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Scary but innocent "blast-like" cells-potentially helpful diagnostic feature for chronic lymphocytic thyroiditis
1Department of Pathology, Cooper University Health Care, Cooper Medical School of Rowan University, Cooper University Hospital, Camden, New Jersey.
Insights
Blast-like cells in Hashimoto thyroiditis (CLT) diagnosis are linked to hypothyroidism. Their presence, especially when non-rare, significantly enhances diagnostic accuracy for this common thyroid disorder.
Area of Science:
- Endocrinology
- Cytopathology
- Immunology
Background:
- Chronic lymphocytic thyroiditis (CLT), or Hashimoto thyroiditis, is a common thyroid disorder diagnosed via fine needle aspiration cytology (FNAC).
- Accurate CLT diagnosis is crucial for managing potential hypothyroidism and lifelong thyroxin supplementation.
- Diagnostic features include lymphoplasmacytes infiltrating thyroid cells, with 'blast-like' lymphocytes sometimes seen in DQ smears.
Purpose of the Study:
- To evaluate the significance of
- blast-like
- cells in CLT diagnosis on DQ smears.
- To correlate the presence of these cells with clinical hypothyroidism in CLT patients.
Main Methods:
- Review of FNAC slides from 35 CLT cases diagnosed between January 2022 and March 2024.
- Assessment of "blast-like" cell presence on DQ smears.
- Correlation with clinical hypothyroidism presentation.
Main Results:
- "Blast-like" cells were identified in 14 out of 35 CLT cases.
- Eleven of these 14 patients (79%) had confirmed clinical hypothyroidism.
- Specificity for hypothyroidism reached 94% when "nonrare" ( >5/3 HPF) ,
Conclusions:
- "Blast-like" cells are more common in advanced CLT cases and correlate strongly with clinical hypothyroidism.
- The presence of these cells enhances the diagnostic accuracy of CLT on FNAC.
- Further evaluation is needed for the diagnostic utility of "blast-like" cells in ambiguous CLT cases.
Introduction:
Chronic lymphocytic thyroiditis (CLT), or Hashimoto thyroiditis, is the second most common thyroid disorder diagnosed on fine needle aspiration cytology (FNAC). Accurate diagnosis is important as patients may subsequently become hypothyroid and require lifelong thyroxin supplement. Cellular lymphoplasmacytes infiltrating follicular and oncocytic cells are diagnostic features of CLT on FNAC. "Blast-like" large lymphocytes can be appreciated on DQ smears in some CLT cases and are believed to represent cells from reactive lymphoid follicles.
Materials And Methods:
The FNAC slides of CLT diagnosed between January 2022 and March 2024 were reviewed to evaluate the significance of "blast-like" cells in CLT. Correlation of their presence with clinical presentation of hypothyroidism was performed.
Results:
Fourteen of 35 CLT cases were found to have "blast-like" cells present on DQ smears, ranging from "rare" (≤5/3 HPF) in 4 cases to "nonrare" (>5/3 HPF) in 10 cases in lymphoid-rich areas. Eleven of these 14 patients were confirmed to have clinical hypothyroidism due to CLT, with a specificity of 82%, in contrast to only 7 of the 21 patients without these cells. The specificity increases to 94% if only cases with "nonrare" large "blast-like" lymphocytes present are counted.
Conclusions:
"Blast-like" cells admixed with polymorphic lymphoplasmacytic infiltrates are more frequently identified in full-blown CLT cases, and their presence shows high correlation with clinical hypothyroidism due to CLT and enhances the diagnosis. The diagnostic value of these "blast-like" cells in cases with insufficient diagnostic features for CLT requires more evaluation.
