甲状腺乳头状癌和滤泡癌病理诊断中的一些问题

绝大多数甲状腺肿瘤是由滤泡细胞组成的原发性上皮肿瘤,这些肿瘤种类相对较少,其中以滤泡性腺瘤、乳头状癌和滤泡癌最为常见,其诊断特征也比较单一而又明确,这就给初学者造成一种假象,会认为甲状腺肿瘤的诊断是一个易于掌握的领域。事实上,看似简单的甲状腺肿瘤的诊断却有许多值得推敲的细节和诊断陷阱,特别是乳头状癌和具有滤泡生长方式的肿瘤,已经受到了人们的关注”…。在日常工作中如何识别这些诊断陷阱是正确诊断甲状腺肿瘤的关键。下面提出避免诊断陷阱的要点,以期达到尽量减少和避免误诊的目的。     

免疫组化法检测甲状腺滤泡癌血管侵袭

对1000例甲状廊滤泡癌进行FVIIIR:Ag、UEA-I、HHF35及Desmin免疫组化染色。结果表明:FVIIIR:Ag和UEA-I都可以明显提高对滤泡癌血管侵袭检出率;HHF35亦可提高血管侵袭检出率,但效果不如前两者;Desmin是不甚理想的检查肿瘤血管侵袭的试剂。免疫组化法检测甲状腺滤泡癌血管侵袭,对正确诊断滤泡癌有较大应用价值。     

伴有罕见肾小球样结构的甲状腺滤泡癌

根据组织学特征和临床参数，2004年WHO内分泌器官分类将滤泡细胞源性的甲状腺癌概括地分为高分化（乳头状和滤泡状癌）、低分化和未分化癌。随后的分子水平研究显示，3种不同类型的肿瘤表现出不同的基因改变，这也有力的支持了上述分类。作者首次描述了1例形态学表现十分罕见的甲状腺滤泡肿瘤。患者女性，57岁，右侧甲状腺结节，肿瘤直径5cm，广泛浸润，并有血管壁侵犯，形态学呈特殊的滤泡结构：滤泡内有圆形至椭圆形上皮细胞丛生长，常有纤维血管轴心，类似肾小球。     

1例巨大甲状腺滤泡腺瘤

甲状腺滤泡腺瘤在临床上较常见,通常需要手术切除病理确诊有无血管及包膜侵犯。甲状腺滤泡腺瘤体积一般较小,容易恶变,肿瘤巨大者比较少见。我科收治1例巨大甲状腺滤泡腺瘤,现将相关病例报告如下。 1资料与方法 患者,女,68岁,因颁部肿物24年入院。     

甲状腺乳头状癌合并滤泡癌10例临床病理分析

目的探讨甲状腺乳头状癌(papillary thyroid carcinoma, PTC)合并滤泡癌(follicular carcinoma, FC)的临床病理特征、预后及发病机制。方法回顾性分析10例PTC合并FC的临床病理特征和免疫表型,并复习相关文献。结果 10例患者中男性3例,女性7例,发病年龄28～70岁(平均50.7岁)。10例甲状腺FC均为单发,瘤体最大径为1.0～8.0 cm,广泛浸润型3例,微小浸润型7例,10例均为有限血管浸润型(≤4个血管),其周围未见合并甲状腺良性病变;PTC单发者5例,多发者5例,瘤体最大径为0.2～2.2 cm,≤1.0 cm者8例,周围伴淋巴细胞性甲状腺炎、桥本甲状腺炎和结节性甲状腺肿者4例。1例合并食管鳞状细胞癌。免疫表型:10例PTC中CK19阳性,8例Galectin-3阳性,6例HMBE-1阳性,6例BRAF V600E蛋白阳性,10例CD56均阴性。结论 PTC较少与FC混合发生,预后与肿瘤是否多灶及有无伴桥本甲状腺炎等有关,其内在机制复杂且仍存在争议,在临床病理外检工作中需警惕,以避免漏诊其中一种肿瘤。     

甲状腺包膜型乳头状癌滤泡亚型的诊断

甲状腺乳头状癌是临床外检中的常见病变。其中包膜型(encapsulated variant)预后较好。而且淋巴结的转移率较典型乳头状癌低。国内文献报道显示乳头状癌局部侵犯以及包膜的防御作用与预后有明显的相关性。甲状腺包膜型乳头状癌滤泡亚型(encapsulated follicular variant of papillary thyroid carcinoma，EFVPTC)。指完全或绝大部分由     

