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Cytology and Pathology: Pitfalls and Challenges

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Abstract

This chapter reviews the morphological features of thyroid C-cell proliferations with a focus on identifying the potential pitfalls in the diagnosis of these important disorders. The most important component of making the diagnosis of medullary thyroid carcinoma is to consider it in the differential diagnosis. The spectrum of parafollicular C-cell proliferations includes C-cell hyperplasia, medullary thyroid carcinoma, and mixed medullary and follicular epithelial tumors. Various histologic variants of medullary thyroid carcinoma can pose diagnostic challenges; however, with the application of immunohistochemistry, C-cell proliferations can be identified. The important markers include those of neuroendocrine differentiation, synaptophysin and chromogranin, and their specific peptide products, calcitonin and carcinoembryonic antigen. Since 25 % of medullary thyroid carcinomas are inherited, pathologists can provide insights into those that warrant genetic testing by performing C-cell mapping that determines whether there is associated C-cell hyperplasia and whether its growth pattern (nodular vs. linear) suggests genetic predisposition. Molecular markers can be applied to predict appropriate therapy, and immunohistochemistry can prove unusual hormone production associated with various clinical syndromes. Novel prognostic markers are being identified, but the accurate identification of angioinvasion is an important feature that has been shown to be the most reliable predictor of disease recurrence and death.

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Authors and Affiliations

  1. Laboratory Medicine Program, Department of Pathology, University Health Network, 200 Elizabeth Street, 11th Floor, Toronto, ON, M5G 2C4, Canada

    Sylvia L. Asa & Ozgur Mete

  2. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, M5G 2C4, Canada

    Sylvia L. Asa & Ozgur Mete

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  1. Sylvia L. Asa
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  2. Ozgur Mete
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Correspondence to Sylvia L. Asa .

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  1. Associate Professor of Surgery; Chief, Section of Endocrine Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA

    Tracy S. Wang

  2. Donald C. Ausman Family Foundation Professor in Surgery and Chair, Medical College of Wisconsin, Milwaukee, Wisconsin, USA

    Douglas B. Evans

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Asa, S.L., Mete, O. (2016). Cytology and Pathology: Pitfalls and Challenges. In: Wang, T., Evans, D. (eds) Medullary Thyroid Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-39412-1_4

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  • DOI: https://doi.org/10.1007/978-3-319-39412-1_4

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