甲状腺髓样癌伴乳头状癌1例

<正>患者女性,27岁,因左侧颈前肿物1个半月于2014年6月2日来江西省九江市第一人民医院就诊。患者于1个月前体检发现左侧颈部肿物,余无不适。入院查体:气管居中,左侧颈部可触及大小4.5 cm×2.5 cm包块,质中,表面光滑,边界清楚,可随吞咽上下移动;左侧颈部可触及多枚淋巴结肿大,右侧甲状腺未触及肿物和肿大淋巴结。眼球无突出,双手无细震颤。实验室检查均未见异常。颈部CT平扫:甲状腺左侧叶实性占位,不除外甲状腺癌并左侧淋巴结     

甲状腺乳头状癌合并髓样癌1例

患者女性,35岁,因发现右侧颈包块2年、颈前包块2个月余入院。2年前无明显诱因下,右侧颈耳后触及一花生米大小质硬无痛性包块,2个月前发现颈前包块并明显增大。查体:颈软,气管居中,右侧甲状腺Ⅱ度,质硬,可随吞咽上下移动,未闻及明显血管杂音,右耳下颈后三角触及3枚肿大质硬淋巴结。颈部CT示:右侧甲状腺内见一类圆形软组织密度影,密度不均匀,边界模糊,与周围结构分界欠清,向下延伸至胸廓入口处,颈部见数枚肿大的淋巴结,初步诊断为甲状腺癌伴颈部淋巴结转移。次日于颈丛麻醉下手术,术中见右甲状腺下极有5.5cm×4cm质硬包块,境界不清,与气管粘…     

Warthin瘤样甲状腺乳头状癌一例

患者男,46岁。体检发现双侧甲状腺结节于2014年7月入院。彩超示双侧甲状腺体积增大,包膜光整,实质回声增粗、减低,分布不均,呈网络状,在右侧上极可见一个低回声结节,大小约0.45 cm ×0.37 cm,边界不清;左实质内见两个结节,较大者约2.2 cm ×1.4 cm,呈囊实性,较小结节大小约0.9 cm ×0.6 cm,呈低回声。考虑双侧桥本甲状腺炎,右侧上极结节考虑甲状腺癌,左侧腺瘤样结节可能。实验室检查示血甲状腺球蛋白抗体13.11 IU／mL （正常＜4.11 IU／mL）,甲状腺过氧化物酶抗体＞1000 IU／mL （正常＜5.61 IU／mL）,高敏促甲状腺素5.71 mIU／L,其他总甲状腺素、游离甲状腺素等均正常。临床考虑桥本甲状腺炎,乳头状癌待排。术中见双侧甲状腺弥漫性肿大,右侧甲状腺上极可及一大小约0.3 cm ×0.3 cm质硬结节,边界不清,左侧甲状腺可及一大小约3 cm ×2 cm结节,质尚软,边界清,颈前区未及明显肿大淋巴结。予以行左侧甲状腺全切除术和右侧次全切除,冷冻切片示右侧微小乳头状癌,伴淋巴细胞性甲状腺炎。左侧为结节性甲状腺肿伴淋巴细胞性甲状腺炎。常规病理检查,右侧甲状腺如上述,切面可见直径0.3 cm的灰白质硬区;左侧甲状腺质地软,红褐色肉样,无明显质硬区。镜下见甲状腺滤泡间散在分布淋巴滤泡,右侧甲状腺可见典型的乳头状癌特征和纤维化,左侧甲状腺内一个结节似淋巴结,周围见纤维组织围绕,结节内有较宽阔的人工裂隙,形成宽大的乳头状结构,乳头间质为淋巴组织,并形成淋巴滤泡（图1）。乳头表面覆盖单层或复层上皮,局灶呈靴钉样突起、细胞异型性大,细胞质丰富嗜酸性,部分细胞扁平,似血管内皮或间皮,无甲状腺滤泡或胶质形成（图2）。部分上皮在淋巴组织内呈腺样,似淋巴结内转移性腺癌（图3）。免疫组织化学示上皮细胞表达甲状腺转录因子（TTF）-1（图4）和CK19,弱表达甲状腺球蛋白（TG）,提示为甲状腺上皮来源。 Ki-67阳性指数约10％。     

