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Suzuki A, Hirokawa M, Kanematsu R, Tanaka A, Yamao N, Higuchi M, Hayashi T, Kuma S, Miyauchi A. B-cell to T-cell ratio as a novel indicator in flow cytometry in the diagnosis of thyroid lymphoma. Endocr J 2022; 69:291-297. [PMID: 34670907 DOI: 10.1507/endocrj.ej21-0451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Preoperative flow cytometry is recommended to prove the monoclonality and confirm the diagnosis of thyroid lymphoma. However, lymphoma cases without light chain restriction may also have monoclonality. The aim of our study was to identify a novel marker for thyroid lymphomas using aspirated materials for flow cytometry. We retrospectively analyzed 26 patients with primary thyroid lymphomas and 16 patients with benign lymphoproliferative lesions. The materials for flow cytometry were obtained by fine-needle aspiration cytology using a 22-gauge needle under ultrasound guidance. Light chain restriction was defined as a κ to λ ratio of less than 0.5 or more than 3.0. According to the light chain-positive rate, 25% or less and more than 25% were classified as the low and high light chain-positive rate groups, respectively. B-cell predominance was defined as a CD19 to CD4 ratio (B- to T-cell ratio) of more than 2.0. B-cell predominance was more frequently observed in lymphomas (88.5%) than in benign lymphoproliferative lesions (25.0%; p < 0.001). Light chain restriction based on the κ/λ ratio was detected in 69.2% of lymphomas, but not in benign lymphoproliferative lesions. Among lymphomas belonging to the low light chain-positive rate group, 88.9% did not exhibit light chain restriction and B-cell predominance was present. In contrast, benign lymphoproliferative lesions with B-cell predominance were not detected in the low light chain-positive rate group. B-cell predominance was a useful indicator for diagnosing thyroid lymphoma in the low light chain-positive rate group without light chain restriction.
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Affiliation(s)
- Ayana Suzuki
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Hyogo 650-0011, Japan
| | - Mitsuyoshi Hirokawa
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Hyogo 650-0011, Japan
| | - Risa Kanematsu
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Hyogo 650-0011, Japan
| | - Aki Tanaka
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Hyogo 650-0011, Japan
| | - Naoki Yamao
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Hyogo 650-0011, Japan
| | - Miyoko Higuchi
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Hyogo 650-0011, Japan
| | - Toshitetsu Hayashi
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Hyogo 650-0011, Japan
| | - Seiji Kuma
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Hyogo 650-0011, Japan
| | - Akira Miyauchi
- Department of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
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Sakiz D, Sencar ME, Calapkulu M, Unsal IO, Aktas L, Ucan B, Ozbek M, Cakal E. The Effects of Chronic Lymphocytic Thyroiditis on Clinicopathological Factors In Papillary Thyroid Cancer. Endocr Pract 2021; 27:1199-1204. [PMID: 34293511 DOI: 10.1016/j.eprac.2021.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/10/2021] [Accepted: 07/13/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This study evaluated the impact of chronic lymphocytic thyroiditis (CLT) on clinicopathological parameters, prognostic outcome and initial treatment responses in patients with papillary thyroid cancer (PTC). METHODS A retrospective review was made of 1409 patients with PTC, comprising 443 pathology proven PTC patients with CLT and 447 PTC patients without CLT. RESULTS The median follow-up time was 58 (8-380) months and the median age at the time of diagnosis was 43 years. The diagnosis age was significantly lower in patients with CLT (42 vs. 45 years, p:0.001). The preoperative TSH level was found to be significantly higher in CLT patients (1.71 mIU/L vs. 1.28 mIU/L, p<0.001). Multifocality, capsular, lymphovascular and perineural invasion were detected at a higher rate in the group with CLT than in the group without CLT (p:0.015, p:0.024, p:0.004, p:0.039, respectively). No difference was found between the two groups in terms of tumor size, bilaterality, extrathyroidal invasion, lymph node metastasis, disease stage and response to treatment (p>0.05). CONCLUSION The results of the present study demonstrated that coexistence of PTC and CLT is very frequent. It was found that patients with PTC and CLT coexistence were diagnosed at an earlier age and the TSH level was higher. Contrary to previous studies, no positive effect of CLT and PTC combination was detected on any clinicopathological factor. In addition, lymphovascular and perineural invasion, which had negative effects on prognosis, was more common in the CLT group.
