Cytodiagnosis of distant metastases from follicular thyroid carcinoma

Diagn Cytopathol. 2016 Feb;44(2):108-12. doi: 10.1002/dc.23412. Epub 2015 Dec 10.

Abstract

Introduction: Follicular carcinoma of the thyroid is second most common primary malignancy of the thyroid gland after papillary carcinoma and metastasis is uncommonly seen in these patients.

Aims and objectives: To describe the cytomorphologic features for the accurate diagnosis of distant metastases from follicular carcinoma of thyroid.

Materials and methods: A total of 10 aspirates reported as metastatic follicular carcinoma of thyroid were reviewed for the available clinical and radiological details.

Results: All the patients were females. Six of these patients presented with subcutaneous and soft tissue swellings, one presented with a lung mass, one with right breast swelling, one with lumbar vertebral lesion and one with left iliac bone involvement. The cytology smears revealed tumour cells predominantly arranged in a repetitive microfollicular pattern with some scattered individually and in sheets. The tumour cells were small, had mild nuclear pleomorphism, round nuclei, low nuclear-cytoplasmic ratio, fine chromatin, inconspicuous nucleoli, and scanty to moderate amount of cytoplasm with some showing marginal vacuoles with "fire-flare" appearance. Occasional microfollicles showed scanty eosinophilic colloid in the center.

Conclusions: Identification and establishment of a correct clinical diagnosis of a distant metastasis from a follicular thyroid carcinoma is a challenging task. We believe that with prior knowledge of characteristic cytologic features, such metastases can be rapidly and accurately diagnosed by fine needle aspiration cytology.

Keywords: follicular carcinoma; metastasis; thyroid.

MeSH terms

  • Adenocarcinoma, Follicular / pathology*
  • Adult
  • Bone Neoplasms / pathology*
  • Bone Neoplasms / secondary
  • Breast Neoplasms / pathology*
  • Breast Neoplasms / secondary
  • Female
  • Humans
  • Lung Neoplasms / pathology*
  • Lung Neoplasms / secondary
  • Middle Aged