Note the trabecular bone (*) with trilineage hematopoiesis including megakaryocytes, granulocytic precursors, and erythroid islands presented in 2D following formalin fixation and paraffin processing. CA Should atypical follicular cells in thyroid fine-needle aspirates be subclassified? In addition, Ohori et al[61] investigated the utility of the above panel in specimens classified as FLUS. Such cases occur with some regularity, and they are best classified as suspicious for malignancy, qualified as suspicious for papillary carcinoma. Nodules called suspicious for papillary carcinoma are resected by lobectomy or thyroidectomy. Oncocytic cells with nuclear features of papillary carcinoma are excluded from this interpretation. Your patients cytopenias remain unexplained. It usually behaves as an indolent malignant tumor; however, an aggressive clinical course with decreased survival has been reported in some histologic variants of PTC[41]. Issue: Non-Gyn specimen slide is sparsely cellular when ample specimen collected and centrifuged cell pellet is visibly adequate. 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]. Hematoxylin-eosinstained section of the bone core biopsy (100). Prepares and stains all specimen types (gyn, medical cytology, fna) for cytologic examination. S In a study that segregated CFO cases and analyzed them separately, the risk of malignancy for a CFO sample was 4%.9 The risk of malignancy for ND/UNS (not including CFO) is 1% to 4%.810, The Bethesda System for Reporting Thyroid Cytopathology: Recommended Diagnostic Categories*, The Bethesda System for Reporting Thyroid Cytopathology: Implied Risk of Malignancy and Recommended Clinical Management, A repeated aspiration with ultrasound guidance is recommended for ND/UNS and clinically or sonographically worrisome CFO cases and is diagnostic in 50% to 88% of cases,2,6,9,11,13,14 but some nodules remain persistently ND/UNS. These features could be intranuclear inclusions, nuclear grooves, or psammoma calcifications; (6) DC VI Malignant (Figures (Figures55--7).7). Since it is a two-dimensional specimen and reveals cells in cut section, it is not ideal for assessment of dysplasia (a marrow aspirate is preferred), but it is extremely useful in identifying possible reasons for a dry tap (a term for when liquid marrow cannot be aspirated during the bone marrow procedure), since the architecture can show fibrosis, sheets of cohesive plasma cells, or metastatic tumor which could result in a dry tap. Jo VY, Stelow EB, Dustin SM, Hanley KZ. Renshaw Whenever a specific diagnosis (eg, lymphocytic thyroiditis) can be rendered and whenever there is any atypia, the specimen is, by definition, adequate for evaluation. They can be sparsely cellular, because of the marked fibrosis and hyalinization encountered in some cases[19,51]. Melton As such, the redundancies in place discussed here and the compound output of the four major components have synergistic effects on diagnostic evaluation. Management of a solitary thyroid nodule. The risk of malignancy in the HCLUS category was significantly lower than in the other subtypes of AUS. The differential diagnosis for the latter includes hyperplastic adenomatoid nodule with Hurthle cell change, Hurthle cell adenoma, and Hurthle cell carcinoma; (5) DC V Suspicious for malignancy. The diagnosis of a MALT lymphoma of the thyroid requires the use of immunophenotyping by flow cytometry or immunocytochemistry[9,37]. ED In: Clark DP, Faquin WC, editors. The phenotypic composition of the various marrow components is key to understanding their utility for further investigative diagnostic studies. However, some three dimensional structures that resemble the epithelial tips of papillae without the fibrovascular cores can be seen[35]. The most widely known is the SIAPEC-IAP thyroid reporting system, which is also consists of 5 diagnostic classes[12]. hWkO+t{9! x,{d^O*D Accessibility Results: We evaluated 5030 thyroid FNAs. First Time Setup Tested phones Android App Settings Estimated Band FAQ Translate . . Gupta In this review we analyze current literature regarding Thyroid Cytopathology Reporting systems trying to identify the most suitable and practical methodology to use in everyday clinical practice. This category includes specimens with features characteristic of a malignant neoplasm, which are quantitatively or qualitatively insufficient to make a definitive diagnosis of malignancy (Figure (Figure4).4). Processing A collection method should harvest well-preserved cells that reliably represent any urinary tract lesion that might be present. Zubair W. Baloch, MD, PhD, served as chair of the Terminology and Morphologic Criteria committee. How do the different parts of a bone marrow workup relate to more in-depth analyses of morphology, markers, lineages, and overall diagnostic information? A clinicopathologic study of 121 cases. However, we cannot answer medical or research questions or give advice. See more. Author contributions: Misiakos EP, Margari N, Meristoudis C, Petropoulos K, and Spathis A