Solitary thyroid nodule: diagnosis and management.

The cytomorphologic features in fine-needle aspiration (FNA) biopsies from 91 histologiacally verified medullary carcinomas of the thyroid (MCT) were investigated. FNA was able to diagnose neoplasms with indications of surgical removal in 98.9% of cases and moreover, was accurate in specific tumor typing in 89% of cases. The most important cytologic criteria of MCT with FNA are: dispersed cell-pattern of polygonal or triangular cells, azurophilic cytoplasmic granules, and extremely eccentrically placed nuclei with coarse granular chromatin and amyloid. These and other cytologic features of MCT are discussed in detail. Fourteen cases of thyroid tumors originally diagnosed as MCT by cytology are illustrated to discuss the differential diagnosis of MCT and its potential pitfalls. If MCT is cytologically presumed but amyloid and azurophilic cytoplasmic granules are not demonstrated, the use of immunostaining is necessary for a correct tumor typing. The application of immunocytochemistry in MCT is discussed.

Cytologic diagnosis of medullary carcinoma of the thyroid gland.

Fine needle aspiration biopsy. Has its time come

The cytologic features of papillary carcinoma of the thyroid in fine-needle aspiration material have been well described. The significance of finding these features in only a small population of cells is not well characterized. I reviewed the results of 28 thyroid fineneedle aspirates processed as direct smears and cell blocks in which only a small population (<20 cells) showed features of papillary carcinoma. Papillary carcinoma was considered in 142 (8.98%) of 1,581 aspirates, and in 28 cases (1.77%), 20 cells or fewer showed features of papillary carcinoma and follow-up was available. Papillary carcinomas greater than 1 cm were identified in 11 cases (39%; 3 follicular variants), papillary carcinomas less than 1 cm were identified in 4 cases (14%), and benign lesions in the remaining 13 cases (46%). The background material (either scant or abundant benign epithelium) did not correlate significantly with the result of resection. Identifying features of papillary carcinoma in a small population of cells in either a scant or an abundant thyroid aspirate are associated with a high rate of papillary carcinomas at resection, only a minority of which represent either the follicular variant or incidental tumors. The classic cytologic criteria for papillary carcinoma of the thyroid have been studied and delineated by numerous authors 1-11 and consist primarily of enlarged, often overlapping nuclei with fine, dusty or powdery chromatin; intranuclear cytoplasmic inclusions; and linear chromatin ridges (grooves) with irregular nuclear outlines. When these features are present in numerous cells, there is little diagnostic difficulty. When these features are present in only a few cells, either in a scanty specimen or in a specimen with abundant benign material in the background, the diagnosis is less certain. Whether these patients are best served by clinical follow-up, repeated aspiration, or resection is not clear. Recent studies suggest that cases with only “focal features” of papillary carcinoma often are associated with the follicular variant of papillary carcinoma at resection. 12 To further characterize aspirates with these features, I correlated a large group of patients with these findings on fine-needle aspiration with the results of subsequent surgical resection.

Focal Features of Papillary Carcinoma of the Thyroid in Fine-Needle Aspiration Material Are Strongly Associated With Papillary Carcinoma at Resection

Nodules of the thyroid gland are frequently encountered, occurring in up to 7% of the population, and although most of these nodules are benign, carcinomas of the thyroid gland are the most common malignancy of the endocrine system. Although the different types of thyroid carcinoma are few, a wide variety of recurring problems exists in both their histologic and cytologic evaluation. Here, I will review a selected group of problematic areas, including unusual histologic variants of follicular adenoma, criteria for diagnosing minimally invasive follicular carcinoma, the use of fine-needle aspiration as a screening test for follicular neoplasia, challenging variants of papillary carcinoma, and features of poorly differentiated carcinoma.

The Thyroid Gland: Recurring Problems in Histologic and Cytologic Evaluation

Fourteen cytologic features seen in fine needle aspirates of papillary carcinoma of the thyroid were subjected to a step-wise logistic regression analysis to determine which are predictive of papillary carcinoma. The study cases included 38 histologically proven papillary carcinomas and 54 other palpable thyroid nodules. The three most important variables in making the prediction of papillary carcinoma were intranuclear inclusions, papillary structures without vessels and cells with metaplastic cytoplasm.

A step-wise logistic regression analysis of papillary carcinoma of the thyroid.

Small-cell malignancies of childhood are a source of diagnostic difficulty, both in cytology and histology. Four cases of neuroblastoma are presented that were diagnosed by fine needle aspiration cytology. The importance of a complete history, physical examination and laboratory evaluation is stressed. In addition to the usual description of cytologic detail obtained by routine methods, a new method of study is introduced: the potential use of plastic embedding and histochemical studies in small-cell tumors is discussed.

Neuroblastoma diagnosed by fine needle aspiration biopsy.

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A step-wise logistic regression analysis of papillary carcinoma of the thyroid.

Neuroblastoma diagnosed by fine needle aspiration biopsy.