Excision is considered for persistently ND/UNS nodules because about 10% prove to be malignant.13. Alexander EK, Kennedy GC, Baloch ZW, Cibas ES, Chudova D, Diggans J, Friedman L, Kloos RT, LiVolsi VA, Mandel SJ, et al. In this pattern the nuclear enlargement is generalized in mild-to-moderate degree with evident nuclear grooves and mild nuclear pallor. Amyloid can be observed in close association with tumor cells, and can be distinguished from the thick colloid of PTC by performing a Congo-red stain. ZW RA The tall cell variant of PTC is an important subtype with a potentially aggressive clinical course. The most common scenarios can be described as follows: There is a prominent population of microfollicles in an aspirate that does not otherwise fulfill the criteria for follicular neoplasm/suspicious for follicular neoplasm. This situation may arise when a predominance of microfollicles is seen in a sparsely cellular aspirate with scant colloid. specimens with obscuring blood, poor cell preservation, and an insufficient sample of follicular cells. Quick tip: If the bone marrow is involved by metastatic carcinoma or clusters of cohesive plasma cells, these abnormal cells may not be amenable to aspiration and may cause a dry tap; however, a bone core biopsy will identify them. For patients with large tumors (> 4 cm), the best approach could be a total thyroidectomy, considering the fact that large tumors have an elevated risk of malignancy[40]. The AUS/FLUS category in the Bethesda system, represents aspirates that contain follicular, lymphoid, or other cell types with architectural and/or nuclear atypia that is more pronounced than that observed in benign lesions yet not sufficient to be characterized as suspicious for follicular neoplasm (SFN), or suspicious for malignancy[10]. et al. This category includes specimens with features characteristic of a malignant neoplasm, which are quantitatively or qualitatively insufficient to make a definitive diagnosis of malignancy (Figure (Figure4).4). According to the Bethesda system for reporting thyroid cytopathology, a specimen . Moreover, a lower percentage of cases in the European system was placed into the TIR 4 and TIR 5 categories as well, compared with the American system. The prepared core biopsy slides can be used for immunohistochemical (IHC) investigations (phenotyping the cells using IHC stains), and an initial standard hematoxylin and eosin stain is done to assess baseline histology. B The core biopsy is useful for assessing overall marrow cellularity, trilineage hematopoiesis, and marrow architecture. Piana S, Frasoldati A, Ferrari M, Valcavi R, Froio E, Barbieri V, Pedroni C, Gardini G. Is a five-category reporting scheme for thyroid fine needle aspiration cytology accurate? In 1966 Williams demonstrated that this tumor derives from the parafollicular cells, known also as calcitonin-producing C cells, which have an ectodermal neural crest origin[47]. In some cases more diffuse but mild nuclear changes may exist with nuclear enlargement, crowding, and pallor, but without other characteristics, such as nuclear contour irregularities, grooves and nuclear pseudoinclusions, suggestive of a PTC. moc.oohay@sokaisime. For example, increased serum calcitonin levels and/or strong immunoresponce of chromogranin which is disclosed after multiple FNA tests can indicate the diagnosis of a medullary carcinoma. A: No. One subcategory includes cases with a microfollicular pattern and minimal colloid, that is, follicular lesion of undetermined significance (FLUS). In sparsely cellular samples especially the urine, CSF and sometimes serous effusions . This is an aggressive variant of PTC characterized by the presence of crowded, stratified clusters of elongated cells resembling cells from a colonic adenoma. The high sensitivity rate, as well as the high negative prognostic value of BRAF testing in AUS/FLUS and SFN/SFN categories have been also demonstrated by Alexander et al[57]. These include hypocellular smears with extensive cystic degeneration with rare follicular cells with nuclear atypia indicative of PTC. Human immunodeficiency virus (HIV)-associated cystic lymphoepithelial lesions. The diagnosis of MTC can be confirmed by simply measuring serum calcitonin levels, which are markedly elevated in the majority of cases (> 10 pg/mL)[48]. Several systems have been proposed for the cyropathologic diagnosis of the thyroid nodules. The nuclei have conventional PTC nuclear features that distinguish it from Hurthle cell neoplasms[35]. Any specimen that contains abundant colloid is adequate (and benign), even if six 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. As a result, 3 to 15 glass slides from each patient are taken and examined, which can be either Giemsa- or Papanikolaou-stained slides[14]. The cancer cells are also elongated, with a height-to-weight ratio of at least 3:1. Cellular crowding and overlapping are conspicuous, and the follicular cells are usually larger than normal. The risk of malignancy for an AUS nodule is difficult to ascertain because only a minority of cases in this category have surgical follow-up. Another diagnostic option for patients with repeat ultrasonography-guided FNA of thyroid nodule with non-diagnostic cytology results, would be the utilization of ultrasonography-guided core needle biopsy[39]. (2021).Demystifying the Bone Marrow Biopsy: A Hematopathology Primer. 