However, outside this context their significance must be assessed cautiously, particularly because a "suspicious" diagnosis may lead to the same surgical consequence as a "definitive" diagnosis. Of the 29 resected PCs, 23 corresponding FNAs showed the characteristic cytologic triad of papillary architecture, nuclear ridges/grooves, and intranuclear inclusions (Fig. The diagnostic accuracy of FNA for thyroid PC exceeds 90%.10 This accuracy rests on multiple criteria,10 but the high specificity of PB in surgical specimens has led some authors to consider their presence in FNAs as sufficient indication for exploratory surgery.7-9 The purpose of this study was threefold: 1) to determine the PPV of aspirated PB for PC; 2) to detect any difference in the significance of PB from other calcifications; and 3) to identify any light microscopic features that might differentiate PB associated with PC from those associated with other entities. These recent false‐positive cases prompted a review of our inhouse specimens to determine the PPV and characteristic features of PB as related to PC. Psammomatoid calcifications were present in resections from 3 PCs, 3 MNGs, and 1 FC; their locations paralleled those for PB. 7, No. In 75% of the true‐positive specimens, PB were accompanied by a triad of characteristic cytologic features (papillary fronds, nuclear ridges/grooves, and intranuclear inclusions). In general, reliance on any isolated finding invites false‐positive predictions10; this type of error is acceptable when the suspected disease is serious or further investigation is noninvasive. Summary: Microcalcifications are a highly specific sign of malignancy being frequently detected in papillary or medullary cancers, while only 5% of nodular goiters and 3–4% of adenomas show this feature on thyroid sonogram. The nature of these spherical, lamellated concretions clearly was benign on histologic examination, but they met the criteria for "psammoma bodies." This study included patients who had non–tumor-associated psammoma bodies in their thyroids or in the … Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username, I have read and accept the Wiley Online Library Terms and Conditions of Use, Psammomkörper in Schilddrüsen eines Kropfendemiegebietes (Psammoma bodies in thyroid glands from an endemic goiter region), Microlithiasis (calcospherites) and carcinoma of the thyroid gland, Les tumeurs papillaires du corps thyroide, Papillary thyroid carcinoma. 5, Endocrine, Metabolic & Immune Disorders - Drug Targets, Vol. The addition of psammomatoid and dystrophic calcifications to PB raised sensitivity moderately (28%) and PPV slightly (57%). 35, No. 3 (48K) from multinodular goiter. 1, 13 April 2011 | Annals of Surgical Oncology, Vol. To simplify the predictive statistical study for cytologic features, aspirates with only one or two findings of the characteristic triad were considered negative; in actual daily practice, FNAs with any suggestive feature (including PB) often are reported as "suspicious for papillary carcinoma.". When grouped together, calcifications were found much more frequently in papillary carcinoma (28%) than in other aspirates (5%). The fine structural morphologic features of a microfollicular thyroid adenoma from a 28 year old female were examined. Of three aspirates whose only suspicious finding was isolated PB, two were false‐positive. Papillary carcinoma … In contrast, of 23 aspirates in our study that showed papillary fronds, nuclear ridges/grooves, and intranuclear inclusions, there were no false‐positive predictions (PPV of 100%); this combination of cytologic features also was much more common than PB in PC (sensitivity of 80% vs. 14%). The PB of MNG and FC were located predominantly within follicles (Figs. Therefore, in practice, the nature and significance of concretions cannot be recognized unless supporting architectural or cytologic features also are present. Psammoma bodies in thyroid aspirates are associated with multinodular goiter as often as they are with papillary carcinoma. 37, No. The 2 occult PCs were categorized with the palpable lesion that led to resection (MNG and follicular carcinoma); both occult lesions were incidental, measured < 1 cm, and lacked PB. Should we treat isolated psammoma bodies as representing metastatic disease? All rights reserved, USA and worldwide. Use the link below to share a full-text version of this article with your friends and colleagues. 1, 12 October 2017 | Scientific Reports, Vol. The issue of post‐test disease probability, or positive predictive value (PPV), was recently highlighted in our laboratory by the occurrence of two cases with "benign" PB. The PB in PC often were related to tumor foci, but in one case they lay exclusively within follicles of the surrounding, apparently benign, thyroid. Learn more. Psammoma bodies can be found in organs such as the thyroid, ovaries, endometrium, and the lining of the central nervous system. Based solely on the presence of PB, our retrospective analysis of 313 aspirates correctly predicted PC in 50% of cases (PPV of 50%); the remaining 50% represented MNG. It is a very A. Meningioma B. Papillary carcinoma thyroid C. Follicular carcinoma thyroid D. Serous cystadenocarcinoma of ovary Correct answer: C. Follicular carcinoma thyroid Psammoma bodies are characteristically seen in: Papillary carcinoma thyroid Meningioma Serous cystadenocarcinoma of ovary Renal cell carcinoma Breast cancer, lung cancer, malignant … Among the 209 papillary carcinomas and follicular carcinomas that had psammoma bodies, dissemination was observed in 114 (55%) cases. New content will be added above the current area of focus upon selection Memory device PSaMMoma: Papillary (thyroid, renal), Serous (ovary), Meningioma, Mesothelioma. Working off-campus? 