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Affiliation(s)
- Davut Sakiz
- Department of Endocrinology and Metabolism, Mardin State Hospital, Mardin Turkey.
| | - Muhammed Erkam Sencar
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Murat Calapkulu
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Ilknur Ozturk Unsal
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Levent Aktas
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Bekir Ucan
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Mustafa Ozbek
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Erman Cakal
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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Subhi O, Schulten HJ, Bagatian N, Al-Dayini R, Karim S, Bakhashab S, Alotibi R, Al-Ahmadi A, Ata M, Elaimi A, Al-Muhayawi S, Mansouri M, Al-Ghamdi K, Hamour OA, Jamal A, Al-Maghrabi J, Al-Qahtani MH. Genetic relationship between Hashimoto`s thyroiditis and papillary thyroid carcinoma with coexisting Hashimoto`s thyroiditis. PLoS One 2020; 15:e0234566. [PMID: 32603365 PMCID: PMC7326236 DOI: 10.1371/journal.pone.0234566] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/28/2020] [Indexed: 12/30/2022] Open
Abstract
Hashimoto's thyroiditis (HT) is present in the background of around 30% of papillary thyroid carcinomas (PTCs). The genetic predisposition effect of this autoimmune condition is not thoroughly understood. We analyzed the microarray expression profiles of 13 HT, eight PTCs with (w/) coexisting HT, six PTCs without (w/o) coexisting HT, six micro PTCs (mPTCs), and three normal thyroid (TN) samples. Based on a false discovery rate (FDR)-adjusted p-value ≤ 0.05 and a fold change (FC) > 2, four comparison groups were defined, which were HT vs. TN; PTC w/ HT vs. TN; PTC w/o HT vs. TN; and mPTC vs. TN. A Venn diagram displayed 15 different intersecting and non-intersecting differentially expressed gene (DEG) sets, of which a set of 71 DEGs, shared between the two comparison groups HT vs. TN ∩ PTC w/ HT vs. TN, harbored the relatively largest number of genes related to immune and inflammatory functions; oxidative stress and reactive oxygen species (ROS); DNA damage and DNA repair; cell cycle; and apoptosis. The majority of the 71 DEGs were upregulated and the most upregulated DEGs included a number of immunoglobulin kappa variable genes, and other immune-related genes, e.g., CD86 molecule (CD86), interleukin 2 receptor gamma (IL2RG), and interferon, alpha-inducible protein 6 (IFI6). Upregulated genes preferentially associated with other gene ontologies (GO) were, e.g., STAT1, MMP9, TOP2A, and BRCA2. Biofunctional analysis revealed pathways related to immunogenic functions. Further data analysis focused on the set of non-intersecting 358 DEGs derived from the comparison group of HT vs. TN, and on the set of 950 DEGs from the intersection of all four comparison groups. In conclusion, this study indicates that, besides immune/inflammation-related genes, also genes associated with oxidative stress, ROS, DNA damage, DNA repair, cell cycle, and apoptosis are comparably more deregulated in a data set shared between HT and PTC w/ HT. These findings are compatible with the conception of a genetic sequence where chronic inflammatory response is accompanied by deregulation of genes and biofunctions associated with oncogenic transformation. The generated data set may serve as a source for identifying candidate genes and biomarkers that are practical for clinical application.
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Affiliation(s)
- Ohoud Subhi
- Center of Excellence in Genomic Medicine Research, Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hans-Juergen Schulten
- Center of Excellence in Genomic Medicine Research, Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
- * E-mail:
| | - Nadia Bagatian
- Center of Excellence in Genomic Medicine Research, Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Roa'a Al-Dayini
- Center of Excellence in Genomic Medicine Research, Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sajjad Karim
- Center of Excellence in Genomic Medicine Research, Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sherin Bakhashab
- Department of Biochemistry, Faculty of Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
- Center of Innovation in Personalized Medicine, Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Reem Alotibi
- Center of Excellence in Genomic Medicine Research, Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Biochemistry, Faculty of Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Alaa Al-Ahmadi
- Center of Excellence in Genomic Medicine Research, Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Biochemistry, Faculty of Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Manar Ata
- Center of Excellence in Genomic Medicine Research, Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Aisha Elaimi
- Center of Innovation in Personalized Medicine, Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Saad Al-Muhayawi
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Majid Mansouri
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Khalid Al-Ghamdi
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Osman Abdel Hamour
- Department of Surgery, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Awatif Jamal
- Department of Pathology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Jaudah Al-Maghrabi
- Department of Pathology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Pathology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mohammed Hussain Al-Qahtani
- Center of Excellence in Genomic Medicine Research, Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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Scott GD, Lau HD, Kurzer JH, Kong CS, Gratzinger DA. Flow immunophenotyping of benign lymph nodes sampled by FNA: Representative with diagnostic pitfalls. Cancer Cytopathol 2018; 126:797-808. [PMID: 30194715 PMCID: PMC6221160 DOI: 10.1002/cncy.22038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 05/31/2018] [Accepted: 06/21/2018] [Indexed: 11/08/2022]
Abstract
Background Fine‐needle aspiration with flow cytometry (FNA‐FC) is routinely used in the evaluation of lymph nodes suspicious for lymphoma, yet data comparing immunophenotype distributions and outliers in benign lymph nodes sampled by fine‐needle aspiration (FNA) versus excision are lacking. Methods Flow cytometry data from 289 benign lymph node FNA cases were assessed for the overall antigen distribution, with a focus on outliers relevant to the diagnosis of lymphoma. Distributions and outlier proportions were compared with those of a separate cohort of 298 excisional biopsies. Results Compared with excisional biopsies, FNA specimens overrepresented CD3+ events (72% vs 63%), underrepresented CD19+ events (22% vs 29%), and had 25% fewer large cell–gated events. Normalized antigen distributions in FNA were equivalent to those in excisional biopsy. Twenty‐three percent of FNA‐FC cases exhibited an outlier, including a skewed kappa:lambda light‐chain ratio, increased CD5+ or CD10+ B‐cell events, a skewed CD4:CD8 ratio, and increased CD7 loss on T cells, with no significant differences in frequency or type in comparison with excisional specimens. Outliers for the light‐chain ratio and T‐cell antigens were enriched among older patients and included patients with a variety of autoimmune/rheumatologic conditions. Conclusions Benign lymph node FNA yields flow immunophenotypes remarkably similar to those from excisional biopsies. Outlier flow immunophenotypes are identified in benign lymph nodes sampled by FNA at a frequency similar to that with excisional biopsies. Older patients, who have a higher baseline risk of lymphoma, are more likely to exhibit lymphoma‐mimicking outliers such as a light‐chain predominance on B cells and skewed CD4:CD8 ratios or increased CD7 loss on T cells, and they warrant additional diagnostic caution. Fine‐needle aspiration–based flow cytometry of lymph nodes is comparable to excisional biopsy and exhibits similar outliers. The reference ranges provided in this study can aid pathologists and contribute in the long term to computational flow analysis and biomedical research.
