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Barry E, Gilley DR, Tassone P. A case of vagal paraganglioma initially diagnosed as metastatic thyroid cancer from fine-needle aspiration. Am J Otolaryngol 2023; 44:103744. [PMID: 36628912 DOI: 10.1016/j.amjoto.2022.103744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/14/2022] [Indexed: 12/29/2022]
Affiliation(s)
- Elsie Barry
- University of Missouri School of Medicine, Degree Program, 1 Hospital Drive, Columbia, MO, USA.
| | - David R Gilley
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Patrick Tassone
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
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Uljanovs R, Sinkarevs S, Strumfs B, Vidusa L, Merkurjeva K, Strumfa I. Immunohistochemical Profile of Parathyroid Tumours: A Comprehensive Review. Int J Mol Sci 2022; 23:ijms23136981. [PMID: 35805976 PMCID: PMC9266566 DOI: 10.3390/ijms23136981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 06/16/2022] [Accepted: 06/19/2022] [Indexed: 01/27/2023] Open
Abstract
Immunohistochemistry remains an indispensable tool in diagnostic surgical pathology. In parathyroid tumours, it has four main applications: to detect (1) loss of parafibromin; (2) other manifestations of an aberrant immunophenotype hinting towards carcinoma; (3) histogenesis of a neck mass and (4) pathogenetic events, including features of tumour microenvironment and immune landscape. Parafibromin stain is mandatory to identify the new entity of parafibromin-deficient parathyroid neoplasm, defined in the WHO classification (2022). Loss of parafibromin indicates a greater probability of malignant course and should trigger the search for inherited or somatic CDC73 mutations. Aberrant immunophenotype is characterised by a set of markers that are lost (parafibromin), down-regulated (e.g., APC protein, p27 protein, calcium-sensing receptor) or up-regulated (e.g., proliferation activity by Ki-67 exceeding 5%) in parathyroid carcinoma compared to benign parathyroid disease. Aberrant immunophenotype is not the final proof of malignancy but should prompt the search for the definitive criteria for carcinoma. Histogenetic studies can be necessary for differential diagnosis between thyroid vs. parathyroid origin of cervical or intrathyroidal mass; detection of parathyroid hormone (PTH), chromogranin A, TTF-1, calcitonin or CD56 can be helpful. Finally, immunohistochemistry is useful in pathogenetic studies due to its ability to highlight both the presence and the tissue location of certain proteins. The main markers and challenges (technological variations, heterogeneity) are discussed here in the light of the current WHO classification (2022) of parathyroid tumours.
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Affiliation(s)
- Romans Uljanovs
- Department of Pathology, Riga Stradins University, LV-1007 Riga, Latvia; (R.U.); (S.S.); (B.S.); (L.V.); (K.M.)
| | - Stanislavs Sinkarevs
- Department of Pathology, Riga Stradins University, LV-1007 Riga, Latvia; (R.U.); (S.S.); (B.S.); (L.V.); (K.M.)
| | - Boriss Strumfs
- Department of Pathology, Riga Stradins University, LV-1007 Riga, Latvia; (R.U.); (S.S.); (B.S.); (L.V.); (K.M.)
- Latvian Institute of Organic Synthesis, LV-1006 Riga, Latvia
| | - Liga Vidusa
- Department of Pathology, Riga Stradins University, LV-1007 Riga, Latvia; (R.U.); (S.S.); (B.S.); (L.V.); (K.M.)
| | - Kristine Merkurjeva
- Department of Pathology, Riga Stradins University, LV-1007 Riga, Latvia; (R.U.); (S.S.); (B.S.); (L.V.); (K.M.)
| | - Ilze Strumfa
- Department of Pathology, Riga Stradins University, LV-1007 Riga, Latvia; (R.U.); (S.S.); (B.S.); (L.V.); (K.M.)
