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'''Thyroid cytopathology''' is a large part of cytopathology.
[[Image:Benign thyroid - FNA -- very high mag.jpg|thumb|right|Benign thyroid cells. FNA specimens. (WC)]]
'''[[Thyroid]] cytopathology''' is a large part of cytopathology.


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==
=Normal thyroid=
Follicular cells:
===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===
*Uniform spacing of cells.
*Uniform spacing of cells.
*"Cracks" (spaces) between cell - "crazy paving".<ref name=Ref_APBR672>{{Ref APBR|672}}</ref>
*"Cracks" (spaces) between cell - "crazy paving".<ref name=Ref_APBR672>{{Ref APBR|672}}</ref>


Colloid - acellular crap with:
Note:
*It is interesting that uniform spacing in the context of thyroid is benign... in breast suggests [[DCIS]].
 
====Microfollicles====
Definition:<ref name=pmid16454552>{{Cite journal  | last1 = Renshaw | first1 = AA. | last2 = Wang | first2 = E. | last3 = Wilbur | first3 = D. | last4 = Hughes | first4 = JH. | last5 = Haja | first5 = J. | last6 = Henry | first6 = MR. | title = Interobserver agreement on microfollicles in thyroid fine-needle aspirates. | journal = Arch Pathol Lab Med | volume = 130 | issue = 2 | pages = 148-52 | month = Feb | year = 2006 | doi = 10.1043/1543-2165(2006)130[148:IAOMIT]2.0.CO;2 | PMID = 16454552 }}</ref>
*<15 follicular cells forming at least two thirds of a circle.
*Usually flat, i.e. not three dimensional.
 
Note:
*A small number of microfollicles is considered normal.
 
====Images====
<gallery>
Image: Benign thyroid - FNA -- high mag.jpg | Thyroid - high mag. (WC)
Image: Benign thyroid - FNA -- very high mag.jpg | Thyroid - very high mag. (WC)
</gallery>
<gallery>
Image: Endocrine atypia in thyroid - 1 -- high mag.jpg | Colloid and [[endocrine atypia]] - high mag. (WC)
Image: Endocrine atypia in thyroid - 2 -- very high mag.jpg | Colloid and endocrine atypia - very high mag. (WC)
</gallery>
 
===Colloid===
Essentially - acellular crap with:
*Irregular/sharp borders.
*Irregular/sharp borders.
*Cracks - '''key feature'''.
*Cracks - '''key feature'''.
*Dark (uniform) staining with 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]].
*+/-Entraped red blood cells (RBCs).
*+/-Entraped red blood cells (RBCs).


Note:
====Images====
*It is interesting that uniform spacing in the context of thyroid is benign... in breast suggests DCIS.
<gallery>
Image: Thyroid colloid - FNA -- high mag.jpg | Colloid - high mag. (WC)
Image: Thyroid colloid - FNA -- very high mag.jpg | Colloid - very high mag. (WC)
</gallery>
 
===Hurthle cells===
:May be spelled ''Hürthle cells''.
Features:
*Large epithelioid cells with red granular material on Pap stain.
*Should ''not'' form 3-D balls.
 
====Images====
<gallery>
Image: Hurthle cells - thyroid FNA -- high mag.jpg | HC - high mag. (WC)
Image: Hurthle cells - thyroid FNA -- very high mag.jpg | HC - very high mag. (WC)
</gallery>
 
=Normal parathyroid cytology=
{{Main|Parathyroid gland}}
===General===
*May be confused with thyroid.
**No single feature can be use to reliably separate them, though several features may allow this.<ref name=pmid11891946/>
*FNAs are not useful for parathyroid lesions;<ref name=pmid19283690/> however, a parathyroid may be sampled inadvertently.
 
===Cytology===
Chief cells:<ref name=pmid11891946>{{Cite journal  | last1 = Absher | first1 = KJ. | last2 = Truong | first2 = LD. | last3 = Khurana | first3 = KK. | last4 = Ramzy | first4 = I. | title = Parathyroid cytology: avoiding diagnostic pitfalls. | journal = Head Neck | volume = 24 | issue = 2 | pages = 157-64 | month = Feb | year = 2002 | doi =  | PMID = 11891946 }}</ref>
*Small round-to-oval nucleus.
*Granular chromatin.
*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 overlap.
*+/-Papillary fragments - uncommon.<ref name=pmid19283690>{{Cite journal  | last1 = Agarwal | first1 = AM. | last2 = Bentz | first2 = JS. | last3 = Hungerford | first3 = R. | last4 = Abraham | first4 = D. | title = Parathyroid fine-needle aspiration cytology in the evaluation of parathyroid adenoma: cytologic findings from 53 patients. | journal = Diagn Cytopathol | volume = 37 | issue = 6 | pages = 407-10 | month = Jun | year = 2009 | doi = 10.1002/dc.21020 | PMID = 19283690 }}</ref>
 
