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Items 1-10 of 10 |
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Fine needle aspiration biopsy of Hashimoto's thyroiditis. Sources of diagnostic error.
MacDonald L, Yazdi HM.
Department of Laboratory Medicine, Ottawa Hospital, Ontario, Canada.
OBJECTIVE: To determine the accuracy of cytologic interpretation in the diagnosis of Hashimoto's thyroiditis (HT). STUDY DESIGN: At Ottawa Hospital from 1987 to 1994, 1,638 fine needle aspiration biopsies (FNABs) from thyroid were performed. HT was suggested in 184 FNAB samples taken from 157 patients. Of the 184 aspirates diagnosed with HT, 39 had corresponding surgical specimens taken from 31 patients. A retrospective review of these FNABs and surgical pathology slides formed the basis of this study. RESULTS: In 27 (69%) aspirates, HT was diagnosed on both the FNAB and surgical specimens. In 10 of 27 FNABs an associated lesion was not sampled by FNAB. In four of these 10 aspirates some of the cellular features of HT were misinterpreted, and the possibility of an associated neoplasm could not be ruled out. This resulted in four false positive diagnoses. In 12 (31%) FNABs from nine patients, the cytologic diagnosis of HT was not confirmed histologically. These cases included five Hurthle cell adenomas and one case each of follicular adenoma, nodular goiter, macrofollicular adenoma and malignant lymphoma. This resulted in five false negative diagnoses. CONCLUSION: These results support the value of FNAB in the diagnosis of HT. The presence of hyperplastic follicular cells on FNAB samples from HT may mimic a follicular neoplasm and result in a false positive interpretation. Adequate sampling of the thyroid is important, particularly when there is an associated lesion. The diagnosis of lymphocytic thyroiditis should not be made when only a few lymphocytes are present. Finally, pleomorphic Hurthle cells may be present in aspirates from Hurthle cell neoplasms and underdiagnosed as HT, especially when they are associated with a few lymphocytes.
PMID: 10349369 [PubMed - indexed for MEDLINE]
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Aspiration cytology of ectopic cervical thymoma mimicking a thyroid mass. A case report.
Oh YL, Ko YH, Ree HJ.
Department of Diagnostic Pathology, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Korea.
BACKGROUND: Ectopic cervical thymoma, first described in 1941 by Boman, is an uncommon tumor of the neck displaying the same histologic features as mediastinal thymoma. Since it is commonly located in the anterolateral part of the neck or is subjacent to or inside the lower pole of the thyroid, the mass is often confused as being of thyroid origin. CASE: A 68-year-old female presented with dyspnea and an anterior neck mass found on routine chest roentgenography. The thyroid scan showed a cold nodule in the lower pole of the left part of the thyroid. Fine needle aspiration (FNA) cytology revealed large numbers of small lymphocytes with hyperchromatic nuclei and frequent clumping pattern in the pale, eosinophilic, fluid background. A few clusters of epithelial cells without atypism were interpreted as thyroid follicular cells. The overall cytologic features were misinterpreted as malignant lymphoma of the thyroid. However, the histologic diagnosis was thymoma, predominantly cortical type. CONCLUSION: The ectopic cervical thymoma is sometimes misdiagnosed as Hashimoto's thyroiditis, anaplastic carcinoma and malignant lymphoma of thyroid on FNA cytology or frozen diagnosis due to its rarity. Therefore, the differential diagnosis of a neck mass showing a variable composition of lymphocyte and epithelial component in a pale, eosinophilic, fluid background should also include ectopic cervical thymoma, especially in elderly females.
PMID: 9755676 [PubMed - indexed for MEDLINE]
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Differentiation of Hashimoto's thyroiditis from thyroid neoplasms in fine needle aspirates.
Ravinsky E, Safneck JR.
Department of Pathology, Health Sciences Centre, Winnipeg, Manitoba, Canada.
