sparsely cellular specimen

An AUS result is obtained in 3% to 6% of thyroid FNAs.2,10 Higher rates likely represent overuse of this category when other interpretations are more appropriate. Baloch ZW, LiVolsi VA. Fine-needle aspiration of the thyroid: today and tomorrow. AS Description of a distinctive morphological variant and report of 7 cases. Does the fine-needle aspiration diagnosis of Hrthle-cell neoplasm/follicular neoplasm with oncocytic features denote increased risk of malignancy? MTC was first described by Horn et al[45] in 1951, and it was first recognized as a unique clinicopathological entity by Hazard et al[46], in 1959. Research is directed to the identification of molecular markers that, in conjunction with FNA, can identify patients with a malignant nodule. Frequency Calculator eNB ID Calculator . Moses W, Weng J, Sansano I, Peng M, Khanafshar E, Ljung BM, Duh QY, Clark OH, Kebebew E. Molecular testing for somatic mutations improves the accuracy of thyroid fine-needle aspiration biopsy. 0 It is critical that cytopathologists communicate thyroid FNA interpretations to referring physicians in terms that are succinct, unambiguous, and clinically helpful. Reduce red blood cells in smears iii. Cerutti JM. Hematoxylin-eosinstained sections of the clot particle. 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. This subset of patients could benefit form a repeat FNA; (4) DC IV Follicular Neoplasm or Suspicious for a Follicular Neoplasm. Ravetto ZW There may be small fragments of amorphous material-colloid vs amyloid. Papillary thyroid carcinoma. ( a) In this sparsely cellular specimen, some of the cells had abundant cytoplasm and enlarged nuclei, some with prominent nucleoli. While their individual turnaround times vary, these specimens are usually reported together to make sure all aspects are accounted for, which can take approximately three days on average. Centrifuge each specimen, and resuspend the cell concentrate in about 5 mL balanced electrolyte solution. et al. You order a bone marrow analysis for your patient. A print atlas, with more than 40 contributing authors Appendix 1, is in press.3. The main purpose of thyroid FNA is to identify patients with higher risk for malignancy, and to prevent unnecessary surgeries for benign conditions. Baloch ZW, LiVolsi VA. Cytologic and architectural mimics of papillary thyroid carcinoma. BRAF mutation has become a specific marker for PTC and its variants[54]. Almost simultaneously, in Europe, the British Thyroid Association-Royal College of Physicians and the Italian Society for Anatomic Pathology and Cytopathology-International Academy of Pathology (SIAPEC-IAP) thyroid reporting systems, each comprised of 5 diagnostic classes, have been introduced[10,11]. Faquin B) 1,000 view. Characteristically, distinct granules (calcitonin granules) are spotted in the cytoplasm of the cancer cells, as well as eccentric nuclei, indicating a plasmacytoid appearance to the tumor cells. 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 general category FN/SFN is a self-sufficient interpretation; narrative comments that follow are optional. The nuclei have conventional PTC nuclear features that distinguish it from Hurthle cell neoplasms[35]. MS Anaplastic carcinoma of the thyroid: a review of 84 cases of spindle and giant cell carcinoma of the thyroid. CellMapper is a crowd-sourced cellular tower and coverage mapping service. Asa Even neurons of the same type show various subtle process characteristics to fit into the diverse neural circuits. Herein, all histological types of thyroid carcinoma are included: PTC and its variants, medullary carcinoma, anaplastic carcinoma, lymphoma, and metastatic lesions. et al. I FNAs contain oncocytic cells with abundant granular cytoplasm, conventional nuclei, a papillary architecture, and a lymphoplasmacytic background. Cyst lining cells are usually elongated, containing pale chromatin, with sparsely found intranuclear grooves, large nucleoli, and always associated with hemosiderin-laden macrophages and benign-appearing macrofollicle fragments. 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. Author contributions: Misiakos EP, Margari N, Meristoudis C, Petropoulos K, and Spathis A contributed significantly in preparation, collection of data, writing and critically revising the manuscript; Machairas N, Schizas D, Karakitsos P and Machairas A contributed in data analysis, and writing the manuscript. The main difference between the 5-tiered system and the 6-tiered system is that the DC III [atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS)] category is included only in the 6-tier system, a category with considerable prevalence, as it is calculated 6%-7% according to various statistics[14]. The following breakdown shines some light inside the black box of hematologic diagnostics and may provide insight into what the hematopathology report tells you. Ghossein Baloch The most common malignant diagnosis made after surgery in cases initially classified as AUS/FLUS is PTC, usually of the follicular variant (PTC-FV)[24,25]. Rabaglia JL, Kabbani W, Wallace L, Holt S, Watumull L, Pruitt J, Snyder WH, Nwariaku FE. For some of the general categories, some degree of sub-categorization can be informative and is often appropriate; recommended terminology is shown in Table 1. