Krane JF, Vanderlaan PA, Faquin WC, Renshaw AA. Bongiovanni et al[14] analyzed the differences between the 5-tiered and the 6-tiered diagnostic systems for reporting thyroid cytopathology, based in a large series of 7686 thyroid FNA specimens, collected from 3751 patients from several institutions from Italy, Switzerland, and the United States. Interestingly all predicted cancer proved to be papillary thyroid carcinoma in the final histology[59]. Jing X, Michael CW, Pu RT. 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. An official website of the United States government. 119 0 obj <>/Filter/FlateDecode/ID[<80B644DBD03A284F83277CD8A09960C6><94D1BF37A2B04B428378CFB47946E293>]/Index[92 53]/Info 91 0 R/Length 121/Prev 842357/Root 93 0 R/Size 145/Type/XRef/W[1 2 1]>>stream specimen from ileal conduits Urine samples from these conduits contain a large number of degenerated intestinal epithelial cells, and Regardless the staining method used, all slides with diagnostic material are used for the evaluation and clarification of each case. Most primary thyroid malignancies with the exception of follicular and Hurthle cell carcinomas have unique cytological features which can differentiate primary malignancies from other thyroid lesions. The project participants hope that the adoption of this flexible framework will facilitate communication among cytopathologists, endocrinologists, surgeons, radiologists, and other health care providers; facilitate cytologic-histologic correlation for thyroid diseases; facilitate research into the epidemiology, molecular biology, pathology, and diagnosis of thyroid diseases; and allow easy and reliable sharing of data from different laboratories for national and international collaborative studies. Guidelines for management of thyroid cancer. Summarizing 3 slide smear methods 6. Gough The National Cancer Institute Thyroid FNA State of the Science Conference: Wrapped up. Fadda et al. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Benign follicular nodules often have a small population of microfollicles and crowded groups. . Hypocellular or paucispicular smears preclude these assessments, which are not easily (or accurately) performed on the core biopsy (Table). Inadequate samples are reported as nondiagnostic (ND) or unsatisfactory (UNS). Ramzy sharing sensitive information, make sure youre on a federal In addition, Ohori et al[61] investigated the utility of the above panel in specimens classified as FLUS. The many faces and mimics of papillary thyroid carcinoma. In adult mammalian testes, spermatids, most notably step 17-19 spermatids in stage IV-VIII tubules, are aligned with their heads pointing toward the basement membrane and their tails toward the tubule lumen. In a large study with 1382 cases in a community practice setting, in the United States, Wu et al[32] diagnosed AUS in 27% of cases, ranging from 10% to 47% among pathologists participating in the study. The nucleoli are usually small and eccentric; however, rare oncocytic variants of PTC can show prominent nucleoli. Baloch Z, LiVolsi VA, Jain P, Jain R, Aljada I, Mandel S, Langer JE, Gupta PK. Yang Recognizably benign cellular changes (eg, typical cyst lining cells, focal Hrthle cell change, changes ascribed to radioiodine therapy, black thyroid) should not be interpreted as AUS. "American Society of Hematology. Cantara S, Capezzone M, Marchisotta S, Capuano S, Busonero G, Toti P, Di Santo A, Caruso G, Carli AF, Brilli L, et al. They are then stained and processed much like the original core biopsy. The AUS/FLUS category in the Bethesda system, represents aspirates that contain follicular, lymphoid, or other cell types with architectural and/or nuclear atypia that is more pronounced than that observed in benign lesions yet not sufficient to be characterized as suspicious for follicular neoplasm (SFN), or suspicious for malignancy[10]. 