Follicular thyroid adenoma, abbreviated FTA, is a benign lesion of the thyroid gland. Adenomatous nodule. Semin Diagn Pathol. 2019 Mar 5;3(4):791-800. doi: 10.1210/js.2018-00427. Thyroid ... without distinct or prevalent thyroid nodules. Answer. This article will help you read and understand your pathology report for follicular adenoma of the thyroid gland. A preoperative FNA diagnosis was available in 10 histologically proven cases of HT. J Endocr Soc. Epub 2017 Jun 21. HT coexisted with follicular adenoma (FA) in 6 cases, follicular variant of papillary carcinoma (FVPC) in 1 case, and goitrous nodule (GN) in 2 cases. Burned-out seminoma revealed by solitary rib bone metastasis. 2001 May;18(2):99-103. Although the architectural features suggest a follicular neoplasm, some nuclear features raise the possibility of an invasive follicular variant of papillary carcinoma or noninvasive follicular thyroid neoplasm with papillary-like nuclear features; distinction between these entities is not cytologically possible. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is an indolent thyroid tumor that was previously classified as an encapsulated follicular variant of papillary thyroid carcinoma, necessitating a new classification as it was recognized that encapsulated tumors without invasion have an indolent behavior, and may be over-treated if classified as a type of cancer. Background: Noninvasive encapsulated follicular variant of papillary thyroid carcinoma (noniEFVPTC) has low risk of adverse outcome in adults, warranting reclassification as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). 2016 Sep;37(5):465-72. doi: 10.1007/s00292-016-0172-x. 2017 Oct;46(10):1415-1420. doi: 10.1007/s00256-017-2701-y. Follicular patterned lesions (nodular goiter, follicular adenoma, follicular variant of papillary carcinoma, follicular carcinoma and noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)) have overlapping cytomorphologic features and cannot be accurately distinguished by fine needle aspiration alone Prevention and treatment information (HHS). Microscopic, immunohistochemical, and molecular analyses of the thyroid lesions were realized. Privacy, Help This can be avoided if the procedure is performed by the pathologist and the aspiration is done on the nodule only. Indeed, aspiration on and around the thyroid nodule helps in sampling HT. Accessibility This study analyzes the cause of this poor correlation between cytology and histology. Gross: Solitary encapsulated tumor of variable size. It is a firm or rubbery, homogeneous, round or oval tumor that is surrounded by a thin fibrous capsule. Non-invasive follicular thyroid neoplasm with papillarylike nuclear features (NIFTP) is a new name for a very low risk thyroid tumor previously known as an Encapsulated Non-invasive Follicular Variant Papillary Thyroid Carcinoma. A follicular adenoma is a common neoplasm of the thyroid gland. All patients except two who died of other diseases were free of thyroid disease after initial surgery. Diagn Cytopathol. All cases of HT diagnosed by fine-needle aspiration (FNA) and/or histology over a 7-yr period were retrospectively studied. 30100 Telegraph Road, Suite 408, Bingham Farms, Michigan 48025 (USA). However, HT may dominate the smear and obscure neoplasia. Diagn Cytopathol. Follicular adenoma Follicular adenoma (FA) is defined as a benign, encapsulated, non-invasive thyroid tumour differentiating towards follicular epithelium and lacking the nuclear features of papillary thyroid carcinoma. There are different patterns like. Follicular thyroid adenoma is more commonly found in women, increases in incidence with increasing age and in regions in which the diet is iodine deficient 3. HT coexisted with follicular adenoma (FA) in 6 cases, follicular variant of papillary carcinoma (FVPC) in 1 case, and goitrous nodule (GN) in 2 cases. Follicular neoplasm of the thyroid--vanishing cytologic diagnosis? Therefore, the presence of a coexistent neoplasm or goitrous nodule reduced the chances of sampling HT by 85.7%, with no