Introduction. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is a significant step to standardize the reporting of thyroid fine needle aspiration (FNA). It has high predictive value, reproducibility, and improved clinical significance. Aim. The study was aimed to evaluate the diagnostic utility and reproducibility of “TBSRTC” at our institute. Methods and Material. The study included 646 thyroid FNAs which were reviewed by three pathologists and classified according to TBSRTC. Cytohistological correlation was done for 100 cases with surgical follow-up and the sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, and risk of malignancy (ROM) were calculated. The interobserver variation among three pathologists was also assessed. Results. The distribution of cases in various TBSRTC categories is as follows: I—nondiagnostic 13.8%, II—benign 75.9%, III—atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS) 1.2%, IV—follicular neoplasm (FN)/suspicious for follicular neoplasm (SFN) 3.7%, V—suspicious for malignancy (SM) 2.6%, and VI—malignant 2.8%. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy are 72.4%, 94.3%, 84%, 89.2%, and 87.9%, respectively. The ROM of various TBSRTC categories were II—8.5%; III—66.7%; IV—63.6%; and V and VI—100%. Cohen’s Weighted Kappa score was 0.99 which indicates almost perfect agreement among the three pathologists. Conclusions. Our study substantiates greater reproducibility among pathologists using TBSRTC to arrive at a precise diagnosis with an added advantage of predicting the risk of malignancy which enables the clinician to plan for follow-up or surgery and also the extent of surgery.

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Anaplastic Thyroid Carcinoma (ATC) is the most active and lethal kind of thyroid carcinoma with a peak incidence in the 6th to 7th decade; women comprising 55%-77% [1]. It accounts for 1% to 2% of all thyroid carcinomas [2]. ATC has a bad prognosis, with a median survival of 4 to 12 months from the time of diagnosis. [3,4]. The diagnosis of ATC is usually based on clinical examination and confirmed by FNAB or core biopsy. The incidence of ATC has steadily decreased over the past few decades, although the reason for this decline is unknown [5]. Here we discuss a case of anaplastic carcinoma of the thyroid, presenting unusually as a periampullary lesion in the gastro-intestinal tract and soft-tissue tumor over the right scapular region. To the best of our knowledge, ATC masquerading as gastro-intestinal tract mass lesion and soft-tissue tumor was never reported before.