sparsely cellular specimen

Vimentin immunoexpression is also a common finding[52]. 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. They found that apart from the TIR III category, for the TIR 1/DCI(unsatisfactory/nondiagnostic) category the percentage of cases in the 5-tiered system was greater than twice the percentage of cases in the 6-tiered system (7.5% vs 3%). Presence of cell group with nuclear crowding, increased nuclear-cytoplasmic ratio, irregularities in nuclear membrane and micro-nuclei ( 40 pap stain on ThinPrep slide) (diagnostic categories V). Colombo 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. Conflict-of-interest statement: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported. However, there are cases with diagnostic uncertainty due to suboptimal sampling or preservation, and overlapping cytomorphologic features with other thyroid conditions. Patients with sporadic MTC present with a solitary, circumscribed thyroid nodule, usually in the middle to upper-outer half of the thyroid gland. Baloch ZW, LiVolsi VA. Cytologic and architectural mimics of papillary thyroid carcinoma. G Zubair W. Baloch, MD, PhD, served as chair of the Terminology and Morphologic Criteria committee. qA;`Yb]@b,@ "~Xbqs8J Summarizing 3 slide smear methods 6. For a thyroid FNA specimen to be satisfactory for evaluation (and benign), 6 . Fine-needle aspiration in the work-up of thyroid nodules. FVPTC is characterized cytologically by the paucity of diagnostic nuclear features. et al. Both the European and the American systems are considered as a significant accomplishment and hold the promise for better classification of thyroid FNA results[6,10,11,17,18]. Additionally, since the cells are smeared, they are technically three-dimensional, and morphology can be assessed. Pathologic Quiz Case: A Large, Ill-Defined Cystic Breast Mass - Allen Press Top Users Networks Stats . Preoperative diagnostic categories of fine needle aspiration - PLOS An AUS result is obtained in 3% to 6% of thyroid FNAs.2,10 Higher rates likely represent overuse of this category when other interpretations are more appropriate. The four components of a routine bone marrow analysis. 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). We also evaluated aspects of specimen quality that differed according to the use of ROSE. Does the fine-needle aspiration diagnosis of Hrthle-cell neoplasm/follicular neoplasm with oncocytic features denote increased risk of malignancy? Alexander EK, Kennedy GC, Baloch ZW, Cibas ES, Chudova D, Diggans J, Friedman L, Kloos RT, LiVolsi VA, Mandel SJ, et al. Such changes may represent atypical but benign cyst lining cells, but a papillary carcinoma cannot be entirely excluded (ThinPrep, Papanicolaou stain). However, in almost 25%-30% of cases, MTC is inherited, and is associated with one of three familial syndromes: Multiple endocrine neoplasia (MEN) syndrome type 2A (Sipples syndrome), MEN type 2B (mucosa neuroma syndrome or Gorlins syndrome), and familial MTC[35]. The remaining 10% of cases represent a significant subset of thyroid specimens with some form of AUS/FLUS. van Heerden Characteristically, distinct granules (calcitonin granules) are spotted in the cytoplasm of the cancer cells, as well as eccentric nuclei, indicating a plasmacytoid appearance to the tumor cells. In these SFN/SFN and AUS/FLUS cases with the K601E mutation, the cytomorphology of the PTC specimens prevented a more definitive diagnosis, in contrast to cases where the V600E mutation was observed, whether the diagnosis resolved to a classic (CL) subtype, tall cell variant (TCV) subtype, or a solid (SD) PTC diagnosis. Hahn SY, Shin JH, Han BK, Ko EY, Ko ES. The precious cell block | Journal of Clinical Pathology That said, this specimen (if involved by a disease process) can be sent for genetic testing such as polymerase chain reaction and does not present the issue of being postdecalcification (which may hinder some genetic tests). However, this requires additional FNA passes or residual cellular material from the cytologic sample. Baloch ZW, LiVolsi VA. Fine-needle aspiration of thyroid nodules: past, present, and future. Edmund S. Cibas, MD, and Susan J. Mandel, MD, MPH, served as moderators. Renshaw AA. This category applies to specimens that are unsatisfactory owing to obscuring blood, overly thick smears, air drying of alcohol-fixed smears, or an inadequate number of follicular cells. Nuclear grooves become an important diagnostic feature when associated with an