J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 10, Number 2, February 2018, pages 106-116

Pattern of Thyroid Lesions in Western Region of Saudi Arabia: A Retrospective Analysis and Literature Review

Figures

Figure 1. Characteristics of thyroid lesions found by ultrasonography. Panel (a) showing (1) number of nodules, (2) size of the nodules, (3) shape of the nodules, (4) consistency of the nodules, and (5) margins of the nodules. Panel (b) showing (6) US echogenicity of the nodules, (7) blood flow to the nodules, (8) site of the FNA done, (9) calcification of the nodules, and (10) lymph node enlargement in the nodules.

Figure 2. Ultrasound features of the various types of thyroid lesions. Panel (a) showing adenomatous thyroid lesion with arrows indicating strap muscles (yellow), margin of nodule (green), trachea (white), heterogeneous nodule (red), and internal jugular vein (blue). Panel (b) showing Hashimoto’s thyroiditis (chronic lymphocytic thyroiditis) with arrows indicating multiple tiny hypoechoic nodular lesions (yellow) and strap muscles (white).

Figure 3. Ultrasound features of a colloid thyroid lesion. Panel (a) showing multiple cystic lesions (white arrows) and strap muscles (yellow). Panel (b) showing lymphoplastc thyroid lesion with arrows indicating cystic changes (white), strap muscles (yellow), and margin of nodule (red).

Figure 4. Ultrasound features of a malignant thyroid nodule. Malignant thyroid lesions with irregular margins are indicated by white arrow marked hypoechogenic; strap muscles and microcalcification are indicated by yellow and green arrows, respectively.

Figure 5. Histopathology of the representative cases with various thyroid lesions stained with H&E, Papanicolaou stain, and Diff quick stain. In panel (a), Hashimoto’s thyroiditis showing diffuse lymphoplasmacytic infiltration, lymphoid follicles with germinal centers (yellow), normal thyroid follicular tissue (black arrows) present around lymphoid follicles (Pap stain, × 10). Panel (b) showing germinal centers (green arrow), red blood cells are indicated by black arrows (H&E stain, × 40). Panel (c) is a colloid goiter showing varied sizes of thyroid follicles lined by low cuboidal epithelium (green arrow) and filled by eosinophilic colloid. Blue arrows indicate thyroid follicles (H&E stain, × 20). Panel (d) is an FNA cell block of follicular carcinoma - tumor tissue showing several neoplastic follicles (black arrows). Blood clot surrounds the neoplastic tissue (yellow arrows, H&E × 20).

Figure 6. Histopathology of the representative cases with neoplastic thyroid lesions stained with H&E, Papanicolaou stain, and Diff quick stain. Panel (a) showing a Diff quick stained slide (× 40), papillae showing clusters of malignant follicular epithelial cells (red arrows). In panel (b), a classic pattern of papillary carcinoma is presented. Photomicrographs (Pap stain, × 40) show papillary structures consisting of many neoplastic follicular epithelial cells with intranuclear cytoplasmic pseudo-inclusions indicated by black arrows. Panel (c), FNA cell block, showing papillary carcinoma (H&E, × 40). Papillary structures consisting of many neoplastic follicular epithelial cells (green arrow) lining the papillae with fibrovascular core (yellow arrow).

Tables

**Table 1.** Distribution of Thyroid Lesions According to Gender and Age of the Patients
Age groups (years)	Male (%)	Female (%)	Total (%)
Pearson Chi-square = 0.068.
< 20	1 (10)	9 (90)	10 (5.8)
21 - 30	4 (14.8)	23 (85.2)	27 (15.6)
31 - 40	3 (7.5)	37 (92.5)	40 (23.1)
41 - 50	6 (12)	44 (88)	50 (28.9)
51 - 60	4 (15.4)	22 (84.6)	26 (15)
> 61	4 (20)	16 (80)	20 (11.6)
Total	22 (12.7)	151 (87.3)	173 (100)

**Table 2.** Distribution of Patients According to Their Nationalities and Gender
Origin of patients	Male (%)	Female (%)	Total	Percent
Saudi	19 (86.36)	127 (84.10)	146	84.39
Syrian	0	4 (2.66)	4	2.31
Palestinian	0	1 (0.66)	1	0.58
Egyptian	0	3 (1.99)	3	1.73
Pakistani	3 (13.64)	6 (3.98)	9	5.2
Yemeni	0	5 (3.31)	5	2.89
Indonesian	0	1 (0.66)	1	0.58
Bangladeshi	0	1 (0.66)	1	0.58
Filipino	0	2 (1.32)	2	1.16
Myanmar	0	1 (0.66)	1	0.58
Total	22 (100)	151 (100)	173	100

