甲状腺玻璃样小梁状腺瘤1例报告并文献复习

目的：探讨甲状腺玻璃样小梁状腺瘤的组织发生、临床病理特征、诊断、鉴别诊断及预后。方法：报道1例罕见的甲状腺玻璃样小梁状腺瘤，并结合文献进行复习。结果：肿瘤由卵圆形或多角形细胞排列成花簇状、束状或小梁状等结构；胞质细颗粒状，嗜酸性或嗜双色性，核卵圆形或长形．染色质细腻，常见核沟及核内包涵体，核分裂罕见；纤维血管间质明显玻璃样变性。免疫组化示甲状腺结合球蛋白（＋），降钙素（-）。结论：该肿瘤具有典型的形态学特征及免疫表型，需与甲状腺乳头状癌、髓样癌、副神经节瘤鉴别。生物学行为良性，手术完整切除预后好，无复发及转移。     

肾嗜酸细胞腺瘤的临床病理学观察

目的观察肾嗜酸细胞腺瘤病理学特点并与其它具有嗜酸性细胞浆的肾上皮性肿瘤鉴别。方法观察４例肾嗜酸细胞腺瘤，在光镜观察基础上，运用免疫组织化学检测Ｃｙｔｏｋｅｒａｔｉｎ及Ｖｉｍｅｎｔｉｎ，并行Ｈａｌｅ胶体铁染色及电镜检查，与形态上类似的肾肿瘤进行鉴别。结果肾嗜酸细胞腺瘤的特点为：胞浆强嗜酸性，粗颗粒，腺泡状或实性片状排列，无坏死，无核分裂像或核分裂像罕见；Ｃｙｔｏｋｅｒａｔｉｎ８阳性，Ｖｉｍｅｎｔｉｎ阴性，Ｈａｌｅ胶体铁染色阴性，电镜下有多量粗大线粒体。据此，可与颗粒型肾细胞癌、混合型肾细胞癌及肾嫌色细胞癌鉴别。结论肾嗜酸细胞腺瘤是有病理特点的良性肾肿瘤，根据组织学改变，免疫组化、组化染色及电镜特点可与胞浆嗜酸性的肾癌鉴别，具有临床意义。     

甲状腺髓样癌16例临床病理分析

目的：对16例甲状腺髓样癌进行分析，探讨甲状腺髓样癌的临床病理特征、诊断及鉴别诊断。方法：收集16例甲状腺髓样癌临床与病理资料进行详细的形态学观察和免疫组化检查。结果：16例甲状腺髓样癌中呈经典型表现的11例，类癌型(小细胞型)2例，腺泡型1例，乳头型1例。免疫组化calcitonin阳性thyroglobulin阴性。结论：甲状腺髓样癌的细胞形态和组织结构多样，尤其非经典型改变的病例易误诊为甲状腺其它肿瘤，易后确诊依靠免疫组化。     

肺嗜酸细胞腺癌的临床病理观察

目的 探讨肺嗜酸细胞腺癌的临床病理特征。方法 运用光镜、电镜及免疫组化方法观察1例肺嗜酸细胞腺癌并复习相关文献。结果 组织病理学特点：肿瘤无包膜，浸润性生长，明显坏死，瘤组织由含有嗜酸性颗粒胞质的细胞构成，细胞和核显著多形性。免疫组化：CK（＋）、EMA、Syn、CgA和S-100（-）。电镜：瘤细胞胞质内充满大量线粒体，无神经内分泌颗粒。结论 肺嗜酸细胞癌是一种极其少见的恶性肿瘤，形态学上应与肺的嗜酸细胞性类癌、嗜酸细胞腺瘤、转移性嗜酸细胞腺癌等相鉴别，免疫组化染色和电镜观察在该肿瘤的诊断和鉴别诊断中具有重要作用。     

甲状腺髓样癌的CGRP原位杂交检测

目的 ＣＧＲＰ在甲状腺髓样癌表达的意义及病理诊断和鉴别诊断的价值。方法 选择甲状腺髓样癌１０例,乳头状癌５例,滤泡癌５例,未分化癌５例,滤泡型腺瘤５例,行地高辛标记ＣＧＲＰ ｃＤＮＡ探针原位杂交检测。结果 １０例髓样癌和１例滤泡性腺癌呈强阳性;其它均呈阴性。结论 ＣＧＲＰ原位杂交分析是甲状腺髓样癌有价值的诊断和鉴别诊断方法。     