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Affiliation(s)
- Gregory D Scott
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Hubert D Lau
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Jason H Kurzer
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Christina S Kong
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Dita A Gratzinger
- Department of Pathology, Stanford University School of Medicine, Stanford, California
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Nakao T, Nishikawa M, Hisakado M, Kasahara T, Kudo T, Nishihara E, Ito M, Fukata S, Nakamura H, Hirokawa M, Miyauchi A. Characteristics and natural course of hypoechoic thyroid lesions diagnosed as possible thyroid lymphomas by fine needle aspiration cytology. Thyroid Res 2018; 11:8. [PMID: 29875824 PMCID: PMC5977489 DOI: 10.1186/s13044-018-0051-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 05/22/2018] [Indexed: 12/02/2022] Open
Abstract
Background There is little information regarding the natural course of hypoechoic thyroid lesions that are probable or possible thyroid lymphoma based on fine needle aspiration cytology (FNAC) results. Methods Sixty-five patients who were diagnosed as probable or possible thyroid lymphoma by ultrasonography (US) and FNAC were investigated. Forty-three patients with strong suspicion underwent thyroid surgery for the diagnosis at our hospital, and 22 patients were followed up with periodic US examination. Thyroid lymphoma was definitely diagnosed in 41 out of 43 patients who underwent thyroid surgery, and such patients were defined as Group A. The outcomes of 22 patients who were followed up without an immediate therapy were analyzed. Their hypoechoic lesions decreased in size (n = 10) or disappeared (n = 2) in 12 of 22 patients, and such patients were defined as Group B. Patients in Group A and B were compared using the Kuma Hospital-US classification (USC), the diagnostic categories of the Bethesda System for Reporting Thyroid Cytopathology, and the κ/λ deviation of the immunoglobulin light chain in the FNAC specimens. Mann-Whitney U-test and chi-squared test (with Yate’s continuity correction) were used to compare the two groups. Results The USC of < 3.5 [9/12 (75.0%) in Group B; 10/41 patients (24.4%) in Group A] and the κ/λ deviation ratio of < 3.40 [11/12 (91.7%) in Group B; 17/41 patients (41.5%) in Group A] were significantly more frequent (p < 0.01), and the FNAC of ‘benign’ or ‘atypia of undetermined significance or follicular lesion of undetermined significance (AUS)’ with a comment of possible lymphoma [9/12 (75.0%) in Group B; 12/41 patients (29.3%) in Group A] was significantly more frequent (p < 0.05) in Group B than Group A. Conclusions Our study suggests that some hypoechoic thyroid lesions that are possible thyroid lymphoma based on US and FNAC might decrease in size or disappear during the careful observation.