- Correspondence:
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Ha HJ, Kim EJ, Kim JS, Shin MS, Noh I, Park S, Koh JS, Lee SS. Major Clues and Pitfalls in the Differential Diagnosis of Parathyroid and Thyroid Lesions Using Fine Needle Aspiration Cytology. ACTA ACUST UNITED AC 2020; 56:medicina56110558. [PMID: 33114338 PMCID: PMC7690923 DOI: 10.3390/medicina56110558] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 01/25/2023]
Abstract
Background: It is difficult to distinguish parathyroid lesions (PLs) from thyroid lesions using fine needle aspiration cytology (FNAC) because of their proximity and their similar cytomorphological features. Methods: FNAC smears of 46 patients with pathologically proven PLs that were histologically diagnosed as parathyroid adenoma (PA, n = 35), parathyroid hyperplasia (PH, n = 3), atypical parathyroid adenoma (APA, n = 1), and parathyroid carcinoma (PC, n = 7) were retrospectively reviewed and analyzed. Results: Our initial cytological diagnoses indicated correct diagnoses in 31 of 46 PL patients (67%). The 15 erroneous diagnoses were 5 patients with non-specific benign disease (11%), 4 with nodular hyperplasia of the thyroid (9%), 5 with atypical cells (11%), and 1 with a metastatic papillary thyroid carcinoma (2%). Follicular pattern, papillary structures, colloid-like material, and macrophages, which often suggest thyroid lesions, were also present in some PLs. We found that branching capillaries along the papillary structures, stippled nuclear chromatin, and frequent occurrence of naked nuclei were useful for determining a parathyroid origin. Conclusions: It is important to be aware that PLs are frequently mistaken for thyroid lesions based on FNAC. The specific and unique characteristics of PLs identified here may be helpful in diagnosis.
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Affiliation(s)
- Hwa Jeong Ha
- Department of Pathology, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul 01812, Korea; (H.J.H.); (J.-S.K.); (M.-S.S.); (S.P.); (J.S.K.)
- Convergence Institute of Biomedical Engineering and Biomaterials, Seoul National University of Science and Technology, Seoul 01811, Korea;
| | - Eun Ju Kim
- Division of Radiation Biomedical Research, Korea Institute of Radiological & Medical Sciences, Seoul 0182, Korea;
- Radiological & Medico-Oncological Sciences, University of Science & Technology, Daejeon 34113, Korea
| | - Jung-Soon Kim
- Department of Pathology, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul 01812, Korea; (H.J.H.); (J.-S.K.); (M.-S.S.); (S.P.); (J.S.K.)
| | - Myung-Soon Shin
- Department of Pathology, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul 01812, Korea; (H.J.H.); (J.-S.K.); (M.-S.S.); (S.P.); (J.S.K.)
| | - Insup Noh
- Convergence Institute of Biomedical Engineering and Biomaterials, Seoul National University of Science and Technology, Seoul 01811, Korea;
- Department of Chemical and Biomolecular Engineering, Seoul National University of Science and Technology, Seoul 01811, Korea
| | - Sunhoo Park
- Department of Pathology, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul 01812, Korea; (H.J.H.); (J.-S.K.); (M.-S.S.); (S.P.); (J.S.K.)
| | - Jae Soo Koh
- Department of Pathology, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul 01812, Korea; (H.J.H.); (J.-S.K.); (M.-S.S.); (S.P.); (J.S.K.)
| | - Seung-Sook Lee
- Department of Pathology, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul 01812, Korea; (H.J.H.); (J.-S.K.); (M.-S.S.); (S.P.); (J.S.K.)
- Correspondence: ; Tel.: +82-2970-1268
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Kang A, Miranda A, de Boer B. Manufactured Cell Blocks: Turning Smears into Sections. Acta Cytol 2019; 63:28-34. [PMID: 30612123 DOI: 10.1159/000493907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 09/19/2018] [Indexed: 11/19/2022]
Abstract
Whilst cytological smears are still the basis of cytodiagnosis, there is an increasing role for ancillary testing. Specimens obtained are not always optimal, often with limited material for ancillary studies. Several reports have described the utility of scraping material from cytological smears to manufacture cell blocks to provide material for ancillary studies. Our objective was a retrospective review of the PathWest (QE2) experience with manufactured cell blocks (mCB) over the last 10 years. A total of 178 fine-needle aspiration cases with mCB were extracted from the PathWest database. Data were subdivided into: lymph node (89), breast (31), thyroid (23), soft tissue (13), liver (11), and other sites (11) and were analysed. All available material was reviewed. Diagnostic material was identified in 163 mCB (91.6%). Immunohistochemistry (IHC) was performed on 149 cases. Positive IHC staining was seen in 139 cases (93.3%) and advanced the diagnosis in 119 cases (79.9%). Molecular studies were performed on 38 mCB with adequate DNA obtained in 37 cases (97.3%). Our review has demonstrated that cellular material scraped from air-dried or prefixed smears can be made into cell blocks. Antigen preservation is adequate to provide diagnostically useful results with IHC whilst DNA integrity is preserved to allow molecular analysis.
