Yazgan Aylin, Balci Serdar, Dincer Nazmiye, Ersoy Pamir Eren, Tuzun Dilek, Ersoy Reyhan, Irkkan Cigdem, Cakir Bekir, Guler Gulnur
Department of Pathology, Ankara Ataturk Research and Training Hospital, Ankara, Turkey.
Department of Pathology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey.
J Cytol. 2016 Oct-Dec;33(4):214-219. doi: 10.4103/0970-9371.190447.
It is a diagnostic challenge to differentiate benign and malignant cytology in the presence of Hürthle cells. In our previous study, it was determined that in fine needle aspirations (FNA), the malignancy outcome of the Hürthle cells containing group tend to be papillary thyroid carcinoma (PTC) in a higher percentage. The most common misinterpretation is caused by PTC cells with large cytoplasm-like Hürthle cells. The aim of this study is to predict histologic outcome of the nodules, which have Hürthle cells in FNA according to cytological, clinical features, and mutation status.
Detailed cytological features of 128 cases were compared with histopathological diagnosis. The analysis of mutation of the PTC cases were performed by real-time polymerase chain reaction.
The neoplastic outcome was increased statistically significantly with younger age ( = 0.020), increase in cellular dyshesion ( = 0.016), presence of nuclear budding ( = 0.046), and granular chromatin ( = 0.003). Nuclear budding ( = 0.014), granular chromatin ( = 0.012), and hypoechoic nodules in ultrasonography ( = 0.011) were significant independent factors for the increase in the malignancy risk. Increased lymphocytes (P= 0.015) and colloid were related to non-neoplastic outcome. According to the surgical outcome, more than half of the malign cases were PTC (74%). mutation was detected in 27.8% of the PTC cases.
PTC cases containing Hürthle cell-like cells may lead to diagnostic errors. Nuclear budding and granular chromatin of Hürthle cells are significant, remarkable findings to predict the outcome of neoplasm and malignancy.
在存在许特莱细胞的情况下鉴别良性和恶性细胞学表现是一项诊断挑战。在我们之前的研究中，已确定在细针穿刺抽吸活检（FNA）中，含许特莱细胞组的恶性结果倾向于更高比例的乳头状甲状腺癌（PTC）。最常见的误诊是由具有大细胞质的PTC细胞（类似许特莱细胞）引起的。本研究的目的是根据细胞学、临床特征和突变状态预测FNA中有许特莱细胞的结节的组织学结果。
将128例病例的详细细胞学特征与组织病理学诊断进行比较。通过实时聚合酶链反应对PTC病例进行突变分析。
肿瘤结果在统计学上随着年龄较小（P = 0.020）、细胞黏附性增加（P = 0.016）、核芽生的存在（P = 0.046）和颗粒状染色质（P = 0.003）而显著增加。核芽生（P = 0.014）、颗粒状染色质（P = 0.012）和超声检查中的低回声结节（P = 0.011）是恶性风险增加的显著独立因素。淋巴细胞增多（P = 0.015）和胶体与非肿瘤结果相关。根据手术结果，超过一半的恶性病例为PTC（74%）。在27.8%的PTC病例中检测到BRAF突变。
含有类似许特莱细胞的PTC病例可能导致诊断错误。许特莱细胞的核芽生和颗粒状染色质是预测肿瘤和恶性结果的重要显著发现。
