scholarly journals Noninvasive Encapsulated Papillary RAS-Like Thyroid Tumor (NEPRAS)

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A894-A894
Author(s):  
Pedro Weslley Rosario ◽  
Gabriela Franco Mourão
Keyword(s):  
Final Diagnosis ◽  
Needle Aspiration ◽  
Thyroid Tumor ◽  
Borderline Tumor ◽  
Papillary Thyroid ◽  
Nuclear Changes ◽  
Poorly Differentiated ◽  
Well Differentiated ◽  
Indeterminate Cytology ◽  
Nuclear Alterations

Abstract Introduction: The diagnosis of thyroid tumors arising from follicular cells that are encapsulated/well delimited and noninvasive is a challenge. When unequivocal nuclear alterations are present, the final diagnosis can range from noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) and classical/encapsulated papillary thyroid cancer (PTC), including aggressive subtypes, to poorly differentiated carcinoma. As proposed recently, the presence of papillae in the absence of exuberant nuclear alterations (nuclear score 2), given that the other criteria for NIFTP are met, may not be sufficient for the diagnosis of PTC. This condition is called “noninvasive encapsulated papillary RAS-like thyroid tumor” (NEPRAS), whose nature would be borderline and not malignant. Revising our cases of tumors > 1 cm that were diagnosed previously as PTC and that were encapsulated/well delimited and noninvasive, we found three cases of NEPRAS. We now revised our cases of tumors > 1 cm diagnosed previously as well-differentiated tumor of uncertain malignant potential (WDT-UMP) because the nuclear alterations were not considered to be sufficient for the diagnosis of PTC on that occasion. Case: In a 29-year-old euthyroid male patient with a single thyroid nodule whose fine-needle aspiration had revealed indeterminate cytology, a single tumor measuring 3.2 cm was reclassified from WDT-UMP to NEPRAS. For this diagnosis, the tumor met the following criteria: encapsulation or clear demarcation, no vascular or capsular invasion, presence of papillae, < 30% solid/trabecular/insular growth pattern, no tumor necrosis or high mitotic activity, and nuclear score 2. The BRAFV600E mutation was absent. The patient continues to show no signs of recurrence 7 years after lobectomy. Conclusion: Despite the presence of papillae, some tumors may be reclassified from malignant (encapsulated PTC) to borderline (NEPRAS). This proposal would result in a change of management, with the same implications as those seen for the change from noninvasive encapsulated follicular variant of PTC to NIFTP. References: Ohba K et al. Encapsulated Papillary Thyroid Tumor with Delicate Nuclear Changes and a KRAS Mutation as a Possible Novel Subtype of Borderline Tumor. J Pathol Transl Med. 2019;53:136-41 AND Rosario PW. Noninvasive encapsulated papillary RAS-like thyroid tumor (NEPRAS) or encapsulated papillary thyroid carcinoma (PTC). J Pathol Transl Med. 2020;54:263-4.

scholarly journals Encapsulated Papillary Thyroid Tumor with Delicate Nuclear Changes and a KRAS Mutation as a Possible Novel Subtype of Borderline Tumor

2019 ◽  
Vol 53 (2) ◽  
pp. 136-141 ◽  
Author(s):  
Kenji Ohba ◽  
Norisato Mitsutake ◽  
Michiko Matsuse ◽  
Tatiana Rogounovitch ◽  
Nobuhiko Nishino ◽  
...  
Keyword(s):  
Thyroid Tumor ◽  
Borderline Tumor ◽  
Papillary Thyroid ◽  
Nuclear Changes

scholarly journals Computerized Cytological Features for Papillary Thyroid Cancer Diagnosis—Preliminary Report

Cancers ◽  
2019 ◽  
Vol 11 (11) ◽  
pp. 1645
Author(s):  
Shyang-Rong Shih ◽  
I-Shiow Jan ◽  
Kuen-Yuan Chen ◽  
Wan-Yu Chuang ◽  
Chih-Yuan Wang ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
Final Diagnosis ◽  
Needle Aspiration ◽  
Cross Sectional Study ◽  
Follicular Neoplasm ◽  
Papillary Thyroid ◽  
Operating Characteristics ◽  
Histologic Diagnosis ◽  
Cross Sectional ◽  
Cytological Features