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Affiliation(s)
- Alexandra Kang
- PathWest Laboratory Medicine, QE2 Medical Centre, Nedlands, Washington, Australia
| | - Alina Miranda
- PathWest Laboratory Medicine, QE2 Medical Centre, Nedlands, Washington, Australia
- School of Biomedical Sciences, Curtin University, Bentley, Washington, Australia
| | - Bastiaan de Boer
- PathWest Laboratory Medicine, QE2 Medical Centre, Nedlands, Washington, Australia,
- School of Pathology and Laboratory Medicine, UWA, Nedlands, Washington, Australia,
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Jiang K, Zhou J, Lei J, Liu Y, Li J, Su X, Li Z, Wei T, Jiang Y, Zhu J. Cell block is a valuable adjunct to conventional smear for thyroid fine needle aspiration: 2395 cases with histological correlation. Cytopathology 2018; 29:525-530. [PMID: 30238537 DOI: 10.1111/cyt.12633] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 09/03/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Ke Jiang
- Thyroid and Parathyroid Surgery Center; West China Hospital of Sichuan University; Chengdu China
| | - Junyi Zhou
- Thyroid and Parathyroid Surgery Center; West China Hospital of Sichuan University; Chengdu China
| | - Jianyong Lei
- Thyroid and Parathyroid Surgery Center; West China Hospital of Sichuan University; Chengdu China
| | - Ying Liu
- Department of Laboratory Medicine; West China Hospital of Sichuan University; Chengdu China
| | - Jinnan Li
- Department of Pathology; West China Hospital of Sichuan University; Chengdu China
| | - Xueying Su
- Department of Pathology; West China Hospital of Sichuan University; Chengdu China
| | - Zhihui Li
- Thyroid and Parathyroid Surgery Center; West China Hospital of Sichuan University; Chengdu China
| | - Tao Wei
- Thyroid and Parathyroid Surgery Center; West China Hospital of Sichuan University; Chengdu China
| | - Yong Jiang
- Department of Pathology; West China Hospital of Sichuan University; Chengdu China
| | - Jingqiang Zhu
- Thyroid and Parathyroid Surgery Center; West China Hospital of Sichuan University; Chengdu China
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Nambirajan A, Jain D. Cell blocks in cytopathology: An update. Cytopathology 2018; 29:505-524. [DOI: 10.1111/cyt.12627] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 08/17/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Aruna Nambirajan
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - Deepali Jain
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
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Abad-Licham M, Galvez-Olortegui J, Astigueta J, Díaz-Plasencia J. Diagnostic validity of fine-needle capillary cytology in palpable tumours at the Oncology Institute of Peru. Ecancermedicalscience 2018; 12:805. [PMID: 29492099 PMCID: PMC5828675 DOI: 10.3332/ecancer.2018.805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Indexed: 11/06/2022] Open
Abstract
Objective To evaluate the diagnostic validity of fine-needle capillary cytology (FNCC) in palpable tumours. Material and methods A retrospective, single-tray, cross-sectional diagnostic test study was carried out. We reviewed the cytological reports of the case files of the Cytology Unit of the Northern Regional Institute of Neoplastic Diseases (IREN) from January 2012 to December 2016. Results A total of 332 patients were selected, with an average age of 54.77 years (range 13-90 years); 61.4% of patients were female. The most frequent anatomical sites were lymph nodes (49.7%), thyroid (13.3%), breast (12.3%) and soft tissues (11.4%). Twenty-five cytologies did not have a histological correlation and six showed an atypical result. In the lymph node study, the most frequent pathology was metastatic carcinoma (49.7%), followed by lymphoma (13.3%). The FNCC had a sensitivity of 99.55%, a specificity of 98.77%, a positive predictive value of 99.55% and a negative predictive value of 98.77%. The positive likelihood ratio was 80.63%. Conclusions FNCC is a useful, safe, reliable and economical ambulatory technique with minimal complications and high diagnostic accuracy.
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Affiliation(s)
- Milagros Abad-Licham
- Graduate School, Antenor Orrego Private University, Trujillo 13007, Peru.,Pathology Department, Regional Institute of Neoplastic Diseases, Trujillo 13601, Peru.,Scientia Clinical and Epidemiological Research Institute, Trujillo 13007, Peru
| | - Jose Galvez-Olortegui
- Graduate School, Antenor Orrego Private University, Trujillo 13007, Peru.,Scientia Clinical and Epidemiological Research Institute, Trujillo 13007, Peru
| | - Juan Astigueta
- Graduate School, Antenor Orrego Private University, Trujillo 13007, Peru.,Scientia Clinical and Epidemiological Research Institute, Trujillo 13007, Peru.,Urology Department, Regional Institute of Neoplastic Diseases, Trujillo 13601, Peru
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