false-negative results. We describe spindle cell proliferations in 10 patients arising in association with papillary carcinoma and follicular adenoma. Thyroid carcinoma with follicular differentiation but no papillary nuclear features ( Hürthle cell (oncocytic) carcinoma is discussed separately) Comprises 6 - 10% of thyroid carcinomas. Definition / general. Visual survey of surgical pathology with 11226 high-quality images of benign and malignant neoplasms & related entities. The tumor … Aspirates of thyroid nodules composed of follicular cells arranged in a predominantly macrofollicular pattern and lacking nuclear features of PTC are benign, and we diagnose them as adenomatous nodules (Figures 6.2-6.9). Co-expression of CK19/CD56 provided 100% sensitivity and 92% diagnostic accuracy in differentiating follicular variant of PTC from follicular adenoma. follicular variant PTC from FA in equivocal cases. 2011 Dec;150(6):1234-41. doi: 10.1016/j.surg.2011.09.006. Concomitant papillary thyroid carcinoma and Hashimoto's thyroiditis. Silva de Morais N, Stuart J, Guan H, Wang Z, Cibas ES, Frates MC, Benson CB, Cho NL, Nehs MA, Alexander CA, Marqusee E, Kim MI, Lorch JH, Barletta JA, Angell TE, Alexander EK. Coexisting Hashimoto's thyroiditis with differentiated thyroid cancer and benign thyroid diseases: indications for thyroidectomy. FNA diagnosed accurately the coexisting lesions in 6 cases; 3 FA, 1 FVPC, and 2 GN, but it did not sample HT. Please enable it to take advantage of the complete set of features! By autopsy findings, FAs have been reported in 3–5% of adults. Pathologe. Does Hurthle cell lesion/neoplasm predict malignancy more than follicular lesion/neoplasm on thyroid fine-needle aspiration? Objectives To use immunohistochemical (IHC) evaluation of proteins encoded by genes that were differentially expressed in follicular thyroid adenomas (FAs) vs follicular thyroid carcinomas (FTCs) to distinguish benign vs malignant follicular thyroid lesions. Quick facts: Follicular adenoma is a non-cancerous thyroid gland tumour. Cellular aspirate composed predominantly of crowded uniform cells without colloid. According to several large studies, the surgical pathologist renders a non-neoplastic diagnosis in ∼20-40% of thyroid fine-needle aspiration (FNA) cases reported as follicular neoplasm. This can be reduced by avoiding the diagnosis of FN in the presence of follicular-cell pleomorphism and/or moderate to excessive numbers of lymphoid cells, provided proper aspiration technique is maintained. Microfollicles but nuclear irregularity (grooves, chromatin clearing, pseudoinclusions) are present, Trabecular or microfollicular pattern but nuclei showing salt and pepper chromatin, When located within the thyroid parenchyma and aspirated as a thyroid nodule, fine needle aspiration may be misdiagnosed as follicular neoplasm (, Noninvasive follicular thyroid neoplasm with papillary-like nuclear features, Follicular adenoma or follicular carcinoma, Invasive follicular variant of papillary carcinoma or noninvasive follicular thyroid neoplasm with papillary-like nuclear features. A false-positive diagnosis of follicular neoplasm (FN) that led to unnecessary thyroidectomies was given in 3 cases. Careers. A follicular adenoma is a benign encapsulated tumor of the thyroid gland. Nishisho T, Sakaki M, Miyagi R, Takao S, Sairyo K. Skeletal Radiol. Introduction: The term ectopic thyroid refers to the presence of thyroid tissue located far from its usual anatomic placement and with no vascular connection to the main gland. by Jason Wasserman, MD PhD FRCPC, reviewed on September 28, 2020. Insufficient dietary iodine is a risk factor. Incidence of neoplasia in Hashimoto's thyroiditis: a fine-needle aspiration study. In one case, FNA diagnosed correctly both HT and the coexisting FA. 2007 Aug;35(8):525-8. doi: 10.1002/dc.20676. Pathology eCollection 2019 Apr 1. This website is intended for pathologists and laboratory personnel but not for patients. Th We welcome suggestions or questions about using the website. Which lesion is not included in follicular neoplasm / suspicious for a follicular neoplasm category? 