In order to refine the cytodiagnostic criteria for distinguishing Hashimoto's thyroiditis from thyroid neoplasms, aspirates from six cases of Hashimoto's thyroiditis, five Hurthle cell neoplasms and one papillary carcinoma associated with Hashimoto's thyroiditis were reevaluated. Distinguishing characteristics were cell arrangements, nuclear chromatin pattern and nucleolar appearance. Hashimoto's thyroiditis was characterized by flat sheets and clusters of epithelial cells with oncocytic changes or occasionally by cohesive tissue fragments with cells well oriented one to the other. Thyroid neoplasms were characterized by loosely cohesive, syncytial-type tissue fragments with crowded overlapping cells poorly oriented one to the other and/or numerous isolated single cells. The nuclear chromatin of Askanazy cells in Hashimoto's thyroiditis was bland and even while that of neoplastic cells was finely granular, coarsely granular or irregularly clumped. Macronucleoli were present in Hurthle cell tumors but not in the Askanazy cells of Hashimoto's thyroiditis. Epithelial cellularity, lymphoid cellularity, cellular polymorphism and nuclear pleomorphism were not useful criteria for making the differential diagnosis between the two conditions. An admixture of epithelial cells and lymphoid cells indicated Hashimoto's thyroiditis but was not helpful in ruling out an associated neoplasm.
PMID: 3201876 [PubMed - indexed for MEDLINE]
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Cytomorphologic aspects of thyroiditis. A study of 51 cases with functional, immunologic and ultrasonographic data.
Jayaram G, Marwaha RK, Gupta RK, Sharma SK.
Department of Pathology, Maulana Azad Medical College, New Delhi, India.
Fine needle aspiration provided material for detailed cytomorphologic study in 51 cases of thyroiditis, 40 of which were diagnosed as Hashimoto's (autoimmune) thyroiditis. Of these 40 cases, 22 were found to be euthyroid on clinical examination and radioimmunoassay (RIA), 10 were hyperthyroid and 8 were hypothyroid. Of the 11 cases of subacute thyroiditis, 4 were thyrotoxic and 7 were euthyroid. Radioactive iodine uptake (RAIU) showed decreased to negligible uptake in ten and normal uptake in one case of subacute thyroiditis, whereas all of the thyrotoxic cases of Hashimoto's thyroiditis showed markedly increased RAIU. Echography showed a hypoechoic or anechoic pattern in most of the cases. Antimicrosomal and/or antithyroglobulin antibodies were positive in 25 cases of Hashimoto's thyroiditis and in 1 case of subacute thyroiditis. The cytologic features that characterized subacute thyroiditis were the presence of multinucleated giant cells and a polymorphonuclear and lymphocytic population associated occasionally with epithelioid-cell granulomas. Hashimoto's thyroiditis was characterized by Hurthle-cell changes and a significant lymphoid population consisting of mature and transformed lymphocytes, often impinging on follicular cells. There was an overlap in the cytomorphologic features between some cases of Hashimoto's and subacute thyroiditis. In such cases, the final diagnosis was arrived at by an integrated approach incorporating all of the diagnostic parameters available.
PMID: 3321814 [PubMed - indexed for MEDLINE]
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Psammoma bodies in fine needle aspirate of the thyroid in lymphocytic thyroiditis.
Dugan JM, Atkinson BF, Avitabile A, Schimmel M, LiVolsi VA.
Psammoma bodies are concentric, laminated microcalcifications that are regarded as nearly specific markers in the thyroid gland for the presence of papillary carcinoma. While psammoma bodies have been seen rarely in some benign thyroid diseases, there appear to be no reports of psammoma body formation in lymphocytic or Hashimoto's thyroiditis. We report a case of Hashimoto's thyroiditis in which psammoma bodies were identified in a fine needle aspiration specimen of the thyroid and in histologic sections of the right thyroid lobectomy; papillary carcinoma was not found in either specimen. We conclude that psammoma bodies may be seen in any benign process, such as nodular goiter or lymphocytic thyroiditis, that produces reactive papillary hyperplasia of thyroid epithelium, as well as in papillary carcinoma. However, the finding of psammoma bodies in a fine needle aspirate without corroborating cytologic evidence of papillary cancer is still an indication for surgical removal of the thyroid nodule since these structures are reliable markers for occult papillary carcinoma of the thyroid, despite the rarity of their formation in benign diseases.
