Picture of four bone marrow specimens in a slide tray. However, in almost 25%-30% of cases, MTC is inherited, and is associated with one of three familial syndromes: Multiple endocrine neoplasia (MEN) syndrome type 2A (Sipples syndrome), MEN type 2B (mucosa neuroma syndrome or Gorlins syndrome), and familial MTC[35]. Moses W, Weng J, Sansano I, Peng M, Khanafshar E, Ljung BM, Duh QY, Clark OH, Kebebew E. Molecular testing for somatic mutations improves the accuracy of thyroid fine-needle aspiration biopsy. RV The FNA specimens show enlarged follicular cells arranged in monolayer sheets and follicular groups in a background of thin and thick colloid (Figure (Figure6).6). Fadda A: Probably, yes. Therefore, detailed neuronal morphology is required to understand normal neuronal function . Two-dimensional fixed tissue specimens from the biopsy and clot are easily stained with immunohistochemical methods while three-dimensional, liquid cellular content can be assessed with flow cytometry. National Center for Biotechnology Information Search for other works by this author on: Fine-needle aspiration biopsy of thyroid nodules: impact on thyroid practice and cost of care, Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation, The Bethesda System for Reporting Thyroid Cytopathology, 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, The: National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference: a summation, Fine-needle aspiration cytology of the thyroid, 1980 to 1986, Long-term follow-up of patients with benign thyroid fine-needle aspiration cytologic diagnoses, Usefulness of fine-needle aspiration in the diagnosis of thyroid carcinoma: a retrospective study in 37,895 patients, Accuracy of thyroid fine-needle aspiration using receiver operator characteristic curves, Fine-needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations, Accuracy of fine-needle aspiration of thyroid: a review of 6226 cases and correlation with surgical or clinical outcome, Fine-needle aspiration cytology of the thyroid: a 12-year experience with 11,000 biopsies, Non-diagnostic fine-needle aspiration biopsy: a dilemma in management of nodular thyroid disease, Value of repeat fine needle aspiration (FNA) of the thyroid [abstract], Post thyroid FNA testing and treatment options: a synopsis of the National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference, Atypical cells in fine-needle aspiration biopsy specimens of benign thyroid cysts, NCCN thyroid carcinoma practice guidelines, Fine-needle aspiration of follicular lesions of the thyroid: diagnosis and follow-up, Diagnosis of follicular neoplasm: a gray zone in thyroid fine-needle aspiration cytology, Factors that predict malignant thyroid lesions when fine-needle aspiration is suspicious for follicular neoplasm., Thyroid cytology and the risk of malignancy in thyroid nodules: importance of nuclear atypia in indeterminate specimens, Fine-needle aspiration biopsy of the thyroid: an appraisal. As a result they may be not diagnosed through the FNA test, resulting in a false-negative test[44]. Figure 2. How does one separate cellular follicular lesions of the thyroid by fine-needle aspiration biopsy? Perceptions of diagnostic terminology and cytopathologic reporting of fine-needle aspiration biopsies of thyroid nodules: a survey of clinicians and pathologists. In some cases more diffuse but mild nuclear changes may exist with nuclear enlargement, crowding, and pallor, but without other characteristics, such as nuclear contour irregularities, grooves and nuclear pseudoinclusions, suggestive of a PTC. Renshaw AA. S %%EOF Gross specimen was measuring about 2x2x1.5 cm in size, soft in consistency, brownish black in color and roughly oval in shape [Table/Fig-4]. A serum protein electrophoresis might have even shown a monotypic expansion. The malignancy rate of the AUS/FLUS category is estimated to be between 5% and 15%[10], which is intermediate between that of the benign category (0%-3%) and that of the SFN category (15%-30%). Literature reviews were limited to English language publications dating back to 1995, using PubMed as the search engine, with key words determined by the committee members. It is not widely agreed whether this neoplasm is a variant of PTC or not, although it seems to have the same RET gene rearrangements as PTC. Since the PTC-FV variant represents one of the most common causes of a false negative diagnosis of PTC, it is important to distinguish this PTC variant from other benign conditions, such as a follicular neoplasm or adenomatous nodule. "American Society of Hematology. 