甲状腺髓样癌的诊断与鉴别诊断

目的探讨甲状腺髓样癌的形态特征、免疫表型、诊断与鉴别诊断。方法用免疫组化方法对25例甲状腺髓样癌进行研究,观察其病理形态特点。结果25例甲状腺髓样癌的癌组织主要由多角形及梭形细胞组成,可呈多种组织学类型,其中巢状型8例,束状/带状型6例,腺样(管状和腺泡)型3例,弥漫和类癌型各3例,透明细胞型和混合型(髓样和滤泡癌)各1例。免疫组化降钙素、铬粒素A均( ),21例神经元特异性烯醇化酶( ),21例癌胚抗原( ),18例突触素( ),1例HMB45( ),1例癌组织甲状腺球蛋白( )。CD44V6( )表达分别为髓样癌40%,滤泡癌30%,髓样癌80%颈部淋巴结转移,而正常甲状腺滤泡上皮(-)。结论诊断时应注意与形态相似的肿瘤相鉴别,CT是甲状腺髓样癌特异性标记物,若CT阴性,CEA及内分泌激素的阳性表达有助于甲状腺髓样癌的诊断和鉴别诊断。     

甲状腺玻璃样变性梁状腺瘤病理研究并文献复习

目的　分析甲状腺玻璃样变性梁状腺瘤 (HTA)的临床病理特征。方法　利用HE染色及免疫组织化学技术 ,并结合文献对 1例HTA进行临床特征、病理形态及免疫表型研究。结果　HTA属甲状腺滤泡上皮来源的肿瘤。其组织学形态具有特征性 :瘤细胞排列成梁状、巢状 ,外围以纤细的玻璃样变性的纤维组织 ,细胞核呈毛玻璃样 ,可见核内包涵体及核沟。免疫组化 :甲状腺球蛋白Thy ( ) ,降钙素Calcitonin ( -) ;癌胚抗原CEA ( -) ;嗜铬素Chr ( -) ;突触素Syn ( -)。 结论　HTA为甲状腺滤泡上皮来源的良性肿瘤 ,临床呈良性经过     

超声与多层螺旋CT对肾嗜酸细胞腺瘤及嫌色细胞癌的鉴别诊断价值

目的 探讨超声与多层螺旋CT对肾嗜酸细胞腺瘤及嫌色细胞癌的鉴别诊断价值。方法：回顾性分析经手术及病理证实的45例嫌色细胞癌和30例肾嗜酸细胞腺瘤临床资料,研究时间为2017年2月至2020年10月,均予以超声与多层螺旋CT检查,对比肾嗜酸细胞腺瘤与嫌色细胞癌的CT征象,观察平扫、皮质期、实质期、排泄期等时期的LKR值、△AT、△TTP、△PI,以及分析各期LKR值、△AT、△TTP、△PI、联合诊断的ROC曲线。结果 常规超声表现：肾嗜酸细胞腺瘤与嫌色细胞癌在病灶性质、回声、形态及边界比较中,差异无统计学意义(P＞0.05)。超声造影表现：肾嗜酸细胞腺瘤与嫌色细胞癌在增强方式、减退方式比较中,差异无统计学意义(P＞0.05); 肾嗜酸细胞腺瘤与嫌色细胞癌在峰值强度、增强均匀度、假包膜、△AT、△TTP、△PI比较中存在统计学意义(P＜0.05)。CT征象分析可见,肾嗜酸细胞腺瘤与嫌色细胞癌在星芒状瘢痕、均匀强化比较中存在统计学意义(P＜0.05); 肾嗜酸细胞腺瘤与嫌色细胞癌在囊变、坏死、钙化、包膜、轮辐状强化、节段性增强反转、出血所占比中差异无统计学意义(P＞0.05)。肾嗜酸细胞腺瘤与肾嫌色细胞癌的平扫LKR值比较,差异无统计学意义(P＞0.05);肾嗜酸细胞腺瘤皮质期、实质期及排泄期的LKR值高于肾嫌色细胞癌(P_均＜0.05)。ROC曲线分析显示,多层螺旋CT中平扫、皮质期、实质期、排泄期的LKR AUC值分别为(0.525、0.931、0.800、0.850,P＜0.05);△AT、△TTP、△PI的AUC值分别为(0.990、0.673、0.909,P＜0.05);联合诊断的AUC值为(0.955,P＜0.05)。结论 超声与多层螺旋CT在嫌色细胞癌诊断中均具有较高的预测价值,尤其是超声造影,能为肾嗜酸细胞腺瘤和嫌色细胞癌的鉴别提供重要信息,但为了避免漏诊情况发生,建议上述两种方法临床联合诊断。     

