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Thyroid gland

Bethesda guidelines for Cytology

Suspicious for malignancy

Reviewer: Michael Constantinescu, M.D. (see Reviewers page)
Revised: 21 March 2011, last major update March 2011
Copyright: (c) 2010-2011, PathologyOutlines.com, Inc.


● Use when some features of malignancy, but lack definitive diagnostic changes
● Papillary carcinoma is most often considered in this diagnostic category
● Other malignancies more commonly considered include medullary thyroid carcinoma, lymphoma and metastases
● Scant diagnostic cells or poor cellular preservation in anaplastic carcinoma may also lead to this diagnosis
● Risk for malignancy is 60-75%
● Management: surgical intervention with or without intraoperative frozen section and ancillary testing (e.g. serum calcitonin, flow cytometry, immunocytochemistry)


Suspicious for papillary carcinoma:

Patchy nuclear changes pattern: moderate to marked cellularity, benign follicle cells (e.g. macrofollicles) admixed with cells with large nuclei, nuclear grooves, nuclear clearing and nuclear molding, rare/absent nuclear pseudoinclusions
Incomplete nuclear changes pattern: sparse, moderate or marked cellularity with generalized mild to moderately increased nuclear size, mild nuclear clearing and conspicuous nuclear grooves, but only minimal molding or irregular nuclear membranes and only rare/absent intranuclear pseudoinclusions
Sparsely cellular specimen pattern: features of papillary carcinoma but sparse cellularity
Cystic degeneration pattern: scattered follicular cells in groups or sheets with large pale nuclei and some grooves, but no intranuclear pseudoinclusions; calcifications reminiscent of psammoma bodies may be present; also hemosiderin-laden macrophages

Suspicious for medullary carcinoma: sparse to moderate cellularity, monomorphic population of discohesive cells, small to medium size, high N/C ratio, nuclei eccentrically located with smudged chromatin, no readily identified cytoplasmic granules

Suspicious for lymphoma: cellular sample with monomorphic small/medium lymphoid cells or sparse cellularity with atypical lymphoid cells

Sample reports

(1) Suspicious for malignancy
(2) Suspicious for papillary carcinoma

End of Thyroid gland > Bethesda guidelines for Cytology > Suspicious for malignancy

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