Fine needle aspiration cytologic characteristics of hyalinizing trabecular adenoma of the thyroid

The cytologic characteristics of a histologically proven hyalinizing trabecular adenoma are presented. The solitary thyroid nodule was diagnosed cytologically as benign and histologically as malignant. Cytologically, the fine needle aspirate showed increased cellularity, with mild nuclear atypia and eosinophilic nuclear pseudoinclusions. Collections of an amorphous colloidlike material were noted surrounded by follicular cells. Inflammatory cells in the background suggested the possibility of a thyroiditis. Since the patient's antibodies were negative, a hemithyroidectomy was performed to rule out a neoplasm. The frozen section was interpreted as suggestive of medullary carcinoma since the tumor showed a poorly differentiated pattern of cells with marked nuclear atypia and abundant fibrous stroma (thought to be amyloid) separating the cells. The results of immunopathology and electron microscopy ruled out a medullary carcinoma. Upon review of the histology at a later date, the case was recategorized as a hyalinizing trabecular adenoma, proving the negative cytologic diagnosis to be correct.     

Cytologic features of metanephric adenoma of the kidney during pregnancy: a case report

BACKGROUND: Metanephric adenoma (MA) is a relatively rare neoplasm derived from metanephric blastema and composed of well-differentiated epithelial nephroblastic cells. In view of its invariably benign clinical outcome, a preoperative diagnosis of this tumor could be of critical importance. Since computed tomography and ultrasound imaging are not per se sufficient to unequivocally distinguish between MA and malignant neoplasms, fine needle aspiration cytology (FNAC) could be the only accurate method to establish a preoperative diagnosis of this tumor. However, cytologic appearance of MA is not well characterized. CASE: A 33-year-old pregnant woman presented with erythrocytosis. Transabdominal ultrasound examination disclosed a mass in her left kidney. FNA smears showed small, uniform cells with bland nuclei arranged in compact acinar and follicular structures; immunocytochemical staining revealed a diffuse, positive reaction for CD57, WT-1 and vimentin, and epithelial membrane antigen and alpha-methylacyl-CoA racemase yielded negative results. These cytologic and immunocytochemicalfindings led to a preoperative diagnosis of MA. After delivery, the diagnosis was confirmed on the surgical specimen. CONCLUSION: A diagnosis of MA could be established by FNAC supported by immunocytochemical analysis. The present case illustrates the clinical impact that this diagnosis could have on patient management.     

Cytologic features of metastatic papillary thyroid carcinoma in cervical lymph nodes

OBJECTIVE: To elucidate the cytologic characteristics of metastatic papillary thyroid carcinoma (PTC) in cervical lymph nodes and the differences in cervical lymph nodes from those of stage I (intrathyroidal) PTC. STUDY DESIGN: Forty-seven cases of papillary thyroid carcinoma with cervical lymph node metastasis (group A) and 38 cases of intrathyroidal papillary carcinoma (group B) were included in this study. Preoperative fine needle aspiration cytology (FNAC) examination was performed on enlarged cervical lymph nodes (47 cases, group A) and enlarged thyroid nodules (13 cases, group A, and 38 cases, group B). All the cases were surgically excised and pathologically verified. The cytologic smears were reviewed and analyzed. RESULTS: The cytologic characteristics of metastatic PTC in cervical lymph nodes displayed a higher frequency of foamy macrophages (51.1% vs. 26.3%) and a lower frequency of distinct cell borders (38.3% vs. 71.1%) than those of stage I PTC. Metastatic PTC in cervical lymph nodes also had a higher frequency of cystic degeneration (44.7% vs. 5.3%) than intrathyroidal lesions. In 1 of the 47 cases with lymph node metastasis, the aspirate contained macrophages but no tumor cells. CONCLUSION: FNAC was useful in the diagnosis of metastatic PTC in cervical lymph nodes. However, because cystic degeneration appeared frequently, FNAC combined with thyroid ultrasonography to find the primary lesion is necessary in this situation.     

Cytologic features of cribriform-morular variant of papillary carcinoma of the thyroid: a case report

BACKGROUND: While the histology of cribriform-morular variant of papillary thyroid carcinoma has been well documented, its appearance on cytologic smears has rarely been described given the rarity of this tumor. CASE: A 28-year-old woman had a neck lump for an unspecified duration for which she sought medical attention. She was previously well, and there was no significant family history of illness. Fine needle aspiration of the thyroid mass disclosed columnar cells with fine to granular chromatin and nucleargrooves associated with papillary fragments and acinar formation. Occasional groups of epithelial cells forming morules, previously unreported on cytology, were present. An excision specimen of the left thyroid nodule revealed morphologic features of cribriform-morular variant of papillary carcinoma of the thyroid. CONCLUSION: A diagnosis of cribriform-morular variant of papillary carcinoma of the thyroid could be established on fine needle aspiration cytology, prompting exclusion of familial adenomatous polyposis and distinguishing it from other, more aggressive variants of thyroid carcinoma, such as columnar cell carcinoma.     

