The National Institutes of Health Consensus Development Program convened surgeons, endocrinologists, pathologists, biostatisticians, radiologists, oncologists, and other health care professionals, as well as members of the general public, to address the causes, prevalence, and natural history of clinically inapparent adrenal masses, or "incidentalomas"; the appropriate evaluation and treatment of such masses; and directions for future research. Improvements in abdominal imaging techniques have increased detection of adrenal incidentalomas, and because the prevalence of these masses increases with age, appropriate management of adrenal tumors will be a growing challenge in our aging society. To address six predetermined questions, the 12-member nonfederal, nonadvocate state-of-the-science panel heard presentations from 21 experts in adrenal incidentalomas and consulted a systematic review of medical literature on the topic provided by the Agency for Healthcare Research and Quality and an extensive bibliography developed by the National Library of Medicine. The panel recommended a 1-mg dexamethasone suppression test and measurement of plasma-free metanephrines for all patients with an adrenal incidentaloma; additional measurement of serum potassium and plasma aldosterone concentration-plasma renin activity ratio for patients with hypertension; and surgery for patients with biochemical evidence of pheochromocytoma, patients with tumors greater than 6 cm, and patients with tumors greater than 4 cm who also meet other criteria. The panel also advocated a multidisciplinary approach to managing adrenal incidentalomas. The statement is an independent report of the panel and is not a policy statement of the National Institutes of Health or the federal government.

Repeated thyroidal FNAs yielding benign diagnoses are nearly always accurate (98%), and therefore the patients can be followed safely without undergoing surgery, unless an unfavorable clinical change occurs.

Fourteen cases of surgically excised lymphoepithelial cysts (13 from the parotid gland and 1 from the submandibular gland) were reviewed for diagnostic histologic features. They showed squamous epithelium-lined cysts within lymph nodes. Lymphocytes, histiocytes, and plasma cells were found in the walls of the cysts. Multinucleated giant cells were present in four cases. The five patients tested for human immunodeficiency virus (HIV) infection were positive, both by enzyme-linked immunosorbent assay (ELISA) and Western Blot. Fine-needle aspiration (FNA) was performed on five cases (two were confirmed histologically). Diff-Quik-stained smears showed a proteinaceous background and a mixed population of lymphocytes, histiocytes, plasma cells, and metaplastic squamous cells. When the above cytologic findings are present on fine-needle aspiration of a major salivary gland lesion, the diagnosis of lymphoepithelial cyst should be considered.

Crile and Hazard reported in 1953 a follicular pattern of papillary thyroid carcinoma. Little has been said about this pattern in the cytologic literature. From more than 8,000 thyroid aspirates in our files, we reviewed all those diagnosed as “follicular variant of papillary carcinoma,” “suspect follicular variant of papillary carcinoma,” and “follicular neoplasm vs. follicular variant of papillary carcinoma.” Also, we reviewed all aspirates in which a diagnosis of follicular variant of papillary carcinoma had been made on surgically excised glands, regardless of the cytologic diagnosis; 63 aspirates from 45 patients were collected. All smears were air‐dried and stained with Diff‐Quik. Most smears were very cellular (“tumor cellularity”), and the neoplastic follicular cells formed empty follicles, rosettes, tubules, and papillary structures. Nuclei were twice the size of red blood cells, had smooth contours, were hyperchromatic, and varied in shape but not much in size. Nuclear overlapping was common. Some nuclei had one small and almost pointed end, thereby resembling arrowheads. Intranuclear inclusions, multinucleated histiocytes, and psammoma bodies were uncommon. Pink‐stained colloid was frequent. Diagn. Cytopathol. 16:207–213, 1997. © 1997 Wiley‐Liss, Inc.