Post on 02-Jul-2018
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Head and Neck FNA Cytology
Workshop
Thyroid
Salivary glands
Lymph nodes
Massimo BONGIOVANNI Lausanne, Switzerland
Beata BODE-LESNIEWSKA Zurich, Switzerland
ECC 2016 Liverpool 5.10.2016 Wen 8.30-10.00
Neck • Lymph nodes
• Thyroid
• Salivary glands
• Soft tissue – Muscle
– Fetty tissue
– Nerves
• Pharynx
• Larynx
• Oesophagus
84 y; F 80 y; F 26 y; M
Pat 1 Pat 3 Pat 2
a) Lymph node
b) Thyroid
c) Salivary gland
d) Soft tissue
a) Lymph node
b) Thyroid
c) Salivary gland
d) Soft tissue
a) Lymph node
b) Thyroid
c) Salivary gland
d) Soft tissue
? ? ?
Interventional Cytopathologists
Lymph node
Tuberculosis
Parotis
Warthin tumor
Thyroid
Goiter
84 y; F 80 y; F 26 y; M
Lymph node enlargement
FNA
Direct smear (PAP stain)
Pure lymphatic population (no obvious large cell lymphoma)
Flow cytometry
• Granulomatous inflammation
• Metastasis
• Hodgkin lymphoma
• Large cell lymphoma Suspicous clinical setting
•Age > 50
•History of NHL
•Multiple enlarged lymph nodes
•Persistent lymphadenopathy of
unknown cause (especially in
repeated FNA)
Low clinical suspicion of NHL
•Age < 30
•Search for metastases with isolated,
slightly enlarged node
•Obvious cause (e.g. inflammation in the
regional tissues)
No flow cytometry Immunocytochemistry and/or special stains and/or FISH / PCR if indicated
IHC cell block: bcl1-, bcl2+, bcl6+
Follicular lymphoma, low grade
TTF1 nuclear postitivity
Adenocarcinoma of the lunge, metastasis
- no EGFR gene mutation
- no ALK1 gene aberration
Dir
ect
sm
ear
s C
ell
blo
ck
Standardized reporting of the FNAs
of the thyroid nodules • In Great Britain since 2003
• Bethesda System (USA) 2008
29 y; man FNA cyst in the right supraclavicular area; „non diagnostic“ FNA 2013 Recurrence, bigger than 2013
60 ml clear fluid
Acellular sediment
Parathyroidal cyst No signs of malignancy
• Whole Range of the FNA Cytology of the
– Salivary glands (1 )
– Thyroid (2 )
– Lymph nodes (3 )
• Mostly cell blocks available (HE)
• Some cases with US & FACS print outs
• In most cases (if possible) histological correlation (slides mostly included)
www.zytologie.usz.ch