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Ng JKM, Chan ABW, Li JJX. Colloid and pigmented histiocytes in lymph node aspirates as a clue to metastasis in patients with a history of papillary thyroid carcinoma. Diagn Cytopathol 2024; 52:22-29. [PMID: 37823320 DOI: 10.1002/dc.25236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/09/2023] [Accepted: 09/27/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Cystic changes, calcification, colloid material, and multinucleated giant cells are frequently associated with primary and metastatic papillary thyroid carcinoma (PTC). These features are sometimes present in negative lymph node fine-needle aspiration cytology (FNAC). This study aims to review nodal aspirates of PTC to elucidate the significance of these cytological features in aspirates without tumor cells. METHODS FNAC specimens from patients with PTC confirmed on thyroidectomy were reviewed for cystic changes, tumor-associated features, and lymphoid components. Histologic follow-up of the lymph nodes were retrieved for correlation. RESULTS A total of 113 aspirates were retrieved, of which 79 showed tumor cells on the FNAC specimen, and 95 were matched to a positive lymph node histology. At univariable analysis, calcification (n = 18/113, p = .044), colloid material (n = 40/113, p = .001), multinucleated giant cells (n = 29/113, p = .028), tumor cells (n = 79/133, p < .001), foamy histiocytes (n = 36/113, p = .002) and pigmented histiocytes (n = 62/113, p < .001) were associated with a positive histology. Presence of lymphoid fragments (n = 11/113, p < .001) and abundant background lymphocytes correlated with a negative histologic follow-up (n = 45/113, p = .005). In aspirates without tumor cells, multivariable analysis demonstrated colloid material (p < .001) and pigmented histiocytes (p = .003) to be independently predictive of metastatic PTC, whereas lymphoid fragments (p < .001) were independently associated with a negative histologic follow up. CONCLUSION Colloid material and pigmented histiocytes, and to lesser degree calcification and multinucleated giant cells, when seen in an aspirate without tumor cells, raises suspicion metastatic disease. On the contrary, the lymphoid fragments can be regarded as supportive evidence of adequate sampling and a true negative result.
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Affiliation(s)
- Joanna K M Ng
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Amy B W Chan
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Joshua J X Li
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong
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2
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Maybank AK, Curtis H, Topp T, Barnes PJ. Metastatic Mammary Carcinoma Presenting as a Large Cystic Axillary Mass: A Report of an Unusual Case. Int J Surg Pathol 2023; 31:1409-1413. [PMID: 36803091 DOI: 10.1177/10668969231152574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
The differential diagnosis of cystic axillary masses is broad and includes intranodal lesions. Cystic metastatic tumor deposits are rare, and have been reported in a few tumor types, most commonly in the head and neck region, but rarely described with metastatic mammary carcinoma. We report a case of a 61-year-old female who presented with a large right axillary mass. Imaging studies revealed a cystic axillary mass and ipsilateral breast mass. She was managed with breast conservation surgery and axillary dissection for invasive ductal carcinoma, no special type, Nottingham grade 2 (21 mm). One of nine lymph nodes contained a cystic nodal deposit (52 mm), which resembled a benign inclusion cyst. Oncotype DX recurrence score for the primary tumor was low (8), conferring a low risk of disease recurrence despite the large size of the nodal metastatic deposit. A cystic pattern of metastatic mammary carcinoma is rare and important to recognize for accurate staging and management decisions.
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Affiliation(s)
- Allison K Maybank
- Department of Pathology, Nova Scotia Health and Dalhousie University, Halifax, NS, Canada
| | - Heather Curtis
- Department of Diagnostic Radiology, Nova Scotia Health and Dalhousie University, Halifax, NS, Canada
| | - Trevor Topp
- Department of Surgery, Nova Scotia Health and Dalhousie University, Halifax, NS, Canada
| | - Penny J Barnes
- Department of Pathology, Nova Scotia Health and Dalhousie University, Halifax, NS, Canada
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3
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Kim JY. Axillary lymph node metastasis from mucoepidermoid carcinoma with cutaneous presentation. Radiol Case Rep 2023; 18:3366-3369. [PMID: 37520390 PMCID: PMC10375372 DOI: 10.1016/j.radcr.2023.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 08/01/2023] Open
Abstract
Extramammary metastases to the breast and axilla are uncommon, and isolated axillary lymph node metastases are especially rare. Contralateral breast malignancies are the most common primary cancers with axillary lymph node metastases. However, in patients with a clinical history of extramammary malignancy and newly developed axillary lesions, consideration of possible extramammary lymph node metastasis is important for diagnosis and treatment and to avoid unnecessary surgery. We report the case of a 73-year-old woman who presented with a palpable lump in the axilla. The patient had a history of surgery for a mass on her back, which was confirmed as mucoepidermoid carcinoma with cutaneous presentation. Ultrasonography revealed a single enlarged lymph node with cystic changes and loss of the fatty hilum in the right axilla. There were no suspicious malignancies in either breast on mammography or sonography. The patient underwent an excisional biopsy and was diagnosed with axillary lymph node metastasis from mucoepidermoid carcinoma.
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4
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Masuoka S, Hiyama T, Kuno H, Sekiya K, Sakashita S, Kobayashi T. Imaging Approach for Cervical Lymph Node Metastases from Unknown Primary Tumor. Radiographics 2023; 43:e220071. [PMID: 36795593 DOI: 10.1148/rg.220071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Neck swelling due to lymph node (LN) metastasis is one of the initial symptoms of head and neck cancer, and in some cases, the primary tumor is not clinically evident. The purpose of imaging for LN metastasis from an unknown primary site is to identify the primary tumor or detect its absence, which leads to the correct diagnosis and optimal treatment. The authors discuss diagnostic imaging approaches for identifying the primary tumor in cases of unknown primary cervical LN metastases. The distribution and characteristics of LN metastases may help locate the primary site. Unknown primary LN metastasis often occurs at nodal levels II and III, and in recent reports, these were mostly related to human papillomavirus (HPV)-positive squamous cell carcinoma of the oropharynx. Another characteristic imaging finding suggestive of metastasis from HPV-associated oropharyngeal cancer is a cystic change in LN metastases. Other characteristic imaging findings such as calcification may help predict the histologic type and locate the primary site. In cases of LN metastases at nodal levels IV and VB, a primary lesion located outside the head and neck region must also be considered. One clue for detecting the primary lesion at imaging is the disruption of anatomic structures, which can help in identifying small mucosal lesions or submucosal tumors at each subsite. Additionally, fluorine 18 fluorodeoxyglucose PET/CT may help identify a primary tumor. These imaging approaches for identifying primary tumors enable prompt identification of the primary site and assist clinicians in making the correct diagnosis. © RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Sota Masuoka
- From the Department of Diagnostic Radiology (S.M., T.H., H.K., K.S., T.K.) and Department of Pathology and Clinical Laboratories (S.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan
| | - Takashi Hiyama
- From the Department of Diagnostic Radiology (S.M., T.H., H.K., K.S., T.K.) and Department of Pathology and Clinical Laboratories (S.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan
| | - Hirofumi Kuno
- From the Department of Diagnostic Radiology (S.M., T.H., H.K., K.S., T.K.) and Department of Pathology and Clinical Laboratories (S.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan
| | - Kotaro Sekiya
- From the Department of Diagnostic Radiology (S.M., T.H., H.K., K.S., T.K.) and Department of Pathology and Clinical Laboratories (S.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan
| | - Shingo Sakashita
- From the Department of Diagnostic Radiology (S.M., T.H., H.K., K.S., T.K.) and Department of Pathology and Clinical Laboratories (S.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan
| | - Tatsushi Kobayashi
- From the Department of Diagnostic Radiology (S.M., T.H., H.K., K.S., T.K.) and Department of Pathology and Clinical Laboratories (S.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan
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5
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Neumann I, Borrelli M, Al Kallaa M, Parker RT, Trigaux C, Teichert N, Geerling G. Rare periorbital, pseudocystic metastasis of squamous cell carcinoma of the bladder: Case report and review of the literature. Orbit 2021; 42:336-342. [PMID: 34913824 DOI: 10.1080/01676830.2021.2012203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We present the case of a man in his fifties with a history of bladder carcinoma who presented with a large periorbital cystic lesion that was found to be a metastasis. Bladder carcinomas are a very rare cause of peri-/orbital metastasis. The primary tumor in this case predominately showed squamous cell differentiation and small areas of adenoid differentiation. To our knowledge only one previous case of orbital metastasis from squamous cell carcinoma of the bladder has been reported. Cyst formation in bladder cancer metastasis has not been reported and is very rare for orbital metastases in general. The pathogenesis of metastatic cyst development is not fully understood and may vary from case to case. A biopsy of an atypical cyst is indicated.
