Journal of Pathology and Translational Medicine

Volume 9(1); June 1998

Original Article

Distinction between Reactive Mesothelial and Carcinoma Cells in Serous Effusions by Mucin- and Immuno-cytochemical Panel .: Byung Heon Kim; Korean J Cytopathol. 1998;9(1):1-14.

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Abstract PDF: The cytologic distinction of carcinoma cells from reactive mesothelial cells can be difficult, especially in specimens containing abundant reactive mesothelial cells and inflammatory cells with scant carcinoma cells. This study evaluates the usefulness of mucin and immunocytochemistry for discrimination between reactive mesothelial cells and carcinoma cells, and sensitivity and specificity of these stains for the detection of metastatic carcinoma in serous effusions. Immunocytochemical panel including mucin cytochemistry with the periodic acid-Schiff(PAS) reaction after or without diastase digestion was undertaken on 127 serous effusion specimens with histologically confirmed diagnoses. The specimens including cell smears and cell blocks were stained with PAS and antibodies to carcinoembryonic antigen(CEA), epithelial membrane antigen(EMA), cytokeratin(CK), and vimentin. The sensitivities of these stains for metastatic carcinoma(127 cases) were 49%(46/94) in PAS, 48%(60/124) in CEA, 89%(97/109) in EMA, 88%(93/106) in CK, and 25%(20/81) in vimentin. The sensitivities of stains for reactive mesothelial cells(36 cases) were 19%(7/36) in EMA, 78%(28/36) in CK, and 75%(27/36) in vimentin. The PAS and CEA stains were not reacted with all cases of benign reactive serous effusions containing abundant reactive mesothelial cells. The specificities of stains for metastatic carcinoma(127 cases) were 100% in PAS, 100% in CEA, 81% in EMA, 22% in CK, and 25% in vimentin. The optimal combination of stains for use in a panel was PAS and CEA. Combined results from these two stains yielded an advanced sensitivity of 8% in PAS and 4% in CEA for metastatic carcinoma. EMA wasalso cosiderably useful for identification of carcinoma cells. CK and vimentin were not suitable for distinguishing between reactive mesothelial cells and carcinoma cells.

Etc

The Transformation of Reticular Cell into Plasma Cell in the Thymus from Different Age Group of Rats: Sang Ho Kim, Sung Keun Chang, Young Che Kim; Korean J Cytopathol. 1975;9(1):1-14.

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Abstract: Generally it is accepted that the plasma cell is transformed from small sensitized lymphocytes when they are met with antigen(Gowans, Roberts, however Fagraeus alleged that the plasma cells are derived from primitive reticular cell. The authors confirmed light and electron-microscopically the formation of plasma cells from reticular cell in the rat thymus after whole body irradiation and cortisone-ACTH-DOCA administration, adrenalectomy which were not immunologic procedures. For this account, we present the aging influence on the transformation of reticular cell into plasma cell. Methods and Materials Albino rats, the age of 1 month, 4 months and 8 months were used. Cortisone acetate (Upjohn) was injected 5mg intramuscularily everyday for 7 days and the rats were sacrificed 24 hours after last injection. The adrenalectomized rats were divided into 2 groups namely; first week group and 3rd week group after adrenalectomy. The thymus from normal rats or the rats received the above mentioned treatment were histologically (methylgreen pyronin and hematoxylin-eosin) and electron-microscopically observed. The results (1) It was confirmed electron-microscopically that the plasma cells were not so many but constant cell element in the thymus from all three different age groups and their distribution is confirmed in both subcapsular region or medulla. (2) A series of transformation from reticular cell into the plasma cell were observed among the newly formed pyroninophilic cells from cortisone treated rats, and the appearance was extremely distinct in the thymus of 1 month or 4 months old rats. (3) After adrenalectomy, prominent proliferation of plasma cell series occured in the rat thymus; the marked increase of mature plasma cell in the thymus from the rats of 1 month or 4 months 3 week after adrenalectomy and from the rats age of 8 months first week or 3rd week after adrenalectomy, however proliferation of transitional form of plasma cell in the thymus from the rats age of 1 month or 4 months first week after adrenalectomy. (4) The mode of plasma cell proliferation after cortisone treatment was almost same in the rats thymus from the both following groups; the one group is the rats treated with cortisone only and the other is the rats received adrenalectomy and cortisone injection.