oval, enlarged nucleus with fine chromatin[41]. After patient preparation, sedation, and the procedure itself, a bone marrow investigation provides four specimen types for pathologist review (Figure 1): the bone marrow core biopsy, the bone marrow touch imprint, the bone marrow aspirate smear, and the bone marrow clot particle. Figure 3. While their individual turnaround times vary, these specimens are usually reported together to make sure all aspects are accounted for, which can take approximately three days on average. Inclusion in an NLM database does not imply endorsement of, or agreement with, Schnadig Dottorini A: Ideally, blasts should be calculated on the aspirate smear differential count; however, in cases where blasts express CD34, then a CD34 count on the core biopsy might be possible. Wright-Giemsa staining of the marrow aspirate smear. 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]. Redman R, Yoder BJ, Massoll NA. PK The management of each case derives from the category that is classified. It was apparent from the discussions at the conference and the Web postings that the primary purpose of terminology is clarity of communication. 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). As a library, NLM provides access to scientific literature. 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. 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. To collect as many cells as possible from sparsely cellular urine, the specimen should have which of the following techniques applied? The diagnosis of a MALT lymphoma of the thyroid requires the use of immunophenotyping by flow cytometry or immunocytochemistry[9,37]. S LJ Ohori NP, Nikiforova MN, Schoedel KE, LeBeau SO, Hodak SP, Seethala RR, Carty SE, Ogilvie JB, Yip L, Nikiforov YE. This is particularly true of the follicular variant of PTC, which can be difficult to distinguish from a benign follicular nodule.28 Other PTCs may be incompletely sampled and yield only a small number of abnormal cells.29 If only 1 or 2 characteristic features of PTC are present, if they are only focal and not widespread throughout the follicular cell population, or if the sample is sparsely cellular, a malignant diagnosis cannot be made with certainty. Atypical cells in fine-needle aspiration biopsy specimens of benign thyroid cysts. 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). "Demystifying the Bone Marrow Biopsy: A Hematopathology Primer, 01 May. Neutrophils are the same as WBCs, and as you know, it is normal to gave some WBCs in the urine. The aspirates from anaplastic carcinoma do not pose any diagnostic difficulties. These features could be intranuclear inclusions, nuclear grooves, or psammoma calcifications; (6) DC VI Malignant (Figures (Figures55--7).7). LiVolsi Interestingly all predicted cancer proved to be papillary thyroid carcinoma in the final histology[59]. 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. Papaparaskeva K, Nagel H, Droese M. Cytologic diagnosis of medullary carcinoma of the thyroid gland. This conference established the Bethesda System for Reporting Thyroid Cytopathology (BSRTC), a 6-tiered diagnostic classification system based on a probabilistic approach[8,9]. Before the specimen is transferred to a container with anticoagulant, some of the already clotted specimen may be submitted for permanent histology in formalin. Deshpande AH, Munshi MM, Bobhate SK. Map ; Apps; Tools . Proposal of the SIAPEC-IAP Italian Consensus Working Group. It is not widely agreed whether this neoplasm is a variant of PTC or not, although it seems to have the same RET gene rearrangements as PTC. A: Ideally, no. The .gov means its official. BRAF is not usually found in the follicular variant of papillary thyroid carcinoma, but is increasingly detectable in each step of dedifferentiation, including tall cell tumors and anaplastic cancer. ?K !o McHenry In order to establish a standardized diagnostic terminology/classification system for reporting thyroid FNAC results, the National Cancer Institute (NCI) in the United States sponsored the NCI Thyroid FNA State of the Science Conference with a group of experts at Bethesda, MD, in October 2007[7]. It is critical that cytopathologists communicate thyroid FNA interpretations to referring physicians in terms that are succinct, unambiguous, and clinically helpful. As such, the redundancies in place discussed here and the compound output of the four major components have synergistic effects on diagnostic evaluation. 