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Affiliation(s)
- Inga Neumann
- Department of Ophthalmology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - M Borrelli
- Department of Ophthalmology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - M Al Kallaa
- Institute of Pathology, University Hospital Duesseldorf, Germany
| | - R T Parker
- Adnexal Department, Moorfields Eye Hospital, London, UK
| | - C Trigaux
- Department of Ophthalmology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - N Teichert
- Institute of Diagnostic and Interventional Radiology, University Hospital Duesseldorf, Germany
| | - G Geerling
- Department of Ophthalmology, University Hospital Duesseldorf, Duesseldorf, Germany
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Papillary Thyroid Cancer Prognosis: An Evolving Field. Cancers (Basel) 2021; 13:cancers13215567. [PMID: 34771729 PMCID: PMC8582937 DOI: 10.3390/cancers13215567] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Over the last couple of decades, the prognostic stratification systems of differentiated thyroid cancer (DTC) patients have been revised several times in an attempt to achieve a tailored clinical management reflecting the single patients’ needs. Such revisions are likely to continue in the near future, since the prognostic value of a number of promising clinicopathological features and new molecular biomarkers are being evaluated. Here, we will review the current staging systems of thyroid cancer patients and discuss the most relevant clinicopathological parameters and new molecular markers that are potentially capable of refining the prognosis. Abstract Over the last few years, a great advance has been made in the comprehension of the molecular pathogenesis underlying thyroid cancer progression, particularly for the papillary thyroid cancer (PTC), which represents the most common thyroid malignancy. Putative cancer driver mutations have been identified in more than 98% of PTC, and a new PTC classification into molecular subtypes has been proposed in order to resolve clinical uncertainties still present in the clinical management of patients. Additionally, the prognostic stratification systems have been profoundly modified over the last decade, with a view to refine patients’ staging and being able to choose a clinical approach tailored on single patient’s needs. Here, we will briefly discuss the recent changes in the clinical management of thyroid nodules, and review the current staging systems of thyroid cancer patients by analyzing promising clinicopathological features (i.e., gender, thyroid auto-immunity, multifocality, PTC histological variants, and vascular invasion) as well as new molecular markers (i.e., BRAF/TERT promoter mutations, miRNAs, and components of the plasminogen activating system) potentially capable of ameliorating the prognosis of PTC patients.
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7
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Branchial cleft anomalies: hybrid "Branchial Inclusion" theory. Eur Arch Otorhinolaryngol 2021; 278:2593-2601. [PMID: 33427915 DOI: 10.1007/s00405-020-06551-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/04/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Branchial cleft anomalies (BCAs) are developmental malformations of the head and neck region. Their histogenesis has been the subject of controversy and is not fully understood. This study aimed to test all present developmental theories ("branchial apparatus," "precervical sinus," "thymopharyngeal," and "inclusion" theories) on a sample of 48 BCAs from a single institution. METHODS We performed a retrospective analysis of clinical-epidemiological and anatomical-pathological characteristics of BCAs treated over a 12-year period in our hospital. RESULTS Overall, 46 patients (24 [52.17%] women and 22 men [47.83%]) underwent surgical excision of 48 BCAs. The mean patient age at presentation was 31.65 ± 19.40 years. Branchial cleft cysts were found in 42 (87.50%) cases, and branchial cleft sinuses were found in six (12.50%) cases. Eight (16.67%) BCAs were distributed in the preauricular region, 34 (70.83%) at the anterior border of the sternocleidomastoid muscle (SCM), three (6.25%) at the posterior border of the SCM, two (4.17%) in the suprasternal notch, and one (2.08%) in the retrosternal space. Histopathologically, 39 (81.25%) BCAs had a lymphoepithelial structure and nine (18.75%) BCAs had solitary epithelial cells. Inflammation and infection were observed in 24 (50%) and 12 (25%) cases, respectively. CONCLUSION None of the hypothesized developmental theories fully explain the embryonic origin of BCA in our study sample. A possible explanation of BCA histogenesis is through the hybrid "branchial inclusion" theory.
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8
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Nguyen K, Siegelman ES, Tu W, Schieda N. Update on MR Imaging of cystic retroperitoneal masses. Abdom Radiol (NY) 2020; 45:3172-3183. [PMID: 31501965 DOI: 10.1007/s00261-019-02196-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This article reviews the MRI appearance of cystic retroperitoneal (RP) masses. CONCLUSION Lymphangiomas are the most common RP cystic masses and typically appear simple; microscopic fat is a specific but insensitive finding. Location, internal complexity, and enhancement pattern suggest alternative diagnoses which range from normal anatomic variants to congenital abnormalities and importantly include benign, neurogenic, and malignant neoplasms. An approach to the MR imaging of cystic RP masses is presented.
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Affiliation(s)
- Kathleen Nguyen
- Department of Medical Imaging, The Ottawa Hospital, The University of Ottawa, Ottawa, Canada
| | - Evan S Siegelman
- Department of Radiology, The Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Wendy Tu
- Department of Medical Imaging, The Ottawa Hospital, The University of Ottawa, Ottawa, Canada
| | - Nicola Schieda
- The Ottawa Hospital, The University of Ottawa, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
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9
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Differential Change in Size of Human Papillomavirus-Positive Cystic Versus Solid Squamous Cell Carcinoma Lymph Node Metastases in Response to Induction Chemotherapy. J Comput Assist Tomogr 2020; 44:389-392. [PMID: 32176158 DOI: 10.1097/rct.0000000000000998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE According to certain cancer treatment protocols, the response to induction chemotherapy of lymph node metastases based on radiographic measurements guides further management. The aim of this study is to verify the observation that cystic metastatic lymph nodes tend not to shrink as rapidly as solid metastatic lymph nodes in response to induction chemotherapy in patients with human papillomavirus-related oropharyngeal squamous cell carcinoma. METHODS The lymphadenopathy in a cohort of patients from a clinical trial with human papillomavirus-related oropharyngeal squamous cell carcinoma with both baseline and postinduction chemotherapy (carboplatin/paclitaxel/cetuximab) contrast-enhanced neck computed tomography was retrospectively reviewed. The appearance of the metastatic lymph nodes on computed tomography was characterized as cystic or solid. A cystic lymph node was defined as having a hypoattenuating component greater than 20% of the total volume. The rates of short-axis and volume changes of cystic and solid lymph nodes were compared using 1-tailed t test. RESULTS A total of 46 patients were included in this study, comprising 39 solid and 45 cystic lymph nodes. The rate of short-axis decrease was significantly greater for solid (1.33% per day) than cystic (1.08% per day) lymph nodes (P = 0.036). Likewise, the rate of volume decrease was significantly greater for solid (2.13% per day) than cystic (1.87% per day) lymph nodes (P = 0.014). CONCLUSIONS This study suggests that in patients with human papillomavirus-related oropharyngeal squamous cell carcinoma solid lymph node metastases generally decrease in size at a greater rate than cystic lymph nodes after induction chemotherapy.
