Lallu Sharda, Naran Sarla, Bethwaite Peter
Department of Cytology, Anatomic Pathology, Capital and Coast Wellington Hospital, Wellington, New Zealand.
Diagn Cytopathol. 2007 Jul;35(7):439-43. doi: 10.1002/dc.20660.
We discuss two cases of unsuspected metastatic thyroid carcinoma of Hurthle cell type, presenting as subcutaneous masses in the occipital scalp and supra-acetabular region of the right ilium; clinically suspected to be a lipoma and a vascular tumour, respectively. These two cases were initially investigated by fine-needle aspiration cytology. In case 1, a definitive diagnosis of metastatic Hurthle cell carcinoma was made based on cell block preparation and positive immunohistochemical stains for thyroglobulin and thyroid transcription factor-1. Case 2 was reported as suggesting an oncocytic process, metastatic Hurthle cell lesion. The filter preparations from both cases showed compact sheets and individual large polygonal cells with voluminous granular cytoplasm, eccentric nuclei with minimal atypia and bland chromatin. Scattered haemosiderin-laden macrophages and cystic debris were also identified in both cases. These cases are of interest as the bland cytologic features may lead to an erroneous benign diagnosis. Immunohistochemistry aids the definitive diagnosis of metastatic Hurthle cell carcinoma of thyroid especially when the presence of a previous thyroid lesion is not communicated to the laboratory.
我们讨论了2例未被怀疑的赫氏细胞型转移性甲状腺癌，分别表现为枕部头皮和右髂骨髋臼上区域的皮下肿块；临床上最初分别怀疑为脂肪瘤和血管肿瘤。这2例最初均通过细针穿刺细胞学检查进行评估。病例1中，基于细胞块制备以及甲状腺球蛋白和甲状腺转录因子-1免疫组化染色阳性，确诊为转移性赫氏细胞癌。病例2报告提示为嗜酸性细胞病变，转移性赫氏细胞病变。两例的滤膜涂片均显示细胞紧密成片，单个大的多边形细胞，胞质丰富呈颗粒状，核偏位，异型性极小，染色质平淡。两例中还均发现散在含铁血黄素的巨噬细胞和囊性碎屑。这些病例值得关注，因为平淡的细胞学特征可能导致错误的良性诊断。免疫组化有助于甲状腺转移性赫氏细胞癌的确诊，尤其是当之前存在的甲状腺病变未告知实验室时。
