Differential Diagnosis of Oncocytic Lesions of the Breast and Thyroid Utilizing a Semiquantitative Approach

Nasuti, Joseph F.; Benedict, Cathy; Hurford, M; Bibbo, Marluce

doi:10.1159/000331145

Cited by 10 publications

(6 citation statements)

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“…[1–3] Some investigators have suggested that based on certain cytologic criteria such as, nuclear pleomorphism (enlargement, hyperchromasia, and prominent nucleoli), mitoses, solid and trabecular architecture and smear background one can distinguish between benign and malignant oncocytic lesions. [68] However, many have disputed this claim based on the fact that it is even difficult to make a diagnosis of oncocytic neoplasm in thyroid FNA specimens rather than suggest malignancy. [4715]…”

Section: Discussionmentioning

confidence: 99%

“…[3–7] Non-neoplastic thyroid lesions characterized by oncocytic metaplasia and/or hyperplasia may result in FNA smears with fairly monotonous cells, leading to a “misdiagnosis” of an oncocytic neoplasm. [478] It is not unusual to encounter cytomorphologic features of CLT in the background of FNA specimens containing a predominant population of OF cells. [39–11] Cytopathologists have long recognized the diagnostic challenge to differentiate between oncocytic metaplasia in a benign nodule versus oncocytic neoplasm arising in CLT.…”

Section: Introductionmentioning

confidence: 99%

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Oncocytic follicular nodules of the thyroid with or without chronic lymphocytic thyroiditis: An institutional experience

et al. 2013

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Background:Oncocytic follicular (OF) cells can be a prominent component of fine needle aspiration (FNA) specimens from neoplasms (adenomas and carcinomas) and nodules arising in multinodular goiter and chronic lymphocytic thyroiditis (CLT). Because OF cells can be present in non-neoplastic and neoplastic thyroid lesions it can be challenging to differentiate between these two in FNA specimens. The aims of this study were to determine the risk of malignancy in cases diagnosed as either oncocytic follicular neoplasm (OFN) or hyperplastic/adenomatoid nodule with OF on FNA and to identify clinicopathologic features that may help in predicting malignancy in such cases, especially the presence or absence of CLT.Design:We retrospectively searched the computerized laboratory information system at our institution between 1998 and 2009 for thyroid US guided FNA specimens in which the term “oncocytic/oncocytes” was mentioned in the final cytopathologic diagnosis. A total of 340 cases were selected for this study. The following data points were collected: Patient demographics, site of thyroid biopsy, size of lesion, FNA diagnosis, histopathologic follow-up and presence of CLT. Surgical pathology follow-up (SPFU) was available in 269 (79%) cases.Results:Two hundred and sixty patients were females and 80 males (average age 53 years). The lesion size was <3.0 cm in 241 (71%) and ≥ 3.0 cm in 99 (29%) cases. Cytologic diagnoses included: Follicular neoplasm with oncocytic features (FNOF) 321 and suggestive of FNOF 19 cases; a secondary cytologic diagnosis of CLT was made in 20 cases. SPFU was available in 269 (79%) cases; it was benign in 213 (213/267 = 79%) and malignant in 56 (56/269 = 21%) cases. The background thyroid showed CLT in 67 (25%) cases; 24% (48/196) neoplasms occurred with versus 76% (147/196) without CLT. The rate of malignancy was lower in nodules measuring less than 3.0 cm as compared to those equal or greater than 3.0 cm in size (17% vs. 28% respectively). The presence of CLT did not significantly alter the rate of malignancy in both FNA and surgical pathology specimens.Conclusions:Based on this study, nodule size and not CLT appears to be an important clinicopathologic features in the management of thyroid FNA specimens diagnosed as OFN.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Oncocytic follicular nodules of the thyroid with or without chronic lymphocytic thyroiditis: An institutional experience

et al. 2013

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“…Diagnostic accuracy of Hürthle cell neoplasms is in the range of 85-90%. [8][9][10][11][12][13][14][15][16][17] The aspirates of Hürthle cell neoplasms are usually very cellular, and contain a monomorphic population of Hürthle cells with scant colloid and inflammatory cells in the background. The cells are oval to polygonal, with well-defined borders and an abundant granular cytoplasm.…”

