SYMPOSIUM CYTOLOGY OF HEAD AND NECK

26. EXTRAMEDULLARY PLASMOCYTOMA OF

HEAD AND NECK

Markov-Glavaš D, Simović S, Bumber Ž, Prstačić R

The extramedullary plasmocytoma (EMP) is rare tumor of the head and neck characterized by monoclonal proliferation of plasma cells. Most frequently it occurs in the mucus of nose, nasopharynx and sinuses. For the EMP diagnosis, the following is needed: valid bone-marrow results, normal results of serum proteins and absence of Bence-Johns proteines in urine, and valid radiological results in other bones. At the otorhinolaryngology unit in the Šalata Hospital, 6 patients with  EMP (5 males and 1 female) were treated. In 4 patients  tumor was localized in  nose, nasopharynx and  sinuses,  in 1 patient in  temporal bone, and in 1 in  parotid. The age of patients was between 34 and 58 years. A preoperative cytologic FNA was performed in 4 patients, and in all the bone-marrow FNAs, other bone  x-raying  was carried out. All the patients were treated surgically and by radiation.

SYMPOSIUM CYTOLOGY OF HEAD AND NECK

27. AMELOBLASTOMA CYTOLOGY

Trutin Ostović K, Ožegović M, Virag M

Clinical Hospital "Dubrava"

Ameloblastoma is  very rare epithelial tumor of odontogenic origin. We wanted to point out this tumor  cytomorphological criteria and diagnostical difficulties.

In the period between 1995. and 2000, at our Unit,  ameloblastoma diagnosis was rendered in three patients (two females and one male), which was also histologically verified.  In all three patients, tumor occured in the  mandibula. However, clinical course is different which suggests distinctive biologic behaviour of ameloblastoma. The cytological smears are hypercellular and two or three types of cells are present: small hypercoromatic basal cells in sheets, particular poligonal cells with abundant cytoplasma and round nucleus, and rare  spiral  mesenchymal cells with extended nucleus.

Cytology has a very important role in establishing the ameloblastoma diagnosis and monitoring the  patient´s treatment. Ameloblastoma with pronaunced  polymorphy can be a diagnostical  problem.

SYMPOSIUM CYTOLOGY OF THE HEAD AND NECK

28. CYTODIAGNOSTICS OF ASPIRATED THYROID

GLAND FRAGMENT UNDER ULTRASOUND CONTROL

Pauzar B,  Dmitrović B, Karner I

KB Osijek, Unit of Clinical Cytology

We have analysed  cytological smears of  aspirated thyroid  fragments under the ultrasound control in 200 patients in the  period between July, 15, 1997 and March 1, 2000, having also the pathohistological diagnosis.

The cytological diagnosis of papillary carcinoma was found in 25 patients (12,5%), suspected papillary carcinoma or suspected papillary extension in 8 (4%) patients, folliculare tumors in 2 (1%) patients, Hurthle´s tumor in 8 (4%), medullary carcinoma in 3 (1,5%), non-Hodgkin lymphoma in 3 (1,5%) and poorly differetiated carcinoma in 4 (2%) patients. Other diagnoses (cyst, colloid cyst, hemorrhagic cyst, Hashimoto´s thyroiditis, description of hyperthyreosis indirect signs) were made in 92 (46%) patients. The finding of thyroid gland tissue testing and inadequate material occurred in 39 patients (19,5).

The results were compared to the test results of patients suffering from  thyroid gland carcinoma and treated in Clinical Hospital Osijek in the thirty-year period, when  FNAs were performed without the ultrasound control.

The following has been demonstrated: mixed medullaro-papillary thyroid carcinoma, parathyroid carcinoma cytologically and histologico-intraoperationally diagnosed as folliculare tumor, eleven-year old patient with the diagnosis of metastatic papillary thyroid gland carcinoma in more lymph nodes on neck, and three patients with primary Non-Hodgkin´s thyroid  lymphoma in a two-month period.