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>
 
DDx of naked nuclei:
*[[Granular cell tumour]].
*Parathyroid.<ref name=pmid19283690/>
 
=Adequacy criteria=
*>=60 follicular cells. †
*No atypical cells.
 
Note 1:
*† Typically described as: at least 6 groups (with 10 or more follicular cells) on at least two smears.<ref name=pmid9809173>{{Cite journal  | last1 = Carpi | first1 = A. | last2 = Sagripanti | first2 = A. | last3 = Nicolini | first3 = A. | last4 = Santini | first4 = S. | last5 = Ferrari | first5 = E. | last6 = Romani | first6 = R. | last7 = Di Coscio | first7 = G. | title = Large needle aspiration biopsy for reducing the rate of inadequate cytology on fine needle aspiration specimens from palpable thyroid nodules. | journal = Biomed Pharmacother | volume = 52 | issue = 7-8 | pages = 303-7 | month =  | year = 1998 | doi =  | PMID = 9809173 }}</ref>
 
Note 2:
*The inadequate & suspicious rate with these criteria is 10-30%. In excision specimens, 75-80% are benign.<ref name=pmid11940037>{{Cite journal  | last1 = Haugen | first1 = BR. | last2 = Woodmansee | first2 = WW. | last3 = McDermott | first3 = MT. | title = Towards improving the utility of fine-needle aspiration biopsy for the diagnosis of thyroid tumours. | journal = Clin Endocrinol (Oxf) | volume = 56 | issue = 3 | pages = 281-90 | month = Mar | year = 2002 | doi =  | PMID = 11940037 }}</ref>
**The above begs the question - should the criteria be changed?
 
===Sign out===
<pre>
Thyroid Gland, Right Lobe, Fine Needle Aspiration:
- Unsatisfactory; specimen processed and examined, but unsatisfactory due to insufficient
  material. Scant follicular cells, Hurthle cells and colloid present in a background of
  mixed inflammatory cells and abundant macrophages. 
 
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>
 
=Standard sign-out language=
There is a standard way of describing thyroid cytopathology results.
 
===Bethesda (2009)===
This is formally known as the "The Bethesda System for Reporting Thyroid Cytopathology"; it is based on the NCI classification of 2008:<ref name=pmid19888858>{{cite journal |author=Cibas ES, Ali SZ |title=The Bethesda System for Reporting Thyroid Cytopathology |journal=Thyroid |volume=19 |issue=11 |pages=1159–65 |year=2009 |month=November |pmid=19888858 |doi=10.1089/thy.2009.0274 |url=}}</ref>
{| class="wikitable"
|-
! Preferred
! Plain language
! Risk of malignancy
! Usual management
|-
| Benign
| Benign
| ~ 0-3%
| Follow-up, clinical
|-
| Follicular lesion of undetermined significance (FLUS)<br> ''or'' atypia of undetermined significance
| Uncertain, favour benign
| 5-15%
| Repeat FNA
|-
| Follicular neoplasm<br> ''or'' suspicious for follicular neoplasm; if oncocytic type it should be noted
| Uncertain, favour malignant
| 15-30%
| Hemithyroidectomy
|-
| Suspicious for malignancy
| Probably malignant
| 60-75%
| Repeat vs. hemithyroidectomy
|-
| Malignant
| Cancer
| ~ 97-99%
| Excise (total thyroidectomy)
|-
| Nondiagnostic or unsatisfactory
| Lesion missed or inadequate
| 1-4%
| Repeat FNA
|}


