Another pitfall encountered with cystic thyroid nodules are the atypical cyst-lining cells[24]. Hematoxylin-eosinstained section of the bone core biopsy (100). PU Sparsely cellular specimens: Sample w/ not many cells in suspension can be made more conc'd by Cytospin or centrifugation preparation: 1mL properly prepared cell suspension in funnel of cytospin, centrifuge, cells will be deposited on slide & fluid absorbed by filter paper: Problem: bloody specimens: However, in almost 25%-30% of cases, MTC is inherited, and is associated with one of three familial syndromes: Multiple endocrine neoplasia (MEN) syndrome type 2A (Sipples syndrome), MEN type 2B (mucosa neuroma syndrome or Gorlins syndrome), and familial MTC[35]. A moderately or even highly cellular specimen by itself (without significant nuclear or architectural atypia) does not qualify a nodule for an AUS interpretation. Q: Can your pathologist give you a preliminary assessment of the aspirate smear or flow cytometry analysis on the same day as a procedure if it was performed early in the morning? Since this is a liquid sample, it does not need to undergo decalcification, can be smeared onto a slide and stained relatively quickly, used for flow cytometry (which needs unfixed, liquid cells), and sent fresh for molecular analysis. Jan 2018 - Present5 years 4 months. Furthermore, spermatid development is likely supported by planar cell polarity (PCP) proteins since polarized spermatids are aligned across the plane of seminiferous epithelium in an orderly fashion, analogous to hair cells in the cochlea of the inner ear. See: http://creativecommons.org/licenses/by-nc/4.0/, P- Reviewer: Eilers SG, Li XL S- Editor: Qiu S L- Editor: A E- Editor: Liu SQ, National Library of Medicine The use of molecular markers can further increase the diagnostic value of FNA samples for the detection of thyroid cancer. Ohori NP, Singhal R, Nikiforova MN, Yip L, Schoedel KE, Coyne C, McCoy KL, LeBeau SO, Hodak SP, Carty SE, et al. Histologic trends in thyroid cancer 1969-1993: a clinico-pathologic analysis of the relative proportion of anaplastic carcinoma of the thyroid. After these initial assessments, immunostains often aim to assess architecture, fibrosis, lymphoid aggregates, myeloid lineage maturity, and other related potential pathologies. Logani The Bethesda System For Reporting Thyroid Cytopathology. PK There were several subsequent drafts and online discussion periods (August 15 to September 30, 2007, and November 30 to December 15, 2007). TBSRTC provides a uniform 6-tier system on thyroid FNA for pathologists to communicate with clinicians. Moreover, a lower percentage of cases in the European system was placed into the TIR 4 and TIR 5 categories as well, compared with the American system. Intussusception in an adult revealing a Vanek's tumor: A case report. The general category malignant is used whenever the cytomorphologic features are conclusive for malignancy. M The documents underwent revision after each comment period before reposting on the Web. This PTC variant is a circumscribed thyroid tumor with papillary architecture and lymphoid follicles that mimics a Warthin tumor of the parotid gland. Each of these four specimens have their strengths and limitations; therefore, they should be assessed separately. Vimentin immunoexpression is also a common finding[52]. Picture of four bone marrow specimens in a slide tray. Diagnostic challenges in fine-needle aspiration and surgical pathology specimens. This category applies to specimens that are unsatisfactory owing to obscuring blood, overly thick smears, air drying of alcohol-fixed smears, or an inadequate number of follicular cells. Description of a distinctive morphological variant and report of 7 cases. Thus, the maximal number of spermatids can be packed and supported by a fixed population . The morphologic findings are very similar to that of the aspirate smear, with the caveat that it only represents the cells that slough off. The specimen is fixed in paraffin and cut for slide preparation. moc.oohay@sokaisime. Cytologic preparations typically have high cellularity, and colloid is scant or absent. L PDF Quality Assurance in Cytopathology and Histopathology of the Thyroid Neutrophils are the same as WBCs, and as you know, it is normal to gave some WBCs in the urine. The separation of these four components allows for multiple sources of data collection and offers insurance against otherwise compromised specimens. This category includes specimens with unequivocal cytologic evidence of a malignant neoplasm. In some cases psammoma bodies may be present[35,44]. Descriptive comments that follow are used to subclassify the benign interpretation. For example, increased serum calcitonin levels and/or