2, 5-8 This neoplasm … Thyroid nodules are frequent in general population, found in 3.7–7% of people by palpation and 42–67% by ultrasonography (US). Learn about our remote access options, Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania. 2), follicular neoplasm or suspicious for follicular neoplasm findings in two nodules (5.0%), a … A total of 5,660 patients underwent preoperative neck ultrasonography and fine-needle aspiration cytology (FNAC), surgical treatment, and follow-up at a medical institute. Over the past few decades, the field of thyroid pathology has witnessed several major changes that significantly impacted upon patients' care. It can be difficult to distinguish between the different types of follicular neoplasm. Management: Hemithyroidectomy. 1), AUS/FLUS findings in eight nodules (20.0%) (Fig. Follicular carcinoma. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has attempted to standardize reporting and In 971 … Usually solitary "cold" nodule on radionuclide scan. thyroid cytology reporting 1st edition, 2010. In 971 cases, frozen section examination was performed during the surgical treatment of follicular neoplasm … Thyroid Cytopathology- Recent Advances October 21, 2017 Dr. Manon Auger, Dept. There has been great difficulty and variability in triaging and reporting follicular neoplasm… The diagnosis of follicular thyroid cancer within a thyroid gland can only be made by Nuclear overlap/crowding. defined tumour entities such as non-invasive follicular thyroid neoplasm with papil-lary like nuclei, or as a molecular marker(s) for targeted therapies. Among 122 patients (67%) undergoing surgical excision (lobectomy, 96; total thyroidectomy, 26), malignancy was identified in 37 cases (31%). Díaz Del Arco C, Fernández Aceñero MJ. 4 Accurate diagnosis of … We performed a retrospective analysis of follicular neoplasm data obtained from frozen section examinations of thyroid nodules. Considered to be a combination of environmental factors (e.g. Use the link below to share a full-text version of this article with your friends and colleagues. 1: nondiagnostic; 2: benign; 3: FLUS; 4: follicular neoplasm Completely enveloped by thin fibrous capsule. PathologyApps.com - making the practice of pathology easier, better, and faster. Pathologists make the diagnosis of suspicious for follicular neoplasm after examining tissue removed by fine-needle aspiration from the thyroid gland. One hundred eighty-four cases in 167 patients were diagnosed as “follicular neoplasm” among 1,024 thyroid FNA evaluated with on-site interpretation from 1998–2000. Follicular (or oncocytic) neoplasm/suspicious for a follicular (or oncocytic) neoplasm (FN/SFN) is a common indeterminate diagnosis with a cancer risk of approximately 15% to 30%. © 2002 Wiley-Liss, Inc. Please check your email for instructions on resetting your password. The thyroid fine‐needle aspiration (FNA) diagnosis of “follicular neoplasm” does not differentiate between a benign and malignant tumor. 40 FVPTC nodules. A fine needle aspiration biopsy specimen consistent with a follicular neoplasm accounts for ∼20% of all fine needle aspiration biopsy results [ 35 – 37 ] and has a 15%–30% risk of malignancy [ 34 ]. Among thyroid papillary carcinomas (PTCs), the follicular variant is the most common and includes encapsulated forms (EFVPTCs). Sonographic and Doppler data were available in all cases and included nodule location, size, echogenicity, and vascularity. Nonpapillary (follicular/Hürthle) carcinoma was diagnosed in 11 (9%), follicular variant of papillary carcinoma in 25, and medullary carcinoma in 1 case. Patients with papillary thyroid microcarcinoma were excluded from this study. In follicular thyroid neoplasms without invasion, a diagnosis of atypical adenoma (AA) (follicular tumor of uncertain malignant potential) may be rendered if atypical features (indefinite capsular/vascular invasion, necrosis, solid growth, increased mitoses) are present. Fine needle aspiration of a thyroid mass cannot diagnosis follicular thyroid cancer because it can only provide analysis of the cells themselves (which have the same appearance of normal follicular cells of the thyroid). INTRODUCTION: The second edition of The Bethesda System for Reporting Thyroid Cytopathology has incorporated the recent change in nomenclature, noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), with an anticipated change in the risk of malignancy (ROM). 