Fine Needle Aspiration Cytology of Parathyroid Lesions

Abstract

BackgroundThere has been an increase in the use of fine needle aspiration cytology (FNAC) for the diagnosis of parathyroid lesions (PLs). Differentiation between a thyroid lesion and a PL is not easy because of their similar features. We reviewed parathyroid aspirates in our institution and aimed to uncover trends in diagnostic criteria.MethodsWe selected 25 parathyroid aspirates (from 6 men and 19 women) confirmed surgically or immunohistochemically from 2006 to 2011.ResultsMajor architectural findings of PLs include scattered naked nuclei, loose clusters, a papillary pattern with a fibrovascular core, tight clusters, and a follicular pattern. These architectures were commonly admixed with one another. Cytological features included anisokaryosis, stippled chromatin, a well-defined cell border, and oxyphilic cytoplasm. Eighteen of the 25 patients were diagnosed with PL using FNAC. Seven patients had been misdiagnosed with atypical cells (n=2), benign follicular cells (n=2), adenomatous goiter (n=2) and metastatic carcinoma (n=1) in FNAC. Using clinicoradiologic data, the sensitivity of the cytological diagnosis was 86.7%. The cytological sensitivity decreased to 50% without this information.ConclusionsFNAC of PL is easily confused with thyroid lesions. A combination of cytological parameters and clinical data will be required to improve the diagnostic sensitivity of PLs.

Abstracts

“…Of the 39 patients, 9 had initial visits in 2014, 17 in 2015, 11 in 2016. The natal male: female ration is 1:1.8 with males presenting at an average age of 11.7 years (4-17 years) and Tanner stage 2.9 (1-5) and females average age 14.9 years (10-18 years) and Tanner stage 4.56 (1)(2)(3)(4)(5). With regard to endocrine treatment, 46% no medication, 8% PS only, 18% SS only, 28% combination PS/SS.…”

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“…FNAs of the parathyroid can be confused with the thyroid because of overlap in cytomorphologic features. A combination of cytological parameters should be used as no one single feature is diagnostic 2 Two studies of cytological evaluation of parathyroid lesions showed scattered naked nuclei, loose clusters, fibrovascular core, and a papillary or follicular pattern that was easily confused with thyroid like lesions 3 Background Severe hypoglycemia can result in neuronal dysfunction and death. It is mostly associated with insulin and/or sulfonylurea use.…”

“…A CT scan of the head showed a possible occipital intraparenchymal hemorrhage. A lumbar puncture was performed; the CSF had 1500 RBC/mm 3 and 0 WBC/mm 3 . A repeat CT scan revealed bilateral low-density changes consistent edema in both cerebellar hemispheres and both occipital and parietal lobes consistent with posterior reversible encephalopathy syndrome and a left occipitoparietal intraparenchymal bleed.…”