strong immunoresponce of chromogranin which is disclosed after multiple FNA tests can indicate the diagnosis of a medullary carcinoma. Follicular cells arranged in a flat sheet, colloid and pigment-laden macrophages ( 40 pap stain on ThinPrep slide) (diagnostic categories II). Such changes may represent atypical but benign cyst lining cells, but a papillary carcinoma cannot be entirely excluded (ThinPrep, Papanicolaou stain). of value in acquiring a cellular sample, possibly due to increasing hemodilution. Each diagnostic category is associated with a specific risk of malignancy and a recommendation for management. In addition, obtaining adequate material at FNA is a very important issue, as the rates of malignancy observed in the nondiagnostic categories of both reporting systems are very high[14]. Logrono Piana S, Frasoldati A, Ferrari M, Valcavi R, Froio E, Barbieri V, Pedroni C, Gardini G. Is a five-category reporting scheme for thyroid fine needle aspiration cytology accurate? As such, if a dry tap is encountered during a bone marrow procedure, it may be beneficial to obtain two bone core biopsies to send to the laboratory. KH (B) A case diagnosed as DC IV (suspicious for a follicular neoplasm) shows moderately cellular specimen with abundant microfollicles (x15; scale bar, 200 m) (C-F) Architectural alterations such as microfollicles (C and D), 3-dimensional branching (E), and architectural crowding (F) are frequently observed in cases categorized as DC IV The high sensitivity rate, as well as the high negative prognostic value of BRAF testing in AUS/FLUS and SFN/SFN categories have been also demonstrated by Alexander et al[57]. . van Hoeven These indeterminate results imply surgeons to consider alternative therapies (e.g., thyroid lobectomy with intraoperative frozen section). Tumor cells with distinct granules with eccentric nuclei. A syringe with applied negative pressure gently removes approximately 5 mL of deep red, semi-liquid marrow content. Map ; Apps; Tools . Loose cellular material can be held together to make into a cell block in all of the following EXCEPT a. agar b. albumin c. blood clot d. resin resin A slide of breast fluid has the cells washing off during staining. Dr Love Will you tell me what sparsely cellular specimen And There are three main methods of sample preparation; smears, liquid-based preparations, and cell block--these preparation methods may be used singly or in . FNA is diagnostic of many thyroid conditions (eg, papillary carcinoma, lymphocytic thyroiditis), but, with regard to follicular carcinoma, it is better considered a screening test. We also evaluated aspects of specimen quality that differed according to the use of ROSE. If no aspirate is collected, then an extra core biopsy specimen can be agitated to release cells for flow cytometry; however, this is not ideal. It allows classification of nodules as benign or malignant, and patients with malignant nodules are scheduled for surgery. First Time Setup Tested phones Android App Settings Estimated Band FAQ Translate . How does one separate cellular follicular lesions of the thyroid by fine-needle aspiration biopsy? Warthin's tumor : the presence of oncocytic epithelium. The presence of true psammoma bodies with concentric laminations is highly suggestive of PTC; however the presence of psammoma bodies in cystic thyroid lesions is not diagnostic. Without individual cells to analyze through flow cytometric methods, the clot section is limited to only tissue-type immunostaining. We reviewed the English literature regarding Thyroid Cytopathology systems in order to identify the most suitable methodology, taking into account our prospective as well. The malignancy rate of the AUS/FLUS category is estimated to be between 5% and 15%[10], which is intermediate between that of the benign category (0%-3%) and that of the SFN category (15%-30%). Cibas V The most common malignant diagnosis made after surgery in cases initially classified as AUS/FLUS is PTC, usually of the follicular variant (PTC-FV)[24,25]. Verizon (United States of America)Cell Tower Map - CellMapper LiVolsi In conclusion, patients who require repeated FNAs for indeterminate diagnoses will be resolved by repeat FNA in a percentage of 72%-80%. Baloch ZW, LiVolsi VA. Fine-needle aspiration of the thyroid: today and tomorrow. Preoperative diagnostic categories of fine needle aspiration - PLOS Frontiers | A Whole-Brain Cell-Type-Specific Sparse Neuron Labeling Atypia of Undetermined Significance/Follicular Lesion of - Springer Cantara S, Capezzone M, Marchisotta S, Capuano S, Busonero G, Toti P, Di Santo A, Caruso G, Carli AF, Brilli L, et al. Any specimen that contains abundant colloid is adequate (and benign), even if 6 groups of follicular cells are