et al. The reason is that in approximately 10%-30% of cases, cytology is indeterminate and nondiagnostic[4]. The sensitivity of thyroid FNA for medullary thyroid carcinoma (MTC) is considered high, actually it is higher than the sensitivity of FNA for PTC[36]. The prognosis of this tumor is good; death due to PTC is rare. Rosen
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The Bethesda System for Reporting Thyroid Cytopathology - OUP Academic
Frontiers | A Whole-Brain Cell-Type-Specific Sparse Neuron Labeling The adequacy of a thyroid FNA is defined by both the quantity and quality of the cellular and colloid components. Fine-needle aspiration biopsy (FNAB) showed sparsely cellular smears with a finely granular background and groups of cells arranged in 3-dimensional clusters and papillary formation (Figure 2, arrow). Additional benign findings (eg, black thyroid, reactive changes, radiation changes, cyst lining cells) can be mentioned as descriptive diagnoses at the discretion of the cytopathologist. The https:// ensures that you are connecting to the In: Clark DP, Faquin WC, editors.
The diagnosis of this variant as a PTC is relatively easy, due to the numerous papillae and the coexisting intranuclear inclusions.
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It also predicted cancer in the majority of indeterminate samples, as well as of the suspicious for cancer samples.
The precious cell block | Journal of Clinical Pathology A: Probably, yes. Figure 5.
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A complete bone marrow biopsy examination usually involves the review of these four specimens noted here in a slide tray: A) marrow aspirate smear, B) marrow core biopsy, C) clot section, and D) touch imprint preparation.
Specimen Adequacy and Non-diagnostic Thyroid Nodules
Primary angiosarcoma of breast: A case report and literature review. Chemotherapy or radiotherapy usually cannot change the dismal prognosis of this cancer. The most common malignant diagnosis made after surgery in cases initially classified as AUS/FLUS is PTC, usually of the follicular variant (PTC-FV)[24,25]. In such laboratories, macrophages only often constituted the great majority of ND/UNS cases, with rates that ranged from 15% to 30%.2,9,11,12 Other laboratories considered the risk of a false-negative result negligible and reported macrophages only as benign.10,11 At the 2007 NCI Conference, it was decided that cyst-fluid-only (CFO) cases should be considered a clearly identified subset of ND/UNS. Preparation Methods I
The first draft of the committees summary documents was posted on the Web site and open for online discussion from May 1 to June 30, 2007. What is one to do with the sparsely cellular specimen consisting mostly of microfollicles? . The management of cases with papillary microcarcinomas, i.e., tumors less than 1.0 cm in diameter, is still controversial. Lin
Approximately 3% to 7% of thyroid FNAs have conclusive features of malignancy, and most are papillary carcinomas.1013 Malignant nodules are usually removed by thyroidectomy, with some exceptions (eg, metastatic tumors, non-Hodgkin lymphomas, and undifferentiated carcinomas). Cibas
The nuclei have conventional PTC nuclear features that distinguish it from Hurthle cell neoplasms[35]. However, in almost 20% to 28% of AUS/FLUS cases, a repeat thyroid FNA will again be characterized as AUS/FLUS[27,28]. Benign follicular nodules often have a small population of microfollicles and crowded groups. Papillary thyroid carcinoma and variants. Q: Can your pathologist tell you what the core biopsy shows on the same day as the procedure? Remedy: The supernatant may not have been completely poured off resulting in dilution of the cell pellet. Since recurrent PTC typically secretes thyroglobulin, serum monitoring of thyroglobulin serves as a useful tumor marker for recurrent PTC[35]. Since the malignancy rate of this category is quite high, TBSRTC recommends that most patients undergo a repeat thyroid FNA within 3 to 6 mo, in order to define the nature of atypia[24,26]. Agarwal A, Kocjan G. FNAC thyroid reporting categories: value of using the British Thyroid Association (Thy 1 to Thy 5) thyroid FNAC reporting guidelines. Renshaw noted that a Hurthle cell neoplasm demonstrating one of the