SYMPOSIUM CYTOLOGY OF   HEAD AND NECK

29. CYTODIAGNOSTICS OF LYMPHOMA IN THYROID GLAND

Ćurić-Jurić S,  Maričević I,  Šokčević M,  Vasilj A,  Žokvić E,

Staničić V, Koprčina M, Gaćina P

KB "Sestre milosrdnice"

Thyroid  lymphomas are rarely diagnosed. Their incidence among malignant thyroid  tumors, according to the data found in literature, ranges from 0,6 - 5%. As immunology and molecular biology   developed, they were identified as an isolated entity and separated from the previous group of small cellular anaplastic carcinoma. Majority of thyroid  lymphomas are B-cell lymphomas of high malignant degree, while a part of low malignant degree lymphoma have lately been classified into MALTomas.

In a ten-year period, we have rendered the lymphoma diagnosis through cytological thyroid  node FNA  in 9 patients. Among the patients there were seven females and two males at the age between 21 and 86 years. In one patient the findings were in favour of M:Hodgkin, six were with HNL of high malignant degree, whilst two patients had NHL of low degree. In one case  NHL transformation from low into high degree occured. In five patients a bone-marrow FNA was performed and bone-marrow infiltration  with lymphoma cells was not detected. Two patients were, besides lymphoma, diagnosed another malignant (epithelial) tumor out of the thyroid gland. Seven patients were operated, and the pathohistological examination confirmed the cytological diagnosis. Six, out of nine patients, died in the period from 15 days to 20 months after rendering the diagnosis. Cytological diagnostics of thyroid  lymphoma appeared to be a useful method in diagnostics and clinical monitoring of  patients.

SYMPOSIUM CYTOLOGY OF   HEAD AND NECK

30. MIXED MEDULLAR - PAPILLARY

THYROID  CARCINOMA - CASE PRESENTATION

Pauzar B¹,   Šeparović V²,    Blažičević V¹,   Karner I¹

¹KB Osijek, Unit of Clinical Pathology, ²Clinic of Tumors, Zagreb

The simultaneous incidence of  thyroid  tumor, originating from follicular epithelium and parafollicular -C cells, is seldom described in the literature.

The case of a 45- year old female patient is presented. She has been trated for two years because of Hashimoto´s thyreoiditis with a node of a nut size in the right thyroid gland lobe which has not been   isolated in the ultrasound. A targeted cytological FNA from both thyroid  lobes is performed, and the diagnosis of medullary carcinoma in the right lobe and Hashimoto´s thyreoiditis in the left lobe is made. The previous histological diagnosis suggested papillary carcinoma of the right lobe and Hashimoto´s thyreoiditis. Later on, extremely high calcitonin values are reported, hence the revision of pathohistological results and immunohistochemical staining are reported. Since  tumorous cells demonstrate positive reaction on both thyroglobulin and calcitonin, the diagnosis of mixed medullar-papillary tumor is established.

