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Cytologic atypia can be quite striking in dyshormonogenetic goiter. In almost 20% of cases, it is so severe as to lead to a mistaken diagnosis of follicular, papillary, medullary, or undifferentiated carcinoma (Ghossein RA, Rosai J, Heffess C. Dyshormonogenetic goiter: A clinicopathologic study of 56 cases. Endocr Pathol 1997;8:283-92.)