Fine needle aspiration cytology (FNAC) is the final diagnosis of thyroid nodules before surgery. It is important to further improve the indeterminate FNAC diagnosis results using computerized cytological features. This retrospective cross-sectional study included 240 cases, of whom 110 had histologic diagnosis of papillary thyroid cancers (PTC), 100 had nodular/adenomatous goiters/hyperplasia (benign goiters), 10 had follicular/Hurthle cell carcinomas, and 20 had follicular adenomas. Morphological and chromatic features of FNAC were quantified and analyzed. The result showed that six quantified cytological features were found significantly different between patients with a histologic diagnosis of PTC and patients with histologic diagnosis of benign goiters in multivariate analysis. These cytological features were used to estimate the malignancy risk in nodules with indeterminate FNAC results. The Area Under the Receiver Operating Characteristics (AUROC) of the diagnostic accuracy with a benign or malignant nature was 81.3% (p < 0.001), 78.7% (p = 0.014), and 56.8% (p = 0.52) for nodules with FNAC results of atypia, which is suspicious for malignancy and follicular neoplasm, respectively. In conclusion, quantification of cytological features could be used to develop a computer-aided tool for diagnosing PTC in thyroid nodules with indeterminate FNAC results.

Mammary Analogue Secretory Carcinoma of the Thyroid Mimicking Locally Advanced Papillary Thyroid Carcinoma: A Rare Case Report

2017 ◽  
Vol 26 (5) ◽  
pp. 459-463 ◽  
Author(s):  
Haihui Liao ◽  
Ashraf Khan ◽  
Patricia M. Miron ◽  
Kristine M. Cornejo
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Rare Case ◽  
Locally Advanced ◽  
Final Diagnosis ◽  
Needle Aspiration ◽  
Papillary Thyroid ◽  
Secretory Carcinoma ◽  
Mammary Analogue Secretory Carcinoma ◽  
Molecular Therapeutic

Mammary analogue secretory carcinoma (MASC) harboring ETV6 gene rearrangements was first described in the salivary gland with a relatively favorable prognosis and a possible molecular therapeutic target with pan-Trk inhibitors. Recently, primary MASC of the thyroid gland has been reported. We report a case of a 4.0 cm MASC arising from the left thyroid of a 58-year-old female with extrathyroidal extension. Initially, it was diagnosed by fine needle aspiration as suspicious for papillary thyroid carcinoma (PTC) and subsequently called a poorly differentiated carcinoma on resection. A final diagnosis of primary MASC of the thyroid was confirmed after an expanded immunohistochemical panel and identification of an ETV6 gene rearrangement by fluorescence in situ hybridization. Morphologically, the tumor was composed of solid, microcystic and focally papillary growth with dense fibrotic stroma and necrosis. Overlapping cytological features with PTC were identified, including foci of enlarged cells with irregular nuclear membranes/grooves. However, most of the cells contained prominent nucleoli with intraluminal and intracytoplasmic eosinophilic secretions. Immunohistochemically, the tumor cells were strongly positive for pancytokeratin, cytokeratin 7, PAX8, mammaglobin, and GCDFP-15, with rare staining for GATA3 and S100 and negative for TTF-1 and thyroglobulin. We report a rare case of a primary thyroid MASC, initially misdiagnosed as PTC. Pathologists should be aware of this entity and, given the similarities to PTC, have a high index of suspicion, prompting the addition of immunohistochemical and molecular studies. Furthermore, an accurate diagnosis is important because of the possible prognostic and treatment implications.

scholarly journals Morphometry of Canine Cutaneous Mast Cell Tumors

2003 ◽  
Vol 40 (3) ◽  
pp. 268-275 ◽  
Author(s):  
R. De F. Strefezzi ◽  
J. G. Xavier ◽  
J. L. Catão-Dias
Keyword(s):  
Mast Cell ◽  
Needle Aspiration ◽  
Nuclear Area ◽  
Mast Cell Tumors ◽  
Mast Cell Tumor ◽  
Mean Diameter ◽  
Poorly Differentiated ◽  
Cutaneous Mast Cell ◽  
Histopathologic Analysis ◽  
Well Differentiated