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. This is the most common variant of PTC and is characterized by a predominantly follicular architecture. RA Enter your ZIP Code, or City and State below to find the stores nearest you and a listing of the device models available within each. What happens after you place the orders, though? Fine-needle aspiration biopsy (FNAB) showed sparsely cellular smears with a finely granular background and groups of cells arranged in 3-dimensional clusters and papillary formation (Figure 2, arrow). It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. V Based on the findings (MRI, gross and histopathology) cysticercosis was confirmed. To collect as many cells as possible from sparsely cellular urine, the specimen should have which of the following techniques applied? 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. H "Demystifying the Bone Marrow Biopsy: A Hematopathology Primer." For a thyroid FNA specimen to be satisfactory for evaluation (and benign), 6 . These cells constitute more than 50% of tumor volume[44]. Deveci Cases that demonstrate the nuclear features of papillary carcinoma are excluded from this category. L 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]. However, we cannot answer medical or research questions or give advice. 92 0 obj <> endobj American Society of Hematology. J Aspirate slides are also used for cytochemical and iron stains. The terms for reporting results should have an implied (or explicit) risk of malignancy on which recommendations for patient management (eg, annual follow-up, repeated FNA, surgical lobectomy, near total thyroidectomy) can be based. A clinicopathologic study of 121 cases. Many of the HCLUS cases did not show any of the above features and were proved to be benign adenomas. Results: We evaluated 5030 thyroid FNAs. In this pattern benign follicular cells are detected, along with cells with nuclear enlargement, nuclear grooves, nuclear membrane irregularity, and/or nuclear molding, usually without any trace of intranuclear inclusions. Hrthle cell carcinoma is a better gold standard than Hrthle cell neoplasm for fine-needle aspiration of the thyroid: defining more consistent and specific cytologic criteria. Jo VY, Stelow EB, Dustin SM, Hanley KZ. et al. 2. JR 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 Aldinger KA, Samaan NA, Ibanez M, Hill CS. Rubenfeld Before Each of the categories has an implied cancer risk (ranging from 0% to 3% for the benign category to virtually 100% for the malignant category) that links it to a rational clinical management guideline Table 2. 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. The neoplastic cells show a greater cell height than the tall cell variant and lack the obvious nuclear features of PTC. The sample is composed of numerous monomorphic lymphoid cells. In conclusion, patients who require repeated FNAs for indeterminate diagnoses will be resolved by repeat FNA in a percentage of 72%-80%. PG The many faces and mimics of papillary thyroid carcinoma. Q: Can flow cytometry be performed on the core biopsy? In addition, obtaining adequate material at FNA is a very important issue, as the rates of malignancy observed in the nondiagnostic categories of both reporting systems are very high[14]. Impact of proto-oncogene mutation detection in cytological specimens from thyroid nodules improves the diagnostic accuracy of cytology. Remedy: The supernatant may not have been completely poured off resulting in dilution of the cell pellet. American Society of Hematology. Lloyd Approximately 3% to 7% of thyroid FNAs have conclusive features of malignancy, and most are papillary carcinomas.1013 Malignant nodules are usually removed by thyroidectomy, with some exceptions (eg, metastatic tumors, non-Hodgkin lymphomas, and undifferentiated carcinomas). Incidence of malignancy in thyroid nodules determined to be follicular lesions of undetermined significance on fine-needle aspiration. Liquid-based preparation can also be made after a FNA pass, with the needle been rinsed in normal saline or ThinPrep solutions. Atypical cells in fine-needle aspiration biopsy specimens of benign thyroid cysts. PU Johnson The National Cancer Institute Thyroid FNA State of the Science Conference: Wrapped up. Your patients cytopenias remain unexplained. 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. sparsely cellular sample but one that is comprised mostly of microfollicles. . The cytotechnologist is specially trained and certified to examine cellular samples under a microscope, evaluating the slides for specific abnormalities in the cell's shape, color, or size which could signal a cancerous process or other disease. ZW Alexander EK, Kennedy GC, Baloch ZW, Cibas ES, Chudova D, Diggans J, Friedman L, Kloos RT, LiVolsi VA, Mandel SJ, et al. 