No abstract

AimsTo determine the proportion of thyroid fine needle aspiration (FNA) and core needle biopsy (CNB) cases reported at a single institute into each UK Royal College of Pathologists (RCPath) Thy1-5 and local T category, respectively. Where subsequent histology was available, malignancy rates, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were compared for both procedures.Methods1591 FNAs (2010–2018) and 514 CNBs (2013–2018) cases were identified, together with paired histology excision specimens.ResultsThe FNA samples were classified as: Thy1: 45.3%, Thy2/Thy2c: 22.1%, Thy3a/Thy3f: 28%, Thy4: 1.6% and Thy5: 3%; while the CNB were classified as: T1: 7.2%, T2: 22.4%, T3 59.3%, T4: 1% and T5: 10.1%. Comparison of FNA and CNB classified as Thy5/T5 showed a 100% risk of malignancy (ROM), sensitivity (98% vs 100%), specificity (14.1% vs 12.1%), PPV (29.4% vs 29.4%), NPV (94.9% vs 100%) and accuracy (36.5% vs 35.6%), respectively, for a diagnosis of malignancy. ROMs for other categories were: Thy1/T1 (9% vs 6.7%), Thy2/T2 (5.1% vs 0%), Thy3/T3 (17.5% vs 18.4%) and Thy4/T4 (73.3% vs 100%).ConclusionsThe proportion of cases in each RCPath Thy category has remained relatively stable during the 9-year study period, with the exception of the Thy3a category, which has increased over time. This finding is in line with other more recent reports in the literature and the proportion of T3 cases in the CNB group. The proportion of Thy2/Thy2c cases has also reduced over time, reflecting a local change in the triaging protocol for probable benign lesions. Both FNA and CNB showed comparable performance in our study.

No abstract

Background: Olfactory Neuroblastoma is a rare, locally aggressive malignant neoplasm arising from the olfactory epithelium, which causes metastasis by lymphatic and haematogenous routes, with most common site being the cervical lymph nodes. Materials and Methods: Clinical history was retrieved from discussion in the Head and Neck multidisciplinary team meeting and medical records. Routine macroscopic and microscopic histological examination along with appropriate immunohistochemistry was performed. In addition, we include the review of literature of olfactory neuroblastoma metastatic to different sites. Results: A 75 year old female presented with a left submandibular mass which on biopsy was diagnosed as high grade neuroendocrine carcinoma requiring further investigation for characterising it as primary or metastatic. The histological diagnosis proved difficult and doubtful, till after five months when on follow up investigation a skull base lesion was identified, this on biopsy was confirmed to be an olfactory neuroblastoma. Conclusion: It is important to think laterally and consider metastatic tumours when evaluating neuroendocrine lesions in the submandibular region as this can be the first manifestation.