肾脏原发性甲状腺样滤泡癌

慢性肾盂肾炎和终末期肾疾病时,两侧肾组织经常会出现形似甲状腺组织的形态学变化,这是一种认识清楚的良性改变。然而肾原发性恶性肿瘤明显类似于甲状腺高分化滤泡性肿瘤则比较罕见。作者报道了6例肾脏原发性甲状腺样滤泡癌,男性3例,女性3例,年龄29—83岁,所有病例都是因其他疾病而偶然发现的。大体上所有肿瘤境界清楚,大小1．9—4cm（平均2．8cm）,质地均匀,褐色、棕色到深棕色,无坏死和出血。组织学上,所有肿瘤有完整包膜,由微滤泡和巨滤泡组成的明显的滤泡样结构,     

甲状腺滤泡癌中miR-133的表达及其诊断意义

目的探讨miR-133在甲状腺滤泡癌(follicular thyroid carcinoma, FTC)中的表达及其对FTC的诊断价值。方法选取FTC标本30例、甲状腺乳头状癌(papillary thyroid carcinoma, PTC)标本30例、结节性甲状腺肿伴腺瘤标本30例。采用qRT-PCR技术检测三组甲状腺病变组织中miR-133的表达量,并分析其与临床病理特征的相关性;构建ROC曲线,分析miR-133对FTC的诊断价值。结果 FTC组的miR-133相对表达量明显低于PTC组和结节性甲状腺肿伴腺瘤组(P<0.05);miR-133在FTCⅢ+Ⅳ期组中的表达量低于Ⅰ+Ⅱ期组,差异有统计学意义(P<0.05);FTC与结节性甲状腺肿伴腺瘤组中,miR-133诊断FTC曲线下面积(area under curve, AUC)为0.723(95%CI:0.595～0.852),诊断灵敏度为63.3%,特异度为80.0%,约登指数为0.433;FTC与PTC组中,miR-133诊断FTC的AUC为0.719(95%CI:0.591～0.846),其诊断灵敏度为6...     

The encapsulated follicular carcinoma of the thyroid

Summary In a retrospective study of 86 follicular carcinomas of the thyroid gland, 35 lesions were classified as encapsulated carcinomas (40.7%). In two of these, lymph node metastases were detected initially. Another patient presented with distant metastases. The biological behaviour of these 35 tumours was studied over a long-term follow-up period (0.4–19.1 years, mean 10.3 years) which featured three cases of death from thyroid carcinoma 0.4–5.0 years after thyroidectomy. Another patient suffered from local recurrence of a follicular carcinoma 13.9 years later. The morphological and clinical findings of those five patients who initially presented with metastases and/or whose follow-up registered the local recurrence of thyroid cancer or death as a result of it, were compared with the remaining 30 cases which were of a benign clinical course. Statistical analysis showed that the prognosis of encapsulated follicular carcinoma is more serious when tumours occur in patients older than 65 years of age and when the tumour diameter is 5.0 cm or more. There was a tendency towards poorer prognosis in those tumours exclusively composed of oxyphilic epithelium.Sponsored by: Hamburger Stiftung zur Förderung der Krebsbekämpfung     

The pathology of preclinical medullary thyroid carcinoma

Medullary carcinoma of the thyroid (MTC) occurs sporadically, or in familial forms in familial medullary thyroid carcinoma and multiple endocrine neoplasia types 2A and 2B. In the familial forms it is associated with well-characterized, germline mutations in the RET protooncogene. The mutation sites differ in MEN2A and MEN2B, and MTC develops at an earlier age and is more aggressive in MEN2B. Screening of relatives of affected individuals for such mutations can identify those at risk of developing MTC and total thyroidectomy can be carried out in the first decade of life before the development of clinical disease. Analysis of such removed thyroid glands shows abnormalities of the parafollcular C-cells in almost all cases. The abnormalities range from C-cell hyperplasia, either diffuse or nodular, to microcarcinoma and occasionally frank MTC. The abnormalities are bilateral and affects the upper two thirds of the thyroid lobes. Microcarcinomas may be visible with the naked eye, but often they are identified only on microscopy. Histopathological examination of the entire gland is essential.     