Section: Discussionmentioning

confidence: 99%

“…The cytologic criteria for diagnosing Hürthle cell neoplasms have been well described. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] However, there were limited studies trying to distinguish HCC from HCA. 7,8,14,18,19 In a recent, larger series of study, 18 Renshaw was able to identify HCC using a total of five cytologic criteria that included a predominance of Hürthle cells with scant colloid and at least one of the following four cytologic features: small cell dysplasia (bland nuclei with cell diameter less than twice the nuclear diameter), large cell dysplasia (cells demonstrate at least twice the variation in the nuclear diameter, often with prominent nucleoli and irregular nuclear outlines), nuclear crowding, and dyshesion.…”

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confidence: 99%

Fine‐needle aspiration cytology of Hürthle cell carcinoma of the thyroid

Clouse

Ren

2008

Diagnostic Cytopathology

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Specific criteria for the diagnosis of fine-needle aspiration (FNA) of Hürthle Cell Carcinoma (HCC) have rarely been discussed in the literature. A retrospective review of 35 FNA cases with the diagnosis of Hürthle cell lesion or Hürthle cell neoplasm was performed. In each case, there was a subsequent surgical excision. The FNA specimens were divided according to histologic diagnoses as HCC (12 cases), Hürthle cell adenoma (HCA) (14 cases), and benign nonneoplastic Hürthle cell lesions (BNHCL) (9 cases). Each case was examined using a semiquantitative scoring system for the following 11 features: presence or absence of colloid, lymphocytes, and transgressed blood vessels (each scored 0 or 1); the percentage of nuclear enlargement, small cell dysplasia, large cell dysplasia, nuclear crowding, and cellular dyshesion (each scored 0-3); and age, gender, and size of lesion. When diagnosed by FNA as either Hürthle cell neoplasm or Hürthle cell lesion, males were much more likely to have malignant tumors than females. Statistically significant cytologic features that favored malignant (HCC) over benign lesions (HCA and BNHCL) included small cell dysplasia, large cell dysplasia, nuclear crowding, and cellular dyshesion. The presence of colloid and lymphocytes favored a benign lesion. Nuclear enlargement and large tumor size are significantly more common in neoplasms than BNHCL.

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“…However, marked cellular atypia can occur in aspirates of Hurthle-cell nodules arising in a background of lymphocytic thyroiditis, GD, and also in Hurthle-cell lesions which have been previously aspirated. 137,138 Recently some authors have suggested that FNA specimens of neoplastic Hurthle-cell lesions usually show intracytoplasmic lumens and transgressing vessels.…”

Section: -132mentioning

confidence: 99%

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

Baloch

LiVolsi

et al. 2008

Diagnostic Cytopathology

835

710

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The National Cancer Institute (NCI) sponsored the NCI Thyroid Fine-needle Aspiration (FNA) State of the Science Conference on October 22-23, 2007 in Bethesda, MD. The two-day meeting was accompanied by a permanent informational website and several on-line discussion periods between May 1 and December 15, 2007 (http://thyroidfna.cancer.gov). This document summarizes matters regarding diagnostic terminology/classification scheme for thyroid FNA interpretation and cytomorphologic criteria for the diagnosis of various benign and malignant thyroid lesions. (http://thyroidfna.cancer.gov/pages/info/agenda/).

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Differential Diagnosis of Oncocytic Lesions of the Breast and Thyroid Utilizing a Semiquantitative Approach

Cited by 10 publications

References 11 publications

Oncocytic follicular nodules of the thyroid with or without chronic lymphocytic thyroiditis: An institutional experience

Oncocytic follicular nodules of the thyroid with or without chronic lymphocytic thyroiditis: An institutional experience

Fine‐needle aspiration cytology of Hürthle cell carcinoma of the thyroid

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

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