not identified; a sparsely cellular specimen with abundant colloid is, by implication, a predominantly macrofollicular nodule and therefore almost certainly benign. et al. Almost simultaneously, in Europe, the British Thyroid Association-Royal College of Physicians and the Italian Society for Anatomic Pathology and Cytopathology-International Academy of Pathology (SIAPEC-IAP) thyroid reporting systems, each comprised of 5 diagnostic classes, have been introduced[10,11]. In this review we analyze current literature regarding Thyroid Cytopathology Reporting systems trying to identify the most suitable and practical methodology to use in everyday clinical practice. Preparations for the conference began 18 months earlier with the designation of a steering committee, coordination with cosponsoring organizations, and the establishment of a dedicated, permanent Web site. In a study by Teixeira et al[29] the overall incidence of malignancy in the FNA-biopsied nodules characterized as FLUS was 16.2%, a higher value than the suggested 5% to 15%[10,29-31]. The sample is composed of numerous monomorphic lymphoid cells. It generally affects elderly patients presenting as a firm mass rapidly growing in the neck infiltrating extrathyroidal tissues, such as muscle, trachea, esophagus, skin, bone and cartilage[49]. Inadequate cellularity is defined as the presence of less than 6 groups of well-preserved follicular cells on each of at least two slides; (2) DC II Benign (Figure (Figure1).1). Aldinger KA, Samaan NA, Ibanez M, Hill CS. Utilization of ancillary studies in thyroid fine needle aspirates: a synopsis of the National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference. The Bethesda System for Reporting Thyroid Cytopathology is the most preferred system for the diagnosis of FNA specimens, which also contains guidelines for the diagnosis and treatment of indeterminate cases. Last but not least, repeated FNAs will lead to a diagnosis in 72%-80% of indeterminate cases where repeated FNAs were needed. HHS Vulnerability Disclosure, Help EK J MTC was first described by Horn et al[45] in 1951, and it was first recognized as a unique clinicopathological entity by Hazard et al[46], in 1959. For some of the general categories, some degree of sub-categorization can be informative and is often appropriate; recommended terminology is shown in Table 1. RT The reason is that in approximately 10%-30% of cases, cytology is indeterminate and nondiagnostic[4]. Moses et al[60] also examined the clinical utility of the above panel in thyroid FNA biopsies. et al. Impact of mutational testing on the diagnosis and management of patients with cytologically indeterminate thyroid nodules: a prospective analysis of 1056 FNA samples. These include hypocellular smears with extensive cystic degeneration with rare follicular cells with nuclear atypia indicative of PTC. The management of each case derives from the category that is classified. Gross specimen was measuring about 2x2x1.5 cm in size, soft in consistency, brownish black in color and roughly oval in shape [Table/Fig-4]. The general category FN/SFN is a self-sufficient interpretation; narrative comments that follow are optional. RT The four components of a routine bone marrow analysis. Moses W, Weng J, Sansano I, Peng M, Khanafshar E, Ljung BM, Duh QY, Clark OH, Kebebew E. Molecular testing for somatic mutations improves the accuracy of thyroid fine-needle aspiration biopsy. Bongiovanni M, Krane JF, Cibas ES, Faquin WC. The project participants hope that the adoption of this flexible framework will facilitate communication among cytopathologists, endocrinologists, surgeons, radiologists, and other health care providers; facilitate cytologic-histologic correlation for thyroid diseases; facilitate research into the epidemiology, molecular biology, pathology, and diagnosis of thyroid diseases; and allow easy and reliable sharing of data from different laboratories for national and international collaborative studies. Marchevsky AM, Walts AE, Bose S, Gupta R, Fan X, Frishberg D, Scharre K, Zhai J. Evidence-based evaluation of the risks of malignancy predicted by thyroid fine-needle aspiration biopsies. Papillary thyroid carcinoma. endstream endobj startxref gynecologic cytology specimens 3. Layfield Lerma E, Arguelles R, Rigla M, Otal C, Cubero JM, Bagu S, Carreras AM, Eulalia E, Gonzalez-Campora R, Galera H, et al. Describing methods to: i. Due to the decalcification and need for fixation, bone core biopsy slides are usually not available to review until the following day. The thyroid nodules are aspirated 3 to 5 times with a 22-gauge or 25-gauge needle. Correspondence to: Evangelos P Misiakos, MD, FACS, Associate Professor of Surgery, Attikon University Hospital, University