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Dr.Sithy Athiya Munavarah Dr. Johnsy Merla J* Original Research Paper

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Dr.Sithy Athiya Munavarah Dr. Johnsy Merla J* Original Research Paper Original Research Paper Volume-9 | Issue-2 | February-2019 | PRINT ISSN - 2249-555X Pathology CYTOMORPHOLOGY OF NODULAR THYROID LESIONS : A COMPARATIVE ANALYSIS OF WET AND AIR DRIED SMEARS Dr.Sithy Athiya PG, Director & HOD, Department of pathology,Karpaga Vinayaga Institute of Medical Munavarah Sciences&Reseacrh center Dr. Meenakshi Assistant Professor , Department of pathology, Karur Medical College. Dr. Suresh Durai J Professor, Department of pathology, Tirunelveli Medical College Dr. Johnsy Merla Assistant Professor, Department of pathology, Tirunelveli Medical College J* *Corresponding Author Dr. Chandru Mari Assistant Professor, Department of pathology, Tirunelveli Medical College Dr. Shantaraman Professor&HOD, Department of pathology, Tirunelveli Medical College. K ABSTRACT FNAC of thyroid lesions have sensitivity as high as 93.4% with a positive predictive value of malignancy 98.6 % and 74.9 %specicity. Two fundamentally different methods of xation and staining are used in FNAC: air-drying followed by a Romanowsky stain such as May Grunwalds Gimsa (MGG), Jenner-Giemsa, Wright's stain or Diff-Quik; and alcohol-xation followed by Papanicolaou (Pap) or hematoxylin and eosin (H&E) staining. Combining the morphological features of various stains often improve the diagnostic accuracy.In the present study, cytoplasmic granularity, paravacuolar granules and thin colloid are very well demonstrated using Wright Giemsa stain. Cell borders and crisp nuclear features such as chromatin pattern, intranuclear inclusions are best appreciated using wet xed smears stained with H&E and Pap stains. The cytomorphologic features of nodular thyroid lesions using multiple cytological staining techniques to enhance diagnostic sensitivity is evaluated in this study. KEYWORDS : : Cytology ,Fine Needle Aspiration, Romanowsky stain, Thyroid. Introduction 2 Nodular colloid goiter 8 20 The incidence of malignancy in a solitary thyroid nodule or in a with multinodular goiter is equal and about 5% in non-endemic cystic degeneration areas(1).FNAC of thyroid lesions have sensitivity as high as 93.4% 3 Follicular neoplasm 4 10 with a positive predictive value of malignancy 98.6 % and 74.9 4 Papillary carcinoma of 3 7.5 %specicity(2). Dignostic accuracy is important in thyroid lesions thyroid since it decides the type of thyroidectomy performed on the patient.Two fundamentally different methods of xation and staining 55 Suspicious of papillary 1 2.5 are used in FNAC: air-drying followed by a Romanowsky stain such as carcinoma of thyroid May Grunwalds Gimsa (MGG), Jenner-Giemsa, Wright's stain or Diff- Quik; and alcohol-xation followed by Papanicolaou (Pap) or hematoxylin and eosin (H&E) staining. Each of these stains highlight specic sub-cellular and extra-cellular components. Hence combining the morphological features of various stains often improve the diagnostic accuracy. The cytomorphologic features of nodular thyroid lesions using multiple cytological staining techniques to enhance diagnostic sensitivity is evaluated in this study. Materials and Methods The study was conducted in the cytopathology Out Patient Department, Department of Tirunelveli Medical College and Hospital. Fine needle aspirate materials obtained from nodular thyroid lesions of patients attending cytology outpatient department of Tirunelveli medical college hospital , were used in this study. Study FIGURE 1 : DISTRIBUTION OF LESIONS material included ne needle aspirate materials obtained from Histopathological correlation was available for 29 cases . A positive nodular thyroid lesions of 40 patients attending cytology OPD. FNAC correlation was observed in 16 cases of nodular colloid goiter, 6 cases was performed using 23 G needles, after obtaining informed written of nodular colloid goiter with cystic degeneration, 3 cases of follicular consent from the patients and multiple smears were prepared. Two neoplasm and 2 cases of papillary carcinoma of thyroid. Two cases smears were wet xed and stained with H&E and Pap stain. One or two reported as nodular colloid goitre turned out to be follicular adenomas. smears were dry xed and stained with Wright- Giemsa .Stained slides were observed using light microscope and analysed .The 1.Nodular colloid goiter : cytomorphologic features of thyroid lesions were analysed using i. Wright Giemsa stain :Follicular cells had pale ill dened various cytological staining techniques namely Hematoxylin and cytoplasm and round nucleus with open chromatin. Colloid eosin stain, Papanicolou stain and Wright Giemsa. Cases were material took bluish violet colour. Thick colloid showed cracking followed up and correlated with histopathology if available. artifacts and it was easy to identify thin colloid . ii. Papanicolou stain :The thyroid follicular cells had uniform round Results nuclei with scanty delicate cytoplasm.Thick and thin colloid took TABLE 1 : DISTRIBUTION OF LESIONS varying shades of light greenish blue colour ,pinkish colour and S.No Lesion Number of cases Percentage orangish colour . Follicular cells showed striking anisokaryosis. 