1. This … The impact of presence of Hashimoto's thyroiditis on diagnostic accuracy of ultrasound-guided fine-needle aspiration biopsy in subcentimeter thyroid nodules: A retrospective study from FUSCC. Features suggest a follicular neoplasm but the possibility of a parathyroid lesion cannot be excluded. Results: The thyroid was multinodular, showing one papillary microcarcinoma, five follicular adenomas, three adenolipomas, 46 tiny adenomatous nodules (microadenomas), scattered foci of adipose tissue, and lymphocytic thyroiditis. Unable to load your collection due to an error, Unable to load your delegates due to an error. NCI CPTC Antibody Characterization Program. Dx / category: suspicious for a follicular neoplasm. National Library of Medicine FOIA Microscopy: It is a very well encapsulated tumor, enveloped by a thin fibrous capsule. Nuclear pleomorphism was observed in none of the follicular adenomas. The overall incidence of thyroid carcinoma has increased more rapidly than that of any other malignancy in recent years, especially in women, from 1.3 per 100 000 in 1935 to 16.3 per 100 000 in 2008. This site needs JavaScript to work properly. Our objectives were to study the types and incidence of thyroid follicular lesions coexisting with Hashimoto's thyroiditis (HT), the pitfalls in their cytodiagnosis, and the effect on management. Epub 2017 Apr 5. Thyroid-like follicular carcinoma of the kidney (TLFCK) is a provisional new entity of renal cell carcinoma (RCC). Cut section it is solid and fleshy. Causes of misdiagnoses by thyroid fine-needle aspiration cytology (FNAC): our experience and a systematic review. [Fine-needle aspiration (FNA) of the thyroid gland : Analysis of discrepancies between cytological and histological diagnoses]. Follicular Adenoma- Thyroid. 8600 Rockville Pike Spindle cell proliferations of the thyroid have been described in association with reactive processes and aggressive malignant neoplasms. The Impact of Hashimoto Thyroiditis on Thyroid Nodule Cytology and Risk of Thyroid Cancer. Cancer Med. Thyroid adenomas are benign neoplasms, which are usually classified as follicular or papillary. Tumors were positive for thyroglobulin, thyroperoxidase, pendrin, cyclin D1, … Comparing FVPTC with follicular carcinoma, sensitivity and diagnostic accuracy increased to 100% and 91.7% respectively. Diagn Pathol. The tumor is composed of closely packed follicles. Follicular Adenoma Focused Follicular Adenoma with stained slides of pathology. However, we cannot answer medical or research questions or give advice. The spindle proliferations were 0.3 to 3.0 cm in size, constituted from 1% to 95% of the primary neoplasm, and were either admixed with the … Which histological diagnosis is most likely to correspond with this cytologic aspirate? Multiple gene microarray studies suggest that benign and malignant follicular thyroid neoplasms have different gene expression profiles. Stage I (T1, N0, M0): The tumor is 2 cm or less across and has not grown outside the thyroid (T1). These nodules are characterized by a predominance of macrofollicles such as the one shown here. Gao L, Ma B, Zhou L, Wang Y, Yang S, Qu N, Gao Y, Ji Q. Oncocytic follicular cells in the thyroid, known as Hürthle cells, are characterised by large size, polygonal to square shape, distinct cell borders, voluminous granular and eosinophilic cytoplasm, and a large, often hyperchromatic nucleus with prominent “cherry pink” macronucleoli. Follicular nodules are the most commonly encountered problems in the surgical pathology of the thyroid. These lesions can be classified along the full spectrum of thyroid pathology from hyperplastic nodules to benign follicular adenomas and malignant follicular carcinomas and follicular … Diagn Cytopathol. Clipboard, Search History, and several other advanced features are temporarily unavailable. The overall incidence rates of thyroid neoplasm and goitrous nodules coexistent with HT were 15% and 3.5%, respectively. Of the 