Thyroid cytology

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A presentation on the cytology of the thyroid. The intended audience is pathologists, cytopathologists, pathology residents and medical students.

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  • 1. Thyroid CytologyTeresa Alasio, MD

2. FNA of ThyroidIndications: Solitary nodule or dominant nodule Radionuclide studies (not specific formalignancy):Cold nodule (non-functioning)Hot nodules are almost always benign (toxicadenomas) 3. AdequacyNumber of passes performed variesPresence of cytopathologist orcytotechnologist can decrease number ofpasses because accuracy is improvedDirect smears and LBP are performed Diff-quik Pap stain Ultrafast Pap stain 4. Evaluation of SmearsNon-diagnostic: Blood, thick smears, air driedCounting groups of benign follicular cells At least 6 groups of 10 cells each required bysome cytopathologists ExceptionsGroups can be broken up (macrofollicles)Abundance of colloidSpecific diagnosis can be rendered (e.g.Hashimotos) 5. Normal Thyroid Gland:Follicular CellsUniformOrderly honeycomb sheetsSingle cells are sparseIntact follicles can be aspirated 6. Benign follicular cells 7. Normal Thyroid Gland:Flame CellsAka flare cellsFollicular cells with cytoplasmic vacuolescontaining metachromatic materialFlame cell change indicates that theindividual cells are hyperfunctioningNumerous in toxic goiters but can also beseen in nontoxic goiters, Hashimotothyroiditis, neoplasms 8. Flame Cells 9. Normal Thyroid Gland:Hurthle CellsAka oncocytesAbundant, dense, finely granularcytoplasmEnlarged nucleiProminent nuceoliBinucleation and multinucleation arecommonAssociated with Hashimotos, goiters andneoplasms 10. Hurthle CellsDiff-Quik Pap 11. Miscellaneous CellsCiliated cells (respiratory epithelial cells) Trachea was enteredFibrocartilageSkeletal muscleSkinAdipose tissue 12. Cystic ChangeDiff-QuikPapH&E 13. Clinical Features FavoringMalignancyYoung (70)MaleHistory of external neck irradiation duringchildhoodRecent changes in breathing, speaking orswallowingFamily history of thyroid cancer or MEN2Firm, irregularly shaped or fixed thyroid glandCervical lymphadenopathy 14. Clinical Features Favoring aBenign NoduleHypothyroidism or hyperthyroidismFamily history of Hashimotos thyroiditis orother benign thyroid diseaseSudden increase in size with pain ortenderness s/o spontaneous infarction and hemorrhage 15. Normal Thyroid Gland: ColloidTwo basic forms:Watery colloid Seen in Diff-Quik stain Blood serum can mimic watery colloid microscopicallyDense colloid Irregular chips of translucent homogenous material Deep purple on Diff-Quik, blue on Papanicolaou stain 16. ColloidThin Thick 17. Amyoid GoiterFocal or diffuse enlargement of the thyroidglandRapid growth, dyspnea, dysphagia,hoarsenessChronic illness predisposing patient tosystemic amyloidosis 18. Amyoid vs. Colloid 19. Thyroid Pathology:InflammatoryInflammatory Disease Acute thyroiditis Granulomatous (deQuervain or subacute)thyroiditis Hashimoto thyroiditis 20. Acute ThyroiditisImmunosuppressed patientsUsually bacterial in origin Strep pyogenes, Staph aureus, Strep pneumoNumerous neutrophils and histiocytes arecharacteristicGranulation tissue, necrosis and debrismay be present 21. Granulomatous ThyroiditisAka deQuervain or Subacute ThyroiditisPostviral syndromeClassic cause of painful thyroidYoung women Fever, chills, fatigueRarely aspirated because clinically apparentwithout biopsyIf no pain and forms a nodule, then may besubject to aspiration biopsy 22. Granulomatous ThyroiditisScanty aspirateNot well toleratedGiant cellsNoncaseating granulomasChronic inflammationHurthle cells are unusual 23. Hashimoto ThyroiditisDiagnosis is usually clinically apparent andpatients dont get FNASome patients with non-classic findingsmay get FNA 24. Hashimotos Thyroiditis 25. Black ThyroidDark brown pigmentation of thyroidfollicular cells in patients who takeantibiotics of the tetracycline groupThyroid gland appears black grosslyBenign condition no treatment necessary 26. Thyroid Pathology:Follicular LesionsGoiterFollicular neoplasms Follicular adenoma Follicular carcinoma 27. Adenoma vs. GoiterFollicular Adenoma Single nodule Completeencapsulation Uniform follicles Different inside fromoutside Preservation No invasion, nometastasisGoiter Multiple nodules Variable encapsulation Variable follicles Same or differentinside vs. outside Degeneration/regeneration No invasion, nometastasis 28. Colloid CellsIIIIIZone I Zone II Zone IIIICytologic Diagnosis Colloid Nodule Cellular Nodule Follicular NoduleMore diagnosticcluesMultiple nodules,honeycomb patter,favor goiterSee Zones I and II Solitary nodule;microfollicularpattern, favorneoplasmRisk of neoplasm Low (