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]. 92 0 obj <> endobj 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. Comparative findings of lymphocytic thyroiditis and thyroid lymphoma. It is the hope of all contributors to this project that this terminology proposal will be a valuable first step toward uniformity and consensus in the reporting of thyroid FNA interpretations. Ultrasound guidance is preferable than palpation-guided FNA for small nodules (< 1 cm), cystic lesions and when a prior FNA is nondiagnostic[13]. For most cases surgical resection is not an effective treatment and only palliative therapies are used. Deveci CS Sarasota Memorial Health Care System. C After this therapy the patients serum thyroglobulin levels should fall to undetectable levels. Contribution of molecular testing to thyroid fine-needle aspiration cytology of follicular lesion of undetermined significance/atypia of undetermined significance. Primary angiosarcoma of breast: A case report and literature review. Cellular crowding and overlapping are conspicuous, and the follicular cells are usually larger than normal. Pathology and Genetics of Tumours of Endocrine Organs, Genetic and biological subgroups of low-stage follicular thyroid cancer. Anaplastic carcinoma of the thyroid: a review of 84 cases of spindle and giant cell carcinoma of the thyroid. Almost simultaneously, in Europe, the British Thyroid Association-Royal College of Physicians and the Italian Society for Anatomic Pathology and Cytopathology-International Academy of Pathology (SIAPEC-IAP) thyroid reporting systems, each comprised of 5 diagnostic classes, have been introduced[10,11]. . VA et al. 2nd ed. The tumor cells show nuclear elongation, chromatin clearing, but nuclear grooves and inclusions are rare[40]. In this pattern benign follicular cells are detected, along with cells with nuclear enlargement, nuclear grooves, nuclear membrane irregularity, and/or nuclear molding, usually without any trace of intranuclear inclusions. and transmitted securely. O They can be readily classified as malignant due to nuclear pleomorphism, chromatin clumping, necrosis, atypical mitoses and other malignant features[40]. Sparsely Definition & Meaning | Dictionary.com However, the percentage of the cases classified into the TIR 3/DC IV (follicular proliferation/neoplasm) category was substantially smaller (4.6%) in the 5-tiered system compared with the 6-tiered system (23.8%). VA Therefore, detailed neuronal morphology is required to understand normal neuronal function . These small tumors may be incidentally discovered in glands removed for other reasons, they are treated with thyroidectomy; these patients usually do not need systemic 131I therapy and do not require a second-stage completion thyroidectomy. Horn RC. LiVolsi V Kinematic comparison between the knee after bicruciate stabilized total knee arthroplasty and the native knee: A cadaveric study. Therefore this tumor may mimic other thyroid tumors, such as Hurthle cell neoplasms, PTCs, anaplastic carcinomas, and metastatic tumors. Baloch of value in acquiring a cellular sample, possibly due to increasing hemodilution. $AJ !b``3iK Quick tip: Flow cytometry cannot be performed on the clot section after the clot has set and after fixation in formalin. Why do some investigations yield more, or less, information than others? Pedro Patricio de Agustin, MD, PhD, Department of Pathology, University Hospital 12 de Octubre, Madrid, Spain, Erik K. Alexander, MD, Department of Medicine, Brigham and Womens Hospital, Boston, MA, Sylvia L. Asa, MD, PhD, Department of Pathology and Laboratory Medicine, University of Toronto; University Health Network and Toronto Medical Laboratories; Ontario Cancer Institute, Toronto, Canada, Kristen A. Atkins, MD, Department of Pathology, University of Virginia Health System, Charlottesville, Manon Auger, MD, Department of Pathology, McGill University Health Center and McGill University, Montreal, Canada, Zubair W. Baloch, MD, PhD, Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, Katherine Berezowski, MD, Department of Pathology, Virginia Hospital Center, Arlington, Massimo Bongiovanni, MD, Department of Pathology, Geneva University Hospital, Geneva, Switzerland, Douglas P. Clark, MD, Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, Batrix Cochand-Priollet, MD, PhD, Department of Pathology, Lariboisire Hospital, University of Paris 7, Paris, France, Barbara A. Crothers, DO, Department of Pathology, Walter Reed Army Medical