Parathyroid cytology: Avoiding diagnostic pitfalls

Absher, Kimberly J.; Truong, Luan D.; Khurana, Kamal K.; Ramzy, Ibrahim

doi:10.1002/hed.10003

Cited by 79 publications

(79 citation statements)

References 10 publications

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“…Hürthle cell thyroid neoplasms have much larger and more prominent nucleoli, and the cells tend to be more dyscohesive [16]. There is no single definite diagnostic criterion that helps to differentiate reliably parathyroid lesions from those of the thyroid, but rather a combination of the cytomorphological features should be applied (Table 1) [21]. …”

Section: Discussionmentioning

confidence: 99%

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Fine-Needle Aspiration Cytology of Parathyroid Carcinoma Mimic Hürthle Cell Thyroid Neoplasm

Sriphrapradang

Sornmayura

Chanplakorn

et al. 2014

Case Reports in Endocrinology

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Background. Fine-needle aspiration (FNA) can cause misdiagnosis of cytomorphological findings between parathyroid and thyroid lesions. Case Presentation. A 31-year-old man presented with a palpable neck mass on the right thyroid lobe. FNA cytology was reported as intrathyroidal lymphoid hyperplasia. After 5 years, repeated FNA was done on the enlarged nodule with result of Hürthle cell lesion. Prior to right lobectomy, laboratories revealed elevated serum calcium and parathyroid hormone (PTH). Careful history taking revealed chronic knee pain and ossifying fibroma at the maxilla. Ultrasonography showed a 2.8 cm mass inferior to right thyroid lobe. Pathology from en bloc resection was parathyroid carcinoma and immunohistochemical study revealed positivity for PTH. Genetic analysis found somatic mutation of CDC73 gene in exon1 (c.70delG) which caused premature stop codon in amino acid 26 (p.Glu24Lysfs*2). The final diagnosis was hyperparathyroidism-jaw tumor syndrome. Conclusions. FNA cytology of parathyroid can mimic thyroid lesion. It is important to consider and correlate the entire information from clinical history, laboratory, imaging, and FNA.

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Section: Discussionmentioning

confidence: 99%

“…A panel of IHC study for the PTH, thyroglobulin, thyroid transcription factor-1 (TTF-1), and chromogranin and analyses of the PTH level of the washouts of FNA might be helpful [25, 26]. However, false negative case of PTH staining can occur due to poor cellularity of smears or previously stained smears [21]. …”

Section: Discussionmentioning

confidence: 99%

Fine-Needle Aspiration Cytology of Parathyroid Carcinoma Mimic Hürthle Cell Thyroid Neoplasm

Sriphrapradang

Sornmayura

Chanplakorn

et al. 2014

Case Reports in Endocrinology

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“…Thyroid transcription factor-1, calcitonin and parathormone serve as markers of the histogenetic determination of cells (e.g. differentiation between thyrocytes, parafollicular and parathyroid cells) [57,58]. DPPIV (CD26) and galectin-3 are markers of malignancy [59,60].…”

Section: The Potential Of Diagnostic and Prognostic Improvement In Aumentioning

confidence: 99%

Thyroid Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance: An Indispensable Bethesda 2010 Diagnostic Category or Waste Garbage?

Kholová

Ludvíková²

2014

Acta Cytologica

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Objective: The Bethesda System for Reporting Thyroid Cytopathology (BSRTC) was introduced in thyroid cytology in 2007 and is now generally accepted. BSRTC categories include a morphologic description and risk of malignancy as well as follow-up suggestions in each group. However, the category entitled ‘atypia of undetermined significance or follicular lesion of undetermined significance' (AUS/FLUS) is problematic. This category is heterogeneous and has been overused so far. Study Design: Twenty-six studies were included in a meta-analysis. In addition to AUS/FLUS percentage, we analysed repeated AUS/FLUS percentage, cytological and histological correlations, and risk of malignancy and neoplasm for AUS/FLUS. Furthermore, stratification, inter- and intra-observer variability, and the possibility of a switch to another category and its clinical consequences were reviewed. Results: Out of a total of 81,833 cases, AUS/FLUS accounted for 10.9%, with a 34% risk of malignancy. Persistent AUS/FLUS was found in 21.6% in repeated cytology. Cytohistological correlation was analysed from 16 studies (4,964 cases), revealing 10.4% as AUS/FLUS and a 21.5% risk of malignancy. Conclusions: An AUS/FLUS category seems to be currently reasonable with clearly defined cytomorphological criteria which do not correspond unequivocally with those of the other categories. An AUS/FLUS category is justified and possible means of its improvement with immunohistochemistry, molecular analysis and imaging are discussed.