Original Articles

p53 Immunoreactivity in the Cytology of Body Cavity Fluid.: Sun Hee Sung, Woon Sup Han; Korean J Cytopathol. 1998;9(1):15-20.

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Abstract PDF: Mutant form of the p53 gene product is abnormally accumulated in the nuclei of the tumor cells due to prolonged half life, and readily detected by immunohisto- chemical methods. To determine the positivity rate of p53 in body cavity fluid according the primary site and histological types of tumors and the utility of p53 immunostaining as an adjunct in the diagnosis of malignancy, we reviewed 69 effusions, including pleural effusion, ascitic fluid, and pericardial fluid, that were diagnosed as overt malignancy and 21 effusions of suspicious malignancy. Immuno- histochemistry was performed on paraffin-embedded cell blocks using a monoclonal antibody to p53 supressor gene product(Clone DO7) and a standard avidin-biotin complex technique with a citrate buffer antigen retrieval solution. The results were as follows; of the 46 pleural effusions with overt malignancy, 22 were immunopositive for p53 protein; of the 21 ascitic fluids with overt malignancy, 5 were positive for p53. Positivity rates according to the primary sites of tumors were 18 of 34(52.9%), 8 of 21(38.1%), 1 of 9(11.1%) cases of the tumors of the lung, GI tract, and ovary, respectively. According to the histologic types of lung cancer, 11 cases(61.6%) were positive out of 18 adenocarcinomas, 2 of 5 large cell undifferentiated carcinomas, and 1 of 2 small cell undifferentiated carcinomas. Of 21 cases of suspicious malignancy, 6 were positive for p53 and all of them(6/6) were confirmed as adeno- carcinoma of the lung or GI tract. These findings indicate that p53 immunostaining using paraffin embedded cell block is useful diagnostic and prognostic marker in body fluid cytology although negative immunostaining does not exclude malignancy.

Cytologic Analysis of Malignant Tumor Cells in Cerebrospinal Fluid.: Jae Hee Suh, Gyungyub Gong, Shin Kwang Khang, On Ja Kim; Korean J Cytopathol. 1998;9(1):21-28.

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Abstract PDF: Cytologic evaluation of cerebrospinal fluid(CSF) is an effective tool in diagnosing many disorders involving the central nervous system(CNS). CSF examination has been found to be of particular value in the diagnosis of metastatic carcinoma, lymphomatous or leukemic involvement of CNS and certain primary CNS tumors. As a survey of metastatic tumors to CSF and an evaluation of the preparation techniques increasing cellular yield in our laboratory, 713 CSF specimens examined between July 1995 and April 1997(1 year 10 months), were reviewed. There were 75 positive and 5 suspicious cases, the latter have had no evidence of tumors clinically. Primary tumors of 75 positive cases were classified as follows; 4(5.3%) as primary brain tumors, 40(53.3%) as secondary carcinomas, 13(17.3%) as leukemias, and 18 (24.0%) as lymphomas. The most common primary site of metastatic carcinomas was the lung in 17 cases(42.5%) followed by the stomach in 13(32.5%), breast in 8 (20.0%), and unknown primary in 2(5.0%). Four primary brain tumors were 3 cerebellar medulloblastomas and a supratentorial primitive neuroectodermal tumor (PNET). All 40 metastatic carcinomas were adenocarcinoma presented as single cells or cell clusters. Although signet ring cells were frequent in the cases of gastric primary cancers, no significant cytologic differences according to the primary site were observed. The cytologic features of leukemia and lymphoma were characterized by hypercellular smears presenting as individual atypical cells with increased N/C ratio, presence of nucleoli, and nuclear protrusions. In medulloblastomas and PNET, the principal cytologic findings were small undifferentiated cells arranged singly or in loose clusters with occasional rosettoid features. This study suggests that the CSF cytology is useful in the diagnosis of malignancy, especially metastatic extracranial tumors and the diagnostic accuracy can be improved by increasing cellular yield using cytocentrifuge.

