Abstract
Lymphocyte-only aspirates pose a significant diagnostic challenge in the interpretation of thyroid fine-needle aspiration specimens. Differential diagnosis includes Hashimoto thyroiditis, lymphoma, intrathyroidal lymph node, intrathyroidal thymoma, and thyroglossal duct cyst. Hashimoto thyroiditis especially in the florid lymphoid phase usually presents as lymphocyte-only aspirates. During this phase, numerous hyperplastic lymphoid follicles are seen throughout the gland, and they often replace the thyroid parenchyma. Lymphomas of the thyroid typically occur in older patients, almost always arise in a background of Hashimoto thyroiditis and are of B-cell lineage. Primary lymphomas of the thyroid gland are mainly diffuse large B-cell lymphoma (DLBCL) and extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) and to a much lesser extent Hodgkin and small lymphocytic lymphoma. Given the limitations of establishing a lymphoma diagnosis with only cytomorphology, morphological evaluation is commonly augmented with flow cytometry or immunohistochemistry in the diagnostic workup of lymphocyte-only fine-needle aspirates from the thyroid.
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Adeniran, A.J., Chhieng, D. (2016). Lymphocyte-Only Aspirates. In: Common Diagnostic Pitfalls in Thyroid Cytopathology. Springer, Cham. https://doi.org/10.1007/978-3-319-31602-4_6
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DOI: https://doi.org/10.1007/978-3-319-31602-4_6
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