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10
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Cheng SCH, Ahuja AT, Ying M. Quantification of intranodal vascularity by computer pixel-counting method enhances the accuracy of ultrasound in distinguishing metastatic and tuberculous cervical lymph nodes. Quant Imaging Med Surg 2019; 9:1773-1780. [PMID: 31867231 DOI: 10.21037/qims.2019.10.02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Ultrasound is a common imaging method for assessment of cervical lymph nodes. However, metastatic and tuberculous lymph nodes have similar sonographic features in routine ultrasound examination. Computer-aided assessment could be a potential adjunct to enhance the accuracy of differential diagnosis. Methods Gray-scale and power Doppler sonograms of 100 patients with palpable cervical lymph nodes were reviewed and analyzed (60 metastatic nodes, 40 tuberculous nodes). Final diagnosis of lymph nodes was based on fine needle aspiration and cytology. Sonograms were reviewed and assessed for nodal shape, echogenic hilus, intranodal necrosis and vascular distribution (conventional assessment). Intranodal vascularity was quantified using a customized computer algorithm to determine vascularity index (VI). The diagnostic accuracy of using conventional assessment and its combination with intranodal VI method was evaluated and compared. Results Metastatic and tuberculous nodes tended to be round (75.0% vs. 50.0%), without echogenic hilus (86.7% vs. 72.5%) and have peripheral vascularity (73.3% vs. 85.0%). Intranodal necrosis is more common in tuberculous nodes (27.5%) than metastatic nodes (8.3%). Using conventional assessment in differentiating metastatic and tuberculous nodes, the diagnostic accuracy was 56% with a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 56.7%, 55%, 65.4% and 45.8% respectively. The VI of metastatic nodes (23.4%±2.1%) was significantly higher than that of tuberculous nodes (12.0%±1.6%) (P<0.05). The optimum cut-off of VI for the differential diagnosis was 20%. By combining conventional assessment and intranodal VI quantification, the diagnostic accuracy was increased to 69% with a sensitivity, specificity, PPV and NPV of 80%, 52.5%, 71.6%, 63.6% respectively. The increase in sensitivity was statistically significant (P=0.006). Conclusions Computer-aided quantification of intranodal vascularity provides added value in routine ultrasound assessment of cervical lymph nodes. It enhances the accuracy of ultrasound in distinguishing metastatic and tuberculous cervical lymph nodes.
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Affiliation(s)
- Sammy C H Cheng
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Anil T Ahuja
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Michael Ying
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, China
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Abstract
In adult cervicofacial pathology, carcinoma of unknown primary is defined as lymph-node metastasis the anatomic origin of which is not known at the time of initial management. It constitutes up to 5% of head and neck cancers. Presentation may suggest benign pathology, delaying and confusing oncologic treatment. Diagnostic strategy in cervical lymph node with suspicion of neoplasia requires exhaustive work-up to diagnose malignancy and, in 45% to 80% of cases, depending on the series, to identify the primary site. Histologic types comprise squamous cell carcinoma, thyroid carcinoma, adenocarcinoma, neuroendocrine carcinoma and undifferentiated carcinoma. Association is sometimes found with human papilloma virus or Epstein Barr virus, guiding treatment. The objective of the present study was to provide clinicians with the necessary diagnostic tools, based on the current state of clinical, imaging and pathologic knowledge, and to detail treatment options.
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12
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Tabet P, Saydy N, Letourneau-Guillon L, Gologan O, Bissada É, Ayad T, Tabet JC, Guertin L, Nguyen-Tan PF, Christopoulos A. Cystic masses of the lateral neck: Diagnostic value comparison between fine-needle aspiration, core-needle biopsy, and frozen section. Head Neck 2019; 41:2696-2703. [PMID: 30945785 DOI: 10.1002/hed.25755] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/09/2019] [Accepted: 03/12/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The usefulness of fine-needle aspiration (FNA), core-needle biopsy (CNB), and frozen section (FS) for assessing lateral cystic neck masses (LCNM) remains unclear. METHODS A retrospective review of patients presenting with a LCNM was undertaken. RESULTS In total, 135 patients were included. FNA had a lower sensitivity then CNB (59% vs 83%; P = .036) and FS (59% vs 93%; P = .01). FS had a better negative predictive value (NPV) when compared to FNA (92% vs 40%; P < .001) and CNB (92% vs 50%; P = .062). Positive predictive values (PPV) and sensitivities were similar among all groups. CONCLUSION Given its adequate PPV (92%), FNA should be used initially on LCNM. Because of its high sensitivity, CNB should be considered if FNA is not diagnostic of malignancy. FS should always follow a CNB indicative of malignancy, because of low NPV. A diagnosis of malignancy on FNA, CNB, or FS strongly indicates presence of malignancy.
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Affiliation(s)
- Paul Tabet
- Division of Otolaryngology - Head & Neck Surgery, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Québec, Canada.,Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Nadim Saydy
- Division of Otolaryngology - Head & Neck Surgery, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Québec, Canada.,Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Laurent Letourneau-Guillon
- Division of Otolaryngology - Head & Neck Surgery, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Québec, Canada.,Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Olga Gologan
- Division of Otolaryngology - Head & Neck Surgery, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Québec, Canada.,Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Éric Bissada
- Division of Otolaryngology - Head & Neck Surgery, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Québec, Canada.,Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Tareck Ayad
- Division of Otolaryngology - Head & Neck Surgery, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Québec, Canada.,Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Jean-Claude Tabet
- Division of Otolaryngology - Head & Neck Surgery, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Québec, Canada.,Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Louis Guertin
- Division of Otolaryngology - Head & Neck Surgery, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Québec, Canada.,Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Phuc Félix Nguyen-Tan
- Division of Otolaryngology - Head & Neck Surgery, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Québec, Canada.,Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Apostolos Christopoulos
- Division of Otolaryngology - Head & Neck Surgery, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Québec, Canada.,Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
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Saadi R, LaRusso S, Vijay K, Goldenberg D. Elastography as a potential modality for screening cervical lymph nodes in patients with papillary thyroid cancer: A review of literature. EAR, NOSE & THROAT JOURNAL 2018; 97:31-39. [PMID: 29493721 DOI: 10.1177/0145561318097001-224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Papillary thyroid cancer often presents with cervical lymph node involvement and has a high incidence of recurrence, which requires routine follow-up with ultrasound imaging. Elastography is a novel ultrasound technique that has been demonstrated to be effective clinically in detecting tissue pathology in areas such as the liver and breast. Preliminary data suggest that it may be effective in screening tissues in the neck for malignancy, specifically cervical lymph nodes. However, diagnostic criteria and elastographic techniques vary significantly among the studies we have reviewed, which all tend to focus on populations of patients with many different types of primary malignancies. Further research is required on the feasibility of creating standardized and reproducible clinical criteria in a specific patient population. To study the clinical utility of elastography in cervical lymph nodes, patients with diagnosed papillary thyroid carcinoma may serve as an ideal population because of their need for ultrasound surveillance and the propensity of papillary thyroid cancer to metastasize to and recur in cervical lymph nodes. We will review the limitations, techniques, and reported clinical utility of elastography on cervical lymph nodes and its potential as a screening modality for papillary thyroid cancer.
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Affiliation(s)
- Robert Saadi
- Division of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, 500 University Dr., H091, Hershey, PA 17033-0850, USA
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Minkara A, Dhanda-Patil R, Patil Y. Syncope caused by a pleomorphic adenoma: Case report and literature review. EAR, NOSE & THROAT JOURNAL 2018; 97:E23-E26. [PMID: 29493727 DOI: 10.1177/0145561318097001-206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Pleomorphic adenomas are considered the most common salivary gland tumors, although they rarely occur in the parapharyngeal space. To the best of our knowledge, this is the first case report of a parapharyngeal parotid pleomorphic adenoma causing syncope. A 57-year-old man was admitted for left-sided blurred vision, left-sided weakness, dysarthria, lightheadedness, and syncope. Upon his admission, an electrocardiogram showed sinus bradycardia, and computed tomography of the neck with contrast showed a large parapharyngeal mass involving the prestyloid compartment, leading to compression of blood flow through the internal carotid artery. The mass was biopsied via intraoral fine-needle aspiration, which revealed cytology consistent with pleomorphic adenoma. The mass was resected via a transcervical approach, and a total parotidectomy was performed. The patient's hypotensive and bradycardic episodes disappeared after surgery. Surgical pathology showed a benign pleomorphic adenoma with a hemorrhagic and necrotic center and without capsular invasion or malignant transformation.
