sparsely cellular specimen

qA;`Yb]@b,@ "~Xbqs8J Cellular crowding and overlapping are conspicuous, and the follicular cells are usually larger than normal. Sparsely definition, in a thinly distributed way; not thickly or densely: Michigan's Upper Peninsula is very sparsely populated, as more than 90% of it is forested. In such laboratories, macrophages only often constituted the great majority of ND/UNS cases, with rates that ranged from 15% to 30%.2,9,11,12 Other laboratories considered the risk of a false-negative result negligible and reported macrophages only as benign.10,11 At the 2007 NCI Conference, it was decided that cyst-fluid-only (CFO) cases should be considered a clearly identified subset of ND/UNS. . Yang Therefore the diagnosis SFM, suspicious for thyroid carcinoma is an indication for surgery. The nuclear chromatin is similar to that seen in other neuroendocrine tumors, i.e., salt and pepper type (Figure (Figure7).7). Nuclear atypia or pleomorphism and mitoses are uncommon. The management of cases with papillary microcarcinomas, i.e., tumors less than 1.0 cm in diameter, is still controversial. A: No. et al. Bukhari MH, Niazi S, Hanif G, Qureshi SS, Munir M, Hasan M, Naeem S. An updated audit of fine needle aspiration cytology procedure of solitary thyroid nodule. VA B A uniform reporting system for thyroid FNA will facilitate effective 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, particularly neoplasia; and allow easy and reliable sharing of data from different laboratories for national and international collaborative studies. However, there are cases with diagnostic uncertainty due to suboptimal sampling or preservation, and overlapping cytomorphologic features with other thyroid conditions. Anderson Cancer Center, Houston, Edward B. Stelow, MD, Department of Pathology, University of Virginia Health System, Charlottesville, Jerry Waisman, MD, Department of Pathology, New York University of Medicine, New York, Helen H. Wang, MD, DrPH, Department of Pathology, Beth Israel-Deaconess Medical Center, Boston, MA, Philippe Vielh, MD, PhD, Department of Pathology, Institut de Cancerologie Gustave Roussy, Villejuif, France, Grace C. H. Yang, MD, Department of Pathology, Weill Medical College of Cornell University, New York, NY, Matthew A. Zarka, MD, Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale. Thyroid FNA specimen a. et al. French Sparsely cellular specimens: Sample w/ not many cells in suspension can be made more conc'd by Cytospin or centrifugation preparation: 1mL properly prepared cell suspension in funnel of cytospin, centrifuge, cells will be deposited on slide & fluid absorbed by filter paper: Problem: bloody specimens: )TEgX>T|*Q0%K5P- HVe t L DeLellis (iii) Cytologic and architectural atypia: . In these SFN/SFN and AUS/FLUS cases with the K601E mutation, the cytomorphology of the PTC specimens prevented a more definitive diagnosis, in contrast to cases where the V600E mutation was observed, whether the diagnosis resolved to a classic (CL) subtype, tall cell variant (TCV) subtype, or a solid (SD) PTC diagnosis. Experience of over 18,000 FNAs reported at the same institution during 1998-2007. Summarizing 3 slide smear methods 6. V ID The thyroid nodules are aspirated 3 to 5 times with a 22-gauge or 25-gauge needle. endstream endobj startxref Conflict-of-interest statement: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported. Centrifuge each specimen, and resuspend the cell concentrate in about 5 mL balanced electrolyte solution. S However, nuclear grooves can be seen also in several thyroid diseases such, as Hashimotos thyroiditis, multinodular goiter, Hurthle cell tumors and medullary carcinoma[42,43]. How do the different parts of a bone marrow workup relate to more in-depth analyses of morphology, markers, lineages, and overall diagnostic information? Lloyd The Paris System for Reporting Urinary Cytology tried lately to address adequacy. Diagnostic challenges in fine-needle aspiration and surgical pathology specimens. Help . 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. 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. Papillary thyroid carcinoma. Gharib Top Users Networks Stats . In other cases it is sparsely cellular and contains atypical lymphoid cells. Q: Can the core biopsy determine the blast count? This conference established the Bethesda System for Reporting Thyroid Cytopathology (BSRTC), a 6-tiered diagnostic classification system based on a probabilistic approach[8,9]. Unlike the core biopsy, decalcification is not required for the clot section. Such changes may represent atypical but benign cyst-lining cells, but a papillary carcinoma cannot be entirely excluded (ThinPrep, Papanicolaou stain). Edmund S. Cibas, MD, and Susan J. Mandel, MD, MPH, served as moderators. (10%) However in doubtful cases definitive diagnosis can be made if sufficient material is available for immunocytochemical stains, or if it is known that the patient has an elevated serum calcitonin level. The hallmark