilateral total thyroidectomy was performed considering a thyroid malignancy infiltrating the skin. Histopathologic examination confirmed a sinus tract between the thyroid gland and skin and thyroid nodule was benign in nature. It must be kept in mind that inflammatory reactions might also occur after fine needle aspiration biopsy of benign thyroid nodules. In patients with needle biopsy-related inflammation, surgery may be delayed until the inflammation subsides.

No MeSH data available.


Related in: MedlinePlus