Fine-needle aspiration (FNA) is an important test for triaging patients with thyroid nodules. The 2007 National Cancer Institute Thyroid Fine-Needle Aspiration State-of-the-Science Conference helped instigate the recent publication of The Bethesda System for Reporting Thyroid Cytopathology. We reviewed 3,080 thyroid FNA samples and recorded interpretations according to the proposed standardized 6-tier nomenclature, and pursued follow-up cytology and histology. Of the 3,080 FNAs, 18.6% were nondiagnostic, 59.0% were benign, 3.4% were atypical follicular lesion of undetermined significance (AFLUS), 9.7% were "suspicious" for follicular neoplasm (SFN), 2.3% were suspicious for malignancy (SM), and 7.0% were malignant. Of 574 cases originally interpreted as nondiagnostic, 47.9% remained nondiagnostic. In 892 cases, there was follow-up histology. Rates of malignancy were as follows: nondiagnostic, 8.9%; benign, 1.1%; AFLUS, 17% (9/53); SFN, 25.4%; SM, 70% (39/56), and malignant, 98.1%. Thus, classification of thyroid FNA samples at the University of Virginia Health System, Charlottesville, according to The Bethesda System yields similar results for risk of malignancy as reported by others. Universal application of the new standardized nomenclature may improve interlaboratory agreement and lead to more consistent management approaches.

Fine-needle aspiration (FNA) is a screening and diagnostic tool used to triage the management of thyroid nodules. While FNA has proved to be a sensitive means of detecting common thyroid malignancies, less is known about the sensitivity and positive predictive value (PPV) of FNA for uncommon thyroid malignancies, including anaplastic thyroid carcinomas, medullary thyroid carcinomas, lymphomas, metastatic carcinomas, and other malignancies. We reviewed our experience with these uncommon malignancies sampled by thyroid FNA and recorded interpretations according to the Bethesda System. We compared the FNA interpretations to the follow-up cytology, histology, and flow cytometry. The sensitivity and PPV were as follows: anaplastic thyroid carcinoma (sensitivity 100%, PPV 89%), lymphoma (sensitivity 100%, PPV 100%), medullary thyroid carcinoma (sensitivity 83%, PPV 100%), metastatic carcinoma (sensitivity 80%, PPV 80%), and other malignancy (sensitivity 100%, PPV 100%). Four false-negative and two false-positive diagnoses were identified. While cases were nearly always triaged correctly, occasional pitfalls were encountered.

Gangliocytic paragangliomas are rare tumors primarily found in the duodenum. We report a case of a woman who presented with a retroperitoneal lymph node involved by metastatic gangliocytic paraganglioma. Subsequently, fine-needle aspiration (FNA) cytology was used to identify the primary duodenal gangliocytic paraganglioma. The smears of the aspirate material were highly cellular and contained a dominant population of epithelioid cells, a second population of ganglion cells and a third population of small, bland spindled cells. To our knowledge, the cytologic features of gangliocytic paraganglioma have not previously been documented.

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Depth of myometrial invasion by endometrioid adenocarcinoma (EMAC) is one of the most important predictive factors of disease recurrence. It is unclear whether myoinvasion arising in carcinomatous involvement of adenomyosis (AM) changes prognosis. The purpose of this study was to evaluate the significance and frequency of the tumor involved AM in otherwise low-stage cancers. Eighty-two hysterectomies with EMAC with less than 50% myoinvasion (T1a, FIGO IA), AM, and at least 2 years of follow-up information were reviewed. The tumors were divided into 4 histologic groups: group 1, no involvement of AM by EMAC (n=38); group 2, tumor involved AM surrounded by endometrial stroma (n=31); group 3, tumor involved AM with incomplete peripheral endometrial stroma (n=10); and group 4, tumor involved AM with invasion into adjacent smooth muscle (n=3). Tumor involved AM was in the inner half of the myometrium in 35 cases and in the outer half of the myometrium in 9 cases. The only adverse outcome was vaginal recurrence, which was noted in 2 of 82 patients; both the patients were from the control group. None of the patients with deep-seated tumor involved AM had tumor recurrence. In otherwise low-stage tumors, our data support the concept that tumor involvement of the deeply located AM does not affect prognosis. Myometrial-based foci of well-differentiated EMAC, completely or partially surrounded by endometrial stroma, most likely represents tumor colonized AM. Determining invasion out of these foci is subjective, and although limited by rarity in this study, carries no adverse outcome. Therefore, staging should be based on the myoinvasion noted at the native endomyometrial junction.