甲状腺嗜酸细胞肿瘤15例临床病理和免疫组化研究

目的　进一步探讨甲状腺嗜酸细胞肿瘤的临床病理和免疫组化特点。方法　复习 1 5例甲状腺嗜酸细胞肿瘤的临床病理资料和存档的HE切片 ,其中 1 2例行vimentin、S 1 0 0、TG、TTF 1、CEA和p2 1免疫组化标记。结果　本组有 7例嗜酸细胞腺瘤 ,5例嗜酸细胞性滤泡癌 ,3例嗜酸细胞性乳头状癌。良性和恶性嗜酸细胞肿瘤均表达TG、vimentin、S 1 0 0和p2 1 ,CEA阳性表达见于多数嗜酸细胞腺瘤和癌。除CEA外 ,甲状腺嗜酸细胞肿瘤的免疫组化表达情况与对照组比较差异不显著 (P >0 0 5)。结论　甲状腺嗜酸细胞肿瘤的临床病理和免疫组化特征与甲状腺其他相对应类型的肿瘤相似     

甲状腺嗜酸细胞肿瘤的超声特征及病理分析

目的分析甲状腺嗜酸细胞肿瘤的超声图像特征,提高对良、恶性甲状腺嗜酸细胞肿瘤的诊断和鉴别诊断水平。方法回顾性分析13例甲状腺嗜酸细胞肿瘤患者的超声图像及临床病理特征。结果 13例甲状腺嗜酸细胞肿瘤(HCN)患者共计14个结节,其中嗜酸细胞腺瘤(HCA)10例,嗜酸细胞癌(HCC)3例。HCN结节大多具有良性病变的超声特征。HCC与甲状腺乳头状癌(PTC)比较,结节的大小、形态、边界、纵横比、周边晕征、有无钙化、血流等差异均具有统计学意义(P0.05);而成分、回声、被膜连续性差异无统计学意义(P0.05)。结论甲状腺Hürthle细胞肿瘤具有特定的超声特征,FNA可诊断嗜酸细胞肿瘤,但不能判断有无血管和包膜侵犯;手术后组织学病理是明确良、恶性病变的金标准。     

甲状腺肿瘤癌基因产物p21ras表达的免疫组化研究

目的 探讨癌基因产物ｐ２１ｒａｓ表达的意义及在甲状腺肿瘤病理诊断和鉴别诊断中的应用价值。方法 采用免疫组化ＬＳＡＢ法检测了１０例甲状腺腺瘤、１０例不典型腺瘤、２０例乳头状癌、２０例滤泡癌、１０例髓样癌、１０例未分化癌。结果 在甲状腺癌、甲状腺腺瘤和周边正常组织中均有表达,但阳性细胞的量和染色强度有所不同。其分布特点是：癌组织区〉腺瘤区〉正常组织。良恶性肿瘤组间比较Ｐ〈０．０１,差异非常显著。结论 甲状腺癌的发生与ｒａｓ基因的活化和２１ｒａｓ的过量表达关系密切。ｐ２１ｒａｓ的过表达有助于甲状腺良恶性肿瘤的鉴别。     

Recommendations for reporting C cell pathology of the thyroid

BACKGROUND: Calcitonin screening programs have proved to be effective in early detection of medullary thyroid carcinoma, not only in patients with known risk factors for the development of hereditary tumors. Thus, more thyroidectomies, based on an abnormal pentagastrin test, can be expected. Here we give summarizing recommendations for reporting C cell pathology. METHODS: All patients underwent total thyroidectomy and were tested for germ-line mutations in the RET-Protooncogene. The entire surgical specimens were blocked and C-cell disorders were assessed using conventional histology and immunohistochemistry. RESULTS: Among 110 patients with an abnormal pentagastrin test, 60 (55%) had medullary thyroid carcinoma (T1 34% [n = 37], T2 14% [n = 16], T4 6% [n = 7]), and 50 (45%) had C cell hyperplasia only. C cell hyperplasia accompanying medullary thyroid carcinoma was found in 13 of 15 familial and in 28 of 45 sporadic patients. All C cell changes were found in the upper two thirds of the thyroid lobes and 83% of the medullary thyroid carcinomas could be identified with frozen sections. CONCLUSION: 1. Abnormal pentagastrin stimulation is always associated with either medullary thyroid carcinoma or C cell hyperplasia. 2. Blocking of the entire upper two thirds of the thyroid lobes is essential for reliable detection of C cell hyperplasia and small medullary thyroid carcinomas. 3. Most medullary thyroid carcinomas can be detected with intraoperative frozen sections. 4. The presence of C cell hyperplasia should always be reported; however its usefulness for indicating familial risk is limited and its role as a preneoplastic condition in patients without RET-protooncogene mutations remains to be elucidated.     

