Thyroid gland
Bethesda guidelines for Cytology
Follicular neoplasm

Author: Phillip A. Williams M.D., MSC, Shahidul Islam M.D., Ph.D., FRCPC (see Authors page)

Revised: 16 January 2017, last major update May 2014

Copyright: (c) 2014-2017, PathologyOutlines.com, Inc.

PubMed Search: Bethesda guidelines follicular neoplasm
Cite this page: Follicular neoplasm. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/thyroidfollicularneoplasm.html. Accessed October 22nd, 2017.
Definition / general
  • Based on the 2009 Bethesda Criteria (Am J Clin Pathol 2009;132:658)
  • Triage category for excision and evaluation of capsular or vascular invasion, as these are indicators of follicular carcinoma, and cannot be evaluated on cytology
Terminology
  • Follicular neoplasm and suspicious for a follicular neoplasm are synonymous
Criteria
  • High cellularity, with conspicuous crowding and overlap
  • Scant / absent colloid
  • Hallmark feature: predominant microfollicular or trabecular arrangement of follicular cells
  • Nuclear atypia, pleomorphism, mitoses are uncommon
  • Hürthle cell neoplasm or suspicious for Hürthle cell neoplasm:
    • Variant of follicular neoplasm
    • Use for lesions consisting exclusively (or almost) of Hürthle cells (abundant finely granular blue / gray-pink cytoplasm on Diff-Quick, green on Pap or pink on H&E; enlarged eccentric nuclei with prominent nucleoli)
    • Usually contains isolated noncohesive cells
    • 16 - 25% eventually are determined to be hyperplastic (in nodular goiter or Hashimoto thyroiditis), not neoplastic
Treatment
  • Risk of malignancy is 15 - 30%
  • Surgical lobectomy to assess capsule (submit in toto) (Thyroid 2006;16:109)
Sample reports
  1. Suspicious for a follicular neoplasm
  2. Suspicious for a follicular neoplasm
    • Comment: cellular aspirate composed primarily of follicular cells exhibiting a microacinar architecture
  3. Suspicious for a follicular neoplasm, Hürthle cell type
Cytology images

Images hosted on PathOut server:

Follicular lesion not further specified, contributed by Dr. Mark R. Wick



Images hosted on other servers:

Follicular crowding

Follicular crowding and microfollicles

Trabecular arrangement of follicular cells

Follicular neoplasm


Hürthle cells

Atypical Hürthle cells

Hürthle cell neoplasm

Differential diagnosis
  • Papillary Thyroid Carcinoma (PTC): microfollicles, but nuclear features of PTC are present (nuclear grooves, prominent nucleoli, intranuclear cytoplasmic inclusions)
Additional references