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Affiliation(s)
- Tomoe Nakao
- 1Department of Internal Medicine, Kuma Hospital, Centre for Excellence in Thyroid Cares, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, 650-0011 Japan
| | - Mitsushige Nishikawa
- 1Department of Internal Medicine, Kuma Hospital, Centre for Excellence in Thyroid Cares, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, 650-0011 Japan
| | - Mako Hisakado
- 1Department of Internal Medicine, Kuma Hospital, Centre for Excellence in Thyroid Cares, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, 650-0011 Japan
| | - Toshihiko Kasahara
- 1Department of Internal Medicine, Kuma Hospital, Centre for Excellence in Thyroid Cares, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, 650-0011 Japan
| | - Takumi Kudo
- 1Department of Internal Medicine, Kuma Hospital, Centre for Excellence in Thyroid Cares, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, 650-0011 Japan
| | - Eijun Nishihara
- 1Department of Internal Medicine, Kuma Hospital, Centre for Excellence in Thyroid Cares, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, 650-0011 Japan
| | - Mitsuru Ito
- 1Department of Internal Medicine, Kuma Hospital, Centre for Excellence in Thyroid Cares, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, 650-0011 Japan
| | - Shuji Fukata
- 1Department of Internal Medicine, Kuma Hospital, Centre for Excellence in Thyroid Cares, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, 650-0011 Japan
| | - Hirotoshi Nakamura
- 1Department of Internal Medicine, Kuma Hospital, Centre for Excellence in Thyroid Cares, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, 650-0011 Japan
| | - Mitsuyoshi Hirokawa
- 2Department of Diagnostic Pathology and Cytology, Kuma Hospital, Centre for Excellence in Thyroid Cares, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, 650-0011 Japan
| | - Akira Miyauchi
- 3Department of Surgery, Kuma Hospital, Centre for Excellence in Thyroid Care, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, 650-0011 Japan
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Peluso AL, Cozzolino I, Bottiglieri A, Lucchese L, Di Crescenzo RM, Langella M, Selleri C, Zeppa P. Immunoglobulin heavy and light chains and T-cell receptor beta and gamma chains PCR assessment on cytological samples. A study comparing FTA cards and cryopreserved lymph node fine-needle cytology. Cytopathology 2016; 28:203-215. [DOI: 10.1111/cyt.12402] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2016] [Indexed: 01/14/2023]
Affiliation(s)
- A. L. Peluso
- Anatomia Patologica; University of Salerno; Salerno Italy
- DEA; University “G. Marconi” of Rome; Rome
| | - I. Cozzolino
- Department of Public Health; University of Naples ‘Federico II’; Naples Italy
| | - A. Bottiglieri
- Anatomia Patologica; University of Salerno; Salerno Italy
| | - L. Lucchese
- Anatomia Patologica; University of Salerno; Salerno Italy
| | - R. M. Di Crescenzo
- Department of Public Health; University of Naples ‘Federico II’; Naples Italy
| | - M. Langella
- UOC Haematology and Transplantation; AOU San Giovanni di Dio e Ruggi D’Aragona; Salerno Italy
| | - C. Selleri
- Department of Medicine and Surgery; University of Salerno; Salerno Italy
| | - P. Zeppa
- Anatomia Patologica; University of Salerno; Salerno Italy
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Affiliation(s)
- Pio Zeppa
- Department of Pathology, Hospital 'San Giovanni di Dio e Ruggi d'Aragona' of Salerno, Salerno, Italy
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Peluso AL, Ieni A, Mignogna C, Zeppa P. Lymph Node Fine-Needle Cytology: Beyond Flow Cytometry. Acta Cytol 2016; 60:372-384. [PMID: 27560152 DOI: 10.1159/000447734] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 06/20/2016] [Indexed: 12/16/2022]
Abstract
Lymph node (LN) fine-needle cytology (FNC) coupled with flow cytometry immunophenotyping provides relevant information for the diagnosis of non-Hodgkin lymphoma (NHL). Numerous studies have shown FNC samples to be suitable for different molecular procedures; in this review, some of the molecular procedures most commonly employed for NHL are briefly described and evaluated in this perspective. Fluorescence in situ hybridization and chromogenic in situ hybridization are briefly described. Polymerase chain reaction (PCR)-based assays are used to identify and quantify mutations and translocations, namely immunoglobulin (IGH) and T-cell receptor rearrangements by clonality testing and IGVH somatic hypermutations either by Sanger sequencing, single-strand conformational polymorphisms or RT-PCR strategies. High-throughput technologies (HTT) encompass numerous and different diagnostic tools that share the capacity of multiple molecular investigation and sample processing in a fast and reproducible manner. HTT includes gene expression profiling, comparative genomic hybridization, single-nucleotide polymorphism arrays and next-generation sequencing technologies. A brief description of these tools and their potential application to LN FNC is reported. The challenge for FNC will be to achieve new knowledge and apply new technologies to FNC, exploiting its own basic qualities.
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Affiliation(s)
- Anna Lucia Peluso
- Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
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Stacchini A, Demurtas A, Aliberti S. Extranodal Lymphoproliferative Processes and Flow Cytometry. Acta Cytol 2016; 60:315-325. [PMID: 27537785 DOI: 10.1159/000448021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/28/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Fine-needle aspiration (FNA) cytology is a safe and cost-effective technique for the diagnosis of lymphoproliferative processes, especially when correlated with clinical and imaging studies. However, cytology alone may be unable to detect a lymphoid neoplastic process, as architectural features are less obvious than in histologic preparations and, in certain cases, reactive processes may mimic lymphoma. Flow cytometry (FC) has been recognized as an important ancillary technique in the diagnosis of lymphoid neoplasms and it can be used in conjunction with FNA in the evaluation of lymphoproliferative processes. STUDY DESIGN We performed a review of the published literature concerning FC applied to the detection of salivary glands and thyroid lymphoproliferative processes, which are frequently related to autoimmune diseases and difficult to diagnose by cytomorphology alone. RESULTS FC is able to detect and subtype non-Hodgkin lymphomas and may contribute to the exclusion of a neoplastic process in cytologically unclear cases. CONCLUSIONS FC can be successfully applied in the differential diagnosis of lymphoproliferative processes in the head and neck region. The FNA-FC combined approach can reduce time to therapy and may prevent unnecessary surgical biopsies.