SYMPOSIUM CYTOLOGY OF   HEAD AND NECK

31. MUCOEPIDERMOID CARCINOMA WITH

PRIMARY LOCALIZATION IN THYROID GLAND

Bence-Žigman Z,  Knežević Obad A,  Serveti Seiwerh R,  Krušlin B

Clinical Department of Nuclear Medicine Rebro

Only a few cases of primary mucoepidermoid thyroid carcinoma (MEC) have been demonstrated in the literature. It is assumed that the thyroid  MEC originates from the CSN (solid nest cells) found in the thyroid gland, and they are probably ultimobabrachial rudiments or originating from thyroglossal canal. We are presenting the case of MEC with primary localization in the thyroid gland. A 35-year old man observes a node on his neck, rapidly growing at the end of 1997. The ultrasound results suggest a hypoechogenic node of 5×4 in size in the left lobe, scintigraphically "cold", and the cytological results suggest poorly differentiated carcinoma. In January, 1998, a complete thyroidectomy was performed, and PHD suggested the thyroid gland MEC. In February, 1998, the intensive accumulation of 131J is detected, but the patient did not receive radioiodide therapy. On the ultrasound examination, a node, 6×7 in size was found in the lower neck third  on the left behind m.SCM, as well as a node, 3×1,5 in size, found in the middle neck third  on the right behind mSCM, and the cytological results indicated  MEC. A surgical operation was recommneded which the patient did not accept immediately, and only in July, 1998 a radical left-sided neck dissection was performed. In the dissectated fragment in 25 lymph nodes,  MEC was detected. In August, 1998,  CT detected an extensive tumorous process which spread from the larynx level, retrotracheally into the mediastinum area, constricting trachea, so the repeated surgical operation was given up. In October, 1998, neck radiation, with totally 6000 cGy received, was undertaken. During the radiation period,  tracheostoma was   performed and cannula was input. A partial tumor regression occured, but already in January, 1999, the progression reappeared, and the patient was sent to scintigraphy with  131J and this is the time   when we first met the patient at the Clinical Department of Nuclear Medicine Rebro. The scintigram with 5 mCi 131J was performed, and intensive accumulation in tumorous formations on the neck was detected. In April, 1999, the patient received a therapeutical dosis of 200 mCi 131J. A partial tumor regression occured, but with new progression in October, 1999. The multiple and extensive metastases in bones and lungs were revealed, and  repeated radioiodic therapy was given up. A palliative radiation of thoracic and lumbar spine and pelvis was carried out. After that, the patient has never appeared for the further control.

The conclusion:  MEC with primary localization in the thyroid gland is extremely rare. There is not enough experience in the treatment of such patients, and this case suggests an extremely agressive type of tumor.

SYMPOSIUM CYTOLOGY OF   HEAD AND NECK

32. RIEDEL´S STRUMA - ULTRASONIC

AND CYTOLOGICAL  PRESENTATION OF DISEASE

Knežević-Obad A, Bence-Žigman Z, Šeparović V

Clinical Department of Nuclear Medicine, Rebro,

Kišpatićeva street 12, 10 000 Zagreb

Riedel´s struma or invasive fibrous thyroiditis is  very rare chronic thyroid  inflammation. It used to be considered as a variant of  chronic lymphocytic thyroiditis, and today, the prevailing opinion is that  Riedel´s struma is one of multiple fibrosis localizations.

In a 25-year period, at the Department of Nuclear Medicine KBC "Rebro", only one case of Riedel´s struma have been diagnosed.

A 50-year old  patient (in 1983), had his thyroid processed because of hoarseness and burning sensation in the throat, the diagnosis of lymphomatous struma  accompained by hypothyreosis was made, and a substitutional therapy was undertaken, but later on, willingly interrupted by the patient in 1991. In 1993, she applied to our clinic with increased  erythrocyte sedimentation, higher temperature, pain in the neck and increased TSH - 118 mIJ/l and increased titre TAA.

The ultrasound picture: enlarged and extremely solid thyroid gland, non-compressible, uneven outer contours, non-homogenically distributed echo-sounds, hypoechogenic in relation to  normal thyroid  tissue. The cytological picture of aspirated fragments of both lobes suggested a late phase of SBT.

Despite an adequate therapy, the thyroid gland is still growing in volume, and, therefore, compressing and constricting the trachea with subsequental stridor. The diagnosis of Riedel´s struma is made by  repeated cytological FNA, and the patient is recommended a surgical operation. A partial resection of both lobes and isthmectomy are performed. Two years after the operation,  hypoparathyroidism was also developed in the patient.

Besides a specific cytologicalal picture, already presented in this work, the ultrasound characteristics of Riedel´s struma are demonstrated for the first time. Apart from the hypoechogenic presentation and non-homogenic distribution of echo-sounds, as well as uneven outer contours, it differs from the other diffusive diseases by glandular incompressibility, further  growing disposition despite the adequate substitutional therapy, and by trachea compression.