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 2-day live conference in October 2007, attended by 154 registrants including pathologists, endocrinologists, surgeons, and radiologists, gave the committees an in-depth opportunity to present their conclusions and debate controversial areas. Cytologic preparations typically have high cellularity, and colloid is scant or absent. Teixeira GV, Chikota H, Teixeira T, Manfro G, Pai SI, Tufano RP. specimens with obscuring blood, poor cell preservation, and an insufficient sample of follicular cells. Patients with sporadic MTC present with a solitary, circumscribed thyroid nodule, usually in the middle to upper-outer half of the thyroid gland. et al. This is an aggressive variant of PTC characterized by the presence of crowded, stratified clusters of elongated cells resembling cells from a colonic adenoma. According to the Bethesda system for reporting thyroid cytopathology, a specimen . ED For example, increased serum calcitonin levels and/or strong immunoresponce of chromogranin which is disclosed after multiple FNA tests can indicate the diagnosis of a medullary carcinoma. The differential diagnosis for the latter includes hyperplastic adenomatoid nodule with Hurthle cell change, Hurthle cell adenoma, and Hurthle cell carcinoma; (5) DC V Suspicious for malignancy. Cibas ES. Auger M, Stelow EB, Yang GCH. Pu [2] First documented in HeLa cells, where there are generally 10-30 per nucleus, [3] Paraspeckles are now known to also exist in all human primary cells, transformed cell lines and . These indeterminate results imply surgeons to consider alternative therapies (e.g., thyroid lobectomy with intraoperative frozen section). Yang Careers, Unable to load your collection due to an error. Thyroid FNA specimen a. endstream endobj startxref This distinction cannot be made by FNA and is of no consequence to the patient. BRAF mutation detection in indeterminate thyroid cytology specimens: underlying cytologic, molecular, and pathologic characteristics of papillary thyroid carcinoma. It is not widely agreed whether this neoplasm is a variant of PTC or not, although it seems to have the same RET gene rearrangements as PTC. 119 0 obj <>/Filter/FlateDecode/ID[<80B644DBD03A284F83277CD8A09960C6><94D1BF37A2B04B428378CFB47946E293>]/Index[92 53]/Info 91 0 R/Length 121/Prev 842357/Root 93 0 R/Size 145/Type/XRef/W[1 2 1]>>stream of value in acquiring a cellular sample, possibly due to increasing hemodilution. PTC accounts for 80% of all thyroid malignancies and occurs more often in women with a 3:1 female-to-male ratio, with a mean age at presentation 30-40 years. Extensive research is going on in this field; an important step for the introduction of new molecular markers in the diagnosis of molecular tumors could be the clinical testing of FNA samples in large multicenter trials. Impact of mutational testing on the diagnosis and management of patients with cytologically indeterminate thyroid nodules: a prospective analysis of 1056 FNA samples. For clarity of communication, the Bethesda System for Reporting Thyroid Cytopathology recommends that each report begin with a general diagnostic category. A suspicious interpretation is rendered only when the majority of the follicular cells are arranged in abnormal architectural groupings (microfollicles, crowded trabeculae). Deshpande AH, Munshi MM, Bobhate SK. CellMapper is a crowd-sourced cellular tower and coverage mapping service. 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. Centrifuge the specimen again and decant the entire supernatant. Some thyroid FNAs are not easily classified into the benign, suspicious, or malignant categories. LiVolsi SL Any specimen that contains abundant colloid is 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. Warthin's tumor : the presence of oncocytic epithelium. The double needle from the same aspirate procedure is used to cut a core biopsy of optimal length (longer is better; i.e., more data). Nuclear atypia or pleomorphism and mitoses are uncommon. To address terminology and other issues related to thyroid FNA, the National Cancer Institute (NCI) hosted the NCI Thyroid Fine Needle Aspiration State of the Science Conference. The meeting was organized by Andrea Abati, MD, and took place on October 22 and 23, 2007, in Bethesda, MD. The Paris System for Reporting Urinary Cytology tried lately to address adequacy. RT For that reason the aspirate is then classified as AUS/FLUS to indicate the uncertainty of the findings. LiVolsi Theoharis CG, Schofield KM, Hammers L, Udelsman R, Chhieng DC. The Bethesda System for Reporting Thyroid Cytopathology is the most preferred system for the diagnosis of FNA specimens, which also contains guidelines for the diagnosis and treatment of indeterminate cases. It generally affects elderly patients presenting as a firm mass rapidly growing in the neck infiltrating extrathyroidal tissues, such as muscle, trachea, esophagus, skin, bone and cartilage[49]. 