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Thyroid

Μυελοειδές καρκίνωμα

?? ?????????? ????????? ????? ??????? ?? 5% ??? ???????? ??? ???????????. ?? ???????? ?? ?? ???? ???????????, ?? ????? ????????????? ??? ?? ????????? ???????, ?? ?????????? ????????? ???????????? ??? ?? ????????????? ??????? (??????? C) ??? ???????????, ?? ????? ????????? ???????????. ??????? ?? 80-90% ????? ????????????? ?? ????????, ??? ?? ???????? ????????????? ?? ?????? ?? ???????? ??? ?????????? ???????? ??????????? ????????? (multiple endocrine neoplasia ? MEN). ?? ???????? ?? ??? 2a (???????? Sipple’s) ??????????? ?? ????????? ???? ?? ????????????t??? ??? ??????? ????? ?????????? ? ??????? ??? ??????????????? ?????. ?? ???????? ?? ??? 2b (???????? ?? ????????? ???????????) ????? ?????????? ?????????, ????????????????, ???????? ????????? ??????????? ??? ??????????? ???????????. ??????? ?? 90% ??? ????? ???????? ??????????? ??? ?????? ?? ?????????????? ? ???? ??? ??????? ????? ??? ??? ?????? ????.

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  • ???????????????????, ???????????? ???/? ??????????? ???????
  • ?????????? ??????? ?? ???????????? (‘salt and pepper’) ? ?? ????? ?????? ??????????
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? ????????????? ????????????? ????????. ?? ??????? ??????? ????? ?????????? ?? ??????? ??? ?????, ???? ?? ??????? ??????????? ?????? ?? ???????????? ?????? ???? ?????? ???????. ?? ??????????? ??????? ????? ??????, ????????? ?????????????, ?? ????? ?????? ?????? ?? ???????? ???????????? ?????????????? ??????, ?? ????? ???????? ??????? ?? ??????? ????? Romanowski, ??? ????????????? ?? May-Grünwald-Giemsa. ?? ????????????? ?????? ?? ????? ????????, ?????????? ???? ??? ‘???????????????????’ ????????, ? ????????. ?????? ??????? ?????? ?? ????? ???????? ? ??????????. ?? ?????????? ???????????? ?? ????????? ???????????. ??????? ?? ?? ??????????, ???? ????? ???????? ??????????? ??? ??????????????? ??????? ??????????. ? ???????? ??? ?????? ?? ???????????? ?? ????? Congo red.

?? ????????????? ??????? ?????????????????? ????? ?????? ???? ??????????? ??? ?? ??????????????? ???????? (CEA).

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  • ????????????? (Hürthle cell) ?????????
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?????? ??????? ???? ???? ??? ???????????? ??? ????????????? ??????????? ??? ?????????? ??? ?????????? ?????????, ?? ????? ???? ??????????? ????????????? ?????? ?? ????? ?????? ????????? ??????????. ?? ?????????? ????????? ?????? ?? ???? ??????????? ???????, ???? ??? ?????????????? ??? ???????????? ???????? ?????? ???? ??? ??????????? ?????????. ?? ??????????? ??????????, ? ?????? ?????????????????? ????? ??? ??????????? ? ?? ????? ??????? ???????????? ????  ??? ????? ????????? ??? ?? ????????????? ??? ????????.

?? ??????????? ????????? ??????????? ?????????????? ????? ??? ??? ????????????? ??????? ?????? ??? FNA. ?? 25% ?????????????? ?????????? ?? ???? ???????????.

Discohesive elongated and 'plasmacytoid' cells (Pap). 
The nuclei have a coarsely granular chromatin and nucleoli are incospicuous (Pap). Note elongated cells and cells with eccentric nucleus.
Discohesive tumour cells with dense, granular cytoplasm (MGG). Few nuclei however appear bare but the chromatin pattern is the same.
'Plasmacytoid' cells with 'salt and pepper' chromatin and finely granular cytoplasm (MGG). These granules are neuroendocrine and are best identified on this stain.
Nuclei are round and cytoplasm well stained; only a few cells show cytoplasmic granularity (MGG). On this stain as well the irregular granularity of chromatin distribution can be identified although it is better seen on Papanicolaou.
Few discohesive tumour cells adjacent to a cell cluster (MGG). 

 

Typical appearance of neuroendocrine granules on MGG. They are fine and uniform, as opposed to the coarser and bluish stain of the colloid-filled fagosomes of thyrocytes in goitre or follicular neoplasms. 
A calcitonin stain on archival FNA material. 

 

Discohesive "plasmacytoid" cells with dense cytoplasm and typical chromatin pattern (MGG). 
Cells from a MTC mimicking oncocytic changes (Pap).
At higher power the typical chromatin pattern is apparent (Pap). 

 

Calcitonin positive cells. Note the eccentric nucleus. 
Calcitonin positive cells.
Calcitonin positive cells.
Calcitonin positive cells. At low power it is hard to identify cells in this blood-stained sample.

 

Nuclear pseudoinclusions may be seen (MGG). In some centres serum calcitonin is measured at the same time as the FNA is obtained, therefore making interpretation of such findings easier. Immunocytochemistry for calcitonin and absence of thyroglobulin will establish the diagnosis. 
A cluster of atypical spindle cells (MGG).This finding is rather useful in suggesting MTC.
A large fragment of elongated atypical cells (MGG) with the typical chromatin pattern. Nuclei are pleomorphic and the occasional 'pseudoinclusion' can be identified.
An histological section (H&E). Amyloid deposits are readily identifiable. Amyloid in cytological samples is more difficult to separate from collagen or colloid. 

 

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