有完整包膜的甲状腺髓样癌临床病理特征

目的：探讨有完整包膜的甲状腺髓样癌（MTC）的临床病理学特征。方法：对有完整包膜的1例MTC进行大体、组织病理学和免疫组化染色观察,并复习相关文献。结果：肿瘤有完整包膜,癌组织免疫组化：NSE、CgA、SyN、CT、CEA阳性;CK19、TG阴性。淀粉样物质染色阳性。结论：有完整包膜的甲状腺髓样癌极其少见,其诊断依赖于组织病理学、免疫组化和组织化学。     

有完整包膜的甲状腺髓样癌临床病理特征

目的:探讨有完整包膜的甲状腺髓样癌(MTC)的临床病理学特征.方法:对有完整包膜的1例MTC进行大体、组织病理学和免疫组化染色观察,并复习相关文献.结果:肿瘤有完整包膜,癌组织免疫组化:NSE、CgA、SyN、CT、CEA阳性;CK19、TG阴性.淀粉样物质染色阳性.结论:有完整包膜的甲状腺髓样癌极其少见,其诊断依赖于组织病理学、免疫组化和组织化学.     

CK19与CD56联合应用在甲状腺乳头状癌诊断中的意义

目的:探究细胞角蛋白19（CK19）和黏附分子CD56 在甲状腺乳头状癌诊断中的意义。方法:采用了回顾分析的方法,收集芜湖市第二人民医院病理科87例具有甲状腺乳头状结构形态特点的甲状腺病变蜡块,采用免疫组化SP法检测 CK19、CD56蛋白的表达。结果:CK19在甲状腺乳头状癌（PTC)中阳性率为100.00%,但在结节性甲状腺肿伴滤泡上皮乳头状增生中阳性率为23.81%,差异有统计学意义。CD56在甲状腺乳头状癌中的阳性表达率为11.11%,在结节性甲状腺肿伴滤泡上皮乳头状增生中阳性率为90.48%,差异有统计学意义。结论:CK19在伴有滤泡上皮乳头状增生的甲状腺良性病变及甲状腺乳头状癌中均可出现阳性表达,CK19单独使用有的时候不易区分两者。CD56在甲状腺乳头状癌中低表达,提示CD56可能作为一种新的免疫标记物诊断甲状腺乳头状癌。联合应用CK19与CD56有助于提高甲状腺乳头状癌的诊断准确率。     

甲状腺髓样癌临床病理分析

目的:探讨甲状腺髓样癌(MTC)的临床病理特点、免疫表型及电镜诊断特点。方法:回顾性分析10例甲状腺髓样癌的临床资料,采用免疫组化、组织化学方法研究其病理形态特点,结合文献分析甲状腺髓样癌的电镜诊断特点。结果:散发型甲状腺髓样癌8例,家族型甲状腺髓样癌2例,6例淋巴结转移;9例肿瘤间质刚果红染色( );免疫组化:癌组织中降钙素( )10例、铬粒素A( )10例、突触素( )7例,1例见甲状腺球蛋白阳性细胞,CD44V6在髓样癌中的阳性表达率为60%;电镜下见癌细胞胞质内有大小不一的神经内分泌颗粒。结论:MTC具有多分化肿瘤的特点,可产生多种神经内分泌物质;其诊断依赖于组织病理学、免疫组化和组织化学,电镜在MTC的诊断中有重要价值;降钙素(CT)是其特异性标记物;CD44V6的高表达与MTC的颈部淋巴结转移密切相关。     

复发转移甲状腺嗜酸细胞癌1例

患者女性,64岁,2009年4月因进行性吞咽困难于当地医院就诊。体检发现双侧甲状腺结节,质硬、不活动、无压痛。行双侧甲状腺全切术,术中见肿物分别为5.5cm×4.0cm、5.0cm×4.0cm大小,包膜完整,无周围组织侵犯;术后病理：甲状腺嗜酸细胞癌,伴少量血管侵犯,切缘阴性;免疫组化：TTF-1（＋＋＋）、Tg（部分＋）、CK8/18（＋）、PCK（＋）、VIM（＋）、Syn（-）、Cga（-）。     

甲状腺转录因子在甲状腺良恶性病变中的表达

目的：探讨甲状腺转录因子（TTF－1）在甲状腺常见良恶性病变中的表达情况，并与甲状腺球蛋白（TG）和降钙素（CT）进行比较。方法：采用Envision二步免疫组织化学分析法分别检测TTF－1和TG在45例常见的甲状腺良性病变和65例甲状腺癌中的表达，其中10例甲状腺髓样癌加做CT检查。结果：TTF－1为核阳性，TG和CT为胞浆阳性。甲状腺滤泡细胞起源的良性病变TTF－1和TG阳性率均为100.0%(45/45)；而相应的恶性肿瘤TTF－1和TG的阳性率分别为89.1%(49/55)和85．5％（47／55）。起源于甲状腺滤泡旁C细胞的髓样癌TTF－1阳性率为70.0%(7/10)，CT和TG阳性率分别为100.0%(10/10)和0（0／10）。结论：TTF－1在甲状腺常见良恶性病变中阳性率高，因其特异地表达在细胞核，是一种很好的甲状腺滤泡细胞和滤泡旁C细胞特异性标记物。     

