sft Sup FNA Cytology Flashcards
Thyroid FNA adequacy criteria. Exceptions?
6 or more groups of follicular cells with 10 or more cells per group
Exceptions are any atypia, colloid nodules, and nodules with abundant inflammation.
Thyroid FNA, dx?
Unsat, right pic has macrophages and watery colloid consistent with cyst contents.
Thyroid FNA, dx?
Colloid nodule on left, Hashimoto’s on right (polymorphous lymphocytes).
Chance of malignancy with diagnosis of benign on thyroid FNA? Possible entities?
0-3%;
benign adenomatous or colloid nodule, lymphocytic/Hashimoto thyroiditis (in proper clinical setting), granulomatous thyroiditis
Thyroid, AUS/FLUS/atypical cells of undetermined significance (ACUS) diagnosis chance of malignancy?
5-15%
Thyroid, Follicular neoplasm or suspicious for follicular neoplasm, chance for malignancy? What cytologic feature must you also specify?
15-30%; must specify if it’s a Hurthle cell neoplasm
Thyroid, Suspicious for malignancy chance for cancer on excision? What types of malignancy must you specify?
60-75% chance of malignancy, must specify papillary, medullary, metastatic, lyphoma, or other (can’t tell if follicular)
Thyroid, Positive for malignancy predictive value?
97-99% chance positive for malignancy on excision; must specify if papillary, medullary, lymphoma, anaplastic, suspected metastastic
Thyroid FNA, dx?
Adenomatous nodule/goiter; follicles of varying size, water colloid, scant dense colloid
Thyroid FNA, malignant?
No, just intracytoplasmic colloid mimicing signet ring cells.
Thyroid FNA, White arrow?
Skeletal muscle mimicing colloid
Thyroid FNA, dx? serologic test? Increased cancer risk?
Hashimoto’s/lymphocytic thyroiditis: Hurthle cells infiltrated by lymphoplasmacytic inflammation
Antithyroid antibodies present in >90% of cases.
Increased risk of lymphoma and papillary carcinoma.
Thyroid FNA, dx? Late vs early stage? Clinical features?
Granulomatous thyroiditis (subacute/de Quervain’s), granulomas, mixed inflammation, and giant cells in later stage disease (early stage is more acute inflammation with microabscesses)
Firm, enlarged, tender, symmetrical thyroid with circulating antibodies to various viruses.
Thyroid FNA, dx? Buzz words? Associated with what HLA haplotypes?
Graves disease/toxic goiter; sheets or microfollicles, low to moderately cellular with perinuclear cytoplasmic vacuoles and pink, frayed edges of follicular groups (flame cells); associated with HLA B8 and DR3; frequently have Hurthle cell change
Thyroid touch prep; dx?
Minocycline crystals; brown to black material in follcular cell cytoplasm or follicle lumina, + with PAS, lipofuscin, lipid, and fontana-masson stains, negative on iron stain
Thyroid FNA, dx of first picture? What gives them this appearance? 2nd?
First picture shows typical Hurthle cells, with abundant cytoplasm, prominent nucleoli, and granular cytopolasm. 2nd picture shows oncocytic medullary thyroid carcinoma, which has granular cytoplasm (caused by accumulation of mitochondria) and some nucleoli, but has overall coarser chromatin, is more dyshesive, and has cytologic atypia characterized by binucleation and cytoplasmic processes.
Thyroid FNA, dx? Most specific feature for diagnosis?
PTC (papillary structures with nuclear grooves and intranuclear inclusions, which are most specific)
Medullary thyroid carcinoma laboratory and genetic features?
Increased serum calcitonin and CEA levels; RET gene mutation analysis important for prognosis and management.
Thyroid FNA, dx?
Medullary thyroid carcinoma: Granular, sometimes oncocytic cells with eccentric nuclei, coarse chromatin, dyscohesion, background lymphocytes, and amyloid in the background.
Thyroid FNA, dx? Stage?
Anaplastic thyroid carcinoma, T4, stage IV by definition.
Most common tumors metastatic to thyroid?
RCC is most common, melanoma, lymphoma, colorectal, lung and breast also happen.
Thyroid nodule FNA, dx? Clues?
