AMYLOID GOITER - A CLINICOPATHOLOGICAL STUDY OF 14 CASES AND REVIEW OF THE LITERATURE

The authors report the clinicopathologic features of 14 cases of amylo id goiter (AG). Eleven patients were males and three were females with ages ranging from 23 to 75 years (median, 54 years). Eight patients h ad secondary amyloidosis and six had primary amyloidosis, Nine cases w ere identified at autopsy. In symptomatic patients (n = 5), the clinic al presentation included a nontender, rapidly enlarging neck mass with associated dysphagia, dyspnea, or hoarseness. Clinical or laboratory evaluation failed to detect evidence of thyroid dysfunction. The histo logic appearance of the thyroid predominantly consisted of diffuse amy loid deposition surrounding thyroid follicles. In two cases, a nodular pattern of amyloid deposition was seen resulting in compression and d istortion of the follicular architecture. Areas of mature adipose tiss ue and focal lymphocytic thyroiditis with or without foreign-body type -giant cells were seen in approximately one third of the cases, Confir mation of amyloid was made by the presence of congophilia and apple-gr een birefringence under polarized-light microscopy. Immunohistochemica l evaluation demonstrated the presence of amyloid A immunoreactivity. No immunoreactivity was seen with calcitonin or thyroglobulin. Fine-ne edle aspiration may facilitate the diagnosis, as occurred in one of th e patients. In symptomatic patients, thyroidectomy is warranted to all eviate pressure symptoms.