SYMPOSIUM CYTOLOGY OF   HEAD AND NECK

33. CORRELATION BETWEEN CYTOLOGICAL FINDINGS

AND PTH IN ASPIRATED PARATHYROID   FRAGMENT

Tomić-Brzac H,  Halbauer M,  Knežević-Obad A,  Dodig D

Clinical Department of Nuclear Medicine and Protection

from Radiation, KBC Rebro

The findings of targeted cytological FNA under the ultrasound control of echographically suspected parathyroid gland (PTŽ) are demonstrated in the work, as well as the findings of cytological analysis are compared to the values of parathormones (PTH)  in the same fragment.

58 patiens have been processed, 36 with primary and 22 with secondary hyperparathyroidism (HPT), with the age mean   48 years, out of which 35 females and 23 males, with 83 targeted cytological FNAs performed. Cytological smears were stained according to the Pappenheim (May-Grunwald-Giemsa) and  Grimelius method. The aspirated material in the fragment was diluted with 1 ml of physilogic solution for a certian PTH.  After that, the PTH concetration was determined by  standard radioimmunological method, in the same way as in the serum.

The adequate material for cytological analysis was obtained in 72 aspirated fragments (86,7%). The cytological parathyroid tissue finding  was detected in 57 fragments, false negative was in 6 fragments, false positive  was in 2 fragments. Accurately negative results of cytological analysis were in 5 fragments, and accurately negative PTH results were found in 8 fragments,   when  the parathyroid gland was not involved.

The determination of PTH in an aspirated fragment has a high sensibility (96%) and specifity (100%), while the cytological analysis method  demonstrates a high sensibility (90,7%) and  little lower specifity (71,4%).

The PTH determination in an aspirated fragment is a higly specified method, and the result can be positive even when the cell material is not obtained cytologically, hence it is always recommended when the parathyroid gland is suspected.

POSTER SECTION

34. AMELANOTIC MELANOMA - DIAGNOSTICAL PROBLEM

Šušterčić D¹,   Kardum-Skelin I¹ ,    Borovečki A¹ ,

Planinc-Peraica A¹, Vrhovac R¹ ,   Kardum MM² ,    Munitić A² ,

Rak² ,   Nosso D² ,  Bačić S³ ,    Jakšić B¹

Clinic of Internal Diseases KB "Merkur", Department of

Clinical Chemistry KB "Merkur", Unit of Otorhinolaryngology

KB "Merkur", Zagreb

A patient, 18- year old, applies as an outpatient because of an enlarged neck node on the neck in February, 1999. After the cytological FNA,  the diagnosis of poorly differentiated tumor is made, and immunocytochemical typing is suggested. Other clinical and laboratory results do not reveal any deviations from the normal.

The patient is hospitalized, immunophenotyping on flow cytometer performed and cells of non-lymphoid origin detected. The pathohistologic finding of the extirpated node part does not reveal elements of neoplastic processes. After a month, localized recidive on the same spot occurs. By cytological and comprehensive immunocytochemical processing, poorly differentiated cells positive on HMB 45, S-100 and vimentin, and negative on all lymphoid markers  (CD45, CD20, CD3 and CD30) are detected, and the diagnosis of amelanotic melanoma is rendered.

Majority of malignant melanomas is pigmented. However, the diagnosis of primary or metastatic amelanotic melanoma presents a great problem for cytologists and pathohistologists regarding various morphologic entities. Two specific antibodies S 100 protein and HMB 45, and  vimentin as well as a negative reaction to cytokeratin and lymphoid markers can help in the isolation  from   tumor of another biologic origin. But, the situation is not simple, since malignant melanocytes can suggest different stages of immunoreactivity even with NSE, certain cytokeratines and CEA.

From the other point of view, non-melanotic cells as  Schwann´s cell and C thyroid  cells, primitive neuroectodermal cell as meduloblasts can also synthesize melanin.

Comprehensive immunocytochemical processing, with ultrastructural electron -microscopic analysis, is the only solution in questionable  cases.

POSTER SECTION

35. FOLLICULAR ADENOMA OF   THYROID:

REVIEW OF CYTOMORPHOLOGICAL FEATURES IN 113 CASES

Mateša N, Tabain I, Kusić Z

KB "Sestre milosrdnice"