Warthiin瘤样甲状腺乳头状癌1例并文献复习

甲状腺乳头状癌(papillary thyroid carcinoma, PTC)是最常见的甲状腺上皮恶性肿瘤,占甲状腺恶性肿瘤的70％～80％,女性较为常见,通常呈惰性,预后良好[1].随着近几年对PTC认识水平的不断提高,多种少见变异亚型陆续被报道,其中War-thin瘤样甲状腺乳头状癌(Warthin-like ...     

颈、甲状腺

颈静脉球瘤的栓塞治疗；颈动脉瘤38例；hPF4 mRNA表达与甲状腺乳头状癌血管生成及转移的关系；伴颈部淋巴结转移的甲状腺乳头状癌的基因差异表达；甲状腺乳头状癌与乳头状增生的病理研究。[编者按]     

甲状腺乳头状癌组织学亚型及其分子研究进展

甲状腺乳头状癌是甲状腺癌中较为常见的肿瘤,近年来,由于亚临床病例的增加,甲状腺乳头状癌的发病率呈逐年增长的趋势,已成为最常见的恶性肿瘤之一.随着对甲状腺乳头状癌组织学、分子遗传学方面研究的不断发展,对甲状腺乳头状癌的认识越来越广,越来越深入,随之而来的是对甲状腺乳头状癌的诊断、治疗带来更多的挑战.精准的诊断及规范化的治疗越来越备受关注.本文将对甲状腺乳头状癌组织学、分子生物学特征及进展进行综述,以期提高病理医师或临床医师对甲状腺乳头状癌诊断、精准治疗及预后的全面认识.     

趋化因子受体CXCR4在甲状腺乳头状癌的表达及临床意义

目的:探讨趋化因子CXCR4在甲状腺乳头状癌中的表达及其与临床病理学参数的相关性.方法:利用半定量RT-PCR和免疫组织化学法分别检测72例新鲜甲状腺乳头状癌组织及52例甲状腺乳头状癌石蜡标本中CXCR4mRNA及蛋白的表达情况.结果:甲状腺乳头状癌组织中CXCR4mRNA及蛋白的阳性表达率分别为77.8%(56/72)、76.6%(95/124),而甲状腺良性病变组织及正常甲状腺组织均无表达,差异具有统计学意义(P＜0.01);在甲状腺乳头状癌组织中,CXCR4mRNA表达与蛋白表达成正相关关系(r=-0.714,P＜0.01).单因素分析显示CXCR4的蛋白表达与年龄、性别、肿瘤大小无关(P＞0.05),但与肿瘤侵犯程度、淋巴结转移、远处转移、临床分期密切相关(P＜0.05),且CXCR4蛋白阳性表达组的预后显著差于CXCR4蛋白阳性表达组(P＜0.05).结论:CXCR4阳性表达的甲状腺乳头状癌具有较高侵袭转移潜能,是预后不良的指标之一,CXCR4可作为抑制甲状腺乳头状癌侵袭转移的有效靶点.     

COX-2、VEGF-C在甲状腺乳头状癌中的表达及临床意义

目的:研究环氧化酶-2(cyclooxygenase-2,COX-2)、血管内皮生长因子C(vascular endothelial growth factor-C,VEGF-C)在甲状腺乳头状癌中的表达及两者间相互关系,结合临床病理资料,初步探讨COX-2和VEGF-C在甲状腺乳头状癌发生发展中的作用及临床意义.方法:应用免疫组化SP法检测49例甲状腺乳头状癌及34例正常甲状腺组织的COX-2、VEGF-C蛋白表达情况,分析甲状腺乳头状癌中COX-2、VEGF-C的表达与临床病理特征及颈部淋巴结转移之间的关系.结果:COX-2和VEGF-C阳性表达都主要定位于细胞浆.49例甲状腺乳头状癌组织中COX-2和VEGF-C蛋白的阳性表达率分别为63.3%和55.1%,34例甲状腺正常组织中COX-2和VEGF-C蛋白的阳性表达率分别为6.25%和20.6%.两种蛋白在甲状腺乳头状癌与甲状腺正常组织中的阳性表达率之间均具有显著性差异(P<0.01 ).COX-2 和VEGF-C蛋白的阳性表达率与淋巴结转移,临床分期显著相关(P<0.01 ),但与患者性别、年龄、肿瘤大小之间无相关性(P>0.05).COX-2的阳性表达和VEGF-C的阳性表达呈正相关(P<0.05).结论:COX-2、VEGF-C的高表达在甲状腺乳头状癌的发生发展过程中起重要的作用,检测其表达对判断临床进展以及推测预后有一定的参考价值.     

