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Zhang W, Lei J, Chen J, Li W. Fine-needle aspiration diagnosis of secondary malignant tumors of the thyroid gland: A single-institution experience of 17 cases. Diagn Cytopathol 2024; 52:303-312. [PMID: 38415953 DOI: 10.1002/dc.25297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Fine-needle aspiration (FNA) is the most commonly used preoperative pathological diagnostic tool for thyroid tumors. Secondary malignant tumors of the thyroid gland account for less than 3% of all thyroid malignancies. The aim of this study was to investigate the types and cytopathological features of secondary thyroid tumors, evaluate diagnostic pitfalls in FNA. METHODS Cases of secondary thyroid tumors diagnosed in the Department of Pathology of Shaanxi Provincial People's Hospital were collected, and their clinical data, cytologic features, immunohistochemical results, and histopathological diagnoses were summarized. RESULTS The study included 17 cases (8 males and 9 females) with a mean age of 60.4 ± 9.4 years (range, 45-83 years). Six cases had a known history of primary malignancy prior to FNA aspiration diagnosis. The most common organs of origin were the lungs (5 cases, 3 adenocarcinoma, and 2 small-cell carcinoma) and esophagus (5 cases, 3 squamous-cell carcinoma, 1 adenocarcinoma, and 1 small-cell carcinoma). The next most common was squamous-cell carcinoma of the larynx (3 cases), and gastric tumor (2 cases), including 1 lymphoma and 1 adenocarcinoma. Cell blocks and immunohistochemistry were performed in 12 of these cases. Comparison of the impact of positive history and IHC availability on the accuracy of pathologic diagnosis showed that both were statistically significant. CONCLUSION FNA is an effective means of diagnosing secondary malignancies of the thyroid, in which knowledge of the patient's history of malignancy is essential, and the use of cell blocks and immunohistochemistry helps to clarify the pathological diagnosis.
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Affiliation(s)
- Wei Zhang
- Pathology Department, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Jianyuan Lei
- Pathology Department, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Jie Chen
- Pathology Department, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Wensheng Li
- Pathology Department, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
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Huang CG, Li MZ, Wang SH, Zhou TJ, Haybaeck J, Yang ZH. The diagnosis of primary thyroid lymphoma by fine-needle aspiration, cell block, and immunohistochemistry technique. Diagn Cytopathol 2020; 48:1041-1047. [PMID: 32609434 DOI: 10.1002/dc.24526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 12/12/2022]
Abstract
AIM Primary thyroid lymphoma (PTL) is a rare malignant disease. Its prognosis depends on early diagnosis. The role of fine-needle aspiration (FNA), including smear cytology, cell block (CB) techniques, and immunohistochemistry (IHC) sections in the diagnosis of PTL is still unclear. Here we reported 19 cases of PTL and literature review to evaluate the diagnostic accuracy for lymphoma by cytology. METHODS Our study retrospectively reviewed 19 patients diagnosed with PTL at the affiliated hospital of Southwest Medical University in China from June 2011 to May 2019. According to the Bethesda system for reporting thyroid cytopathology, the CB sections were evaluated for the presence of single tumor cells. IHC was performed on CB. RESULTS The diagnostic accuracy for PTL of FNA, CB with smears, and the joint application of the three methods (FNA + CB + IHC) of our study with 19 cases was 68.4% (13/19), 83.3% (15/18), and 100% (17/17), respectively. CONCLUSION The present study demonstrates that FNA has low sensitivity in diagnosing PTL, but the joint application of FNA, CB, and IHC might provide high diagnostic accuracy for lymphoma and should be applied in all cases where the clinical suspicion is high regardless of the FNA findings.
