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1-8 Thyroid Cytology: W. Faquin MD PhD, Lisa Ring CT
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== 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 ==
'''Basic cytomorphology'''
 
 
<br>
 
<br>
 
'''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  
 
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{{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
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{{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}}
Enlarge image
 
 
 
 
Macrofollicles
 
Enlarge image
 
 
 
 
From a benign follicular lesion FNA
 
Enlarge image
 
 
 
 
Macrofollicles and colloid, consistent with a benign thyroid nodule
 
Enlarge image
 
 
<br>
 
<br>
 
 
'''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
 
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[[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
 
Enlarge image
 
 
<br>
 
<br>
 
 
'''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
 
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{{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 reuslts in a malignant or suspicous diagnosis
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{{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}}
Enlarge image
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{{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}}
 
 
 
PTC with syncytial groups
 
Enlarge image
 
 
 
 
PTC with longitudinal nuclear grooves
 
Enlarge image
 
 
 
 
Easier to identify follicular variant of PTC
 
Enlarge image
 
 
 
 
Harder to identify follicular variant of PTC
 
Enlarge image
 
 
 
 
PTC with abundant cytoplasm
 
Enlarge image
 
 
<br>
 
<br>
 
 
'''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)
 
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[[Image:1-8-12 medullary+thyroid+carcinoma.png|thumb|Medullary thyroid carcinoma]]
Medullary thyroid carcinoma
 
Enlarge image
 
 
<br>
 
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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
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{{:mgh:cytology-footer}}

Latest revision as of 11:52, July 6, 2020

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
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
1-8-3_benign_follicular_lesion.jpg 1-8-4_ben%2Bfollicular%2B2.png
Single Endox Cells
Macrofollicles and colloid, consistent with a benign thyroid nodule


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
Hurthle cells in Hashimoto thyroiditis are easily recognized as benign


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
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
1-8-8_PTC_longitudinal_nuclear_grooves.jpg 1-8-9_PTC%2Bfollicular%2Beasy.png
PTC with longitudinal nuclear grooves
Easier to identify follicular variant of PTC
1-8-10_PTC_follicular_harder.jpg 1-8-11_PTC%2B2.jpeg
Harder to identify follicular variant of PTC
PTC with abundant cytoplasm


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)
Medullary thyroid carcinoma


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

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