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Abstract
Fine needle aspiration (FNA) biopsy is the most commonly used method for diagnosing papillary thyroid carcinoma (PTC) and other thyroid lesions. However, cytomorphologic markers of PTC currently used in diagnostic FNA cytology are insufficiently specific. They are observed in both malignant and benign lesions, expressed by cells of not every PTC subtype and by a varying fraction of the tumor cell population. The aim was to examine new morphological markers of PTC applicable in FNA smears of a thyroid gland material. Material and methods. The study material included FNA smears of nodular goiter (n=620), follicular
thyroid adenoma (n=332), Hashimoto’s thyroiditis (n=54), oncocytic cell lesions (n=50), follicular thyroid carcinoma (n=22), medullary thyroid carcinoma (n=42), and PTC (n=280). FNA smears from patients of both sexes (1164 women and 236 men) aged from 17 to 87 years were examined. To analyze them cytochemistry, immunocytochemistry and computer morphometry were applied. Results. Two unusual epithelial cell phenotypes were identified in FNA smears of PTC but never in smears of benign and non-PTC malignant lesions of the thyroid. Cytokeratin (CK) immunocytochemistry indicated the epithelial origin of these enlarged and pleomorphic cells. Key features of the first cell phenotype included a clear cytoplasm, sharply-delineated cell borders strongly refracting light, low or negative reaction for thyroglobulin, and epCAM-negativity. Cells of the second phenotype possessed a RNA-containing macula, displayed thyroglobulin-positivity and specific pattern of epCAM expression. The question whether cells of the two identified phenotypes are related cell forms is open to discussion. Conclusions. The cells revealed are observed only in PTC and, thus, can be used as highly specific morphological markers having a potential to improve the reliability of PTC detection in Giemsa-stained conventional FNA smears of the thyroid. The unusual morphology of these cells permits their easy identification without time-consuming immunocytochemistry.
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