of this diagnostic category is a disturbed cytoarchitecture: follicular cells are arranged predominantly in microfollicular or trabecular arrangements. CR The .gov means its official. Immediately after the core biopsy is obtained, the procured tissue is "touched" several times onto glass slides. The documents underwent revision after each comment period before reposting on the Web. Once obtained, the core biopsy is used to make touch preps (discussed below) and then is transferred into a container with appropriate fixative (usually formalin) and sent to the laboratory for processing. Unlike complete blood counts (CBCs), which produce fast results, a bone marrow analysis requires a more in-depth analysis and, as a more invasive procedure, necessitates built-in redundancies to ensure the highest-quality results. Faquin They can be readily classified as malignant due to nuclear pleomorphism, chromatin clumping, necrosis, atypical mitoses and other malignant features[40]. 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]. Unless specified as ND/UNS, the FNA specimen is considered adequate for evaluation. O This category applies to specimens that are unsatisfactory owing to obscuring blood, overly thick smears, air drying of alcohol-fixed smears, or an inadequate number of follicular cells. . R We welcome suggestions or questions about using the website. and transmitted securely. ?K !o The molecular diagnosis and management of thyroid neoplasms. The many faces and mimics of papillary thyroid carcinoma. 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]. A serum protein electrophoresis might have even shown a monotypic expansion. 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. Papillary thyroid carcinoma and variants. In some cases psammoma bodies may be present[35,44]. Papaparaskeva K, Nagel H, Droese M. Cytologic diagnosis of medullary carcinoma of the thyroid gland. Baloch See more. The tall cell variant of PTC is an important subtype with a potentially aggressive clinical course. This category is reserved for aspirates with borderline cellularity and is subdivided into two subcategories. . Yang This variant is sometimes difficult to diagnose, because in some cases the characteristic neoplastic cells are sparsely evident in the mass. Schlinkert Thyroid aspiration cytology: current status. Some laboratories, for example, may want to state the risk of malignancy associated with the general category, based on their own data or that found in the literature (Table 2). Clark DP, Faquin WC. The clot sections, core biopsy, marrow aspirate, and touch preps all contribute to the overall assessment of patients collected marrow. Every thyroid FNA must be evaluated for adequacy. 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. If no aspirate is collected, then an extra core biopsy specimen can be agitated to release cells for flow cytometry; however, this is not ideal. The thyroid FNAs can be performed either by direct puncture after palpating the thyroid nodule, or more commonly under ultrasound guidance by dedicated thyroid specialists (endocrinologists, radiologists, or pathologists). A moderately or even highly cellular specimen by itself (without significant nuclear or architectural atypia) does not qualify a nodule for an AUS interpretation. Furthermore, spermatid development is likely supported by planar cell polarity (PCP) proteins since polarized spermatids are aligned across the plane of seminiferous epithelium in an orderly fashion, analogous to hair cells in the cochlea of the inner ear. MS Handle sparsely cellular specimens ii. Issue: Non-Gyn specimen slide is sparsely cellular when ample specimen collected and centrifuged cell pellet is visibly adequate. A cellular specimen composed of Hrthle cells arranged in loosely cohesive sheets or isolated in a case diagnosed as Hrthle cell adenoma ( 40 pap stain on ThinPrep slide) (diagnostic categories IV). 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). 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. These include hypocellular smears with extensive cystic degeneration with rare follicular cells with nuclear atypia indicative of PTC. In some cases more diffuse but mild nuclear changes may exist with nuclear enlargement, crowding, and pallor, but without other characteristics, such as nuclear contour irregularities, grooves and nuclear pseudoinclusions, suggestive of a PTC. It also predicted cancer in the majority of indeterminate samples, as well as of the suspicious for cancer samples. The following breakdown shines some light inside the black box of hematologic diagnostics and may provide insight into what the hematopathology report tells you. The purpose of this diagnostic category is to identify a nodule that might be a follicular carcinoma (FC) and triage it for surgical lobectomy. Occasionally FNAC results can be inconsistent and can be a source of dispute among clinicians. Accessibility The most common scenarios can be described as follows: There is a prominent population of microfollicles in an aspirate that does not otherwise fulfill the criteria for follicular neoplasm/suspicious for follicular neoplasm. This situation may arise when a predominance of microfollicles is seen in a sparsely cellular aspirate with scant colloid. While the V600E and K601E mutations were almost equally observed in the AUS/FLUS category, there was a slight predominance of K601E mutation in SFN/SHN category. M G Since there is a considerable proportion of patients with a thyroid nodule who remain undiagnosed with FNA, molecular biology could be very helpful at that point. AA %PDF-1.6 % 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. 