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“…The parameters were identified from a literature search[31012141516] and findings from our own observations, which included epithelial cellularity, predominant pattern (flat sheets, 2D, 3D, microfollicles, loose clusters, papillary, single cells), naked nuclei, vascularity, perivascular epithelial cells, cell size, cell shape, nuclear-to-cytoplasmic (N:C) ratio, chromatin quality, nuclear contour, anisonucleosis, presence/size of nucleoli, cytoplasmic quality, cytoplasmic vacuoles, cytoplasmic borders, and presence of histiocytes and/or hemosiderin-laden macrophages.…”

Section: Methodsmentioning

confidence: 99%

“…[1213] However, to the best of our knowledge, no previous studies have examined the features specifically distinguishing parathyroid from Bethesda category IV (Beth-IV) thyroid lesions, a potential and most likely pitfall given that both are likely to be cellular and have relatively scant colloid/colloid-like material, of the recently implemented Bethesda category terminology. We have noted some overlapping features between the two entities.…”

Section: Introductionmentioning

confidence: 99%

Cytomorphologic features distinguishing Bethesda category IV thyroid lesions from parathyroid

Sung¹,

Saqi

Margolskee³

et al. 2017

CytoJournal

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Background:Thyroid follicular cells share similar cytomorphological features with parathyroid. Without a clinical suspicion, the distinction between a thyroid neoplasm and an intrathyroidal parathyroid can be challenging. The aim of this study was to assess the distinguishing cytomorphological features of parathyroid (including intrathyroidal) and Bethesda category IV (Beth-IV) thyroid follicular lesions, which carry a 15%–30% risk of malignancy and are often followed up with surgical resection.Methods:A search was performed to identify “parathyroid” diagnoses in parathyroid/thyroid-designated fine-needle aspirations (FNAs) and Beth-IV thyroid FNAs (follicular and Hurthle cell), all with diagnostic confirmation through surgical pathology, immunocytochemical stains, Afirma® analysis, and/or clinical correlation. Unique cytomorphologic features were scored (0-3) or noted as present versus absent. Statistical analysis was performed using R 3.3.1 software.Results:We identified five FNA cases with clinical suspicion of parathyroid neoplasm, hyperthyroidism, or thyroid lesion that had an eventual final diagnosis of the parathyroid lesion (all female; age 20–69 years) and 12 Beth-IV diagnoses (11 female, 1 male; age 13–64 years). The following cytomorphologic features are useful distinguishing features (P value): overall pattern (0.001), single cells (0.001), cell size compared to red blood cell (0.01), nuclear irregularity (0.001), presence of nucleoli (0.001), nuclear-to-cytoplasmic ratio (0.007), and nuclear chromatin quality (0.028).Conclusions:There are cytomorphologic features that distinguish Beth-IV thyroid lesions and (intrathyroidal) parathyroid. These features can aid in rendering correct diagnoses and appropriate management.

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Parathyroid cytology: Avoiding diagnostic pitfalls

Cited by 79 publications

References 10 publications

Fine-Needle Aspiration Cytology of Parathyroid Carcinoma Mimic Hürthle Cell Thyroid Neoplasm

Fine-Needle Aspiration Cytology of Parathyroid Carcinoma Mimic Hürthle Cell Thyroid Neoplasm

Thyroid Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance: An Indispensable Bethesda 2010 Diagnostic Category or Waste Garbage?

Cytomorphologic features distinguishing Bethesda category IV thyroid lesions from parathyroid

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