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Pathology > Bethesda Thyroid Cytology > Flashcards

Bethesda Thyroid Cytology Flashcards

1
Q

Implied Risk of Malignancy of Benign

A

0-3%

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2
Q

Implied Risk of Malignancy of Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance

A

5-15%

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3
Q

Implied Risk of Malignancy of Follicular Neoplasm or Suspicious for a Follicular Neoplasm

A

15-30%

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4
Q

Implied Risk of Malignancy of Suspicious for Malignancy

A

60-75%

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5
Q

Implied Risk of Malignancy of Malignant

A

97-99%

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6
Q

Conditions for Satisfactory

A

If otherwise normal constituents, IE. no abnormal dx can be made:

  • 6 groups of 10 follicular cells
  • exceptions:solid nodules with inflammation fitting dx for Hashimoto’s, thyroid abscess or granulomatous thyroiditis; colloid nodules
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7
Q

Management for nondx?

A

Reaspirate no sooner than 3 months later

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8
Q

Criteria for undifferentiated (anaplastic) carcinoma

A

moderately to markedly cellular

  • isolated cells or variable sized groups
  • epithelioid (round to polygona) and/or spindle-shaped, ranging from small to giant sized
  • plasmacytoid/rhabdoid
  • nuclear enlargement, irregularity, pleomorphism, eccentric placement, multinucleation
  • clumped chromatin with parahcromatin clearing
  • prominent irregular nucleoli
  • intranuclear inclusions
  • necrosis, extensive inflammation, fibrous connective tissue
  • osteoclast-like giant cells, neutrophils
  • mitotic figures
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9
Q

Criteria for poorly differentiated thyroid carcinoma

A
  • insular, solid or trabecular cytoarchitecture
  • uniform population of follicular cells with scant cytoplasm
  • malignant cells have high NC ratio with variable nuclear atypia
  • apoptosis and mitotic activity
  • necrosis
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10
Q

Criteria for medullary thyroid carcinoma

A
  • numerous isolated cells alternating with syncytial-like clusters in variable proportions from case to case
  • plasmacytoid, polygonal, round and/or spindle-shaped
  • long cell processes
  • mild to moderate pleomorphism
  • rare bizarre giant cells
  • nuclei round, eccentrically placed, binucleation/multinucleation
  • finely or coarsely granular chromatin
  • nuclear pseudoinclusions
  • nucleoli are usually inconspicuous but can be prominent
  • cytoplasm is granular and variable in quantity
  • amyloid
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11
Q

Criteria for papillary thyroid carcinoma

A
  • papillae/syncytial-like monolayers/swirling sheets
  • enlarged nuclei
  • oval or irrgeularly haped, molded nuclei
  • longitudinal nuclear grooves
  • intranuclear cytoplasmic pseudoinclusion
  • pale nuclei w/ powdery chromatin
  • marginally placed micronucleoli, solitary or multiple
  • psammoma bodies
  • multinucleated giant cells
  • variable colloid, stringy, ropy
  • hurthle cell/squamous metaplsia
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12
Q

variants described features

A 
follicular
macrofollicular
cystic
oncocytic
Warthin-like
tall cell
columnar cell
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13
Q

Follicular variant PTC

A

hypercellular/syncytial-like fragments w/ micorfollicles, clusters, isolated follicles,. sheets

  • some colloid, typically thick
  • nuclear changes subtle
  • may not have: papillary, MNGC, INCI, psammoma bodies, cystic change
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14
Q

Macrofollicular variant PTC

A

-monolayered sheets of atypical epithelium and/or variably sized follicles
-nucelar features
-convincing nuclear changes must be present
abnudant thin colloid or fragmentso f thick colloid

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15
Q

Cystic variant PTC

A
  • small groups with irregular borders, sheets, papillae, or follicles
  • tumour cells look histiocytoid (hypervacuolated)
  • macrophages, hemosideing
  • variable thin or watery colloid
  • convincing nuclear changes
  • powdery chromatin usually less prominent (cellular degeneration and cell swirls/onion-skin appearance and cart wheel arrangement of follicular cells are more frequent
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16
Q

Oncocytic variant PTC

A
  • oncocytic cells arranged in papillae, sheets or as isolated cells
  • nuclear features of PTC
  • lymphocytes are absent or few in number
17
Q

Warthin-like variant PTC

A
  • oncocytic and arranged in papillae and singles
  • lymphoplasmacytic background
  • lymphocytes in papillae and intimate assoc with follicular cells
  • nuclear changes of PTC
18
Q

Tall cell variant PTC

A
  • elongated shape
  • height to width ration of 3:1
  • distinc cell border
  • papillary fragments
  • some lymphocytes
  • nuclear features of PTC
  • in contrast to conventional PTC: less powdery and more granular, psammoma bodies are few, INCI more frequent and multiple (soapbubble)
19
Q