of Athens School of Medicine, 76 Aigeou Pelagous Street, Agia Paraskevi, 15 341, Attica, 12462 Athens, Greece. Another diagnostic option for patients with repeat ultrasonography-guided FNA of thyroid nodule with non-diagnostic cytology results, would be the utilization of ultrasonography-guided core needle biopsy[39]. In 1966 Williams demonstrated that this tumor derives from the parafollicular cells, known also as calcitonin-producing C cells, which have an ectodermal neural crest origin[47]. and transmitted securely. Such changes may represent atypical but benign cyst-lining cells, but a papillary carcinoma cannot be entirely excluded (ThinPrep, Papanicolaou stain). If resected, virtually all benign follicular nodules turn out to be nodules of a multinodular goiter or follicular adenomas. The nuclear chromatin appears as salt and pepper type in a medullary carcinoma case ( 40 pap stain on ThinPrep slide) (diagnostic categories VI). b=D`.+u{tZ>aSW}\b_ ^/:'!!TQf1H7y` fY0Xa8 Rosen Goellner French Agarwal A, Kocjan G. FNAC thyroid reporting categories: value of using the British Thyroid Association (Thy 1 to Thy 5) thyroid FNAC reporting guidelines. B) 600 view of trilineage hematopoiesis. ZW Hamberger Royal College of Physicians. However, there are cases with diagnostic uncertainty due to suboptimal sampling or preservation, and overlapping cytomorphologic features with other thyroid conditions. Grant For clarity of communication, TBSRTC recommends that each report begin with 1 of 6 general diagnostic categories. Go to: . A: Probably, yes. Filie AC, Asa SL, Geisinger KR, Logani S, Merino M, Nikiforov YE, Clark DP. The NCI conference participants acknowledged the importance of developing a uniform terminology for reporting thyroid FNA results. A uniform reporting system for thyroid FNA will facilitate effective communication among cytopathologists, endocrinologists, surgeons, radiologists, and other health care providers; facilitate cytologic-histologic correlation for thyroid diseases; facilitate research into the epidemiology, molecular biology, pathology, and diagnosis of thyroid diseases, particularly neoplasia; and allow easy and reliable sharing of data from different laboratories for national and international collaborative studies. Yang J, Schnadig V, Logrono R, Wasserman PG. Fleisher Dottorini Enlarged follicular cells arranged in monolayer sheets and follicular groups with nuclear elongation and chromatin clearing in a follicular variant of PTC case ( 40 pap stain on ThinPrep slide) (diagnostic categories VI). The remaining 10% of cases represent a significant subset of thyroid specimens with some form of AUS/FLUS. Chemotherapy or radiotherapy usually cannot change the dismal prognosis of this cancer. This document summarizes several years of work, begun as a Web-based discussion, followed by a live conference, and culminating in the production of a print and online atlas. Q: Can flow cytometry be performed on the core biopsy? This is particularly true of the follicular variant of PTC, which can be difficult to distinguish from a benign follicular nodule.28 Other PTCs may be incompletely sampled and yield only a small number of abnormal cells.29 If only 1 or 2 characteristic features of PTC are present, if they are only focal and not widespread throughout the follicular cell population, or if the sample is sparsely cellular, a malignant diagnosis cannot be made with certainty. Search for other works by this author on: Fine-needle aspiration biopsy of thyroid nodules: impact on thyroid practice and cost of care, Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation, The Bethesda System for Reporting Thyroid Cytopathology, Diagnostic terminology and morphologic criteria for cytologic diagnosis of thyroid lesions: a synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference, The: National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference: a summation, Fine-needle aspiration cytology of the thyroid, 1980 to 1986, Long-term follow-up of patients with benign thyroid fine-needle aspiration cytologic diagnoses, Usefulness of fine-needle aspiration in the diagnosis of thyroid carcinoma: a retrospective study in 37,895 patients, Accuracy of thyroid fine-needle aspiration using receiver operator characteristic curves, Fine-needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations, Accuracy of fine-needle aspiration of thyroid: a review of 6226 cases and correlation with surgical or clinical outcome, Fine-needle aspiration cytology of the thyroid: a 12-year experience with 11,000 biopsies, Non-diagnostic fine-needle aspiration biopsy: a dilemma in management of nodular thyroid disease, Value of repeat fine needle aspiration (FNA) of the thyroid [abstract], Post thyroid