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Affiliation(s)
- Cong-Gai Huang
- Department of Pathology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Meng-Ze Li
- Department of Orthopaedics, Luzhou Traditional Chinese Medicine Hospital, Luzhou, China
| | - Shao-Hua Wang
- Department of Pathology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Tie-Jun Zhou
- Department of Pathology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Johannes Haybaeck
- Department of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Innsbruck, Austria.,Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Zhi-Hui Yang
- Department of Pathology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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Kaba S, Hirokawa M, Higuchi M, Suzuki A, Kojima M, Miyauchi A. Cytological findings for the diagnosis of primary thyroid mucosa-associated lymphoid tissue lymphoma by fine needle aspiration. Acta Cytol 2014; 59:26-36. [PMID: 25531657 DOI: 10.1159/000369443] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 10/28/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We examined cytological findings for the diagnosis of primary thyroid mucosa-associated lymphoid tissue (MALT) lymphoma by fine needle aspiration. STUDY DESIGN During the study period of 4 years, a total of 101 cases including 51 MALT lymphomas, 20 Hashimoto's thyroiditis (HT), and 30 diffuse large-cell B-cell lymphomas were cytologically examined. MALT lymphomas were divided into 44 common MALT and 7 MALT lymphomas with extreme plasmacytic differentiation (MALT-EPCD). RESULTS (1) Small- to medium-sized cells displaying irregularly shaped nuclei with prominent nucleoli (ISN-PN) were neoplastic cells. (2) In the case of a frequency of plasma cells (PC) below 15%, the accuracy rate for distinguishing common MALT from HT was 97% for ISN-PN cell frequencies above 20% in combination with the presence of lymphoepithelial lesion clusters (LELC) and mountain range-like clusters (MRLC). The frequency of large-sized cells was below 15% in common MALT. (3) In the case of a frequency of PC above 15%, cases with a sum of PC and ISN-PN cells above 30% were MALT-EPCD. (4) MRLC were cell clusters derived from regions of follicular colonization, and LELC were cell clusters from lymphoepithelial lesions of MALT lymphomas. CONCLUSION Useful cytological criteria for the diagnosis of thyroid primary MALT lymphoma, such as neoplastic cells and cell clusters, were defined.
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Affiliation(s)
- Sadayuki Kaba
- Department of Laboratory Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Japan
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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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Sakorafas GH, Kokkoris P, Farley DR. Primary thyroid lympoma. Surg Oncol 2010; 19:e124-9. [DOI: 10.1016/j.suronc.2010.06.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 06/10/2010] [Accepted: 06/12/2010] [Indexed: 01/08/2023]
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Sun TQ, Zhu XL, Wang ZY, Wang CF, Zhou XY, Ji QH, Wu Y. Characteristics and prognosis of primary thyroid non-Hodgkin's lymphoma in Chinese patients. J Surg Oncol 2010; 101:545-50. [DOI: 10.1002/jso.21543] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Reid-Nicholson M, Moreira A, Ramalingam P. Cytologic features of mixed papillary carcinoma and chronic lymphocytic leukemia/small lymphocytic lymphoma of the thyroid gland. Diagn Cytopathol 2008; 36:813-7. [PMID: 18831028 DOI: 10.1002/dc.20894] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We report a case of papillary thyroid carcinoma (PTC) and chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma of the thyroid gland. To the best of our knowledge, this is the first such case to be reported in the cytology literature. An 81-year-old male with known CLL presented for routine physical examination and was found to have a left-sided thyroid nodule. Thyroid ultrasound showed a calcified nodule. Fine-needle aspiration biopsy (FNAB) was performed and revealed PTC and an atypical lymphoid infiltrate that was suspicious for lymphoma. A partial thyroidectomy was performed and confirmed PTC with concurrent gland involvement by chronic lymphocytic leukemia/small lymphocytic lymphoma (SLL).
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Abstract
When not to perform fine needle aspiration of a thyroid nodule In summary, FNA of thyroid nodules has become one of the most useful, safe, and accurate tools in the diagnosis of thyroid pathology. Thyroid nodules that should be considered for FNA include any firm, palpable, solitary nodule or nodule associated with worrisome clinical features (rapid growth, attachment to adjacent tissues, new hoarseness, or palpable lymphadenopathy). FNA should also be performed on nodules with suspicious ultrasonographic features (microcalcifications, rounded shape, predominantly solid composition); dominant or atypical nodules in multinodular goiter; complex or recurrent cystic nodules; or any nodule associated with palpable or ultrasonographically abnormal cervical lymph nodes. Finally, FNA should be performed on any abnormal-appearing or palpable cervical lymph nodes. The management of thyroid nodules based on FNA findings is summarized in Table 2. It can be argued that in certain circumstances the results of thyroid FNA do not change the surgical management of a thyroid nodule, and thus preoperative FNA may be unnecessary. These cases include solitary nodules in patients who have a strong family history of thyroid cancer, multiple endocrine neoplasia type II, or radiation to the head and neck. These patients when they have thyroid nodules have at least a 40% risk for thyroid cancer and frequent multifocal or bilateral disease and should undergo total thyroidectomy with or without central neck lymph node dissection. Patients who have multinodular goiter and compressive symptoms, patients who have Graves disease and a thyroid nodule, or patients who have large (greater than 4 cm) or symptomatic unilateral thyroid nodules could also be considered for total thyroidectomy or lobectomy as indicated without preoperative FNA. Finally, patients who have a solitary hyperfunctioning nodule on radioiodine scan and a suppressed TSH have an extremely low incidence of malignancy and may be considered for therapeutic thyroid lobectomy or radioiodine ablation as indicated without undergoing FNA biopsy.
