Cystic Medullary Thyroid Carcinoma: Report of a Case with Morphological and Clinical Correlations

Fadda, Guido; Mulè, Antonino; Rufini, Vittoria; Ardito, G; Revelli, Luca; Fiorino, Marilena; Capelli, Arnaldo

doi:10.1385/ep:11:4:373

Cited by 11 publications

(14 citation statements)

References 7 publications

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“…In evaluations of cystic nodules, the role of FNAC is limited, and false-negative diagnoses of malignant cysts are well documented [20,[59][60][61][62][63]. However, only a few authors have emphasized that atypical cyst-lining cells may produce false-positive cytologic results, and few have fully demonstrated the cytologic and histologic features of atypical cyst-lining cells [5,61].…”

Section: Analysis Of the False-positive Casesmentioning

confidence: 99%

Causes of misdiagnoses by thyroid fine-needle aspiration cytology (FNAC): our experience and a systematic review

Zhu

Song

et al. 2020

Diagn Pathol

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Objective: FNA is a simple, safe, cost-effective and accurate diagnostic tool for the initial screening of patients with thyroid nodules. The aims of this study were to determine the diagnostic utility of FNAC performed in our institution, assess the cytomorphologic features that contribute to diagnostic errors and propose improvement measures.Methods: A total of 2781 FNACs were included in the study, and 1122 cases were compared with their histological diagnoses. We retrospectively reexamined our discordant (both false-negative and false-positive) cases and performed a systematic review of previous studies on causes of misdiagnoses.Results: When DC V and DC VI were both considered cytologic-positive, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were 98.3, 30.9, 94.9, 58.3 and 93.5%, respectively. If DC VI was considered cytologic-positive, the sensitivity, specificity, PPV, NPV and diagnostic accuracy of FNAC were 98.0, 84.0, 99.4, 58.3, and 97.5% respectively. The main cause of false-negative diagnoses was sampling error (13/15, 86.7%), while interpretation error led to the majority of the false-positive diagnoses (38/47, 80.9%). Overlapping cytological features in adenomatous hyperplasia, thyroiditis and cystic lesions were the major factors contributing to interpretation errors, while the size and number of nodules may have led to false-negative diagnoses because of heterogeneity and unsampled areas. Conclusions:The sensitivity and PPV of thyroid FNAC in our institution were higher than those in the published data, while the specificity and NPV were lower. Regarding the FNA category DC V, a frozen section analysis during diagnostic lobectomy is necessary. Multiple passes should be performed in various parts of a large nodule or from different nodules to reduce the risk of false-negative findings. Cytopathologists should strengthen their criteria for the identification of adenomatous hyperplasia, thyroiditis and cystic lesions to avoid false-positive diagnoses. NIFTP has little effect on diagnostic accuracy and the distribution of diagnostic errors.

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Section: Analysis Of the False-positive Casesmentioning

confidence: 99%

Causes of misdiagnoses by thyroid fine-needle aspiration cytology (FNAC): our experience and a systematic review

Zhu

Song

et al. 2020

Diagn Pathol

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“…We have described a case of MTC with a very rare cystic presentation within a multinodular goiter. A few cases of cystic MTC have been reported (5)(6)(7)(8)(9)(10)(11). The main details of these articles are illustrated in Table II.…”

Section: Discussionmentioning

confidence: 99%

Serum Markers Measured in FNA Fluids of Medullary Thyroid Carcinoma Occurring as a Cyst

et al. 2016

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“…For a definitive diagnosis of medullary carcinoma, cytological samples might be studied with an immunopanel made up of carcinoembryonic antigen (CEA), calcitonin and thyroglobulin. Evidence of low levels of calcitonin and CEA in the fluid and in the serum might rule out this diagnosis . A rarer condition which needs to be ruled out is the possible metastatic cystic localization of an unknown primitive malignancy, although this type of sample presents certain specific morphological features which can be carefully pointed out and can lead to the application of a more adequate diagnostic immunopanel or clinical correlation.…”

Section: Discussionmentioning

confidence: 99%

Large non‐functioning parathyroid cysts: our institutional experience of a rare entity and a possible pitfall in thyroid cytology

et al. 2014

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Large non-functioning parathyroid cysts: our institutional experience of a rare entity and a possible pitfall in thyroid cytology Objective: Large non-functioning parathyroid cysts represent a rare entity with a benign clinical course. They may be misdiagnosed as thyroid cystic neoplasms on fine needle aspiration cytology (FNAC), resulting in inappropriate surgical treatment. We evaluated our institutional experience in the diagnosis of large parathyroid cystic lesions underlining all the differential diagnoses and pitfalls. Methods: In the period between 1998 and 2012, we reported the cytology of eight large (>2.5 cm) parathyroid cystic lesions (all female patients) with histological control. The aspirations were performed with a 25-gauge needle with ultrasonographic guidance. The aspirated material was processed with liquid-based cytology (LBC). All the patients had normal serum parathyroid hormone (PTH) and calcium. Results: The cytological samples showed a fluid watery component without colloid and few or absent epithelial cells. The resulting negativity for thyroglobulin and positivity for PTH, carried out on the cystic fluids, suggested parathyroid lesions rather than either thyroid cystic lesions (including follicular thyroid neoplasm) or cystic malignant lesions. All the patients underwent surgery without complications. Conclusions: To the best of our knowledge, this is one of the largest series with cytohistological evaluation of large parathyroid cysts. The incidence of large parathyroid cysts remains controversial as most patients are asymptomatic. FNAC may be performed with conclusive results in the majority of cystic cases. The detection of PTH and calcium on the cystic liquid is likely to achieve a correct cytological diagnosis, allowing adequate treatment and ruling out a more frequent thyroid lesion.

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Cystic Medullary Thyroid Carcinoma: Report of a Case with Morphological and Clinical Correlations

Cited by 11 publications

References 7 publications

Causes of misdiagnoses by thyroid fine-needle aspiration cytology (FNAC): our experience and a systematic review

Causes of misdiagnoses by thyroid fine-needle aspiration cytology (FNAC): our experience and a systematic review

Serum Markers Measured in FNA Fluids of Medullary Thyroid Carcinoma Occurring as a Cyst

Large non‐functioning parathyroid cysts: our institutional experience of a rare entity and a possible pitfall in thyroid cytology

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