Parathyroid adenoma; clues are lack of colloid and numerous naked nuclei.
Thyroid nodule FNA, dx? Clues?
Parathyroid carcinoma. Naked nuclei and lack of colloid point to parathyroid. Extreme cellularity, dyshesion, and anaplasia point to carcinoma over adenoma.
LN FNA, dx? most common bacterial and fungal causes?
Granuloma. Most common bacterial cause is Bartonella henselae, most common fungal cause is Cryptococcus
Dx?
Mycobacterium tuberculosis organisms (negative image)
What’s the organism?
Histoplasma (intracellular)
LN FNA, dx?
Rosai Dorfman; key feature is histiocytes with emperipolesis; presents as asymptomatic lymphadenopathy.
LN FNA, dx?
HPV associated SCC; very cohesive groups with high N/C ratios. Usually in cystic lymph nodes.
LN FNA, dx? IHC?
SLL; mostly small lymphocytes with occasional paraimmunoblasts; CD5+, CD23+, FMC7-, cyclin D1-, CD20weak, light chain weak but monoclonal
Lymph node FNA, dx? Variant? IHC? Buzz words?
Lymphoplasmacytic lymphoma, lymphocytes with varying degrees of plasma cell differentiation; Waldenstrom’s if it has an IgM paraprotein; 5-, 10-; Russell bodies are IG inclusions in cytoplasm; Dutcher bodies are inclusions over nucleus
Mantle cell trasnlocation?
t(11:14)
LN FNA, dx? Translocations? IHC
Burkitt; t(8,14) in 80%, also t(2,8) and t(8,22); Ki-67 around 100%, + for mature B cell markers; 8 is cmyc, 14 is IGH; 2 and 22 are K and L
LN FNA, dx?
Probably DLBCL, requires further testing.
LN FNA in someone with a skin rash, dx? IHC?
CTCL with nodal involvment; 2nd pic with more large cell transformation; these are 2, 3, 5+, 7-, 4+, 8-
Angioimmunoblastic T cell lymphoma features
Atypical, wrinkled and elongated T cells in a background of B (often EBER+) lymphocytes, eosinophils and arborizing vasculature; can transform to DLBCL from the EBER+ B cells.
Anaplastic large cell lymphoma IHC and features, buzzword cells?
CD30 and ALK+; t(2,5) (ALK gene, 2p23) is common; cell is the Hallmark cell, large cell with horsheshoe nucleus; can have cells that look like RS cells
LN FNA, dx, cell type?
Hodgkin lymphoma, RS cell
Salivary gland cyst FNA, dx? Clinical association?
Lymphoepithelial cyst, associated with HIV; branchial cleft cyst is in differential.
Salivary gland cyst FNA, dx?
Branchial cleft cyst (lymphs and epithelial cells without keratinization); lymphoepithelial cyst is in differential
Parotid gland FNA, dx? Features?
pleomorphic adenoma; chondroid stroma has a troll hair appearance; 2nd pic shows tyrosine crystals. in 1st pic, plasmacytoid cells are the myoepithelial component.
Salivary gland FNA, dx? Clinical association?
Warthin tumor, lymphocytes and oncocytes; associated with cigarette smoking.
Salivary gland FNA, dx? Special stain?
Oncocytoma, looks like Warthin but without lymphocytes. PTAH+ and PAS- (opposite from acinic cell carcinoma).
Salivary gland FNA, dx?
Acinic cell carcinoma; cellular specimen composed of acini without significant ductal cells and many background naked nuclei; may be attached to capillaries; PAS+
Salivary gland, dx?
Adenoid cystic, acellular material surrounded by cohesive cells
Salivary gland FNA, dx? Translocation?
Mucoepidermoid carcinoma, mix of mucous, squamous, and intermediate cells and mucous in the background. t(11;19)(q21-22;p13)
Breast FNA, dx?
Fat necrosis.
Breast FNA, dx?
Granulomatous mastitis.
Breast FNA, dx?
UDH (proliferative change without atypia); streaming hyperplastic ductal cells with slitlike spaces (no cribriforming)
Breast FNA, dx?
Proliferative change with atypia (ADH/DCIS); uniform cells with cribriforming