15例甲状腺间变癌临床病理及免疫组化分析

[目的]探讨甲状腺间变癌的临床病理特征和免疫组化结果的意义。[方法]光镜观察和免疫组织化学SP法检测15例甲状腺间变癌。[结果]甲状腺间变癌的病理分型为梭形细胞型、巨细胞型和混合细胞型。15例中免疫组化阳性表达率分别是：Vimentin86．6％(13／15)、CK73．3％(11/15)、CEA60．0％(9／15），CD68 6．6％(1/15)；TG和降钙素均为阴性。2例伴有乳头状癌其中Vimentin和CK均阳性；1例伴破骨样巨细胞CD68阳性。[结论]甲状腺间变癌是上皮源性、恶性度高的肿瘤。熟悉其形态特征．结合免疫组化对诊断甲状腺间变癌具有重要意义。     

胃肠道混合性类癌-腺癌临床病理分析

目的探讨胃肠道混合性类癌.腺癌的临床病理特点。方法对3例胃肠道混合性类癌一腺癌进行常规HE染色及免疫组化染色观察。结果无特异临床症状,组织形态学特点:有类癌和腺癌两种成分。免疫组化:腺癌CK、CEA阳性,Syn、CgA、NSE均阴性,类癌Syn、CsA、NSE阳性,CK、CEA可阴性也可阳性。结论 胃肠道混合性类癌-腺癌少见,依据组织形态学和免疫组化标记可确诊。     

甲状腺髓样癌的神经内分泌激素免疫组化研究

目的 :探讨神经内分泌激素在甲状腺髓样癌表达的意义及在病理诊断和鉴别诊断中的应用价值。方法 :选择甲状腺髓样癌 10例 ,滤泡性腺癌、乳头状腺癌和未分化癌各 3例 ,行免疫组化LSAB法检测。结果 :10例髓样癌降钙素均阳性 ,嗜铬粒素A 8例 ,NSE 7例 ,Syn 4例 ,Somat 3例阳性 ;其他类型癌均呈阴性。结论 :降钙素是甲状腺髓样癌特异的标记物 ,其余内分泌激素的检出也有助于甲状腺髓样癌的诊断和鉴别诊断。     

Association of medullary carcinoma of the thyroid with carcinoembryonic antigen.

To investigate the association between medullary carcinoma of the thyroid (MCT) and carcinoembryonic antigen (CEA), we assayed 78 sera from patients with thyroid diseases for CEA, employing the radioimmunoassay of double antibody technique. All 13 sera from patients with MCT had high levels of CEA, ranging from 14 to 170 ng/ml. Increased serum CEA was noted even in cases of small, localized carcinoma. By contrast, serum CEA levels were normal (below 10 ng/ml) in all other histological types of thyroid carcinoma (33 cases), except for one case of papillary adenocarcinoma. In 32 patients with non-malignant thyroid diseases, with few exceptions serum CEA levels remained within the normal range. The elevated serum levels of CEA in MCT returned to normal after successful operation. Furthermore, very high tissue concentrations of CEA were demonstrated in MCT. The results indicate that CEA is actively produced by MCT, and that its measurement is useful in the diagnosis and management of the disease. It is suggested that the highly specific association of CEA with MCT may well be related to a defect of neural crest origin.     

Family study of serum carcinoembryonic antigen in inherited medullary carcinoma of the thyroid.

Serum carcinoembryonic antigen (CEA) and calcitonin were assayed in 8 patients with medullary carcinoma of the thyroid (MCT) and 14 unaffected family members, from 4 pedigrees of Sipple's syndrome and one pedigree with inherited MCT. Serum CEA ranged from 5.4 to 44.5 ng/ml in the patients, but less than 2.5 ng/ml in the unaffected. This is in contrast with retinoblastoma and cancer family syndrome, where not only the patients but also unaffected family members show high serum CEA, and cytoplasmic or selective maternal inheritance of serum CEA level is presumed. In inheritable MCT, serum CEA increases in association with the development of MCT, and serum CEA level per se is not inherited.     