甲状腺乳头状癌预后因素的研究进展

甲状腺癌是最常见的内分泌系统恶性肿瘤,近年来发病率迅速上升,其中以甲状腺乳头状癌最为多见.尽管甲状腺乳头状癌患者的肿瘤特异性死亡率较低,但仍有部分患者可出现复发甚至远处转移,严重影响患者的生活质量.包括临床特征和分子特征在内的多种因素可影响甲状腺乳头状癌患者的预后,本文综合相关研究,对甲状腺乳头状癌患者的预后因素进行综述,以便于临床评估患者的预后,并根据患者的个体情况制订合理的治疗方案及临床管理策略.     

Ku80在甲状腺乳头状癌组织中的表达及其临床意义

目的:探讨甲状腺乳头状癌组织中Ku80的表达水平及其与临床病理特征的关系。方法:收集22例甲状腺乳头状癌患者的组织蜡块,应用免疫组化检测甲状腺乳头状癌、癌旁组织中Ku80的表达,并分析Ku80表达与甲状腺乳头状癌临床病理特征的关系。结果:甲状腺乳头状癌组织中Ku80阳性表达率为63.6%,癌旁组织阳性表达率为22.7%,差异有统计学意义（P<0.05）;Ku80表达与患者的肿瘤TNM分期中T分期有关（P=0.005）,与患者年龄、性别、是否有淋巴结转移、肿瘤大小、发病部位及是否有其他合并症无显著相关性（P>0.05）。结论:Ku80在甲状腺乳头状癌中高表达,并与肿瘤T分期显著相关。     

24例隐灶性甲状腺乳头状癌及其临床处理

隐灶性甲状腺乳头状癌(OPTC)是指瘤体直径小于1.0cm的一类甲状腺癌。本所自1980年5月～1990年4月间共收治甲状腺癌病人315例,其中乳头状腺癌240例(76.2％),滤泡性腺癌38例(12.1％),髓样癌25例(7.9％),未分化癌6例     

伴颈部Ⅵ区淋巴结转移的甲状腺乳头状癌临床分析

目的：分析伴颈部Ⅵ区淋巴结转移的甲状腺乳头状癌患者的临床特点及其相关因素。方法：回顾性分析2004年1月至2014年10月顺义区医院收治的121例甲状腺乳头状癌患者的临床资料,其中伴颈部Ⅵ区淋巴结转移者56例。结果：肿瘤最大径越大,甲状腺乳头状癌患者的颈部Ⅵ区淋巴结转移率越高（ P﹤0.05）,病灶位于峡部或肿瘤侵犯包膜的患者颈部Ⅵ区淋巴结转移率高（ P﹤0.05）。患者性别、年龄、甲状腺结节数目与是否伴颈部Ⅵ区淋巴结转移无关（P﹥0.05）。结论：甲状腺肿瘤大小、病灶位置及是否侵犯包膜是辅助评估甲状腺乳头状癌患者是否伴有颈部Ⅵ区淋巴结转移的重要指标。     

