Journal List > Korean J Cytopathol > v.19(2) > 1006519

Korean J Cytopathol. 2008 Sep;19(2):152-159. Korean.
Published online September 30, 2008.  https://doi.org/10.3338/kjc.2008.19.2.152
Copyright © 2008 The Korean Society for Cytopathology
Cytologic Features of Follicular sAdenoma and Follicular Carcinoma of the Thyroid: A Study on the Likelihood of Cytologic Diagnosis by Fine Needle Aspiration Cytology
Hee Dae Park, C.T.(IAC), Woon Sun Park, C.T.(IAC), Sun Hee Kim, C.T.(IAC), Seock Hyun Choi, M.T., Young Hye Cho, M.D., Sung Hee Kang, M.D., Kyung Bun Lee, M.D., Dong Hoon Kim, M.D., Seoung Wan Chae, M.D. and Jin Hee Shon, M.D.
Department of Pathology, Kangbuk Samsung Hospital, SungKyunkwan University School of Medicine, Seoul, Korea.
Received July 17, 2008; Accepted August 29, 2008.

Abstract

Fine-needle aspiration cytology (FNAC) cannot differentiate follicular adenoma from follicular carcinoma since this distinction can only be based on the presence of capsular or vascular invasion, and this cannot be detected on a cytologic smear. The goal of this study was to define the diagnostic cytologic findings of follicular neoplasm and the possibility of diagnosing follicular neoplasm by performing FNAC. The cases of histologically diagnosed follicular adenoma and follicular carcinoma on the thyroidectomy specimens were retrieved. Among them, the cases with preoperative FNAC that was done within 3 months of the operation were finally selected. Then we reviewed the FNAC and histologic slides of 19 cases: 9 follicular adenomas and 10 follicular carcinomas. Our results suggest that for cases of follicular neoplasm, the aspirates show high or abundant cellularity, frequent follicle formation and occasional cellular atypism of the follicular cells. However, the atypism is more pronounced and more frequently noticed in the cases of follicular carcinoma, which reveals more higher anisocytosis (7/10, 70%), nuclear pleomorphism (9/10, 90%), coarse clumping of chromatin (8/10, 80%) and cellular overlapping (8/10, 80%).

Keywords: Fine needle aspiration cytololgy; Follicular adenoma; Follicular carcinoma; Thyroid

Figures


Fig. 1
Fine needle aspiration cytology of the follicular adenoma. (A) Follicular adenoma confirmed by histologic diagnosis shows many small follicles composed of bland - looking follicular cells. (B) Follicular cells exhibit mild anisocytosis and anisonucleosis with preserved cytoplasm. (H&E).
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Fig. 2
Fine needle aspiration cytology of the follicular carcinoma. (A) Follicular carcinoma confirmed by histologic diagnosis shows abundant syncytial clusters and small follicles. (B) Follicular cells exhibit moderate anisocytosis and anisonucleosis with hyperchromasia, coarse nuclear chromatin and small nucleoli. Irregularity of the nuclear membrane is also noted. (H&E).
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Tables


