Fine Needle Aspiration Cytology of Hurthle Cell Carcinoma of the Thyroid Ppt Powerpoint Presentation slides Howard Her-Jung Wu, M.D. Medical Slideshow Fine Needle Aspiration Cytology Of Hurthle Cell Carcinoma of the Thyroid

Fine Needle Aspiration Cytology of Hurthle Cell Carcinoma of the Thyroid

Rating :

Rate It:

Send This

Download

Comment

Favourite

more

Post To:

Facebook

Twitter

Digg

Delicious

more share options

There is no comments now for this Slide.

Post a comment

Post Comment on Twitter Post Comment on SlideWorld

Comments:

Subscribe to follow-up comments

Notes

Show Notes

Slide 1 :

Fine-Needle Aspiration Cytology of Hürthle Cell Carcinoma of the Thyroid Howard Her-Juing Wu, M.D. Ball Memorial Hospital, Muncie, IN

Slide 2 :

Hürthle Cell (Oncocytic) Large polygonal cells with eosinophilic granular cytoplasm, derived from follicular epithelium Ultrastructurally shows numerous large mitochondria Originally described by Dr. Karl Hürthle, a German Histologist in 1894 Hürthle cells are not specific to any pathology Other than neoplasms, can be found in nodular goiter, Hashimoto’s thyroiditis, long standing hyperthyroidism, in thyroid of elderly persons, in the thyroid of patients who have received radiation

Slide 3 :

Hürthle cell neoplasm A follicular neoplasm composed exclusively or predominantly (>75%) of Hürthle cells or oncocytic cells

Slide 4 :

Fine-needle aspiration cytology (FNAC) of Hürthle cell neoplasm Cellular specimen with monomorphic, oncocytic cells arranged in syncytial, cohesive clusters or dispersed single cells (Non-macrofollicular architecture) > 90% Hürthle cells : Variable sized polygonal cells with abundant granular cytoplasm Nuclei are round, eccentrically or centrally located with finely granular chromatin and a single prominent nucleoli Scant or absent colloid Absence of lymphoid cells Elliott et al. Cancer Cytopathology 2006;108:102-9

Slide 5 :

Hürthle cell neoplasm, FNAC

Slide 6 :

Hürthle Cell Carcinoma Hürthle cell neoplasm with histologically detected clearcut vascular invasion and capsular penetration

Slide 7 :

Hürthle cell carcinoma

Slide 8 :

FNAC of Hürthle Cell Carcinoma (Renshaw) Predominantly Hürthle cells and scant colloid with at least one of 4 following features 1. Small cell dysplasia bland nuclei with cell diameter less than twice the nuclear diameter 2. Large cell dysplasia Greater than 2 times nuclear size variation Irregular nuclear membrane and prominent nucleoli 3. Nuclear crowding Cells with overlapping nuclei 4. Dyshesion (single cells) Renshaw AA. Cancer Cytopathol 2002;96:261-6

Slide 9 :

Small cell dysplasia

Slide 10 :

Large cell dysplasia

Slide 11 :

Nuclear crowding

Slide 12 :

Dyshesion

Slide 13 :

FNAC Hürthle Cell Carcinoma

Slide 14 :

Objectives To evaluate Renshaw’s criteria in our material A semiquantitative approach to compare a group of FNA cases that were diagnosed as either Hürthle cell neoplasms or Hürthle cell lesions. Compare cytologic features that may be able to distinguish between Hürthle cell carcinoma (HCC), Hürthle cell adenoma (HCA) and benign nonneoplastic Hürthle cell lesions (BNHCL)

Slide 15 :

Materials and Methods 35 FNA cases with diagnoses of either Hürthle cell lesion or Hürthle cell neoplasm were retrieved. All cases were followed by surgical excision. Cases include 12 HCC, 14 HCA and 9 BNHCL Demographic data: 9 men (one individual with 2 separate aspirates) and 25 women; age range from 29 to 90 years

Slide 16 :

