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Fine-needle aspirates of three thyroid nodules displayed hypercellularity and papillary tissue fragments that suggested neoplasms. Neither microfollicles (either empty or with inspissated colloid) nor the characteristic nuclei of papillary carcinoma were evident. Surgical specimens contained adenomatoid nodules with focal papillary hyperplasia. These cases demonstrate that no single cytologic feature should be used independently in the cytologic diagnosis of thyroid lesions. Tumor cellularity and papillary tissue fragments should not be equated with neoplasia per se; all cytomorphologic features should be evaluated.

Palpable thyroid nodules are common in women. The thyroid gland may enlarge in response to hyperemia, relative iodine depletion, and slight stimulation by beta Human Chorionic Gonadotrophin (HCG) during pregnancy. The presence of goiter or a discrete nodule requires investigation. Fine-needle aspiration (FNA), a reliable diagnostic tool, can be safely used during pregnancy. The tenet that a "histologic hyperplasia" accompanies the physiologic hyperplasia of pregnancy may hamper FNA interpretation. We reviewed 97 (10 previous, 46 pregnant, 13 postpartum, 1 spontaneous abortion, and 27 follow-up) aspirates of thyroid nodules from 57 patients. Cytologic diagnoses were divided into five categories: 31 benign, 7 cellular adenomatoid nodules, 5 suspicious for papillary carcinoma, 12 papillary carcinomas, and 2 follicular neoplasms. There were an unanticipated number of carcinomas. Lesions present before pregnancy did not show "progression" or significant change. No characteristic features ascribable to pregnancy were identified. Standard diagnostic criteria may be used in the evaluation of FNA of thyroid nodules from pregnant patients.