36.3-50 mL); all 3 scantly cellular specimens had volumes below this median value. Oncocytic cells with nuclear features of papillary carcinoma are excluded from this interpretation. Statistics . H Jo VY, Stelow EB, Dustin SM, Hanley KZ. Additionally an immunohistochemical panel, including thyroglobulin, TTF1, and CDX2 may help in the differential diagnosis of such difficult cases. (A) A representative case classified as diagnostic category (DC) III (atypia of undetermined significance) showing sparsely cellular specimen (x15; scale bar, 200 m). Fine-needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations. Such changes may represent atypical but benign cyst-lining cells, but a papillary carcinoma cannot be entirely excluded (ThinPrep, Papanicolaou stain). Fleisher The nuclei are enlarged, with usually an oval or irregular shape, and include intense nuclear grooves and inclusions. Guidelines for management of thyroid cancer. Issue: Non-Gyn specimen slide is sparsely cellular when ample specimen collected and centrifuged cell pellet is visibly adequate. The hyalinizing trabecular tumor is an uncommon malignancy originating from follicular cells, with certain unique features, such as trabecular growth, marked intracellular hyalinization along with nuclear grooves and pseudoinclusions. Preoperative diagnostic categories of fine needle aspiration - PLOS Q: Can your pathologist give you a preliminary assessment of the aspirate smear or flow cytometry analysis on the same day as a procedure if it was performed early in the morning? ZW S The difficulties in securing diagnosis of a diffuse large B-cell lymphoma derive from the inadequate sampling technique and/or insufficient preservation of the specimen. The most common sites are the lungs, bone, liver and brain. M It allows classification of nodules as benign or malignant, and patients with malignant nodules are scheduled for surgery. The cellular sample is typically monomorphic, although some specimens may appear pleomorphic; the cells are usually small or medium-sized, noncohesive, and contain an eccentrically located nuclei[35]. Theoharis CG, Schofield KM, Hammers L, Udelsman R, Chhieng DC. A: Ideally, no. Liquid-based preparation can also be made after a FNA pass, with the needle been rinsed in normal saline or ThinPrep solutions. Hematology.org.https://www.hematology.org/education/trainees/fellows/trainee-news/2021/demystifying-the-bone-marrow-biopsy-a-hematopathology-primer(label-accessed May 01, 2023). The differential diagnosis includes hyperplastic adenomatous nodules, follicular adenoma, follicular carcinoma, and follicular variant of PTC, where the nuclear features remain ill defined. Piana S, Frasoldati A, Ferrari M, Valcavi R, Froio E, Barbieri V, Pedroni C, Gardini G. Is a five-category reporting scheme for thyroid fine needle aspiration cytology accurate? To help the cells stay on the slide: a. add acetic acid to the fixative b. fix in neutral Benign follicular nodules often have a small population of microfollicles and crowded groups. et al. Marchevsky AM, Walts AE, Bose S, Gupta R, Fan X, Frishberg D, Scharre K, Zhai J. Evidence-based evaluation of the risks of malignancy predicted by thyroid fine-needle aspiration biopsies. The reason is that in approximately 10%-30% of cases, cytology is indeterminate and nondiagnostic[4]. Unless specified as ND/UNS, the FNA specimen is considered adequate for evaluation. Note the trabecular bone (*) with trilineage hematopoiesis including megakaryocytes, granulocytic precursors, and erythroid islands presented in 2D following formalin fixation and paraffin processing. The main purpose of thyroid FNA is to identify patients with higher risk for malignancy, and to prevent unnecessary surgeries for benign conditions. VA If resected, virtually all benign follicular nodules turn out to be nodules of a multinodular goiter or follicular adenomas. VanderLaan PA, Marqusee E, Krane JF. Open in a separate window The hallmark of this diagnostic category is a disturbed cytoarchitecture: follicular cells are arranged predominantly in microfollicular or trabecular arrangements. Some cases may present with diagnostic difficulty if the specimen consists mainly of necrotic debris or if the tumor is extremely sclerotic (the paucicellular variant)[40,53]. The spindle-shaped morphology of these cells is helpful in distinguishing these cells from PTC[24,34]. The site is secure. Atypia of Undetermined Significance/Follicular Lesion of - Springer This is used to immediately make slide preparations on one to 10 pre-prepared glass slides which will be stained, usually within the Giemsa family of stains, to assess cellular morphology (how the cells look), perform a lineage assessment (what cell line they belong to, both by morphology and phenotyping), and provide a complete differential count (500 cells are counted). Baloch Z, LiVolsi VA, Jain P, Jain R, Aljada I, Mandel