Twenty-four canine cutaneous nodules, diagnosed as mast cell tumors by fine-needle aspiration biopsy and confirmed by histopathologic analysis by staining with hematoxylin and eosin (HE) and toluidine blue, were analyzed by computerized nuclear morphometry on panoptic- and HE-stained cytopathology slides. Two hundred nuclei per lesion were examined. The morphometric parameters investigated were nuclear area, mean diameter, perimeter, regularity factor, and ellipticity factor. Lesions were graded as I (well differentiated), II (intermediate differentiation), or III (poorly differentiated) according to the following morphologic features: invasiveness, cellularity and cellular morphology, mitotic index, and stromal reaction. Nuclear morphometric results were then compared with histopathologic grades. Values of nuclear area, mean diameter, and perimeter increased with increase in histopathologic grade, but statistical analysis revealed significant differences only between grades II and III and between grades I and III when HE was used ( P, 0.01) and between grades I and III with panoptic stain ( P, 0.05). The ellipticity factor and regularity factor did not reveal significant differences between histopathologic grades. The results indicate that nuclear morphometric analysis, in combination with the rapid and inexpensive cytopathology technique, can help in mast cell tumor grading, thus contributing to the establishment of a more precise prognosis and treatment.

scholarly journals The outcomes and decision-making process for neck lymph nodes with indeterminate fine-needle aspiration cytology

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246437
Author(s):  
Ping-Chia Cheng ◽  
Chih-Ming Chang ◽  
Li-Jen Liao ◽  
Po-Wen Cheng ◽  
Wu-Chia Lo
Keyword(s):  
Lymph Nodes ◽  
Medical Center ◽  
Final Diagnosis ◽  
Needle Aspiration ◽  
Prior History ◽  
Stepwise Logistic Regression ◽  
Risk Of Malignancy ◽  
History Of ◽  
Indeterminate Cytology ◽  
Neck Lymph Nodes

Objectives This study aims to propose a cytological classification, to evaluate predictive factors of the final malignancy, and to suggest a proper management strategy for neck lymph nodes (LNs) with indeterminate cytology. Methods Patients who had neck lymphadenopathy with indeterminate cytology between 2007 and 2017 were analyzed retrospectively in a tertiary medical center. Cytological classification was conducted according to the cytological descriptions. We examined the clinical characteristics according to the final diagnosis of the neck lymphadenopathy. Results According to the final diagnoses, there were 142 malignant and 95 benign neck LNs among 237 patients. Multivariate analyses using a stepwise logistic regression model showed that cytological classification [p < 0.001, OR = 5.67 (3.48–9.23)], prior history of malignancy [p = 0.01, OR = 2.97 (1.26–6.99)], long axis [p = 0.01, OR = 3.06 (1.33–7.06)], short-to-long axis (S/L) ratio [p = 0.047, OR = 2.15 (1.01–4.57)] and internal echogenicity [p = 0.01, OR = 2.72 (1.26–5.86)] were independent predictors of malignancy. Conclusions In patients who have neck LNs with indeterminate cytology, a cytological classification and four other predictors (prior history of malignancy, long axis ≥ 1.93 cm, S/L ratio ≥ 0.64 and heterogeneity of internal echogenicity) are statistically associated with the risk of malignancy and helpful in guiding further management.

Fine-Needle Aspiration Biopsy of Neuroendocrine Neoplasms in the Liver: A 9-Year Retrospective, Single Institutional Study

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S94-S94
Author(s):  
Lin Zhang ◽  
Zhenjian Cai ◽  
Hui Zhu
Keyword(s):  
Fine Needle Aspiration ◽  
Fine Needle Aspiration Biopsy ◽  
Needle Aspiration ◽  
Aspiration Biopsy ◽  
Neuroendocrine Neoplasms ◽  
Gi Tract ◽  
Fine Needle ◽  
Poorly Differentiated ◽  
Needle Aspiration Biopsy ◽  
Well Differentiated

