1. CASE 1: FNA OF A LARGE GOITRE Roberto Dina, MD Cytology Dept of Histopathology Hammersmith Hospital London (U.K.)

2. CASE HISTORY A 77 yr old Female with a history of long standing goitreA 77 yr old Female with a history of long standing goitre Presents with a recently enlarged thyroidPresents with a recently enlarged thyroid SmokerSmoker

3. Imaging Large heterogeneous mass within the neck consistent with the patients goitre. The trachea is markedly deviated to the right and narrowed in the coronal dimension to 6 mm. The goitre extends to the superior aspect of the sternum. Within the anterior segment of the LUL there is a spiculated 11 mm diameter nodule which appears to be cavitating anteriorly.Large heterogeneous mass within the neck consistent with the patients goitre. The trachea is markedly deviated to the right and narrowed in the coronal dimension to 6 mm. The goitre extends to the superior aspect of the sternum. Within the anterior segment of the LUL there is a spiculated 11 mm diameter nodule which appears to be cavitating anteriorly.

4. Bronchoscopy Bronchoscopy normalBronchoscopy normal Bronchial washing and brushing Negative for malignant cellsBronchial washing and brushing Negative for malignant cells

5. FNA PERFORMED 4 Passes (27 G needle)4 Passes (27 G needle) Scanty MaterialScanty Material

10. Isolated atypical nuclei lymphocytes

11. CYTOLOGY Necrotic BackgroundNecrotic Background Multinucleated Giant CellsMultinucleated Giant Cells Histiocyte like cellsHistiocyte like cells Atypical CellsAtypical Cells Aggregates of LymphocytesAggregates of Lymphocytes