CD151及整合素α3β1与甲状腺乳头状癌发生的关系及临床意义

目的:探讨CD151和整合素α3、β1在甲状腺乳头状癌中的表达及临床意义.方法:收集甲状腺乳头状癌标本64例、滤泡性腺瘤12例及瘤旁2cm以远正常甲状腺组织10例,采用免疫组织化学EnvisionTM二步法检测CD151及整合素α3、β1,并分析它们的相关性.结果:甲状腺乳头状癌、滤泡性腺瘤及正常甲状腺组织中CD151表达的阳性卒分别为87.5%(56/64)、41.7%(5/12)及0(0/10),癌的表达显著高于其余两组,腺瘤的表达亦高于正常组织,三者间的比较均有统计学差异(P<0.01);整合素d3表达的阳性率分别为78.1%(50/64)、33.3%(4/12)及0(0/10),癌的表达明显高于其余两组(P<0.01);整合素β1表达的阳性率分别为71.9%(46164)、25%(3,12)72.0(0/10),甲状腺乳头状癌组亦显著高于其余两组,差异有统计学意义(P<0.01).它们的表达均与甲状腺乳头状癌患者的年龄、性别、肿瘤大小及淋巴结转移无相关性(P>0.05);CD151与整合素α3、β1蛋白在甲状腺乳头状癌、滤泡性腺瘤及正常甲状腺组织中的表达经双变量相关分析呈正相关.结论:CD151和整合素α3、β1的高表达与甲状腺乳头状癌的发生相关,三者在甲状腺乳头状癌、滤泡性腺瘤及正常甲状腺组织中的表达成正相关,三者联合检测可为甲状腺乳头状癌的诊断提供参考依据.     

甲状腺乳头状癌中c-met和c-src的表达与临床病理特征的关系

目的:探讨c-met和c-src在甲状腺乳头状癌(thyroid papillary cancer,TPC)中的表达及其相关性与临床病理特征的关系.方法:免疫组化SP法检测80例甲状腺乳头状癌和38例良性病变切除标本中c-met和c-src的表达,并分析表达情况与临床病理特征之间的关系.结果:c-met和c-src在TPC中的表达阳性率分别为96.3％和63.8％,与在甲状腺良性病变组织中表达有显著差异(P＜0.01).c-met在TPC组织中的表达与患者年龄相关(P＜0.05).c-src在TPC组织中的表达与肿瘤大小和淋巴结转移相关(P＜0.01).TPC中c-src和c-met的表达呈正相关(r=0.698,P＜0.01).结论:c-src和c-met的异常表达在TPC的发生、发展中具有重要意义,并且c-src可为TPC的淋巴结转移提供依据.     

Cyclin E expression in papillary thyroid carcinoma: relation to staging

Cyclin E plays a pivotal role in the regulation of G1-S transition and relates to malignant transformation of the cells. However, the clinical significance of cyclin E expression in patients with papillary thyroid carcinoma (PTC) remains unknown. We examined by immunohistochemistry the expression of cyclin E in 41 resected PTCs in pathologic stages from pT1a to pT4 and analyzed its relation to clinicohistopathologic factors. The positive staining was divided into 3 grades: no expression if less than 10%, expression if 11-50% and overexpression if more than 50% of the nuclei of tumor cells were stained positively. Cylin E expressions were observed in 75.6% of analyzed PTCs but only 60% of papillary microcarcinomas (PMCs) were immunopositive for cyclin E expression. However, cyclin E staining was observed in 90.4% of PTCs in a group with TNM higher than pT1a. The staining index was significantly different between the PMCs and the rest of the cancers investigated (14.91% +/- 14.4% vs. 34.03% +/- 23.44%, respectively; p < 0.005) and we observed positive relation between the staining index and factor T of staging of PTCs. All the lymph node metastases coexisted with cyclin E expression and most, but not all, of them coexisted with cyclin E overexpression. These findings indicate that cyclin E may play a key role for the oncogenesis and biologic behavior of PTC. If our results are confirmed in a larger study, a high level of cyclin E expression may become a new prognostic marker for PTCs.     