FNA testing and treatment options: a synopsis of the National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference, Atypical cells in fine-needle aspiration biopsy specimens of benign thyroid cysts, NCCN thyroid carcinoma practice guidelines, Fine-needle aspiration of follicular lesions of the thyroid: diagnosis and follow-up, Diagnosis of follicular neoplasm: a gray zone in thyroid fine-needle aspiration cytology, Factors that predict malignant thyroid lesions when fine-needle aspiration is suspicious for follicular neoplasm., Thyroid cytology and the risk of malignancy in thyroid nodules: importance of nuclear atypia in indeterminate specimens, Fine-needle aspiration biopsy of the thyroid: an appraisal. View an interactive bone marrow aspirate online. Quick tip: A cellular aspirate smear is crucial to an adequate differential count and assessment of morphologic dysplasia. The discussions and conclusions regarding terminology and morphologic criteria from the NCI meeting, summarized in the publications by Baloch et al,4,5 form the framework for the terminology presented here and in atlas form.3 It is intended as a flexible framework that can be modified to suit the needs of the particular laboratory and the patients it serves. Thyroid FNA specimen a. Deveci Pu specimens with obscuring blood, poor cell preservation, and an insufficient sample of follicular cells. American Society of Hematology. 2. hbbd``b`$Ks ^ Notes and recommendations are not required but can be useful in certain circumstances. On the other hand a definitive diagnosis of a low-grade lymphoma (usually a MALT lymphoma) is even more difficult. The risk of malignancy in the HCLUS category was significantly lower than in the other subtypes of AUS. However, nuclear grooves can be seen also in several thyroid diseases such, as Hashimotos thyroiditis, multinodular goiter, Hurthle cell tumors and medullary carcinoma[42,43]. Alexander Accessibility In part, each component is analyzed and interpreted in correlation together for a final report. How to Interpret Thyroid Fine-Needle Aspiration Biopsy Reports: A Guide Rathan This is the most common variant of PTC and is characterized by a predominantly follicular architecture. Ultrasonography-guided core needle biopsy for the thyroid nodule: does the procedure hold any benefit for the diagnosis when fine-needle aspiration cytology analysis shows inconclusive results? Research is directed to the identification of molecular markers that, in conjunction with FNA, can identify patients with a malignant nodule. While the V600E and K601E mutations were almost equally observed in the AUS/FLUS category, there was a slight predominance of K601E mutation in SFN/SHN category. Edmund S. Cibas, MD, Syed Z. Ali, MD, The Bethesda System for Reporting Thyroid Cytopathology, American Journal of Clinical Pathology, Volume 132, Issue 5, November 2009, Pages 658665, https://doi.org/10.1309/AJCPPHLWMI3JV4LA. The prepared core biopsy slides can be used for immunohistochemical (IHC) investigations (phenotyping the cells using IHC stains), and an initial standard hematoxylin and eosin stain is done to assess baseline histology. I et al. A: Ideally, no. The heterogeneity of this category precludes outlining all scenarios for which an AUS interpretation is appropriate. Note extensive red blood cells in the background. A) 20 view of the clot. By using redundancies across components, your consultant hematopathologists may offer insights into the architecture, morphology, immunostaining, and flow cytometry profiles of any identified hematologic entity. et al. Crowded macrofollicles with mild irregularities in nuclear membrane and prominent nucleoli in a specimen with scant colloid ( 40 pap stain on ThinPrep slide) (diagnostic categories III). It is expected that the many benefits, clinical and investigational, of the Bethesda cervical terminology will also apply to the Bethesda thyroid terminology. S Almost all patients with MTC have a significantly elevated serum calcitonin level, and in some cases these tumors can produce substances that can lead to paraneoplastic syndromes[35,44]. The adequacy of a thyroid FNA is defined by both the quantity and quality of the cellular and colloid components. ( a) In this sparsely cellular specimen, some of the cells had abundant cytoplasm and enlarged nuclei, some with prominent nucleoli. Gupta According to the Bethesda system for reporting thyroid cytopathology, a specimen . In FNA specimens of this variant, the cancer cells appear more profuse, granular or vacuolated compared to regular PTC. This interpretation applies to cellular samples that are composed exclusively (or almost exclusively) of Hrthle cells. Cytologic features of histologically proven follicular adenoma and