Nuclear crease as a cytodiagnostic feature of papillary thyroid carcinoma in fine-needle aspiration biopsies

Nuclear crease or grooving was found to be a diagnostic feature of papillary thyroid carcinoma (PTC) in fine-needle aspiration (FNA) biopsies. The FNA biopsies of 37 cases of PTC, 50 cases of multinodular goiter, and 50 cases of follicular neoplasms (45 follicular adenomas and five follicular carcinomas) were examined. The diagnosis was histologically verified in all the cases. The nuclear crease was found to be present in 34 of 37 cases of PTC and in two of five cases of follicular carcinoma. There was no nuclear crease in any of the other cases examined. Thus, it is concluded that the nuclear crease is a fairly constant and characteristic feature of PTC in FNA biopsies and can be used as a valuable diagnostic criterion.     

“Cellular adenomatoid nodules” of the thyroid: Review of 219 fine-needle aspirates

We reviewed 219 consecutive thyroid aspirates previously diagnosed as “cellular adenomatoid nodule.” applying the criteria presented in this paper and reclassifying them as 146 adenomatoid nodules (AN), 31 cellular adenomatoid nodules (CELL-AN), 29 cellular adenomatoid nodules vs. follicular neoplasms (CELL-AN vs. FN), 5 follicular neoplasms (FN), 2 FN of oxyphilic cell type, 4 papillary carcinomas, and 2 chronic lymphocytic (Hashimoto's) thyroiditis. Of the 146 adenomatoid nodules, 14 occurred in multinodular goiters on histologic examination. Of the 31 CELL-AN, five had surgery: two were follicular adenomas, one was papillary carcinoma, and two were multinodular goiters. Of the 29 CELL-AN vs. FN, 11 had surgery: six were follicular adenomas, two were follicular carcinomas, two were multinodular goiters, and one was Hashimoto's thyroiditis. Surgery on four FN showed follicular adenomas (a fifth patient was lost to follow-up). Of the two FN of oxyphilic cell type, one was a multinodular goiter and the other a follicular adenoma with oxyphilic cells. Three of the four papillary carcinomas were confirmed histologically (one patient was lost to follow-up). Of the two cases showing Hashimoto's thyroiditis, one was diagnosed as FN on repeat aspiration and follicular carcinoma at surgery. After review, we identified 40 patients at higher risk of harboring a neoplasm and 31 with cellular adenomatoid nodules. Twenty-five underwent surgery with the above results. In the classification of follicular lesions of the thyroid by FNA, adherence to strict cytologic criteria helps identify those patients who will benefit most from surgery.     

Light and electron microscopic examination of fine-needle aspirates in the preoperative diagnosis of cartilaginous tumors

Twenty-eight patients with chondrogenic tumours--2 chondroblastomas, 4 chondromas, 18 chondrosarcomas, 1 clear-cell chondrosarcoma, and 3 mesenchymal chondrosarcomas--underwent fine-needle aspiration biopsy (FNAB) in the preoperative investigation. The cytologic features in smears were compared with the histopathologic findings in the surgical specimens; in 14 cases they were also compared with the light and electron microscopic findings in resin-embedded fine-needle aspirates. The smears of the vast majority of the classical chondrosarcomas presented features that made possible the FNAB diagnosis of a chondrogenic tumor to be made. In the case of the low-grade chondrosarcomas in particular, which were poorly or moderately cellular in smears and showed chondroblastic cells often in lacunary structures of hyaline matrix, consideration of the clinical presentation, size, location, and roentgenographic appearance was essential for the diagnosis of chondrosarcoma. On the other hand, the high-grade chondrosarcomas presented cytologic features that clearly indicated their malignancy and they usually had a myxoid matrix. The possible differential diagnoses that may arise from the FNAB diagnosis of cartilaginous tumors are discussed. The resin-embedding technique for the light and electron microscopic examination of FNABs, along with the histochemical analysis for the demonstration of sulphated glucosaminoglycans and the immunocytochemistry applied to smears, was found to be of value in the definite diagnosis, especially in the distinction of chondrogenic tumors from chordoma and metastatic mucous-producing carcinoma.     