多灶甲状腺乳头状癌的临床特点分析

目的:比较多灶甲状腺乳头状癌（MPTC）与单灶甲状腺乳头状癌（SPTC）的临床和病理特点。方法:回顾性分析我院经手术治疗且病理证实的43例MPTC和78例SPTC患者的临床及病理资料。结果:两组间性别、年龄分段、合并桥本甲状腺炎及结节性甲状腺肿、微小癌比例、病理分期,无统计学差异（P＞0.05）;MPTC组年龄、腺外浸润发生率、淋巴结转移率、手术并发症发生率及术后低钙发生率均高于SPTC组,差异有统计学意义（P＜0.05）。结论:MPTC年龄多较大,更易发生腺外浸润和淋巴结转移,建议行全甲状腺切除+患侧颈中央区淋巴结清扫。     

甲状腺透明变梁状肿瘤研究进展

甲状腺透明变梁状肿瘤是新发现的一种原发性甲状腺肿瘤,肿瘤细胞核形态与甲状腺乳头状癌相似,术前常被误诊为甲状腺乳头状癌。甲状腺透明变梁状肿瘤恶性潜能性尚不确定,但目前研究表明一般预后较好,术前或术中误诊常导致甲状腺的全切除,提高术前、术中诊断准确率可缩小手术范围。本研究对甲状腺透明变梁状肿瘤的病理特点、诊断及治疗预后等进行综述。     

Warthin-like tumor of the thyroid - A case report

A case of Warthin-like tumor of the thyroid (WaLTT) with cervical lymph node metastasis is presented. The problems of the FNA diagnosis of this type of tumor is discussed as well as the histogenesis, nature and behaviour of this peculiar tumor.     

Different structural components of conventional papillary thyroid carcinoma display mostly identical BRAF status

Activating BRAF(T1799A) mutation is closely associated with a papillary thyroid carcinoma (PTC) histotype. The transversion is frequently detected in the conventional type, Warthin-like and tall cell variants, but is rare in the follicular variant of PTC. Conventional PTC is often presented with tumors of mixed architecture, which besides the papillary structures also contain areas with follicular and solid morphology in which the details of BRAF mutational status are unknown. We set out to differentially investigate the presence of mutated BRAF in the individual structural components microdissected from 44 formalin-fixed, paraffin-embedded PTC tissues from 40 patients. The mutation was detected in at least 1 structural component in 23 tumors (52%). Different structural components of the same tumor had identical BRAF status in 41/44 tumors (93%). In 3 tumors the BRAF(T1799A) mutation was found only in the papillary, but not in the follicular component. Mutational patterns identical to those in the primary tumors were found in 11/12 lymph node metastases (92%, including both BRAF(T1799A)-positive and -negative cases). The high concordance of the BRAF mutational status in structurally distinct areas suggests a rather homogeneous distribution of neoplastic epithelial cells in a conventional PTC tumor in most cases. These results imply the reliability of preoperative molecular diagnosis of PTC regardless of the type of tumor component at the site of biopsy sampling and suggest that the majority of patients with BRAF mutation-positive PTC may benefit from the targeted pharmacotherapy.     

ARHⅠ和E钙粘蛋白在乳头状甲状腺癌中的表达及意义

[目的]探讨ARHI蛋白及E钙粘蛋白在乳头状甲状腺癌中的表达及意义。[方法]56例经病理确诊的乳头状甲状腺癌患者人组,并取其距癌组织边缘〉2cm的正常甲状腺组织作为对照。采用免疫组化方法检测ARHI蛋白及E钙粘蛋白的表达。[结果]ARHI及E钙粘蛋白在乳头状甲状腺癌中的表达均显著低于正常甲状腺组织（48．2％V,q80．4％,51．8％VS91．1％．P均〈0．05）。ARHI、E钙粘蛋白在乳头状甲状腺癌中的表达与肿瘤大小、TNM分期、淋巴结转移情况有关（P〈0．05）。ARHI与E钙粘蛋白在乳头状甲状腺癌中的表达无明显相关性（Kappa=0．287,P=0．023）。[结论]ARHI、E钙粘蛋白在乳头状甲状腺癌中表达降低,提示其在乳头状甲状腺癌的发生发展、侵袭中可能发挥重要作用。     