Materials and Methods 8 cytologic features in addition to age, gender and size were analyzed in each FNA Lymphocytes Colloid Transgressed blood vessels Nuclear enlargement Small cell dysplasia Large cell dysplasia Nuclear crowding Cellular dyshesion

Slide 17 :

Individual cytologic features were scored according to the quantity of the cytologic changes Scoring criteria for cytologic features ______________________________________________________________ Score 0 1 Lymphocytes Scant Numerous Colloid Scant Abundant Transgressed blood vessels Absent Present ______________________________________________________________ Score 1 2 3 Nuclear enlargement <5% 6-50% >50% Small cell dysplasia <5% 6-50% >50% Large cell dysplasia <5% 6-50% >50% Nuclear crowding <5% 6-50% >50% Cellular dyshesion <5% 6-50% >50% ______________________________________________________________

Slide 18 :

Materials and Methods The data were analyzed using the independent t-test (SPSS software for Window, version 11.5; Chicago, IL)

Slide 19 :

Results: Scoring for cytologic features of Hürthle cell carcinoma (HCC) -1 ______________________________________________________________________________ FNA Histology Age Sex Size (cm) Coll Lym TBV ______________________________________________________________________________ 1. HCL HCC 73 M 5 0 0 1 2. HCL HCC 57 F 1.5 0 0 0 3. HCN HCC 90 F 2.6 0 0 1 4. HCN HCC 63 M 8.5 0 0 1 5. HCL HCC 58 F 2 0 0 0 6. HCN HCC 77 M 6 0 0 0 7. HCN HCC 67 M 5 0 0 0 8. HCN HCC 47 F 3 0 0 1 9. HCN HCC 68 M 8 0 0 1 10. HCL HCC 40 M 1.8 0 0 0 11. HCN HCC 40 M 1.5 0 0 1 12. HCN HCC 75 M 3.7 0 0 1 Average 62.92 M/F= 2/1 4.05 ______________________________________________________________________________ Coll: Colloid; Lym: Lymphocytes; TBV: Transgressed blood vessels

Slide 20 :

Scoring for cytologic features of Hürthle cell carcinoma (HCC) - 2 NE SCD LCD NC Dys 1. 3 1 2 3 2 2. 2 2 1 3 2 3. 3 1 2 3 2 4. 3 1 3 3 2 5. 2 1 2 2 3 6. 2 1 2 2 3 7. 3 1 2 2 3 8. 3 1 3 3 2 9. 2 3 2 3 2 10. 3 2 2 3 2 11. 3 2 2 3 2 12. 3 2 2 3 1 NE: Nuclear enlargement; SCD: Small cell dysplasia; LCD: Large cell dysplasia; NC: Nuclear crowding; Dys: Dyshesion

Slide 21 :

Table 2 Scoring for cytologic features of Hürthle cell adenoma (HCA) -1 13. HCL HCA 29 F 1.5 0 0 1 14. HCN HCA 68 F 7 0 0 0 15. HCN HCA 42 F 3 0 0 1 16. HCN HCA 71 F 5 0 0 0 17. HCN HCA 72 F 8.5 0 0 1 18. HCN HCA 79 F 5.6 0 0 0 19. HCN HCA 72 M 8.5 0 0 0 20. HCN HCA 90 F 2.8 0 0 1 21. HCN HCA 44 F 2.3 0 0 0 22. HCL HCA 55 F 1 1 0 1 23. HCL HCA 55 F 1 0 0 0 24. HCN HCA 43 F 1.5 0 0 1 25. HCN HCA 83 F 1.5 1 0 1 26. HCN HCA 68 F 1 0 0 0 Average 62.21 M/F= 1/13 3.59 _________________________________________________________________ Coll: Colloid; Lym: Lymphocytes; TBV: Transgressed blood vessels FNA Histology Age Sex Size (cm) Coll Lym TBV _______________________________________________________________

Slide 22 :