contributed significantly in preparation, collection of data, writing and critically revising the manuscript; Machairas N, Schizas D, Karakitsos P and Machairas A contributed in data analysis, and writing the manuscript. Another diagnostic option for patients with repeat ultrasonography-guided FNA of thyroid nodule with non-diagnostic cytology results, would be the utilization of ultrasonography-guided core needle biopsy[39]. %PDF-1.6 % Guidelines for management of thyroid cancer. The interpretation should provide clinically relevant information that will assist referring physicians in the management of patients. After these initial assessments, immunostains often aim to assess architecture, fibrosis, lymphoid aggregates, myeloid lineage maturity, and other related potential pathologies. Herein, all histological types of thyroid carcinoma are included: PTC and its variants, medullary carcinoma, anaplastic carcinoma, lymphoma, and metastatic lesions. In this pattern cystic degeneration with hemosiderin-laden macrophages is present. Perceptions of diagnostic terminology and cytopathologic reporting of fine-needle aspiration biopsies of thyroid nodules: a survey of clinicians and pathologists. Baloch ZW, LiVolsi VA. Cytologic and architectural mimics of papillary thyroid carcinoma. Alternatively, a more prominent than usual population of microfollicles may occur (and may be disproportionately apparent on a minority of smears) in a moderately or markedly cellular sample, but the overall proportion of microfollicles is not sufficient for a diagnosis of follicular neoplasm/suspicious for follicular neoplasm. Seventeen . This document summarizes several years of work, begun as a Web-based discussion, followed by a live conference, and culminating in the production of a print and online atlas. VanderLaan PA, Marqusee E, Krane JF. The same general principle applies to other thyroid malignancies like medullary carcinoma and lymphoma, but these are encountered less frequently than PTC. In other cases it is sparsely cellular and contains atypical lymphoid cells. Hahn SY, Shin JH, Han BK, Ko EY, Ko ES. The cytotechnologist is specially trained and certified to examine cellular samples under a microscope, evaluating the slides for specific abnormalities in the cell's shape, color, or size which could signal a cancerous process or other disease. B) 600 view of trilineage hematopoiesis. IB There are three main methods of sample preparation; smears, liquid-based preparations, and cell block--these preparation methods may be used singly or in . Figure 5. 0 These changes are not pathognomonic, as they are frequently detected in some PTCs, especially in the follicular variant, and in benign lesions as well, such as follicular adenomas. TBSRTC provides a uniform 6-tier system on thyroid FNA for pathologists to communicate with clinicians. However cases with indeterminate cytological findings still remain a matter of debate. 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. A: Ideally, no. MTC represents 3%-12% of thyroid cancers, the majority of which are sporadic. The TBSRTC classifies thyroid follicular lesions with microfollicle predominance and lack of colloid into the suspicious for follicular neoplasm category. Enter your ZIP Code, or City and State below to find the stores nearest you and a listing of the device models available within each. The following breakdown shines some light inside the black box of hematologic diagnostics and may provide insight into what the hematopathology report tells you. Each diagnostic category is associated with a specific risk of malignancy and a recommendation for management. et al. Sarasota Memorial Health Care System. A suspicious interpretation is rendered only when the majority of the follicular cells are arranged in abnormal architectural groupings (microfollicles, crowded trabeculae). Thus, the maximal number of spermatids can be packed and supported by a fixed population . PK One subcategory includes cases with a microfollicular pattern and minimal colloid, that is, follicular lesion of undetermined significance (FLUS). Layfield Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. The inherited forms are characterized by an autosomal dominant mode of inheritance and are associated with point mutations in the RET proto-oncogene on chromosome 10. Interestingly all predicted cancer proved to be papillary thyroid carcinoma in the final histology[59]. If the nodule is almost entirely cystic, with no worrisome sonographic features, an endocrinologist might proceed as if the CFO were a benign result. Since the malignancy rate of this category is quite high, TBSRTC recommends that most patients undergo a repeat thyroid FNA within 3 to 6 mo, in order to define the nature of atypia[24,26]. The FNA specimens show enlarged follicular cells arranged in monolayer sheets and follicular groups in a background of thin and thick colloid (Figure (Figure6).6). We thank Diane Solomon, MD, for review of the manuscript and helpful comments. The bone marrow aspirate smear. Hay A