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]. These specimens are differentially used to study morphology, assess lineage, perform cell counts and differentials, triage and send for appropriate immunohistochemical stains, perform flow cytometry, and send ancillary cytogenetic and molecular genetic studies. The specimen is fixed in paraffin and cut for slide preparation. Such changes may represent atypical but benign cyst-lining cells, but a papillary carcinoma cannot be entirely excluded (ThinPrep, Papanicolaou stain). However; less than 10% of them represent malignant tumors. A moderately or markedly cellular sample is composed of a virtually exclusive population of Hrthle cells, yet the clinical setting suggests a benign Hrthle cell nodule, eg. A) 20 view of the bone marrow aspirate reveals a deeply basophilic smear of cells. For example, increased serum calcitonin levels and/or strong immunoresponce of chromogranin which is disclosed after multiple FNA tests can indicate the diagnosis of a medullary carcinoma. BRAF testing has been coupled successfully with the Bethesda Thyroid FNA classification system to offer molecular quality assurance on positive samples, as well as a diagnostic upgrade on samples of indeterminate diagnostic categories, such as AUS/FLUS and SFN/SHN[54]. Use freshly squeaky-cleaned slides. Table: Comparative advantages and drawbacks of the marrow aspirate versus the core biopsy. Centrifuge the specimen again and decant the entire supernatant. ES Before It is expected that the many benefits, clinical and investigational, of the Bethesda cervical terminology will also apply to the Bethesda thyroid terminology. Primary angiosarcoma of breast: A case report and literature review. The six-tier diagnostic approach includes the following six categories[8,15]: (1) Disctrict of columbia (DC)INondiagnostic or Unsatisfactory. You can now find us in many convenient retail stores, including select Walmart and Target locations. $AJ !b``3iK These specimens typically show sheets of bland thyroid follicular cells, which represent flattened macrofollicles. Q: Can your pathologist give you a preliminary assessment of the aspirate smear or flow cytometry analysis on the same day as a procedure if it was performed early in the morning? O The second subcategory includes cases with nuclear atypia, such as the presence of occasional nuclear grooves, nuclear crowding, and abnormal chromatin pattern, which are characteristics of papillary carcinoma (PTC). These specimens demonstrate inadequate cellularity, poor fixation and preservation, obscuring blood or ultrasound gel, or a combination of the above factors. LiVolsi 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. ES Bethesda, MD 20894, Web Policies 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 individual tumor cells are enlarged, oval in shape with eosinophilic cytoplasm; the nuclei show elongation, oval shape, membrane thickening, chromatin clearing, grooves, and inclusions. These specimens are differentially used to study morphology, assess lineage, perform cell counts and differentials, triage and send for appropriate immunohistochemical stains, perform flow cytometry, and send ancillary cytogenetic and molecular genetic studies. Some thyroid FNAs are not easily classified into the benign, suspicious, or malignant categories. Kelman Low and high power of clot particle. RA Additionally an immunohistochemical panel, including thyroglobulin, TTF1, and CDX2 may help in the differential diagnosis of such difficult cases. Thus, our aim was to standardize a manual, simple, cost-effective innovative technique, namely, ACS to process clear/sparsely cellular specimens and also to compare ACS smears along with cytocentrifuged specimens which were used as control smears. Immunohistochemistry test for specific biomarkers (i.e., calcitonin, thyroglobulin) will easily distinguish MTC from other thyroid malignancies. The TBSRTC classifies thyroid follicular lesions with microfollicle predominance and lack of colloid into the suspicious for follicular neoplasm category. 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. Tyrosine-derived polymeric surfactant nanospheres insert cholesterol in cell membranes. They can be readily classified as malignant due to nuclear pleomorphism, chromatin clumping, necrosis, atypical mitoses and other malignant features[40]. These specimens demonstrate inadequate cellularity, poor fixation and preservation, obscuring blood or ultrasound gel, or a combination of the above factors. Impact of mutational testing on the diagnosis and management of patients with cytologically indeterminate thyroid nodules: a prospective analysis of 1056 FNA samples. This is used to immediately make slide preparations on one to 10 pre-prepared glass slides which will be stained, usually within the Giemsa family of stains, to assess cellular morphology (how the cells look), perform a lineage assessment (what cell line they belong to, both by morphology and phenotyping), and provide a complete differential count (500 cells are counted). Picture