Abstract Objectives Neuroendocrine neoplasms (NENs) are divided into two major categories according to the 2018 WHO expert consensus proposal: well-differentiated neuroendocrine tumors (NETs) and poorly differentiated neuroendocrine carcinoma (NECs). Primary liver NENs are very rare and majority of NENs in the liver are metastatic. In this study, we retrospectively reviewed NENs in the liver diagnosed by fine-needle aspiration biopsy (FNAB). Methods We retrospectively reviewed malignant neoplasms diagnosed by imaging-guided liver FNAB performed between 2010 and 2018 in our institution. Patients’ electronic medical records and selective slides were reviewed. Results A total of 624 liver FNAB cases with a diagnosis of positive for malignancy were identified. Among those cases, 56 cases (9%) were NENs. Poorly differentiated NECs constituted 71% (40/56) of cases, and well-differentiated NETs constituted 29% (16/56) of cases. The most common primary sites of poorly differentiated NECs were lung (35%, 13/40), followed by pancreas (20%, 8/40), GI tract (17.5%, 7/40), GU (7.5%, 3/40), breast (5%, 2/40), head and neck (2.5%, 1/40), GYN tract (2.5%, 1/40), and CNS (dedifferentiated glioblastoma, 2.5%, 1/40). The remaining three cases (7.5%, 3/40) were diagnosed as primary liver NECs based on the clinical presentation. All three patients presented with a single large liver mass with no other mass lesions identified in other organ systems. For well-differentiated NETs, majority were from the GI tract (81.3%, 13/16), followed by pancreas (6.25%, 1/16) and lung (6.25%, 1/16). One patient was diagnosed with metastatic NET of unknown primary. Conclusion NENs in liver are predominantly metastatic, and majority of them are high-grade NECs. Most of well-differentiated NETs are metastases from the GI tract, while more than one-third of poorly differentiated NECs are metastases from the lung. Primary liver NENs also occur and all three cases in this study are poorly differentiated NECs.

McGill Thyroid Nodule Score in Differentiating Benign and Malignant Pediatric Thyroid Nodules: A Pilot Study

2017 ◽  
Vol 157 (4) ◽  
pp. 589-595 ◽  
Author(s):  
Michael Canfarotta ◽  
Douglas Moote ◽  
Christine Finck ◽  
Rebecca Riba-Wolman ◽  
Shefali Thaker ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Pilot Study ◽  
Thyroid Carcinoma ◽  
Thyroid Nodule ◽  
Differentiated Thyroid Cancer ◽  
Chart Review ◽  
Thyroid Nodules ◽  
Papillary Thyroid ◽  
Well Differentiated ◽  
Indeterminate Cytology

Objective The McGill Thyroid Nodule Score (MTNS) is a preoperative tool used to predict the risk for well-differentiated thyroid cancer given a specific nodule in adults. We evaluated the clinical utility of a modified pediatric MTNS with children and adolescents. Study Design Case series with chart review. Setting Tertiary care children’s hospital. Subjects and Methods This is a retrospective chart review of 46 patients ≤18 years of age presenting with a solitary or dominant thyroid nodule treated with surgical resection between September 2008 and December 2015. The cumulative MTNS for each nodule was calculated and compared with the final pathology. Results Of 46 patients, 10 (21.7%) were diagnosed with well-differentiated thyroid cancer (80% papillary thyroid carcinoma, 10% follicular variant of papillary thyroid carcinoma, 10% follicular thyroid carcinoma). Malignant nodules were associated with a greater mean MTNS (benign, 5.72 ± 3.03; malignant, 16 ± 3.13; P < .05). The sensitivity, specificity, and positive predictive value of malignancy were 100%, 94.4%, and 83.3% for scores ≥10 and 80%, 100%, and 100% for scores ≥11, respectively. In nodules with indeterminate cytology (Bethesda III and IV), the pediatric MTNS showed good differentiation between benign and malignant disease, with mean scores of 7.95 and 12.5, respectively ( P = .006). Conclusion This pilot study suggests that a comprehensive scoring system may help assess the risk of malignancy in pediatric thyroid nodules and differentiate nodules with indeterminate cytology into higher- and lower-risk categories. Given these findings, larger, multi-institutional studies are warranted.

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