隐匿型转移性甲状腺髓样癌合并原发性乳头状癌1例

<正>患者女性,45岁。PET-CT示：左侧颈部淋巴结肿大、可疑恶性肿瘤淋巴结转移,其他部位未见可疑恶性肿瘤病灶。颈部超声检查示：左侧颈部Ⅲ区见一大小3 cm×1.5 cm肿大淋巴结;左侧甲状腺多发结节,最大0.6 cm×0.3 cm。粗针穿刺病理活检提示Ⅲ区肿大淋巴结内见甲状腺髓样癌细胞,患者遂行手术治疗,首先切除左叶及峡部甲状腺、清扫左侧中央区淋巴结,病理结果提示左叶原发性甲状腺微小乳头状癌及左侧中央区淋巴结转移,未提示原发髓样癌病灶;     

甲状腺髓样癌1例

<正>患者女性,78岁,因甲状腺肿物及纵膈病变入院。入院后查血Calcitonin2 000 pg/mL(5.17~9.82 pg/mL)、CEA35.43 ng/mL(0~5 ng/mL)、TG在正常参考值内。颈部超声:甲状腺多发实性及囊实性结节,考虑为TI-RADS 3级;左侧颈部及锁骨上窝多发实性占位。CT示:气管周围前上纵膈软组织肿物,侵袭性胸腺瘤?甲状腺来源恶性肿瘤?左侧颈根部、纵膈内多发肿大淋巴结;双侧甲状腺多发低密度灶。因纵膈病变位置较深且紧邻重要脏器无法取得活检标本,遂     

甲状腺乳头型髓样癌1例

患者女性, 35岁, 2003年 4月因左甲状腺肿瘤在外院行手术切除。术后病理诊断:甲状腺乳头状癌。同年 5月中旬来我院复诊,复阅原病理切片并检查原手术切除标本。眼观:肿瘤呈卵圆形, 4cm×2 5cm×2 5cm,表面光滑,有包膜,切面灰白、实质性,质硬。镜检:肿瘤由增生的纤维包绕,瘤细胞形态、大小较一致 (图 1 ),围绕血管和纤维形成乳头状结构(图 2),局部可见假复层或栅状排列;胞核圆形或卵圆形,无明显异型性,染色质呈粗颗粒状,核仁不清,少数见小核仁,偶见核分裂象;肿瘤间质和血管周围有粉染的淀粉样物和较多钙化灶。淀粉样物经刚果红染色呈砖红…     

甲状腺混合性髓样-滤泡状细胞癌的临床病理分析

目的探讨甲状腺混合性髓样-滤泡癌（MMFTC）临床病理特征、免疫组织化学表型及诊断与鉴别诊断。方法对2例甲状腺混合性髓样-滤泡癌临床资料进行分析,免疫组化（SP法）检测CT、Tg、CgA、vimentin、Galectin-3、CD56、CD57、CK19等,并结合文献进行复习。结果肿瘤组织由胖瘦不等的梭形细胞及甲状腺滤泡构成,二者互相穿插、分割排列,并侵犯被膜血管。免疫组化CT梭形细胞弥漫（＋）,个别滤泡上皮（＋）;Tg滤泡上皮（＋）,梭形细胞灶性（＋）;CgA部分滤泡上皮（＋）,部分梭形细胞（＋）;vimentin梭形细胞及滤泡旁细胞（＋）,个别滤泡上皮细胞（＋）;Galectin-3部分梭形细胞及滤泡上皮细胞（＋）。结论MMFTC临床罕见,依据梭形细胞和甲状腺滤泡组织二者同时侵犯被膜和（或）血管,结合免疫组化表型可确诊。     

家族性甲状腺髓样癌

甲状腺髓样癌是一种分泌降钙素的甲状腺泸泡旁C细胞肿瘤。这种肿瘤很少见,多数难以诊断。降钙素升高是本病的明显标志。血浆降钙素的免疫学测定简单易行。此病有散发的,也有遗传的(常染色体显性)当诊断出一例时,家系调查很重要。因降钙素的基础水平有时测不到,所以可采取降钙素分泌激发试验,这是家系研究的一种有效的普查方法。因肿瘤的恶性程度及各家系患病类型不同,该病的治疗是复杂的。作者通过对     