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Affiliation(s)
- Anas Minkara
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, PO Box 670528, 231 Albert Sabin Way, Cincinnati, OH 45267-0528, USA
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16
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Shield PW, Crouch SJ, Papadimos DJ, Walsh MD. Identification of metastatic papillary thyroid carcinoma in FNA specimens using thyroid peroxidase immunohistochemistry. Cytopathology 2018; 29:227-232. [PMID: 29508480 DOI: 10.1111/cyt.12531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION We evaluated immunohistochemical staining for thyroid peroxidase (TPO), a glycoprotein found in the apical plasma membrane of thyroid follicular cells, as a marker for metastatic PTC in FNA samples and compared results with thyroglobulin (Tg) and thyroid transcription factor 1 (TTF1) staining. METHODS Cell block sections prepared from 100 FNA specimens were stained with a rabbit monoclonal antibody to TPO (EP159). The FNAs included 64 metastatic malignancies from non-thyroid primary sites, including 18 lung, and 36 cases of thyroid tumours (29 PTC, six cases of medullary thyroid carcinoma and one thyroid anaplastic carcinoma). Thyroid tumours were stained with TTF1 and Tg in addition to TPO. All cases of metastatic lung carcinoma also had TTF-1 staining results. RESULTS TPO staining was negative in all non-thyroid malignancies. Ninety percent (26/29) of PTC were positive. All positive cases showed strong cytoplasmic staining, although 54% (14/26) showed positivity in less than half of the cells. By comparison, Tg staining of TPC cases was present in 62% and TTF-1 in 100%. In addition to showing higher sensitivity, interpretation of staining results with TPO was generally easier with than Tg. All metastatic lung adenocarcinomas were positive for TTF-1 and TPO negative. The six medullary cancers showed positivity in 17%, 0% and 83% with TPO, Tg and TTF-1, respectively. CONCLUSIONS TPO (mAb EP159) may be a useful addition to immunohistochemical panels for FNA specimens where metastatic PTC is a consideration, particularly in cases where metastatic lung carcinoma features in the differential diagnosis.
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Affiliation(s)
- P W Shield
- School of Biomedical Science, Queensland University of Technology, Brisbane, Qld, Australia.,Cytology Department, Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
| | - S J Crouch
- Histopathology Department, Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
| | - D J Papadimos
- School of Biomedical Science, Queensland University of Technology, Brisbane, Qld, Australia.,Histopathology Department, Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
| | - M D Walsh
- Histopathology Department, Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
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The incidence of malignancy in clinically benign cystic lesions of the lateral neck: our experience and proposed diagnostic algorithm. Eur Arch Otorhinolaryngol 2017; 275:767-773. [PMID: 29282522 DOI: 10.1007/s00405-017-4855-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 12/21/2017] [Indexed: 12/13/2022]
Abstract
AIM Solitary cystic masses of the lateral neck in an adult patient can pose a diagnostic dilemma. Malignancy must be ruled out since metastases arising from H&N cancers may mimic the presentation of benign cystic masses. Only a small number of studies have investigated the diagnostic management and malignancy rate of clinically benign solitary cervical cystic lesions. There are no established guidelines for the diagnostic evaluation. METHODS Retrospective review of the clinical, cytological, radiological, and pathological records of all adult patients (> 18 years) operated on for second branchial cleft cysts (BrCC) between 1/2008-2010/2016. Patients with apparent primary H&N malignancy, history of H&N cancer or irradiation, preoperative fine needle aspiration (FNA) of highly suggestive or confirmed malignancy, missing pertinent data, or age less than 18 years were excluded from analysis. RESULTS 28 patients were diagnosed as having BrCC. The diagnosis was based on clinical findings, FNA cytology, and typical sonographic features. The histologic analysis determined an overall rate of malignancy of 10.7% (3/28): two patients had metastatic papillary thyroid carcinoma, and one patient had metastatic tonsillar squamous cell carcinoma. Purely cystic features on pre-operative ultrasound was the only significant predictor for true BrCC on final histology (p = .02). CONCLUSIONS Occult malignancy is not rare among adult patients presenting with a solitary cystic mass of the lateral neck. A diagnostic algorithm is proposed. Further studies are needed to establish the appropriate workup and management of an adult patient presenting with a solitary cystic mass of the lateral neck.
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Aydin C, Dellal FD, Tam AA, Ogmen B, Kilicarslan A, Topaloglu O, Ersoy R, Cakir B. Comparative analysis of diagnostic adequacy rate between aspiration and nonaspiration techniques of fine-needle cytology in patients with thyroid cancer and ultrasonographically suspicious cervical lymph nodes. Diagn Cytopathol 2017; 45:889-894. [DOI: 10.1002/dc.23793] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 07/17/2017] [Accepted: 07/20/2017] [Indexed: 01/14/2023]
Affiliation(s)
- Cevdet Aydin
- Department of Endocrinology and Metabolism; Faculty of Medicine, Yildirim Beyazit University; Ankara Turkey
| | - Fatma Dilek Dellal
- Department of Endocrinology and Metabolism; Ataturk Training and Research Hospital; Ankara Turkey
| | - Abbas Ali Tam
- Department of Endocrinology and Metabolism; Faculty of Medicine, Yildirim Beyazit University; Ankara Turkey
| | - Berna Ogmen
- Department of Endocrinology and Metabolism; Ataturk Training and Research Hospital; Ankara Turkey
| | - Aydan Kilicarslan
- Department of Pathology; Faculty of Medicine, Yildirim Beyazit University; Ankara Turkey
| | - Oya Topaloglu
- Department of Endocrinology and Metabolism; Faculty of Medicine, Yildirim Beyazit University; Ankara Turkey
| | - Reyhan Ersoy
- Department of Endocrinology and Metabolism; Faculty of Medicine, Yildirim Beyazit University; Ankara Turkey
| | - Bekir Cakir
- Department of Endocrinology and Metabolism; Faculty of Medicine, Yildirim Beyazit University; Ankara Turkey
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Ting Y, Chee J, Charn TC, Loh KS, Choong CC, Ting E, Lim CM. Prognostic significance of cystic lymph nodal metastasis in nasopharyngeal carcinoma. Head Neck 2017. [PMID: 28640471 DOI: 10.1002/hed.24844] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine the prevalence of cystic lymph nodal metastasis (CLNM) and its prognostic value in patients with nasopharyngeal carcinoma (NPC). METHODS A retrospective review was conducted on 257 patients with NPC, analyzing the presence of CLNM on MRI or CT scans. Oncologic outcomes were performed using the Kaplan-Meier analysis. RESULTS One hundred eleven patients (43.2%) had CLNM at diagnosis. Overall, patients with CLNM had a poorer disease-specific survival (DSS; P < .001) and overall survival (OS; P < .001) compared with patients without CLNM. When analyzed according to nodal status, CLNM was associated with a higher rate of distant metastasis recurrence (P = .007), a poorer DSS (P < .001), and a poorer OS (P < .001) among patients with N2 disease. CONCLUSION The prevalence of CLNM was 43.2%. In patients with N2 disease, the presence of CLNM was significantly associated with a poorer DSS, OS, and increased risk of distant metastasis recurrence.
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Affiliation(s)
- Yohanes Ting
- Department of Otolaryngology - Head and Neck Surgery, National University Health System, Singapore
| | - Jeremy Chee
- Department of Otolaryngology - Head and Neck Surgery, National University Health System, Singapore
| | - Tze Choong Charn
- Department of Otolaryngology - Head and Neck Surgery, National University Health System, Singapore
| | - Kwok Seng Loh
- Department of Otolaryngology - Head and Neck Surgery, National University Health System, Singapore
| | - Chih Ching Choong
- Department of Diagnostic Radiology, National University Health System, Singapore
| | - Eric Ting
- Department of Diagnostic Radiology, National University Health System, Singapore
| | - Chwee Ming Lim
- Department of Otolaryngology - Head and Neck Surgery, National University Health System, Singapore
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Sorrenti S, Baldini E, Tartaglia F, Catania A, Arcieri S, Pironi D, Calò PG, Filippini A, Ulisse S. Nodular thyroid disease in the elderly: novel molecular approaches for the diagnosis of malignancy. Aging Clin Exp Res 2017; 29:7-13. [PMID: 27832468 DOI: 10.1007/s40520-016-0654-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/12/2016] [Indexed: 12/14/2022]
Abstract
Epithelial thyroid cancers (TC) comprise two differentiated histotypes (DTC), the papillary (PTC) and the follicular (FTC) thyroid carcinomas which, following dedifferentiation, are assumed to give rise to the poorly differentiated thyroid carcinomas and the rare, but highly aggressive and invariably fatal, anaplastic thyroid carcinomas. Although thyroid cancer mortality has not been changed, its annual incidence has increased over the last two decades, mainly because of the improved ability to diagnose malignant transformation in small non-palpable thyroid nodules. Despite DTC patients have a favorable prognosis, aggressive disease is more frequently observed in the elderly showing a higher disease-specific mortality. Of relevance is the high prevalence of nodular thyroid disease in aged patients being higher than 90%, in women older than 60 year, and 60% in men older than 80 year. This implies a careful evaluation of thyroid nodules in this group of patients in order to exclude malignancy. In fact, despite the tremendous progress in the comprehension of the underlying molecular mechanisms deregulated in DTC progression, several aspects of their clinical management remain to be solved and novel diagnostic strategies are sorely needed. Here, we will attempt to review new molecular approaches, which are currently being exploited in order to ameliorate the diagnosis of thyroid nodules.