**Table 3.** Distribution of Thyroid Lesions According to Age Groups and Location
Age groups (years)	Gender	Thyroid lobe						Total (%)
Age groups (years)	Gender	Right	Left	Both	Isthmus	Diffuse	LN only	Total (%)
< 20	Male	1	0	0	0	0	0	1
	Female	3	3	3	0	0	0	9
	Total	4	3	3	0	0	0	10
21 - 30	Male	4	0	0	0	0	0	4
	Female	14	2	7	0	0	0	23
	Total	18	2	7	0	0	0	27
31 - 40	Male	0	1	2	0	0	0	3
	Female	15	10	10	1	1	0	37
	Total	15	11	12	1	1	0	40
41 - 50	Male	2	0	4	0	0	0	6
	Female	16	8	18	1	0	1	44
	Total	18	8	22	1	0	1	50
51 - 60	Male	1	1	2	0	0	0	4
	Female	7	5	10	0	0	0	22
	Total	8	6	12	0	0		26
> 60	Male	1	0	3	0	0	0	4
	Female	8	3	5	0	0	0	16
	Total	9	3	8	0	0	0	20
Total		72 (41.6%)	33 (19.1%)	64 (37%)	2 (1.2%)	1 (0.6%)	1 (0.6%)	173 (100%)
Pearson Chi-square		0.505	0.792	0.491				0.806

**Table 4.** Distribution of Benign Nodules According to Age Groups of Patients
Age groups (years)	Benign nodules (%)					Total (%)
Age groups (years)	Not benign	Adenomatous	Colloid	Lymphocytic	Others	Total (%)
< 20	0	1	7	2	0	10
21 - 30	5	2	15	5	0	27
31 - 40	1	6	30	3	0	40
41 - 50	5	2	38	5	0	50
51 - 60	1	3	18	3	1	26
Total	14 (8.1)	16 (9.3)	124 (71.7)	18 (10.4)	1 (0.6)	173 (100)

**Table 5.** Spectrum of Thyroid Diseases in Different Sexes by Final Diagnosis
Thyroid lesions	Gender (%)		Total (%)
Thyroid lesions	Male	Female	Total (%)
SOM: suspicious of malignancy.
Non-diagnostic	0	4 (2.65)	4 (2.31)
Benign	20 (90.92)	139 (92.1)	159 (91.91)
Atypia	0	1 (0.66)	1 (0.6)
SOM	1 (4.54)	0	1 (0.6)
Malignant	1 (4.54)	7 (4.64)	8 (4.63)
Total	22 (12.72)	151 (87.28)	173 (100)
Adenomatous nodules	3 (15)	13 (9.35)	16 (10.2)
Colloid nodules	16 (80)	108 (77.7)	124 (77.91)
Lymphocytic (Hashimoto)	1 (1)	17 (12.24)	18 (11.31)
Others	0	1 (0.72)	1 (0.63)
Total (benign)	20 (12.58)	139 (87.42)	159 (100)

**Table 6.** Distribution of Thyroid Lesions According to Age Groups in Different Sexes
Age groups (years)	Diagnosis	Gender (%)		Total (%)
Age groups (years)	Diagnosis	Male	Female	Total (%)
SOM: suspicious of malignancy.
< 20	Benign	1 (100)	9 (100)	10
	Total	1 (100)	9 (100)	10
21 - 30	Benign	2 (50)	20 (86.96)	22
	SOM	1 (25)	0	1
	Malignant	1 (25)	3 (13.04)	4
	Total	4 (100)	23 (100)	27
31 - 40	Benign	3 (100)	36 (97.3)	39
	Malignant	0	1 (2.7)	1
	Total	3 (100)	37	40
41 - 50	Non-diagnostic	0	3 (6.82)	3
	Benign	6 (100)	39 (88.7)	45
	Malignant	0	2 (4.55)	2
	Total	6 (100)	44 (100)	50
51 - 60	Non-diagnostic	0	1 (4.55)	1
	Benign	4 (100)	21 (95.45)	25
	Total	4 (100)	22 (100)	26
> 60	Benign	4 (100)	14	18
	Atypia	0	1	1
	Malignant	0	1	1
	Total	4 (20)	16 (80)	20
Grand total		22 (12.72)	151 (87.28)	173 (100)