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 Chronic sialadenitis: sparsely cellular specimen with fewer lymphocytes and germinal center fragments; no characteristic lymphoepithelial islands. The risk of malignancy for an AUS nodule is difficult to ascertain because only a minority of cases in this category have surgical follow-up. The positive predictive value of a malignant FNA interpretation is 97% to 99%. Careers, Unable to load your collection due to an error. Fleisher Hay Received 2015 May 24; Revised 2015 Nov 19; Accepted 2015 Dec 9. The main purpose of thyroid FNA is to stratify higher risk patients for surgery, and to prevent unnecessary surgeries for benign conditions. Baloch Z, LiVolsi VA, Jain P, Jain R, Aljada I, Mandel S, Langer JE, Gupta PK. The general category FN/SFN is a self-sufficient interpretation; narrative comments that follow are optional. Tyrosine-derived polymeric surfactant nanospheres insert cholesterol in cell membranes. lobectomy). For a thyroid FNA specimen to be satisfactory for evaluation (and benign), at least 6 groups of benign follicular cells are required, each group composed of at least 10 cells.6,7 The minimum size requirement for the groups allows one to determine (by the evenness of the nuclear spacing) whether they represent fragments of macrofollicles. 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). Each diagnostic category is associated with a specific risk of malignancy and a recommendation for management. One nucleus has an apparent intranuclear pseudoinclusion (arrow). Preoperative diagnosis of benign thyroid nodules with indeterminate cytology. The adequacy of a thyroid FNA is defined by both the quantity and quality of the cellular and colloid components. et al. Regardless the staining method used, all slides with diagnostic material are used for the evaluation and clarification of each case. Patients with the sporadic forms of MTC or the familial MTC are most often middle-aged (mean age 50 years old), except in familial cases, in which they are relatively younger. Cochand-Priollet Warthin's tumor : the presence of oncocytic epithelium. IB 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. Consequently it is essential to distinguish this form of atypical calcification from true psammomatous calcifications with their concentrically laminated microscopic appearance[35]. Figure 5. 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. As a medical procedure, bone marrow collection may sometimes have limitations in obtaining adequate specimens. . Chemotherapy or radiotherapy usually cannot change the dismal prognosis of this cancer. Faquin WC, Cibas ES, Renshaw AA. An explicit statement of adequacy is optional. The diagnosis of this variant as a PTC is relatively easy, due to the numerous papillae and the coexisting intranuclear inclusions. specimen from ileal conduits Urine samples from these conduits contain a large number of degenerated intestinal epithelial cells, and Literature reviews were limited to English language publications dating back to 1995, using PubMed as the search engine, with key words determined by the committee members. 0 Teixeira GV, Chikota H, Teixeira T, Manfro G, Pai SI, Tufano RP. Like the marrow aspirate smear, touch imprint preparations provide a quick turnaround time (i.e., do not need decalcification) and great morphologic detail (if the aspirate smears are paucispicular or hemodiluted). There are three main methods of sample preparation; smears, liquid-based preparations, and cell block--these preparation methods may be used singly or in . Furthermore, various other thyroid FNA reporting systems have been created, in which the experiences of the pathologists and/or associated risks of malignancy have been taken into account. Gharib et al. In order to establish a standardized diagnostic terminology/classification system for reporting thyroid FNAC results, the National Cancer Institute (NCI) in the United States sponsored the NCI Thyroid FNA State of the Science Conference with a group of experts at Bethesda, MD, in October 2007[7]. Moreover, a lower percentage of cases in the European system was placed into the TIR 4 and TIR 5 categories as well, compared with the American system. CellMapper is a crowd-sourced cellular tower and coverage mapping service. 