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Affiliation(s)
- Jennifer B Ogilvie
- Division of Surgical Oncology, Section of Endocrine Surgery, University of Pittsburgh Medical Center, 497 Scaife Hall, Pittsburgh, PA 15261-1497, USA
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Daneshbod Y, Omidvari S, Daneshbod K, Negahban S, Dehghani M. Diffuse large B cell lymphoma of thyroid as a masquerader of anaplastic carcinoma of thyroid, diagnosed by FNA: a case report. Cytojournal 2006; 3:23. [PMID: 17052355 PMCID: PMC1630693 DOI: 10.1186/1742-6413-3-23] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2006] [Accepted: 10/19/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Both thyroid lymphoma and anaplastic carcinoma of thyroid present with rapidly growing mass in eldery patients. Anaplastic carcinoma has high mortality rate and combination of surgery, radiation therapy and multidrug chemotherapy are the best chance for cure. Prognosis of thyroid lymphoma is excellent and chemotherapy for widespred lymphoms and radiotherapy with or without adjuvant chemotherapy for tumors localized to the gland, are the treatment of choice. CASE REPORT This article reports a 70 year old man presenting with diffuse neck swelling and hoarseness of few weeks duration. Fine needle aspiration was done and reported as anaplastic carcinoma of thyroid which thyroidectomy was planned. The slides were sent for second opinion. After review, with initial diagnosis of anaplastic carcinoma versus lymphoma, immunocytochemical study was performed. Smears were positive for B cell markers and negative for cytokeratin, so with the impression of diffuse large B cell lymphoma, the patient received two courses of chemotherapy by which the tumor disappeared during two weaks. CONCLUSION Despite previous reports, stating easy diagnosis of high-grade thyroid lymphoma on the grounds of cytomorphological features we like to emphasize, overlapping cytologic features of the curable high grade thyroid lymphoma form noncurable anaplastic thyroid carcinoma and usefulness of immunocytochemistry to differentiate these two disease.
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Affiliation(s)
- Yahya Daneshbod
- Department of Cytopathology, Dr. Daneshbod Pathology Laboratory, Shiraz, Iran
- Department of Hematopathology, Dr. Daneshbod Pathology Laboratory, Shiraz, Iran
| | - Shapour Omidvari
- Department of Radiation-Oncology, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Khosrow Daneshbod
- Department of Cytopathology, Dr. Daneshbod Pathology Laboratory, Shiraz, Iran
- Department of Pathology, Dr. Daneshbod Pathology Laboratory, Shiraz, Iran
| | - Shahrzad Negahban
- Department of Cytopathology, Dr. Daneshbod Pathology Laboratory, Shiraz, Iran
- Department of Pathology, Dr. Daneshbod Pathology Laboratory, Shiraz, Iran
| | - Mehdi Dehghani
- Department of Hematology-Oncology, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Gupta N, Nijhawan R, Srinivasan R, Rajwanshi A, Dutta P, Bhansaliy A, Sharma SC. Fine needle aspiration cytology of primary thyroid lymphoma: a report of ten cases. Cytojournal 2005; 2:21. [PMID: 16336672 PMCID: PMC1325037 DOI: 10.1186/1742-6413-2-21] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2005] [Accepted: 12/09/2005] [Indexed: 11/26/2022] Open
Abstract
Primary lymphoma is an uncommon malignancy of the thyroid, comprising of 0.6 to 5 per cent of thyroid cancers in most series. Primary thyroid lymphomas (PTL) occur most commonly in elderly women and are commonly of B- cell origin. These frequently present in clinical stage IE and IIE. We report here ten cases of PTL diagnosed over a period of about 7 years in our institute. Out of these ten cases, nine were diagnosed on fine needle aspiration cytology (FNAC) and one case was misdiagnosed as lymphocytic thyroiditis. This case was diagnosed as Non- Hodgkin's lymphoma on surgical specimen. Five patients are disease free and doing well, while two died of disease and the other two were lost to follow-up. One patient is currently on chemotherapy. The salient clinical, biochemical, radiological features, FNA findings along with diagnostic difficulties are discussed.
