BH: a 30-year-old female complained of a palpable mass in the right breast. A cystic lesion was identified in the previous US. At the time of the US, the FNA radiologist noticed thickening in the wall surrounding the cyst that was 26 mm × 14 mm in size. First, the cyst was aspirated, and 3 cc of partially thick cystic fluid was obtained. Consequently, a sample in the form of “bird-pecking” was taken from the cystic wall. Cytologic diagnosis: (i) Cystic fluid: cystic macrophages were observed in a partially dirty inflamed background. (ii) Wall samples: malignant ductal epithelial groups were observed []. Histopathology: Infiltrating ductal carcinoma.\nTHM: sampling not only from the cyst but also from the wall enabled the detection of the malignancy.[]
BH: a 42-year-old female was referred to us for FNA due to her thyroid nodule. The US showed a multinodular goiter. A microcalcified nodule 16 mm × 11 mm in size in the right thyroid lobe was considered important; a US-FNA was performed. Cytologic findings and diagnosis: Smears presented typical findings of thyroid papillary carcinoma []. Surgery and afterward: After a certain period, the patient angrily came to my office with the pathology report in her hand, trying to reproach me by saying; “It turned out to be benign after surgery. You told me it was cancer; you made me go through this stress.” I gave the preparations to the patient and directed her to the pathology institution that had reported that her nodule was benign.\nThe FNA slides received the diagnosis of “papillary carcinoma” during the consultation at the institution. Consequently, the thyroidectomy specimen was sampled again. It was determined that a nodule that was overlooked and not sampled the first time turned out to be “papillary carcinoma.”\nThe thyroidectomy material was sent to pathology from the operation theater with the note reading “multinodular goiter + total thyroidectomy.” The information of malignancy at FNA was not specified.\nTHM: (1) If the patient had accepted the pathology report and not taken into account the FNA result, she could have experienced eventual metastasis because she would not have received radioactive iodine therapy and would not have been monitored. (2) Following the first pathology report, the surgeon did not take into account the incompatibility between the cytological and histological diagnoses. When the patient investigated herself, her condition turned out to be “real.”