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Contribution of cytologic examination to diagnosis of poorly differentiated thyroid carcinoma

Journal of Pathology and Translational Medicine 2020년 54권 2호 p.171 ~ 178
김나래, 석재연, 정유승, 이준협, 정동해,
소속 상세정보
김나래 ( Kim Na-Rae ) - Gachon University Gil Medical Center Department of Pathology
석재연 ( Seok Jae-Yeon ) - Gachon University Gil Medical Center Department of Pathology
정유승 ( Chung Yoo-Seung ) - Gachon University Gil Medical Center Department of Surgery
이준협 ( Lee Joon-Hyop ) - Gachon University Gil Medical Center Department of Surgery
정동해 ( Chung Dong-Hae ) - Gachon University Gil Medical Center Department of Pathology

Abstract


Background: The cytologic diagnosis of poorly differentiated thyroid carcinoma (PDTC) is difficult because it lacks salient cytologic findings and shares cytologic features with more commonly encountered neoplasms. Due to diverse cytologic findings and paucicellularity of PDTC, standardization of cytologic diagnostic criteria is limited. The purpose of this study is to investigate and recognize diverse thyroid findings of fine needle aspiration (FNA) cytology and frozen smear cytology in diagnosis of this rare but aggressive carcinoma.

Methods: The present study included six cases of FNA cytology and frozen smears of histologically diagnosed PDTCs.

Results: PDTC showed cytologic overlap with well-differentiated thyroid carcinomas (WDTCs). Five of six cases showed dedifferentiation arising from well differentiated thyroid carcinomas. Only one de novo PDTC showed highly cellular smears composed of discohesive small cells, high nuclear/cytoplasmic (N/C) ratio, prominent micronucleoli, and irregular nuclei. Retrospectively reviewed, these findings are highly suspicious for PDTC. Cytologic findings of nuclear atypia, pleomorphism, and irregularity were frequently found, whereas scattered small cells were seen only in the de novo case.

Conclusions: Heterogeneous cytologic findings of PDTCs are shared with those of WDTCs and contribute to difficult preoperative cytologic diagnoses. Most PDTCs show dedifferentiation from WDTCs. Albeit rare, de novo PDTC should be considered with cytology showing discohesive small cells with high N/C ratio. This will enable precise diagnosis and prompt treatment of this aggressive malignancy

키워드

Cytology; Biopsy, fine-needle; Poorly differentiated thyroid carcinoma; Frozen sections

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