234 aspirates with follow‐up, surgical pathology reported 130 cases (55.6%) of follicular adenoma, 15 cases (6.4%) of follicular carcinoma, 14 cases (6.1%) of follicular variant of papillary carcinoma, and 75 cases (32.3%) of nodular goiter. lack of iodine in the diet) and genetic factors (often with autosomal dominant inheritance). The adjacent thyroid tissue will usually be compressed. Keywords: CD56, papillary thyroid carcinoma, follicular adenoma, benign thyroid lesions Address for correspondence: Nurismah Md Isa, Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM) Medical Centre, It has not spread to nearby lymph nodes (N0) or distant sites (M0). Follicular adenomas are encountered approximately 5 times more frequently than follicular carcinomas 2. Dalquen P, Rashed B, Hinsch A, Issa R, Clauditz T, Luebke A, Lüttges J, Saeger W, Bohuslavizki KH. Papillae, invasion or cytological features of papillary thyroid carcinoma are required” in the 2017 WHO classification (the 4th edition). 2006 May;34(5):330-4. doi: 10.1002/dc.20440. The patients ranged in age from 32 to 74 years (mean: 55.8 years), and the mean follow‐up period was 11.0 years. The overlapping cytological features of FN and HT were the main causes of false-positive results. In two autopsy series, the incidence of thyroid adenoma was 3 and 4.3% [1, 2]. Usually solitary "cold" nodule on radionuclide scan. We herein reported and compared one TLFCK case and one PRCC case with thyroid-like feature. A variety of. Cases consisting of oncocytic (Hurthle) cells were excluded from study. The results were compared with those of 30 follicular adenomas and 13 follicular carcinomas. © Copyright PathologyOutlines.com, Inc. Click, Ali: The Bethesda System for Reporting Thyroid Cytopathology - Definitions, Criteria, and Explanatory Notes, 2nd Edition, 2018, atypia of undetermined significance or follicular lesion of undetermined significance (AUS / FLUS), Invasive follicular variant of papillary carcinoma, noninvasive follicular thyroid neoplasm with papillary-like nuclear features, Bethesda category IV, "follicular neoplasm / suspicious for a follicular neoplasm (FN / SFN)" is used for cases with a cellular aspirate comprised of follicular cells showing cell crowding or microfollicle formation (, Cases cytologically suspected for follicular adenoma and follicular carcinoma are included, Final diagnosis is based on tissue histology because capsular or vascular invasion are essential criteria, Follicular patterned lesions (nodular goiter, follicular adenoma, follicular variant of papillary carcinoma, follicular carcinoma and noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)) have overlapping cytomorphologic features and cannot be accurately distinguished by fine needle aspiration alone, Some definitions and criteria for this category were slightly modified in the latest edition of the, Includes cases with most of the follicular cells are arranged in cell crowding or microfollicle formation, Frequency 2.3 - 2.9%, resection rate 41.8 - 45.0%, risk of malignancy 25 - 40%, Most common histopathological diagnosis is follicular adenoma, followed by adenomatous nodule, follicular variant of papillary carcinoma and follicular carcinoma (, Impossible to distinguish follicular adenoma from follicular carcinoma by fine needle aspiration cytology, Laboratory should choose one preferable term and use it exclusively for this category, Term "suspicious for a follicular neoplasm" may be more convenient than "follicular neoplasm" because some nodular goiter cases are included in this category, Rate of neoplastic lesion after resection: 65 - 85%, 27 - 68%: interpreted histologically as papillary carcinoma, usually follicular variant, Risk of malignancy decreased to 10 - 40% when noninvasive follicular thyroid neoplasm with papillary-like nuclear features is implicated (, Cellular aspirate comprised of follicular cells; most are arranged in an altered architectural pattern characterized by significant cell crowding or microfollicle formation, Sparsely cellular aspirates