Scoring for cytologic features of Hürthle cell adenoma (HCA) - 2 NE SCD LCD NC Dys 13. 2 1 1 3 1 14. 3 1 2 2 2 15. 2 1 1 3 1 16. 2 1 1 2 1 17. 3 1 2 2 2 18. 2 2 1 3 1 19. 3 1 2 2 2 20. 3 1 2 2 2 21. 3 1 2 3 1 22. 2 1 1 2 2 23. 2 2 1 3 1 24. 3 1 2 2 2 25. 3 1 2 2 2 26. 3 1 2 2 2 NE: Nuclear enlargement; SCD: Small cell dysplasia; LCD: Large cell dysplasia; NC: Nuclear crowding; Dys: Dyshesion

Slide 23 :

27. HCN Goiter 57 F 3 1 0 1 28. HCL Goiter 76 F 2.7 1 1 0 29. HCL HT 54 F 1 0 1 0 30. HCL HT 63 M 3.5 0 1 0 31. HCN HT 42 F 2 0 1 0 32. HCN Goiter/HT 50 F 4.1 0 1 1 33. HCL HT 45 F 1 0 1 0 34. HCN Goiter/HT 54 F 3.5 0 1 0 35. HCN Goiter 49 F 5 1 1 1 Average 54.44 M/F= 1/8 2.87 _________________________________________________________________ Coll: Colloid; Lym: Lymphocytes; TBV: Transgressed blood vessels FNA Histology Age Sex Size (cm) Coll Lym TBV ___________________________________________________________________________________ Scoring for cytologic features of Benign nonneoplastic Hürthle cell lesion - 1

Slide 24 :

Scoring for cytologic features of Benign nonneoplastic Hürthle cell lesion - 2 NE SCD LCD NC Dys 27. 2 1 1 0 1 28. 2 1 1 1 0 29. 2 1 0 1 0 30. 2 1 0 1 0 31. 2 1 0 1 0 32. 2 1 0 1 1 33. 2 1 0 1 0 34. 2 1 0 1 0 35. 2 1 1 1 1 NE: Nuclear enlargement; SCD: Small cell dysplasia; LCD: Large cell dysplasia; NC: Nuclear crowding; Dys: Dyshesion

Slide 25 :

Comparison of criteria between benign and malignant Hürthle cell lesions P value (t-test) HCC vs. HCC vs. HCA vs. HCC vs. HCA BNHCL BNHCL HCA + BNHCL ____________________________________________________________ Colloid 0.187 0.008 0.118 0.05 Lymphocytes NA <0.001 <0.001 0.019 Transgressed 0.687 0.279 0.454 0.419 Blood vessels Nuclear enlargement 0.635 0.001 0.003 0.076 Small cell dysplasia 0.099 0.040 0.255 0.016 Large cell dysplasia 0.018 0.012 0.952 0.004 Nuclear crowding 0.047 <0.001 0.022 0.002 Cellular dyshesion 0.010 0.297 0.190 0.025 Age 0.916 0.169 0.251 0.501 Sex 0.001 0.009 0.755 <0.001 Tumor size 0.660 0.048 0.012 0.650 HCC: Hürthle cell carcinoma; HCA: Hürthle cell adenoma; BNHCL: Benign non-neoplastic Hürthle cell lesion

Slide 26 :

Hürthle Cell Carcinoma (HCC) vs. Hürthle Cell Adenoma (HCA) Men were much more likely to have malignant lesions than women when diagnosed with Hürthle cell lesion/neoplasm by FNA (p = 0.001). In our study, 8 of the 12 HCC were found in men whereas all but one (13/14) of the HCA were diagnosed in women. Malignant lesions displayed a greater percentage of large cell dysplasia (p=0.018), nuclear crowding within clusters of cells (p=0.047), and cellular dyshesion (p=0.01). Transgressed blood vessels within clusters of cells, nuclear enlargement, and small cell dysplasia were not found to be statistically more common in malignant cases

Slide 27 :

Hürthle Cell Carcinoma (HCC) vs. Benign Nonneoplastic Hürthle Cell Lesions (BNHCL) The presence of abundant colloid and numerous lymphocytes were reliable indicators of BNHCL. None of the 12 cases of HCC contained more than scant colloid and lymphocytes, while numerous lymphocytes were found in 8 of 9 BNHCL and abundant colloid was found in 3 of 9 BNHCL. HCC had statistically larger mean tumor size than BNHCL (4.05 cm vs 2.87 cm, p = 0.048). None of the BNHCL was larger than 5 cm in size, while 3 of 12 HCC were larger than 5 cm. The presence of nuclear enlargement, either small cell or large cell dysplasia, and nuclear crowding favored HCC.