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. This variant is sometimes difficult to diagnose, because in some cases the characteristic neoplastic cells are sparsely evident in the mass. The significance and clinical value of a CFO result depend in large part on sonographic correlation. For most cases surgical resection is not an effective treatment and only palliative therapies are used. Should atypical follicular cells in thyroid fine-needle aspirates be subclassified? )TEgX>T|*Q0%K5P- HVe t Rathan Prognosis is dismal with a mean survival of 2.5 to 6 mo and an overall 5-year survival of 0% to 14%. VA By using redundancies across components, your consultant hematopathologists may offer insights into the architecture, morphology, immunostaining, and flow cytometry profiles of any identified hematologic entity. Kinematic comparison between the knee after bicruciate stabilized total knee arthroplasty and the native knee: A cadaveric study. Gharib Baloch ZW, LiVolsi VA. Fine-needle aspiration of thyroid nodules: past, present, and future. Figure 2. Note extensive red blood cells in the background. If these constitute the minority of the follicular cells, they have little significance and the FNA can be interpreted as benign. Quick tip: If the bone marrow is involved by metastatic carcinoma or clusters of cohesive plasma cells, these abnormal cells may not be amenable to aspiration and may cause a dry tap; however, a bone core biopsy will identify them. Thus, the maximal number of spermatids can be packed and supported by a fixed population . Review of the literature suggests a malignancy rate of 55%-75% for the suspicious category[8]. As a library, NLM provides access to scientific literature. 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). Moreover, large, atypical, histiocytoid cells with enlarged nuclei and abundant vacuolated cytoplasm usually coexist. The separation of these four components allows for multiple sources of data collection and offers insurance against otherwise compromised specimens. Explaining the use and composition of pre-fixatives and their effect on cellular morphology 4. Fine-needle aspiration (FNA) cytology is an important diagnostic tool in patients with thyroid lesions. Broome JT, Solorzano CC. Nikiforov YE, Ohori NP, Hodak SP, Carty SE, LeBeau SO, Ferris RL, Yip L, Seethala RR, Tublin ME, Stang MT, et al. Bethesda guidelines suspicious for malignancy, Ali: The Bethesda System for Reporting Thyroid Cytopathology - Definitions, Criteria and Explanatory Notes, 2nd Edition, 2018, Head Neck Pathol 2019 Oct 17 [Epub ahead of print], Noninvasive follicular thyroid neoplasm with papillary-like nuclear features, invasive follicular variant of papillary thyroid carcinoma, Bethesda category V suspicious for malignancy (SM) is used when some cytologic features are strongly suspected of malignancy but are not sufficient for a conclusive diagnosis (, Higher suspicion of malignancy than atypia of undetermined significance / follicular lesion of undetermined significance (AUS / FLUS) but lower suspicion than malignant, Molecular testing with mutation panels may be useful, particularly for potential noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) cases, Purpose of separating suspicious for malignancy from malignant is to preserve the very high positive predictive value of the malignant category without compromising the overall sensitivity of fine needle cytology aspiration, Used when cytology is strongly suspected of malignancy but is not sufficient for a conclusive diagnosis, Frequency < 5%, resection rate 70%, risk of malignancy 80% (NIFTP = malignant), 45 - 60% (NIFTP malignant), Most common histological diagnosis is papillary thyroid carcinoma (PTC) (, Risk of malignancy: 80% (NIFTP = malignant), 45 - 60% (NIFTP malignant) (, Suspicious for malignancy interpretation allows for more conservative management options (e.g. Maybe a routine peripheral smear caught some circulating blasts. Hematology.org.https://www.hematology.org/education/trainees/fellows/trainee-news/2021/demystifying-the-bone-marrow-biopsy-a-hematopathology-primer(label-accessed May 01, 2023). 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). We thank Diane Solomon, MD, for review of the manuscript and helpful comments. Role of repeat fine-needle aspiration biopsy (FNAB) in the management of thyroid nodules. Ultrasound guidance is preferable than palpation-guided FNA for small nodules (< 1 cm), cystic lesions and when a prior FNA is nondiagnostic[13]. et al. Notes and recommendations are not required but can be useful in certain circumstances. III On the other hand a definitive diagnosis of a low-grade lymphoma (usually a MALT lymphoma) is even more difficult. How does one separate cellular follicular lesions of the thyroid by fine-needle aspiration biopsy? Descriptive comments that follow are used to subclassify the benign interpretation. Mazzaferri EL. Perceptions of diagnostic terminology and cytopathologic reporting of fine-needle aspiration biopsies of thyroid nodules: a survey of clinicians and pathologists. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. Architectural atypia may present in smears with paucity of cells, which contain a few microfollicles, trabeculae, or crowded groups. The impact of atypia/follicular lesion of undetermined significance on the rate of malignancy in thyroid fine-needle aspiration: evaluation of the Bethesda System for Reporting Thyroid Cytopathology. Crowded macrofollicles with mild irregularities in nuclear membrane and prominent nucleoli in a specimen with scant colloid ( 40 pap stain on ThinPrep slide) (diagnostic categories III). Single neurons, as the basic unit of the brain, consist of a cell body and processes, including dendrites and axons. To address terminology and other issues related to thyroid fine-needle aspiration (FNA), the National Cancer Institute (NCI) hosted the NCI Thyroid FNA State of the Science Conference. Oncocytic cells with nuclear features of papillary carcinoma are excluded from this interpretation. Abati A. (iii) Cytologic and architectural atypia: JR Weber D, Brainard J, Chen L. Atypical epithelial cells, cannot exclude papillary carcinoma, in fine needle aspiration of the thyroid. Williams ED. What is one to do with the sparsely cellular specimen consisting mostly of microfollicles? Surgical intervention consisted of a 15 7 7-cm segmental mastectomy specimen that contained a large, ill-defined, irregular pink-tan . 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. 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. The core biopsy is useful for assessing overall marrow cellularity, trilineage hematopoiesis, and marrow architecture. the contents by NLM or the National Institutes of Health. 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. 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. The differential diagnosis includes hyperplastic adenomatous nodules, follicular adenoma, follicular carcinoma, and follicular variant of PTC, where the nuclear features remain ill defined. (B) A case diagnosed as DC IV (suspicious for a follicular neoplasm) shows moderately cellular specimen with abundant microfollicles (x15; scale bar, 200 m) (C-F) Architectural alterations such as microfollicles (C and D), 3-dimensional branching (E), and architectural crowding (F) are frequently observed in cases categorized as DC IV 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]. M T Undifferentiated (anaplastic) thyroid carcinoma (UTC) is an extremely aggressive thyroid malignancy with a very poor prognosis. Conflict-of-interest statement: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported. There are cyst-lining cells that may appear atypical owing to the presence of nuclear grooves, prominent nucleoli, elongated nuclei and cytoplasm, and/or intranuclear cytoplasmic inclusions in an otherwise predominantly benign-appearing sample.16. The management of cases with papillary microcarcinomas, i.e., tumors less than 1.0 cm in diameter, is still controversial. 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. Jan 2018 - Present5 years 4 months. Papillary thyroid carcinoma and variants. In this pattern the nuclear enlargement is generalized in mild-to-moderate degree with evident nuclear grooves and mild nuclear pallor. The phenotypic composition of the various marrow components is key to understanding their utility for further investigative diagnostic studies. FVPTC is characterized cytologically by the paucity of diagnostic nuclear features. Additionally, since the cells are smeared, they are technically three-dimensional, and morphology can be assessed. Edmund S. Cibas, MD, Syed Z. Ali, MD, The Bethesda System for Reporting Thyroid Cytopathology, American Journal of Clinical Pathology, Volume 132, Issue 5, November 2009, Pages 658665, https://doi.org/10.1309/AJCPPHLWMI3JV4LA. In this pattern cystic degeneration with hemosiderin-laden macrophages is present. Table: Comparative advantages and drawbacks of the marrow aspirate versus the core biopsy. This category also includes cases with a predominant population of Hurthle cells; these cases are labelled Hurthle cell neoplasm (Figure (Figure3).3). As such, if a dry tap is encountered during a bone marrow procedure, it may be beneficial to obtain two bone core biopsies to send to the laboratory. Furthermore, the clot section, like the core biopsy, can be used for immunohistochemical stains. Sparsely cellular and contains atypical lymphoid cells Suspicious for malignancy, not otherwise specified Other primary thyroid malignancies like anaplastic carcinoma and poorly differentiated carcinoma Suboptimal cellularity or preservation can lead to uncertainty and result in a suspicious for malignancy interpretation Cytology images DeLellis In FNA specimens of this variant, the cancer cells appear more profuse, granular or vacuolated compared to regular PTC. Flat sheets showing enlarged, pale nuclei with finely granular chromatin of a papillary Ca case ( 40 pap stain on ThinPrep slide) (diagnostic categories VI). LiVolsi Other benign subcategories include consistent with lymphocytic (Hashimoto) thyroiditis in the proper clinical context and consistent with granulomatous (subacute) thyroiditis. This is a partial list and does not include a variety of other benign conditions like infections and amyloid goiter that are occasionally sampled by FNA. 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. The adequacy of a thyroid FNA is defined by both the quantity and quality of the cellular and colloid components.

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