minor population of follicular cells show nuclear enlargement, often accompanied by prominent nucleoli, eg, Specimens from patients with a history of radioactive iodine, carbimazole, or other pharmaceutical agents, Repair due to involutional changes such as cystic degeneration and/or hemorrhage, There is an atypical lymphoid infiltrate (in which a repeated aspirate for flow cytometry is desirable), but the degree of atypia is insufficient for the general category suspicious for malignancy.. Inadequate samples are reported as nondiagnostic (ND) or unsatisfactory (UNS). , eds. DA Faquin WC, Cibas ES, Renshaw AA. PG Hematology.org.https://www.hematology.org/education/trainees/fellows/trainee-news/2021/demystifying-the-bone-marrow-biopsy-a-hematopathology-primer(label-accessed May 01, 2023). In part, each component is analyzed and interpreted in correlation together for a final report. The Bethesda System for Reporting Thyroid Cytopathology is the most preferred system for the diagnosis of FNA specimens, which also contains guidelines for the diagnosis and treatment of indeterminate cases. Theoharis CG, Schofield KM, Hammers L, Udelsman R, Chhieng DC. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Sherman SI, Tuttle RM. The atypia of undetermined significance/follicular lesion of undetermined significance: malignant ratio: a proposed performance measure for reporting in The Bethesda System for thyroid cytopathology. gynecologic cytology specimens 3. L When evaluating an undifferentiated carcinoma using immunocytochemistry a basic immunopanel should include cytokeratins, calcitonin, leucocyte common antigen, carcinoembryonic antigen, thyroglobulin, chromogranin, and TTF-1. A malignant thyroid FNA diagnosis accounts for 4%-8% of all thyroid FNAs, the majority of which are PTCs, and these patients will require thyroidectomy[53]. The four components of a routine bone marrow analysis. [2] First documented in HeLa cells, where there are generally 10-30 per nucleus, [3] Paraspeckles are now known to also exist in all human primary cells, transformed cell lines and . BRAF is not usually found in the follicular variant of papillary thyroid carcinoma, but is increasingly detectable in each step of dedifferentiation, including tall cell tumors and anaplastic cancer. In this selected population, 20% to 25% of patients with AUS prove to have cancer after surgery, but this is undoubtedly an overestimate of the risk for all AUS interpretations.2,10 The risk of malignancy is certainly lower and probably closer to 5% to 15%. L By using redundancies across components, your consultant hematopathologists may offer insights into the architecture, morphology, immunostaining, and flow cytometry profiles of any identified hematologic entity. View an interactive bone marrow clot specimen online. The FNA aspirates of an MTC are usually composed of numerous cells, either presenting in cell aggregates or as a mixture of non-cohesive cells. It is a point of great significance that Ohori et al[56] found a greater percentage of BRAF-mutated (V600E, K601E, and others) cases in the AUS/FLUS and SFN/SFN categories, rendering BRAF mutational testing a useful predictor of PTC diagnosis in these indeterminate cases. On the other hand a definitive diagnosis of a low-grade lymphoma (usually a MALT lymphoma) is even more difficult. Highly cellular specimens are ideal for smeared preparations, whereas sparsely cellular specimens will require multiple centrifugation steps and special cell consolidation processing. Theoharis C, Roman S, Sosa JA. 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]. Wu HH, Rose C, Elsheikh TM. 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. To address terminology and other issues related to thyroid FNA, the National Cancer Institute (NCI) hosted the NCI Thyroid Fine Needle Aspiration State of the Science Conference. The meeting was organized by Andrea Abati, MD, and took place on October 22 and 23, 2007, in Bethesda, MD. To address terminology and other issues related to thyroid fine-needle aspiration (FNA), the National Cancer Institute (NCI) hosted the NCI Thyroid FNA State of the Science Conference. Or the predominantly benign-appearing specimen that contains 1 or 2 groups with a few of the nuclear features of papillary carcinoma? Vimentin immunoexpression is also a common finding[52]. The Paris System for Reporting Urinary Cytology tried lately to address adequacy. In this pattern benign follicular cells are detected, along with cells with nuclear enlargement, nuclear grooves, nuclear membrane irregularity, and/or nuclear molding, usually without any trace of intranuclear inclusions. As a medical procedure, bone marrow collection may sometimes have limitations in obtaining adequate specimens. Teixeira GV, Chikota H, Teixeira T, Manfro G, Pai SI, Tufano RP. Venkatesh YS, Ordonez NG, Schultz PN, Hickey RC, Goepfert H, Samaan NA. Therefore, it is not prudent to remove every thyroid nodule we encounter in our medical practice. The FNA specimens should be immediately processed for