Subacute thyroiditis: fine-needle aspiration cytology of 14 cases presenting with thyroid nodules

Subacute thyroiditis (SAT) is usually diagnosed clinically without the need for fine-needle aspiration. The cytologic literature on this condition is therefore rare. We report on 14 cases of SAT presenting with thyroid nodules. The majority of patients were women with a mean age of 46 yr. All had pain/tenderness in the thyroid area accompanied by fever or an elevated ESR. The salient cytologic features included cellular smears; multinucleated giant cells in 100% of cases, some ingesting colloid or neutrophils; fibrous fragments with enmeshed inflammatory cells were a constant feature; follicular cells were scant to absent in most cases. Granulomas were rare. Colloid, when present was thick, with central cracks and frayed edges. One case was suspicious for malignancy. We conclude that the cytologic features of SAT are predictable, particularly, in the appropriate clinical setting. FNA is also helpful in ruling out concomitant neoplastic conditions.     

Parotid gland fine-needle aspiration cytology: an approach to differential diagnosis

Parotid glands can undergo a wide range of pathologic changes that may be difficult to characterize by clinical features alone. No single diagnostic modality is currently accepted unequivocally as the definitive approach to parotid gland enlargement or tumors. Although it is generally accepted that fine-needle aspiration (FNA) biopsy is useful in the preoperative setting, the accuracy is highly dependent on both operator experience and the interpretative skills of the cytopathologist. Results of FNA biopsy must be considered in a global context, in conjunction with clinical and radiographic findings. The objectives of this paper are threefold: (1) to define the clinical role of parotid FNA, such that pathologists performing and/or interpreting such specimens have a clearer understanding of the expectations of our surgical colleagues; (2) to clearly describe a protocol for the performance of parotid FNA biopsy, including a discussion of complications and pitfalls; and (3) to present the cytologic differential diagnoses of diverse clinicopathologic parotid gland processes that may present as generalized enlargement, cystic lesions, or discrete masses.     

A diagnostic pitfall: nodular tumor-like squamous metaplasia with Hashimoto's thyroiditis mimicking a sclerosing mucoepidermoid carcinoma with eosinophilia

Nodular tumor-like squamous metaplasia with Hashimoto's thyroiditis is an exceptional, benign condition presenting diagnostic difficulties for the pathologist. The main differential diagnosis is a sclerosing mucoepidermoid carcinoma (SMC) with eosinophilia. One case arising in a 50-year-old Caucasian man is reported. Histologically, the nodule consisted of large nests of squamous cells surrounded by connective tissue in Hashimoto's thyroiditis. We present the different histological criteria, allowing us to eliminate an SMC and other neoplastic tumors of the thyroid. The etiology of this tumor-like lesion, which is still under debate, is discussed.     

Incidence of neoplasia in Hashimoto's thyroiditis: A fine-needle aspiration study

There is a recognized association between Hashimoto's thyroiditis (HT) and thyroid neoplasms. We reviewed fine-needle aspirations (FNAs) from 90 patients with HT to assess the contribution of this procedure. For seven patients, FNA showed HT and follicular neoplasm (n = 6) or HT and papillary carcinoma (n = 1). Eighteen patients underwent thyroid resection. Three patients had follicular adenomas which were not detected by FNA, one patient had papillary carcinoma confirmed, and six patients with follicular neoplasm by FNA were negative for tumor. Thus, 4% of our patients had confirmed neoplasms, an incidence lower than usually reported. One reason for the lower rate of neoplasia in our series was misinterpretation of follicular neoplasia in the background of HT. The cytologic changes in the hyperplastic follicular and metaplastic oncocytic epithelium are similar to those seen in follicular neoplasm. Our study suggests that these processes may be indistinguishable, and thus, in the presence of HT, the diagnosis of follicular neoplasm probably should not be rendered. Diagn Cytopathol 1996;14:38–42. © 1996 Wiley-Liss, Inc.     

Cytologic features in fine-needle aspirates from a sclerosing mucoepidermoid thyroid carcinoma with eosinophilia

Fine-needle aspirates from a sclerosing mucoepidermoid thyroid carcinoma with eosinophilia showed peculiar but nonspecific features. The overall picture seems more important than individual elements in recognizing this rare entity cytologically, since the predominant type of malignant cells has a deceptively bland appearance. The differential diagnoses include other primary thyroid malignancies, as well as metastatic growth and Hashimoto's thyroiditis. Diagn Cytopathol 1996;15:301–305. © 1996 Wiley-Liss, Inc.     