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Affiliation(s)
- Nalini Gupta
- Department of Cytopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Raje Nijhawan
- Department of Cytopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Radhika Srinivasan
- Department of Cytopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Arvind Rajwanshi
- Department of Cytopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Pinaki Dutta
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Anil Bhansaliy
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - SC Sharma
- Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
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Vélayoudom FL, Cardot-Bauters C, Decouvelaere AV, Vlaeminck V, Bauters F, Wémeau JL. Non Hodgkin's lymphoma involving the adrenal glands and the central nervous system (CNS): a particular evolution after chemotherapy. ANNALES D'ENDOCRINOLOGIE 2005; 66:527-31. [PMID: 16357815 DOI: 10.1016/s0003-4266(05)82113-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Adrenal lymphoma is extremely rare. The prognostic depends on involvement of other organs (such as the central nervous system) responsible for lower median survival. We report the case of a 51-year-old man with non Hodgkin's Diffuse Large B Cell Lymphoma (DLBCL) involving the central nervous system (CNS) and the adrenal glands simultaneously. The endocrine exploration revealed a partial adrenal insufficiency and ruled out a pheochromocytoma. Computerized tomographic (CT) scan directed needle biopsy of the adrenal gland allowed the diagnostic of non-Hodgkin lymphoma (NHL). CNS biopsies showed similar histopathologic lesions. After aggressive polychemotherapy and methotrexate intrathecal injection, a dissociated therapeutic response was observed with a decrease of the cerebral lesion and an increase of the adrenal mass. This result may be explained by the efficacy of corticosteroid therapy on cerebral edema. The prognosis was poor with tumor infiltration of the leptomeninges and death 16 months after diagnosis.
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Affiliation(s)
- F-L Vélayoudom
- Department of Endocrinology, Marc Linquette Clinic, 6, rue du Pr. Laguesse, CHRU de Lille, 59037 Lille
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Berbano RR, Young I, Petrov E, Cook W, Moussouris HF. Non-Hodgkin's lymphoma of the thyroid gland occurring after treated Hodgkin's lymphoma. Endocr Pract 2004; 3:302-4. [PMID: 15251786 DOI: 10.4158/ep.3.5.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To present a case report of the occurrence of non-Hodgkin's lymphoma in the thyroid gland of a patient who had previously undergone successful treatment of Hodgkin's lymphoma. METHODS We describe pertinent historical features and current symptoms and laboratory findings in a 62-year-old man who had had successful treatment of Hodgkin's lymphoma 10 years previously and had been free of disease for a decade. We also review the related medical literature on the course of patients after therapy for Hodgkin's lymphoma. RESULTS Because of a progressively enlarging anterior neck mass, hoarseness, and difficulty with breathing, a patient sought medical attention. Ten years previously, he had undergone irradiation and splenectomy for treatment of Hodgkin's lymphoma. In the current assessment, fine-needle aspiration and open biopsy yielded the diagnosis of non-Hodgkin's lymphoma, for which the patient received irradiation and chemotherapy. Review of the literature pertaining to diseases after treated Hodgkin's lymphoma, including second cancers, failed to identify any such prior reported case. CONCLUSION Because the clinical profile of our patient was consistent with primary non-Hodgkin's lymphoma of the thyroid gland developing after radiation-treated Hodgkin's lymphoma, we conclude that this represents the first such reported example.