Etc

An Experimental Study on Metaplasia in Tracheo-bronchial Epithelium of Rats, Exposed to Nitrogen Dioxide: Eui Keun Ham; Korean J Cytopathol. 1975;9(1):21-29.

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Abstract: Bronchial epithelial metaplasia of the rats was experimentally studied by mean of inhalation of Nitrogen Dioxide (1,000ppm, 500ppm and 100ppm in concentration). Used animals were healthy adult rats weighing about 250gm and having no pulmonasy diseases. No₂ gas was administered according to the exposure chamber and 10 sections were taken from the definite sites of the trachea and main bronchi of lungs. The following results and conclusions were made. 1. In the group of control(0 ppm NO2) was net observed any typical squamous metaplasia of bronchial epithelium in the course of time. 2. In the group which was exposed to the NO2 gas, the incidence of epithelial metaplasia of trachea and bronchi was approximately 83 per cent. Male rat (93% positive) showed definite high positivity compared to the female rat (78% positivity). 3. In the groups which was exposed for long time (-average 74hrs-90% positive), metaplastic tendency was apparently increased compared to that of short term exposure groups(-average 6 and 7hrs-78% positive). But invasiveness of metaplasia was relatively high and especially conspicuous in the groups of high No₂ concentration (1, 000ppm and 500ppm). 4. Observation on distribution of metaplasia indicated that site prepondence was trachea, carina and right upper lobe bronchus in orders, which were proximal parts of tracheobronchial tree. But on range of metaplasia, failed to indicate any specificity. 5. In the group which was exposed to No₂ gas epithelial finidings to be consistent with atypical metaplasia or carcinoma in situ were not observed.

Original Article

Histologic and Cytologic Follow-up in Atypical Squamous Cells of Undetermined Significance(ASCUS) on Cervical Smears.: Mi Kyung Shin; Korean J Cytopathol. 1998;9(1):29-36.

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Abstract PDF: In 1988, The Bethesda System for reporting cervical and vaginal cytologic diagnoses was introduced and this was revised in 1991. The new diagnostic category "atypical squamous cells of undetermined significance(ASCUS)" introduced by The Bethesda System is an area of controversy about the diagnostic category, clinical significance and appropriate treatment. A retrospective 2 years and 9 months study(April,1994-December,1996) was performed to evaluate the significance of reporting ASCUS on cervical smears. Sixtyseven(1.17%) of 5,730 smears were diagnosed as ASCUS and 21 cases were followed by cervical biopsies and/or endocervical curettages in 4 cases(19%), and repeat cervical smears in 17 cases (81%). Tissue diagnoses were benign in 2 cases and squamous cell carcinoma in situ in 2 cases. Cytologic diagnosis of follow up smear were negative in 14 cases (82.4%) and persistent ASCUS in 3 cases(17.6%).

Etc

The Histopathologic Study of Atypical Lesion in the Benign and Cancer Breasts: Woon Sup Han, Tae Sung Kim, In Joon Choi, Yoo Bok Lee, Dong Sik Kim; Korean J Cytopathol. 1975;9(1):31-36.

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Abstract: Many publications for correlative studies and a possible relationship of benign conditions and carcinoma of the breasts have been reported for many years. Quite recently 1974, there has been presented the atypical lesion as precancerous lesion of the breast. For this interesting reason, histopathologic study of atypical lesion was performed to compare frequency both in the benign lesions and in the remaining tissues of breast cancer, for 15 years from Jan. 1960 to Sept. 1974, with the histopathologic criteria by Ashikari et al. (1974) A total of 17 cases of atypical lesion were found both in the benign and cancer breasts; the mean age was 45; there were found in 3% of the benign breast lesions and in 5.5% of the remaining breast tissues of breast cancer. The conditions of periductal elastic fiber in atypical lesion are found without difference from the other benign breast lesions. It is not certain that this is definitely precancerous with this limited study, but it can be assumed that this is probably precancerous, and that a special attention both for pathologists and surgeons should be necessary.

