INTRAEPITHELIAL NEUTROPHILS IN THYROID FINE-NEEDLE ASPIRATION - A PORTENT OF AGGRESSIVE THYROID-CANCER

We report three patients with papillary thyroid carcinoma in whom fine -needle aspiration (FNA) showed neutrophils within tumor cells. All th ree patients presented with large neck masses; at excision, two proved to be tall cell variants of papillary cancer. Nodal metastasis, extra thyroidal extension, and vascular invasion were found in both cases. O ne patient has experienced recurrent disease; the other has an increas ing thyroglobulin titer but no clinically appreciable recurrence. The third patient refused further therapy, but brain metastases were noted clinically; this patient died of disease. In each case, FNA showed tu mor clusters with characteristic nuclear features, papillary groups, a nd psammoma bodies. Neutrophils were present in the cytoplasm of tumor cells in the absence of necrosis. Immunostaining for proliferating ce ll nuclear antigen (PCNA), MIB-1 (Ki-67), and p53 tumor suppressor gen e product was markedly positive. Intraepithelial neutrophils have not been previously reported in differentiated thyroid tumors. We postulat e that these neoplasms produce specific leukocyte-attracting cytokines analogous to those produced by anaplastic and poorly differentiated t hyroid carcinomas. We believe the finding of intraepithelial leukocyte s in the absence of necrosis in thyroid FNA specimens represents a cha racteristic of clinically aggressive differentiated papillary neoplasm s; in our small series, each represented a tall cell variant of papill ary carcinoma.