血清降钙素追查甲状腺髓样癌一例临床报道

2001年5月22日,我院收治了一例在外地做甲状腺右叶肿块局部切除后,要求进一步检查和做根除手术的患者,现报道如下。1诊断与治疗患者女,42岁,2001年2月偶然发现颈右下侧有一肿物,4月初入当地医院治疗,查体右颈前可触及2.5cm×2.5cm大小肿块,质硬且光滑,可随吞咽上下活动。患者血     

甲状腺髓样癌81例临床病理分析

目的探讨甲状腺髓样癌(medullary thyroid carcinoma, MTC)的临床病理特征、诊断及鉴别诊断、治疗及预后。方法对81例MTC行免疫组化、BRAF V600E基因检测,分析其临床病理特征及免疫表型等,并复习相关文献。结果女性45例,男性36例,年龄20～77岁,平均42.5岁。临床表现:颈部肿物、无明显症状或体检发现。肿块直径0.3～15 cm,平均6.5 cm。镜检:瘤细胞呈圆形、多角形或梭形,大小较一致,核圆形或椭圆形,核仁不明显,未见核分裂象。瘤细胞呈器官样、片状、巢状、梁状排列,8例瘤细胞围绕血管和纤维形成乳头状结构。间质见多少不等的淀粉样物质沉积(67/81)。免疫表型:瘤细胞Calcitonin(81/81)、Syn(80/81)、CgA(63/81)、CEA(25/38)和TTF-1(81/81)均阳性,刚果红染色阳性(67/81)。Ki-67增殖指数3%～30%。BRAF V600E基因检测1例(1/36)阳性。结论 MTC确诊主要依赖病理学形态和免疫表型,MTC预后较好,易复发和转移,手术完整切除后,应注意随访。     

Mixed medullary-papillary carcinoma of the thyroid: a previously unrecognized variant of thyroid carcinoma

Two unusual medullary carcinomas of the thyroid gland and their metastases contained a population of cells (20% to 25%) with the characteristic clear nuclei of papillary carcinoma. The predominant component of the tumors exhibited the typical growth pattern and cytologic features of medullary carcinoma with abundant amyloid deposits. The cells with clear nuclei lined follicle-like or tubular structures. In both the primary and the metastatic lesions, immunoreactive thyroglobulin was demonstrated only in the cells with clear nuclei, while calcitonin, carcinoembryonic antigen, and neuron-specific enolase were present only in cells of the predominant medullary carcinomatous component. Moreover, intense and diffuse staining for cytokeratin was seen only in the cells with clear nuclei, but not in those of the major medullary carcinomatous component. These findings suggest the existence of a distinctive variant of mixed medullary-papillary carcinoma that can be recognized with routine stains.     

Mixed follicular-medullary thyroid carcinoma: a case report

We report on a 35-yr-old woman presenting with a single thyroid nodule. Fine-needle aspiration (FNA) of the nodule was reported to contain both follicular and parafollicular cells. The biphasic nature of the tumor was highlighted on immunohistochemical investigation of the cellblock. Positive staining for thyroglobulin was limited to the follicular structures and the dense areas stained positive for calcitonin. The serum calcitonin level was highly elevated. Surgery was recommended because of suspected malignancy. The patient underwent total thyroidectomy. The diagnosis of mixed medullary and follicular carcinoma of the thyroid was established by histological investigation using immunohistochemical staining for thyroglobulin, chromogranin, and calcitonin. The patient was well 1 yr after the operation. Repeated measurements of serum calcitonin levels were normal. Total body scan revealed no radioactive iodine uptake in the thyroid bed, bones, or lungs.     