Original Article

Clinical Experience and Sensitivity of the AutoPap 300 QC System in Cervicovaginal Cytology.: Sung Ran Hong, Jong Sook Park, Hoi Sook Jang, Yee Jeong Kim, Hy Sook Kim, Chong Taik Park, In Sou Park; Korean J Cytopathol. 1998;9(1):37-44.

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Abstract PDF: OBJECTIVE: False negatives of cervical smears due to screening errors pose a significant and persistent problem. AutoPap 300 QC System, an automated screening device, is designed to rescreen conventionally prepared Pap smears initially screened by cytotechnologists as normal. Clinical experience and sensitivity of the AutoPap 300 QC System were assessed and compared with current 10% random quality control technique. MATERIALS AND METHODS: In clinical practice, a total of 18,592 "within normal limits" or "benign cellular changes" cases classified by The Bethesda System were rescreened by the AutoPap System. In study for sensitivity of The AutoPap System to detect false negatives, a total of 1,680 "within normal limits" or "benign cellular changes" cases were rescreened both manually and by the AutoPap System. The sensitivity of the AutoPap System to these false negatives was assessed at 10% review rate to compare 10% random manual rescreen.
RESULTS
In clinical practice, 38 false negatives were identified by the AutoPap System and we had achieved 0.2% reduction in the false negative rate of screening error. In study for sensitivity, 37 false negatives were identified by manual rescreening, and 23 cases(62.2%) of the abnormal squamous cytology were detected by the AutoPap System at 10% review rate. CONCLUSONS: The AutoPap 300 QC System is a sensitive automated rescreening device that can detect potential false negatives prior to reporting and can reduce false negative rates in the laboratory. The device is confirmed to be about eight times superior to the 10% random rescreen in detecting false negatives.

Etc

Clinical and Histopathological Studies on Trophoblastic Tumors among Korean Women: Dong Wha Lee; Korean J Cytopathol. 1975;9(1):39-52.

