11.3.09

Papillary Thyroid Ca Criteria in Cytology

Papillary Thyroid Ca Criteria in Cytology (Kini)

5 criteria "Definite"; 4 criteria "Suspicious"; 3 criteria "Follicular Lesion"

Adequate Specimen: 6 clusters of 10-15 cells

1 Syncytial tissue fragments
2 Enlarge nuclei with fine dusty chromatin
3 Multiple micro and or macro nucleoli
4 Intranuclear inclusions
5 Nuclear grooves

Papillary Thyroid Ca Diagnostic Criteria in Histology

4 Major or (3 Major + 4 Minor required)

Major Criteria
1 Nuclei oval (not rounded)
2 Nuclei crowded, manifesting as lack of polarization in cells lining a follicle and overlapping nuclei
3 Pale chromatin esp. at the edge of the tissue where well-fixed
4 Psammoma bodies

Minor Criteria
1 Abortive papillae
2 Elongated or irregular follicles
3 Dark staining colloid
4 Rarely nuclear pseudo inclusion
5 Multinucleated histiiocytes in lumens of follicles
6 Grooves


Ref:
1 Chan JKC Strict criteria should be applied in the diagnosis of encapsulated follicular variant of papillay thyroid ca. AJCP 2002;117:16-18
2 Balock ZW, LiVolsi VA Follicular-patterned lesions of the thyroid. AJCP{ 2002;117:143-150
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2 comments:

Biren Parikh said...

Dear sir,
Kindly specify percentage(%) of criteria for total score.
In how many % cell should have grooves or nucleoli..etc.

Regards,
Biren Parikh

March 12, 2009 at 10:57 PM
Dr.Prashant Jani said...

Hello Dr.Parikh,
Thanks for your email and feed back.

The papers which I refereed in my blog doesn't mention about the percentage of grooves or psedoinclusions required for the diagnosis.
In my practice I usually try to see "convincing" number of inclusions or grooves to consider diagnosis of papillary carcinoma.
Thanks,
regards

Prashant Jani

March 13, 2009 at 9:58 AM

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Interesting Case

Clinical History:

53 years male,History of hypertension and tachycardia,MRI abdomen:-Left adrenal mass:- size 5.8 cm Right renal mass:- size-3.0cm Microscopic examination of the renal mass showed vascular tumor with diffuse sheets of clear cells having Fuhrman grade III nuclei. There was no evidence of necrosis within the tumor. There was no evidence of extraparenchymal invasion.
Gross examination of the left adrenal gland revealed cortically centered, solid and multinodular mass measuring 6.5 x 6.0 x 5.0 cm and weighing 122 grams. The tumor was encapsulated but showed evidence of extraparenchymal penetration. The tumor had golden brown cut surface with areas of hemorrhage and necrosis. The partial nephrectomy showed 3.0cm x 3.0cm x 3.0 cm yellow solid mass which did not invade into the perinephric adipose tissue.
Microscopically, the adrenal mass had predominant diffuse sheets and focal trabecular arrangements. The former pattern was present in about third of tumor. The cells had clear cytoplasm and round to ovoid nuclei with conspicuous nucleoli. Mitotic rate was 9/50 HPF and included atypical forms. Gross necrosis and capsular invasion were documented microscopically. There was no evidence of lymphovascular invasion. Considering the above mentioned features, a Weiss histopathologic score2 of 7/9 was applied.



Discussion:

The differential diagnosis included Renal Cell Carcinoma (RCC) with contralateral adrenal metastasis, Adrenocortical carcinoma (ACC) with contralateral renal metastasis, synchronous RCC and ACC or synchronous RCC and adrenocortical adenoma. A panel of immunohistochemical stains was performed to sort out the diagnosis. Adrenal tumor demonstrated strong Vimentin positivity and is negative for CK7, CK20, E1/AE3, EMA, Synaptophysin and S100.Renal cell carcinoma was positive for CK7, AE1/AE3, EMA (weak) and Vimentin. It was negative for CK20, Synaptophysin and S100. The difference of immunoprofile between the two tumors documented that they originated from two different primaries.

Final Diagnosis:

The diagnosis of synchronous RCC and ACC rather than metastasis influences the prognosis.

Prognosis:

The longest disease free interval after removal of contralateral adrenal metastasis was 12.1 years8 and the longest crude survival was 14.3 years. In contrast non metastazing RCC has an excellent prognosis if no metastasis developed.