Difference between revisions of "mgh:cyto-1-8"
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− | 1-8 Thyroid Cytology: W. Faquin MD PhD, Lisa Ring CT | + | __NOCACHE__{{DISPLAYTITLE:1-8 Thyroid Cytology: W. Faquin MD PhD, Lisa Ring CT}}{{:TOC}} |
− | + | == Lecture slides: == | |
− | Lecture slides: | ||
* [https://www.medialab.com/dv/dl.aspx?d=1324779&dh=4878c&u=111736&uh=c3cf8 Bethesda_System_for_Reporting_Thyroid_FNAs_and_Molecular_Testing.ppt] | * [https://www.medialab.com/dv/dl.aspx?d=1324779&dh=4878c&u=111736&uh=c3cf8 Bethesda_System_for_Reporting_Thyroid_FNAs_and_Molecular_Testing.ppt] | ||
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− | + | == Basic cytomorphology == | |
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'''Benign Thyroid –THY4-16''' | '''Benign Thyroid –THY4-16''' | ||
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* May find few macrophages (foam cells) | * May find few macrophages (foam cells) | ||
* Reactive Hurthle cell changes can be seen | * Reactive Hurthle cell changes can be seen | ||
− | + | {{img4|1-8-1 watery_colloid.jpg|1-8-2 macrofollicle_benign.jpg|Watery colloid is usually a benign feature, with the exception of papillary thyroid carcinoma|Macrofollicles}} | |
− | Watery colloid is usually a benign feature, with the exception of papillary thyroid carcinoma | + | {{img4|1-8-3 benign_follicular_lesion.jpg|1-8-4 ben+follicular+2.png|Single Endox Cells|Macrofollicles and colloid, consistent with a benign thyroid nodule}} |
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− | Macrofollicles | ||
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− | Macrofollicles and colloid, consistent with a benign thyroid nodule | ||
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'''Hashimoto Thyroiditis (chronic lymphocytic thyroiditis) –THY2-15''' | '''Hashimoto Thyroiditis (chronic lymphocytic thyroiditis) –THY2-15''' | ||
* 2 cell types NEEDED for diagnosis: lymphocytes and Hürthle cells! | * 2 cell types NEEDED for diagnosis: lymphocytes and Hürthle cells! | ||
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* Tingible body macrophages and germinal center fragments | * Tingible body macrophages and germinal center fragments | ||
* Plasma cells | * Plasma cells | ||
− | + | [[Image:1-8-5 hashimoto.jpg|thumb|Hurthle cells in Hashimoto thyroiditis are easily recognized as benign]] | |
− | Hurthle cells in Hashimoto thyroiditis are easily recognized as benign | ||
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'''Papillary Carcinoma –THY2-26''' | '''Papillary Carcinoma –THY2-26''' | ||
* Increased cellularity! | * Increased cellularity! | ||
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* SCANT colloid (or very little--dense, bubble-gum appearance) | * SCANT colloid (or very little--dense, bubble-gum appearance) | ||
* Psammoma bodies | * Psammoma bodies | ||
− | + | {{img4|1-8-6 PTC.jpg|1-8-7 PTC_syncytial_groups.jpg|Papillary thyroid carcinoma (PTC) often results in a malignant or suspicious diagnosis|PTC with syncytial groups}} | |
− | Papillary thyroid carcinoma (PTC) often | + | {{img4|1-8-8 PTC_longitudinal_nuclear_grooves.jpg|1-8-9 PTC+follicular+easy.png|PTC with longitudinal nuclear grooves|Easier to identify follicular variant of PTC}} |
− | + | {{img4|1-8-10 PTC_follicular_harder.jpg|1-8-11 PTC+2.jpeg|Harder to identify follicular variant of PTC|PTC with abundant cytoplasm}} | |
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− | PTC with syncytial groups | ||
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− | PTC with longitudinal nuclear grooves | ||
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− | Easier to identify follicular variant of PTC | ||
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− | Harder to identify follicular variant of PTC | ||
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− | PTC with abundant cytoplasm | ||
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'''Medullary Carcinoma –THY4-05''' | '''Medullary Carcinoma –THY4-05''' | ||