46, Journal of Korean Thyroid Association, Vol. They are involved in both cancerous and benign tumors, and can also be a sign of chronic inflammation. The microphotographs of cytological smears show psammoma bodies as 50 to 70 < m round-shaped calcific concretions with a glassy appearance, concentrically laminated. 4, 30 September 2011 | Journal of Medical Ultrasonics, Vol. 10, 19 January 2018 | PLOS ONE, Vol. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. 11, 1 October 2016 | Journal of Ultrasound in Medicine, Vol. However, 85% of PCs are low risk, with a mortality of 2%; this figure equals the risk of recurrent laryngeal nerve damage and is much lower than that for hypoparathyroidism.18 Thus conservative management appears justified. Summary: Microcalcifications are a highly specific sign of malignancy being frequently detected in papillary or medullary cancers, while only 5% of nodular goiters and 3–4% of adenomas show this feature on thyroid sonogram. 5a (94K)]); and "dystrophic calcifications" (irregular shape, lacking laminations [Figs. A term for a round, laminated, 20–100-µm diameter calcified mass seen by light microscopy, which corresponds to degenerated papillary clusters of cellular debris. As early as 1980s, a pathological study carried out by Johannessen et al. 42, No. PC accounts for only 1% of palpable solitary thyroid nodules18; thus, the predictive value of PB would be expected to reflect a high proportion of false‐positive tests. Scattered Psammomatous Calcifications around Papillary Thyroid Carcinoma, The pattern and significance of the calcifications of papillary thyroid microcarcinoma presented in preoperative neck ultrasonography, The Prognostic Relevance of Psammoma Bodies and Ultrasonographic Intratumoral Calcifications in Papillary Thyroid Carcinoma, Consensus français sur la prise en charge du nodule thyroïdien : ce que le radiologue doit connaître, Sonographic findings of Sister Mary Joseph’s nodule from ovarian cancer, Diffuse Microcalcifications Only of the Thyroid Gland Seen on Ultrasound: Clinical Implication and Diagnostic Approach, Guidelines of the French society of endocrinology for the management of thyroid nodules, Fine-needle aspiration of the diffuse sclerosing variant of papillary thyroid carcinoma masked by florid lymphocytic thyroiditis; A potential pitfall: A case report and review of the literature. A study of its many morphologic expressions and clinical correlates, Surgical pathology of the thyroid: major problems in pathology, Psammoma bodies in fine needles aspirate of the thyroid in lymphocytic thyroiditis, Psammoma bodies in fine needle aspirates from thyroids containing nontoxic hyperplastic goiters, Guides to clinical aspiration biopsy. (b and c) "Dystrophic" type, with shattered irregular plates in papillary fronds (b) or syncytial tissue fragment (c). References ↑ Without such features, these calcifications could not be recognized as originating from malignant entities, and may not even be noticed on Romanowsky's stain due to their optical clarity (a and b: Papanicolaou stain, x400; c: Diff‐Quik® modification of May‐Grünwald‐Giemsa stain, x400). 5b (94K)). We agree that psammoma bodies are concerning for the presence of metastatic papillary thyroid carcinoma, likely a metastasis consisting of very few tumor cells or tumor that has regressed. Isolated psammoma bodies in smears or aspirates are an unreliable predictor of papillary carcinoma. But if you are looking at a thyroid carcinoma and trying to figure out which kind it is (papillary, follicular, medullary or anaplastic thyroid carcinoma), seeing psammoma bodies would be very helpful. Vincenzo Triggiani, Edoardo Guastamacchia, Brunella Licchelli, and Emilio Tafaro. The entire nodule was frozen, and sections showed small, tightly packed tubules and nests of epithelioid cells in a fibrous background notable for many psammoma bodies (Figure 1). 1 (68K), 2b (45K), and 3 (48K)]); "psammomatoid calcifications" (spherical shape, lacking laminations or irregular shape with laminations [Fig. Psammoma bodies in the thyroid are common in glands with papillary thyroid carcinoma. Psammoma bodies in normal thyroid tissue were observed in 45% of papillary carcinomas with psammoma bodies in the primary tumor, but in none of the papillary carcinomas without psammoma bodies in the primary tumor. … 4 (82K). T h e frequent association of psammoma bodies and thyroid cancer has been commented upon for more than 50 years. 2a (45K) and b) or pooled hemorrhagic colloid (Fig. The presence of these calcifications in aspirates is often considered nearly diagnostic of PC, warranting surgical exploration.7-9 However, Kini advised caution in interpreting their diagnostic significance10 because they also have been described in patients with diverse benign conditions.1, 2, 8-17. (a‐c) Calcifications from papillary carcinoma. 212, No. Internal Spreading of Papillary Thyroid Carcinoma: A Case Report and Systemic Review. In 3 of these 14 FNAs, the sole worrisome feature was the presence of rare PB; subsequent surgery in these cases yielded MNG in 2 patients and PC in 1 patient. These effects on predictive value are particularly important in patients with PC because the condition is rarely fatal, and the surgical risks (vocal cord paralysis, hypoparathyroidism, and hypothyroidism) are relatively serious. Subsequent lobectomy specimens were negative in both instances, one showing multinodular goiter (MNG) with intrafollicular PB, the other a follicular adenoma with lobulated dystrophic calcification.
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