Hyalinizing trabecular tumor of the thyroid gland: A puzzling entity on fine needle aspiration cytology

Hyalinizing trabecular tumor (HTT) is a rare unique but controversial thyroid neoplasm, characterized by prominent trabecular growth pattern and stromal hyalinization. Whether HTT is a benign tumor or a variant of papillary thyroid carcinoma (PTC) is still unclear. Cytology findings of HTT have been described in few reports. Cytological features of HTT frequently overlap with those of PTC and medullary thyroid carcinoma, which can lead to frequent misdiagnosis. In order to avoid overtreatment like total thyroidectomy, pathologist should be aware of cytological features of HTT. We present a case of 35-year-old female with a right-side thyroid swelling for three years. Fine needle aspiration cytology was performed. According to The Bethesda System for Reporting Thyroid Cytopathology, cytological diagnosis of benign thyroid neoplasm was made. Histopathology of the right thyroidectomy specimen showed HTT. Accurate preoperative diagnosis of HTT requires a very meticulous and cautious approach in the evaluation of cytological features. Trabecular pattern of cells, vague curved nuclear palisading, radiating arrangement of cells around hyaline material, spindled to elongated cells, filamentous cytoplasmic processes with ill-defined cell border and yellow bodies are important diagnostic features of HTT. Nuclear features alone are insufficient for the diagnosis of HTT. Any suspicious cytology of thyroid lesion should follow hemithyroidectomy and histopathological evaluation.