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. Renshaw AA. Psammoma bodies are occasionally seen in some aspirates, most possibly arising from calcification of epithelial tips. In this study the AUS category was further subdivided into HCLUS (atypical cells rule out Hurthle cell neoplasm) and FLUS. EK The neoplastic cells show a greater cell height than the tall cell variant and lack the obvious nuclear features of PTC. Fine-needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations. C Figure 1. It allows classification of nodules as benign or malignant, and patients with malignant nodules are scheduled for surgery. Without individual cells to analyze through flow cytometric methods, the clot section is limited to only tissue-type immunostaining. Before the specimen is transferred to a container with anticoagulant, some of the already clotted specimen may be submitted for permanent histology in formalin. The specimen is usually cellular with polygonal cells in loose papillary clusters with abundant eosinophilic cytoplasm. Rabaglia JL, Kabbani W, Wallace L, Holt S, Watumull L, Pruitt J, Snyder WH, Nwariaku FE. 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. A) 20 view of the bone marrow aspirate reveals a deeply basophilic smear of cells. 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. The Bethesda System For Reporting Thyroid Cytopathology. 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? Deveci However, in almost 20% to 28% of AUS/FLUS cases, a repeat thyroid FNA will again be characterized as AUS/FLUS[27,28]. What is one to do with the sparsely cellular specimen consisting mostly of microfollicles? 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. Explaining the use and composition of pre-fixatives and their effect on cellular morphology 4. As a library, NLM provides access to scientific literature. Therefore, the DC III (AUS/FLUS) cases are managed conservatively with repeat FNAs, whereas the DC IV, DC V, and DC VI cases, and TIR 3, TIR 4 and TIR 5 cases respectively, are managed operatively, with thyroid lobectomy or total thyroidectomy. After patient preparation, sedation, and the procedure itself, a bone marrow investigation provides four specimen types for pathologist review (Figure 1): the bone marrow core biopsy, the bone marrow touch imprint, the bone marrow aspirate smear, and the bone marrow clot particle. Therefore, in the majority of patients in the AUS/FLUS category (72%-80%) the diagnosis will be resolved by repeat FNA, although 20%-28% of them will have AUS/FLUS on the repeat aspirate and thus require surgery. The standard management of PTCs greater than 1 cm is total, or near-total thyroidectomy followed by radioactive iodine (131I) therapy to ablate residual thyroid tissue. Three of the 28 specimens (11%) were sparsely cellular, and the rest (89%) were at least moderately cellular. Note the trabecular bone (*) with trilineage hematopoiesis including megakaryocytes, granulocytic precursors, and erythroid islands presented in 2D following formalin fixation and paraffin processing. Hahn SY, Shin JH, Han BK, Ko EY, Ko ES. Most (60%75%) prove to be papillary carcinomas, and the rest are usually FAs.2,10,12,30. official website and that any information you provide is encrypted This category also includes cases with a predominant population of Hurthle cells; these cases are labelled Hurthle cell neoplasm (Figure (Figure3).3). At low magnification, aspirates of PTC are typically cellular, epithelium-rich structures. This resulted in diagnostic inconsistencies among different laboratories and difficulty in communicating the implications of thyroid fine-needle aspiration (FNA) results both to clinicians (endocrinologists and endocrine surgeons) and laboratory doctors (pathologists and radiologists)[6]. Suspicious for medullary thyroid carcinoma, Suspicious for papillary thyroid carcinoma, Vote for your favorite image from the PathologyOutlines.com Directory. This interpretation applies to cellular samples that are composed exclusively (or almost exclusively) of Hrthle cells. Descriptive comments that follow are used to subclassify the benign interpretation. Report of the Thyroid Cancer Guidelines Update Group. Venkatesh YS, Ordonez NG, Schultz PN, Hickey RC, Goepfert H, Samaan NA. Sarasota Memorial Health Care System. The false-negative rate of a benign interpretation is low (0%3%),2,12 but patients are nevertheless followed up with repeated assessment by palpation or ultrasound at 6- to 18-month intervals.15 If the nodule shows significant growth or suspicious sonographic changes, a repeated FNA is considered. Cibas You can now find us in many convenient retail stores, including select Walmart and Target locations. Pu 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). The molecular testing proved to have a high specificity, although the sensitivity was quite low (60%). VA These indeterminate results imply surgeons to consider alternative therapies (e.g., thyroid lobectomy with intraoperative frozen section).

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