甲状腺髓样癌 5例临床病理分析

目的 探讨甲状腺髓样癌(medullary thyroid carcinoma,MTC)的临床病理学特点.方法 对清远市人民医院2010年1月至2019年9月发生的5例甲状腺髓样癌的临床资料、组织形态、免疫组化及特殊染色进行回顾性分析和研究,结合文献了解其最新进展.结果 5个病例均以颈部肿物入院治疗.肿瘤呈实性,边界较清,无包膜,切面灰黄色或灰褐色;低倍镜下见肿瘤细胞呈泡巢状、器官样、乳头状或梁状排列,细胞质少,核增大、深染,间质见多量纤维组织及血管分隔,并见较多无定形粉染物;高倍镜见细胞核呈圆形或椭圆形,核仁明显,可见核分裂象.免疫组化显示癌胚抗原(CEA)、嗜铬素A(CgA)、突触素(Syn)、白细胞分化抗原56(CD56)均阳性,甲状腺球蛋白(TG)阴性,增殖指数Ki-67约2％～5％.最后诊断均为甲状腺髓样癌,其中2例淋巴结见癌转移,余3例未送检淋巴结.随访13个月至10年,其中1例带瘤生存,余4例尚无复发迹象.结论 甲状腺髓样癌发病率较低,容易误诊;结合HE形态、免疫组化及特殊染色,可明确诊断.

Medullary carcinoma of thyroid:a clinicopathologic study of 5 cases

Objective To investigate the clinicopathological features of medullary thyroid carcinoma (MTC).Methods Five cases of medullary thyroid carcinoma admitted to Qingyuan People''s Hospital from January 2010 to September 2019 were retrospectively ana-lyzed and the clinical data, histomorphology, immunohistochemistry and special staining results were studied. The latest progress ofMTC was summarized in combination with literature.Results All the 5 cases were admitted to hospital with cervical masses. The tu-mors were solid, well-defined, non-enveloped, and greyish-yellow or grayish-brown in section. At low magnification, tumor cells were ar-ranged in alveolar nests, organoid, papillary or beam shape, with less cytoplasm, enlarged and deep-stained nuclei. Numerous fibrous tissues and blood vessels separated the tumor nests. And amorphous amyloids were seen in the stroma. At high magnification, the nu-clei were round or elliptic, with obvious nucleoli and mitotic figures. The tumor cells were positive for carcinoembryonic antigen (CEA),chromogranin A (CgA), synapsin (Syn) and cluster differentiation antigen 56 (CD56), but negative for thyroglobulin (TG). Proliferationindex Ki-67 was about 2%~5%. The final diagnosis of 5 cases were medullary thyroid carcinoma, of which 2 cases had metastasis inlymph nodes and 3 cases had not been examined. Following up for 13 months to 10 years, 1 case survived with tumor, and the remain-ing 4 cases showed no signs of recurrence.Conclusion The incidence of medullary thyroid cancer is low, and it is easy to be misdiag-nosed as other diseases. Combined with HE morphology, immunohistochemistry and special staining, it can be clearly diagnosed.