Cytopathologic analysis of thyroid secondary tumors

doi:10.16150/j.1671-2870.2023.03.10

Abstract

Abstract:

Objective: To observe the cytological pathological features of secondary thyroid neoplasm (STN) by ultrasound-guided fine-needle aspiration（FNA）. Methods: A total of 5023 cases of thyroid malignancy diagnosed by FNA cytology in The First Affiliated Hospital of Air Force Medical University from January 2011 to May 2021 were collected. Hematoxylin-eosin (HE) staining, Pap staining and cellular immunohistochemistry (IHC) staining were performed on traditional smears, liquid-based preparation and cell wax blocks made from FNA samples of all these STNs respectively. Using medullary thyroid carcinoma smear as a control, two senior cytopathologists analyzed the cytopathological and cellular immunohistochemical features of STN. Based on clinical practice, the key points of cytopathological differentiation between STN and medullary thyroid carcinoma were summarized. Result: Among 5023 cases of thyroid malignancy, there were 8 cases of STN (0.16%), 33 cases of medullary thyroid carcinoma (0.66%), 4955 cases of papillary thyroid carcinoma (98%), 16 cases of lymphoma (0.32%), 7 cases of squamous cell carcinoma (0.14%), and 2 cases each of anaplastic carcinoma and poorly differentiated carcinoma (0.04%). The 33 cases of medullary carcinoma tumor cells were diverse in morphology, including plasmacytoid cells, epithelioid cells, and fusiform cells, with a small number of bizarre giant cells and amyloid in the background. None of the 8 STNs showed typical nuclear features of thyroid papillary carcinoma， three-dimensional papillary and adenoid structures were seen in 1 case of metastatic lung adenocarcinoma， clusters or scattered heterotypic squamous cells were seen in 4/4 cases of metastatic squamous cell carcinoma, combined with their respective characteristic immunophenotypes, the diagnosis can be confirmed. The cytological morphological characteristics of 2 metastatic breast cancers and 1 metastatic small cell lung carcinoma overlapped with medullary thyroid carcinoma. The cells were all small and hyperchromatic nuclei, which required the detection of immunohistochemical markers including estrogen receptor (ER), Progesterone receptor（PR）, Cytokeratin7 (CK7), GATA3, Synaptophysin (Syn), Neural cell adhesion molecule (CD56), Chromogranin A (CgA), Calcitonin (CT), Thyroglobulin(TG), Thyroid transcription factor-1(TTF-1), Paired box gene 8 (PAX-8), and identification were made in the combination with medical history. Conclusions: STN accounts for 0.16% of thyroid malignancies and is relatively rare. In cases with myeloid cancer cell morphology, attention should be paid to the possibility of STN, and differential diagnosis should be made in combination with immunohistochemistry and medical history.

Key words: Secondary thyroid neoplasms, cytologic diagnosis, differential diagnosis, Fine-needle aspiration

CLC Number:

R736.1

YANG Qiao, FU Xin, WANG Zhe, LIU Tantan. Cytopathologic analysis of thyroid secondary tumors[J]. Journal of Diagnostics Concepts & Practice, 2023, 22(03): 270-276.

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	Sex	Age (years)	History disease	Ultrasound results	Follow-up (months)
1	Female	57	/	Right, mixed echo region, 1.9cm×1.5cm	1
2	Female	64	Small cell carcinoma of the left lung, 2 years and 8 months, cervical lymph node metastasis lasted 6 months	Right, low echo area, 2.4cm×1.4cm	24 (death)
3	Female	56	Breast cancer, 5 years and 6 months	Isthmus to the right, Low echo area, 1.7cm×1.2cm	29
4	Female	58	Breast cancer, eight years and ten months	Right, low echo area, 2.2cm×1.5cm	18
5	Male	56	Squamous cell carcinoma of larynx， 1 year	Right, low echo area, 0.9cm×0.8cm	24
6	Male	68	Squamous cell carcinoma of the esophagus, 3 years	Right, low echo area, 1.5cm×1.2cm	60 (death)
7	Male	75	Squamous cell carcinoma of hypopharynx, 4 years and 2 months	Right, low echo area, 3.2cm×3.7cm	81
8	Male	64	Squamous cell carcinoma of the trachea, 5 days	Right, low echo area, 2.8cm×2.6cm	48

	Number of cases	Normal follicles in the background	Arrangement mode	Cytological characteristics	Nuclear chromatin	Positive (IHC)	Negative (IHC)
Adenocarci- noma of lung	1	Occasionally	Three-dimensional adenoid structure, papillary structure	Large, abundant cytoplasm, visible mucous vacuoles	Obvious nucleolus	CK7、TTF-1、NapsinA	CA125、WT-1、TG、PAX-8
Small cell carci- noma of lung	1	Massive necrosis, apoptosis	Clustered,scattered, Mosaic-like	Uniform size, bare nucleus	Pepper salt like, fine granular	Syn、CD56、CgA	CT、TG
Breast cancer	2	Not seen	Clumps, clusters, scattered	Difference in size, The cytoplasm is medium to abundant with occasional vacuoles	Hyperchromatic nuclei, nucleolus were not obvious	ER、PR、CK7、GATA3	TTF-1、PAX-8、CT
Squamous cell carcinoma	4	More or less, Neutrophils visible	Lamellar, nestlike, scattered	Significant size difference, round or fusiform, cytoplasmic keratosis is common	Hyperchromatic nuclei, polygon, irregular nuclear membranes	P63、P40	TG
Medullary thyr- oid carcinoma	33	More or less	Single scattered, cell boundaries is unclear	Plasmacytoid, epithelioid, strange giant cell	Pepper salt like, fine granular	Syn、CD56、CgA、CT	TG