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Affiliation(s)
- R R Berbano
- Department of Medicine, Section of Endocrinology, St. Vincent's Hospital, and Medical Center, New York, New York 10011, USA
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Abstract
OBJECTIVE To present a review of the traditional and more recent techniques and applications of thyroid fine-needle aspiration biopsy. METHODS We describe the cytologic features and differential diagnoses of various thyroid lesions, outline recommendations for diagnostic categories, and discuss new techniques that have shown some promise in the diagnosis of thyroid nodule fine-needle aspiration specimens. RESULTS Fine-needle aspiration biopsy of the thyroid has proved to be an excellent diagnostic tool in the initial management of thyroid nodules. Numerous studies have shown its high sensitivity and specificity in diagnosing malignant tumors of the thyroid, especially papillary thyroid carcinoma. As with other diagnostic tests, however, its effectiveness is highly dependent on the expertise of the operator performing the procedure and the adequacy of the specimen for interpretation of the cytomorphologic features. On-site evaluation of thyroid specimens promotes adequate specimen sampling and reduces the incidence of nondiagnostic specimens. Diagnostic reports on thyroid fine-needle aspiration should include patient demographics and pertinent clinical history, site and size of the thyroid nodule, mode of aspiration, number of needle passes, assessment of specimen adequacy, diagnosis, and recommendations. Although immunohistochemical and molecular markers have received considerable attention recently, additional studies are needed before they can be used to separate benign from malignant follicular thyroid lesions. CONCLUSION Overall, fine-needle aspiration biopsy of thyroid nodules has proved to be sensitive, specific, and well accepted by patients because of minimal discomfort and complications.
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Affiliation(s)
- Zubair W Baloch
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 19103, USA
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Sangalli G, Serio G, Zampatti C, Lomuscio G, Colombo L. Fine needle aspiration cytology of primary lymphoma of the thyroid: a report of 17 cases. Cytopathology 2001; 12:257-63. [PMID: 11488875 DOI: 10.1046/j.1365-2303.2001.00338.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Between 1980 and 1998, 4272 thyroid surgical specimens with a preoperative fine needle aspirate were sent to our Anatomical Pathology Department. Among these cases there were 17 primary thyroid lymphomas, which constituted 0.3% of all the thyroid lesions and 2.3% of the thyroid malignancies. Seven cases were diffuse large B-cell (DLBC) lymphomas and 10 were MALT lymphomas. Of the DLBC lymphomas six were correctly diagnosed by fine needle aspiration cytology (FNAC) and one was diagnosed as positive for malignancy, and among MALT lymphomas four were diagnosed as lymphoma, four as suspicious for lymphoma, and three as Hashimoto's thyroiditis (HT). Our data indicate that the diagnosis of primary thyroid lymphoma of high grade is easy, and immunocytochemistry (ICC) can confirm suspicious cases. The diagnosis of MALT lymphoma is more difficult; ICC can confirm suspicious cases, and false-negative results seem to be caused by sampling error, because HT usually coexists with MALT lymphoma.
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Affiliation(s)
- G Sangalli
- Department of Anatomical Pathology, Hospital of Busto Arsizio, Piazzale Solaro 3, 21052 Busto Arsizio, Italy
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15
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Abstract
The fine needle aspiration (FNA) cytologic diagnosis of non-Hodgkin's lymphoma (NHL) depends upon finding a relatively monotonous population of lymphoid cells in smears. Lymphomas have successfully been classified by FNA cytology following the prevalent histologic classifications. The success rate of FNA cytology ranges from 80%-90% in diagnosis of NHL and from 67.5%-86% in its subtyping. The cytodiagnosis of Hodgkin's disease (HD) depends upon demonstration of Reed-Sternberg cells or Hodgkin's cells amongst appropriate reactive cell components. The diagnostic accuracy of FNA cytology for HD has also been invariably high (>85%). Yet, the role of cytology in primary diagnosis, subclassification and management of patients with lymphoma remains controversial. The differential diagnostic problems for NHL include a group of small round cell tumors, nonlymphoid acute leukemias and HD. Reservations have been expressed regarding the efficacy of cytology in separating florid reactive hyperplasia from low-grade malignant lymphoma. The reported cytodiagnostic accuracy for follicular lymphomas and nodular sclerosis type of HD is less compared to other subtypes of NHL and HD respectively since nodular pattern and sclerosis are strict histologic criteria which can not be appreciated in cytologic preparations. Entities like atypical lymphoproliferative disorders, peripheral T-cell lymphomas and Ki-1 positive anaplastic large cell lymphomas pose diagnostic challenges to cytologists. Despite these limitations, FNA cytology remains the first line of investigations (screening test) used in cases of lymphadenopathy. Besides initial diagnosis of lymphoma, it helps in detection of residual disease, recurrences and progression of low-grade to high-grade lymphoma, and helps in staging the disease. Availability of prior FNA cytology report facilitates the histologic diagnosis and classification of NHL. Various special ancillary techniques are now being performed on lymph node aspirates to diagnose lymphoma versus other malignancies, and to decide the functional character of lymphomas and their clonal nature. Diagn. Cytopathol. 1999;21:240-249.