of four bone marrow specimens in a slide tray. Preparation Methods CB Alexander EK, Kennedy GC, Baloch ZW, Cibas ES, Chudova D, Diggans J, Friedman L, Kloos RT, LiVolsi VA, Mandel SJ, et al. Gharib Many of the HCLUS cases did not show any of the above features and were proved to be benign adenomas. Nuclear atypia or pleomorphism and mitoses are uncommon. The terms for reporting results should have an implied (or explicit) risk of malignancy on which recommendations for patient management (eg, annual follow-up, repeated FNA, surgical lobectomy, near total thyroidectomy) can be based. FVPTC is characterized cytologically by the paucity of diagnostic nuclear features. Inadequate cellularity is defined as the presence of less than 6 groups of well-preserved follicular cells on each of at least two slides; (2) DC II Benign (Figure (Figure1).1). Faquin WC, Cibas ES, Renshaw AA. Within these sections, there are often small areas of hematopoietic material preserved from their original marrow environment. A review of the English literature was conducted, and data were analyzed and summarized and integrated from the authors perspective. Half of patients present with significant compression of the upper respiratory and the digestive tract in the neck, resulting in dyspnea, hoarseness, dysphagia, and pain. S It generally affects elderly patients presenting as a firm mass rapidly growing in the neck infiltrating extrathyroidal tissues, such as muscle, trachea, esophagus, skin, bone and cartilage[49]. Williams ED. American Society of Hematology. Rubenfeld In addition, obtaining adequate material at FNA is a very important issue, as the rates of malignancy observed in the nondiagnostic categories of both reporting systems are very high[14]. Results: We evaluated 5030 thyroid FNAs. Lin This distinction cannot be made by FNA and is of no consequence to the patient. These can be highly useful when a core biopsy is suboptimal, demonstrates marked myelofibrosis, is a dry tap, or otherwise fails to provide adequate visual data for morphology, architecture, cellularity, and hematopoietic lineage assessments. 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. They can be sparsely cellular, because of the marked fibrosis and hyalinization encountered in some cases[19,51]. CA LJ Diagnostic challenges in fine-needle aspiration and surgical pathology specimens. Before the specimen is transferred to a container with anticoagulant, some of the already clotted specimen may be submitted for permanent histology in formalin. Human immunodeficiency virus (HIV)-associated cystic lymphoepithelial lesions. Proposal of the SIAPEC-IAP Italian Consensus Working Group. Such patients were followed clinically with periodic physical and sonographic examinations. A moderately or even highly cellular specimen by itself (without significant nuclear or architectural atypia) does not qualify a nodule for an AUS interpretation. 36.3-50 mL); all 3 scantly cellular specimens had volumes below this median value. Without the bone marrow matrix, these slides contain only cells directly from the marrow and can be stained and assessed both for lineage and cytologic morphology, with high correlations to what may be seen on aspirate and biopsy. In several countries the Cytological Communities have adopted the first system or the other, as there is still an ongoing dispute on whether the 5-tiered system or the 6-tiered system is more efficient[12]. Some cases may present with diagnostic difficulty if the specimen consists mainly of necrotic debris or if the tumor is extremely sclerotic (the paucicellular variant)[40,53]. Pu Flat sheets showing enlarged, pale nuclei with finely granular chromatin of a papillary Ca case ( 40 pap stain on ThinPrep slide) (diagnostic categories VI). M There are also sheets of follicular cells with large pale nuclei and some with nuclear grooves, but without intranuclear inclusions. Hematoxylin-eosinstained sections of the clot particle. Of those that prove to be malignant, many are FCs, but a significant proportion are follicular variants of papillary carcinoma.2,8,11,19. Histologic trends in thyroid cancer 1969-1993: a clinico-pathologic analysis of the relative proportion of anaplastic carcinoma of the thyroid. 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]. hb```f``jg`e`bf@ a=TbO>9\!@)s\2q F)}w38|)0KQD[Vi>Rc@8[@5ii` .Q@q!d - `' }i@&QAz@%,700g& pL`r, l|Bj2"BTg]((@G@{2L2xVWA0Kk3\2 Ii
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