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Thyroid

Κυτταρολογικά ύποπτες θυλακιώδεις αλλοιώσεις

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?????? ??? ??? ???? ?? ?????????????? ?????? ?? ????? ??????? ??? ?? ????????????? ??? ?????????? ???????? ?? ‘????????????? ??????’. ???????????? ???????? ?????? ????? ??????, ???? ?????? ??? ?? ????????. ????????? ??? ????????. ?? ?????? ??????? ????? ??????? ??????? ? ??????????? ???????.

?????? ???????? ??? ???? ??? ??? ????? ?????? ??? ?? ????? ???????? ??????? ?? ????????? ??? ???????? ?????. ? ???????? ??????? ??????????????? ??????? ??? ?????????? ??? ??????????, ??? ???? ?? ?????? ?? ??????? ? ???????? ????????????? ??????? ????. ???? ?? ????????????? ??? ???????????? ???? ??? ??????? Hürtle ????? ??????? ?? ???????.

? ????????? ???????? ???????????? ???? ??????????? ???????????. ?????????? ??? ?????? ??? ?????????????? ?????? ?? ???????????? ??????? ?? ?????? ????????? ????????? ??? ???????????. ??? ????????????? ??????? ??? ?? ?????? ?? ??????? ???? ???????? ???????? ????????????, ???? ?? ??????? ?? ?????? ??? ????????. ??? ????????????????? ????????? ???????, ?? ??????????? ????? ???? ? ????????????? ??????? ?? ?????? ? ????????????. ???????? ??? ??? ????? ???????? ????? ? ???????? ???????????, ?????????? ???????? ????????, ?????? ????????? ????? ??? ???????????? ??????? ????. ? ???????????????? ????? ??? ??????????? ?????????? ?????? ?? ????????? ??????????? ?? ???????? ?????? ??? ???????????????? ? ?? ??????????? ??????? ?????????, ???? ?? ??????? ????? ?????????????????? ??????? ?????? ???? ?????????????.

??????? ????? ?? 30-40% ??? ??????????? ??? ??????????????? ?? ‘??????? ??????????? ????’ ?????????????? ?????? ?? ????? ?????????. ??????? ?? ??????, ???? ?? 50-75% ????? ????????? ???????????, ??? ?? ????? ?????????????? ?? ????? ?????????? ????? ??? ???????? ????????????.

? ??????????????? Thy ????? ??????? ??? ???? ???????????? ??? ?? ?????????? ??? ?????????? ?????? ???????? ?????????? ??? ??? ?????????? ??????? ???????? ??????????. ??? ???? ??? ??????????? ? ?????????? ?? ????????? ???????? ??? ???? ???? ?? ???????? ??? ???? ?????? ?????????? (????????? Thy4) ? ???????? ?? ??????? ????????? ????? ??????? 80%, ??? ???? ????? (????????? Thy3) ? ???????? ????? ??????? 20%. ????? ???????? ?? ???????? ‘??????? ?????????? ????’ ??????? ???????????? ?????????. ??? ???? ?????????? ??????? ?????????? ?????????, ???? ??????????? ????? ??????????????.

???????? ???????? ????? ????????, ??? ?? ???????????? ? ???????? ?????? ???????? ??? ??????? ?????????? ??????????. ? ?????????? ??? ? ??????? ??????? ???????????? ??? ??? ????? ???????? ??? ??????? ?????. ????????? ??? DNA ?? ????????????? ???? ??? ????? ???????? ??????. ? ??????????? ??? ???????? ??? ? ????? ????? ????????. ? ?????????????????? ??? ???-1 ??? ????? ?????? ???? ???????, ????? ? ????????????? ????????? ??? ????????? ??? ?? ??????????? ?????? ?? ????? ????????. ? ?????????????????? ??? ??????????-3 ??????? ?? ????????? ???????????, ????? ?? ??????????? ??????????? ????? ?????? ??? ?? ??????????? ????????? ????? ????????, ???? ??? ????? ?????? ????????? ??? ?????? ??? ??????? ?????. ? ???????? ?? ???????? ?? ????? ?????? ?? ?????????? ???????. ? ?????????? t(2;3) ????? ??????? ??????? ??? ?? ?????????? ?????????.