are excluded from this category and could be interpreted as, Cases that demonstrate suspicious or definitive nuclear features for papillary carcinoma are excluded from this category and should be classified as, Follicular patterned aspirates with mild nuclear changes (swelling, contour irregularity or chromatin clearing) can be classified as follicular neoplasm / suspicious for a follicular neoplasm if true papillae and intranuclear cytoplasmic inclusions are absent, Invasive follicular variant of papillary carcinoma or noninvasive follicular thyroid neoplasm with papillary-like nuclear features can be represented in this category (, 21 year old man with multifocal follicular thyroid carcinoma following radiotherapy for Hodgkin disease (, 30 year old woman with mucin producing microfollicular adenoma of the thyroid (, 39 year old woman with follicular thyroid adenoma showing numerous intracytoplasmic lumina mimicking yellow bodies (, 45 year old man with follicular thyroid carcinoma and clinical hyperthyroidism showing due to functioning metastases (, 75 year old woman with follicular carcinoma of the thyroid metastasizing to the breast (, Atypical follicular cell architecture (cell crowding, microfollicles, trabecular and dispersed isolated cells), Microfollicle is a flat group of < 15 follicular cells arranged in a circle that is at least two thirds complete (, Follicular cells are normal sized or enlarged and relatively uniform, with scant or moderate amount of cytoplasm, Nuclei are usually round and slightly hyperchromatic, with inconspicuous nucleoli, Some nuclear atypia may be seen, either enlarged, variably sized nuclei and prominent nucleoli or enlarged nuclei with nuclear contour irregularity and mild or focal chromatin clearing, Colloid is scant or absent but a small amount of inspissated colloid may be present within the microfollicle, Foamy histiocytes are not common unless the neoplasm is large, Hürthle cell predominant cases should be classified as follicular neoplasm, Hürthle cell type or suspicious for a follicular neoplasm, Hürthle cell type. Follicular thyroid cancer in patients 55 years and older. The impact of atypia/follicular lesion of undetermined significance on the rate of malignancy in thyroid fine-needle aspiration: evaluation of the Bethesda System for Reporting Thyroid Cytopathology. 2017 May;6(5):1014-1022. doi: 10.1002/cam4.997. Considered to be a combination of environmental factors (e.g. The main causes of these diagnostic pitfalls were the presence of hyperplastic follicular cells with nuclear pleomorphism, a paucity of lymphoid cells in burned-out HT, and lack of ones exposure. Bethesda, MD 20894, Copyright 2020 Jan 3;15(1):1. doi: 10.1186/s13000-019-0924-z. Figure 6.2. Surgery. The overall incidence rates of thyroid neoplasm and goitrous nodules coexistent with HT were 15% and 3.5%, respectively. stimulating thyroid follicular cell receptors show an enlarged hypervascular thyroid without ... and pathology. In 2 of these, the cytological diagnosis was HT with the possibility of coexisting FN, and in the third case, the cytological finding of HT was misinterpreted as FN. Would you like email updates of new search results? 1996 Feb;14(1):38-42. doi: 10.1002/(SICI)1097-0339(199602)14:1<38::AID-DC8>3.0.CO;2-R. Pu RT, Yang J, Wasserman PG, Bhuiya T, Griffith KA, Michael CW. Head and tail of the Bethesda system for thyroid, Thyroid cancer: fine needle aspiration, malignant or indeterminate results. Follicular thyroid carcinoma is being diagnosed less and less frequently despite the increasing incidence of well-differentiated thyroid carcinomas everywhere. Correlation with clinical, serologic and radiologic findings should be considered. Cellular aspirate of follicular cells with a predominantly microfollicular architecture, scattered isolated cells and scant colloid. It starts from the cells normally found inside the thyroid gland. The former entirely consisted of thyroid-like follicular architecture and the tumor cells wer …

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