Prognostic values of the doubling time of serum carcinoembryonic antigen and calcitonin levels in medullary thyroid carcinoma

Fifteen patients operated on for medullary thyroid carcinoma with elevated postoperative serum calcitonin (CT) levels underwent serial measurements of serum CT and carcinoembryonic antigen (CEA) levels. Both CT and CEA levels showed an exponential increase in 12 patients and a slight decrease in three. CEA levels manifested less fluctuation than CT levels. The doubling time of these tumor marker levels calculated from the regression line in each patient showed a strong correlation with three-year survival, recurrence within five years, and the time interval between surgery and recurrence of the tumor, allowing quantitative prediction of the prognosis. However, the doubling time of CEA was longer than that of CT in most patients.     

甲状腺髓样癌降钙素及其基因相关肽检测的临床意义——附88例报告(英文)

目的研究甲状腺髓样癌患者降钙素及其基因相关肽的变化规律,指导临床治疗方案的选择和患者预后的判断。方法回顾性研究包括对58例甲状腺髓样癌病例血清中降钙素的分析及应用免疫组织化学方法观察相应标本中降钙素及其基因相关肽的表达情况;对新入组30例病例进行放射免疫学测定。结果 (1)术后1个月降钙素水平正常与升高的患者之间,肿瘤复发存在显著性差异(P<0.01)。(2)约98%的患者肿瘤标本降钙素染色呈阳性,而降钙素基因相关肽的阳性率为87.8%。(3)部分术前降钙素水平正常的患者降钙素基因相关肽水平升高。(4)术后1周左右降钙素下降至一稳定水平。结论降钙素可以作为指导甲状腺髓样癌诊断和治疗的重要指标,检测降钙素基因相关肽有助于部分降钙素阴性的甲状腺髓样癌患者术前诊断。     

Demonstration and diagnostic significance of pro-gastrin-releasing peptide in medullary thyroid carcinoma

The expression of pro-gastrin-releasing peptide (proGRP) in medullary thyroid carcinoma (MTC) and other histological types of thyroid carcinoma was studied by an immunohistochemical technique, using polyclonal anti-proGRP antiserum. Immunoreactivity for proGRP was detected exclusively in MTC (n = 7); other histological types (n = 12) were all negative for proGRP. In addition, serum proGRP levels were elevated in patients with primary or recurrent MTC (n = 3), and they changed in parallel with serum calcitonin (CT), and carcinoembryonic antigen (CEA). These results show that proGRP, which is considered to be a specific marker for small-cell lung carcinoma, may be also a potential tumor marker for MTC, in addition to CT and CEA.     

甲状腺髓样癌降钙素及其基因相关肽检测的临床意义--附88例报告

Objective： To investigate the changes of calcitonin （CT） and calcitonin gene-related peptide （CGRP） in patients with medullary thyroid carcinoma （MTC）. Methods： Fifty-eight cases of MTC were selected and the relationship between the CT levels and metastasis was investigated. The immunohistochemical method was used to detect the expression of CT and CGRP in the 58 samples of MTC tissues. The CT and CGRP in 30 newly diagnosed MTC inpatients were measured before operation and in the first few days after operation using a radioimmunoassy. Results： （1） The rate of residual tumor had a significant difference between the normal serum CT group one month after operation and the elevated group at the same period （P〈0.01）. （2） Immunohistochemical study revealed the positive rate of CT was about 98%, and that of the CGRP was 87.8%. （3） Part of the patients had an elevated CGRP levels while CT levels was normal. （4） The serum CT levels were decreased to a stable range one week after operation. Conclusion： CT is a useful index to evaluate the efficacy of surgical treatment. The measurement of serum CGRP is helpful in the diagnosis of MTC, especially for those whose preoperative CT levels are normal.     

(131I)meta-iodobenzylguanidine scintigraphy and selective venous catheterization after thyroidectomy for medullary thyroid carcinoma

Fifteen patients with medullary carcinoma of the thyroid (MCT), who had persistently elevated levels of serum calcitonin (CT) and carcinoembryonic antigen (CEA) after total thyroidectomy, were studied in order to localize the sites of the recurrent disease. Routine diagnostic examinations, including ultrasonography (US) and computed axial tomography (CAT), were carried out in all the cases. Scintigraphy with radio-iodinated metaiodobenzylguanidine ((131I)-MIBG) was performed in 13 cases; selective venous catheterization (SVC) to reveal a gradient of CT levels was performed in 12 cases. Ten patients underwent both (131I)-MIBG scintigraphy and SVC. US and CAT revealed the sites of recurrent tumor in only 4 out of the total 15 patients. SVC in basal conditions showed the presence of small metastases in 2 cases, and after intravenous stimulus with pentagastrin in 4 others. The MIBG scan showed metastatic foci of sporadic MCT in 2 patients, residual medullary thyroid tissue in 4 others, and a pheochromocytoma in a previously undiagnosed patient with Sipple's syndrome. More particularly, MIBG scan and SVC showed the localization of residual or metastatic tumor in 10 cases. In all 10 cases, results of the MIBG scan and SVC were confirmed as true positive by subsequent surgery and histopathologic examination.(ABSTRACT TRUNCATED AT 250 WORDS)     