2-4 To our knowledge, few cytology reports have been published. Atypia of Undetermined Significance or Follicular Lesion ~5-15‡ Repeat FNA of Undetermined Significance Follicular Neoplasm or Suspicious for a Follicular Neoplasm 15-30 Surgical lobectomy Suspicious for Malignancy 60-75 Near-total thyroidectomy or surgical lobectomy§ Malignant 97-99 Near-total thyroidectomy§ FNA, fine-needle aspiration. Can be thought of as a (neoplasm) garbage category for the thyroid gland - may represent: Follicular adenoma. Background: The 2007 Bethesda classification for thyroid cytology defines follicular neoplasm as a category of cases with cellular specimens demonstrating abundant follicular cells arranged in a microfollicular pattern with little or no colloid. If you do not receive an email within 10 minutes, your email address may not be registered, The cases were evaluated for the following variables: histologic diagnosis, age, sex, and size of the nodule. Learn more. Architecturally and cytologically different from surrounding gland; surrounding thyroid tissue shows signs of compression. Noninvasive EFVPTCs have very low risk of recurrence or other adverse events and have been recently proposed to be designated as noninvasive follicular thyroid neoplasm with papillary-like nuclear features or NIFTP, thus eliminating the term carcinoma. Closely packed follicles, trabeculae or solid sheets. Metastatic renal cell carcinomas may mimic Hürthle cell neoplasms, but immunocytochemistry for thyroid transcription factor 1 (TTF-1), which is positive in follicular and Hürthle cells, is negative in the cells of renal cell carcinoma. When examined under the microscope, the cells in a follicular neoplasm look similar to normal, healthy follicular cells. Thyroid cancer is the most common endocrine malignancy. Patients with papillary thyroid microcarcinoma were excluded from this study. PathologyApps™ | iPhone, iPad | Android | Copyright @ 2015 - PathologyApps.com - All Rights Reserved, who to FNA: cold nodules > 1 cm or have microcalcifications (look up TSH and ultrasound), complications: hematoma (uncommon), biopsy site artifacts later on, needle tract seeding (virtually nonexistent), stains: Pap (better nuclear features) or Romanowsky (better cytoplasmic and extracellular features), nondiagnosis: repeat FNA with US guidance, suspicious for follicular neoplasm: lobectomy, suspicious for malignancy: lobectomy or thyroidectomy, false negative and false positive both at 1-3%, used for atypical/indeterminant cytology: PPV 88%, NPV 94%, 6 groups of 10 well preserved follicular cells, or sparsely cellular with abundant colloid (colloid nodule). Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features: Can Cytology Face the Challenge of Diagnosis in the Light of the New Classification? 2002;26:41–44. Thyroid nodules are common; almost 20% of the population has a palpable thyroid nodule and approximately 70% has a nodule detected by ultrasound. Diagn. This study analyzes the cause of this poor correlation between cytology and histology. Features: Hypercellular lesion. Papillary carcinoma (PTC) is the most common malignant neoplasm of the thyroid; the diagnosis of this most … According to several large studies, the surgical pathologist renders a non-neoplastic diagnosis in ∼20-40% of thyroid fine-needle aspiration (FNA) cases reported as follicular neoplasm. The aim of this study was to identify clinical features that may help in predicting malignancy in patients with an FNA diagnosis of follicular neoplasm… Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username, I have read and accept the Wiley Online Library Terms and Conditions of Use. Cytopathol. Background. Follicular neoplasm arises from cells inside the thyroid gland. suspicious for follicular neoplasm: lobectomy; suspicious for malignancy: lobectomy or thyroidectomy; malignant: thyroidectomy; false negative and false positive both at 1-3%; molecular. The follicular cells may also … +/-Microfollicles, numerous. Insufficient dietary iodine is a risk factor. The current recommendation for the management of these cases is diagnostic lobectomy. The diagnosis “follicular neoplasm” is indeterminate, and the majority of cases (70% in the current study) are benign. 