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Abstract: Trophoblastic disease represents an inclusive term for hydatidiform mole, choriocarcinoma and chorioadenoma destruens, which is relatively uncommon disease in the United States and Europe, but certain areas of the Asia have greater incidence. Most of the patients are of the extremely poverty-stricken group where-in an inadequate diet is standard. Historically it was Sanger, in 1889, who suggested that there was a special tumor derived from the decidua of pregnancy which he felt was of a sarcomatous nature. In 1895, Marchand demonstrated that these tumors were invariably the sequel to normal pregnancy, abortion, hydatidiform mole, or ectopic pregnancy, and that they were derived from chorionic epithelium. There is still a difference of opinion as to whether hydatidiform mole is to be considered a degenerative or neoplastic lesion. Hertig and Mansell (1956) believe that mole is a degenerative process, though capablitity of neoplastic change. The direct causation of the hydatid process is seemingly deficiency of the circulation to the placental tissue. Chorioadenoma destruens should always follow a molar pregnancy, but exception rarely occurs such as abortion and term delivery. Most pathologists regard chorioadenoma destruens to be morphologically benign, but it causes uterine perforation with consequent intraperitoneal hemorrhage and more frequently transition to the choriocarcinoma than hydatidiform mole, so it can not always be regarded as a benign neoplasm. Scott(1962) suggests that the cause of choriocarcinoma be related to a lack of maternal antibody to retained pregnant tissue, but the cause is still unknown. It is well known that the most common preceding pregnancy type of choriocarcinoma is hydatidiform mole and the hydatidiform mole is transformed of the choriocarcinoma mole and chorionic malignant change is still debated. The prospective study on histological observation of the process from hydatidiform mole to choriocarcinoma by biopsy is impossible and a few reports of retrospecitive study on choriocarcinoma are reported and which are very important. There are several reports on trophoblastic disease among Korean Women based on clinical aspects but there is very little reports on trophoblastic tumors based on pathological aspects. The present study is an attempt to investigate mainly the relationship between histopathological classification, the clinical course and prognosis of hydatidiform mole classified by Eoston and Eagshawe(1972) and choriocarcinoma by Kawashima(1974), using retrospective study because the prospective study for hisological follow up is impossible. Materials and Methods The materials used in this study consist of 209 cases of trophoblastic disease for 14 years from January, 1960 to December, 1973. All specimens were fixed in 10% neutral formalin, paraffin embedded blocks were cut in 5 micron thickness, and sections were stained by hematoxylin-eosin methods and the classification was done on all cases of hydatidiform mole by Elston and Bagshawe(1972) and of choriocarcinoma by Kawashima(1974). For all cases of trophoblastic disease whose clinical records were available, sex age, chief complaints, durations, gravidity, previous pregnancy history, metastatic site, H.C.G. titer and X-ray findings were investigated.
Results
and Summary By histopathological and clinical studies on 209 cases of trophoblastic disease which were submitted to the Department of Pathology, Yonsei University, College of Medicine, during the period of 14 years from January 1960 to December, 1973, following results were obtained. 1. The histological types and respective frequencies of the trophoblastic disease were hydatidiform mole 125 cases, chorioadenoma destruens 25 cases, and choriocarcinoma 59 cases. 2. The histological gradings of hydatidiform mole showes Grade Ⅰ 46.2%, Grade Ⅱ 35.9%, Grade Ⅲ 17.9%, and that of choriocarcinoma were Group Ⅰ 29.5%, Group Ⅱ 41.0% and Group Ⅲ 29.5%. Chorioadenoma destruens was frequently associated with hydatidiform mole, particularly Grade Ⅱ and Ⅲ. 3. The average ages were 32.5 year-old in hydatidiform mole, 39.5 year-old in chorioadenoma destruens, 36.5 year-old in choriocarcinoma. 4. The relationship between histological types and age distribution was not significant in hydatidiform mole and choriocarcinoma except the frequency of Group Ⅲ choriocarcinoma is apparently low in age group of 20-29. 5. Metastases in choriocarcinoma in order of frequency were lung(79.2%), vagina(45.8%), intestine(20.8%), brain(16.7%), etc. Metastases in chofiocarcinoma were frequent in Group Ⅱ and Ⅲ. In Summary, these findings suggest that the higher grades of hydatidiform mole may closely be related to chorioadenoma destruens and the histological type of trophoblastic disease is correlated with clinical course. Therefore it can be said that the follow-up study based on the histological grading and grouping is considered to be significant.

Original Articles

Fine Needle Aspiration Cytology of the Breast Lesions: Application of the Masood's Scoring System.: Ae Lee Kim, Hye Sun Kim, Han Kyeom Kim, Nam Hee Won, Mee Ja Park, Bum Hwan Koo; Korean J Cytopathol. 1998;9(1):45-54.

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Abstract PDF: Fine needle aspiration cytology is considered as a useful diagnostic procedure in management of patients with breast lesions. This study was undertaken to evaluate the scoring system of Masood in the interpretation of breast aspirates, to establish the most useful cytologic criteria for the diagnosis of breast lesions, and to subclassify the benign breast diseases. To assess the feasibility of a cytologic grading system, 57 cases of benign breast disease, 61 cases of malignant breast disease were studied, respectively. The aspirates were evaluated for the cellular arrangement, the degree of cellular pleomorphism and anisonucleosis, and the presence of myoepithelial cells and nuceoli. Values ranging from 1 to 4 were assigned to each criterion and the sum of the individual values was made for each case. The presence of stroma, apocrine metaplasia, foamy histiocytes and inflammatory cells, background of the smear, and cellularity were also evaluated. Cut-off value of the scoring system of Masood between benign and malignant lesion was 15. Among the cytologic criteria, cellular arrangement, presence of myoepithelial cells, nucleoli, and stroma, status of chromatin pattern, and background of smear were useful criteria in the differentiation between benign and malignant lesions. Application of the scoring system of Masood does not always make the accurate diagnosis and the subclassification of benign breast disease.