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Affiliation(s)
- Alessandra Stacchini
- Flow Cytometry Unit, Anatomic Pathology, Diagnostic Laboratory Department, Città della Salute e della Scienza, Turin, Italy
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10
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Pedicelli I, Patriciello G, Scala G, Sorrentino A, Gravino G, Patriciello P, Zeppa P, Di Crescenzo V, Vatrella A. Cushing's like syndrome in typical bronchial carcinoid a case report and review of the literature. Int J Surg Case Rep 2016; 20S:1-4. [PMID: 26923475 PMCID: PMC4883057 DOI: 10.1016/j.ijscr.2016.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cushing’s syndrome occurred in 1–5% of cases of bronchial carcinoids. In this paper we describe a case of typical bronchial carcinoid in a nonsmoker young male with clinical manifestations mimicking a Cushing’s syndrome. The patient performed chest radiograph and computed tomography. Fiberoptic bronchoscopy revealed the presence of an endobronchial mass occluding the bronchus intermedius. A rigid bronchoscopy was necessary for the conclusive diagnosis and for partial resection of the intraluminal tumor. Despite of the presence of Cushingoid features, the normal blood levels of ACTH and cortisol excluded the coexistence of a Cushing’s syndrome.
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Affiliation(s)
- Ilaria Pedicelli
- Division of Respiratory Disease, Ospedali Riuniti Area Nolana, Italy.
| | | | - Giovanni Scala
- Division of Respiratory Disease, Ospedali Riuniti Area Nolana, Italy.
| | | | - Gennaro Gravino
- Division of Respiratory Disease, Ospedali Riuniti Area Nolana, Italy.
| | | | - Pio Zeppa
- Department of Medicine and Surgery, University of Salerno, Italy.
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Qu N, Zhang L, Lin DZ, Ji QH, Zhu YX, Wang Y. The impact of coexistent Hashimoto's thyroiditis on lymph node metastasis and prognosis in papillary thyroid microcarcinoma. Tumour Biol 2015; 37:7685-92. [PMID: 26692097 DOI: 10.1007/s13277-015-4534-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 10/21/2014] [Indexed: 11/25/2022] Open
Abstract
The impact of coexistent Hashimoto's thyroiditis (HT) on lymph node metastasis (LNM) and prognosis in papillary thyroid microcarcinoma (PTMC) remains controversial. We evaluated the association of coexistent HT with clinicopathologic parameters, LNM, and prognosis by retrospectively reviewing a series of consecutive patients treated for PTMC at Fudan University Cancer Center from January 2005 to December 2010. Of all 1,250 patients with complete data for analysis, 364 (29.1 %) had coexistent HT (HT group) and 886 patients (70.9 %) had no evidence of HT (control group). The HT group had higher proportion of female (87.9 vs 70.1 %) patients, higher mean level of thyroid-stimulating hormone (TSH) (2.39 vs 2.00 mIU/L), and lower incidence of extrathyroidal extension (7.4 vs 11.7 %) than those in the control group. However, the incidence of LNM and recurrence was similar between the two groups, and HT was not associated with LNM and recurrence. A series of clinicopathologic factors identified for predicting LNM and recurrence in the control group did not show any prediction in the HT group. In summary, this study suggested that coexistent HT had insignificant protective effect on LNM and prognosis in PTMC, which was inconsistent with prior studies. Further studies aiming to determine novel predictors are recommended in PTMC patients with coexistent HT.
