Thyroid cytopathology: Difference between revisions
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This article deals only with thyroid cytopathology. An introduction to cytopathology is in the ''[[cytopathology]]'' article. Head and neck cytopathology is dealt with in the ''[[Head and neck cytopathology]]'' article. | This article deals only with thyroid cytopathology. An introduction to cytopathology is in the ''[[cytopathology]]'' article. Head and neck cytopathology is dealt with in the ''[[Head and neck cytopathology]]'' article. | ||
=Normal thyroid | =Normal thyroid= | ||
===Radiology=== | |||
Benign features - terms:<ref name=pmid19542415>{{Cite journal | last1 = Bonavita | first1 = JA. | last2 = Mayo | first2 = J. | last3 = Babb | first3 = J. | last4 = Bennett | first4 = G. | last5 = Oweity | first5 = T. | last6 = Macari | first6 = M. | last7 = Yee | first7 = J. | title = Pattern recognition of benign nodules at ultrasound of the thyroid: which nodules can be left alone? | journal = AJR Am J Roentgenol | volume = 193 | issue = 1 | pages = 207-13 | month = Jul | year = 2009 | doi = 10.2214/AJR.08.1820 | PMID = 19542415 }}</ref> | |||
*Spongiform configuration. | |||
*Colloid clot - cyst. | |||
*Giraffe pattern. | |||
*Diffuse hyperechogenicity. | |||
===Follicular cells=== | ===Follicular cells=== | ||
*Uniform spacing of cells. | *Uniform spacing of cells. | ||
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===Colloid=== | ===Colloid=== | ||
Paucicellular/acellular material with:<ref name=pmid15987502>{{cite journal |authors=Nguyen GK, Lee MW, Ginsberg J, Wragg T, Bilodeau D |title=Fine-needle aspiration of the thyroid: an overview |journal=Cytojournal |volume=2 |issue=1 |pages=12 |date=June 2005 |pmid=15987502 |pmc=1184092 |doi=10.1186/1742-6413-2-12 |url=}}</ref> | |||
*Irregular/sharp borders. | *Irregular/sharp borders. | ||
*Cracks - '''key feature'''. | *Cracks - '''key feature'''. | ||
*Bubble pattern. | |||
*Dark (uniform) staining with [[Romanowsky stain|Romanowsky type stains]]. | *Dark (uniform) staining with [[Romanowsky stain|Romanowsky type stains]]. | ||
**Green edge + red/orange centre with [[Pap stain]]. | **Green edge + red/orange centre with [[Pap stain]]. | ||
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*Granular chromatin. | *Granular chromatin. | ||
*Cytoplasm - often not distinct. | *Cytoplasm - often not distinct. | ||
*Scattered naked nuclei.<ref name=pmid24255635>{{Cite journal | last1 = Heo | first1 = I. | last2 = Park | first2 = S. | last3 = Jung | first3 = CW. | last4 = Koh | first4 = JS. | last5 = Lee | first5 = SS. | last6 = Seol | first6 = H. | last7 = Choi | first7 = HS. | last8 = Cho | first8 = SY. | title = Fine needle aspiration cytology of parathyroid lesions. | journal = Korean J Pathol | volume = 47 | issue = 5 | pages = 466-71 | month = Oct | year = 2013 | doi = 10.4132/KoreanJPathol.2013.47.5.466 | PMID = 24255635 }}</ref> | |||
*+/-Nuclear moulding. | *+/-Nuclear moulding. | ||
*+/-Nuclear overlap. | *+/-Nuclear overlap. | ||
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Images: | Images: | ||
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1770637/figure/f1/ Parathyroid gland (nih.gov)].<ref name=pmid15790694>{{Cite journal | last1 = Johnson | first1 = SJ. | last2 = Sheffield | first2 = EA. | last3 = McNicol | first3 = AM. | title = Best practice no 183. Examination of parathyroid gland specimens. | journal = J Clin Pathol | volume = 58 | issue = 4 | pages = 338-42 | month = Apr | year = 2005 | doi = 10.1136/jcp.2002.002550 | PMID = 15790694 | PMC = 1770637 }}</ref> | *[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1770637/figure/f1/ Parathyroid gland (nih.gov)].<ref name=pmid15790694>{{Cite journal | last1 = Johnson | first1 = SJ. | last2 = Sheffield | first2 = EA. | last3 = McNicol | first3 = AM. | title = Best practice no 183. Examination of parathyroid gland specimens. | journal = J Clin Pathol | volume = 58 | issue = 4 | pages = 338-42 | month = Apr | year = 2005 | doi = 10.1136/jcp.2002.002550 | PMID = 15790694 | PMC = 1770637 }}</ref> | ||
DDx of naked nuclei: | |||
*[[Granular cell tumour]]. | |||
*Parathyroid.<ref name=pmid19283690/> | |||
=Adequacy criteria= | =Adequacy criteria= | ||
*>=60 follicular cells. † | *>=60 follicular cells. † | ||
**If abundant colloid is present less follicular cells are accepted. | |||
*No atypical cells. | *No atypical cells. | ||
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Note: A repeat aspiration should be considered if clinically warranted. | Note: A repeat aspiration should be considered if clinically warranted. | ||
</pre> | |||
====Alternate==== | |||
<pre> | |||
Thyroid Gland, Right Lobe, Fine Needle Aspiration: | |||
- Non-diagnostic. (Category I) | |||
Specimen processed and examined, but unsatisfactory due to scant cellularity. | |||
Some cellular degeneration noted, rare colloid and inflammatory cells present. | |||
Note: A repeat aspiration should be considered if clinically warranted. | |||
</pre> | |||
====Abundant colloid==== | |||
<pre> | |||
Left Thyroid, FNA: BENIGN, see comment. | |||
Note: | |||
The specimen has abundant colloid. The background consists of histiocytes in keeping with a cyst. The number of follicular cells falls below the typically desired threshold; however, the case is sufficient on the basis of the abundant colloid, as per the 2023 Bethesda System for Reporting Thyroid Cytopathology. The clinical impression is noted. | |||
</pre> | </pre> | ||
=Standard sign-out language= | =Standard sign-out language= | ||
There is a standard way of describing thyroid cytopathology results. | There is a standard way of describing thyroid cytopathology results. | ||
===Bethesda (2023)=== | |||
*A new iteration of Bethesda 2009. | |||
===Bethesda (2009)=== | ===Bethesda (2009)=== | ||
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**Mild size variation or nuclear enlargement. | **Mild size variation or nuclear enlargement. | ||
**Mild accentuation of nuclear staining. | **Mild accentuation of nuclear staining. | ||
===Sign out=== | |||
<pre> | |||
Atypia of undetermined significance (AUS). | |||
</pre> | |||
=Neoplastic and malignant= | =Neoplastic and malignant= | ||
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**Multinucleation. | **Multinucleation. | ||
DDx: | |||
* | *[[Granular cell tumour]]. | ||
====Images==== | ====Images==== | ||
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DDx: | DDx: | ||
*Anaplastic carcinoma. | *[[anaplastic thyroid carcinoma|Anaplastic carcinoma]]. | ||
Images: | Images: | ||