Medullary carcinoma of thyroid mimicking Hurthle cell neoplasm on cytology: a diagnostic dilemma

Agarwal, Charu; Raychaudhuri, Sujata; Batra, Akshay; Pujani, Mukta; Dhingra, Shruti

doi:10.1002/dc.24220

Cited by 4 publications

(3 citation statements)

References 13 publications

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“…The differential diagnosis of Hurthle cell type follicular neoplasia includes medullary carcinoma variants, parathyroid tissue, and histiocytes in FNA samples. Although they do not have the characteristic sharply delineated cytoplasmic density [35,36], we believe CNB samples facilitate the diagnosis with this structural evaluation advantage in these cases.…”

Section: Discussionmentioning

confidence: 87%

The histopathologic checkpoints for thyroid core needle biopsy compared with resection sections

Kıran¹,

Guler²

2022

pjp

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Introduction:The nuclear features that are thought to be classic indicators of thyroid nodules are not fully observed in core needle biopsies (CNB). The aim of this study was to evaluate the histopathological differences between CNB samples and resection sections. Material and methods: The haematoxylin and eosin-stained CNB and resection sections of thyroid nodules were retrospectively re-evaluated in terms of nuclear and architectural parameters. The evaluations were conducted by 2 pathologists. Statistical analysis was applied in 80 selected cases diagnosed as benign (n = 37) and papillary carcinoma/suspicious for papillary carcinoma (n = 43). Results: The nuclear findings in the CNB were more subtle than in the resection sections. The nuclei were smaller (measurements of the nuclear areas, major axes, and minor axes in CNB and resection sections were 52.62 µm 2 , 9.89 µm, 6.75 µm, 129.18 µm 2 , 14.53 µm, and 10.79 µm, respectively). Hypochromia was detected in 46.5% of the papillary carcinoma cases. Grooves and pseudoinclusions were the other nuclear features that could be detected. However, nuclear contour irregularity was the most reliable finding that could predict papillary carcinoma diagnosis in the CNB sections (v: 0.82, p < 0.001). Conclusions: We believe that the histopathological differences we found have an important place in diagnostics and should be emphasized, and new diagnostic algorithms should be developed.

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Section: Discussionmentioning

confidence: 87%

The histopathologic checkpoints for thyroid core needle biopsy compared with resection sections

Kıran¹,

Guler²

2022

pjp

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“…The characteristic cytologic features of MTC are sometimes misleading. For example, dispersed cell patterns and an oxyphilic cytoplasm yielded the impression of follicular or oxyphilic neoplasm [32,33]. Recognition of the constitutive cytomorphologic features is needed for each cytopreparatory method, which may result in a lower threshold to initiate further workup for MTC.…”

Section: Discussionmentioning

confidence: 99%

Constitutive Cytomorphologic Features of Medullary Thyroid Carcinoma Using Different Staining Methods

et al. 2021

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(1) Background: Accurate preoperative identification of medullary thyroid carcinoma (MTC) is challenging due to a spectrum of cytomorphologic features. However, there is a scarcity of studies describing the cytomorphologic features as seen on fine-needle aspiration (FNA) smears prepared using different staining methods. (2) Methods: We performed a retrospective study on MTC cases with available FNA slides from 13 hospitals distributed across 8 Asia-Pacific countries. The differences in the constitutive cytomorphologic features of MTC with each cytopreparatory method were recorded. A comparative analysis of cytologic characteristics was carried out with appropriate statistical tests. (3) Results: Of a total of 167 MTC samples retrospectively recruited, 148 (88.6%) were interpreted as MTC/suspicious for MTC (S-MTC). The staining methods used were Papanicolaou, hematoxylin-eosin, and Romanowsky stains. Seven out of the eleven cytologic criteria can be readily recognized by all three cytopreparatory methods: high cellularity, cellular pleomorphism, plasmacytoid cells, round cells, dyshesive cells, salt-and-pepper chromatin, and binucleation or multinucleation. An accurate diagnosis was achieved in 125 (84.5%) of the 148 samples whose FNAs exhibited five or more atypical features. Conclusions: The present work is the first study on MTC to compare the morphological differences among the cytologic staining techniques. We investigated the constitutive features and the reliability of diagnostic parameters. A feasible scoring system based upon cytomorphologic data alone is proposed to achieve a high degree of diagnostic accuracy.

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“…26 Our survey the diagnosis of follicular neoplasm. 25,[27][28][29] In such circumstances, the misinterpretation could impede the subsequent diagnostic workup.…”

Section: Application Of Calcitonin Measurement In Washout Fluidmentioning

confidence: 99%

Cytologic diagnosis of medullary thyroid carcinoma in the Asia‐Pacific region

Liu

Bychkov

Agarwal

et al. 2020

Diagnostic Cytopathology

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Background The accurate preoperative identification of medullary thyroid carcinoma (MTC) is challenging due to the rarity of tumor and variable cytologic appearance. The Asian experience with diagnosing MTC by fine‐needle aspiration (FNA) was scarcely reported. Methods Cases of MTC with available FNA slides were enrolled from 13 hospitals representing 8 Asia‐Pacific countries. Clinicopathological information, including sample preparation technique, staining method, original cytologic diagnosis and review diagnosis were collected. Results Of a total of 145 MTC cases retrospectively recruited, 99 (68.3%) were initially interpreted as MTC/suspicious for MTC (S‐MTC). The distribution of original FNA diagnostic categories was not associated with the staining method or sample preparation technique. The staining methods used were Papanicolaou, hematoxylin‐eosin and Romanowsky stains. Liquid‐based cytology (LBC) was used only in three countries. After reviewing all cases, the diagnostic rate of MTC/S‐MTC increased to 91.7% (133/145). Cases with initially unrecognized MTC had either marked pleomorphism or cytology mimicking papillary carcinoma or follicular neoplasm. Although LBC provided certain benefits, there was no significant difference in diagnostic accuracy between conventional smear and LBC. Immunocytochemistry was available in 38 cases (26.2%), all of which were correctly recognized as MTC. Conclusion Our report summarizes how MTC is handled in contemporary Asian thyroid FNA practice. Although the detection rate of MTC by cytology alone is less satisfactory, integration with ancillary tests could achieve an excellent performance. The recognition of constitutive cytomorphologic features is needed for each cytopreparatory method, which may result in a lower threshold to initiate further workup for MTC.

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Medullary carcinoma of thyroid mimicking Hurthle cell neoplasm on cytology: a diagnostic dilemma

Cited by 4 publications

References 13 publications

The histopathologic checkpoints for thyroid core needle biopsy compared with resection sections

The histopathologic checkpoints for thyroid core needle biopsy compared with resection sections

Constitutive Cytomorphologic Features of Medullary Thyroid Carcinoma Using Different Staining Methods

Cytologic diagnosis of medullary thyroid carcinoma in the Asia‐Pacific region

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