cytomorphologic analysis. According to the Bethesda system for reporting thyroid cytopathology, a specimen . Filie AC, Asa SL, Geisinger KR, Logani S, Merino M, Nikiforov YE, Clark DP. Highly cellular specimens are ideal for smeared preparations, whereas sparsely cellular specimens will require multiple centrifugation steps and special cell concentration methods. Intussusception in an adult revealing a Vanek's tumor: A case report. That said, this specimen (if involved by a disease process) can be sent for genetic testing such as polymerase chain reaction and does not present the issue of being postdecalcification (which may hinder some genetic tests). Those that are resected represent a selected population of patients with repeated AUS results or patients with worrisome clinical or sonographic findings. Additional descriptive comments (beyond such subcategorization) are optional and left to the discretion of the cytopathologist. Williams ED. Since the marrow is abundantly deep red and more viscous than blood, the red cell and platelet components will eventually form clots if no anticoagulant is present. ID In the World Health Organization classification, Hrthle cell adenoma and Hrthle cell carcinoma are considered oncocytic variants of FA and FC, respectively.24 Studies suggest, however, that follicular and Hrthle cell tumors have different underlying genetics.4,25 For this reason, and because they have such distinctive morphologic features, it is helpful to specify that a sample raises the possibility of a Hrthle cell rather than a follicular neoplasm. CellMapper is a crowd-sourced cellular tower and coverage mapping service. Krane JF, Vanderlaan PA, Faquin WC, Renshaw AA. 2nd ed. Table: Comparative advantages and drawbacks of the marrow aspirate versus the core biopsy. lobectomy). DP Tumor cells with distinct granules with eccentric nuclei. In this pattern the nuclear enlargement is generalized in mild-to-moderate degree with evident nuclear grooves and mild nuclear pallor. 2021 L Street NW, Suite 900,Washington, DC 20036, Phone 202-776-0544Toll Free 866-828-1231Fax 202-776-0545, Copyright 2023 by American Society of Hematology, Support Opportunities|Privacy Policy|Terms of Service|Contact Us, Helping hematologists conquer blood diseases worldwide, Demystifying the Bone Marrow Biopsy: A Hematopathology Primer, https://www.hematology.org/education/trainees/fellows/trainee-news/2021/demystifying-the-bone-marrow-biopsy-a-hematopathology-primer, Relative quantity of different cell types, Provides material for flow and molecular studies. Any specimen that contains abundant colloid is adequate (and benign), even if six 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. Therefore, detailed neuronal morphology is required to understand normal neuronal function . 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]. Click, Copyright PathologyOutlines.com, Inc. Click, 30150 Telegraph Road, Suite 119, Bingham Farms, Michigan 48025 (USA). Bethesda, MD 20894, Web Policies Immunohistochemistry test for specific biomarkers (i.e., calcitonin, thyroglobulin) will easily distinguish MTC from other thyroid malignancies. FVPTC is characterized cytologically by the paucity of diagnostic nuclear features. Johnson Assisted nurses with recovering over 70 post-surgical patients daily. 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. Furthermore, the clot section, like the core biopsy, can be used for immunohistochemical stains. EK Clinical outcome for atypia of undetermined significance in thyroid fine-needle aspirations: should repeated fna be the preferred initial approach? However, the percentage of the cases classified into the TIR 3/DC IV (follicular proliferation/neoplasm) category was substantially smaller (4.6%) in the 5-tiered system compared with the 6-tiered system (23.8%). In some cases psammoma bodies may be present[35,44]. Gross specimen was measuring about 2x2x1.5 cm in size, soft in consistency, brownish black in color and roughly oval in shape [Table/Fig-4]. The specimen is usually cellular with polygonal cells in loose papillary clusters with abundant eosinophilic cytoplasm. Due to the fact that the nuclei of this variant are darker than those of the regular PTC, the neoplastic cells of this variant may be mistaken for benign respiratory epithelial cells, or a colorectal neoplasm. As with the Bethesda System for cervical cytology, it is expected that subsequent workshops will lead to further refinements to this framework. Cibas et al. Summarizing 3 slide smear methods 6. The clot sections, core biopsy, marrow aspirate, and touch preps all contribute to the overall assessment of patients collected marrow. S Pu (2021).Demystifying the Bone Marrow Biopsy: A Hematopathology Primer. The neoplastic cells show a greater cell height than the tall cell variant and lack the obvious nuclear features of PTC.
Larry Davis Obituary 2020,
Penzance Police Station Opening Times,
Houston Methodist Hospital Locations,
Doordash Cancelled My Order After Pickup,
Desert Tech Mdr Aftermarket Trigger,
Articles S