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21
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Liu Z, Zeng W, Liu C, Wang S, Xiong Y, Guo Y, Li X, Sun S, Chen T, Maimaiti Y, Yu P, Huang T. Diagnostic accuracy of ultrasonographic features for lymph node metastasis in papillary thyroid microcarcinoma: a single-center retrospective study. World J Surg Oncol 2017; 15:32. [PMID: 28125992 PMCID: PMC5270215 DOI: 10.1186/s12957-017-1099-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 01/12/2017] [Indexed: 12/23/2022] Open
Abstract
Background Whether sonography is an appropriate imaging modality for cervical lymph nodes in patients with papillary thyroid microcarcinoma (PTMC) remains unclear. Hence, this study aimed to evaluate the diagnostic value of ultrasonography (US) features for lymph node metastasis in PTMC. Methods Seven hundred twelve patients with PTMC who underwent conventional ultrasonography examinations of the cervical lymph nodes were included. All included cases underwent total thyroidectomy plus prophylactic central lymph node dissection. The included lymph nodes were marked superficially, and the corresponding lymph nodes were completely removed and sent for pathological examination. The US features of lymph nodes with and without metastasis were compared, and the odds ratios of the suspicious US features were determined with univariate and multivariate analyses. Results Round shape, loss of an echogenic fatty hilum, cystic change, calcification, and abnormal vascularity were significantly more common in metastatic than nonmetastatic lymph nodes, whereas the boundary and echo did not significantly differ. Multivariate logistic regression analysis showed that round shape, loss of echogenic fatty hilum, cystic change, calcification, and abnormal vascularity were independent predictive factors for the assessment of metastatic lymph nodes. Round shape had the highest sensitivity of all variables, while loss of an echogenic fatty hilum had the highest specificity and accuracy. The area under the receiver operating characteristic curve, which was calculated to verify the relationship between the various US features and metastatic lymph nodes, was 0.793. Conclusions Our study found that the US features of round shape, cystic change, calcification, loss of echogenic fatty hilum, and abnormal vascularity were useful sonographic criteria for differentiating between cervical lymph nodes with and without metastasis.
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Affiliation(s)
- Zeming Liu
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Number 1277, Jiefang Road, Wuhan, Hubei Province, People's Republic of China
| | - Wen Zeng
- Department of Ophthalmology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China
| | - Chunping Liu
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Number 1277, Jiefang Road, Wuhan, Hubei Province, People's Republic of China.
| | - Shuntao Wang
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Number 1277, Jiefang Road, Wuhan, Hubei Province, People's Republic of China
| | - Yiquan Xiong
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Number 1277, Jiefang Road, Wuhan, Hubei Province, People's Republic of China
| | - Yawen Guo
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Number 1277, Jiefang Road, Wuhan, Hubei Province, People's Republic of China
| | - Xiaoyu Li
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Number 1277, Jiefang Road, Wuhan, Hubei Province, People's Republic of China
| | - Shiran Sun
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Number 1277, Jiefang Road, Wuhan, Hubei Province, People's Republic of China
| | - Tianwen Chen
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Number 1277, Jiefang Road, Wuhan, Hubei Province, People's Republic of China.,Department of Breast and Thyroid Surgery, Affiliated Nanshan Hospital, Guangdong Medical University, Shenzhen, China
| | - Yusufu Maimaiti
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Number 1277, Jiefang Road, Wuhan, Hubei Province, People's Republic of China
| | - Pan Yu
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Number 1277, Jiefang Road, Wuhan, Hubei Province, People's Republic of China
| | - Tao Huang
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Number 1277, Jiefang Road, Wuhan, Hubei Province, People's Republic of China.
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Mema E, Cho E, Ha R, Taback B. Cystic metastatic lymph nodes in malignant melanoma: a case report. Clin Imaging 2016; 42:158-160. [PMID: 28012358 DOI: 10.1016/j.clinimag.2016.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/08/2016] [Accepted: 12/13/2016] [Indexed: 11/20/2022]
Abstract
Melanoma is a rare type of skin cancer with a high mortality rate. Local invasion and metastatic spread are primarily responsible for the morbidity and mortality of melanoma. While metastatic lesions vary from cystic to solid, cystic metastases can be challenging to diagnose. Up to date, there are only a few published studies that describe cystic metastases in melanoma and other conditions such as lymphoma, squamous cell carcinoma and thyroid papillary carcinoma. We describe a case of cystic metastatic axillary lymph nodes in a patient with subungual acral lentiginous melanoma and the challenges to reaching an accurate diagnosis.
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Affiliation(s)
- Eralda Mema
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave., 10th Floor, New York, NY 10032, United States.
| | - Emma Cho
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave., 10th Floor, New York, NY 10032, United States.
| | - Richard Ha
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave., 10th Floor, New York, NY 10032, United States.
| | - Bret Taback
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave., 10th Floor, New York, NY 10032, United States.
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23
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Rosário PW, Tavares WC, Borges MAR, Santos JBN, Calsolari MR. Ultrasonographic differentiation of cervical lymph nodes in patients with papillary thyroid carcinoma after thyroidectomy and radioiodine ablation: a prospective study. Endocr Pract 2016; 20:293-8. [PMID: 24246348 DOI: 10.4158/ep13307.or] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of the present study was to validate an ultrasound (US) classification of cervical lymph nodes (LNs) in patients with papillary thyroid cancer (PTC) after thyroidectomy and radioactive iodine (131I) ablation. METHODS We performed a prospective study in which the patients were submitted to thyroidectomy and 131I ablation and then followed until neck US revealed LN(s) ≥5 mm. A total of 288 LNs from 112 patients with PTC were evaluated. Patient management was based on LN characteristics grouped according to the classification system studied here. RESULTS The presence of microcalcifications and/or cystic degeneration of cervical LNs were highly suggestive of a metastatic etiology (specificity of 99.4%). In contrast, the most sensitive finding for LNs affected by PTC was the absence of an echogenic hilum (sensitivity of 100%). In the absence of these findings (microcalcifications, cystic degeneration, echogenic hilum), a metastatic etiology was the most likely in the case of a round LN (specificity of 89%). The differentiation of a spindle-shaped LN without a visible hilum by Doppler analysis permitted us to dichotomize an initial probability of metastases of 13% in 25% (with peripheral vascularization) versus 3.3% (without peripheral vascularization). CONCLUSIONS Our results confirm that the classification proposed for cervical LNs in patients with PTC is valid for determining patient management following initial therapy.
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Affiliation(s)
- Pedro W Rosário
- Instituto de Ensino e Pesquisa da Santa Casa de Belo Horizonte
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Ying M, Cheng SCH, Ahuja AT. Diagnostic Accuracy of Computer-Aided Assessment of Intranodal Vascularity in Distinguishing Different Causes of Cervical Lymphadenopathy. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2010-2016. [PMID: 27131839 DOI: 10.1016/j.ultrasmedbio.2016.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 03/10/2016] [Accepted: 03/20/2016] [Indexed: 06/05/2023]
Abstract
Ultrasound is useful in assessing cervical lymphadenopathy. Advancement of computer science technology allows accurate and reliable assessment of medical images. The aim of the study described here was to evaluate the diagnostic accuracy of computer-aided assessment of the intranodal vascularity index (VI) in differentiating the various common causes of cervical lymphadenopathy. Power Doppler sonograms of 347 patients (155 with metastasis, 23 with lymphoma, 44 with tuberculous lymphadenitis, 125 reactive) with palpable cervical lymph nodes were reviewed. Ultrasound images of cervical nodes were evaluated, and the intranodal VI was quantified using a customized computer program. The diagnostic accuracy of using the intranodal VI to distinguish different disease groups was evaluated and compared. Metastatic and lymphomatous lymph nodes tend to be more vascular than tuberculous and reactive lymph nodes. The intranodal VI had the highest diagnostic accuracy in distinguishing metastatic and tuberculous nodes with a sensitivity of 80%, specificity of 73%, positive predictive value of 91%, negative predictive value of 51% and overall accuracy of 68% when a cutoff VI of 22% was used. Computer-aided assessment provides an objective and quantitative way to evaluate intranodal vascularity. The intranodal VI is a useful parameter in distinguishing certain causes of cervical lymphadenopathy and is particularly useful in differentiating metastatic and tuberculous lymph nodes. However, it has limited value in distinguishing lymphomatous nodes from metastatic and reactive nodes.