==Standard sign-out language==
===NCI (2008)===
There is a standard way of describing entities on thyroid cytology (from a National Cancer Institute (NCI) consensus conference):<ref name=pmid18478609>{{cite journal |author=Baloch ZW, LiVolsi VA, Asa SL, ''et al.'' |title=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 |journal=Diagn. Cytopathol. |volume=36 |issue=6 |pages=425-37 |year=2008 |month=June |pmid=18478609 |doi=10.1002/dc.20830 |url=}}</ref>
A National Cancer Institute (NCI) consensus conference in 2008:<ref name=pmid18478609>{{cite journal |author=Baloch ZW, LiVolsi VA, Asa SL, ''et al.'' |title=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 |journal=Diagn. Cytopathol. |volume=36 |issue=6 |pages=425-37 |year=2008 |month=June |pmid=18478609 |doi=10.1002/dc.20830 |url=}}</ref>
{| class="wikitable"
{| class="wikitable"
|-
|-
Line 34: Line 177:
| Follow/nothing
| Follow/nothing
|-
|-
| Follicular lesion of undetermined significance
| Follicular lesion of undetermined significance (FLUS)
| 1. Atypia of undetermined significance<br>2. Rule-out neoplasm<br>3. Atypical follicular lesion<br>4. Cellular follicular lesion
| 1. Atypia of undetermined significance<br>2. Rule-out neoplasm<br>3. Atypical follicular lesion<br>4. Cellular follicular lesion
| Uncertain, favour benign
| Uncertain, favour benign
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| Repeat FNA in 3 months
| Repeat FNA in 3 months
|}
|}
=Benign disease=
==Adenomatoid nodule==
{{Main|Adenomatoid nodule of the thyroid gland}}
===General===
*Diagnosis ''benign thyroid tissue''.
===Cytology===
Features:
*Benign follicular cells (abundant) with relatively little colloid.
DDx:
*[[Colloid nodule]] - has more colloid.
===Sign out===
<pre>
Thyroid Gland, Left, Fine Needle Aspiration:
- Benign.
- Cellular aspirate.
- Benign-appearing follicular cells with colloid, consistent with an adenomatous nodule.
</pre>
==Colloid nodule==
===General===
*Diagnosis ''benign thyroid tissue''.
===Cytology===
Features:
*Colloid - paucicellular material:
**"Thick" colloid = dense appearing blob, well-circumscribed +/- "cracking".
**"Watery" colloid = light, whispy/fluffy material.
*Macrofollicles:
**Ball of cells ~ 20 cells across.
====Images====
<gallery>
Image: Thyroid colloid - FNA -- high mag.jpg | Colloid - high mag. (WC)
Image: Thyroid colloid - FNA -- very high mag.jpg | Colloid - very high mag. (WC)
</gallery>
==Graves disease==
{{Main|Graves disease}}
===General===
*'''Clinical diagnosis''' - based on serology.
===Cytology===
Features:
*+/-Flame cells on [[Romanowsky stain]], e.g. Diff-Quik.<ref name=ouhsc_37>URL: [http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CQ-037-M.htm http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CQ-037-M.htm]. Accessed on: 10 April 2012.</ref>
**Red granular discolourization of the cytoplasm - thought to be endoplasmic reticulum.
Notes:
*Flame cells are indicative of cellular hyperactivity.
**Not pathognomonic for Graves disease, e.g. may be seen in early [[Hashimoto disease]],
Images:
*[http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CI-Image-0803/FQ-057a.gif Flame cells (ouhsc.edu)].<ref name=ouhsc_37/>
*[http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CI-Image-0803/FQ-057b.gif Flame cells (ouhsc.edu)].


==Lymphocytic thyroiditis==
==Lymphocytic thyroiditis==
===Microscopic===
===General===
*Non-specific finding.
**May represent [[Hashimoto thyroiditis]].
**Can be seen in [[Graves' disease]].<ref name=pmid6129766>{{Cite journal  | last1 = Leövey | first1 = A. | last2 = Bakó | first2 = G. | last3 = Sztojka | first3 = I. | last4 = Bordán | first4 = L. | last5 = Szabó | first5 = T. | last6 = Kálmán | first6 = K. | last7 = Balázs | first7 = C. | title = The pathogenetic connection between Graves' disease and chronic lymphocytic thyroiditis. (The role and incidence of thyroid stimulating antibodies). | journal = Acta Med Acad Sci Hung | volume = 39 | issue = 1-2 | pages = 1-6 | month =  | year = 1982 | doi =  | PMID = 6129766 }}</ref>
===Cytology===
Features:
Features:
#Lymphocytes not typical of circulating blood:
#Lymphocytes not typical of circulating blood:
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#**Small lymphocytes with a cleft.
#**Small lymphocytes with a cleft.
#*Centroblasts.
#*Centroblasts.
#**Large lymphocytes with nucleolus and eccentric nucleus.
#**Large lymphocytes with [[nucleolus]] and eccentric nucleus.
#*Plasma cells.
#*Plasma cells.
#**Cells with a "clockface nucleus".
#**Cells with a "clockface nucleus".
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*Usually #1 and #2 are seen.
*Usually #1 and #2 are seen.