3-dimensional clusters of cells. BRAF in 44% of papillary ca; used for atypical/indeterminant cytology: PPV 88%, NPV 94%; Bathesda categories. The full text of this article hosted at iucr.org is unavailable due to technical difficulties. However, clinical features, including gender, nodule size, and age, can be a part of the decision analysis in selecting patients for surgery. Working off-campus? Intermediate in aggressiveness between well differentiated (follicular and papillary) and anaplastic thyroid carcinomas, insular carcinoma of the thyroid (ICT) subsequently has been well documented both as a discrete tumor entity and as a component of other, better differentiated thyroid neoplasms. Follicular neoplasm General. Knowledge of the molecular pathology of thyroid tumours originating from follicular cells has greatly advanced in the past several years. Thyroid carcinoma with follicular differentiation but no papillary nuclear features ( Hürthle cell (oncocytic) carcinoma is discussed separately) Comprises 6 - 10% of thyroid carcinomas. The risk of malignancy was greater in males (47% vs. 29%, P < 0.0004) than females, in nodules measuring 3 cm or more (55% vs. 23%, P < 0.0001), than in nodules measuring less than 3 cm, and in patients 40 or more yr old (20% vs. 10%, P = 0.0001) than in patients younger than 40 years. However, the follicles are often smaller than normal. We performed a retrospective analysis of follicular neoplasm data obtained from frozen section examinations of thyroid nodules. Cases consisting of oncocytic (Hurthle) cells were excluded from study. The thyroid fine-needle aspiration (FNA) diagnosis of “follicular neoplasm” does not differentiate between a benign and malignant tumor. One hundred thirty-nine patients were female, and 28 were male (age range, 23–80 yr). Often cases diagnosed as “follicular or Hürthle‐cell neoplasm” undergo surgical excision for further characterization. and you may need to create a new Wiley Online Library account. Often cases diagnosed as “follicular or Hürthle-cell neoplasm” undergo surgical excision for further characterization. According to the Bethesda system for reporting thyroid cytopathology, this cytologic appearance is classified as follicular neoplasm or suspicious for follicular neoplasm. Patterns: Growths in the thyroid gland may not be obvious at first, but could lead to symptoms such as a visible neck lump or problems with speech or swallowing. These small follicles are called microfollicles. The differential diagnosis ranges from papillary (PC), follicular (FC) and medullary (MC) carcinomas to follicular adenoma (FA) and colloid goitre. standardised approach to thyroid cytology handling and reporting was recently endorsed by the Royal College of Pathologists of Australasia (RCPA), and a comprehensive document The new Italian 6‐tier reporting system for thyroid cytology was originally intended to update the previous system devised by the Italian Society for Anatomic Pathology and Cytology (SIAPEC) and the Italian Division of International Academy of Pathology (IAP) in 2007. Background: Fine-needle aspiration (FNA) cytology is a common approach to evaluating thyroid nodules, although 20% to 30% of FNAs have indeterminate cytology, which hampers the appropriate management of these patients. Medullary thyroid carcinoma shows a dispersed cell pattern and a cytologic appearance that can mimic a Hürthle cells neoplasm. lack of iodine in the diet) and genetic factors (often with autosomal dominant inheritance). A total of 5,660 patients underwent preoperative neck ultrasonography and fine‐needle aspiration cytology (FNAC), surgical treatment, and follow‐up at a medical institute. The noninvasive encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC) is an example, accounting for 10% to 20% of all thyroid cancers currently diagnosed in Europe and North America.2, 3 It was recently renamed as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) because of its unique behavior and good prognosis. This review describes practical examples of molecular techniques as applied to thyroid FNA in routine clinical practice and the value of molecular diagnostics in thyroid FNA. During the study period from January 1996 to April 2010, histologic follow‐up was available for 234 of 670 cases (34.9%) reported as follicular neoplasm on ultrasound‐guided thyroid FNA. Thyroid cancer is the most frequent endocrine malignancy, and incidence rates have steadily increased over the last decades. Of the 40 thyroid nodules, the preoperative cytology results were as follows: benign findings were observed in one nodule (2.5%) (Fig. The aim of this study was to identify clinical features that may help in predicting malignancy in patients with an FNA diagnosis of follicular neoplasm. Cytology.
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