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Dorinda Mullen Department of Pathology, St. Vincent’s University Hospital, Dublin 4, Ireland

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Sarah Mullins Department of Pathology, St. Vincent’s University Hospital, Dublin 4, Ireland

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Aoife Doyle Department of Pathology, St. Vincent’s University Hospital, Dublin 4, Ireland

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Rachel K. Crowley Department of Endocrinology, St. Vincent’s University Hospital, Dublin 4, Ireland
School of Medicine and Medical Sciences, University College Dublin, Dublin 4, Ireland

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Stephen Skehan Department of Radiology, St. Vincent’s University Hospital, Dublin 4, Ireland
School of Medicine and Medical Sciences, University College Dublin, Dublin 4, Ireland

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Enda W. McDermott Department of Surgery, St. Vincent’s University Hospital, Dublin 4, Ireland
School of Medicine and Medical Sciences, University College Dublin, Dublin 4, Ireland

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Ruth S. Prichard Department of Surgery, St. Vincent’s University Hospital, Dublin 4, Ireland
School of Medicine and Medical Sciences, University College Dublin, Dublin 4, Ireland

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David Gibbons Department of Pathology, St. Vincent’s University Hospital, Dublin 4, Ireland
School of Medicine and Medical Sciences, University College Dublin, Dublin 4, Ireland

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. The Thy3 category, which indicates that a neoplasm is possible, is divided into 2 subgroups. Thy3f suggests a follicular neoplasm. It is not possible to use cytology to distinguish benign from malignant follicular neoplasms in Thy3f aspirates and

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Kaoru Kobayashi Kuma Hospital, Kobe, Japan

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Hisashi Ota Kuma Hospital, Kobe, Japan

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Mitsuyoshi Hirokawa Kuma Hospital, Kobe, Japan

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Tomonori Yabuta Kuma Hospital, Kobe, Japan

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Mitsuhiro Fukushima Kuma Hospital, Kobe, Japan

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Hiroo Masuoka Kuma Hospital, Kobe, Japan

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Takuya Higashiyama Kuma Hospital, Kobe, Japan

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Minoru Kihara Kuma Hospital, Kobe, Japan

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Yasuhiro Ito Kuma Hospital, Kobe, Japan

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Akihiro Miya Kuma Hospital, Kobe, Japan

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Akira Miyauchi Kuma Hospital, Kobe, Japan

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follicular carcinoma or follicular neoplasm within benign tumors histopathologically. The ultrasonographic significance of this appearance has not been clarified. What Does This Case Report Add? • A small number of follicular carcinoma cases or

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Tumay Ozgur Departments of Pathology, Mustafa Kemal University Medical Faculty, Hatay, Turkey

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Hasan Gokce Departments of Pathology, Mustafa Kemal University Medical Faculty, Hatay, Turkey

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Ihsan Ustun Endocrinology and Metabolism, Mustafa Kemal University Medical Faculty, Hatay, Turkey

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Mehmet Yaldiz Departments of Pathology, Mustafa Kemal University Medical Faculty, Hatay, Turkey

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Mehmet Mustafa Akin Departments of Pathology, Mustafa Kemal University Medical Faculty, Hatay, Turkey

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Cumali Gokce Endocrinology and Metabolism, Mustafa Kemal University Medical Faculty, Hatay, Turkey

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beginning of a vascular encasement. USG-guided fine-needle aspiration cytology (FNAC) was performed on the nodule of greatest size [ 9 ]. FNAC was consistent with ‘suspicious for a follicular neoplasm’ according to the Bethesda system [ 10 ]. Due to the

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Dong Gyu Na Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, South Korea

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Hye Sook Min Departments of Pathology, Seoul, South Korea

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Hunkyung Lee Department of Pathology, Ewha Clinical Laboratory, Seoul, South Korea

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Jae-Kyung Won Departments of Pathology, Seoul, South Korea

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Hyo Bin Seo Department of Radiology, Seoul National University Hospital Kangnam Center, Seoul, South Korea

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Ji-Hoon Kim Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea

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subcategory included nodules with architectural atypia such as the presence of a prominent population of microfollicles or Hurthle cells in sparsely cellular aspirates with scant colloid, but not enough to be diagnosed as a follicular neoplasm or suspicious

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Kassia B. Reuters Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil

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Maria C.O.C. Mamone Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil

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Elsa S. Ikejiri Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil

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Cleber P. Camacho Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil

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Claudia C.D. Nakabashi Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil

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Carolina C.P.S. Janovsky Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil

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Ji H. Yang Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil

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Danielle M. Andreoni Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil

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Rosalia Padovani Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
Santa Casa de São Paulo, São Paulo, Brazil

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Rui M.B. Maciel Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
Fleury Medicina e Saúde, São Paulo, Brazil

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Felipe A.B. Vanderlei Head and Neck Division, Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil

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Rosa P.M. Biscolla Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
Fleury Medicina e Saúde, São Paulo, Brazil

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), follicular neoplasm or suspicious for follicular neoplasm (FN/SFN, Bethesda IV), suspicious for malignancy (SM, Bethesda V), and malignant (Bethesda VI) [ 11 - 13 ]. Since its publication, several centers in different countries have applied the Bethesda