慢性淋巴细胞性甲状腺炎伴TRAb阴性的甲状腺相关性眼病1例

甲状腺相关性眼病是一种自身免疫系统紊乱引起的眼球后及眶周组织的浸润性病变,常与Graves病并存或先后发病,但慢性淋巴细胞性甲状腺炎中甲状腺相关性眼病较罕见。本文报告1例促甲状腺素受体抗体(TRAb)阴性,细针穿刺活检示弥漫性淋巴细胞浸润,符合慢性淋巴细胞性甲状腺炎相关性眼病的诊断病例。     

CA-125 in fine-needle aspirates of solid tumors: Comparison with cytologic diagnosis and carcinoembryonic antigen (CEA) assay

One hundred and twenty-two fine needle aspirates (FNA) from female patients were studied to determine whether CA-125 assay contributed to cytologic diagnosis and CEA assay. Cytologic examination was done on Papanicolaou-stained smears and cell blocks, CEA by EIA (Abbott Laboratory, > 5 ng/ml cutoff) and CA-125 by RIA (Abbott Laboratory, North Chicago, IL, > 66 μ/ml cutoff). Final diagnosis were correlated with histologic diagnosis when available, clinical, radiologic studies, and follow-up. Results: 29 benign, 93 malignant. Sensitivities and specificities: cytology, 91%, 100%; CEA: 59%, 86%; CA-125, 50%, 55%. CEA plus cytology sensitivity, 97%. CA-125 content was highest in endometrial/ovarian carcinoma (39,899 μ/ml) and < 5,000 μ/ml in other tumors and benign FNA in contrast to CEA which showed highest levels in carcinomas of colon, pancreas, and lung (> 280 ng/ml). While elevated CEA enhances the sensitivity of cytologic diagnosis of carcinomas of the colon, pancreas, and lung, low CEA and high CA-125 content supports an ovarian/endometrial primary. Diagn Cytopathol 1996;14:121–125. © 1996 Wiley-Liss, Inc.     

Pathologic Spectrum of Lymphocytic Infiltration and Recurrence of Papillary Thyroid Carcinoma

Purpose

The aim of this study was to investigate the prognosis of papillary thyroid carcinoma (PTC) patients according to different pathologic grades of lymphocytic thyroiditis (LT).

Materials and Methods

This study included 144 PTC patients who underwent total thyroidectomy with radioactive iodine remnant ablation therapy. Pathologic grades of LT were separated at two points, chronic lymphocytic thyroiditis (CLT) and Hashimoto thyroiditis (HT). Patients were divided into two groupings according to the presence of the diseases (Grouping 1; patients with CLT or HT and without CLT or HT, Grouping 2; patients with HT and without HT). The groupings were compared according to recurrence, clinicopathologic and ultrasound (US) characteristics, and disease free survival.

Results

Of 144 patients, 41 had CLT and 19 had HT. There were 10 patients (6.9%) with tumor recurrence. In both groupings, the presence of calcification was more frequently associated with patients with LT (p=0.041 and 0.047, respectively). In Grouping 2, the mean age at diagnosis was older in patients without HT compared to patients with HT (p=0.032). On multivariate analysis, the presence of LT was not an independent predictor of recurrence in both groupings. For both groupings, pathologic tumor size and taller than wide shape on US were independent predictors of recurrence. The presence of LT in PTC patients did not affect recurrence.

Conclusion

There was no relationship between PTC prognosis and different grades of LT. Pathologic tumor size and taller than wide shape on ultrasound were independent predictors of PTC recurrence regardless of concurrent LT.     

Thyroid cancer and thyroiditis in Salta,Argentina: a 40-yr study in relation to iodine prophylaxis

The natural history of thyroid cancer and thyroiditis in relation to iodine prophylaxis in the region of Salta, Argentina, where goiter is common was investigated over a time span of 40 yr. For analysis of thyroid cancer, the specimens were divided into two periods. The first 15 yr (59 cases), including 5 yr before prophylaxis, was compared with the second 25 yr (182 cases), a period well after salt iodination. Papillary carcinomas formed the largest group of tumors in both periods, with a significant increase in their proportion in the second period (44 vs 60%, x ²: p<0.05), while the percentage of follicular and undifferentiated carcinomas decreased and medullary carcinoma remained about the same. The ratio of papillary to follicular carcinoma rose from 1.7:1 in the first period to 3.1:1 in the second. Four thyroid lymphomas of non-Hodgkin’s B-cell type occurred in the second period in females over age 50. A severe lymphoid thyroiditis was present in the two cases with assessable background thyroid tissue. The frequency of moderate to severe lymphoid infiltrate in females rose from 2 of 12 (16.6%) in the preprophylaxis period to 34 of 114 (28.0%) in the last 25 yr after prophylaxis. After salt prophylaxis, thyroiditis was more frequent in patients with papillary carcinoma (36.2%) than in those with nonpapillary tumors (14.7%) (x ², p<0.02). These observations indicate that a high dietary intake of iodine may be associated with a high frequency of papillary carcinoma and thyroiditis, and that thyroiditis is more commonly associated with papillary carcinoma than with other thyroid tumors. The occurrence of non-Hodgkin’s lymphomas only in the postprophylaxis period may be linked to an increase in thyroiditis.     

