ABSTRACT
INTRODUCTION: Encapsulated follicular variant of papillary thyroid carcinoma (PTC) has an indolent behavior; hence, a change in terminology to "noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)" has been proposed. Data are scant on the fine-needle aspiration (FNA) diagnosis of nodules proven to be NIFTP upon resection. The aim was to evaluate the FNA diagnosis of nodules diagnosed as NIFTP upon resection. MATERIALS AND METHODS: The archives of 8 participating institutions were searched for thyroid resection specimens obtained in a 1-year period, and pertinent demographic and pathology data were recorded. RESULTS: 2226 thyroid surgeries were performed over the indicated time period. NIFTP was diagnosed in 6.3% of cases; 118 patients (119 nodules) with NIFTP and available preoperative thyroid FNA were included. Preoperative cytologic diagnosis were: non-diagnostic: 0.8%; benign: 5.9%; atypia of undetermined significance/follicular lesion of undetermined significance: 42.9%; follicular neoplasm/suspicious for a follicular neoplasm: 31.0%; suspicious for malignancy: 15.9%; malignant: 3.4%. Molecular data was available for 49 cases, either by Afirma or ThyGenX/ThyroSeq. Of the Afirma cases, 11% were classified as "benign", 2% as "indeterminate", and 87% as "suspicious"; of the ThyGenX/ThyroSeq cases, 50% had NRAS mutations, 20% demonstrated KRAS mutations, 20% showed HRAS mutations, and 10% showed a BRAF mutation (K601E). CONCLUSIONS: NIFTP are tumors demonstrating nuclear features similar to those seen in PTC. Our series shows that a preoperative diagnosis of "suspicious for malignancy" or "malignant" is uncommon in NIFTP, suggesting that there are sufficient cytomorphologic differences between PTC and NIFTP to allow for the suspicion of NIFTP on FNA specimens.
ABSTRACT
Post transplant lymphoproliferative disorders (PTLD) complicates the course of 0.3 to 3% of renal transplant patients receiving immunosuppression. Epstein-Barr virus (EBV) related non-Hodgkin's lymphomas of B-cell type is more common than those of T-cell origin. CD30 positive Anaplastic Large Cell Lymphoma (ALCL) is a Non-Hodgkin's lymphoma (B or T cell type) that accounts for a small percentage of PTLD's. ALCL of T-cell type are a spectrum of disease ranging from primary cutaneous to systemic nodal ALCL. The systemic nodal ALCL is further subdivided into anaplastic lymphoma kinase-1 (ALK-1) positive or negative. ALK-1 protein is a gene fusion product of translocation (2;5) and carries prognostic implications. We present an unusual manifestation of ALK-1 negative CD30 positive ALCL in a post renal transplant patient in FNA cytology with all supportive adjuvant studies and differential diagnoses and review the cytology literature on this topic.
Subject(s)
Ki-1 Antigen/analysis , Kidney Transplantation/adverse effects , Lymphoma, Large-Cell, Anaplastic/pathology , Mediastinal Neoplasms/pathology , Protein-Tyrosine Kinases/analysis , Adult , Anaplastic Lymphoma Kinase , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Biomarkers, Tumor/analysis , Biopsy, Fine-Needle , Carcinoma/diagnosis , Cyclophosphamide/therapeutic use , Diagnosis, Differential , Doxorubicin/therapeutic use , Humans , Immunocompromised Host , Immunohistochemistry , Lymphoma, Large-Cell, Anaplastic/chemistry , Lymphoma, Large-Cell, Anaplastic/etiology , Lymphoma, Large-Cell, Anaplastic/immunology , Male , Mediastinal Neoplasms/chemistry , Mediastinal Neoplasms/etiology , Mediastinal Neoplasms/immunology , Melanoma/diagnosis , Postoperative Complications , Prednisone/therapeutic use , Receptor Protein-Tyrosine Kinases , Remission Induction , Seminoma/diagnosis , Seminoma/secondary , Testicular Neoplasms/diagnosis , Vincristine/therapeutic useABSTRACT
Licensing of laboratory professionals has been a controversial issue for the individuals working in these professions for many years. In New York State (NYS), licensing of laboratory professionals has been debated for over three decades and did not become law until 2005. The NYS licensure law stipulates specific educational requirements that include course work as well as curricular content areas. In addition to these educational requirements, the licensure law stipulates successful completion of a certification examination for new licensure applicants. To determine if the new legislation in NYS has had a demonstrable impact on the ability to recruit qualified laboratory professionals, a survey tool was developed to gather baseline data for a longitudinal study on the same topic. A 20 item survey along with a letter of explanation and a self addressed return envelope was distributed by mail to managers and/or supervisors of laboratories in 150 hospitals that ranged in size from small community hospitals to large medical centers across the state of New York. Questions were created addressing each of the following categories: day to day laboratory staffing, increased cost of recruiting to the facility after licensure law, impact on ability to cross train and staff evenings and weekends, and impact on patient care. It is apparent from the survey results that the employers have already started experiencing difficulty to staff certain laboratory vacancies especially for Clinical Laboratory Technologists (CLT) and fear that this trend might continue over the years not only pertaining to CLT but also to other laboratory vacancies such as Histotechnologists-Histotechnicians and Cytotechnologists. The impact of the NYS licensure law on staffing, facility costs, patient care, and laboratory professionals are discussed.