following features: Small cell dysplasia, large cell dysplasia, severe nuclear crowding, and dishesive cellular pattern is usually associated with a high risk of malignancy[33]. The main difference between the 5-tiered system and the 6-tiered system is that the DC III [atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS)] category is included only in the 6-tier system, a category with considerable prevalence, as it is calculated 6%-7% according to various statistics[14]. The hallmark of this diagnostic category is a disturbed cytoarchitecture: follicular cells are arranged predominantly in microfollicular or trabecular arrangements. If these constitute the minority of the follicular cells, they have little significance and the FNA can be interpreted as benign. Yang
Papillary thyroid carcinoma. In other cases it is sparsely cellular and contains atypical lymphoid cells. Statistics . Note granulocytic precursors (arrows) and erythroid cells (arrow heads). PK
Liquid-based preparation can also be made after a FNA pass, with the needle been rinsed in normal saline or ThinPrep solutions. Additionally an immunohistochemical panel, including thyroglobulin, TTF1, and CDX2 may help in the differential diagnosis of such difficult cases. Inadequate cellularity is defined as the presence of less than 6 groups of well-preserved follicular cells on each of at least two slides; (2) DC II Benign (Figure (Figure1).1). This category refers to cellular specimens with abundant follicular cells arranged in a microfollicular pattern with minimal colloid. This is an aggressive variant of PTC characterized by the presence of crowded, stratified clusters of elongated cells resembling cells from a colonic adenoma. Intussusception in an adult revealing a Vanek's tumor: A case report. Neutrophils are the same as WBCs, and as you know, it is normal to gave some WBCs in the urine. Three of the 28 specimens (11%) were sparsely cellular, and the rest (89%) were at least moderately cellular. These specimens demonstrate inadequate cellularity, poor fixation and preservation, obscuring blood or ultrasound gel, or a combination of the above factors. et al. The differential diagnosis includes hyperplastic adenomatous nodules, follicular adenoma, follicular carcinoma, and follicular variant of PTC, where the nuclear features remain ill defined. Nayar R, Ivanovic M. The indeterminate thyroid fine-needle aspiration: experience from an academic center using terminology similar to that proposed in the 2007 National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference. Edmund S. Cibas, MD, and Susan J. Mandel, MD, MPH, served as moderators. Nikiforov YE, Ohori NP, Hodak SP, Carty SE, LeBeau SO, Ferris RL, Yip L, Seethala RR, Tublin ME, Stang MT, et al. If the tumor is small and confined to the thyroid, thyroidectomy may be feasible; however, in most cases the tumor extends outside the thyroid gland preventing adequate resection[35]. The Bethesda System for Reporting Thyroid Cytopathology: Definitions, Criteria and Explanatory Notes. Review of the literature suggests a malignancy rate of 55%-75% for the suspicious category[8]. Several patterns of nuclear atypia may be also present without being quantitatively and/or qualitatively sufficient for the interpretation of suspicious for malignancy. ID
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This variant is sometimes difficult to diagnose, because in some cases the characteristic neoplastic cells are sparsely evident in the mass. Furthermore, various other thyroid FNA reporting systems have been created, in which the experiences of the pathologists and/or associated risks of malignancy have been taken into account. In a large study with 1382 cases in a community practice setting, in the United States, Wu et al[32] diagnosed AUS in 27% of cases, ranging from 10% to 47% among pathologists participating in the study. Various diagnostic terminologies, including indeterminate, atypical, and suspicious for malignancy, were used to describe these challenging cases[5]. These changes are not pathognomonic, as they are frequently detected in some PTCs, especially in the follicular variant, and in benign lesions as well, such as follicular adenomas. In conclusion, patients who require repeated FNAs for indeterminate diagnoses