Occlusive phlebitis,a diagnostic feature in Riedel's thyroiditis

Summary Five cases of Riedel's invasive fibrous thyroiditis are presented.-Clinically and histopathologically all cases fulfilled the criteria for this lesion. In both small and large veins there were inflammatory changes and obliteration of the lumen, followed by sclerosis. These changes were found in each operative specimen, and seemed to be a diagnostic feature of invasive fibrous thyroiditis. We consider this change to be an occlusive phlebitis, and have noted that it occurs in association with multifocal fibrosclerosis. Three stages can be recognised: infiltrative, occlusive and sclerotic.In other thyroid lesions such as Hashimoto's thyroiditis, granulomatous thyroiditis of the Quervain type and adenomatous goitre these peculiar changes in the veins were not found.     

Carcinoid tumors of the lung: cytologic differential diagnosis in fine-needle aspirates

Pulmonary carcinoid tumors presenting as peripheral or coin lesions are rare and radiologically may resemble other primary or metastatic neoplasms in the lung. This study consisted of the cytologic evaluation of fine-needle aspirates from five peripheral carcinoid tumors of the lung with particular reference to the differences between the cytologic manifestations of this neoplasm and of small-cell carcinoma and well-differentiated adenocarcinoma. Aspirates of typical carcinoid tumors are characterized by isolated cells and loose aggregates of cells; spindle- and oval-shaped cells of uniform size with scanty, pale eosinophilic cytoplasm; and nuclei with evenly dispersed finely granular chromatin and usually prominent single micronucleoli with occasional macronucleoli. In contrast, the cells of small-cell carcinoma are pleomorphic and arranged in noncohesive loose aggregates, their cytoplasm is scanty, and they show nuclear molding. Their nuclei are hyperchromatic with fine to coarsely granular chromatin. The cells of well-differentiated adenocarcinoma are arranged in three-dimensional clusters or loose aggregates of relatively uniform cells with a columnar configuration. The nuclei are uniformly round and hyperchromatic with finely granular chromatin. Macronucleoli are usually prominent. This study demonstrates that cytologic analysis of fine-needle aspirates can play a significant role in the evaluation and management of peripheral lung tumors.     

Coexistence of chronic lymphocytic thyroiditis with papillary thyroid carcinoma: clinical manifestation and prognostic outcome

The study aimed to identify the clinical characteristics of coexisting chronic lymphocytic thyroiditis (CLT) in papillary thyroid carcinoma (PTC) and to evaluate the influence on prognosis. A total of 1,357 patients who underwent thyroid surgery for PTC were included. The clinicopathological characteristics were identified. Patients who underwent total thyroidectomy (n = 597) were studied to evaluate the influence of coexistent CLT on prognosis. Among the total 1,357 patients, 359 (26.5%) had coexistent CLT. In the CLT group, the prevalence of females was higher than in the control group without CLT (P < 0.001). Mean tumor size and mean age in the patients with CLT were smaller than without CLT (P = 0.040, P = 0.047, respectively). Extrathyroidal extension in the patients with CLT was significantly lower than without CLT (P = 0.016). Among the subset of 597 patients, disease-free survival rate in the patients with CLT was significantly higher than without CLT (P = 0.042). However, the multivariate analysis did not reveal a negative association between CLT coexistence and recurrence. Patients with CLT display a greater female preponderance, smaller size, younger and lower extrathyroidal extension. CLT is not a significant independent negative predictive factor for recurrence, although presence of CLT indicates a reduced risk of recurrence.     

