Cytological diagnosis of papillary thyroid carcinoma with tall cells on ThinPrep liquid‐based cytology

Abstract

Background The tall cell variant of papillary thyroid carcinoma (PTC‐TC) has been associated with aggressive features including extrathyroidal extension, higher rate of lymph node and distant metastases, and higher recurrence rate. We aimed to evaluate the cytomorphologic features of PTC‐TC on ThinPrep (TP) along with its diagnostic efficacy to detect PTC‐TC. Methods Preoperative cytology samples from 30 cases of histologically‐proven PTC‐TC and 30 classical PTC controls were selected for this study. TP preparations were evaluated for varying architectural and cytomorphologic features. Results Tall cells were present in the majority of PTC‐TC cases and were located at the periphery of cell clusters and as single cells. Cytoplasmic cuff along the periphery of cell clusters and soap‐bubble pseudoinclusions were very specific features of PTC‐TC, when present. PTC‐TC cases were more likely to show abundant oncocytic cytoplasm and distinct cell borders. Cytoplasmic tails were more likely to be present and more numerous in PTC‐TC. The presence of nuclear grooves, papillary architecture, and giant cells were not reliable distinguishing features of PTC‐TC vs controls. Conclusion Our results indicate that tall cell cytomorphologic and architectural features in PTC are identifiable on TP.

Atypical Histiocytoid Cells and Multinucleated Giant Cells in Fine-Needle Aspiration Cytology of the Thyroid Predict Lymph Node Metastasis of Papillary Thyroid Carcinoma

“…In our study, psammoma bodies were found in only 11 (5.0%) of 222 liquid-based cytology specimens. Tall cells are easily identified in liquid-based preparations and their presence in FNAC was strongly correlated with tall cell variants of PTC [14,26]. However, there was no association between tall cells and lymph node metastasis in our present and previous studies [18].…”

Clinical value of ultrasound parameters PI, TTP, and MTT in assessing cervical lymph node metastasis of papillary thyroid carcinoma

“…Papillary thyroid carcinoma (PTC) develops slowly, without causing obvious pain during the course of development, and it has a low rate of distant metastasis and death, so many potential patients are only identified postmortem [14,15].…”

Case for staged thyroidectomy

“…Classically for these tumors that are considered as "intermediate risk" according to the ATA, the option of a total thyroidectomy is generally retained. [29][30][31] In particular, the tall-cell variant of PTC is more likely to present with multifocal and bilateral disease, thus the indication becomes more compelling under such circumstances. 32 The removal of all thyroid tissue is justified for most tall-cell and other aggressive variants based on a higher likelihood for ETE.…”

“…However, such variants are more often diagnosed on histopathology. Classically for these tumors that are considered as “intermediate risk” according to the ATA, the option of a total thyroidectomy is generally retained 29‐31 . In particular, the tall‐cell variant of PTC is more likely to present with multifocal and bilateral disease, thus the indication becomes more compelling under such circumstances 32 .…”