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Thyroid fine needle aspiration: the dilemma of indeterminate cytology
S10
Pathology (2014), 46(S2)
PATHOLOGY 2014 ABSTRACT SUPPLEMENT
Cytopathology: SY06-2 THYROID FINE NEEDLE ASPIRATION: THE DILEMMA OF INDETERMINATE CYTOLOGY Soon Won Hong Deptartment of Pathology, Gangnam Severance Hospital, Yonsei University, Seoul The thyroid aspiration cytology diagnosis already has merits in the aspects of accuracy and economy. However, when it is indeterminate cytology, it decreases the accuracy of diagnosis and causes confusion, so other methods need to be added together for diagnosis before surgery or diagnostic surgery needs to be performed, which take more time and money. Therefore, each diagnostic procedure will be divided into three steps and examined the points for improvements and limits by discussing each step’s problem. First, it is the problem of lesion itself. It is difficult to diagnose even with tissue sample. Second, it is the problem of cytopathologists’ reading experiences. Third, it is the problem of sampling procedure. As for the second and third problems, they require training from each field for improvement. For the first problem, immunohistochemical stain could be carried out if possible for help and make diagnosis by taking clinical findings into account; however, considering the fact that it is difficult to diagnose even with tissue sample due to the characteristic of lesion, the limit can only be admitted that accurate diagnosis is difficult from only cytological diagnosis.
Dermatopathology: LC07-1 CUTANEOUS XANTHOMATOUS INFILTRATE Yu-Hung Wu Department of Dermatology, Mackay Memorial Hospital, Taipei, Taiwan Xanthomatous infiltrate indicates aggregation of foamy histiocytes in the dermis. It may show nodular, interstitial, diffuse, perivascular, perifollicular pattern and corresponds to various disorders, including neoplasm, deposition, inflammation, and infection. Usually xanthomatous infiltrate represents hyperlipidemic xanthoma, such as eruptive xanthoma, tuberous xanthoma, and xanthelasma. They can be also seen in normolipidemic conditions, including diffuse plane xanthoma, papular xanthoma, and verruciform xanthoma. Xanthomatous infiltrate can also be seen in certain infectious diseases, especially lepromatous leprosy. This lecture reviews and summarizes various conditions of cutaneous xanthomatous infiltrate and emphasizes the diagnostic pitfalls in different settings.
Dermatopathology: LC07-1 PANNICULITIS Eduardo Calonje St John’s Institute of Dermatology, St Thomas’ Hospital, London, UK The subcutaneous fat is a metabolic depot and also provides insulation from trauma. The subcutis is divided into lobules by
fibrous septa. Within the fibrous septae course the small arteries, arterioles, veins and small nerve fibres. The nutrient artery supplies the centre of the lobule and drains to venules within the septum. Inflammatory disorders of the subcutaneous fat can be grouped into three main categories: 1) Septal panniculitis. 2) Lobular panniculitis. 3) Panniculitis associated with large vessel vasculitis. Most panniculitis are strictly speaking mixed but the classification is based on the predominant area of involvement. In septal panniculitis the inflammation is centred upon the connective tissue septa. There is often some spill over of the inflammatory cells into the periphery of the lobule. Erythema nodosum (EN) is the prototype of septal panniculitis. Other disorders associated with a septal panniculitis include necrobiosis lipoidica, factitial panniculitis, nephrogenic systemic fibrosis, cellulitis and microscopic polyangiitis. In the lobular panniculitides the inflammation is centered mainly within the lobule. Examples of lobular panniculitis include nodular vasculitis, lupus panniculitis, subcutaneous fat necrosis of the newborn, sclerema neonatorum, cold panniculitis, a1 anti-trypsin deficiency and pancreatic panniculitis.
Dermatopathology: SS07-2 ERYTHEMATOUS TUMOR ON THE INGUINAL AREA Dong-Youn Lee Samsung Medical Center, Sungkyunkwan University, Seoul, Korea A 43-year-old woman presented with skin rash on the body which had developed 5 years ago. Several years ago she was diagnosed with parapsoriasis. She received phototherapy with some improvement in another hospital. She complained of itching. Skin examination showed multiple erythematous patches and plaques on the body. Skin biopsy was performed. Based on histopathology the diagnosis was mycosis fungoides. Since then she received NBUVB therapy in another hospital. Very recently, she presented to our hospital with new lesions including a tumor in the inguinal area. Skin biopsy was performed from the tumor in left inguinal area. What is your diagnosis?
Dermatopathology: SS07-2 FIBRODYSPLASIA OSSIFICANS PROGRESSIVA Tariq J. Al-Zaid King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia Fibrodysplasia ossificans progressiva (FOP) is a rare autosomal dominant disorder principally affecting young children. It is a slowly progressive disease characterized by progressive fibroblastic proliferation leading to calcification and ossification. Early diagnosis can be challenging, yet important to avoid unnecessary invasive medical procedures which may play a role in disease progression. At a later stage of the disease, patients suffer from muscle stiffness, inability to move, contraction deformities and difficulties in respiration. Many patients die during early adult life due to respiratory failure or pneumonia. A case of FOP will be presented illustrating the clinicopathological features of this disorder.