S, Langer JE, Gupta PK. Review of the literature suggests a malignancy rate of 55%-75% for the suspicious category[8]. The purpose of this diagnostic category is to identify a nodule that might be a follicular carcinoma (FC) and triage it for surgical lobectomy. Accessibility Palpation-guided FNA can be performed when a thyroid nodule is easily palpable (> 1.0 cm in diameter) and rather solid. Apart from imaging studies, serological or immunohistochemical studies can be used to secure diagnosis, when the FNA indicated suspicious for MTC or suspicious for lymphoma. Figure 6. As a result, 3 to 15 glass slides from each patient are taken and examined, which can be either Giemsa- or Papanikolaou-stained slides[14]. The molecular diagnosis and management of thyroid neoplasms. A benign result is obtained in 60% to 70% of thyroid FNAs. . Before AS As a library, NLM provides access to scientific literature. Kinematic comparison between the knee after bicruciate stabilized total knee arthroplasty and the native knee: A cadaveric study. After patient preparation, sedation, and the procedure itself, a bone marrow investigation provides four specimen types for pathologist review (Figure 1): the bone marrow core biopsy, the bone marrow touch imprint, the bone marrow aspirate smear, and the bone marrow clot particle. This category includes specimens with unequivocal cytologic evidence of a malignant neoplasm. In 1966 Williams demonstrated that this tumor derives from the parafollicular cells, known also as calcitonin-producing C cells, which have an ectodermal neural crest origin[47]. Regardless the staining method used, all slides with diagnostic material are used for the evaluation and clarification of each case. The first draft of the committees summary documents was posted on the Web site and open for online discussion from May 1 to June 30, 2007. IR While there are advantages and disadvantages to each component regarding turnaround time, comprehensiveness, and diagnostic utility (Table), their synergism provides ample information for your consultant hematopathologists. RA B) 600 view of trilineage hematopoiesis. CellMapper is a crowd-sourced cellular tower and coverage mapping service. Research is directed to the identification of molecular markers that, in conjunction with FNA, can identify patients with a malignant nodule. Hematoxylin-eosinstained sections of the clot particle. Redman R, Yoder BJ, Massoll NA. Several patterns of nuclear atypia may be also present without being quantitatively and/or qualitatively sufficient for the interpretation of suspicious for malignancy. Salivary Glands and Other Head and Neck Structures et al. The positive predictive value of a malignant FNA interpretation is 97% to 99%. Each diagnostic category is associated with a specific risk of malignancy and a recommendation for management. Renshaw noted that a Hurthle cell neoplasm demonstrating one of the following features: Small cell dysplasia, large cell dysplasia, severe nuclear crowding, and dishesive cellular pattern is usually associated with a high risk of malignancy[33]. Preoperative diagnosis of benign thyroid nodules with indeterminate cytology. Filie AC, Asa SL, Geisinger KR, Logani S, Merino M, Nikiforov YE, Clark DP. The specimen is fixed in paraffin and cut for slide preparation. Centrifuge the specimen again and decant the entire supernatant. Cibas The phenotypic composition of the various marrow components is key to understanding their utility for further investigative diagnostic studies. A minor population of macrofollicles (intact spheres and fragments) can be present. Pu A full molecular panel of BRAF, RAS, RET/PTC and PAX8PPAR offer additional diagnostic value[58]. These specimens demonstrate inadequate cellularity, poor fixation and preservation, obscuring blood or ultrasound gel, or a combination of the above factors. In several countries the Cytological Communities have adopted the first system or the other, as there is still an ongoing dispute on whether the 5-tiered system or the 6-tiered system is more efficient[12]. Oxford University Press is a department of the University of Oxford. The remaining 10% of cases represent a significant subset of thyroid specimens with some form of AUS/FLUS. Hamberger , eds. It usually behaves as an indolent malignant tumor; however, an aggressive clinical course with decreased survival has been reported in some histologic variants of PTC[41]. Thyroid FNA specimen a. Faquin WC, Cibas ES, Renshaw AA. et al. Many laboratories have traditionally considered a macrophages-only sample unsatisfactory and included them in the ND/UNS category, with the understanding that, because the parenchyma of the nodule has not been sampled, one cannot exclude a cystic papillary