Colloid and pigmented histiocytes in lymph node aspirates as a clue to metastasis in patients with a history of papillary thyroid carcinoma.
cytology
fine-needle aspiration
metastasis
papillary thyroid carcinoma
Journal
Diagnostic cytopathology
ISSN: 1097-0339
Titre abrégé: Diagn Cytopathol
Pays: United States
ID NLM: 8506895
Informations de publication
Date de publication:
Jan 2024
Jan 2024
Historique:
revised:
09
09
2023
received:
01
08
2023
accepted:
27
09
2023
medline:
4
12
2023
pubmed:
12
10
2023
entrez:
12
10
2023
Statut:
ppublish
Résumé
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. 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. 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. 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.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
22-29Informations de copyright
© 2023 The Authors. Diagnostic Cytopathology published by Wiley Periodicals LLC.
Références
Adeniran AJ, Chhieng D. Cystic papillary thyroid carcinoma. In: Adeniran AJ, Chhieng D, eds. Common Diagnostic Pitfalls in Thyroid Cytopathology. Springer International Publishing; 2016:109-120.
Wunderbaldinger P, Harisinghani MG, Hahn PF, et al. Cystic lymph node metastases in papillary thyroid carcinoma. AJR Am J Roentgenol. 2002;178(3):693-697.
Bago-Rožanković P, Bašić S, Vavro H, et al. Multiple cystic brain metastases from papillary thyroid carcinoma mimicking neurocysticercosis. Int J Surg Pathol. 2013;21(4):390-393.
Pyo J-S, Jung J, Lee SG, Kim N-Y, Kang D-W. Diagnostic accuracy of fine-needle aspiration cytology and Core-needle biopsy in the assessment of the axillary lymph nodes in breast cancer-a meta-analysis. Diagnostics. 2020;10(9):717.
Mokhtari M, Kumar PV, Hayati K. Fine-needle aspiration study of cystic papillary thyroid carcinoma: rare cytological findings. J Cytol. 2016;33(3):120-124.
Vazquez Salas S, Pedro K, Balram A, et al. Head and neck cystic lesions: a cytology review of common and uncommon entities. Acta Cytol. 2022;66(5):359-370.
Gonzalez Obeso E, Murphy E, Brugge W, Deshpande V. Pseudocyst of the pancreas: the role of cytology and special stains for mucin. Cancer. 2009;117(2):101-107.
Pantanowitz L, Jing X, Lew M. Introduction. In: Lew M, Pang J, Pantanowitz L, eds. Normal Cytology: an Illustrated, Practical Guide. Springer International Publishing; 2022:1-13.
Tseng FY, Hsiao YL, Chang TC. Cytologic features of metastatic papillary thyroid carcinoma in cervical lymph nodes. Acta Cytol. 2002;46(6):1043-1048.
Ustün M, Risberg B, Davidson B, Berner A. Cystic change in metastatic lymph nodes: a common diagnostic pitfall in fine-needle aspiration cytology. Diagn Cytopathol. 2002;27(6):387-392.
Mokhtari S. Mechanisms of cyst formation in metastatic lymph nodes of head and neck squamous cell carcinoma. Diagn Pathol. 2012;7:6.
Chang Y-C, Lo W-C, Lo C-Y, Liao L-J. Occult papillary thyroid carcinoma initially presenting as cervical cystic lymph node metastasis: report of two cases. J Med Ultrasound. 2013;21(2):92-96.
Chung SR, Baek JH, Choi YJ, et al. Diagnostic algorithm for metastatic lymph nodes of differentiated thyroid carcinoma. Cancers. 2021;13(6):1338.
Dinets A, Pernemalm M, Kjellin H, et al. Differential protein expression profiles of cyst fluid from papillary thyroid carcinoma and benign thyroid lesions. PLoS One. 2015;10(5):e0126472.
Ng JKM, Li JJX. Metastatic lung carcinoma in thyroid aspirates: a case series and literature review illustrating diagnostic challenges. Cytopathology. 2022;33(6):696-706.
Li JJX, Ng JKM, Aphivatanasiri C, et al. Fine needle aspiration cytology of metastatic carcinomas with papillary architecture: a systemic assessment of clinical, cytological and immunohistochemical parameters. Cytopathology. 2022;33(3):328-343.
Khoo MLC, Asa SL, Witterick IJ, Freeman JL. Thyroid calcification and its association with thyroid carcinoma. Head Neck. 2002;24(7):651-655.
Britton PD, Provenzano E, Barter S, et al. Ultrasound guided percutaneous axillary lymph node core biopsy: how often is the sentinel lymph node being biopsied? Breast. 2009;18(1):13-16.
Sever AR, Mills P, Weeks J, et al. Preoperative needle biopsy of sentinel lymph nodes using intradermal microbubbles and contrast-enhanced ultrasound in patients with breast cancer. Am J Roentgenol. 2012;199(2):465-470.
Iwamoto N, Aruga T, Asami H, Horiguchi SI. False-negative ultrasound-guided fine-needle aspiration of axillary lymph nodes in breast cancer patients. Cytopathology. 2020;31(5):463-467.
Monaco SE. Practical approach to cytological evaluation and adequacy assessment in EBUS-TBNA. Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA): A Practical Approach. S.Karger AG; 2014.
Ng JKM, Chan JYK, Li JJX, Tang K, Yeung DCM, Chan ABW. SMARCB1 (INI1)-deficient sinonasal carcinoma with yolk sac differentiation showing co-loss of SMARCA4 immunostaining - a case report and literature review. Head Neck Pathol. 2022;16(3):934-941.