Rates of Thy 1-non-diagnostic thyroid fine needle aspiration using the UK Royal College of Pathologists Thy Terminology. A systematic review of the literature comparing patients who undergo rapid on-site evaluation and those who do not.

INTRODUCTION: The UK Royal College of Pathologists (RCPath) Thy terminology is an internationally recognised system for reporting thyroid fine needle aspiration. The terminology has been used throughout the UK and Ireland, in some parts of Italy and Switzerland, and elsewhere in the world. There is no systematic review of the literature specifically addressing the use of the non-diagnostic for cytological diagnosis-Thy1/Thy 1c category in the UK RCPath terminology. METHODS: A comprehensive literature search of online databases was conducted in October 2019 specifically examining overall reported rates of Thy1 and Thy1c in aspirates classified according to the UK Thy terminology. RESULTS: Twenty-five articles were identified showing a Thy1 rate of 13.4% (2540/18 920). The studies were then stratified according to whether or not the patients underwent rapid on-site evaluation (ROSE): 6.0% (353/5841; range 3.0%-10.9%) of ROSE aspirates were Thy1 whereas 18.5% (2072/11 204; range 7.9%-43.3%) of non-ROSE patients were Thy1; (P < .05). Three studies from 2016 reported Thy1c rates of 5.4%, 6.5% and 10.6%, respectively, implying Thy1 rates excluding Thy1c aspirates of 20.9%, 8.7% and 12.7%, respectively. CONCLUSION: This systematic review of the literature shows relatively high rates of aspirates non-diagnostic for cytological diagnosis-Thy1 in the peer-reviewed published literature using the UK terminology. Utilisation of ROSE appears to produce lower rates of Thy1 aspirates and ROSE should be considered if rates of non-diagnostic for cytological diagnosis-Thy1/Thy 1c are high.

Superficial myofibroblastoma of the lower female genital tract with description of the MRI features.

Superficial myofibroblastomas of the lower female genital tract are an unusual type of benign mesenchymal tumour. To the authors' knowledge, there has been no previous imaging description of a superficial myofibroblastoma in the literature. Here, we describe a case that presented with symptoms consistent with vaginal prolapse. However, a mass was palpable on clinical examination with unusual features on MRI. Following surgery, the histopathological features were considered consistent with superficial myofibroblastoma. By presenting the MRI and histological findings, we aim to raise awareness about this lesion so that it may be considered in the differential diagnosis of a vaginal mass.

An unusual breast mass: primary synovial sarcoma.

We describe a 54-year-old woman presenting with mastalgia and a 6 mm breast lesion on imaging. Core biopsy revealed a lesion characterised by a predominant epithelioid and a minor spindle cell component. Our differential diagnosis included intraduct papilloma/adenoma and adenomyoepithelioma. However, initial immunohistochemistry did not support these diagnoses and further immunohistochemistry raised the possibility of a synovial sarcoma. This was confirmed with the finding, using fluorescence in-situ hybridisation, of the characteristic translocation t(x; 18) (p11.2; q11.2). Establishing a diagnosis of synovial sarcoma at unusual sites may be difficult, especially when limited tissue is available, for example, within a core biopsy. In this case, immunohistochemistry was useful, but cytogenetics was the key additional investigation. It is important to consider the possibility of rare tumours when the morphological and immunohistochemical features of a lesion initially appear conflicting or inconclusive.