The morphology is similar to that seen on the core biopsy. Because the nuclear changes of FVPTC are subtle, the majority of cytologic samples are often diagnosed as suspicious for PTC. The isolated cyst-lining cells in thyroid aspirates are often difficult to distinguish from PTC. The adequacy of a thyroid FNA is defined by both the quantity and quality of the cellular and colloid components. Lloyd Cibas In: Ali SZ, Cibas ES, editors. The inherited forms are characterized by an autosomal dominant mode of inheritance and are associated with point mutations in the RET proto-oncogene on chromosome 10. The Bethesda thyroid fine-needle aspiration classification system: year 1 at an academic institution. The cancer cells are also elongated, with a height-to-weight ratio of at least 3:1. View an interactive bone marrow core biopsy online. Lee TI, Yang HJ, Lin SY, Lee MT, Lin HD, Braverman LE, Tang KT. Enlarged follicular cells arranged in monolayer sheets and follicular groups with nuclear elongation and chromatin clearing in a follicular variant of PTC case ( 40 pap stain on ThinPrep slide) (diagnostic categories VI). Sparsely cellular specimens: Sample w/ not many cells in suspension can be made more conc'd by Cytospin or centrifugation preparation: 1mL properly prepared cell suspension in funnel of cytospin, centrifuge, cells will be deposited on slide & fluid absorbed by filter paper: Problem: bloody specimens: An online atlas of illustrations of the Bethesda diagnostic categories is currently being assembled on the Papanicolaou Society Website under the direction of Syed Ali, MD, chair of the Online Atlas Committee. ES There is a predominance of Hrthle cells in a sparsely cellular aspirate with scant colloid. Click, Copyright PathologyOutlines.com, Inc. Click, 30150 Telegraph Road, Suite 119, Bingham Farms, Michigan 48025 (USA). Interestingly all predicted cancer proved to be papillary thyroid carcinoma in the final histology[59]. This category includes the diagnoses of nodular goiter, nodular goiter with hyperplastic nodules, colloid nodules, cyst contents with/without benign follicular cells, and lymphocytic thyroiditis; (3) DC III Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance (Figure (Figure2).2). HHS Vulnerability Disclosure, Help 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. 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]. In the World Health Organization classification, Hrthle cell adenoma and Hrthle cell carcinoma are considered oncocytic variants of FA and FC, respectively.24 Studies suggest, however, that follicular and Hrthle cell tumors have different underlying genetics.4,25 For this reason, and because they have such distinctive morphologic features, it is helpful to specify that a sample raises the possibility of a Hrthle cell rather than a follicular neoplasm. 2. A cellular specimen composed of Hrthle cells arranged in loosely cohesive sheets or isolated in a case diagnosed as Hrthle cell adenoma ( 40 pap stain on ThinPrep slide) (diagnostic categories IV). Note the trabecular bone (*) with trilineage hematopoiesis including megakaryocytes, granulocytic precursors, and erythroid islands presented in 2D following formalin fixation and paraffin processing. Most (60%75%) prove to be papillary carcinomas, and the rest are usually FAs.2,10,12,30. Johnson Baloch ZW, Cibas ES, Clark DP, Layfield LJ, Ljung BM, Pitman MB, Abati A. Chronic sialadenitis: sparsely cellular specimen with fewer lymphocytes and germinal center fragments; no characteristic lymphoepithelial islands. van Hoeven PDF Quality Assurance in Cytopathology and Histopathology of the Thyroid Employing genetic markers to improve diagnosis of thyroid tumor fine needle biopsy. Therefore the diagnosis SFM, suspicious for thyroid carcinoma is an indication for surgery. Listing the acceptable fixatives for use in cytology 5. Cytocentrifugation | SpringerLink The discs are 2 mm thick in the unprocessed state, but less thick when processed, and sometimes slightly . The main purpose of thyroid FNA is to stratify higher risk patients for surgery, and to prevent unnecessary surgeries for benign conditions. Paraspeckle - Wikipedia Unlike complete blood counts (CBCs), which produce fast results, a bone marrow analysis requires a more in-depth analysis and, as a more invasive procedure, necessitates built-in redundancies to ensure the highest-quality results. FNAs contain oncocytic cells with abundant granular cytoplasm, conventional nuclei, a papillary architecture, and a lymphoplasmacytic background. Unlike the core biopsy, decalcification is not required for the clot section. Each of the categories has an implied cancer risk (ranging from 0% to 3% for the benign category to virtually 100% for the malignant category) that links it to a rational clinical management guideline Table 2. Each diagnostic category is associated with a specific risk of malignancy and a recommendation for management. IB Immediately after the core biopsy is obtained, the procured tissue is "touched" several times onto glass slides. Most primary thyroid malignancies with the exception of follicular and Hurthle cell carcinomas have unique cytological features which can differentiate primary malignancies from other thyroid lesions. Specifically, the ultrasound image of the malignant nodule, as well as the patients general condition and age and other comorbidities should be taken into account when planning surgery. 