* Malignant parafollicular C-cells | * Malignant parafollicular C-cells | ||
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* Cell types include plasmacytoid, spindle, polygonal, round or triangular | * Cell types include plasmacytoid, spindle, polygonal, round or triangular | ||
* Amyloid--looks like dense colloid (stains bright green with Congo Red) | * Amyloid--looks like dense colloid (stains bright green with Congo Red) | ||
− | + | [[Image:1-8-12 medullary+thyroid+carcinoma.png|thumb|Medullary thyroid carcinoma]] | |
− | Medullary thyroid carcinoma | ||
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'''Undifferentiated (Anaplastic) Carcinoma –THY5-19''' | '''Undifferentiated (Anaplastic) Carcinoma –THY5-19''' | ||
* Increased cellularity | * Increased cellularity | ||
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* May see mitoses | * May see mitoses | ||
* Background is usually rich in necrotic debris and blood | * Background is usually rich in necrotic debris and blood | ||
+ | {{:mgh:cytology-footer}} |
Latest revision as of 11:52, July 6, 2020
Contents
[hide]Lecture slides:
Indications for cytology examination
Procuring the specimen
Test platforms/specimen processing and triage
Reporting and terminology
Basic cytomorphology
Benign Thyroid –THY4-16
- Adequacy: must meet a minimum of 6 groups of well-visualized follicular cells with at least 10 cells per group
- Abundant watery colloid in background
- Scattered fragments of macrofollicles
- Normal follicular cells contain small amounts of granular cytoplasm with a small, dark round central nucleus
- May find few macrophages (foam cells)
- Reactive Hurthle cell changes can be seen
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Hashimoto Thyroiditis (chronic lymphocytic thyroiditis) –THY2-15
- 2 cell types NEEDED for diagnosis: lymphocytes and Hürthle cells!
- Lymphocytes embedded within the groups of follicular/Hürthle cells are a characteristic feature
- Hürthle cells may show increased N/C ratio, prominent nucleoli and nuclear irregularity
- Small amounts of dense colloid may be present
- Squamous metaplastic cells, foam cells, giant cells, fibrous tissue, granulomas and calcifications may be present
- Tingible body macrophages and germinal center fragments
- Plasma cells
Papillary Carcinoma –THY2-26
- Increased cellularity!
- 3D papillary architecture or monolayered sheets
- Intranuclear inclusions
- Nuclear grooves (less specific for diagnosis)
- Pale even chromatin
- May see small but prominent nucleoli
- Variation in nuclear size and shapes
- Generally abundant cytoplasm that is either dense and homogenous or granular but well defined borders
- Blood in background
- SCANT colloid (or very little--dense, bubble-gum appearance)
- Psammoma bodies
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Medullary Carcinoma –THY4-05
- Malignant parafollicular C-cells
- CELLULAR SMEAR with isolated cells and some loosely cohesive cell clusters
- Mild to absent pleomorphism
- Can have a neuroendocrine-like appearance--salt & pepper chromatin pattern
- Intranuclear pseudoinclusions are also present
- Cytoplasm is finely granular and may contain red granules (seen in 30% of cases with Diff-Quik)
- Cell types include plasmacytoid, spindle, polygonal, round or triangular
- Amyloid--looks like dense colloid (stains bright green with Congo Red)
Undifferentiated (Anaplastic) Carcinoma –THY5-19
- Increased cellularity
- Malignant features
- Epithelioid cells present in groups and singly--round, spindled or polygonal in shape
- Pleomorphic nuclei--may see bi or multinucleated cells
- Increased N/C ratios
- Cytoplasm is moderate to abundant, basophilic and well-defined which sometimes may be vacuolated or granular
- Prominent nucleoli
- Irregular, clumped, coarse chromatin patterns
- May find intranuclear inclusions
- May see mitoses
- Background is usually rich in necrotic debris and blood