will be resolved by repeat FNA in a percentage of 72%-80%. Until recently there were no uniform criteria for the various diagnostic categories in thyroid cytopathology. The nuclei are hyperchromatic, uniform in size and shape, and with indinstinct nucleoli. While the V600E and K601E mutations were almost equally observed in the AUS/FLUS category, there was a slight predominance of K601E mutation in SFN/SHN category. Adequacy issues usually arise in sparsely cellular specimens, since low cellularity or inadequate representation may pose potential for missing a significant pathological process including malignancy. Fine-needle aspiration cytology (FNAC) has been widely adopted as a meticulous, secure and cost-effective method for the diagnosis of non-toxic thyroid nodules[1,2]. Benign cyst-lining cells are typically polygonal or fusiform with abundant cytoplasm, well-defined cellular borders, sometimes enlarged, grooved nuclei, and small distinct nucleoli. Half of patients present with significant compression of the upper respiratory and the digestive tract in the neck, resulting in dyspnea, hoarseness, dysphagia, and pain. Edmund S. Cibas, MD, Syed Z. Ali, MD, The Bethesda System for Reporting Thyroid Cytopathology, American Journal of Clinical Pathology, Volume 132, Issue 5, November 2009, Pages 658665, https://doi.org/10.1309/AJCPPHLWMI3JV4LA. The majority of the thyroid FNA specimens, in the range of 60% to 70%, are classified as benign, whereas approximately 20% to 30% fall into the 3 categories of suspicious for follicular neoplasm, suspicious for malignancy, and malignant[19]. et al. et al. Among thyroid malignancies, PTC has the highest propensity to appear cystic, as 10% of the PTC specimens are entirely cystic. Several systems have been proposed for the cyropathologic diagnosis of the thyroid nodules. Wu HH, Rose C, Elsheikh TM. G
Maybe a routine peripheral smear caught some circulating blasts. These cells constitute more than 50% of tumor volume[44]. What happens after you place the orders, though? The heterogeneity of this category precludes outlining all scenarios for which an AUS interpretation is appropriate. , eds. There are focal features suggestive of papillary carcinoma, including nuclear grooves, enlarged nuclei with pale chromatin, and alterations in nuclear contour and shape in an otherwise predominantly benign-appearing sample (especially in patients with Hashimoto thyroiditis or with abundant colloid and other benign-appearing follicular cells). Bongiovanni et al[14] analyzed the differences between the 5-tiered and the 6-tiered diagnostic systems for reporting thyroid cytopathology, based in a large series of 7686 thyroid FNA specimens, collected from 3751 patients from several institutions from Italy, Switzerland, and the United States. et al. Grant
Based on the findings (MRI, gross and histopathology) cysticercosis was confirmed. It generally affects elderly patients presenting as a firm mass rapidly growing in the neck infiltrating extrathyroidal tissues, such as muscle, trachea, esophagus, skin, bone and cartilage[49]. In addition, Ohori et al[61] investigated the utility of the above panel in specimens classified as FLUS. In this review we analyze all literature regarding Thyroid Cytopathology Reporting systems trying to identify the most suitable methodology to use in clinical practice for the preoperative diagnosis of thyroid nodules. . The term benign follicular nodule applies to the most common benign pattern: an adequately cellular specimen composed of varying proportions of colloid and benign follicular cells arranged as macrofollicles and macrofollicle fragments. Comparative findings of lymphocytic thyroiditis and thyroid lymphoma. Effect of the Bethesda system for reporting thyroid cytopathology on thyroidectomy rates and malignancy risk in cytologically indeterminate lesions. Any specimen that contains abundant colloid is considered adequate (and benign), even if 6 groups of follicular cells are not identified: A sparsely cellular specimen with abundant colloid is, by implication, a predominantly macrofollicular nodule and, therefore, almost certainly benign. Processing A collection method should harvest well-preserved cells that reliably represent any urinary tract lesion that might be present.