carcinoma. L Go to: . a. crush method b. cytocentrifuge c. fine needle aspiration d. liquid-based b. cytocentrifuge cytocentrifugation is the most common method of handling sparsely cellular specimens such as urine or spinal fluid Descriptive comments that follow are used to subclassify the malignancy and summarize the results of special studies, if any. The general category malignant is used whenever the cytomorphologic features are conclusive for malignancy. Inadequate cellularity is defined as the presence of less than 6 groups of well-preserved follicular cells on each of at least two slides; (2) DC II Benign (Figure (Figure1).1). Figure 5. Wu HH, Rose C, Elsheikh TM. The specimen is usually cellular with polygonal cells in loose papillary clusters with abundant eosinophilic cytoplasm. The sensitivity of thyroid FNA for medullary thyroid carcinoma (MTC) is considered high, actually it is higher than the sensitivity of FNA for PTC[36]. Within these sections, there are often small areas of hematopoietic material preserved from their original marrow environment. L Whenever a specific diagnosis (eg, lymphocytic thyroiditis) can be rendered and whenever there is any atypia, the specimen is, by definition, adequate for evaluation. Renshaw AA. If the nodule is almost entirely cystic, with no worrisome sonographic features, an endocrinologist might proceed as if the CFO were a benign result. Tyrosine-derived polymeric surfactant nanospheres insert cholesterol in cell membranes. In the World Health Organization classification, Hrthle cell adenoma and Hrthle cell carcinoma are considered oncocytic variants of FA and FC, respectively.24 Studies suggest, however, that follicular and Hrthle cell tumors have different underlying genetics.4,25 For this reason, and because they have such distinctive morphologic features, it is helpful to specify that a sample raises the possibility of a Hrthle cell rather than a follicular neoplasm. The isolated cyst-lining cells in thyroid aspirates are often difficult to distinguish from PTC. The nuclei are hyperchromatic, uniform in size and shape, and with indinstinct nucleoli. Ramzy The Bethesda System for Reporting Thyroid Cytopathology - OUP Academic Weber D, Brainard J, Chen L. Atypical epithelial cells, cannot exclude papillary carcinoma, in fine needle aspiration of the thyroid. Jan 2018 - Present5 years 4 months. ES IB For that reason the aspirate is then classified as AUS/FLUS to indicate the uncertainty of the findings. A) 20 view of the clot. official website and that any information you provide is encrypted The high sensitivity rate, as well as the high negative prognostic value of BRAF testing in AUS/FLUS and SFN/SFN categories have been also demonstrated by Alexander et al[57]. Cytopreparatory Techniques | SpringerLink Dottorini Anaplastic carcinoma of the thyroid. LiVolsi LJ It usually affects the elderly population, and often presents as a large and bulky tumor with extrathyroidal extension and metastases. Impact of mutational testing on the diagnosis and management of patients with cytologically indeterminate thyroid nodules: a prospective analysis of 1056 FNA samples. It is the hope of all contributors to this project that this terminology proposal will be a valuable first step toward uniformity and consensus in the reporting of thyroid FNA interpretations. The following breakdown shines some light inside the black box of hematologic diagnostics and may provide insight into what the hematopathology report tells you. Hematopathologists can assess morphology, histologic architecture, and immunologic and phenotype profiles (Figure 2) across all four components to create a comprehensive report for your patient. The most widely known is the SIAPEC-IAP thyroid reporting system, which is also consists of 5 diagnostic classes[12]. Therefore, the DC III (AUS/FLUS) cases are managed conservatively with repeat FNAs, whereas the DC IV, DC V, and DC VI cases, and TIR 3, TIR 4 and TIR 5 cases respectively, are managed operatively, with thyroid lobectomy or total thyroidectomy. Since the marrow is abundantly deep red and more viscous than blood, the red cell and platelet components will eventually form clots if no anticoagulant is present. . Since it is a two-dimensional specimen and reveals cells in cut section, it is not ideal for assessment of dysplasia (a marrow aspirate is preferred), but it is extremely useful in identifying possible reasons for a dry tap (a term for when liquid marrow cannot be aspirated during the bone marrow procedure), since the architecture can show fibrosis, sheets of cohesive plasma cells, or metastatic tumor which could result in a dry tap. Bongiovanni M, Crippa S, Baloch Z, Piana S, Spitale A, Pagni F, Mazzucchelli L, Di Bella C, Faquin