Mucoepidermoid carcinoma of the thyroid: a case report

Primary mucoepidermoid carcinoma (MEC) of thyroid is an uncommon tumour and reports on its' cytology are consequently scanty. A 46-year-old male presented with a thyroid nodule of nine months duration. Fine needle aspiration (FNA) cytology of the nodule showed features of a malignant tumor that was different from the usual types of thyroid carcinoma. Monolayers and syncytial clusters of round and spindle tumour cells with large vesicular nuclei and single macronucleoli were present. A diagnosis of carcinoma was given with the comment that this was unlike any of the usual types of thyroid cancer and that a metastatic malignancy should be ruled out. The cytological picture of MEC may not always be distinctive enough for accurate tumour typing. Nevertheless the cytological features are usually sufficiently different to rule out all of the usual types of thyroid carcinoma. This distinction may be important from the point of view of differing prognosis in MEC of thyroid (as compared to differentiated thyroid cancers) and the need to exclude a metastatic carcinoma, especially from a primary in one of the salivary glands.     

Marginal vacuoles in metastatic thyroid carcinoma: a case report

A case of metastatic follicular carcinoma to the iliac bone in a 78-yr-old woman is presented. Fine-needle aspiration biopsy (FNAB) smears showed numerous, cohesive tumor cell groups with moderately abundant cytoplasm and distinctive, peripherally situated pink-staining vacuoles on May-Grünwald-Giemsa stain. The presence of marginal vacuoles strongly suggested the possibility of metastatic thyroid carcinoma. Immunohistochemical studies performed on a concomitant needle core biopsy showed immunoreactivity for thyroglobulin, supporting a thyroid derivation for this metastasis. To our knowledge, this is the first reported case in which marginal vacuoles ("flame cells") have been identified in a malignant thyroid condition.     

Multistep carcinogenesis in anaplastic thyroid carcinoma: a case report

We previously established an anaplastic thyroid carcinoma cell line (KOA2) that had double mutations: an N-ras mutation and a p53 gene mutation. To clarify multistep carcinogenesis, we analysed surgical material from the patient from whom KOA2 was derived for abnormalities in the N-ras and p53 genes. The resected material had two histologically different lesions: a follicular neoplasm and an anaplastic carcinoma. The N-ras mutation was observed in both lesions, but the p53 gene mutation only in the anaplastic lesion. These facts indicate that an N-ras mutation may induce follicular neoplasm and a subsequent p53 mutation may have caused the follicular neoplasm to transform to anaplastic carcinoma in this patient. This report suggests direct evidence for multistep carcinogenesis in anaplastic thyroid carcinoma.     

Cytologic features of insular carcinoma of the thyroid: a case report

Fine-needle aspiration of the thyroid has been accepted as one of the initial diagnostic tools in the evaluation of thyroid nodules. As its use becomes more widespread, the demand for more precise diagnosis has increased. The histopathology of insular carcinoma of the thyroid is now well recognized. However, the cytologic diagnostic criteria are not well established. The reported series have been small (4-6 cases), which is not surprising because of the rarity of this tumor. They consist of retrospective reviews of the aspirates (after the histologic diagnosis had been made from the thyroidectomy specimens). Also, the case reports do not provide uniform cytologic criteria; this could be due to limited sampling of these tumors (which are usually large). A cytologic diagnosis of insular carcinoma can be suggested if multiple samples of a thyroidal mass are markedly cellular, with a cytologic pattern reminiscent of a follicular variant of papillary carcinoma. However, the follicular cells are arranged predominantly in rosettes, their nuclei appear more monotonous, some "intranuclear cytoplasmic pseudoinclusions" are seen, and there is an occasional large cell with a pleomorphic nucleus.     

Occult thyroid carcinoma: a rare case report and review of literature

Occult thyroid carcinoma is very common in the clinic and is generally divided into four groups. Here, we proposed two types of occult thyroid carcinoma as the fifth group. The first type was locoregional lymph node metastases from thyroid carcinoma, and the second type was distant organ metastases from thyroid carcinoma. The unique aspect of the fifth group was that the primary carcinoma of the fifth group was not finally found by pathological examination. To better understand the fifth group, we reported a typical case. Furthermore, we discussed the diagnostic criteria and procedures and the management of the fifth group of occult thyroid carcinoma.