Nested PCR for diagnosis of tuberculous lymphadenitis and PCR-SSCP for identification of rifampicin resistance in fine-needle aspirates

An accurate diagnosis of tuberculosis and multidrug resistance is important for the control of tuberculosis, which remains a major public health problem. Fine-needle aspiration (FNA) has provided an alternative tool for bacterial examination. This study was performed to investigate the usefulness of one-step polymerase chain reaction (PCR) and PCR-SSCP as a routine test for the detection of Mycobacterium tuberculosis and rifampicin-resistant strain in FNA. Ziehl-Neelsen stain (Z-N) and PCR were processed using the aspirates of tuberculous lymphadenitis for the detection of M. tuberculosis. PCR-SSCP was done for the identification of rpoB mutation. M. tuberculosis was detected in 49/63 (77.8%) by PCR and 25/63 (39.7%) by Z-N. There were 26 cases with PCR(+)/Z-N(-) and two cases with PCR(-)/Z-N(+). Twelve cases showed negativity against both. In 7/22 (31.8%), rpoB mutation was observed. In conclusion, PCR is more sensitive in the detection of M. tuberculosis in FNA than Z-N. PCR-SSCP could also be used in FNA in the prediction of multidrug resistance.     

Immunohistological findings in Hashimoto's thyroiditis,focal lymphocytic thyroiditis and Thyroiditis de Quervain

Summary 65 cases of focal lymphocytic thyroiditis and Hashimoto's disease and five cases of thyroiditis de Quervain were studied with immunohistological methods. In both focal lymphocytic thyroiditis and Hashimoto's disease, lymph follicles with active germinal centers were found which contained germinal center cells that stained positively for intracytoplasmic immunoglobulins (heavy and/or light chains). Positively staining germinal center cells made up only a minor portion of overall immunoglobulin-positive cells; most of the positive infiltrating cells were plasmacytes arranged in small groups or clusters among thyroid follicles. Thus the number of immunoglobulin-containing cells differed greatly between focal lymphocytic thyroiditis, where sites of infiltration were represented by lymph follicles, and Hashimoto's disease. In the former, only a few cells outside lymph follicles stained positively for intracytoplasmic immunoglobulins, whereas in the latter numerous cells within areas of coherent infiltration did. Furthermore, in most cases of Hashimoto's disease macrophages and giant cells with positive staining for lysozyme were present in variable numbers, while in focal thyroiditis they were less frequent or absent. Between these two immunohistologically separable groups, i.e. focal lymphocytic thyroiditis and Hashimoto's disease, there were many cases with features of both. Considering the occurrence of such intermediate forms and some immunohistological similarities between Hashimoto's disease and focal lymphocytic thyroiditis (nearly identical ratio of the different immunoglobulin classes and similar distribution of immunoglobulin-positive germinal center cells), it is likely that these lesions represent different activities of a same immunological process.Thyroiditis de Quervain was characterized immunologically by numerous macrophage clusters and giant cells that both stained positively for lysozyme. Compared with the giant cells seen in Hashimoto's disease (mainly of Langhans type), those of de Quervain's thyroiditis (mainly of foreign body type) were larger and more numerous. Lymph follicles (with or without active germinal centers) were not observed. Among infiltrating cells, numerous plasmacytes that stained positively for intracytoplasmic immunoglobulins were identified. Their number and the distribution pattern of the different classes of immunoglobulins contained within them was similar to those seen in Hashimoto's disease.     

Neuritic Hansen's disease: An unusual presentation and a diagnostic challenge on fine-needle aspirate

Fine-needle aspiration cytology is now routinely used in the diagnosis of cervical lumps. We report on a case of leprous neuritis which presented as a cervical swelling. A diagnosis of leprosy was suggested on the basis of globi within histiocytes. These histiocytes differed from those classically described in leprosy. Retrospective review demonstrated the presence of occasional nerve fragments, and some of these closely resembled granulomas. The possible close resemblance of this lesion to tuberculosis and a histiocytic proliferative disorder is highlighted. Recognition of nerve fragments along with histiocytes should suggest the diagnosis. Diagn. Cytopathol. 1998;19:198–200. © 1998 Wiley-Liss, Inc.     

Hemangioma of the thyroid gland in an adolescent with chronic lymphocytic thyroiditis and adenomatous hyperplasia

We report a case of benign hemangioma of the thyroid gland which involved one lobe of the thyroid gland in an adolescent female with classic chronic lymphocytic thyroiditis and adenomatous hyperplasia. The lesion produced a clinical picture suspicious for malignancy owing to the presence of a very large cold nodule on scan, lack of response to TSH suppression, and the subsequent development of an enlarged cervical lymph node. The histologic and immunohistologic findings, including positive staining for factor VIII-related antigen,Ulex europaeous lectin, CD31, CD34, and the presence of linear staining for type IV collagen and laminin are consistent with a hemangioma. In our review of the literature, only one other report of a hemangioma of the thyroid gland was found.