Common Diagnostic Pitfalls in Thyroid Cytopathology PDF
Preview Common Diagnostic Pitfalls in Thyroid Cytopathology
Common Diagnostic Pitfalls in Thyroid Cytopathology Adebowale J. Adeniran David Chhieng 123 Common Diagnostic Pitfalls in Thyroid Cytopathology Adebowale J . Adeniran (cid:129) David Chhieng Common Diagnostic Pitfalls in Thyroid Cytopathology Adebowale J. Adeniran David Chhieng Department of Pathology Department of Pathology Yale University School of Medicine Mount Sinai Health System New Haven , CT , USA New York, NY , USA ISBN 978-3-319-31600-0 ISBN 978-3-319-31602-4 (eBook) DOI 10.1007/978-3-319-31602-4 Library of Congress Control Number: 2016937359 © Springer International Publishing Switzerland 2016 T his work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. T he use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. T he publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG Switzerland To my parents, for their unfailing love and constancy and all the sacrifi ce during the days of little beginning. To my wife, Olabisi, for her unwavering support, patience and enduring love. To my precious children, Oluwademilade, Temiladeoluwa and Titiladeoluwa, for their understanding. – Adebowale J. Adeniran v Contents 1 Aspirates with Macrophages and/or Colloid Only .............................. 1 Case Study ................................................................................................ 1 Discussion ................................................................................................. 1 References ................................................................................................. 10 2 Usefulness of Subclassification of Follicular Lesion of Undetermined Significance ................................................................ 13 Case Study ................................................................................................ 13 Discussion ................................................................................................. 13 References ................................................................................................. 21 3 Cytologic Atypia in Toxic Goiter ........................................................... 23 Case Study ................................................................................................ 23 Discussion ................................................................................................. 28 References ................................................................................................. 31 4 Hurthle Cell Lesions ............................................................................... 33 Case Study ................................................................................................ 33 Discussion ................................................................................................. 38 References ................................................................................................. 57 5 Hashimoto Thyroiditis ............................................................................ 59 Case Study ................................................................................................ 59 Discussion ................................................................................................. 59 References ................................................................................................. 71 6 Lymphocyte-Only Aspirates ................................................................... 73 Case Study ................................................................................................ 73 Discussion ................................................................................................. 73 References ................................................................................................. 87 7 Molecular Testing .................................................................................... 89 Case Study ................................................................................................ 89 Case 1 .................................................................................................... 89 Case 2 .................................................................................................... 93 Discussion ................................................................................................. 97 vii viii Contents Molecular Pathway of Thyroid Carcinogenesis .................................... 97 Limitations of Cytology ........................................................................ 97 Currently Available Molecular Testing for Routine Clinical Use ......... 98 Detection of Somatic Mutations ........................................................... 98 Gene Expression Classifi ers .................................................................. 101 Beyond the Horizon .............................................................................. 104 References ................................................................................................. 105 8 Cystic Papillary Thyroid Carcinoma .................................................... 109 Case Study ................................................................................................ 109 Discussion ................................................................................................. 109 References ................................................................................................. 120 9 Follicular Variant of Papillary Thyroid Carcinoma ............................ 121 Case Study ................................................................................................ 121 Discussion ................................................................................................. 121 References ................................................................................................. 134 10 Variants of Papillary Thyroid Carcinoma ............................................ 137 Case Study ................................................................................................ 137 Discussion ................................................................................................. 141 Oncocytic Variant and Clear Cell Changes ........................................... 142 Warthin-Like Variant ............................................................................. 146 Papillary Thyroid Carcinoma with Nodular Fasciitis-Like Stroma ...... 151 Macrofollicular Variant ......................................................................... 153 Diffuse Sclerosing Variant .................................................................... 155 Solid Variant .......................................................................................... 160 Tall Cell Variant .................................................................................... 163 Columnar Cell Variant........................................................................... 171 Cribriform-Morular Variant .................................................................. 174 References ................................................................................................. 177 11 Medullary Carcinoma............................................................................. 181 Case Study ................................................................................................ 181 Discussion ................................................................................................. 182 References ................................................................................................. 205 12 Hyalinizing Trabecular Tumor .............................................................. 209 Case Study ................................................................................................ 209 Discussion ................................................................................................. 209 References ................................................................................................. 222 13 Poorly Differentiated Thyroid Carcinoma ............................................ 225 Case Study ................................................................................................ 225 Discussion ................................................................................................. 229 References ................................................................................................. 238 Contents ix 14 Anaplastic Thyroid Carcinoma.............................................................. 239 Case Study ................................................................................................ 239 Discussion ................................................................................................. 248 References ................................................................................................. 262 15 Metastatic Neoplasms to the Thyroid .................................................... 263 Case Study ................................................................................................ 263 Discussion ................................................................................................. 264 References ................................................................................................. 279 16 Thyroglobulin Detection in Fine-Needle Aspiration of Nodal Metastases from Differentiated Thyroid Cancers ................ 281 Case Study ................................................................................................ 281 Discussion ................................................................................................. 284 References ................................................................................................. 287 17 Pediatric Thyroid FNA ........................................................................... 289 Case Study ................................................................................................ 289 Discussion ................................................................................................. 294 References ................................................................................................. 296 18 Ectopic Thyroid Tissue Versus Nodal Metastasis ................................. 299 Case Study ................................................................................................ 299 Discussion ................................................................................................. 304 References ................................................................................................. 307 19 Parathyroid Tissue Versus Thyroid Tissue ........................................... 309 Case Study ................................................................................................ 309 Discussion ................................................................................................. 310 References ................................................................................................. 320 20 Evaluation of Thyroid Bed Sampling .................................................... 323 Case Study ................................................................................................ 323 Discussion ................................................................................................. 323 References ................................................................................................. 336 Index ................................................................................................................. 339
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