Logani S, Gupta P K, LiVolsi V A, Mandel S, Baloch Z W
Division of Cytopathology, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Diagn Cytopathol. 2000 Dec;23(6):380-5. doi: 10.1002/1097-0339(200012)23:6<380::aid-dc3>3.0.co;2-0.
Thyroid nodules diagnosed as follicular neoplasm on fine-needle aspiration biopsy (FNAB) may represent hyperplastic/adenomatous nodules, follicular adenoma or carcinoma, and follicular variants of papillary thyroid carcinoma (FVPTC) on histologic follow-up. In our laboratory, we attempted to identify a subset of cases which showed cellular specimens with focal features (nuclear chromatin clearing, membrane thickening, and rare grooves) suspicious for the follicular variant of papillary thyroid carcinoma. These cases are reported as follicular-derived neoplasms with nuclear features suspicious for FVPTC to distinguish them from those diagnosed as follicular neoplasm. This study documents our experience with 52 cases so diagnosed and followed prospectively with histologic follow-up. A neoplastic nodule was confirmed in 45/52 cases (86%), of which 40 were malignant (77%). FVPTC was identified in 35/52 cases (67%). Four cases were usual papillary carcinoma, 3 were follicular adenoma, 2 were Hürthle-cell adenoma, and 1 was insular carcinoma. In 7 cases, the subsequent histologic findings were nonneoplastic (5 hyperplastic nodules and 2 colloid nodules). Our prospective study shows that in cellular smears from thyroid nodules, a careful search for the nuclear features of papillary carcinoma should be performed, and it is appropriate to diagnose cases as suspicious for FVPTC if the nuclear features of papillary carcinoma are focal. The surgical management of this group may include an intraoperative confirmation of cytologic diagnosis by scrape preparation and/or frozen section in order to avoid a second surgical intervention for completion thyroidectomy.
在细针穿刺活检（FNAB）中被诊断为滤泡性肿瘤的甲状腺结节，在组织学随访中可能表现为增生性/腺瘤性结节、滤泡性腺瘤或癌，以及甲状腺乳头状癌的滤泡变体（FVPTC）。在我们实验室，我们试图识别出一部分病例，这些病例的细胞标本具有局灶性特征（核染色质清晰、膜增厚和罕见的沟），怀疑为甲状腺乳头状癌的滤泡变体。这些病例被报告为具有可疑FVPTC核特征的滤泡源性肿瘤，以将它们与诊断为滤泡性肿瘤的病例区分开来。本研究记录了我们对52例如此诊断并进行前瞻性组织学随访的经验。52例中有45例（86%）确诊为肿瘤性结节，其中40例为恶性（77%）。52例中有35例（67%）确诊为FVPTC。4例为普通型乳头状癌，3例为滤泡性腺瘤，2例为嗜酸性细胞腺瘤，1例为岛状癌。7例中，后续组织学检查结果为非肿瘤性（5例增生性结节和2例胶样结节）。我们的前瞻性研究表明，在甲状腺结节的细胞涂片中，应仔细寻找乳头状癌的核特征，如果乳头状癌的核特征为局灶性，则将病例诊断为可疑FVPTC是合适的。该组患者的手术处理可能包括术中通过刮片制备和/或冰冻切片对细胞学诊断进行确认，以避免因行甲状腺全切术而进行二次手术干预。
