Harshan Manju, Crapanzano John P, Aslan Deniz L, Vazquez Madeline F, Saqi Anjali
Department of Pathology, Weill Cornell Medical Center, New York, New York, USA.
Diagn Cytopathol. 2009 Apr;37(4):244-50. doi: 10.1002/dc.20990.
Although papillary thyroid carcinoma (PTC) usually has classic cytological characteristics on fine-needle aspiration (FNA), it can present rarely with aberrant features resembling those of histiocytes in a cystic nodule. The aim of the current study was to describe PTC with atypical histiocytoid cells and distinguish it from benign histiocytes. A retrospective computerized search for FNAs with atypical features suggestive of PTC and cystic degeneration was performed, and if available, the corresponding resection specimens were compared. Four cases met the criteria for FNAs and three had surgical pathology follow-up, which showed PTC. One aspirate had some features typical of PTC, but the remaining FNAs had atypical histiocytoid cells, which had traits intermediate between those of PTC and histiocytes. Large cell size, pseudoinclusions, nuclear grooves, and multiple well-defined vacuoles in atypical histiocytoid cells favor PTC over benign histiocytes. Ancillary immunocytochemical studies can also be useful in confirming the diagnosis. Histiocytic cells are frequently present in thyroid aspirates, and occasionally, they have atypical features that represent an unusual presentation of PTC. Closer examination of these cells can provide diagnostic clues for preventing false-negative diagnosis of PTC.
尽管甲状腺乳头状癌（PTC）在细针穿刺活检（FNA）时通常具有典型的细胞学特征，但在囊性结节中，它很少会呈现出类似组织细胞的异常特征。本研究的目的是描述具有非典型组织细胞样细胞的PTC，并将其与良性组织细胞区分开来。我们对提示PTC和囊性变的非典型特征的FNA进行了回顾性计算机检索，如有相应的切除标本，也进行了比较。4例符合FNA标准，3例有手术病理随访，结果显示为PTC。1例穿刺物具有一些PTC的典型特征，但其余FNA具有非典型组织细胞样细胞，其特征介于PTC和组织细胞之间。非典型组织细胞样细胞的大细胞大小、假包涵体、核沟和多个界限清晰的空泡更支持诊断为PTC而非良性组织细胞。辅助免疫细胞化学研究也有助于确诊。组织细胞经常出现在甲状腺穿刺物中，偶尔它们会有非典型特征，这代表了PTC的一种不寻常表现。对这些细胞进行更仔细的检查可为防止PTC的假阴性诊断提供诊断线索。