Medullary thyroid carcinoma and other rare types of thyroid carcinoma

Among 4 major traditional groups of thyroid carcinoma, papillary and follicular carcinomas are most common, and other forms, anaplastic and medullary carcinomas, are relatively rare. The 2003 WHO histological classification of thyroid tumor separated 7 other malignant thyroid tumors into distinct pathological entities, such as poorly differentiated, squamous cell, mucinous carcinomas, carcinoma showing thymus-like differentiation (CASTLE), etc. Although they are also extremely rare, recognition of their clinicopathologic features are very important. In this review, not only diagnostic and therapeutic strategies for the rare forms of thyroid carcinomas, specifically focussed on medullary carcinoma and CASTLE, but also their histogenetic abnormalities were discussed.     

Sipple syndrome (bilateral phaeochromocytoma medullary C-cell carcinoma of the thyroid gland) with exceptionally prolonged clinical course

The sporadic occurrence of the Sipple syndrome with bilateral phaeochromocytoma and medullary thyroid carcinoma is a well-known pathological entity. The present report refers to a patient with medullary thyroid carcinoma, initially misdiagnosed as Hurthle-cell adenoma after partial resection of the thyroid gland. 5 and 8 years later the patient underwent bilateral adrenalectomy for phaeochromocytoma. 4 years after the second phaeochromocytoma a palpable thyroid nodule developed, thyroidectomy was performed and the tumour diagnosed as a medullary thyroid carcinoma. This diagnosis was confirmed by reexamination of the histological specimens obtained during the first surgical intervention. We were prompted to report the current case history, because of the protracted course of the medullary thyroid carcinoma in this patient and to point out the value of the determination of pentagastrin stimulated calcitonin values in patients with medullary thyroid carcinoma for diagnosis, postoperative follow-up and in family screening studies.     

甲状腺癌组织中p27和增殖细胞核抗原的表达及其相关性分析

目的探讨甲状腺癌组织中p27和增殖细胞核抗原(PCNA)的表达情况及其相关性。方法用免疫组织化学法检测86例甲状腺癌(甲状腺癌组)、54例甲状腺腺瘤(腺瘤组)和瘤旁正常甲状腺组织(正常组)中p27和PCNA的表达情况。结果 p27在甲状腺癌组阳性表达率分别为37.21%,高于腺瘤组和正常组,差异有统计学意义(P<0.01)。PCNA在甲状腺癌组阳性表达率为66.27%,高于腺瘤组和正常组,差异有统计学意义(χ2=22.16,P<0.01)。p27在甲状腺乳头状癌、滤泡癌、髓样癌和未分化癌中的阳性表达率分别为48.94%、31.25%、14.29%和11.11%,差异有统计学意义(χ2=8.85,P<0.05);PCNA在乳头状癌、滤泡癌、髓样癌和未分化癌中的阳性表达率分别为53.19%、75%、85.71%和88.89%,差异有统计学意义(χ2=8.57,P<0.05)。甲状腺癌p27和PCNA表达呈负相关(r=-0.51,P<0.01)。结论 p27和PCNA在甲状腺癌中的阳性表达明显减少,并且随着分化程度降低减少更为明显;而PCNA在甲状腺癌中的阳性表达明显增加,并且随分化程度降低增加更为明显;并且p27和PCNA表达呈负相关。     

Effects of thyroid-stimulating hormone on adenyl cyclase activity and intermediary metabolism of “cold” thyroid nodules and normal human thyroid tissue