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.
Pathology (2014), 46(S2)
PATHOLOGY 2014 ABSTRACT SUPPLEMENT
Cytopathology: SY06-2 THYROID FINE NEEDLE ASPIRATION: THE DILEMMA OF INDETERMINATE CYTOLOGY Soon Won Hong Deptartment of Pathology, Gangnam Severance Hospital, Yonsei University, Seoul The thyroid aspiration cytology diagnosis already has merits in the aspects of accuracy and economy. However, when it is indeterminate cytology, it decreases the accuracy of diagnosis and causes confusion, so other methods need to be added together for diagnosis before surgery or diagnostic surgery needs to be performed, which take more time and money. Therefore, each diagnostic procedure will be divided into three steps and examined the points for improvements and limits by discussing each step’s problem. First, it is the problem of lesion itself. It is difficult to diagnose even with tissue sample. Second, it is the problem of cytopathologists’ reading experiences. Third, it is the problem of sampling procedure. As for the second and third problems, they require training from each field for improvement. For the first problem, immunohistochemical stain could be carried out if possible for help and make diagnosis by taking clinical findings into account; however, considering the fact that it is difficult to diagnose even with tissue sample due to the characteristic of lesion, the limit can only be admitted that accurate diagnosis is difficult from only cytological diagnosis.
Dermatopathology: LC07-1 CUTANEOUS XANTHOMATOUS INFILTRATE Yu-Hung Wu Department of Dermatology, Mackay Memorial Hospital, Taipei, Taiwan Xanthomatous infiltrate indicates aggregation of foamy histiocytes in the dermis. It may show nodular, interstitial, diffuse, perivascular, perifollicular pattern and corresponds to various disorders, including neoplasm, deposition, inflammation, and infection. Usually xanthomatous infiltrate represents hyperlipidemic xanthoma, such as eruptive xanthoma, tuberous xanthoma, and xanthelasma. They can be also seen in normolipidemic conditions, including diffuse plane xanthoma, papular xanthoma, and verruciform xanthoma. Xanthomatous infiltrate can also be seen in certain infectious diseases, especially lepromatous leprosy. This lecture reviews and summarizes various conditions of cutaneous xanthomatous infiltrate and emphasizes the diagnostic pitfalls in different settings.
Dermatopathology: LC07-1 PANNICULITIS Eduardo Calonje St John’s Institute of Dermatology, St Thomas’ Hospital, London, UK The subcutaneous fat is a metabolic depot and also provides insulation from trauma. The subcutis is divided into lobules by
fibrous septa. Within the fibrous septae course the small arteries, arterioles, veins and small nerve fibres. The nutrient artery supplies the centre of the lobule and drains to venules within the septum. Inflammatory disorders of the subcutaneous fat can be grouped into three main categories: 1) Septal panniculitis. 2) Lobular panniculitis. 3) Panniculitis associated with large vessel vasculitis. Most panniculitis are strictly speaking mixed but the classification is based on the predominant area of involvement. In septal panniculitis the inflammation is centred upon the connective tissue septa. There is often some spill over of the inflammatory cells into the periphery of the lobule. Erythema nodosum (EN) is the prototype of septal panniculitis. Other disorders associated with a septal panniculitis include necrobiosis lipoidica, factitial panniculitis, nephrogenic systemic fibrosis, cellulitis and microscopic polyangiitis. In the lobular panniculitides the inflammation is centered mainly within the lobule. Examples of lobular panniculitis include nodular vasculitis, lupus panniculitis, subcutaneous fat necrosis of the newborn, sclerema neonatorum, cold panniculitis, a1 anti-trypsin deficiency and pancreatic panniculitis.
Dermatopathology: SS07-2 ERYTHEMATOUS TUMOR ON THE INGUINAL AREA Dong-Youn Lee Samsung Medical Center, Sungkyunkwan University, Seoul, Korea A 43-year-old woman presented with skin rash on the body which had developed 5 years ago. Several years ago she was diagnosed with parapsoriasis. She received phototherapy with some improvement in another hospital. She complained of itching. Skin examination showed multiple erythematous patches and plaques on the body. Skin biopsy was performed. Based on histopathology the diagnosis was mycosis fungoides. Since then she received NBUVB therapy in another hospital. Very recently, she presented to our hospital with new lesions including a tumor in the inguinal area. Skin biopsy was performed from the tumor in left inguinal area. What is your diagnosis?
Dermatopathology: SS07-2 FIBRODYSPLASIA OSSIFICANS PROGRESSIVA Tariq J. Al-Zaid King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia Fibrodysplasia ossificans progressiva (FOP) is a rare autosomal dominant disorder principally affecting young children. It is a slowly progressive disease characterized by progressive fibroblastic proliferation leading to calcification and ossification. Early diagnosis can be challenging, yet important to avoid unnecessary invasive medical procedures which may play a role in disease progression. At a later stage of the disease, patients suffer from muscle stiffness, inability to move, contraction deformities and difficulties in respiration. Many patients die during early adult life due to respiratory failure or pneumonia. A case of FOP will be presented illustrating the clinicopathological features of this disorder.
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.