Cyst lining cells are usually elongated, containing pale chromatin, with sparsely found intranuclear grooves, large nucleoli, and always associated with hemosiderin-laden macrophages and benign-appearing macrofollicle fragments. The Bethesda System for Reporting Thyroid cytopathology. Herein, all histological types of thyroid carcinoma are included: PTC and its variants, medullary carcinoma, anaplastic carcinoma, lymphoma, and metastatic lesions. The cystic lining showed outer cellular and inner sparsely cellular areas [Table/Fig-8]. Yang
Lee TI, Yang HJ, Lin SY, Lee MT, Lin HD, Braverman LE, Tang KT. A specimen is considered as suspicious for malignancy (SFM), when some features of malignancy (usually PTC features) exist, but the findings are not sufficient for a definitive diagnosis[9]. Filie AC, Asa SL, Geisinger KR, Logani S, Merino M, Nikiforov YE, Clark DP. J
( a) In this sparsely cellular specimen, some of the cells had abundant cytoplasm and enlarged nuclei, some with prominent nucleoli. et al. The site is secure. Conspicuous cellularity alone does not qualify the nodule for a suspicious interpretation.23 If the sample is cellular but mostly macrofollicular (intact spheres and flat fragments of evenly spaced follicular cells), a benign interpretation is appropriate. endstream
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The 6 general diagnostic categories are shown in bold type in Table 1. Picture of four bone marrow specimens in a slide tray. Quick tip: Flow cytometry cannot be performed on the clot section after the clot has set and after fixation in formalin. The difficulties in securing diagnosis of a diffuse large B-cell lymphoma derive from the inadequate sampling technique and/or insufficient preservation of the specimen. MTC represents 3%-12% of thyroid cancers, the majority of which are sporadic.
Cerutti JM. Figure 4. Loose cellular material can be held together to make into a cell block in all of the following EXCEPT a. agar b. albumin c. blood clot d. resin resin A slide of breast fluid has the cells washing off during staining. It was apparent from the discussions at the conference and the Web postings that the primary purpose of terminology is clarity of communication. Gharib
Issue: Non-Gyn specimen slide is sparsely cellular when ample specimen collected and centrifuged cell pellet is visibly adequate. Kelman
In FNA specimens of this variant, the cancer cells appear more profuse, granular or vacuolated compared to regular PTC. Top Users Networks Stats .
et al. Centrifuge the specimen again and decant the entire supernatant. Immunohistochemistry test for specific biomarkers (i.e., calcitonin, thyroglobulin) will easily distinguish MTC from other thyroid malignancies. The spindle-shaped morphology of these cells is helpful in distinguishing these cells from PTC[24,34]. KH
The interpretation of follicular cell atypia is hindered by sample preparation artifact, eg, Air-drying artifact with slight nuclear and cytoplasmic enlargement, pale and slightly smudgy chromatin, and/or mildly irregular nuclear contours. Author contributions: Misiakos EP, Margari N, Meristoudis C, Petropoulos K, and Spathis A contributed significantly in preparation, collection of data, writing and critically revising the manuscript; Machairas N, Schizas D, Karakitsos P and Machairas A contributed in data analysis, and writing the manuscript. Lymphoepithelial cyst. In part, each component is analyzed and interpreted in correlation together for a final report. Because of the mixture of oncocytes with lymphocytes on smears, this tumor should be distinguished from Hashimoto thyroiditis or a follicular lesion with oncocytic changes[44]. Inadequate cellularity is defined as the presence of less than 6 groups of well-preserved follicular cells on each of at least two slides; (2) DC II Benign (Figure (Figure1).1). The FNA specimens show enlarged follicular cells arranged in monolayer sheets and follicular groups in a background of thin and thick colloid (Figure (Figure6).6). Thus, the maximal number of spermatids can be packed and supported by a fixed population . FCs have cytomorphologic features that distinguish them from benign follicular nodules. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Sherman SI, Tuttle RM. Lymphadenopathy is also present in one quarter to half of patients, whereas the lungs is the most common site of metastases[49,50]. A) 20 view of the bone marrow aspirate reveals a deeply basophilic smear of cells. VA
(iii) Cytologic and architectural atypia: Deshpande AH, Munshi MM, Bobhate SK. sparsely cellular sample but one that is comprised mostly of microfollicles. Psammoma bodies are occasionally seen in some aspirates, most possibly arising from calcification of epithelial tips.