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Affiliation(s)
- D K Das
- Institute of Cytology and Preventive Oncology, Maulana Azad Medical College Campus, New Delhi, India
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Abstract
BACKGROUND The routine use of immunocytochemical analysis has led to the recognition that many thyroid neoplasms previously diagnosed as anaplastic or small cell carcinomas are actually lymphomas of the thyroid. The great majority are B-cell lymphomas which can be associated with Hashimoto's thyroiditis. In spite of this, thyroid lymphomas are still not commonly recognized as a significant part of thyroid differential diagnosis. METHODS A rare case of a primary T-cell lymphoma of the thyroid gland is presented along with general clinical history and physical findings which should make the practitioner suspicious of a thyroid lymphoma. The usefulness of radiology scans and fine-needle aspiration are discussed. RESULTS Both prognosis and treatment options are very different for thyroid lymphomas and anaplastic carcinoma. CONCLUSIONS Cyclophosphamide/adriamycin/vincristine/prednisolone chemotherapy/radiotherapy regimens have proven to be very effective for most thyroid lymphomas.
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Affiliation(s)
- M D Coltrera
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle 98195, USA
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17
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Eldar S, Sabo E, Cohen A, Misselevich I, Cohen O, Kelner J, Mor C, Shvero J, Feinmesser R, Shibi J, Shabtai M, Bejar J, Boss JH. Computer-assisted image analysis of small cell lymphoma of the thyroid gland. Comparison of nuclear parameters of small lymphocytes in lymphomas and Hashimoto's thyroiditis. Comput Med Imaging Graph 1998; 22:479-88. [PMID: 10098895 DOI: 10.1016/s0895-6111(98)00056-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The nuclear parameters of the small lymphocytes in nine cases of small cell lymphomas of the thyroid gland and 17 cases of Hashimoto's thyroiditis were assessed by computer-assisted image analysis. The nuclear area, maximal, minimal and averaged Ferret diameters, perimeter, regularity factor and elongation factor were gauged. Statistically, the nuclear area was ascertained to be the optimum descriptor discriminating between small neoplastic and reactive lymphocytes. Application of a novel variable, combining a nuclear area cut-off value of 14 microm2 with a nuclear averaged Ferret diameter cut-off value of 4.5 micron, allows for the distinction - with a high degree of sensitivity and specificity - between small neoplastic lymphocytes in thyroidal lymphomas and the reactive lymphocytes in Hashimoto's thyroiditis.
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Affiliation(s)
- S Eldar
- Department of Surgery, Bnai-Zion Medical Center and Technion Israel Institute of Technology, Haifa
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Abstract
The assessment of lymphoproliferative disorders using fine-needle aspiration (FNA) cytology may be problematic particularly when organs other than lymph node are involved. In this report we have reviewed 26 consecutive FNA specimens from superficial extranodal sites which were reported as diagnostic or suggestive of malignant lymphoma. The aspirates were obtained from skin or subcutaneous tissue (ten cases), thyroid (five cases), salivary gland (five cases), breast (four cases), neck, and pharynx (one case each). Ancillary studies including immunocytochemistry, in situ hybridisation to detect immunoglobulin light chain mRNA expression, and polymerase chain reaction for analysis of immunoglobulin heavy chain gene rearrangement were performed in 20, 12, and 7 cases, respectively. Clinicopathologic correlation confirmed the diagnosis of lymphoma in 25/26 aspirates. Nine of the 14 patients whose initial presentation was with an extranodal mass were considered to have primary lymphomas of mucosa-associated lymphoid tissue (MALT) type. In contrast, ten of 11 patients with recurrent extranodal disease had primary nodal type lymphomas. There was one false-positive diagnosis, a neck mass misinterpreted cytologically as B-cell lymphoma which was ultimately shown to be a branchial cyst. FNA cytology supported by appropriate ancillary investigations provides accurate diagnosis in most cases of extranodal lymphoma.
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Affiliation(s)
- C J Stewart
- Department of Pathology, Glasgow Royal Infirmary, Scotland, United Kingdom
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