背景:当观察到甲状腺乳头状癌(PTC)的典型细胞形态特征时,颈部淋巴结的细针穿刺(FNA)细胞学检查是一种有效的诊断工具。然而,由于囊性变性引起的非典型组织细胞样细胞(AHCs)的存在有时会带来诊断挑战.这项研究的目的是评估转移性PTC中AHC的存在和细胞形态学。
方法:我们分析了在大约10年期间诊断的66例转移性PTC患者的共76个FNA宫颈淋巴结细胞学样本,从2010年1月到2020年4月。样品是基于液体的制剂(n=53)或常规涂片(n=23)。
结果:76例FNA中有38例(50%)存在AHCs,其余38例具有典型的PTC特征。在38个案例中,八个显示纯AHC,占淋巴结中所有转移性PTC的10.5%。与常规涂片(1/23,4.3%)相比,在基于液体的制剂中更常见地检测到纯AHC(7/53,13.2%)。其余30例具有与特征PTC组分混合的AHC。发现AHC的存在与囊性背景在统计学上相关(p<.002)。
结论:转移性PTC经常表现为囊性变性,FNA细胞学可能无法产生PTC的经典细胞学特征。纯AHC占所有病例的10.5%,可能是诊断转移性PTC的液基制剂的潜在陷阱。在囊性背景中发现AHC应引起转移性PTC的关注。
BACKGROUND: Fine needle aspiration (FNA) cytology of cervical lymph nodes is an effective diagnostic tool to detect metastatic papillary thyroid carcinoma (PTC) when typical cytomorphologic features of PTC are observed. However, the presence of atypical histiocytoid cells (AHCs) due to cystic degeneration sometimes poses a diagnostic challenge. The purpose of this study was to evaluate the presence and cytomorphology of AHCs in metastatic PTC.
METHODS: We analyzed a total of 76 FNA cytological samples of cervical lymph nodes from 66 patients with metastatic PTC diagnosed during approximately 10-year period, from January 2010 to April 2020. Samples were either liquid based preparation (n = 53) or conventional smear (n = 23).
RESULTS: AHCs were present in 38 (50%) of the 76 FNA cases and the remaining 38 cases showed classic PTC features. Among the 38 cases, eight displayed pure AHCs that constituted 10.5% of all the metastatic PTC in the lymph nodes. Pure AHCs were more commonly detected in the liquid based preparation (7/53, 13.2%) than the conventional smear (1/23, 4.3%). The remaining 30 cases had AHCs mixed with the characteristic PTC components. The presence of AHCs was found to be statistically associated with cystic background (p < .002).
CONCLUSIONS: Metastatic PTC frequently exhibits cystic degeneration and the FNA cytology may not yield classic cytological features of PTC. Pure AHCs composed 10.5% of all cases and might be a potential pitfall for liquid based preparation in diagnosing metastatic PTC. The finding of AHCs within the cystic background should raise the concern of metastatic PTC.