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. Deveci Distant metastases seldom occur, but may develop in 20% of cases in late stage. 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. Melton LJ Descriptive comments that follow are used to subclassify the benign interpretation. The presence of true psammoma bodies with concentric laminations is highly suggestive of PTC; however the presence of psammoma bodies in cystic thyroid lesions is not diagnostic. Baloch The adequacy of a thyroid FNA is defined by both the quantity and quality of the cellular and colloid components. 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. Thyroid nodules is a very usual clinical problem, as it is diagnosed in approximately 60% of the general population in Western countries[1]. Although these nuclear alterations are usually disseminated, they are mild and incomplete. Faquin ME hWkO+t{9! x,{d^O*D van Hoeven Pathology and Genetics of Tumours of Endocrine Organs, Genetic and biological subgroups of low-stage follicular thyroid cancer. III The cellular sample is typically monomorphic, although some specimens may appear pleomorphic; the cells are usually small or medium-sized, noncohesive, and contain an eccentrically located nuclei[35]. 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]. PTC most commonly metastasizes via lymphatics. In this review we analyze current literature regarding Thyroid Cytopathology Reporting systems trying to identify the most suitable and practical methodology to use in everyday clinical practice. Before the routine use of thyroid FNA, the percentage of surgically resected thyroid nodules that were malignant was 14%.1 With current thyroid FNA practice, the percentage of resected nodules that are malignant surpasses 50%.2. Search for other works by this author on: Fine-needle aspiration biopsy of thyroid nodules: impact on thyroid practice and cost of care, Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation, The Bethesda System for Reporting Thyroid Cytopathology, Diagnostic terminology and morphologic criteria for cytologic diagnosis of thyroid lesions: a synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference, The: National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference: a summation, Fine-needle aspiration cytology of the thyroid, 1980 to 1986, Long-term follow-up of patients with benign thyroid fine-needle aspiration cytologic diagnoses, Usefulness of fine-needle aspiration in the diagnosis of thyroid carcinoma: a retrospective study in 37,895 patients, Accuracy of thyroid fine-needle aspiration using receiver operator characteristic curves, Fine-needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations, Accuracy of fine-needle aspiration of thyroid: a review of 6226 cases and correlation with surgical or clinical outcome, Fine-needle aspiration cytology of the thyroid: a 12-year experience with 11,000 biopsies, Non-diagnostic fine-needle aspiration biopsy: a dilemma in management of nodular thyroid disease, Value of repeat fine needle aspiration (FNA) of the thyroid [abstract], Post thyroid FNA testing and treatment options: a synopsis of the National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference, Atypical cells in fine-needle aspiration biopsy specimens of benign thyroid cysts, NCCN thyroid carcinoma practice guidelines, Fine-needle aspiration of follicular lesions of the thyroid: diagnosis and follow-up, Diagnosis of follicular neoplasm: a gray zone in thyroid fine-needle aspiration cytology, Factors that predict malignant thyroid lesions when fine-needle aspiration is suspicious for follicular neoplasm., Thyroid cytology and the risk of malignancy in thyroid nodules: importance of nuclear atypia in indeterminate specimens, Fine-needle aspiration biopsy of the thyroid: an appraisal. A: Ideally, no. endstream endobj 93 0 obj <>>> endobj 94 0 obj <>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/Thumb 35 0 R/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 95 0 obj <>stream This system also contains guidelines for the diagnosis and treatment of indeterminate or suspicious for malignancy cases. 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. Seventeen . Phenotyping hematopoietic cells. Zubair W. Baloch, MD, PhD, served as chair of the Terminology and Morphologic Criteria committee. Broome JT, Solorzano CC. Does the fine-needle aspiration diagnosis of Hrthle-cell neoplasm/follicular neoplasm with oncocytic features denote increased risk of malignancy? The Bethesda System For Reporting Thyroid Cytopathology. Figure 5. Undifferentiated (anaplastic) thyroid carcinoma (UTC) is an extremely aggressive thyroid malignancy with a very poor prognosis. five below posters size, coromal caravan models, ecclesia of sinai beliefs,

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