Comparison between Transthoracic Fine Needle Aspiration Cytologyand Gun Biopsy of Pulmonary Mass.: Eun Sook Nam, Duck Hwan Kim, Hyung Sik Shin; Korean J Cytopathol. 1998;9(1):55-62.

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Abstract PDF: To compare the diagnostic yields and complication rates of transthoracic fine needle aspiration cytology(FNAC) and gun biopsy in the diagnosis of pulmonary mass, a retrospective review was performed in 125 cases. Under the fluoroscopic guide, FNAC was performed by 20G Chiba needle in 91 cases, core biopsy was done by 18.5 G vaccum needle attached with automated biopsy gun in 74 cases and both procedures were done together in 37 cases. Overall sensitivity was 88.4% in FNAC and 87.5% in gun biopsy. For malignant pulmonary tumors, correct type correlation with final diagnosis was obtained in 33(76.7%) out of 43 cases by FNAC and 30(75.0%) out of 40 cases by gun biopsy. For benign pulmonary lesions, there were correct type correlation in 14(35.0%) out of 40 cases by FNAC and 14(53.8%) out of 26 cases by gun biopsy. The complication was pneumothorax and hemoptysis. Pneumothorax occured in 11.1% of FNAC, 10.9% of gun biopsy and 10.9% of both technique, among which chest tube drainages were necessary in one patient by gun biopsy and in three patients by both technique. Although no significant difference of diagnositc accuracy and complication rate was found between FNAC and gun biopsy, gun biopsy was more helpful in the diagnosis of pulmonary benign lesions than FNAC.

Etcs

Separation of Lymphocytes from Human Peripheral Blood: Kui Nyung Yi, Sang In Kim; Korean J Cytopathol. 1975;9(1):55-60.

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Abstract: This paper describes a technique for the isolation of lymphocytes from haparinized human peripheral blood. When whole blood was layered on top of a mixture of Ficoll and Isopaque and gradient centrifuged at room temperature, the cellular elements of whole blood were divided into two main parts, a lymphocyte bone in plasma layer and a layer consisting of sedimented granulocytes and erythrocytes at the bottom of the tube. By this method the isolation of viable lymphocyte with 96.6% purity was possible in a short period of time. Impurities found in the lymphocyte zone was granulocytes; 0.2%, monocytes; 2.8%, eosinophils; 0.4%, erythrocytes; less than 5% of total cell counts respectively. Isolating conditions and purities together with detailed directions are presented. It is shown in the present paper that adopting the procedure introduced a lymphocyte suspension of extreme purity with high viability may be obtained for lymphocyte research.

Studies on Values for Blood Cells of Healthy Children in rural area of Korea: Jung Ik Suh, Young Hun Chung; Korean J Cytopathol. 1975;9(1):61-69.

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Abstract: This survey was done on 576 male and 469 female subjects at age ranging from 6 to 12 years who live in rural area. It was carried out between Apr. 15 to Oct. 14, 1974. Eight elementary Schools were chosen which would provide each grade of children from relatively similar socioeconomic group. The number of red blood cells, quantity of hemoglobin, volume of packed cells, the percentage of reticulocytes, the number of white blood cells and their differential lebel had been determined to establish the blood values in the healthy rural Korean children. The indices of mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration were calulated according to wintrobe. The results of these studies are summarized in table I to 10 & Fig. I. The hematologic standards should be used as a basis for interpretation until they are superseded by more extensive data of equal or greater accuracy.

Original Articles

Morphometric Study on Fine Needle Aspirates from Follicular Adenoma and Follicular Carcinoma of the Thyroid.: Young Chae Chu, Hee Jung Cha, Soo Kee Min, Joon Mee Kim, Tae Sook Hwang; Korean J Cytopathol. 1998;9(1):63-68.