===Hashimoto's thyroiditis===
===Hashimoto thyroiditis===
{{Main|Hashimoto thyroiditis}}
====General====
*'''This is a clinical diagnosis'''.
**It should be reported by the pathologist as "lymphocytic thyroiditis".
 
Associations:<ref name=Ref_APBR672>{{Ref APBR|672}}</ref><ref name=pmid7813361/>
Associations:<ref name=Ref_APBR672>{{Ref APBR|672}}</ref><ref name=pmid7813361/>
*AMA +ve.
*AMA +ve.
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*Increased risk of B-cell lymphoma.
*Increased risk of B-cell lymphoma.


====Cytology====
Features:<ref name=Ref_APBR672>{{Ref APBR|672}}</ref>
Features:<ref name=Ref_APBR672>{{Ref APBR|672}}</ref>
*Polymorphous lymphoplasmacytic infiltrate with germinal centres.
*Polymorphous lymphoplasmacytic infiltrate with germinal centres.
Line 102: Line 312:
**Found in almost 100% of cases.<ref name=pmid7813361 >{{cite journal |author=Poropatich C, Marcus D, Oertel YC |title=Hashimoto's thyroiditis: fine-needle aspirations of 50 asymptomatic cases |journal=Diagn. Cytopathol. |volume=11 |issue=2 |pages=141-5 |year=1994 |pmid=7813361 |doi= |url=http://www3.interscience.wiley.com/journal/112701408/abstract?CRETRY=1&SRETRY=0}}</ref>
**Found in almost 100% of cases.<ref name=pmid7813361 >{{cite journal |author=Poropatich C, Marcus D, Oertel YC |title=Hashimoto's thyroiditis: fine-needle aspirations of 50 asymptomatic cases |journal=Diagn. Cytopathol. |volume=11 |issue=2 |pages=141-5 |year=1994 |pmid=7813361 |doi= |url=http://www3.interscience.wiley.com/journal/112701408/abstract?CRETRY=1&SRETRY=0}}</ref>
*Lymphoglandular bodies.
*Lymphoglandular bodies.
**Cytoplasmic fragment of a lymphoid cell.<ref>[http://www.definition-of.com/lymphoglandular+body http://www.definition-of.com/lymphoglandular+body]</ref>
**Cytoplasmic fragment of a lymphoid cell.<ref>URL: [http://www.definition-of.com/lymphoglandular+body http://www.definition-of.com/lymphoglandular+body]. Accessed on: 27 January 2012.</ref>
 
Note:
*Lymphocyte infiltration into fragments of oncocytic cells - strongly suggestive of Hashimoto disease. (???)


====Diagnosis====
=Waffle category=
*This is a clinical diagnosis.
==Follicular lesion of undetermined significance==
**It should be reported by the pathologist as "lymphocytic thyroiditis".
*Abbreviated ''FLUS''.
*Also known as ''atypia of undetermined significance'' (abbreviated ''AUS'').
 
===General===
*This is [[waffle diagnosis]], i.e. something the pathologist diagnoses when they cannot decide whether it is benign or suspicious for malignant (''follicular neoplasm'' or ''suspicious for malignancy'').<ref name=pmid19373907>{{cite journal |author=Layfield LJ, Morton MJ, Cramer HM, Hirschowitz S |title=Implications of the proposed thyroid fine-needle aspiration category of "follicular lesion of undetermined significance": A five-year multi-institutional analysis |journal=Diagn. Cytopathol. |volume=37 |issue=10 |pages=710–4 |year=2009 |month=October |pmid=19373907 |doi=10.1002/dc.21093 |url=}}</ref>
**Like all waffle diagnoses...  
***Use should be minimized; < 7% is suggested, though it varies considerably between pathologists and institutions.<ref name=pmid19373907/>
 
===Cytology===
Features:
*Mild nuclear atypia - that by definition is insufficient for ''follicular neoplasm'' or ''suspicious for malignancy''.
**Mild irregularities in the nuclear contour.
**Mild size variation or nuclear enlargement.
**Mild accentuation of nuclear staining.
 