Slide 28 :

Hürthle Cell Adenoma vs. Benign Nonneoplastic Hürthle Cell Lesions (BNHCL) Lymphocytes strongly favored BNHCL (p<0.001) as they were present in 8/9 of these lesions and absent in all cases of HCA. The second useful criterion was nuclear enlargement (p=0.003) which was more prevalent in HCA than BNHCL. HCA had statistically larger mean tumor size than BNHCL (3.59 cm vs 2.87 cm, p = 0.012). None of the BNHCL was larger than 5 cm in size, while 3 of 14 HCA were larger than 5 cm

Slide 29 :

Hürthle Cell Carcinoma (HCC) vs. Benign lesions including both Hürthle Cell Adenoma and Benign Nonneoplastic Hürthle Cell Lesions (HCA + BNHCL): Hürthle cell neoplasms are more likely to be malignant in men than in women. (P< .001) Useful cytologic features to distinguish HCC from benign Hürthle cell lesions (both HCA and BNHCL) include small cell (p=0.016) and large cell dysplasia (p=0.004), nuclear crowding (p = 0.002), and cellular dyshesion (p = 0.025). The presence of abundant lymphocytes and colloid favored HCA/BNHCL

Slide 30 :

Conclusions: 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 (either adenoma or carcinoma) than BNHCL. Wu HH, Clouse J, Ren R. Fine-needle aspiration cytology of Hürthle cell carcinoma of the thyroid. Diagn Cytopathol. 2008;36:149-154

Slide 31 :

Discussion The risk factors for Hürthle cell carcinoma include cytologic features of large cell dysplasia, small cell dysplasia, dyshesion (single cells), and nuclear crowding. In addition, male sex and large tumor size also increase the risk for Hürthle cell carcinoma. Older age is associated with higher risk for Hürthle cell carcinoma in some studies but not in our findings.

Slide 32 :

Discussion In our practice, we diagnose a group of Hürthle cell neoplasms with cytologic features of Hürthle cell carcinoma on FNA as “Hürthle cell neoplasm suspicious for Hürthle cell carcinoma” and recommend surgical excision. However such diagnosis requires a second opinion because of a high degree of interobserver variability in the interpretation of FNA showing predominantly Hürthle cells.

Slide 33 :

Discussion For FNA with Hürthle cell lesion without atypia, the findings raise the possibility of a Hürthle cell neoplasm, but the lack of atypia suggest it is benign, clinical follow-up with ultrasound in 6-18 months is an option. However, the final management decision should be determined by both patients and physicians after the risk factors such as tumor size, scanning findings, gender and age have been considered.

Slide 34 :

Thank You !

	wuh@palab.com 1 Years ago. Category: Pathology

Tags:	Pathology

Embed:
314 Views, 0 favourite
PowerPoint Presentation on Fine Needle Aspiration Cytology of Hurthle Cell Carcinoma of the Thyroid more PowerPoint Presentation on Fine Needle Aspiration Cytology of Hurthle Cell Carcinoma of the Thyroid or PowerPoint Presentation on Describe cytologic criteria for diagnosis of Hurthle cell carcinoma of the thyroid less

SWINE Flu

Why do women live longer then men? Humor

History of Medicine

Yoga and Medicine

How to be a Successful Interventional Fellow size 50 MB

Cardiac Pathology

Hypertension: New Concepts, Guidelines, and Clinical Management

Diabetes Pathology

Medical Powerpoint Templates
(20% Dicsount For Student/Faculty)