Table 1
Cytologic - Histologic Correlation of the Follicular Adenoma
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Table 2
Cytologic - Histologic Correlation of the Follicular Carcinoma
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Table 3
Cellular Features of the Follicular Adenoma in FNAC
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Table 4
Cellular Features of the Follicular Carcinoma in FNAC
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Table 5
Comparison of the Cytologic Features in Thyroid Neoplasm
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References
1. Hadi M, Gharib H, Goellner JR, Heerden JA. Has fine-needle aspiration biopsy changed thyroid practice? Endocr Pract 1997;3:9–13.
2. Corrias A, Einaudi S, Chiorboli E, et al. Accuracy of fine needle aspiration biopsy of thyroid nodules in detecting malignancy in childhood: comparison with conventional clinical, laboratory, and imaging approaches. J Clin Endocrinol Metab 2001;86:4644–4648.
3. Altavilla G, Pascale M, Nenci I. Fine needle aspiration cytology of thyroid gland diseases. Acta Cytol 1990;34:251–256.
4. Chiappetta G, Tallini G, De Biasio MC, et al. FRA-1 expression in hyperplastic and neoplastic thyroid diseases. Clin Cancer Res 2000;6:4300–4306.
5. Saggiorato E, De Pompa R, Volante M, et al. Characterization of thyroid 'follicular neoplasms' in fine-needle aspiration cytological specimens using a panel of immunohistochemical markers: a proposal for clinical application. Endocr Relat Cancer 2005;12:305–317.
6. Saggiorato E, Aversa S, Deandreis D, et al. Galectin-3. presurgical marker of thyroid follicular epithelial cell-derived carcinomas. J Endocrinol Invest 2004;27:311–317.
7. Finley DJ, Zhu B, Barden CB, Fahey TJ 3rd. Discrimination of benign and malignant thyroid nodules by molecular profiling. Ann Surg 2004;240:425–436.
discussion 436-7.
8. Mazzaferri EL. Management of a solitary thyroid nodule. N Engl J Med 1993;25:553–559.
9. Arda IS, Yildirim S, Demirhan B, Firat S. Fine needle aspiration biopsy of thyroid nodules. Arch Dis Child 2001;85:313–317.
10. Sohn JH, Chae SW, Cho EY, Kim EJ. Diagnostic Correlation and Accuracy Between Fine Needle Aspiration Cytology and Histopathologic Examination. Korean J Cytopathol 2003;14:53–59.
11. Bahar G, Braslavsky D, Shpitzer T, et al. The cytological and clinical value of the thyroid "follicular lesion". Am J Otolaryngol 2003;24:217–220.
12. Park IA, Ham EK. Fine needle aspiration cytology of thyroid nodules: assessment of diagnostic accuracy and evaluation of each cytologic diagnosis. Korean J Cytopathol 1999;10:43–53.
13. Chu YC, Cha HJ, Min SK, Kim JM, Hwang TS. Morphometric study on fine needle aspirates from follicular Adenoma and follicular carcinoma of the thyroid. Korean J Cytopathol 1998;9:63–68.
14. Nagashima T, Suzuki M, Oshida M, et al. Morphometry in the cytologic evaluation of thyroid follicular lesions. Cancer 1998;84:115–118.
15. Kini SR, Miller JM, Hamburger JI, Smith-Purslow MJ. Cytopathology of follicular lesions of the thyroid gland. Diagn Cytopathol 1985;1:123–132.
16. Kelman AS, Rathan A, Leibowitz J, Burstein DE, Haber RS. Thyroid cytology and the risk of malignancy in thyroid nodules: importance of nuclear atypia in indeterminate specimens. Thyroid 2001;11:271–277.
17. Florentine BD, Staymates B, Rabadi M, Barstis J, Black A. The reliability of fine-needle aspiration biopsy as the initial diagnostic procedure for palpable masses: a 4-year experience of 730 patients from a community hospital-based out-patient aspiration biopsy clinic. Cancer 2006;107:406–416.
18. Dwarakanathan AA, Staren ED, D'Amore MJ, et al. Importance of repeat fine-needle biopsy in the management of thyroid nodules. Am J Surg 1993;166:350–352.
19. Cavallari V, Maiorana A, La Rosa GL, Maiorana MC, Scimone S, Fano RA. Morphometric studies on fine-needle aspirates from follicular proliferative lesions of the thyroid. Pathologica 1989;81:441–446.
20. Faquin WC, Cibas ES, Renshaw AA. "Atypical" cells in fine-needle aspiration biopsy specimens of benign thyroid cysts. Cancer 2005;105:71–79.
21. Hayashi N, Kitaoka M. Fine-needle aspiration biopsy of the thyroid nodule: uses and limitations. Nippon Rinshe 2007;65:2003–2007.