title: Can the tall cell variant of papillary thyroid carcinoma be distinguished from the conventional type in fine needle aspirates? A cytomorphologic study with assessment of diagnostic accuracy.
abstract: OBJECTIVE
  The tall cell variant of papillary thyroid carcinoma (TCV-PTC) is an aggressive variant of PTC requiring accurate cytopathologic diagnosis for early aggressive management.
  
  
  METHODS
  Twenty-five cases of TCV-PTC in which the tall cells comprised at least 30% of surgically resected tumor were included in the study. The direct smears from a preoperative fine needle aspiration (FNA) and available hematoxylin and eosin cell block sections were reviewed. Ten cases of TCV-PTC were randomly selected and blinded with an equal number of conventional PTC cases. Representative slides were independently reviewed by 7 cytologists.
  
  
  RESULTS
  In a majority of the cases, the FNA direct smears were hypercellular and displayed flat monolayer sheets of cells. Tall columnar cells with cytoplasmic tails were seen in 56% of cases. The presence of large polygonal follicular cells with abundant granular oncocytic cytoplasm and distinct cell borders was the most common feature seen in all cases. Seventeen (68%) cases displayed intranuclear pseudoinclusions in cells with abundant granular cytoplasm. A correct diagnosis of TCV-PTC was made in 30-40% of cases by 7 study participants.
  
  
  CONCLUSIONS
  The correct recognition of TCV-PTC features in preoperative FNA is important for clinical management, and reporting these features in a cytopathology report is suggested.
authors.affiliation: Department of Pathology, The Johns Hopkins Hospital, Baltimore, Md., USA.
authors.forename: Hui
authors.initials: H
authors.lastname: Guan
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Vandenbussche
authors.forename: Yener S
authors.initials: YS
authors.lastname: Erozan
authors.forename: Dorothy L
authors.initials: DL
authors.lastname: Rosenthal
authors.forename: Armanda D
authors.initials: AD
authors.lastname: Tatsas
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Olson
authors.forename: Rui
authors.initials: R
authors.lastname: Zheng
authors.forename: Manon
authors.initials: M
authors.lastname: Auger
authors.forename: Syed Z
authors.initials: SZ
authors.lastname: Ali
mesh_terms: D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle; D002277:Carcinoma / Q000175:diagnosis* / Q000473:pathology; D002291:Carcinoma, Papillary; D003581:Cytodiagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000473:pathology