Goellner The positive predictive value of a malignant FNA interpretation is 97% to 99%. This technique is conclusive for the majority of cases suspicious for PTC, lymphoma, or follicular neoplasm after previous incomplete FNA results. Once obtained, the core biopsy is used to make touch preps (discussed below) and then is transferred into a container with appropriate fixative (usually formalin) and sent to the laboratory for processing. Bukhari MH, Niazi S, Hanif G, Qureshi SS, Munir M, Hasan M, Naeem S. An updated audit of fine needle aspiration cytology procedure of solitary thyroid nodule. Fadda The 2-day live conference in October 2007, attended by 154 registrants including pathologists, endocrinologists, surgeons, and radiologists, gave the committees an in-depth opportunity to present their conclusions and debate controversial areas. T The most common scenarios can be described as follows: There is a prominent population of microfollicles in an aspirate that does not otherwise fulfill the criteria for follicular neoplasm/suspicious for follicular neoplasm. This situation may arise when a predominance of microfollicles is seen in a sparsely cellular aspirate with scant colloid. The Bethesda System for Reporting Thyroid Cytopathology: Definitions, Criteria and Explanatory Notes. IB Lymphoepithelial cyst. Layfield LJ, Cibas ES, Gharib H, Mandel SJ. Fine-needle aspiration cytology (FNAC) has been widely adopted as a meticulous, secure and cost-effective method for the diagnosis of non-toxic thyroid nodules[1,2]. The Paris System for Reporting Urinary Cytology tried lately to address adequacy. PTC accounts for 80% of all thyroid malignancies and occurs more often in women with a 3:1 female-to-male ratio, with a mean age at presentation 30-40 years. Fine-needle aspiration (FNA) cytology is an important diagnostic tool in patients with thyroid lesions. Gharib Giorgadze Cibas Lin (General, Ortho . 92 0 obj <> endobj Help . Nayar R, Ivanovic M. The indeterminate thyroid fine-needle aspiration: experience from an academic center using terminology similar to that proposed in the 2007 National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference. Such atypia may result from a variety of benign cellular changes, but in some cases may reflect an underline malignancy which has been suboptimally sampled or has intermediate diagnostic features[20-22]. They found that apart from the TIR III category, for the TIR 1/DCI(unsatisfactory/nondiagnostic) category the percentage of cases in the 5-tiered system was greater than twice the percentage of cases in the 6-tiered system (7.5% vs 3%). What is the hematopathologist looking for when assembling all the parts to report back in consultation with you? There are cyst-lining cells that may appear atypical owing to the presence of nuclear grooves, prominent nucleoli, elongated nuclei and cytoplasm, and/or intranuclear cytoplasmic inclusions in an otherwise predominantly benign-appearing sample.16. 2nd ed. Gough In this review we analyze all literature regarding Thyroid Cytopathology Reporting systems trying to identify the most suitable methodology to use in clinical practice for the preoperative diagnosis of thyroid nodules. H Results: We evaluated 5030 thyroid FNAs. Kinematic comparison between the knee after bicruciate stabilized total knee arthroplasty and the native knee: A cadaveric study. It is the hope of all contributors to this project that this terminology proposal will be a valuable first step toward uniformity and consensus in the reporting of thyroid FNA interpretations. Salivary Glands and Other Head and Neck Structures Many of the HCLUS cases did not show any of the above features and were proved to be benign adenomas. V Albores-Saavedra J, Wu J. Because the nuclear changes of FVPTC are subtle, the majority of cytologic samples are often diagnosed as suspicious for PTC. National Center for Biotechnology Information Colombo Characteristically, distinct granules (calcitonin granules) are spotted in the cytoplasm of the cancer cells, as well as eccentric nuclei, indicating a plasmacytoid appearance to the tumor cells. L However, this requires additional FNA passes or residual cellular material from the cytologic sample. On the other hand, these polarized spermatids also align across the plane of seminiferous epithelium, mimicking planar cell polarity (PCP . The https:// ensures that you are connecting to the Any specimen that contains abundant colloid is considered adequate (and benign), even if 6 groups of follicular cells are not identified: A sparsely cellular specimen with abundant colloid is, by implication, a predominantly macrofollicular nodule and, therefore, almost certainly benign.
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