Blood Elements And Foamy Macrophages In Thyroid Cyst

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Figure 8.1. Algorithmic approach to cystic lesions.

obtaining a sample from the solid portion of a thyroid cyst. For most types of cysts, both benign and malignant, the microscopic features of the cyst contents are similar and include a combination of abundant hemosiderin-laden macrophages, foamy histiocytes, blood, proteinaceous debris, watery colloid, and giant cells with foamy cytoplasm (Figure 8.2). Cholesterol crystals may also be present and are best visualized using Diff-Quik stains. The amount of background watery colloid will vary depending upon the nature of the cyst and may be difficult to appreciate. Cystic adenomatous nodules usually have more background watery colloid than cystic neoplasms. The cyst fluid in the aspirate can be clear yellow or bloody; however, the gross color of the fluid is not predictive of whether the cyst is benign or malignant.

A note of caution when evaluating thyroid cysts: when an epithelial component is absent, the specimen should be con-

Macrophages Papanicolaou

Figure 8.2. Cyst contents. Aspiration of thyroid cysts typically yields specimens containing abundant hemosiderin-laden macrophages and debris. When adequate epithelial cells are absent, the specimen is considered "less than optimal" for evaluation and "nondiagnostic." (ThinPrep, Papanicolaou.)

Figure 8.2. Cyst contents. Aspiration of thyroid cysts typically yields specimens containing abundant hemosiderin-laden macrophages and debris. When adequate epithelial cells are absent, the specimen is considered "less than optimal" for evaluation and "nondiagnostic." (ThinPrep, Papanicolaou.)

sidered nondiagnostic because it does not meet basic specimen adequacy requirements. Adhering to specimen adequacy criteria will help avoid making a false-negative diagnosis of a cystic PTC.

Nonepithelial Components of Cyst Contents

• Hemosiderin-laden macrophages

• Foamy histiocytes

• Cholesterol crystals

• Chronic inflammation

• Giant cells with vacuolated cytoplasm

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