Category Archives: Macrophages

Trying to stay research-free

We are at the beach for an extra long weekend getaway, which means I am writing this on my phone.  I have been trying really hard to stay research-free, with mixed success. The past few days have been good, and I have made a personal vow to myself not to look up anything related to my thyroid issues at least while we are on vacation.

That said, I did go on a PubMed binge several days ago (before vacation), and I learned a few more things that I wanted to make note of here.

One is that “hemosiderin laden macrophages” can occur in HCC. (ETA: Here’s the article.).  So, in terms of my Hurthle cell lesion, it doesn’t, as I previously believed, matter if my macrophages have hemosiderin or not.

Also, I had previously read an abstract that listed “absence of inflammation” as an increased risk factor for malignancy in Hurthle cell lesions. I thought this was a food sign for me, since I know my thyroid has inflammatory cells (lymphocytes) in it. But I found the full text of the article, and what “absence of inflammation” meant in their study was an absence of inflammatory cells within the lesion. Well, as far as my FNA report goes, there aren’t any inflammatory cells in my Hurthle cell lesion, so that is no longer a factor in my favor.

I feel like these two findings tip the needle a little away from the benign side, but not necessarily more towards the malignant side, if that is even possible or makes sense. I’m not sure it does.

The fact is that I feel mostly like I will have the surgery, get a benign diagnosis (maybe including Hashimoto’s and/or multi-modular goiter) and go on my merry way. I know that things may go a different direction, and I am trying to be prepared for that possibility without dwelling on it or inviting it into my life.

Weaning is still not going great. We are going to try to use the change of routine during this vacation to eliminate nap-time nursing.  Then we’ll be down to just first thing in the morning.

Later.

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Macrophages

Ok, so I couldn’t leave well enough alone.  I HAD to keep on researching.

Let me back up.  Here is the word-for-word write up of FNA of the the larger nodule on the isthmus of my thyroid:

Hurthle cell lesion–see comment

COMMENT:

The specimen consists of numerous Hurthle cells and fragments of Hurthle cell epithelium, with a population of macrophages.  The differential diagnosis includes Hurthle cell change in a background of thyroiditis or a hyperplastic colloid nodule versus a Hurthle cell neoplasm.  Clinical correlation recommended and follow up as indicated.

So that actually didn’t sound too bad, especially the idea that it could be “Hurthle cell change in a background of thyroiditis.”

But I couldn’t leave well enough alone.  I wanted to know what, if any, meaning the macrophages had.  I had some vague memory that macrophages were immune cells, maybe a type of white blood cell?  I knew that certain cell types like lymphocytes tended to point towards a benign nodule.  So I went looking, using “macrophage” as a term in combination with “Hurthle cell lesion,” “Hurthle cell adenoma,” “Hurthle cell FNA,” etc. ad nauseum.

I found one case study in which two different patients had similar FNA samples that included Hurthle Cells and macrophages.  One ended up being a Hurthle Cell Adenoma (benign) and the other a Hurthle Cell Carcinoma (malignant).  So I know that macrophages could be present in either.

Then, for whatever reason, I searched for “macrophage thyroid cancer.”  From that I learned that macrophages are generally present in tumors (benign or malignant) and that a certain type of macrophage, known as a Tumor-Associated-Macrophages can sometimes make up up to 50% of a tumor, and that their actions tends to help the tumor grow and spread.

I found this article.  The title alone almost sent me into a panic attack.

I had a little freak out moment, feeling SURE that the “population of macrophages” meant my nodule is FOR SURE cancer. I have reeled it in a bit, and I’m now back to the recognition that “tumor-associated” doesn’t have to mean “cancer-associated,” and that, once again, I cannot find out if my nodule is cancer or not by doing research.  Still, I am not comforted.

I’ve also learned that “hemosiderin-laden” macrophages are usually associated with benign tumors; they “digest” red blood cells when a colloid nodule (always or almost always benign, from what I understand) undergoes “hemorrhagic decay”.  My FNA report didn’t say whether the macrophages were “hemosiderin-laden” or not.  So I really have no idea where I stand.

Before I made my macrophage discovery, I sent Dr. B an email to ask how long surgery should take (45 minutes to an hour)  and where pathology would be done (right here in our local hospital).  I have now looked up the pathologists on staff and am considering sending them gift baskets the day before my surgery, to make sure they do top-notch work for me.

Also, my sweet, sweet Aunt Sharon has said that if I need her, she can come for a few days.  We are going to play it by ear to see how things go.  And UK is in Uganda, preaching.  Love it.

Ok, I REALLY, REALLY need to forget all about this until maybe a few days before June 7th!  Although, I think it would be good to work on some things that would be helpful to accomplish before surgery. I am going to put my “folder” (containing my lab reports, surgery instructions, etc.)  somewhere out-of-the-way.

Should I Google “Hashimoto’s macrophage,” just to make myself feel better?  You see how sick I am?

ETA:  I did Google some more.  I am back to the realization–full realization, not just what I’m telling myself to think–that macrophages don’t mean I have cancer, and very well could point to a Hurthle Cell Lesion associated with Hashimoto’s.    Must.  Stop.  Googling.