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Affiliation(s)
- Michael Ying
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Sammy C H Cheng
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Anil T Ahuja
- Department of Imaging and Interventional Radiology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China.
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Layfield LJ, Esebua M, Schmidt RL. Cytologic separation of branchial cleft cyst from metastatic cystic squamous cell carcinoma: A multivariate analysis of nineteen cytomorphologic features. Diagn Cytopathol 2016; 44:561-7. [PMID: 26956661 DOI: 10.1002/dc.23461] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 02/04/2016] [Accepted: 02/12/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND The separation of branchial cleft cysts from metastatic cystic squamous cell carcinomas in adults can be clinically and cytologically challenging. Diagnostic accuracy for separation is reported to be as low as 75% prompting some authors to recommend frozen section evaluation of suspected branchial cleft cysts before resection. We evaluated 19 cytologic features to determine which were useful in this distinction. METHODS Thirty-three cases (21 squamous carcinoma and 12 branchial cysts) of histologically confirmed cystic lesions of the lateral neck were graded for the presence or absence of 19 cytologic features by two cytopathologists. The cytologic features were analyzed for agreement between observers and underwent multivariate analysis for correlation with the diagnosis of carcinoma. RESULTS Interobserver agreement was greatest for increased nuclear/cytoplasmic (N/C) ratio, pyknotic nuclei, and irregular nuclear membranes. Recursive partitioning analysis showed increased N/C ratio, small clusters of cells, and irregular nuclear membranes were the best discriminators. CONCLUSION The distinction of branchial cleft cysts from cystic squamous cell carcinoma is cytologically difficult. Both digital image analysis and p16 testing have been suggested as aids in this separation, but analysis of cytologic features remains the main method for diagnosis. In an analysis of 19 cytologic features, we found that high nuclear cytoplasmic ratio, irregular nuclear membranes, and small cell clusters were most helpful in their distinction. Diagn. Cytopathol. 2016;44:561-567. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Lester J Layfield
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri
| | - Magda Esebua
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri
| | - Robert L Schmidt
- Department of Pathology and Laboratory Medicine and ARUP Laboratories, University of Utah, Salt Lake City, Utah
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Improvement in the Detection of Cystic Metastatic Papillary Thyroid Carcinoma by Measurement of Thyroglobulin in Aspirated Fluid. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8905916. [PMID: 26881230 PMCID: PMC4736329 DOI: 10.1155/2016/8905916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/16/2015] [Indexed: 01/29/2023]
Abstract
Cystic change in metastatic lymph nodes of papillary thyroid carcinoma (PTC) is a diagnostic challenge for fine needle aspiration (FNA) because of the scant cellularity. The aim of this study was to evaluate the measurement of thyroglobulin in fine needle aspirate (Tg-FNA) for detecting metastatic PTC in patients with cystic neck lesions and to validate the optimal cutoff value of Tg-FNA. A total of 75 FNA specimens of cystic lesions were identified, including 40 of metastatic PTC. Predetermined threshold levels of 0.04 (minimum detection level), 0.9, 10.0, and 77.0 ng/mL (maximum normal serum-Tg level) were used to evaluate the diagnostic accuracy of Tg-FNA for metastatic PTC detection. The areas under the receiver operating characteristic curve for diagnosing metastatic PTC of Tg-FNA values of 0.04, 0.9, 10.0, and 77.0 ng/mL were 0.5 (95% confidence interval [CI], 0.382–0.618), 0.645 (95% CI, 0.526–0.752), 0.945 (95% CI, 0.866–0.984), and 0.973 (95% CI, 0.907–0.996), respectively. With a cutoff value of 77.0 ng/mL, the combination of Tg-FNA and FNA cytology showed superior diagnostic power (97.5% sensitivity and 100% specificity) compared to FNA cytology alone (80% sensitivity and 100% specificity). We recommend a Tg-FNA cutoff of 77.0 ng/mL, the maximum normal serum-Tg level, for cystic neck lesions.
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Zhang GZ, Liu ZL, Gong JS, Cheng ZQ, Ke C. Cystic metastatic nasopharyngeal carcinoma presenting as branchial cleft cyst: report of two cases and review of the literature. J Oral Maxillofac Surg 2014; 72:2366-74. [PMID: 25172673 DOI: 10.1016/j.joms.2014.05.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/10/2014] [Accepted: 05/17/2014] [Indexed: 12/14/2022]
Abstract
PURPOSE To describe the differential diagnosis between solitary cystic metastatic carcinoma from branchial cleft cyst and provide references for clinicians to treat cystic metastases from primary sites of the head and neck region. MATERIALS AND METHODS Two cases of cystic metastatic nasopharyngeal carcinoma (NPC) are presented and a review of the relevant English literature on cystic metastasis from head and neck cancer was performed. RESULTS Two adult patients with a lateral cystic neck mass were initially clinically diagnosed as branchial cleft cysts. Based on the postoperative histopathologic examination and nasopharyngeal blind biopsy, they were finally diagnosed as cystic metastases from occult nasopharyngeal carcinoma. After a review of the literature, diagnostic strategies, histopathologic features, and therapeutic options for cervical cystic metastases were discussed. CONCLUSION Cervical cystic metastasis of NPC in adults may mimic branchial cleft cyst in clinical, radiological, and even histological features. Surgeons should bear in mind that when lateral neck cysts with characteristics of suspected malignancy are confronted, nasopharynx examination, including blind or random biopsy, is highly recommended before surgery. Metastatic disease should always be considered as a potential differential diagnosis in adult patients with a cystic neck lesion. Correct diagnosis is important so that appropriate surgical and radiotherapeutic treatment can be delivered.
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Affiliation(s)
- Guo Zhi Zhang
- Professor and Chairman, Department of Oral and Maxillofacial Surgery, Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, China.
| | - Zi Long Liu
- Resident, Department of Oral and Maxillofacial Surgery, Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, China
| | - Jing Shan Gong
- Professor and Chairman, Department of Radiology, Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, China
| | - Zhi Qiang Cheng
- Professor and Chairman, Department of Pathology, Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, China
| | - ChaoYang Ke
- Professor and Chairman, Department of Otorhinolaryngology, Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, China
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Abstract
Sonography is the modality of choice for imaging cervical lymph nodes in patients with papillary thyroid cancer, both before surgery and for postoperative surveillance. Sonography is also an invaluable tool to guide fine-needle aspiration of abnormal nodes. Microcalcifications, cystic changes, abnormal morphology, and disordered vascularity are features of metastatic nodal involvement with papillary thyroid carcinoma and should be sought during surveillance scans as well as in targeting for fine-needle aspiration.
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Crist HS, Evans JJ, Mani H, Saunders B, Fornadley J, Camacho F, Goldenberg D. Do black (dark) lymph-node metastases in papillary thyroid carcinoma suggest more advanced or aggressive disease? Thyroid 2013; 23:977-81. [PMID: 23343222 DOI: 10.1089/thy.2012.0321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND In some patients, papillary thyroid carcinoma (PTC) lymph-node metastases are noted to be black (dark) in color at the time of surgical removal. The goal of this project was to determine histological, genetic, and clinical features that are associated with regional black PTC metastasis. METHODS Fifteen patients with black PTC metastases (black-PTC) were compared to a control cohort of 15 patients with nonblack PTC metastasis (nonblack PTC). Each sample was evaluated for the histological characteristics, BRAF V600E mutational status, and associated patient clinical data. RESULTS The degree of cystic degeneration (80% vs. 27%, p=0.004), percent hemosiderin deposition (20% vs. 6%, p=0.001), and presence of classical variant (100% vs. 67%, p=0.018) were significantly greater in black PTC than nonblack PTC (α=0.05). Other results were not significantly different. CONCLUSION This study demonstrates that black compared to nonblack metastases have a greater degree of cystic degeneration and hemosiderin deposition leading to discoloration, and a trend toward an increased incidence in BRAF V600E mutations. This study is the first of its kind to describe the clinical, pathological, and genetic features associated with black PTC lymph-node metastasis.