W. Comparison of 5-tiered and 6-tiered diagnostic systems for the reporting of thyroid cytopathology: a multi-institutional study. The FNA specimen of this neoplasm is usually cellular and shows neoplastic cells arranged in papillary groups, or clusters, or as single cells in a background of thick colloid, nuclear or calcific debris, macrophages and stromal fragments[41] (Figure (Figure44). Kelman Clinical, cytologic, and immunohistochemical features of sarcomas Since recurrent PTC typically secretes thyroglobulin, serum monitoring of thyroglobulin serves as a useful tumor marker for recurrent PTC[35]. A moderately or even highly cellular specimen by itself (without significant nuclear or architectural atypia) does not qualify a nodule for an AUS interpretation. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. Free Histology Flashcards about Cytology - StudyStack Clark DP, Faquin WC. Results: We evaluated 5030 thyroid FNAs. Report of the Thyroid Cancer Guidelines Update Group. It also predicted cancer in the majority of indeterminate samples, as well as of the suspicious for cancer samples. The nuclear chromatin appears as salt and pepper type in a medullary carcinoma case ( 40 pap stain on ThinPrep slide) (diagnostic categories VI). When evaluating an undifferentiated carcinoma using immunocytochemistry a basic immunopanel should include cytokeratins, calcitonin, leucocyte common antigen, carcinoembryonic antigen, thyroglobulin, chromogranin, and TTF-1. This website is intended for pathologists and laboratory personnel but not for patients. This is the most common variant of PTC and is characterized by a predominantly follicular architecture. The interpretation of follicular cell atypia is hindered by sample preparation artifact, eg, Air-drying artifact with slight nuclear and cytoplasmic enlargement, pale and slightly smudgy chromatin, and/or mildly irregular nuclear contours. Cellular crowding and overlapping are conspicuous, and the follicular cells are usually larger than normal. The disc is then wrapped in tissue paper and paraffin processed as for a biopsy specimen. To address terminology and other issues related to thyroid FNA, the National Cancer Institute (NCI) hosted the NCI Thyroid Fine Needle Aspiration State of the Science Conference. The meeting was organized by Andrea Abati, MD, and took place on October 22 and 23, 2007, in Bethesda, MD. Figure 3. Fine-needle aspiration (FNA) has an essential role in the evaluation of euthyroid patients with a thyroid nodule. The standard management of PTCs greater than 1 cm is total, or near-total thyroidectomy followed by radioactive iodine (131I) therapy to ablate residual thyroid tissue. hWkO+t{9! x,{d^O*D In: Ali SZ, Cibas ES, editors. Therefore, in the majority of patients in the AUS/FLUS category (72%-80%) the diagnosis will be resolved by repeat FNA, although 20%-28% of them will have AUS/FLUS on the repeat aspirate and thus require surgery. Fine-needle aspiration (FNA) cytology is an important diagnostic tool in patients with thyroid lesions. Patients with sporadic MTC present with a solitary, circumscribed thyroid nodule, usually in the middle to upper-outer half of the thyroid gland. Sarasota Memorial Health Care System. How to Interpret Thyroid Fine-Needle Aspiration Biopsy Reports: A Guide van Heerden et al. In this pattern the nuclear enlargement is generalized in mild-to-moderate degree with evident nuclear grooves and mild nuclear pallor. JR What is the hematopathologist looking for when assembling all the parts to report back in consultation with you? Click, Copyright PathologyOutlines.com, Inc. Click, 30150 Telegraph Road, Suite 119, Bingham Farms, Michigan 48025 (USA). Preparation Methods They can be sparsely cellular, because of the marked fibrosis and hyalinization encountered in some cases[19,51]. ZW Verizon (United States of America)Cell Tower Map - CellMapper WC Listing the acceptable fixatives for use in cytology 5. DA Copyright 2023 American Society for Clinical Pathology. We also evaluated aspects of specimen quality that differed according to the use of ROSE. AA A: No. Melton BRAF is not usually found in the follicular variant of papillary thyroid carcinoma, but is increasingly detectable in each step of dedifferentiation, including tall cell tumors and anaplastic cancer. Moses et al[60] also examined the clinical utility of the above panel in thyroid FNA biopsies. Rubenfeld Taken together, the study results confirmed several tenets of TBSRTC approach to adequacy: 1) A sample should be considered ND/UNS if it is sparsely cellular, even if there are a few groups of. RT Furthermore, spermatid development is likely supported by planar cell polarity (PCP) proteins since polarized spermatids are aligned across the plane of seminiferous epithelium in an orderly fashion, analogous to hair cells in the cochlea of the inner ear. The conclusions regarding terminology and morphologic criteria from the NCI meeting led to the Bethesda Thyroid Atlas Project and form the framework for The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). et al. FOIA Impact of proto-oncogene mutation detection in cytological specimens from thyroid nodules improves the diagnostic accuracy of cytology. 