Diagnostic clues for hyalinizing trabecular tumor on fine needle aspiration cytology

Abstract

Objectives: The hyalinizing trabecular tumor (HTT) is a rare benign neoplasm of the thyroid gland. This neoplasm has overlapping cytological features with Papillary Thyroid Carcinoma, Medullary Carcinoma and Follicular Neoplasm with Nuclear Features of Papillary Carcinoma. This can lead to misdiagnosis of malignancy in fine needle aspiration (FNA) cytology specimens with unnecessary total thyroidectomy. The aim of this study is to determine if there are some cytological features that could help us to suspect HTT on FNA specimens and avoid radical surgery.

Material and methods: With this purpose we have collected 6 cases diagnosed of HTT in Hospital Clínico San Carlos of Madrid (Spain) in the last 10 years and reviewed the cytological specimens.

Result: We conclude that the presence of hyaline material in FNA specimens of HTT is a constant feature being a diagnostic clue. We must be cautious not to confuse it with dense colloid or amyloid material, the latter seen in Medullary Carcinoma. Papillary architecture and fibrovascular cores are not present in a HTT. Special stains as ki-67, calcitonin and Congo Red staining could help us in achieving the correct diagnosis.

Conclusion: We feel the cytopathologists must be aware of the distinguishing features of this lesion, mainly the typical hyaline material to achieve a proper diagnosis and be able to reduce unnecessary aggressive management of these patients.

Keywords: Colloid; Fine needle aspiration; Hyaline material; Hyalinizing trabecular tumor; Nuclear pseudoinclusions.

Figure 1:

Hyaline material (a) with intermingled discohesive cells, one of them showing an intranuclear pseudoinclusion, in a bloody background. We must differentiate this material from the dense colloid (b) with a more homogeneous aspect, without intermingled cells and more blunt and sharp edges.

Figure 2:

(a and b) Hyaline material between small groups of polygonal/fusocellular shaped cells.

Figure 3:

Psammomatous calcifications.

Figure 4:

(a and b) Discohesive sheets of elongated cells with nuclear grooves and nuclear pseudoinclusions and scant hyaline material in the bloody background. The elongated features of the cells can lead to a misdiagnosis of medullary thyroid carcinoma.