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Affiliation(s)
- Henry S Crist
- Department of Pathology, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
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Giacomini CP, Jeffrey RB, Shin LK. Ultrasonographic Evaluation of Malignant and Normal Cervical Lymph Nodes. Semin Ultrasound CT MR 2013; 34:236-47. [DOI: 10.1053/j.sult.2013.04.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
OBJECTIVE This article reviews the imaging and histopathologic findings of various axillary diseases and suggests management guidelines for radiologists based on imaging findings with clinical correlation. CONCLUSION Although axillary diseases may reveal nonspecific imaging findings, a knowledge of the characteristic radiologic manifestations of specific diseases according to anatomic origin (nodal, accessory breast, adipocytic, fibrous, nerve, vascular, stromal, and dermal) and postsurgical lesions aids in establishing an appropriate differential diagnosis and determining whether intervention is necessary.
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Baldini E, Sorrenti S, Di Gioia C, De Vito C, Antonelli A, Gnessi L, Carbotta G, D'Armiento E, Miccoli P, De Antoni E, Ulisse S. Cervical lymph node metastases from thyroid cancer: does thyroglobulin and calcitonin measurement in fine needle aspirates improve the diagnostic value of cytology? BMC Clin Pathol 2013; 13:7. [PMID: 23421519 PMCID: PMC3583740 DOI: 10.1186/1472-6890-13-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 02/11/2013] [Indexed: 02/05/2023] Open
Abstract
Background Measurement of thyroglobulin (Tg) protein in the washout of the needle used for fine needle aspiration biopsy cytology (FNAB-C) has been shown to increase the sensitivity of FNAB-C in identifying cervical lymph node (CLN) metastasis from well-differentiated thyroid cancer (TC). In this study, we evaluated whether routine measurement of Tg protein (FNAB-Tgp), Tg mRNA (FNAB-Tgm) and calcitonin (CT) mRNA (FNAB-CTm) in the FNAB washout of CLN increases the accuracy of FNAB-C in the diagnosis of suspicious metastatic CLN. Methods In this prospective study 35 CLN from 28 patients were examined. Histology showed metastatic papillary TC (PTC) in 26 CLN, metastatic medullary TC (MTC) in 3 CLN, metastatic anaplastic TC (ATC) in 3 CLN and 3 metastatic CLN from extra-thyroidal cancers. Results The overall accuracy of FNAB-C was 84.4%, reaching 95.7% when the analysis was restricted to PTC. Both FNAB-Tgp and FNAB-Tgm compared favorably with FNAB-C and shown diagnostic performances not statistically different from that of FNAB-C. However, FNAB-Tgp and FNAB-Tgm/FNAB-CTm were found useful in cases in which cytology results were inadequate or provided diagnosis inconsistent with patient's clinical parameters. Conclusions We demonstrated that FNAB-C, Tg/CT mRNA and Tg protein determination in the fine-needle washout showed similar accuracy in the diagnosis of metastatic CLN from TC. The results of this study suggest that samples for Tg protein and Tg/CT mRNA measurements from CLN suspicious for metastatic TC should be collected, but their measurements should be restricted to cases in which FNAB-C provides uninformative or inconsistent diagnosis with respect to patient's clinical parameters.
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Affiliation(s)
- Enke Baldini
- Department of Experimental Medicine, University of Rome, Rome, Italy
| | | | - Cira Di Gioia
- Department of Radiological, Oncological and Anato-Pathological Sciences, University of Rome, Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | | | - Lucio Gnessi
- Department of Experimental Medicine, University of Rome, Rome, Italy
| | - Giovanni Carbotta
- Department of Experimental Medicine, University of Rome, Rome, Italy
| | | | - Paolo Miccoli
- Department of Surgery, University of Pisa, Pisa, Italy
| | - Enrico De Antoni
- Department of Surgical Sciences, University of Rome, Rome, Italy
| | - Salvatore Ulisse
- Department of Experimental Medicine, University of Rome, Rome, Italy.,Department of Experimental Medicine, "Sapienza", University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
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Mokhtari S. Mechanisms of cyst formation in metastatic lymph nodes of head and neck squamous cell carcinoma. Diagn Pathol 2012; 7:6. [PMID: 22248307 PMCID: PMC3283492 DOI: 10.1186/1746-1596-7-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 01/16/2012] [Indexed: 12/02/2022] Open
Abstract
Cystic change in metastatic lymph nodes occurs in certain types of tumors and mostly in squamous cell carcinoma of the head and neck. In the majority of cases, psuedocystic change is the mechanism of cyst formation. However, sometimes a true cyst cavity is formed. This occurrence is unexplained and some theories are introduced to explain it. In this paper, related articles and introduced concepts are reviewed and the best conclusions of present hypotheses are provided. Cystic SCC in cervical lymph node is now considered as a typical presentation of metastatic SCC arising in the oro/nasopharynx. True cystic cavities have eosinophilic fluid content and present active transport mechanism across the epithelium; Cytokeratin7 is also expressed in the lining of these cysts, which is an accepted marker of ductal differentiation. These are all strong evidences that show salivary gland type cells are present among tumor cells. In fact, some squamous cell carcinomas, especially those arising in Waldeyer's ring, originate from minor salivary glands. The other probability is that these tumors are cancers of transitional type and arise from transformed keratinocytes, which have intrinsic property for cyst formation. These malignant cells in lymph nodes, rather than primary sites, found the opportunity to express their parental property.
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Affiliation(s)
- Sepideh Mokhtari
- Department of Oral and Maxillofacial Pathology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Abstract
This overview is intended to give a general outline about the basics of Cytopathology. This is a field that is gaining tremendous momentum all over the world due to its speed, accuracy and cost effectiveness. This review will include a brief description about the history of cytology from its inception followed by recent developments. Discussion about the different types of specimens, whether exfoliative or aspiration will be presented with explanation of its rule as a screening and diagnostic test. A brief description of the indications, utilization, sensitivity, specificity, cost effectiveness, speed and accuracy will be carried out. The role that cytopathology plays in early detection of cancer will be emphasized. The ability to provide all types of ancillary studies necessary to make specific diagnosis that will dictate treatment protocols will be demonstrated. A brief description of the general rules of cytomorphology differentiating benign from malignant will be presented. Emphasis on communication between clinicians and pathologist will be underscored. The limitations and potential problems in the form of false positive and false negative will be briefly discussed. Few representative examples will be shown. A brief description of the different techniques in performing fine needle aspirations will be presented. General recommendation for the safest methods and hints to enhance the sensitivity of different sample procurement will be given. It is hoped that this review will benefit all practicing clinicians that may face certain diagnostic challenges requiring the use of cytological material.
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Affiliation(s)
- Mousa A. Al-Abbadi
- Department of Pathology and Cytopathology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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Rossing M, Kaczkowski B, Futoma-Kazmierczak E, Glud M, Klausen M, Faber J, Nygaard B, Kiss K, Sørensen CH, Nielsen FC, Bennedbæk FN, Friis-Hansen L. A simple procedure for routine RNA extraction and miRNA array analyses from a single thyroidin vivofine needle aspirate. Scandinavian Journal of Clinical and Laboratory Investigation 2010; 70:529-34. [PMID: 20950121 DOI: 10.3109/00365513.2010.522250] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Maria Rossing
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark.
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Pietarinen-Runtti P, Apajalahti S, Robinson S, Passador-Santos F, Leivo I, Mäkitie AA. Cystic neck lesions: clinical, radiological and differential diagnostic considerations. Acta Otolaryngol 2010; 130:300-4. [PMID: 19593684 DOI: 10.3109/00016480903127450] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS Metastatic disease should always be considered as a potential differential diagnosis in the adult patient with a cystic neck lesion. OBJECTIVES The most common cause of a cystic neck lesion in young adults is a branchial cleft cyst (BCC). In older patients metastatic lymph nodes may be easily misdiagnosed as BCC. This study aimed to investigate the incidence of unsuspected carcinoma in routinely excised cervical cysts at a tertiary care teaching hospital and to determine the characteristics of benign BCC and cystic malignancy in preoperative imaging. PATIENTS AND METHODS A total of 196 consecutive adult patients operated on with the initial diagnosis of benign lateral cervical cyst were identified and the hospital charts and imaging studies were reviewed. The mean age of the patients was 40 years (range 17-79 years). RESULTS Metastatic squamous cell carcinoma was demonstrated histologically postoperatively in six (3.1%) patients and metastatic papillary thyroid carcinoma in one (0.5%) patient. Therefore, the incidence of unsuspected carcinoma in the cystic neck lesions initially diagnosed as BCC was 3.6%. The preoperative imaging appearances of these lesions had been considered identical to that of BCC.