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Affiliation(s)
- Ning Qu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Ling Zhang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Dao-Zhe Lin
- Department of Oncology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qing-Hai Ji
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
| | - Yong-Xue Zhu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Yu Wang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
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Stacchini A, Pacchioni D, Demurtas A, Aliberti S, Cassenti A, Isolato G, Gazzera C, Veltri A, Sapino A, Papotti M, Freddi M, Palestini N, Sisto G, Novero D. Utilility of flow cytometry as ancillary study to improve the cytologic diagnosis of thyroid lymphomas. CYTOMETRY PART B-CLINICAL CYTOMETRY 2014; 88:320-9. [DOI: 10.1002/cyto.b.21204] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 10/10/2014] [Accepted: 11/06/2014] [Indexed: 12/30/2022]
Affiliation(s)
- Alessandra Stacchini
- Diagnostic Laboratory Department; Flow Cytometry Unit, Citta' della Salute e della Scienza; Turin Italy
| | - Donatella Pacchioni
- Diagnostic Laboratory Department; Pathology Service, Citta' della Salute e della Scienza; Turin Italy
| | - Anna Demurtas
- Diagnostic Laboratory Department; Flow Cytometry Unit, Citta' della Salute e della Scienza; Turin Italy
| | - Sabrina Aliberti
- Diagnostic Laboratory Department; Flow Cytometry Unit, Citta' della Salute e della Scienza; Turin Italy
| | - Adele Cassenti
- Diagnostic Laboratory Department; Pathology Service, Citta' della Salute e della Scienza; Turin Italy
| | - Giuseppe Isolato
- Diagnostic Imaging Department; Citta' della Salute e della Scienza; Turin Italy
| | - Carlo Gazzera
- Diagnostic Imaging Department; Citta' della Salute e della Scienza; Turin Italy
| | - Andrea Veltri
- Department of Clinical and Biomedical Sciences; University of Turin at San Luigi Hospital; Orbassano Turin Italy
| | - Anna Sapino
- Diagnostic Laboratory Department; Pathology Service, Citta' della Salute e della Scienza; Turin Italy
| | - Mauro Papotti
- Department of Clinical and Biomedical Sciences; University of Turin at San Luigi Hospital; Orbassano Turin Italy
| | - Milena Freddi
- Surgery Department; Citta' della Salute e della Scienza; Turin Italy
| | - Nicola Palestini
- Surgery Department; Citta' della Salute e della Scienza; Turin Italy
| | - Gabriella Sisto
- Surgery Department; Citta' della Salute e della Scienza; Turin Italy
| | - Domenico Novero
- Diagnostic Laboratory Department; Pathology Service, Citta' della Salute e della Scienza; Turin Italy
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13
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Zeppa P, Vitale M. Fine needle cytology and flow cytometry in hashimoto thyroiditis and primary thyroid lymphoma. Acta Cytol 2014; 58:318. [PMID: 24642841 DOI: 10.1159/000360067] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 01/28/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Pio Zeppa
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
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14
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Guerra A, Di Crescenzo V, Garzi A, Cinelli M, Carlomagno C, Tonacchera M, Zeppa P, Vitale M. Genetic mutations in the treatment of anaplastic thyroid cancer: a systematic review. BMC Surg 2013; 13 Suppl 2:S44. [PMID: 24267151 PMCID: PMC3851243 DOI: 10.1186/1471-2482-13-s2-s44] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Anaplastic thyroid cancer (ATC) is a rare, lethal disease associated with a median survival of 6 months despite the best multidisciplinary care. Surgical resection is not curative in ATC patients, being often a palliative procedure. Multidisciplinary care may include surgery, loco-regional radiotherapy, and systemic therapy. Besides conventional chemotherapy, multi kinase-targeted inhibitors are emerging as novel therapeutic tools. The numerous molecular alteration detected in ATC are targets for these inhibitors. The aim of this review is to determine the prevalence of the major genetic alterations occurring in ATC and place the results in the context of the emerging kinase-targeted therapies. METHODS The study is based on published PubMed studies addressing the prevalence of BRAF, RAS, PTEN, PI3KCA and TP53 mutations and RET rearrangements in ATC. RESULTS 21 articles dealing with 652 genetic analyses of the selected genes were used. The overall prevalence determined were the following: RET/PTC, 4%; BRAF, 23%; RAS, 60%; PTEN, 16%; PI3KCA, 24%; TP53, 48%. Genetic alterations are sometimes overlapping. CONCLUSIONS Mutations of BRAF, PTEN and PI3KCA genes are common in ATC, with RAS and TP53 being the most frequent. Given ATC genetic complexity, effective therapies may benefit from individualized therapeutic regimens in a multidisciplinary approach.
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Vigliar E, Caleo A, Vitale M, Di Crescenzo V, Garzi A, Zeppa P. Early cytological diagnosis of extranodal stage I, primary thyroid Non-Hodgkin lymphoma in elderly patients. Report of two cases and review of the literature. BMC Surg 2013; 13 Suppl 2:S49. [PMID: 24267471 PMCID: PMC3851195 DOI: 10.1186/1471-2482-13-s2-s49] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Primary thyroid lymphomas (PTLs) account for 5% of thyroid malignant tumors and often develop in patients with Hashimoto Thyroiditis (HT). Fine-needle cytology (FNC) is widely used in the diagnosis of thyroid nodules, including those arising in HT. Two PTL cases in HT elderly patients are here described and discussed. Methods FNC was performed in rapidly enlarged thyroid nodules of 2 elderly patients under ultrasound (US) control. FNC was used to prepare conventional cytologic smears, immunocytochemistry (ICC) and flow cytometry (FC) assessment of cell populations. Results The above cases were diagnosed as well differentiated, small B-cell and diffuse large B-cell thyroid lymphomas, respectively, by means of FNC. The histological diagnoses were mucosa-associated non Hodgkin lymphoma (MALT) and diffuse large B-cell lymphoma (DLBCL), confirming FNC diagnoses, and patients were treated accordingly. Conclusions FNC diagnosis of PTL is reliable and accurate; it may be conveniently used in the clinical practice since it provides indications for appropriate therapeutic procedures or diagnostic surgery, and avoids to treat benign nodules.