1 Nodular colloid goiter 24 60 iii. Hematoxylin and eosin stain:Thyroid follicular cells had scant 46 INDIAN JOURNAL OF APPLIED RESEARCH Volume-9 | Issue-2 | February-2019 | PRINT ISSN - 2249-555X cytoplasm and round nucleus with condensed chromatin. Colloid reliable and optimal results . Minimising false negative and false appeared as eosinophilic material . Anisokaryosis was noted in the positive reports is greatly dependant on type and quality of stains used follicular cells.When aspirates are overly bloody, serum may be .The present study analyses the cytomorphologic features of individual mistaken for colloid, thyroid lesions using H&E, Pap and Wright Giemsa stains .These three especially on Pap stains. This problem was overcome by using air dried stains are widely used in most cytology laboratories smears stained with Romanowsky stains such as Wright Giemsa / MGG in which thin colloid appears as watery blue. Krafts K et al3 states that Romanowsky-type stains enhance cytoplasmic detail, a useful feature for determining differentiation of 2.Nodular colloid goiter with cystic degeneration neoplastic cells, Romanowsky-type stains frequently show excellent I. Wright Giemsa stain : Cyst macrophages showed dusky grayish granule detail Romanowsky-type stains are superior to wet xed cytoplasm and follicular cells had pale ill dened cytoplasm and preparations for diagnosing hematolymphoid neoplasms, particularly round nucleus with condensed chromatin. in body uid specimens. Certain characteristic features of ii. Papanicolou stain :Benign follicular cells and cyst macrophages hematolymphoid cells either not seen or are more difcult to were seen in the background of colloid or uid background. Cyst recognize in Papanicolaou or hematoxylin and eosin stains. macrophages showed engulfed colloid within their cytoplasm. Follicular cells showed anisokaryosis. The present study comprised of 24 cases of nodular colloid iii. Hematoxylin and eosin stain: Follicular cells arranged in goiter.Literature described that colloid appear as ne lm of varying microfollicles and macrofollicles admixed with cyst macrophages colour from gray-green to rose4, Colloid is cyanophilic to eosinophilic were in the background of colloid. The cyst macrophages had and orangish when mixed with blood 5 .In PAP-stained smears, thin vacuolated cytoplasm .Few had hemosiderin laden colloid stains pale green or orange, with cracking artifacts seen. Thick macrophages. Anisokaryosis was well appreciated in Pap and H & colloid appears as clumps of dark green or orange material2 E stained smears.Engulfed colloid within the cytoplasm of cyst macrophages were well demonstrated using Pap stain. This could In Romanowsky stains, thin colloid is recognized easily owing to its help in determining whether the cystic degeneration is recent or characteristic folding and cracking patterns, which imparts a “mosaic old. like crackling ” described by Krafts, Kp et al6 “ crazy pavement” appearance or “ cracked glass ” and red-violet colour 4. Orell et al2 3.Follicular neoplasm : describes blue violet colour and hyaline texture of colloid appear to be I. Wright Giemsa stain : Thyroid follicular cells showed moderately an advantage in May Grunwalds Giemsa (MGG)-stained smears and preserved microfollicular architecture with nuclear crowding and helps in distinguishing it from brillary collagen and deep magenta overlapping in some foci. Follicular cells had pale and poorly staining amyloid. In present study colloid appeared as eosinophilic in dened cytoplasmic limits. Nuclei are enlarged, round to oval and H&E stained smears.Colloid took light greenish blue colour, pinkish contain uniformly dispersed coarse granular chromatin. colour and orangish colour in Pap stained slides. In Wright Giemsa ii. Papanicolou stain : Predominant microfollicular architecture and stained smears colloid took bluish violet colloid. Thick colloid showed three dimensional clusters. The follicular cells were cracking artifacts. And it was easy to identify thin colloid in air dried monomorphic with pale ill dened cytoplasm and round nucleus smears stained with Wright Giemsa stain. The present study comprised with smooth contour. Background was hemorrhagic and free of of 4 cases of follicular neoplasm. E.A Sinna et al7 described a case of colloid follicular neoplasm showing atypical follicular cells with high N/C iii. Hematoxylin and eosin stain: Repetitive microfollicular pattern ratio and nuclear pleomorphism,
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