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Affiliation(s)
- Petra Pietarinen-Runtti
- Department of Otolaryngology - Head & Neck Surgery, Helsinki University Central Hospital, PO Box 220, FIN-00029 HUCH, Helsinki, Finland
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Diagnostic Approach for Evaluation of Lymph Node Metastasis From Thyroid Cancer Using Ultrasound and Fine-Needle Aspiration Biopsy. AJR Am J Roentgenol 2010; 194:38-43. [DOI: 10.2214/ajr.09.3128] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Diagnosis and treatment of a neck node swelling suspicious for a malignancy: an algorithmic approach. Int J Surg Oncol 2010; 2010:581540. [PMID: 22312490 PMCID: PMC3265261 DOI: 10.1155/2010/581540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 03/27/2010] [Indexed: 12/03/2022] Open
Abstract
Aim. To present an up-to-date algorithm incorporating recent advances regarding its diagnosis and treatment. Method. A Medline/Pubmed search was performed to identify relevant studies published in English from 1990 until 2008. Only clinical studies were identified and were used as basis for the diagnostic algorithm. Results. The eligible literature provided only observational evidence. The vast majority of neck nodes from occult primaries (>90%) represent SCC with a high incidence among middle aged man. Smoking and alcohol abuse are important risk factors. Asiatic and North African patients with neck node metastases are at risk of harbouring an occult nasopharyngeal carcinoma. The remainder are adenocarcinoma, undifferentiated carcinoma, melanoma, thyroid carcinoma and Merkel cell carcinoma. Fine needle aspiration cytology (FNAC) reaches sensitivity and specificity percentages of 81% and 100%, respectively and plays an important role as the second diagnostic step after routine ENT mirror and/or endoscopic examination. FDG-PET/CT has proven to be helpful in identifying occult primary carcinomas of the head and neck, especially when applied as a guiding tool prior to panendoscopy, and may induce treatment related clinical decisions in up to 60% of cases. Conclusion. Although reports on the diagnostic process offer mainly descriptive studies, current information seems sufficient to formulate a diagnostic algorithm to contribute to a more systematic diagnostic approach preventing unnecessary steps.
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Giovanella L, Ceriani L, Suriano S, Crippa S. Thyroglobulin measurement on fine-needle washout fluids: Influence of sample collection methods. Diagn Cytopathol 2009; 37:42-4. [DOI: 10.1002/dc.20964] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Thyroid Follicular Epithelial Cell-Derived Carcinomas: An Overview of the Pathology of Primary and Recurrent Disease. Otolaryngol Clin North Am 2008; 41:1079-94, vii-viii. [DOI: 10.1016/j.otc.2008.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Gülicher D, Hoffman J, Hahn U, Kröber SM, Leitner C. Cystic tumor of the jugulodigastric triangle. ACTA ACUST UNITED AC 2007; 103:446-51. [PMID: 17218124 DOI: 10.1016/j.tripleo.2006.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2006] [Revised: 09/28/2006] [Accepted: 09/28/2006] [Indexed: 11/26/2022]
Affiliation(s)
- D Gülicher
- Department of Oral and Maxillofacial Surgery, University Hospital, Tübingen, Germany.
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Sigstad E, Heilo A, Paus E, Holgersen K, Grøholt KK, Jørgensen LH, Bogsrud TV, Berner A, Bjøro T. The usefulness of detecting thyroglobulin in fine-needle aspirates from patients with neck lesions using a sensitive thyroglobulin assay. Diagn Cytopathol 2007; 35:761-7. [DOI: 10.1002/dc.20726] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Nordemar S, Tani E, Högmo A, Jangard M, Auer G, Munck-Wikland E. Image Cytometry DNA-Analysis of Fine Needle Aspiration Cytology to Aid Cytomorphology in the Distinction of Branchial Cleft Cyst from Cystic Metastasis of Squamous Cell Carcinoma: A Prospective Study. Laryngoscope 2004; 114:1997-2000. [PMID: 15510030 DOI: 10.1097/01.mlg.0000147950.35923.ba] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Frequently, the distinction between branchial cleft cyst and cystic metastases from squamous cell carcinoma is difficult by cytomorphology. In a prospective study, we investigated the need for, and the value of, image cytometry DNA-analysis as a complement to cytologic evaluation of cystic lesions in the neck. STUDY DESIGN Image cytometry DNA-analysis was performed on the fine needle aspiration cytology smears from 50 patients, referred to our department, with a solitary cystic lesion in the lateral region of the neck. METHODS Smears from aspirates were Giemsa stained and cytologically evaluated. Ahrens image analysis was used for DNA analysis on smears stained with Schiff reagent, and lymphocytes were used as control cells. Epithelial cells with DNA values exceeding 5c were regarded as aneuploid, indicating malignancy. RESULTS Nine lesions were diagnosed as squamous cell cancer metastases cytologically. DNA analysis showed aneuploidy in all of them except one. Three of these lesions had earlier been diagnosed as branchial cleft cyst at the referring hospital. Eight lesions were cytologically inconclusive and four of them were revealed as cystic metastasis at histopathologic analysis, and DNA analysis showed aneuploidy in all but one, which could not be analyzed. Two of these lesions were also diagnosed as branchial cleft cysts at the referring hospital. All benign lesions were diploid. Nine lesions were thyroid and salivary gland lesions. CONCLUSION Image cytometry DNA-analysis was shown to help in the distinction between benign and malignant cystic lesions. Thus, when conventional cytomorphology does not suffice, DNA-analysis is clearly a valuable supplement.
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Affiliation(s)
- Sushma Nordemar
- Department of Oto-Rhino-Laryngology, Karolinska University Hospital, Stockholm, Sweden.
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Cignarelli M, Ambrosi A, Marino A, Lamacchia O, Campo M, Picca G, Giorgino F. Diagnostic utility of thyroglobulin detection in fine-needle aspiration of cervical cystic metastatic lymph nodes from papillary thyroid cancer with negative cytology. Thyroid 2003; 13:1163-7. [PMID: 14751038 DOI: 10.1089/10507250360731578] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Cystic changes in metastatic cervical lymph nodes (CLN) from papillary thyroid cancer (PTC) may be a diagnostic pitfall in fine-needle aspiration biopsy (FNAB) cytology. We investigated in a series of CLN metastases from thyroid cancers (TC), including cystic PTC, and from a wide spectrum of extrathyroidal malignancies, the diagnostic role for metastatic TC of the rapid detection of thyroglobulin in eluates from FNAB (FNAB-Tg) of CLN. The study was carried out in a group of 79 subjects (22/57 M/F; median age, 56 years; range, 20-86 years) with enlarged CLN and thyroid nodules (TN), examined for potential metastatic TC, and harboring a large spectrum of incidentally diagnosed extrathyroidal malignancies (n = 24, mostly represented by lymphomas, lung, and breast cancers), CLN metastases from thyroid cancers (n = 28, including 6 cystic metastatic PTC), 6 specific lymphadenitis and 21 reactive lymphadenitis mostly detected (n = 16) during follow-up of patients with previously ablated TC. Markedly high FNAB thyroglobulin (Tg) values were found in all metastatic CLN TC. Two of the six cases with cystic metastatic CLN PTC were diagnosed by FNAB-Tg but not by cytology. In conclusion, FNAB-Tg has been confirmed as an easy modality and fast procedure to diagnose CLN metastasis from TC and high FNAB-Tg values with nondiagnostic cystic cytology strongly suggest cystic metastatic PTC.
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Affiliation(s)
- M Cignarelli
- Cattedradi Endocrinologia e Malattie Metaboliche, Università degli Studi di Foggia, Foggia, Italy.
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