PMID: 3473869 [PubMed - indexed for MEDLINE]
Hashimoto's thyroiditis: cytodiagnostic accuracy and pitfalls.
Nguyen GK, Ginsberg J, Crockford PM, Villanueva RR.
Department of Laboratory Medicine and Pathology, University of Alberta Hospitals, Edmonton, Canada.
To determine the cytodiagnostic accuracy rate and pitfalls of Hashimoto's thyroiditis (HT), the files and smears prepared from the thyroid needle aspirates of 146 patients with suspected HT and/or clinically and serologically confirmed HT were reviewed. Of those patients, 105 presented with a diffuse and rubbery thyroid enlargement, and 41 with one or two prominent nodules. For the first group (105 patients), the needle aspiration biopsy (NAB) was performed on one or two thyroid lobes during their initial endocrinologic consultation, and for the second group (41 patients), the NAB was performed on and around the predominant nodules that were found either at initial physical examination or during the patients' routine follow-ups. In 134 cases, a cytodiagnosis of HT was made on the first NAB. Among the 41 patients with a prominent thyroid nodule, a thyroid neoplasm was suspected clinically in four because their thyroid nodules increased in size. In the other 12 patients, a cytodiagnosis of follicular neoplasm (FN) was made in five cases, and a Hurthle cell tumor (HCT) was diagnosed or suspected in seven patients. All 16 patients had thyroid surgery, and a HT was histologically confirmed in all cases. In the first four patients, no tumor was found. Among five patients with a cytodiagnosis of FN, one had a hyperplastic follicular cell nodule (HFCN), two had follicular adenomas, and two had papillary carcinomas of follicular variant. For the seven patients with a cytodiagnosis of HCT, HCT was confirmed in three, three were found to have hyperplastic Hurthle cell nodules (HHCN), and one showed a benign colloid nodule with Hurthle cell changes and remote hemorrhagic necrosis. It is concluded that NAB is highly sensitive in diagnosing HT, with a diagnostic accuracy rate of 92% by the first biopsy attempt. The cytologic differential diagnosis between an HFCN and a follicular neoplasm and between an HHCN and an HCT is impossible in some cases.
PMID: 9181321 [PubMed - indexed for MEDLINE]
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Incidence of neoplasia in Hashimoto's thyroiditis: a fine-needle aspiration study.
Carson HJ, Castelli MJ, Gattuso P.
Department of Pathology, Loyola University Medical Center, Maywood, IL 60153, USA.
There is a recognized association between Hashimoto's thyroiditis (HT) and thyroid neoplasms. We reviewed fine-needle aspirations (FNAs) from 90 patients with HT to assess the contribution of this procedure. For seven patients, FNA showed HT and follicular neoplasm (n = 6) or HT and papillary carcinoma (n = 1). Eighteen patients underwent thyroid resection. Three patients had follicular adenomas which were not detected by FNA, one patient had papillary carcinoma confirmed, and six patients with follicular neoplasm by FNA were negative for tumor. Thus, 4% of our patients had confirmed neoplasms, an incidence lower than usually reported. One reason for the lower rate of neoplasia in our series was misinterpretation of follicular neoplasia in the background of HT. The cytologic changes in the hyperplastic follicular and metaplastic oncocytic epithelium are similar to those seen in follicular neoplasm. Our study suggests that these processes may be indistinguishable, and thus, in the presence of HT, the diagnosis of follicular neoplasm probably should not be rendered.
PMID: 8834075 [PubMed - indexed for MEDLINE]
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Inflammatory and lymphoid lesions of the thyroid gland. Cytopathology by fine-needle aspiration.