Center, Springfield, VA, Richard M. DeMay, MD, Department of Pathology, University of Chicago, Chicago, IL, Tarik M. Elsheikh, MD, Ball Memorial Hospital/PA Labs, Muncie, IN, William C. Faquin, MD, PhD, Department of Pathology, Massachusetts General Hospital, Boston, Armando C. Filie, MD, Laboratory of Pathology, National Cancer Institute, Bethesda, MD, Pinar Firat, MD, Department of Pathology, Hacettepe University, Ankara, Turkey, William J. Frable, MD, Department of Pathology, Medical College of Virginia Hospitals, Virginia Commonwealth University Medical Center, Richmond, Kim R. Geisinger, MD, Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, Hossein Gharib, MD, Department of Endocrinology, Mayo Clinic College of Medicine, Rochester, MN, Ulrike M. Hamper, MD, Department of Radiology and Radiological Sciences, The Johns Hopkins Medical Institutions, Baltimore, MD, Michael R. Henry, MD, Department of Laboratory Medicine and Pathology, Mayo Clinic and Foundation, Rochester, MN, Jeffrey F. Krane, MD, PhD, Department of Pathology, Brigham and Womens Hospital, Boston, MA, Lester J. Layfield, MD, Department of Pathology, University of Utah Hospital and Clinics, Salt Lake City, Virginia A. LiVolsi, MD, Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, Britt-Marie E. Ljung, MD, Department of Pathology, University of California San Francisco, Claire W. Michael, MD, Department of Pathology, University of Michigan Medical Center, Ann Arbor, Ritu Nayar, MD, Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, IL, Yolanda C. Oertel, MD, Department of Pathology, Washington Hospital Center, Washington, DC, Martha B. Pitman, MD, Department of Pathology, Massachusetts General Hospital, Boston, Celeste N. Powers, MD, PhD, Department of Pathology, Medical College of Virginia Hospitals, Virginia Commonwealth University Medical Center, Richmond, Stephen S. Raab, MD, Department of Pathology, University of Colorado at Denver, UCDHSC Anschutz Medical Campus, Aurora, Andrew A. Renshaw, MD, Department of Pathology, Baptist Hospital of Miami, Miami, FL, Juan Rosai, MD, Dipartimento di Patologia, Instituto Nazionale Tumori, Milano, Italy, Miguel A. Sanchez, MD, Department of Pathology, Englewood Hospital and Medical Center, Englewood, NJ, Vinod Shidham, MD, Department of Pathology, Medical College of Wisconsin, Milwaukee, Mary K. Sidawy, MD, Department of Pathology, Georgetown University Medical Center, Washington, DC, Gregg A. Staerkel, MD, Department of Pathology, the University of Texas M.D. On the other hand, these polarized spermatids also align across the plane of seminiferous epithelium, mimicking planar cell polarity (PCP . Research is directed to the identification of molecular markers that, in conjunction with FNA, can identify patients with a malignant nodule. In this pattern cystic degeneration with hemosiderin-laden macrophages is present. L The authors of the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) recommended that the DC III (AUS/FLUS) category should not exceed 7% of the thyroid FNA diagnoses, and the risk of malignancy in this category should be in the range of 5% to 15%[23]. The positive predictive value of a malignant FNA interpretation is 97% to 99%. 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. The atypia of undetermined significance/follicular lesion of undetermined significance: malignant ratio: a proposed performance measure for reporting in The Bethesda System for thyroid cytopathology. B) 1,000 view. The malignancy rate of the AUS/FLUS category is estimated to be between 5% and 15%[10], which is intermediate between that of the benign category (0%-3%) and that of the SFN category (15%-30%). Human immunodeficiency virus (HIV)-associated cystic lymphoepithelial lesions. 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. Some laboratories, for example, may want to state the risk of malignancy associated with the general category, based on their own data or that found in the literature (Table 2). The neoplastic cells resemble Hurthle cells but have diagnostic nuclear features of PTC. Auger M, Stelow EB, Yang GCH. These specimens demonstrate inadequate cellularity, poor fixation and preservation, obscuring blood or ultrasound gel, or a combination of the above factors. 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. Excision is considered for persistently ND/UNS nodules because about 10% prove to be malignant.13. The 2017 Bethesda System for Reporting Thyroid Cytopathology

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