"Cold" thyroid nodules do not concentrate (131)I before or after thyrotropin (TSH) administration. In an attempt to elucidate the reason for this TSH unresponsiveness, the effect of TSH in vitro on several metabolic parameters was studied in 11 "cold" thyroid adenomas, 2 medullary carcinomas, and in the surrounding normal thyroid tissue. Basal adenyl cyclase activity, glucose-1-(14)C oxidation, and (32)P incorporation into phospholipids were significantly greater in the adenomas than in the adjacent normal thyroid; basal cyclic 3',5'-adenosine monophosphate (cyclic AMP) concentration and adenine-(3)H incorporation into (3)H-labeled cyclic AMP were not different. In adenomas as well as normal thyroid, all parameters responded significantly to in vitro TSH stimulation. The response to TSH of adenyl cyclase activity and (32)P incorporation was enhanced in adenomas compared with that of the adjacent normal thyroid. These differences were not explained by an increased cellularity of the adenomas. Medullary carcinomas did not respond to TSH in any of the above parameters.The studies demonstrate an intact, TSH-responsive adenyl cyclase-cyclic AMP system in the adenomas and, accordingly, imply the presence of receptor sites for TSH on the cells of the adenoma. The failure of such nodules to concentrate (131)I may be owing to a subsequent impairment in the expression of cyclic AMP action on iodine metabolism.     

甲状腺结节性病变的MSCT诊断

目的探讨甲状腺结节性病变的MSCT诊断和鉴别诊断要点。方法回顾性分析经手术病理证实的149例甲状腺结节性病变CT表现。结果本组149例中,甲状腺瘤55例,结节性甲状腺肿63例,甲状腺癌31例;单发结节89例,其中甲状腺瘤53例,结节性甲状腺肿8例,甲状腺癌28例;多发结节60例,其中甲状腺瘤2例,结节性甲状腺肿55例,甲状腺癌3例。术前CT诊断符合率:甲状腺瘤为84.31%,结节性甲状腺肿为75.64%,甲状腺癌为75.00%;良性病变诊断符合率为79.10%,恶性病变诊断符合率为75.00%。甲状腺瘤典型CT表现为单发密度均匀、边界光整的低密度结节,显著均质强化,周边光整环状强化;结节性甲状腺肿典型CT表现为多发密度不均的低密度结节,可有宽大的岛状壁结节,外形多不规则,实性结节中度强化,边缘可见厚薄不均强化环,与周围组织分界尚清晰;甲状腺癌典型CT表现为单发的低密度结节,密度不均匀,肿瘤壁不规则,边界模糊不清,形态多不规则,内部细沙砾状钙化,增强环不完整呈"强化残圈征",突破甲状腺包膜呈"节段缺损征"和转移。结论掌握各种甲状腺结节性病变的CT特点及其与周围结构的关系、以及有无颈部淋巴结转移,对其诊断及鉴别诊断具有重要意义。     

应用组织芯片技术探讨HBME-1、RET在良、恶性甲状腺病变中表达的意义

目的研究HBME-1、RET在良、恶性甲状腺病变中表达的特点，寻找有助于诊断良、恶性甲状腺病变的标记物。方法应用组织芯片和免疫组化法检测22例结节性甲状腺肿、7例甲状腺滤泡性腺瘤、47例甲状腺乳头状癌、7例未分化癌、5例髓样癌、4例滤泡性癌、1例低分化岛状癌及1例鳞状细胞癌中单克隆抗体HBME-1、RET的表达。结果HBME-1、RET在甲状腺癌中的表达阳性率分别为67．69％和27．69％，在甲状腺良性病变中的表达阳性率分别为10．34％和0。结论HBME-1、RET在甲状腺癌中的表达增加对明确诊断有一定价值。     

Ret oncogene activation in human thyroid neoplasms is restricted to the papillary cancer subtype.

We have recently reported the activation of a new oncogene in human papillary thyroid carcinomas. This oncogene, papillary thyroid carcinoma (PTC), is a novel rearranged version of the ret tyrosine-kinase protooncogene. Thyroid neoplasms include a broad spectrum of malignant tumors, ranging from well-differentiated tumors to undifferentiated anaplastic carcinomas. To determine the frequency of ret oncogene activation, we analyzed 286 cases of human thyroid tumors of diverse histologic types. We found the presence of an activated form of the ret oncogene in 33 (19%) of 177 papillary carcinomas. By contrast, none of the other 109 thyroid tumors, which included 37 follicular, 15 anaplastic, and 18 medullary carcinomas, and 34 benign lesions, showed ret activation.