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]. Figure 1. Liquid-based preparation can also be made after a FNA pass, with the needle been rinsed in normal saline or ThinPrep solutions. The National Cancer Institute Thyroid FNA State of the Science Conference: Wrapped up. Faquin WC, Cibas ES, Renshaw AA. Jo VY, Stelow EB, Dustin SM, Hanley KZ. Therefore, detailed neuronal morphology is required to understand normal neuronal function . Before Many laboratories have traditionally considered a macrophages-only sample unsatisfactory and included them in the ND/UNS category, with the understanding that, because the parenchyma of the nodule has not been sampled, one cannot exclude a cystic papillary carcinoma. Cantara et al[59] evaluated this panel of tumor-associated mutations in thyroid FNA samples. Therefore, it is not prudent to remove every thyroid nodule we encounter in our medical practice. It allows classification of nodules as benign or malignant, and patients with malignant nodules are scheduled for surgery. Recognizably benign cellular changes (eg, typical cyst lining cells, focal Hrthle cell change, changes ascribed to radioiodine therapy, black thyroid) should not be interpreted as AUS. In 2007 the Royal College of Pathologists introduced a new thyroid FNA reporting system, which was based on the existing United Kingdom terminology, but with some alterations, like new subcategories (i.e., c for cystic lesions, a for atypia, f for follicular neoplasm). There may be small fragments of amorphous material-colloid vs amyloid. 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. Nikiforov YE, Ohori NP, Hodak SP, Carty SE, LeBeau SO, Ferris RL, Yip L, Seethala RR, Tublin ME, Stang MT, et al. Broome JT, Solorzano CC. Management of a solitary thyroid nodule. Undifferentiated (anaplastic) thyroid carcinoma (UTC) is an extremely aggressive thyroid malignancy with a very poor prognosis. JR %%EOF Sparsely Definition & Meaning | Dictionary.com et al. Venkatesh YS, Ordonez NG, Schultz PN, Hickey RC, Goepfert H, Samaan NA. Excision is considered for persistently ND/UNS nodules because about 10% prove to be malignant.13. Hypocellular or paucispicular smears preclude these assessments, which are not easily (or accurately) performed on the core biopsy (Table). Thus, our aim was to standardize a manual, simple, cost-effective innovative technique, namely, ACS to process clear/sparsely cellular specimens and also to compare ACS smears along with cytocentrifuged specimens which were used as control smears. The individual tumor cells are enlarged, oval in shape with eosinophilic cytoplasm; the nuclei show elongation, oval shape, membrane thickening, chromatin clearing, grooves, and inclusions. Bone core biopsy. Atypia of Undetermined Significance/Follicular Lesion of - Springer 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]. lobectomy). 92 0 obj <> endobj 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]. As with the Bethesda System for cervical cytology, it is expected that subsequent workshops will lead to further refinements to this framework. 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 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). Benson et al. Urine cytology-general principles Flashcards | Quizlet Bukhari MH, Niazi S, Hanif G, Qureshi SS, Munir M, Hasan M, Naeem S. An updated audit of fine needle aspiration cytology procedure of solitary thyroid nodule. Dottorini Figure 5. 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 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. The TBSRTC classifies thyroid follicular lesions with microfollicle predominance and lack of colloid into the suspicious for follicular neoplasm category. This category refers to cellular specimens with abundant follicular cells arranged in a microfollicular pattern with minimal colloid. Cross PA, Poller D. The Bethesda thyroid terminology and progress towards international agreement on thyroid FNA cytology reporting. Cytological diagnosis of paucicellular variant of anaplastic carcinoma of thyroid: report of two cases. Many of the HCLUS cases did not show any of the above features and were proved to be benign adenomas. However, nuclear grooves can be seen also in several thyroid diseases such, as Hashimotos thyroiditis, multinodular goiter, Hurthle cell tumors and medullary carcinoma[42,43]. Baloch ZW, LiVolsi VA. Cytologic and architectural mimics of papillary thyroid carcinoma. b=D`.+u{tZ>aSW}\b_ ^/:'!!TQf1H7y` fY0Xa8 Renshaw Kocjan G, Cochand-Priollet B, de Agustin PP, Bourgain C, Chandra A, Daneshbod Y, Deery A, Duskova J, Ersoz C, Fadda G, et al. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. EK Thyroid FNA is a well established procedure used in the preoperative diagnosis of thyroid nodules. A syringe with applied negative pressure gently removes approximately 5 mL of deep red, semi-liquid marrow content. As a two-dimensional section of islands of preserved marrow content, the same stains applied to the core biopsy can be applied to the clot sections. Centrifuge each specimen, and resuspend the cell concentrate in about 5 mL balanced electrolyte solution. Even neurons of the same type show various subtle process characteristics to fit into the diverse neural circuits. A malignant thyroid FNA diagnosis accounts for 4%-8% of all thyroid FNAs, the majority of which are PTCs, and these patients will require thyroidectomy[53]. Incidence of malignancy in thyroid nodules determined to be follicular lesions of undetermined significance on fine-needle aspiration. The nuclear chromatin appears as salt and pepper type in a medullary carcinoma case ( 40 pap stain on ThinPrep slide) (diagnostic categories VI). National Center for Biotechnology Information Once obtained, the core biopsy is used to make touch preps (discussed below) and then is transferred into a container with appropriate fixative (usually formalin) and sent to the laboratory for processing. How do the different parts of a bone marrow workup relate to more in-depth analyses of morphology, markers, lineages, and overall diagnostic information? A print atlas, with more than 40 contributing authors Appendix 1, is in press.3. After the aspirate, the most expected informative component of a bone marrow workup is likely the core needle biopsy.
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