Common Diagnostic Pitfalls in Thyroid Cytopathology

344 Pages·2016·34 MB·English

by  Adebowale J. Adeniran

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
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does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant
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Printed on acid-free paper
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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