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Cozzolino I, Caleo A, Di Crescenzo V, Cinelli M, Carlomagno C, Garzi A, Vitale M. Cytological diagnosis of adult-type fibrosarcoma of the neck in an elderly patient. Report of one case and review of the literature. BMC Surg 2013; 13 Suppl 2:S42. [PMID: 24266985 PMCID: PMC3850999 DOI: 10.1186/1471-2482-13-s2-s42] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Fibrosarcoma (FS) accounts for about 3% of all soft tissue sarcomas. It may arise in any area of the body, but it is relative rare in the head and neck district. Fine-needle cytology (FNC) is widely used in the diagnosis of neoplastic and non-neoplastic lesions of soft tissue. This article describes a case of FS of the neck diagnosed by FNC. METHODS FNC was performed in a sub-fascial supraclavicular mass of an elderly patient under ultrasound (US) control. FNC was used to prepare cytological smears that were conventionally and immunocytochemically (ICC) stained. RESULTS Smears showed a monomorphous spindle cell population and were positive at ICC for Vimentin and negative for CKAE1AE3, Actin, S-100, CD68, CT and PAX-8. The cytological diagnosis was confirmed by histological diagnosis. The patient underwent surgical resection and subsequent radiotherapy. CONCLUSIONS FNC diagnosis of FS is reliable and accurate and may be conveniently used in the scheduling of surgical procedures, when needed, avoiding the treatment of benign nodules.
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Caleo A, Vigliar E, Vitale M, Di Crescenzo V, Cinelli M, Carlomagno C, Garzi A, Zeppa P. Cytological diagnosis of thyroid nodules in Hashimoto thyroiditis in elderly patients. BMC Surg 2013; 13 Suppl 2:S41. [PMID: 24266923 PMCID: PMC3851014 DOI: 10.1186/1471-2482-13-s2-s41] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background Long standing Hashimoto Thyroiditis (HT) causes shrinking and atrophy of the thyroid, but may also lead to diffuse enlargement of the gland and/or formation of nodules. These nodules should be differentiated from papillary thyroid carcinoma (PTC) and primary thyroidal non-Hodgkin lymphoma (PTL), which are possible complications of HT, and require pre-surgical diagnoses and different treatments. This study focuses on the role of fine-needle cytology (FNC) in the clinical surveillance and pre-surgical diagnosis of HT with diffuse and nodular enlargement of the gland in elderly patients. Methods Thirty-four elderly patients (≥ 65 yrs) with HT and diffuse or nodular enlargement of the thyroid underwent ultrasound (US)-guided FNC. Smears were routinely stained and evaluated; additional passes were used for flow cytometry (FC) assessment of lymphoid infiltrate in 6 cases. Results The cytological diagnosis was HT in 12 cases with prevalence of Hurtle cells in 2 cases, PTC in 1 case and PTL in 2 cases. FC assessed the reactive, non-lymphomatous nature of the lymphoid infiltrate in 5 cases and demonstrated light chain restriction, hence the lymphomatous nature of the lymphoid infiltrate in 2 cases of PTL. Conclusions FNC plays a key role in the clinical surveillance and pre-surgical diagnosis of diffuse enlargement and nodular presentation of HT in elderly patients. FNC can correctly diagnose HT, PTC and PTL indicating the need for surgery and its extension in suspicious or neoplastic cases, leaving other cases to the medical treatment and clinical surveillance.
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Guerra A, Di Crescenzo V, Garzi A, Cinelli M, Carlomagno C, Pepe S, Zeppa P, Tonacchera M, Vitale M. Diagnostic utility of BRAFV600E mutation testing in thyroid nodules in elderly patients. BMC Surg 2013; 13 Suppl 2:S37. [PMID: 24267957 PMCID: PMC3850960 DOI: 10.1186/1471-2482-13-s2-s37] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background Thyroid cancer is a rare disease characterized by the subtle appearance of a nodule. Fine-needle cytology (FNC) is the first diagnostic procedure used to distinguish a benign from a malignant nodule. However, FNC yields inconclusive results in about 20% of cases. BRAFV600E mutation is the most frequent genetic alteration in papillary thyroid carcinoma (PTC); its high prevalence makes this oncogene a useful marker to refine inconclusive FNC results. However, the prevalence of the BRAFV600E mutation depends on detection methods, geographical factors, and age. The aim of this study is to determine the prevalence of BRAFV600E mutation and its utility as a diagnostic tool in elderly subjects. Methods FNC from 92 PTC patients were subjected to the analysis of BRAF mutation by pyrosequencing and direct sequencing; age-dependent prevalence was also determined. Results BRAF mutation analysis was successful in all FNC specimens. BRAFV600E was documented in 62 (67.4%) and in 58 (63.0%) PTCs by pyrosequencing and direct sequencing, respectively. BRAFV600E prevalence did not correlate with patient's age at diagnosis. Twenty out of 32 PTCs (62.5%) were correctly diagnosed by BRAF mutation analysis in inconclusive FNC results. Conclusions Detection of BRAFV600E in cytology specimens by pyrosequencing is a useful diagnostic adjunctive tool in the evaluation of thyroid nodules also in elderly subjects.