Nuclei showing a coarse chromatin pattern and nuclear grooving. A follicular lesion with nuclei showing a coarser chromatin pattern and nuvlear grooving.
The same lesion confirming a coarsely granular chromatin, mild nuclear pleomorphism. A high power view showing a coarsely granular chromatin and mild nuclear pleomorphism. Although there is some nuclear overlapping this feature is not so reliable in thicker clusters of cells.
Cells exhibiting some crowding, mild pleomorphism and irregular chromatin -  An MGG stain showing a microfollicular pattern with cells exhibiting some crowding, mild pleomorphism and a more irregularly granular chromatin.
Changes can be very focal and admixed with otherwise unremakable areas. This a rather bland follicle; in suspicous follicular lesions changes can be very focal and admixed with otherwise unremakable areas.
A rather crowded group of thyrocytes showing mild pleomorphism. A rather crowded group of thyrocytes showing mild pleomorphism; although a follicular arrangement can be identified nuclei are overlapping thoughout the group. This does not appear to be dictated by thickness of the cluster but is rather an expression of a more disordered architecture.
A nuclear pseudoinclusion in one cells and a flake of dense colloid. A monolayered sheet of thyroid cells which appear uniform, however a nuclear pseudoinclusion is visible in one cell and a flake of dense colloid is present at the upper right corner of the field (MGG); these would qualify the lesion as suspicious. Elsewhere more obvious features of papillary carcinoma, follicular variant were present.
A crowded group with prominent nucleoli and obvious nuclear grooves. A group of overlapping thyroid cells with prominent nucleoli and obvious nuclear grooves (Pap) in a blood stained smear. These features are suspicious but quantitatively insufficient for a definitive diagnosis of malignancy: other findings must be present.
Two similar groups of thryoid cells with prominent nucleolus and mild nuclear pleomorphism. Two groups of thryoid cells with prominent nucleolus and mild nuclear pleomorphism.
Nuclear overlapping in the upper left corner of the fragment. This lower power view of a Papanicolaou stained microbiopsy still identifies sheets of monolayered uniform thyroid cells which elsewhere showed suspicious nuclear features. You may note the more disordered architecture with nuclear overlapping in the upper left corner of the fragment. This low power finding should prompt an accurate screening of the slides for confirmation of suspicious features, this architectural feature alone being insufficient for diagnosis of suspicion.
A group of cells with marked anisonucleosis. A high power view of an MGG stained smear showing a group of cells with marked anisonucleosis, again a finding which should prompt a thorough search for more diagnostic features of suspicion for malignancy.
A central nucleus is much larger, hyperchromatic and has an irregular contour. A group of thyrocytes: a central nucleus is much larger, hyperchromatic and has an irregular contour (MGG). This is a suspicious finding.

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?????????????? ??? ??????? ??? ????? ??????? ??? ??????????? (5-15% ??? ?????????? ??? ???????????). ??????? ????? ??? ??????? ??????, ????, ??????????? ??? ?? ?????????? ??????? ??????????? ??????? ????? ??? ??????? ???????. ?? ?????????? ????????? ??????? ????????? ?? ??? ???????????? ??????: ??? ??????????????, ??? ???? ???? ???? ???????? ??? ??? ?????? ????????? ?? ????? ????????, ?? ????? ?????? ?? ?????????? ???? ???????? ??? ?? ????.

?? ??????? ??? ??????????? ???????????? ??? ????? ???? ?? ???????? ?????????????? ??? ???????? ???????????? ?? ????? ??????? ???? ????????? ???????? ??? ??????????? ???????????? ??? ??? ????????? ???? ??? ???????? ????????????.

An MGG stain of an FNA from a follicular carcinoma. This case was mistakenly thought to be a medullary carcinoma because of the presence of cytoplasmic granules; it proved to be a follicular carcinoma. The granules are not the fine metachromatic ones found in medullary carcinoma and probably represent lysosomes. In our experience the vast majority of follicular carcinomas are labelled as suspicious follicular lesions.
Groups of thyrocytes from a follicular carcinoma.