miR-221在甲状腺乳头状癌中的表达及其临床意义

目的:探究miR-221在甲状腺乳头状癌中的表达及其与患者临床资料和预后的关系.方法:收集甲状腺乳头状癌和癌旁组织47例以及甲状腺良性病变21例,RT-PCR技术检测患者组织中miR-221的表达,Spearman相关性分析及X2检验比较甲状腺乳头状癌患者miR-221的表达与患者性别、年龄、体重、肿瘤大小、病理分级及临床分期的关系,Kaplan-Meier生存分析法分析miR-221的表达与患者预后的关系.结果:甲状腺乳头状癌组织中miR-221的表达显著高于癌旁组织及甲状腺良性病变(P<0.05),癌旁组织与甲状腺良性病变表达未见显著差异(P>0.05).miR-221的表达与患者性别、年龄及体重无显著相关性,与患者肿瘤大小、病理分级及临床分期存在显著正相关性,X2检验得出相对一致的结果,不同性别、年龄及体重的患者miR-221的表达无显著差异,病理分级及临床分期高的患者miR-221的表达较高,但肿瘤体积未显示出统计学差异.高表达miR-221的患者比低表达患者预后更差.结论:miR-221在甲状腺乳头状癌中高表达,且与肿瘤恶性程度和进展程度正相关,不利于患者预后,是潜在的促癌基因.     

Comprehensive evaluation of risk factors for lymph node metastasis in patients with papillary thyroid carcinoma

With the increasing incidence of papillary thyroid cancer (PTC), it is important to risk-stratify patients who may have a more aggressive tumor biology. The present study aimed to evaluate the risk factors for lymph node metastasis (LNM) in patients with PTC, which may provide a significant reference for clinical diagnosis and treatment. In total, 1,045 patients with PTC [313 with PT microcarcinoma (PTMC) and 732 with non-PTMC] between August 2016 and August 2019 were investigated. The B-type Raf kinase (BRAF) V600E mutation was tested in all samples. The clinical data (sex, age, tumor location, sample type and pathological features) were retrospectively analyzed. Logistic regression analysis was performed to evaluate independent risk factors for LNM. A total of 181/313 (57.8%) PTMC cases and 145/732 (19.8%) non-PTMC cases had a BRAF V600E mutation. In the PTMC cases, significant differences in sex and sample type were identified (BRAF V600E mutation vs. wild-type). In the non-PTMC cases, significant differences in sex and age were identified (BRAF V600E mutation vs. wild-type). Female sex and tumor diameter ≤1 cm were significant independent predictors of LNM in PTC. In PTMC, female sex was a significant independent predictor of LNM. A bilateral tumor was an independent protective factor for LNM in PTC, PTMC and non-PTMC. The BRAF V600E mutation rate of ultrasound-guided fine-needle aspiration cytology was higher compared with FFPE in PTMC (P=0.018). In contrast to previous studies, the results of the present study suggested that being female and having a tumor of diameter ≤1 cm were risk factors for LNM, and that the BRAF wild-type of PTMC may be more aggressive than other types. Notably, the position of the tumor in the bilateral thyroid was also an independent protective factor for LNM. Therefore, ultrasound-guided fine-needle aspiration should be recommended for gene analysis (BRAF V600E) in PTMC. In addition, clinicians should consider an individualized treatment according to gene mutations, sex, age, tumor size and the location of the tumor, in order to achieve an improved therapeutic efficacy.     

甲状腺乳头状癌声像图特征探讨

目的：评价甲状腺乳头状癌（papillary thyroid carcinoma,PTC）的声像图特点。方法：回顾性分析34例经手术和病理证实的PTC彩色多普勒超声图像特点。结果：32例（94.1%）低回声,30例（88.2%）结节纵/横≥1,26例（76.5%）伴细微钙化,23例（67.6%）毛剌边缘,29例（85.3%）结节单发,20例（58.8%）边界不清晰,14例（41.2%）侧后方声影,6例（17.6%）检出血流信号,8例（23.5%）颈淋巴结肿大。出现上述异常声像图特征2项以上者占73.5%（25/34）。结论：低回声、微钙化、纵/横≥1、边界、毛剌是PTC具有特征性的超声表现。