Karyometric marker features in fine needle aspirates of follicular adenoma of the thyroid

Karyometric measurements were performed on fine needle aspirates of clearly identifiable adenomatous areas and adjacent normal-appearing areas in the surgical specimens from ten patients with follicular adenomas of the thyroid. Similar measurements were made on aspirates from nine patients free of thyroid disease. A total of 95 karyometric features were evaluated for each nucleus. Analysis of variance of optical density values did not show a significant difference between the three types of nuclei. Discriminant analysis selected seven karyometric features that produced a statistically highly significant separation of adenoma nuclei from control nuclei. A similar analysis selected six features that produced a statistically highly significant discrimination of normal-appearing nuclei from control nuclei. The validity of these markers for distinguishing control nuclei from adenoma nuclei and normal-appearing nuclei adjacent to adenomas was demonstrated by analysis in further training and test sets. These findings parallel those previously demonstrated for invasive and microinvasive follicular carcinomas of the thyroid.     

Cytologic features of islet-cell tumors

Although a number of reports have demonstrated the accuracy of fine needle aspiration (FNA) in the diagnosis of nonendocrine pancreatic carcinomas, the cytomorphology of islet-cell tumors (pancreatic endocrine tumors) is not well defined. This paper describes the cytologic features of three histologically confirmed cases of islet-cell tumors. The three tumors occurred in one man and two women, who were 63, 64 and 70 years of age, respectively. Each patient underwent FNA of pancreatic mass with computed body tomography guidance. The aspirates contained large numbers of tumor cells in two cases and a smaller number in one case. The cells, distributed singly and in small groups, were small and round or polygonal, with scant to more often abundant, dense or granular cytoplasm. The nuclei were often located eccentrically and were round to oval, with smooth nuclear borders and finely stippled chromatin. Many nuclei contained a single nucleolus. Multinucleated cells were present and generally contained two or three nuclei. Although the diagnosis of islet-cell tumors in fine needle aspirates is difficult, the cytomorphologic features of these tumors are sufficiently distinctive to suggest the diagnosis, especially when a relatively monomorphic population composed predominantly of single cells is present.     

Cytologic features of secretory meningioma

OBJECTIVE: To describe the cytologic features of secretory meningioma on crush preparations. STUDY DESIGN: In five cases, the diagnosis of secretory meningioma was made and crush preparations were available. In each case, crush preparations were made at the time of intraoperative consultation from an open biopsy specimen or stereotactic biopsy. RESULTS: Hematoxylin and eosin-stained crushes showed the presence of clusters of cohesive cells containing variable numbers of inclusions among less cohesive typical meningothelial cells. In two cases, the inclusions were especially prominent. Inclusions varied in size from 3 to 40 microns, had a well-defined rim and contained finely granular or hyaline material and a central core. CONCLUSION: Secretory meningiomas demonstrate distinct cytologic features on crush preparations. Recognition of these inclusions is important since their prominence in some stereotactic smear preparations may lead to diagnostic problems.     

Cytologic features of poorly differentiated "insular" carcinoma of the thyroid. A case report.

A case of poorly differentiated "insular" carcinoma of the thyroid is presented. Fine needle aspiration cytology suggested the differential diagnosis of poorly differentiated carcinoma versus anaplastic carcinoma. Histologic examination of the resected specimen confirmed the diagnosis of insular carcinoma. The cytologic features of this uncommon primary thyroid malignancy are described and discussed with reference to the literature.     

Cytologic features of nonfatal herpesvirus tracheobronchitis

Herpesvirus infections of the lower respiratory tract have most commonly been reported in patients with severe burns, immunosuppression or malignancies. Two patients without any of these underlying conditions developed severe herpetic tracheobronchitis, diagnosed by cytologic examination and confirmed by serologic studies. Serial examination of sputum, bronchial brushings and bronchial washings permitted observation of the evolution and progression of cellular changes found in herpesvirus infection of the lower respiratory tract. both patients recovered without specific antiviral therapy, but both developed superinfection with gram-negative organisms, requiring intensive antibiotic therapy. The distinctive features of herpesvirus infection in the tracheobronchial tree are similar to those recognized elsewhere in the body. Early findings include a variety of nonspecific changes in nuclear chromatin configurations; multinucleated cells may be common but do not often contain the central intranuclear inclusion bodies seen in later stages. These distinctive central intranuclear inclusions disappear in a few days, leaving only reparative changes in the surface epithelium. Herpesviruses are increasingly being reported in the literature as an etiologic agent of acute tracheobronchitis in otherwise healthy individuals.