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Difference between revisions of "Thyroid cytopathology"
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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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Note: | Note: | ||
*It is interesting that uniform spacing in the context of thyroid is benign... in breast suggests [[DCIS]]. | *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==== | ====Images==== | ||
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Image: Benign thyroid - FNA -- high mag.jpg | Thyroid - high mag. (WC) | Image: Benign thyroid - FNA -- high mag.jpg | Thyroid - high mag. (WC) | ||
Image: Benign thyroid - FNA -- very high mag.jpg | Thyroid - very 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> | </gallery> | ||
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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= | ||
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material. Scant follicular cells, Hurthle cells and colloid present in a background of | material. Scant follicular cells, Hurthle cells and colloid present in a background of | ||
mixed inflammatory cells and abundant macrophages. | 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. | Note: A repeat aspiration should be considered if clinically warranted. | ||
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=Waffle category= | =Waffle category= | ||
==Follicular lesion of undetermined significance== | ==Follicular lesion of undetermined significance== | ||
Abbreviated ''FLUS''. | *Abbreviated ''FLUS''. | ||
*Also known as ''atypia of undetermined significance'' (abbreviated ''AUS''). | |||
===General=== | ===General=== | ||
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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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#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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**Multinucleation. | **Multinucleation. | ||
DDx: | |||
* | *[[Granular cell tumour]]. | ||
====Images==== | ====Images==== | ||
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DDx: | DDx: | ||
*Anaplastic carcinoma. | *[[anaplastic thyroid carcinoma|Anaplastic carcinoma]]. | ||
Images: | Images: | ||