Atypical Histiocytoid Cells in Metastatic Papillary Thyroid CarcinomaAn Underrecognized Cytologic Pattern

Published on Jul 1, 2017in American Journal of Clinical Pathology2.493
· DOI :10.1093/AJCP/AQX049
Mariana Canepa3
Estimated H-index: 3
(Brown University),
Tarik M. Elsheikh6
Estimated H-index: 6
(Cleveland Clinic)
+ 2 AuthorsJordan P. Reynolds18
Estimated H-index: 18
(Cleveland Clinic)
Source
Abstract
Objectives: Fine-needle aspiration (FNA) of head and neck lymph nodes (LNs) is useful in diagnosing metastatic papillary thyroid carcinoma (PTC) and most commonly shows classic cytologic features of PTC. Metastatic PTC, however, may occasionally present with a pattern unfamiliar to most pathologists: atypical histiocytoid cells (AHCs). Methods: All PTC thyroidectomy specimens with associated FNA of LNs were retrieved from our files for 2007 to 2013. We aimed to assess cytologic features of metastatic PTC, as well as the presence of AHCs and their morphology. Results: Fifty-six FNAs from LNs with metastatic PTC were reviewed. AHCs were identified in 38 (68%) cases, while only PTC with classic cytologic features was seen in 18 (32%) cases. AHCs did not show diagnostic nuclear features of PTC and presented as large cells with abundant cytoplasm either vacuolated or dense. Nuclei varied from vesicular with prominent nucleoli to dark and smudgy. Thirty-one cases showed mixed AHCs and classic PTC, but seven cases (13% of all metastatic PTCs in LNs) consisted only of AHCs. Conclusions: AHCs are an often unrecognized metastatic morphologic pattern of cystic PTC, as it does not show diagnostic classic nuclear features of PTC. AHCs are the predominant cytologic finding in approximately 13% of metastatic PTCs to neck LNs.
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References11
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#1Chung Hun LeeH-Index: 1
#2Soo Young ChungH-Index: 2
Last. Han Suk RyuH-Index: 20
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Objective: Fine-needle aspiration cytology (FNAC) based on a liquid-based preparation is a safe and valuable diagnostic tool. However, due to unfamiliarity with this method and the considerably altered morphology that is associated with it, diagnosing renal cell carcinoma (RCC) from this type of preparation remains a challenge for cytopathologists. The aim of this study was to evaluate the cytomorphological characteristics of SurePath™ (SP)-based preparations compared with conventional smear (CS...
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Last. Peter M. SadowH-Index: 41
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Background: Papillary thyroid carcinoma (PTC) is increasing in incidence while mortality is unchanged. Identifying patients with higher risk of recurrence and death is essential. Case series identify the hobnail variant of PTC (HVPTC), which is characterized by micropapillary architecture, apocrine features, and loss of cellular polarity. Herein, we describe the clinical course, pathologic features, and mutational profile of patients at our institution with HVPTC. Methods: A query into the surgi...
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#2Rajni Sharma (Johns Hopkins University)H-Index: 50
Last. George J. NettoH-Index: 84
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Clear-cell renal cell carcinoma (ccRCC) may present with metastatic lesions in patients with a concurrent undiagnosed primary or a remote history of ccRCC. The thyroid is not uncommonly involved by metastatic ccRCC, in which a metastasis could be misinterpreted as a clear-cell change in adenomatoid nodules, follicular adenomas, or parathyroid glands. PAX8 is a transcription factor expressed by thyroid and renal-lineage cells. No previous study has evaluated the diagnostic use of PAX8 and ccRCC m...
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#1Ja Seung Koo (University Health System)H-Index: 35
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T cancer is the most common cancer among malignant endocrine tumors, and the majority are papillary carcinoma, which is known for its favorable prognosis.1 However, 5–20% of patients experience regional recurrence, which occurs almost always in cervical lymph nodes.1,2 In addition, about 20% of patients with papillary thyroid carcinoma (PTC) had cervical lymph node metastasis as the initial clinical presentation.3 Therefore, the exact diagnosis of cervical lymph node metastasis is very important...
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Background: Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and diff...
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#1Manju Harshan (Cornell University)H-Index: 1
#2John P. Crapanzano (Cornell University)H-Index: 1
Last. Anjali Saqi (Cornell University)H-Index: 1
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Although papillary thyroid carcinoma (PTC) usually has classic cytological characteristics on fine-needle aspiration (FNA), it can present rarely with aberrant features resembling those of histiocytes in a cystic nodule. The aim of the current study was to describe PTC with atypical histiocytoid cells and distinguish it from benign histiocytes. A retrospective computerized search for FNAs with atypical features suggestive of PTC and cystic degeneration was performed, and if available, the corres...
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#1Andrew A. RenshawH-Index: 2
#2Edmund S. CibasH-Index: 64
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#1Aziza Nassar (Emory University)H-Index: 2
#2Prabodh Gupta (UPenn: University of Pennsylvania)H-Index: 2
Last. Zubair W. Baloch (UPenn: University of Pennsylvania)H-Index: 70
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Macrophages/histiocytes are commonly seen in fine-needle aspiration biopsy (FNAB) specimens of thyroid nodules with varying degrees of cystic change. In some cases the histiocytic component of a cystic thyroid nodule can occur as large tissue fragments with marked nuclear atypia, including elongated nuclei with chromatin clearing, nuclear grooves, and membrane thickening. These nuclear changes mimic cytologic features of papillary thyroid carcinoma (PTC), thus leading to diagnostic difficulty in...
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BACKGROUND Although the classic cytologic features of papillary carcinoma of the thyroid in fine-needle aspirates have been well described, one uncommon feature, a vacuolated, histocyte-like cell without classic nuclear changes of papillary carcinoma, has been less well characterized. METHODS The author reviewed a large series of thyroid aspirates for specimens with these cytologic features. RESULTS Seven specimens were identified, representing approximately 6% of all aspirates with the features...
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#2Yung-Lien HsiaoH-Index: 12
Last. Tien-Chun ChangH-Index: 26
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OBJECTIVE: To elucidate the cytologic characteristics of metastatic papillary thyroid carcinoma (PTC) in cervical lymph nodes and the differences in cervical lymph nodes from those of stage I (intrathyroidal) PTC. STUDY DESIGN: Forty-seven cases of papillary thyroid carcinoma with cervical lymph node metastasis (group A) and 38 cases of intrathyroidal papillary carcinoma (group B) were included in this study. Preoperative fine needle aspiration cytology (FNAC) examination was performed on enlarg...
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BACKGROUND: This study was conducted to evaluate the diagnostic utility of cell block material in fine needle aspiration (FNA) of thyroid nodules. DESIGN: A total of 242 thyroid fine need aspirations (FNAs) were performed between January 2015 and December 2015. Of those, all consecutive thyroid FNA cases with cell blocks (n = 140) from 129 patients (age: 58.9 ± 12.8 years) are included in this study. Cytology slides and cell blocks are reviewed for adequacy assessment based on the Bethesda Syste...
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#1Ji Eun Choi (Catholic University of Korea)H-Index: 8
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Preoperative detection of cervical lymph node metastasis in papillary thyroid carcinoma (PTC) is crucial for determining the surgical strategy to prevent locoregional recurrence of the disease. We identified the cytological predictors of lymph node metastasis in 222 consecutive patients with PTC using fine-needle aspiration cytology (FNAC) of the thyroid. Cervical lymph node metastases occurred in 99 (44.6%) of 222 PTC patients. Lymph node metastasis was significantly associated with tumor multi...
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