===Sign out===
<pre>
Atypia of undetermined significance (AUS).
</pre>


=Neoplastic and malignant=
==Papillary carcinoma==
==Papillary carcinoma==
*Papillary thyroid carcinoma is basically the only entity (in cytopathology) that has near universally accepted criteria.
{{Main|Papillary thyroid carcinoma}}
===General===
*[[Papillary thyroid carcinoma]] is basically the only entity (in cytopathology) that has near universally accepted criteria.
**This is why radiation oncologists say... "Basing stuff on pathology is like basing something on shifting sand."
**This is why radiation oncologists say... "Basing stuff on pathology is like basing something on shifting sand."


===Cytology===
===Cytology===
Criteria for papillary thyroid carcinoma:<ref>SM. 12 January 2010.</ref><ref>Kini SR. Guides to clinical aspiration biopsy: thryoid. 2nd Ed. 1996. P.134.</ref>
Criteria for papillary thyroid carcinoma:<ref>SM. 12 January 2010.</ref><ref>Kini SR. Guides to clinical aspiration biopsy: thryoid. 2nd Ed. 1996. P.134.</ref>
#Nuclear inclusion (really pseudoinclusions):<ref>Boerner SL, Asa SL. Biopsy Interpretation of the Thyroid. Lippincott williams & Wilkins. ISBN 978-0-7817-7204-4. PP.112-3.</ref>
#Nuclear inclusion (really pseudoinclusions):<ref>Boerner SL, Asa SL. Biopsy Interpretation of the Thyroid. Lippincott Williams & Wilkins. ISBN 978-0-7817-7204-4. PP.112-3.</ref>
##Edge of inclusion must be sharp (nuclear membrane-like).
##Edge of inclusion must be sharp (nuclear membrane-like).
##Size: at least 1/4 of the nucleus.
##Size: at least 1/4 of the nucleus.
Line 132: Line 366:
**Clump of epithelial cells with attached fibrous tissue "tail" - that has a smooth edge.
**Clump of epithelial cells with attached fibrous tissue "tail" - that has a smooth edge.
*Cellular/nuclear membrane overlapping; cells do not respect one another (very common).
*Cellular/nuclear membrane overlapping; cells do not respect one another (very common).
*+/-Psammoma bodies (uncommon - but helpful if seen).  
*+/-[[Psammoma bodies]] (uncommon - but helpful if seen).  


Notes:
Notes:
*Nuclear enlargement may be seen in Hashimoto's disease.<ref>WG. 8 January 2010.</ref>
*Nuclear enlargement may be seen in Hashimoto's disease.<ref>WG. 8 January 2010.</ref>
*Nuclear grooves may be seen in Hashimoto's disease.<ref>WG. 8 January 2010.</ref>
*Nuclear grooves may be seen in Hashimoto's disease.<ref>WG. 8 January 2010.</ref>
*Papillary architecture may be seen in Graves's disease.<ref>Biopsy Interpretation of the Thyroid. PP.97-98.</ref>
*Papillary architecture may be seen in [[Graves disease]].<ref>Biopsy Interpretation of the Thyroid. PP.97-98.</ref>
*Thick (dense) colloid common - described as "bubble gum". (???)
 
====Images====
<gallery>
Image: Papillary thyroid carcinoma -- intermed mag.jpg | PTC - intermed. mag. (WC)
Image: Papillary thyroid carcinoma -- high mag.jpg | PTC - high mag. (WC)
Image: Papillary thyroid carcinoma -- very high mag.jpg | PTC - very high mag. (WC)
 
Image: Papillary thyroid carcinoma - pi -- high mag.jpg | PTC - high mag. (WC)
Image: Papillary thyroid carcinoma - pi -- very high mag.jpg | PTC - very high mag. (WC)
</gallery>
<gallery>
Image:Papillary_Carcinoma_of_the_Thyroid.jpg | PTC. (WC)
</gallery>


===Variants of PTC===
===Variants of PTC===
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==Follicular neoplasm==
==Follicular neoplasm==
*Sort of a garbage category for the thyroid.
===General===
*Can be thought of as a (neoplasm) garbage category for the thyroid gland - may represent:
**[[Follicular adenoma]].
**[[Follicular carcinoma]].
 
Management:
*Hemithyroidectomy.


===Cytology===
===Cytology===
Line 159: Line 413:
#Nuclear overlap/crowding.
#Nuclear overlap/crowding.
#+/-Microfollicles, numerous.
#+/-Microfollicles, numerous.
#*Microfollicles are defined as: <15 cells forming at least two thirds of a circle.
#*[[Microfollicles]] are defined as: <15 cells forming at least two thirds of a circle.
#+/-Atypia marked.
#+/-Atypia marked.


