Guan Hui, Vandenbussche Christopher J, Erozan Yener S, Rosenthal Dorothy L, Tatsas Armanda D, Olson Matthew T, Zheng Rui, Auger Manon, Ali Syed Z
Department of Pathology, The Johns Hopkins Hospital, Baltimore, Md., USA.
Acta Cytol. 2013;57(5):534-42. doi: 10.1159/000353823. Epub 2013 Sep 7.
The tall cell variant of papillary thyroid carcinoma (TCV-PTC) is an aggressive variant of PTC requiring accurate cytopathologic diagnosis for early aggressive management.
Twenty-five cases of TCV-PTC in which the tall cells comprised at least 30% of surgically resected tumor were included in the study. The direct smears from a preoperative fine needle aspiration (FNA) and available hematoxylin and eosin cell block sections were reviewed. Ten cases of TCV-PTC were randomly selected and blinded with an equal number of conventional PTC cases. Representative slides were independently reviewed by 7 cytologists.
In a majority of the cases, the FNA direct smears were hypercellular and displayed flat monolayer sheets of cells. Tall columnar cells with cytoplasmic tails were seen in 56% of cases. The presence of large polygonal follicular cells with abundant granular oncocytic cytoplasm and distinct cell borders was the most common feature seen in all cases. Seventeen (68%) cases displayed intranuclear pseudoinclusions in cells with abundant granular cytoplasm. A correct diagnosis of TCV-PTC was made in 30-40% of cases by 7 study participants.
The correct recognition of TCV-PTC features in preoperative FNA is important for clinical management, and reporting these features in a cytopathology report is suggested.
甲状腺乳头状癌高细胞变体（TCV-PTC）是PTC的一种侵袭性变体，需要准确的细胞病理学诊断以便早期进行积极治疗。
本研究纳入了25例TCV-PTC病例，其中高细胞至少占手术切除肿瘤的30%。回顾了术前细针穿刺抽吸（FNA）的直接涂片以及可用的苏木精和伊红细胞块切片。随机选择10例TCV-PTC病例，并与同等数量的传统PTC病例进行盲法处理。7位细胞病理学家独立审阅代表性玻片。
在大多数病例中，FNA直接涂片细胞丰富，呈现扁平的单层细胞片。56%的病例中可见带有胞质尾的高柱状细胞。所有病例中最常见的特征是存在具有丰富颗粒状嗜酸性细胞质和明显细胞边界的大的多边形滤泡细胞。17例（68%）病例在具有丰富颗粒状细胞质的细胞中显示核内假包涵体。7名研究参与者在30%-40%的病例中做出了TCV-PTC的正确诊断。
术前FNA中正确识别TCV-PTC特征对临床治疗很重要，建议在细胞病理学报告中报告这些特征。