Clinical value of color Doppler ultrasound combined with serum tumor markers for the diagnosis of medullary thyroid carcinoma

The present study aimed to explore the clinical value of color Doppler ultrasound combined with serum tumor markers, including calcitonin (CT) and carcinoembryonic antigen (CEA), for the diagnosis of medullary thyroid carcinoma (MTC). A total of 39 patients with MTC (MTC group), 50 patients with papillary thyroid carcinoma (PTC) (PTC group) and 30 patients with thyroid adenoma (benign control group) were enrolled in the present study. The patients were hospitalized at the Affiliated Hospital of Qingdao University from January 2012 to December 2018 and were diagnosed through surgical procedures and pathology laboratory results. The ultrasound results, as well as serum CT and CEA results, were collected and analyzed. A significant difference was observed between the MTC and PTC groups in regards to morphology, margin, aspect ratio, calcification, internal blood flow and lymph node metastasis (all P<0.01). There was also a significant difference between the MTC and benign control group in regards to internal echo, calcification, internal blood flow and lymph node metastasis (all P<0.01). In addition, the levels of serum CT and CEA in the MTC group were significantly higher than those in the PTC and the benign control groups (both P<0.01). For patients with MTC, the levels of serum CT and CEA were significantly associated with maximum tumor diameter, lymph node metastasis and the patient state after treatment (all P<0.01). Furthermore, the sensitivities of ultrasound, serum CT and CEA for the diagnosis of MTC were 76.92, 74.36 and 68.23%, respectively. The value for the combination of the three markers (94.87%) was significantly higher compared with the sensitivity value of each separate marker (all P<0.05). In conclusion, color Doppler ultrasound combined with detecting the levels of serum tumor markers (CT and CEA) significantly improved the diagnostic efficiency for MTC, which could be useful for the clinical diagnosis and treatment of MTC.     

NCAM、CEA及caspase-3在甲状腺髓样癌中的表达及临床价值

目的探究神经细胞黏附因子(NCAM)、癌胚抗原(CEA)及caspase-3在甲状腺髓样癌中的表达及意义。方法选择82例甲状腺髓样癌患者为实验组,另选取同期41例良性甲状腺病变组织为对照组,对比2组组织NCAM、CEA及caspase-3的表达,并分析上述因子与甲状腺髓样癌临床病理特征的相关性。结果(1)甲状腺髓样癌组织中NCAM和caspase-3表达阳性率明显低于良性甲状腺病变组织,CEA水平明显高于良性病变组织(P<0.05);(2)临床病理特征比较显示,淋巴结转移与TNM分期Ⅲ~Ⅳ期甲状腺髓样癌患者NCAM和caspase-3表达明显更低,CEA水平明显更高(P<0.05)。结论NCAM和caspase-3在甲状腺髓样癌组织中呈现明显低表达态,CEA水平明显增高,同时临床病理特征分析显示NCAM、caspase-3的低表达和CEA的异常高水平与淋巴结转移及TNM分期相关。     

Chromogranin A and the alpha-subunit of glycoprotein hormones in medullary thyroid carcinoma and phaeochromocytoma

Using specific immunoradiometric assays, we evaluated the clinical usefulness of chromogranin A and the alpha-subunit of glycoprotein hormones in neuroendocrine tumours of neuroectodermic origin. The serum alpha-subunit of glycoprotein hormones was only slightly increased in 2 out of 44 medullary thyroid carcinoma or phaeochromocytoma patients with increased calcitonin or 24-hour urinary metanephrine levels. Serum chromogranin A was increased in 12 of 45 (27%) medullary thyroid carcinoma patients with an elevated calcitonin level and in 4 of 16 medullary thyroid carcinoma patients (25%) with an undetectable calcitonin level, in 5 of 7 phaeochromocytoma patients with increased urinary catecholamine and metabolite excretion, and in 2 of 3 patients with a non-functioning phaeochromocytoma. During follow-up, the course of chromogranin A was found to parallel that of tumour burden and/or 24-hour urinary metanephrine in 5 phaeochromocytoma patients. We conclude that chromogranin A measurement is not recommended for the diagnosis of medullary thyroid carcinoma patients. It may be useful in patients with functioning and non-functioning phaeochromocytomas as a follow-up marker. In neuroendocrine tumour patients with elevated calcitonin secretion, the serum alpha-subunit of glycoprotein hormone measurement may help differentiate medullary thyroid carcinoma or phaeochromocytoma patients from other endodermal-derived neuroendocrine tumour patients in whom it is frequently elevated.