Histopathological Spectrum of Thyroidectomy Specimens and Clinicopathological Characteristics of Thyroid Malignancy in Mogadishu, Somalia: A Retrospective Cross-Sectional Study

Abstract

Background Thyroid cancer incidence is rising globally; however, histopathological data from Somalia are scarce, and no comprehensive characterization of resected thyroid specimens has been reported. Methods A retrospective review of 438 thyroidectomy specimens reported at a histopathology referral laboratory in Mogadishu, Somalia, between 2022 and 2025 was performed. Each specimen was classified as benign, borderline, or malignant according to the World Health Organization criteria. The associations between malignancy and age and sex were examined using chi-square or Fisher exact tests and unadjusted logistic regression. Results The cohort was predominantly female (90%), with a median age of 37 years. Benign lesions accounted for 366 specimens, borderline lesions for 8, and malignant lesions for 64, giving an overall malignancy proportion of 14.6%. Nodular and colloid goiters dominated the benign diagnoses, and papillary thyroid carcinoma was the most frequent malignant subtype, accounting for 50 of 64 cases. Malignancy was highest in patients aged 30 years or younger (22.2%), and the variation across age groups was statistically significant. The incidence of malignancy did not differ significantly according to sex. Among malignant tumors, the median size was 3.0 cm, and most were in the early tumor category. Conclusion Benign goiter dominates thyroid surgical pathology in Mogadishu, while papillary carcinoma leads to a modest malignant burden that is proportionally greatest in younger patients. Strengthening pathology capacity, preoperative cytology, and cancer surveillance is therefore warranted. Plain Language Summary Thyroid surgery is common in Somalia; however, no one has described what the thyroid glands removed during surgery show when examined under a microscope. Therefore, doctors had little local evidence regarding the prevalence of thyroid cancer, the types of thyroid cancer, and the patients who are most likely to have it. We conducted this study to close this gap. We reviewed the laboratory records of 438 individuals who underwent thyroid surgery in Mogadishu between 2022 and 2025 and recorded each person’s age and sex, together with the final diagnosis made by the pathologist. We found that most patients had a thyroid condition that was not cancer. Nodular and colloid goiters, which are harmless glandular enlargements, were the most common diagnoses. Approximately one in seven people had thyroid cancer, and papillary thyroid carcinoma was the most common type. Cancer was found most often in people aged 30 years and younger and was as common in men as in women. A small number of people had borderline growths that were between harmless and cancerous. Most cancers measured approximately 3 cm across when removed. These results indicate that most thyroid operations in Mogadishu are performed for conditions that are not cancer; therefore, better testing before surgery could spare some people from unnecessary surgery. This also means that a young person with a thyroid lump should not be assumed to be at low risk. For doctors and pathologists, the findings offer a local reference point for recognizing thyroid disease and making accurate diagnoses. For health authorities, these provide the first baseline figures that can be used to plan cancer detection, treatment, and long-term monitoring across the country. plain-language-summary