Columnar cell variant

A
  • cellular and lack colloid
  • papillae, clusters and flat sheets with small tubular structures
  • nuclei elongated and stratified
  • nuclear features of PTC
  • -in contrast to conventional PTC: nuclear features can be focal(grooves, INCI), chromatin hyperchromatic rather than pale and powdery, colloid and cystic change
20
Q

Hyalinising trabecular tumour

A
  • cohesive neoplastic cells radially oriented around amyloid-like hyaline stromal material
  • INCI and nuclear grooves numerous
  • occasional psammoma bodies
  • cytoplasmic paranuclear yellow bodies
21
Q

Suspicious for PTC, Pattern A

A

Patchy nuclear changes
-moderately or highly cellul
-benign follicular cells (macrofollicle framents)
mix of cells with nuclear enlargement, nuclear pallor, nuclear grooves, nuclear membrane irregularity and or nuclear molding
-INCI rare or absent

22
Q

Suspicious for PTC, Pattern B

A

Incomplete nucelar changes pattern

  • sparsely, moderatly or highly cellular
  • generlised mold to moderate nucelar enlargement iwth mild nucelar pallor
  • nuclear grooves are evident but nucelar membrane irregularity and nuclear modling are minimal or absent
  • INCI rare or absent
23
Q

Suspicious for PTC, Pattern C

A

Sparsely cellular Pattern

-features of PTC but sample is very sparsely cellular

24
Q

Suspicious for PTC, Pattern D

A

Cystic degeneration pattern
-hemosiderin-laden macrophages
-scattered groups and sheets of follicular cells have enlarge, pale nuclei and some have nuclear grooves but INCI are rare or absent
-occasional large, atypical, histocytoid cells with enlarged nuclei and abundant vacuolated cytoplasm
rare calcification that resemble psammoma bodies

25
Q

Suspicious for medullary carcinoma

A

sparse to moderately cellular

  • monomorphic population of noncohesive small or medium-sized cells with high NC ratio
  • eccentric nuclei
  • smudged chromatin with no cytoplasmic granules
  • small fragments of amorphous material - colloid vs amyloid
26
Q

Follicular neoplasm, Hurthle cell type

A

exclusively Hurthle cells

  • abundant finely granular cytoplasm
  • enlarged central or eccentrically located, round nucleus
  • prominent nucleolus
  • small cells with high NC ratio
  • large cell with at least 2X variability in nuclear size
  • Hurthle cells dispersed as isolated cells in syncytial-like arrangements
  • little or no colloid or lymphocytes
  • transgressing vessels
27
Q

Follicular neoplasm

A
  • moderately or markedly cellular
  • alteration of follicular cell architecture, characterized by cell crowding, microfollicles and dispersed isolated cells
  • follicular cells are normal-sized or enlarged and relatively uniform, with scant or moderate amount of cytoplasm
  • nuclei are round and slightly hyperchromatic with inconspicuous nucleoli
  • some nuclear typia may be seen with enlarged, variable sized nuclei and prominent nucleoli
  • colloid scant or absent
28
Q

FLUS/Atypi of undetermined significance

A

most common scenarios:

  • population of microfollicles that does not fulfill criteria for FN
  • predmoniance of H cells in sparsely cellular sample with scant colloid
  • sample artifact hinders follicular cell atypia interpretation
  • hypercellular specimen exculsively H cells, yet clinical setting suggests benign nodule (MNG, Hashimoto)
  • focal features of PTC
  • cyst-lining cells atypical with PTC features but otherwise benign
  • minor population nuclear enlargement with promient nucleoli and: hx rads, thyroid altering drugs or reparte due to involution/cystic degen
  • atypical lymphoid infiltrate
  • NOS
29
Q

Benign follicular nodule

A
  • sparse to moderately cellular
  • copious colloid thick or thin
  • follicular cells are monolayered sheets and honeycombed
  • some intact spheres
  • rare microfollicles
  • scant or moderate amounts of cytoplasm
  • nuclei are dark, round to oval, size of rbc
  • granular chromatin pattern
  • anisonucleosis but not significant pleomorphism/atypia
  • lipofuscin or hemosiderin
  • H cells, macrophages can be present
  • focal reparative hcanges
30
Q

Hashimoto’s

A

hypercellular, unless fibrosed

  • polymorphic lymphoid population with large reactive and small mature lymphocytes with occ plasma cells
  • background or infiltrating lymphocytes into epithelial cell groups
  • intact lymphoid follicles and lymphohistiocytic aggregates
  • oncocytes arranged in sheets or as isolated cells
  • abundant granular cytoplasm, large nuclei and prominent nucleoli

Pathology (11 decks)

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