Guarda LA, Baskin HJ.
The cytopathologic characteristics of the inflammatory and lymphoid thyroid lesions as seen in fine-needle aspirate smears of 103 patients are reviewed, with emphasis on pitfalls and association with other neoplasms. The cytologic diagnoses were as follows: subacute thyroiditis, 3; Hashimoto's thyroiditis (HT) with or without Hurthle cell nodule, 77; HT and Hurthle cell tumor, 2; HT and follicular neoplasm, 3; HT and papillary carcinoma, 5; lymphoma, 3; HT and nodular colloid goiter, 10. Fourteen patients were operated. Five erroneous diagnoses were uncovered; inexperience was the main reason for the mistakes. The greatest diagnostic difficulties are encountered in cases of Hurthle cell nodules and malignant lymphoma, but mistakes are likely to disappear after reasonable experience. Thyroid antibodies are of no help in sorting diagnostic problems, because a positive titer is only corroborative evidence of underlying HT and does not rule out an associated tumor. Conversely, a negative titer does not discard the diagnosis of HT. The association of nodular colloid goiter and HT is depicted. Problems of sampling and staining technic are discussed.
PMID: 3799541 [PubMed - indexed for MEDLINE]
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Diagnostic pitfalls in thyroid fine-needle aspiration: a review of 394 cases.
Caraway NP, Sneige N, Samaan NA.
Department of Pathology, University of Texas, M. D. Anderson Cancer Center, Houston 77030.
To determine the diagnostic pitfalls of thyroid fine-needle aspiration (FNA), we reviewed 394 thyroid aspirates obtained between January 1986 and December 1990. Surgical follow-up was available for 150 aspirations. The cytologic diagnoses were categorized into four groups: benign, 57; indeterminate, 51; malignant, 33; and nondiagnostic specimen, nine. There were three false negative diagnoses (3%), which upon review were judged to be inadequate specimens. Three false positive diagnoses (7%) were identified: in the first two cases, follicular adenomas were mistaken for papillary carcinoma; in the third case, atypical Hurthle cells were mistaken for a Hurthle cell carcinoma. Our results showed a sensitivity of 93% and a specificity of 91% for the detection of malignancy. If indeterminate cases were considered positive, the specificity decreased to 50%, while the sensitivity increased to 97%. We conclude that: 1) certain follicular adenomas may display cytologic features mimicking papillary carcinoma; 2) as in follicular neoplasms, aspirates of Hurthle cell adenomas cannot be differentiated from Hurthle cell carcinomas; 3) with adequate sampling, false negative results can be markedly reduced.
PMID: 8519202 [PubMed - indexed for MEDLINE]
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Hashimoto's thyroiditis and carcinoma of the thyroid: optimal management.
Sclafani AP, Valdes M, Cho H.
Department of Otolaryngology, Head & Neck Surgery, New York Medical College, NY 10003.
Several authors have noted a high incidence of thyroid carcinoma in patients with Hashimoto's thyroiditis (HT), and some have even considered HT a premalignant condition. The authors evaluated all patients with surgically proven HT at Beth Israel Medical Center in New York from 1985 through 1990. Of these 48 patients, 8 (17%) had thyroid carcinoma in addition to HT. No statistically significant difference between patients with and without concurrent carcinoma was noted in the percentage of patients with a dominant mass, irregular thyromegaly, compressive symptoms, suspicious fine needle aspiration biopsies (FNABs), or a cold nodule on thyroid scintigraphy. However, patients with neither a positive FNAB nor a cold nodule were much less likely to have carcinoma than patients with one or both of these tests positive (0% vs. 26%, P < or = .05). A management scheme for patients with HT is proposed to adequately and efficiently evaluate and treat patients for concurrent thyroid carcinoma.
PMID: 8361285 [PubMed - indexed for MEDLINE]
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Items 1-10 of 10 |
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One page. |
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