0 A syringe with applied negative pressure gently removes approximately 5 mL of deep red, semi-liquid marrow content. Ohori NP, Singhal R, Nikiforova MN, Yip L, Schoedel KE, Coyne C, McCoy KL, LeBeau SO, Hodak SP, Carty SE, et al. Asa Anaplastic carcinoma of the thyroid: a review of 84 cases of spindle and giant cell carcinoma of the thyroid. Pathology Outlines - Suspicious for malignancy The prognosis of this tumor is good; death due to PTC is rare. The risk of malignancy in the HCLUS category was significantly lower than in the other subtypes of AUS. Agarwal A, Kocjan G. FNAC thyroid reporting categories: value of using the British Thyroid Association (Thy 1 to Thy 5) thyroid FNAC reporting guidelines. The TBSRTC classifies thyroid follicular lesions with microfollicle predominance and lack of colloid into the suspicious for follicular neoplasm category. MTC was first described by Horn et al[45] in 1951, and it was first recognized as a unique clinicopathological entity by Hazard et al[46], in 1959. In addition, Ohori et al[61] investigated the utility of the above panel in specimens classified as FLUS. The FNA specimens should be immediately processed for cytomorphologic analysis. Herein, all histological types of thyroid carcinoma are included: PTC and its variants, medullary carcinoma, anaplastic carcinoma, lymphoma, and metastatic lesions. Determination of cellular phenotype (what the cell expresses on its surface, or in its cytoplasm) on an aspirate is carried out by flow cytometry. Bongiovanni et al[14] analyzed the differences between the 5-tiered and the 6-tiered diagnostic systems for reporting thyroid cytopathology, based in a large series of 7686 thyroid FNA specimens, collected from 3751 patients from several institutions from Italy, Switzerland, and the United States. Frontiers | A Whole-Brain Cell-Type-Specific Sparse Neuron Labeling Its clinical utilization is significant, as it can define whether a recently emerged thyroid nodule should be managed expectantly or surgically, and can assist in selecting the appropriate surgical procedure when necessary[3]. The 2017 Bethesda System for Reporting Thyroid Cytopathology In 2007 the Royal College of Pathologists introduced a new thyroid FNA reporting system, which was based on the existing United Kingdom terminology, but with some alterations, like new subcategories (i.e., c for cystic lesions, a for atypia, f for follicular neoplasm). Effect of the Bethesda system for reporting thyroid cytopathology on thyroidectomy rates and malignancy risk in cytologically indeterminate lesions. O The 6 general diagnostic categories are shown in bold type in Table 1. Rathan Malignancy risk for fine-needle aspiration of thyroid lesions according to the Bethesda System for Reporting Thyroid Cytopathology. (iii) Cytologic and architectural atypia: Inadequate cellularity is defined as the presence of less than 6 groups of well-preserved follicular cells on each of at least two slides; (2) DC II Benign (Figure (Figure1).1). Flat sheets showing enlarged, pale nuclei with finely granular chromatin of a papillary Ca case ( 40 pap stain on ThinPrep slide) (diagnostic categories VI). A complete bone marrow biopsy examination usually involves the review of these four specimens noted here in a slide tray: A) marrow aspirate smear, B) marrow core biopsy, C) clot section, and D) touch imprint preparation. The separation of these four components allows for multiple sources of data collection and offers insurance against otherwise compromised specimens. Yassa Deveci In other cases it is sparsely cellular and contains atypical lymphoid cells. The tumor cells show nuclear elongation, chromatin clearing, but nuclear grooves and inclusions are rare[40]. . ( a) In this sparsely cellular specimen, some cells have abundant cytoplasm, enlarged nuclei, and prominent nucleoli. Aldinger KA, Samaan NA, Ibanez M, Hill CS. Baloch Baloch ZW, LiVolsi VA. Fine-needle aspiration of thyroid nodules: past, present, and future. Jing X, Michael CW, Pu RT. EK Medullary carcinoma is highly metastatic, as tumor cells can be disseminated through hematogenous and metastatic routes to numerous sites, including cervical lymph nodes, liver, lung, bone, and adrenal glands.

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