Minimally invasive follicular thyroid carcinoma

Infiltration of the capsule, vascular invasion, and/or neoplastic extension into the adjacent parenchyma are regarded as prerequisites for the diagnosis of follicular carcinoma. In modern practice, most of these tumors fall into the category of follicular carcinoma, minimally invasive (FCMI) characterized by evidence of limited capsular or vascular invasion with an excellent long-term prognosis and a good patient outcome. Notwithstanding the wide acceptance of the diagnostic criteria established by the World Health Organization for the classification of follicular carcinomas in particular, they have been difficult to apply and have led to a great deal of confusion. This confusion is compounded when applied to "low-grade" or "minimally invasive" follicular carcinoma because of the poor reproducibility of the classification and the variable results reported in the literature. Our surgical colleagues face a similar lack of a standardized treatment for low-grade follicular carcinomas, which leads to unnecessary surgical treatment. Standardization of histologic criteria is necessary to promote confidence and uniformity in the therapeutic approach of these tumors. We believe that a FCMI is defined as an encapsulated follicular tumor (not papillary), with only small to medium vessel invasion within or immediately adjacent to the tumor capsule and/or up to full-thickness capsular transgression without accompanying extension into the thyroid parenchyma with intervening fibrosis. By using these criteria, patients can be managed with conservative surgical excision to yield an excellent long-term patient outcome.     

Endobronchial metastasis of thyroid follicular carcinoma

Well-differentiated forms of thyroid cancer, including follicular carcinoma, usually have good prognoses. But they are also known to metastasize to the bones, lungs and central nervous system. Endobronchial metastasis is exceptionally rare. In this paper, we report on a patient with endobronchial metastasis of follicular thyroid carcinoma. A 77-year-old male patient presented to our hospital with hemoptysis and a growing mass over the right clavicula. Computerized tomography (CT) of the chest revealed multiple lung metastases. Flexible bronchoscopy revealed a fragile polypoid mass of 1.5 cm, 6 cm distal to the vocal cords. Biopsy from the supraclavicular mass was consistent with follicular thyroid carcinoma. Taking into account the advanced nature of the disease as well as the general condition and age of the patient, aggressive treatment modalities were not considered in the management. Palliation for hemoptysis was attained by external radiotherapy. After radiotherapy, hemoptysis did not recur, and the patient was discharged. Although endobronchial metastasis of thyroid follicular carcinoma is very rare, the presence of endobronchial metastasis may be life threatening due to massive hemoptysis, and such a lesion must be suspected in any cancer patients presenting with hemoptysis.     

Recent advances in molecular gynaecological pathology

This review gives an overview of recent advances in our understanding of the molecular basis of gynaecological malignancy, including cervical, vulval, endometrial and ovarian tumours. These advances are beginning to influence clinical practice, perhaps most notably with the introduction of human papillomavirus vaccination for the prevention of anogenital neoplasia, but are likely to have broader clinical implications as further details emerge.     

Recent advances in the histopathology and molecular pathology of carcinoma of the endometrium

Endometrial carcinoma is the commonest malignancy of the female genital tract. The pathogenesis is complex and at least three pathogenetic subtypes exist with different prognostic implications. The molecular events involved remain poorly defined but several genes are involved and mutations of tp53 , WAF1/CIP1, PTEN, bcl-2 and c -erb B -2 have been implicated. Although care is needed in interpreting the results, the majority of these mutations can be detected immunohistochemically and therefore have the potential to aid the pathologist and surgeon in assessing the prognosis of a tumour. However, for the time being, no molecular marker is as valuable in determining prognosis as conventional parameters such as tumour type, grade and vascular space involvement.     

Medullary thyroid carcinoma,follicular variant

We report here a 48-yr-old woman presenting with a solitary thyroid nodule in the left lobe of the thyroid. The aspiration cytology of the nodule was reported as follicular neoplasia and she underwent surgery. Frozen section was suspicious for medullary thyroid carcinoma and a total thyroidectomy was performed. The pathology report revealed medullary thyroid carcinoma, follicular variant. Immunohistochemical analysis was negative for thyroglobulin and positive for calcitonin. A few patients with this variant have been reported in the literature, mainly diagnosed by immunohistochemical features of the tumor. In light of the limited information we have obtained from the literature, it is reasonable to emphasize that these cases should be distinguished from the mixed medullary-follicular thyroid carcinomas and medullary carcinomas with entrapped follicles. Immunohistochemical examination with calcitonin and thyroglobulin is also essential.     

内分泌肿瘤组织病理学及分子病理学研究进展

自20世纪60～70年代发现了人体内存在有弥漫性神经内分泌系统(dispersed neumendocrine system,DNES)后,内分泌系统已大大地扩展了,它不仅包括传统的内分泌腺,还包括了广泛散在分布于许多器官组织的神经内分泌细胞即DNES系统。多年来国内病理界对内分泌系统的病理形态和免疫