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Abstract PDF: Fine needle aspiration cytology of "cold" nodules of the thyroid has proved to be of great value in their preoperative diagnosis. Most types of thyroid tumors are readily recognizable from characteristic cellular patterns in the smears of needle aspirates. But follicular neoplasms present some problems because the cytomorphology of the adenomas frequently is same as in carcinoma. For differentiation of benign from malignant follicular neoplasms of the thyroid we tested the usefulness of two objective parameters - nuclear area and perimeter - by morphometry. This study was made on fine needle aspirates from 30 cases with cytologic diagnosis of follicular neoplasm of thyroid. The histologic classification was follicular adenoma in 22 cases and follicular carcinoma in 8 cases. As a reference group we used seven caes with nodular hyperplasia. The smears of aspirates were stained by Papanicolaou method. On each slide 200 randomly selected cells with intact nuclei were measured. The mean value of nuclear area are 25.32+/-5.50 micrometer2, 34.08+/-7.50 micrometer2 and 39.97+/-6.63 micrometer2 in nodular hyperplasia, follicular adenoma, and follicular carcinoma, respectively. The mean value of perimeter are 19.48+/-2.26 micrometer, 22.95+/-2.65 micrometer and 24.78+/-2.23 micrometer in nodular hyperplasia, follicular adenoma and follicular carcinoma, respectively. The mean nuclear areas and perimeters of cells from follicular adenoma were significantly larger than those from nodular hyperplasia (p<0.05). The mean nuclear areas and perimeters of cells from follicular carcinoma were larger than those from follicular adenoma but the differences are not significant statistically(p<0.05). Therefore, morphometric assessment alone is inadequate to predict malignancy in thyroid aspirates.

A Study on the Cytologic Features of Fine Needle Aspiration Cytology in the Thyroid Follicular Neoplasm and Nodular Goiter.: Jin Ye Yoo, Hye Jae Cho, Il Hyang Ko; Korean J Cytopathol. 1998;9(1):69-78.

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Abstract PDF: There is a lot of difficulty in the diagnosis of follicular lesions of the thyroid by fine needle aspiration cytology(FNAC). The main purpose of this report is offering more guidance regarding the cytologic appearance to distinguish follicular neoplasm from nodular goiter and laying stress on the presence of mixed group. The histologic and cytologic findings of 23 follicular neoplasms and 13 nodular (adenomatous) goiters were reviewed. Histologic specimens were classified into the microfollicular(MIF), mixed(MIX), and nodular goiter(NG) groups. The comparison of histologic patterns with histologic diagnosis revealed that all the lesions with predominantly microfollicular, trabecular, or solid pattern were follicular carcinoma and all the lesions with predominantly macrofollicular pattern were nodular goiter. The distinguishing cytologic features for the MIF group were irregular cell arrangement in cell groups(100%, p=0.00001), absence of atrophic follicular cells(100%, p=0.0007), abundant microfollicles(100%, p=0.002), pleomorphic nuclei(100%, p=0.002), not predominant syncytial smear pattern(100%, p=0.002), heterochromatin(100%, p=0.032), absence of macrofollicles(100%, p=0.038), scant colloid(100%, p=0.04), clear background(83%, p=0.00006), and uniform sized follicles(83%, p=0.014). And regular cell arrangement(honeycomb appearance) in cell groups(85%, p=0.0000), atrophic change of follicular cells(69%, p=0.0002), syncytial smear pattern(54%, p=0.006), monomorphic nuclei(85%, p=0.008), and hemorrhagic background(100%, p=0.027) were characteristic features of the NG group. Seventeen out of 36 cases(47%) were the MIX group composed of combined cytologic features of the MIF and NG groups. Therefore the frequent presence of the MIX group is considered to be main cause of the difficultyin the diagnosis of follicular lesions by FNAC. The mixed morphologic feature may support the hypothesis of a biologic "continuum" between nodular goiter and follicular neoplasm of thyroid gland.

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