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*A few microfollicles are normal.
*A few microfollicles are normal.
*''Atypia'' alone - "suspicious for malignancy" or "malignant".
*''Atypia'' alone - "suspicious for malignancy" or "malignant".
*Nuclei are described as having the shape of an ''orange'' in follicular neoplasms... and ''potatoes'' in papillary thyroid carcinomas.


Management:
==Oncocytic neoplasm==
*Hemithyroidectomy.
{{Main|Hürthle cell neoplasm}}
 
*[[AKA]] ''Hurthle cell neoplasm''.
==Oncocytic neoplasm (Hurthle cell neoplasm)==
===General===
General:
*''Oncocytic'' perferred by WHO over ''Hurthle cell''.
*''Oncocytic'' perferred by WHO over ''Hurthle cell''.


===Cytology===
Features:<ref name=pmid18478609/>
Features:<ref name=pmid18478609/>
#Single cells or sheets of oncocytic cells.
#Single cells or sheets of oncocytic cells.
Line 190: Line 445:
**Multinucleation.
**Multinucleation.


Diagnosis by MB:
DDx:
*If single cells -- need abundant.
*[[Granular cell tumour]].


Image:
====Images====
*[http://commons.wikimedia.org/wiki/File:Hurthle_cell_neoplasm.jpg Hurthle cell neoplasm (WC)].
<gallery>
Image:Hurthle_cell_neoplasm.jpg | Hurthle cell neoplasm. (WC)
</gallery>
www:
*[http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CI-Image-0803/FQ-059b.gif ON - Diff-Quik - intermed. mag. (ouhsc.edu)].<ref>URL: [http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CQ-039-M.htm http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CQ-039-M.htm]. Accessed on: 10 April 2012.</ref>
*[http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CI-Image-0803/FQ-059c.gif ON - Pap stain - high mag. (ouhsc.edu)].


==Medullary thryoid carcinoma==
==Medullary thryoid carcinoma==
{{Main|Medullary thyroid carcinoma}}
===General===
*May be familial - associated with MEN II syndrome.
*May be familial - associated with MEN II syndrome.
*Sometimes described as the ''melanoma of the thyroid'' - as it can look like almost anything.


===Cytology===
===Cytology===
Line 216: Line 479:


Notes:
Notes:
*May have pseudoinclusions - mimic papillary thyroid carcinoma.<ref>URL: [http://www.papsociety.org/guidelines/Morphologic%20criteria.doc http://www.papsociety.org/guidelines/Morphologic%20criteria.doc]. Accessed on: 28 April 2010.</ref>
*May have [[pseudoinclusions]] - mimic [[papillary thyroid carcinoma]].<ref>URL: [http://www.papsociety.org/guidelines/Morphologic%20criteria.doc http://www.papsociety.org/guidelines/Morphologic%20criteria.doc]. Accessed on: 28 April 2010.</ref>


DDx:
DDx:
*Anaplastic carcinoma.
*[[anaplastic thyroid carcinoma|Anaplastic carcinoma]].


Images:
Images:
Line 230: Line 493:
*Congo-red +ve (if amyloid present) - mnemonic: ''CRAP'' -- congo red amyloid protein.
*Congo-red +ve (if amyloid present) - mnemonic: ''CRAP'' -- congo red amyloid protein.


==Anaplastic carcinoma==
==Anaplastic thyroid carcinoma==
{{Main|Anaplastic thyroid carcinoma}}
===General===
*Prognosis: very crappy.
*Prognosis: very crappy.
*Classically rapid growth.
Note:
*Other fast growing lesion:
**Lymphoma (faster than anaplastic carcinoma).
**Blood accumulation.


===Cytology===
===Cytology===
Line 239: Line 510:
*Nucleolus.
*Nucleolus.
*Usually scant cellularity.<ref>GS. March 2, 2010.</ref>
*Usually scant cellularity.<ref>GS. March 2, 2010.</ref>
*Necrosis very common.
*[[Necrosis]] very common.


DDx:
DDx:
*Medullary carcinoma.
*Medullary thyroid carcinoma.


==See also==
=See also=
*[[Cytopathology]].
*[[Cytopathology]].
*[[Thyroid]].
*[[Thyroid gland]].


==References==
=References=
{{reflist|2}}
{{reflist|2}}


[[Category:Cytopathology]]
[[Category:Cytopathology]]
Michael
48,466

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