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Catherine Brophy Departments of Otolaryngology - Head and Neck Surgery, Cork, Ireland

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Rania Mehanna Departments of Otolaryngology - Head and Neck Surgery, Cork, Ireland

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Julie McCarthy Departments of Cytopathology, Cork University Hospital, Cork, Ireland

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Antoinette Tuthill Departments of Endocrinology, Cork University Hospital, Cork, Ireland

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Matthew S. Murphy Departments of Endocrinology, South Infirmary Victoria University Hospital, Cork, Ireland

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Patrick Sheahan Departments of Otolaryngology - Head and Neck Surgery, Cork, Ireland

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(follicular neoplasm) [ 4 ]. The Thy-3f category is used for cases which are cytologically suspicious for a follicular or Hürthle cell neoplasm (analogous to the Bethesda follicular neoplasm category), whereas the Thy-3a category is used for cases

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Ralf Paschke
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Silvia Cantara
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Anna Crescenzi
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Barbara Jarzab
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Thomas J. Musholt
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Manuel Sobrinho Simoes
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) atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS); (IV) follicular neoplasm/suspicious for follicular neoplasm (FN/SFN), a category that also encompasses the diagnosis of Hürthle cell neoplasm/suspicious for

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Dorothée Bouron-Dal Soglio Department of Pathology, CHU Sainte-Justine, Montreal, Québec, Canada

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Leanne de Kock The Lady Davis Institute, Segal Cancer Centre, Jewish General Hospital, Montreal, Québec, Canada
Department of Human Genetics, McGill University, Montreal, Québec, Canada

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Richard Gauci Nuclear Medicine, Sir Charles Gairdner Hospital, Nedlands, Washington, Australia

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Nelly Sabbaghian The Lady Davis Institute, Segal Cancer Centre, Jewish General Hospital, Montreal, Québec, Canada

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Elizabeth Thomas Nuclear Medicine, Sir Charles Gairdner Hospital, Nedlands, Washington, Australia
Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Subiaco, Washington, Australia

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Helen C. Atkinson Faculty of Health and Medical Sciences, School of Medicine, The University of Western Australia, Crawley, Washington, Australia

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Nicholas Pachter Faculty of Health and Medical Sciences, School of Medicine, The University of Western Australia, Crawley, Washington, Australia
King Edward Memorial Hospital, Perth, Washington, Australia

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Simon Ryan Department of General Surgery, Sir Charles Gairdner Hospital, Nedlands, Washington, Australia

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John P. Walsh Faculty of Health and Medical Sciences, School of Medicine, The University of Western Australia, Crawley, Washington, Australia
Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Washington, Australia

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M. Priyanthi Kumarasinghe PathWest, QEII Medical Centre, Perth, Washington, Australia

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Karen Carpenter Department of Diagnostic Genomics, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, Washington, Australia

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Ayça Aydoğan Department of Molecular Biology and Genetics, Bilkent University, Ankara, Turkey

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Colin J.R. Stewart King Edward Memorial Hospital, Perth, Washington, Australia

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William D. Foulkes The Lady Davis Institute, Segal Cancer Centre, Jewish General Hospital, Montreal, Québec, Canada
Department of Human Genetics, McGill University, Montreal, Québec, Canada
Department of Medical Genetics, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada

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Catherine S. Choong Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Subiaco, Washington, Australia
Faculty of Health and Medical Sciences, School of Medicine, The University of Western Australia, Crawley, Washington, Australia

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). Ultrasound-guided fine needle aspiration (FNA) cytology revealed a follicular neoplasm and the patient underwent a right hemithyroidectomy in October 2007. Histopathological examination revealed 2 thyroid nodules (Fig 2 a, b). The first was a 35 mm

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Rachelle P Mendoza Department of Pathology, University of Rochester Medical Center, Rochester, New York, USA

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Richard Cody Simon Department of Pathology, University of Chicago, Chicago, Illinois, USA

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Nicole A Cipriani Department of Pathology, University of Chicago, Chicago, Illinois, USA

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Tatjana Antic Department of Pathology, University of Chicago, Chicago, Illinois, USA

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which underwent resection. Four nodules had benign resection pathology (of which one had two incidental PTmCs, measuring 0.1 and 0.8 cm), and one nodule was diagnosed as a noninvasive atypical follicular neoplasm with HRAS (Q61R) and TERT promoter (c

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Pi-Ling Chiang Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Taiwan

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Sheng-Dean Luo Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Taiwan
Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan

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Yen-Hsiang Chang Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Taiwan
Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan

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Chen-Kai Chou Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Taiwan
Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan

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Shun-Yu Chi Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Taiwan
Departments of Surgery, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan

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Yi-Fan Chen Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Taiwan

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Wei-Che Lin Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Taiwan
Department of Radiology, Jen-Ai Hospital, Dali Branch, Taichung, Taiwan
School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung City, Taiwan

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) follicular neoplasm, and (vi) malignancy discovered at the second diagnosis. A total of four thyroid nodules were excluded, three of which were determined as follicular neoplasm (Bethesda IV) upon repeat FNAC and one was determined to be papillary

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