 

?????????????? (Hürtle cell) ?????

?? ??????????? (Hürtle cells) ????? ???????????? ????????? ??????? ?? ????? ????? ??????? ?? ???????????. ??? ????????????? ???????????, ???????????? ?? ?????????? ???????, ?? ?????? ??? ????????????? ?????????????, ????? ???? ????? MGG, ??? ?????????????? ???? ????? ????????????. ?????? ?? ????? ????????, ?? ?????? ?????? ??? ?? ??????? ???? ????????, ????? ?? ?????? ???????.

?? ??????????? (Hürtle cells) ????????????? ????? ???? ????????????? Hashimoto ??? ??? ????????? ??????????, ???? ??????? ?????? ?? ??????????? ???????????? ??????. ?? ??????? ??????????? ????? ??????? ???? ?????? ??? ??? ????? ?????? ???????. ??? ????? ??? ?????? ??????????? ?????? ??????? ????? ?? ???????????. ???? ????????????? Hashimoto ????????????? ??????? ?? ?????????? ????????? ???????. ???? ????? ?????????? ????????????? ??????? ?? ????????? ??? ??????????.

????? ??????????????? (Hürtle cell) ?????? ? ??????????? ?????? ??????????? ???? ??? ??????????? (Hürtle cells). ?? ??????? ????? ??????? ?????? ??????, ???? ?????? ?? ???????????? ??????. ??????????? ??????? ?? ??????, ????? ??????? ????????????? ?????. ???? ????????? ?????????????? ???????????? ??????? ??? ????????????? ??????????? ????????? ??????? ??? ??????  ????????????. ????????? ?????? ?? ???????.

? ????????? ???????? ???????????? ???????? ?????? ??? ???????? ????????????, ???? ??? ????????????? ???? ??? ??? ????????????????? ????. ????????, ??????? ?????????????? ????? ????? ?????? ????????????? (????????????? ??????? ?????????). ?? ????? ??? ???????? ???????????? ??????? ?? ???????????? ?? ??????? ??? ?????????? ????????? ??????????????? ?????? ?? ???? ??? ???????????. ?? ??????????? ??????? ????????? ?????? ?? ??????? ?? ????????????? ?????????, ???? ? ??????????????????? ??????? ??? ??F-1, ?? ????? ????? ?????? ??? ????????? ??? ?? ??????? Hürtle, ????? ????????? ??? ??????? ??? ???????? ????????????. ?? ?????????? ??????????? ????????? ??????????? ????????? ??????? ??? ? ????????????? ??? ???????? ?????? ?? ??????? ????????? ??? ??????? Hürtle. ??????? ???? ??? ?????????? ????????? ??? ??????? ?????? ???????. ?? ????? MGG ?? ????????????????? ?????? ??? ???????? Hürtle ????? ????, ??? ???? ??? ???????? ??? ??????????? ???????????? ????? ???????.

A low power view of a FNA from a Hürthle cell neoplasm (MGG). A pure population of Hürthle cells (MGG). Note the pleomorphism which is apparent even at low power; this is not diagnostic of malignancy as it is a common feature in these neoplasms, whether benign or malignant. In our experience it is rather monomorphism which is more commonly associated with malignancy. In all cases definitive criteria for malignancy are exclusively histological (capsular or vascular invasion). 
A group of rather pleomorphic Hürthle cell (Pap). The pleomorphism is striking, with very large nuclei, prominent nucleoli and multinucleations. The N/C ratio however is not high. 
A follicular group of Hürthle cells (Pap). A cohesive group of cells showing the typical features of Hürthle cells (Pap). Note the dense cytoplasm with well defined borders, vescicular nuclei and prominent nucleoli.
Discohesive Hürthle cells (Pap). Discohesive cells with marked pleomorphism but preserved N/C ratio. Cytoplasm is dense and nuclei are round, often eccentrically placed imparting a "plasmacytoid" appearance. This may mimic medullary carcinoma.
A rather pleomorphic collection of Hürthle cells (MGG) showing pleomorphic nuclei, nucleoli and dense cytoplasm, often containing coarse granules. These are different from the fine granularity of medullary carcinoma.
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