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Szczepanek-Parulska E, Szkudlarek M, Majewski P, Breborowicz J, Ruchala M. Thyroid nodule as a first manifestation of Hodgkin lymphoma-report of two cases and literature review. Diagn Pathol 2013; 8:116. [PMID: 23856094 PMCID: PMC3751227 DOI: 10.1186/1746-1596-8-116] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 06/30/2013] [Indexed: 01/08/2023] Open
Abstract
UNLABELLED Lymphomas account for less than 5% of thyroid malignant lesions. Vast majority of them are B-cell non-Hodgkin lymphomas (NHL), while Hodgkin lymphoma (HL) is extremely rare. Here we present two cases of HL, at baseline manifesting as a thyroid lesion. First patient, 29-year-old pregnant female, initially suspected for metastatic medullary thyroid cancer, was eventually diagnosed with mixed cellularity type of thyroid HL. Second patient, 22-year-old woman with suspicion of advanced thyroid cancer, was in the end diagnosed with an extra-lymphatic classical HL of the thyroid. In both cases, despite repeated fine-needle aspiration biopsy, cytological examination gave inconclusive or misleading results. On histopathological examination, thyroid tumor cells were positive for CD15 and CD30 antigen, which is typical for Reed-Sternberg cells. In the report authors also discuss difficulties in management as well as potential importance of novel methods such as FISH, PCR and other molecular techniques in diagnostics of thyroid lymphomas. VIRTUAL SLIDES The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2896947559559648.
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Affiliation(s)
- Ewelina Szczepanek-Parulska
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
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Mondal SK. Cytodiagnosis of primary thyroid lymphoma with histologic correlation: A case report. Diagn Cytopathol 2011; 40:444-6. [PMID: 21681970 DOI: 10.1002/dc.21730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 04/06/2011] [Indexed: 11/07/2022]
Abstract
Primary thyroid lymphoma is a very rare disease. Here, we present a case of primary diffuse large B-cell lymphoma (DLBCL) in a 48-year-old female involving thyroid gland. The patient had thyroid swelling for 15 years which rapidly increased during last 5 months. Fine needle aspiration cytology revealed monomorphic large cells arranged discretely. The cells have high nuclear-cytoplasmic ratio with prominent single to multiple nucleoli. Aggregates of thyroid follicular cells were absent in the smears. A cytodiagnosis of DLBCL was made and a differential diagnosis of lymphocytic thyroiditis was also included. Subsequent histologic examination revealed a high-grade non-Hodgkin lymphoma (NHL). Immunohistochemistry showed the tumor cells expressing CD45, CD20, BCl-6, and tumor cells were negative for cytokeratin, epithelial membrane antigen, CD3, CD5, and CD30. Proliferative index (Ki-67) was very high (70%). Thus, a final diagnosis of NHL of DLBCL subtype was established. The patient was treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristin, prednisone) and radiotherapy. The patient is under one-year follow-up which is uneventful.
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Cozzolino I, Nappa S, Picardi M, De Renzo A, Troncone G, Palombini L, Zeppa P. Clonal B-cell population in a reactive lymph node in acquired immunodeficiency syndrome. Diagn Cytopathol 2010; 37:910-4. [PMID: 19582804 DOI: 10.1002/dc.21127] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A 40-year-old female, HIV positive, stage C, since 4 years, complained of a right cervical lymph node swelling. Two years before, the patient had been diagnosed with follicular B-cell non-Hodgkin lymphoma (FL); she had been treated with four cycles of multiagent chemotherapy plus rituximab, the last cycle being administered 10 months before coming to our attention. An ultrasound (US) guided fine-needle cytology (FNC) showed an atypical lymphoid cell proliferation. The phenotype evidenced by flow cytometry (FC) analysis was D5: 10%, CD19: 49%, CD23: 10%, FMC7: 0%, CD10: 40%, CD10/19: 40%, lambda light chain 40%, kappa light chain 0%. FDG-positron emission tomography (PET/CT) scan showed positivity in the corresponding cervical area. Since low LDH values and a reduced lymph node size were observed, the lymph node was therefore excised; the histology revealed a reactive hyperplastic lymph node with florid follicular pattern. A subsequent PCR analysis, performed on DNA extracted from a whole histological section, did not evidence IgH rearrangement. The patient is currently undergoing strict clinical and instrumental follow-up, including PET every 3 months; after 13 months, she is alive without recurrence of lymphoma. Clonal B-cell populations in non-lymphomatous processes have been described in mucosa-associated lymphoid cell populations and reactive lymph nodes, and are considered non-malignant, antigen driven, proliferations of B-lymphocytes determined by an abnormal response to bacterial or viral antigen stimulation. The present case occurred in an HIV patient and was clinically complex because of the patient's history of FL. This experience suggests much attention in the evaluation of radiological, cytological, and FC data and in clinical correlation in patients suffering from autoimmune or immunodeficiency syndromes.
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Affiliation(s)
- Immacolata Cozzolino
- Department of Pathological Anatomy and Cytopathology, University of Naples "Federico II," Naples, Italy
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