免疫组化在甲状腺乳头状病变诊断中的意义探讨

目的：探讨甲状腺良性乳头状增生性病变与甲状腺乳头状癌的关系。方法：对36例普通型甲状腺乳头状癌、11例微小乳头状癌、9例伴发于结节性甲状腺肿的乳头状增生性病变和7例Grave’s病伴滤泡上皮乳头状增生标本进行HBME-1和CD15免疫组化染色，并将染色结果与HE切片进行对比观察。结果：36例普通型甲状腺乳头状癌和11例微小乳头状癌均为HBME-1表达阳性；CD15在普通型甲状腺乳头状癌和微小癌中表达阳性率分别为38．9％和27．3％，HBME-1和CD15在普通型乳头状癌和微小癌中的表达无显著性差异。伴发于结节性甲状腺肿的良性乳头状增生性病变HBME-1表达阳性率为66．7％，阳性程度与乳头结构和细胞核特点密切相关：CD15表达均为阴性。Grave’s病伴乳头状增生性病变HBME-1和CD15表达均为阴性．结论：伴发于结节性甲状腺肿的乳头状病变在形态和免疫表型上与甲状腺乳头状癌有部分重叠，是一类介于良性增生和乳头状癌之间的性质未明、有组织学和免疫表型异质性的病变；结节性甲状腺肿病变内的网状瘢痕提示恶性可能。对这两种病变的认识有助于甲状腺疾病的正确诊断。

The Study on Papillary Lesions of Thyroid by Immunohistochemistry

Objective:To investigate the probable relationship between papillary thyroid carcinoma and benign thyroid lesions with papillary structure.Methods:36cases of usual papil-lary thyroid carcinoma,11cases of microcarcinoma,9cases of nodular goitre with papillary struc-ture and7cases of Grave 's disease with papillary structure were reviewed and studied im muno-histo chemically for HBME-1and CD15expression.Results:All cases of papillary thyroid carcino-ma,including11cases of microcarcinoma were HBME-1positive.38.9%of usual papillary carci-noma and27.3%of microcarcinoma were CD15positive.There is no difference in both HBME-1and CD15expression between usual papillary carcinoma and microcarcinoma.66.7%of papillary lesions associated with nodular goitre were HBME-1positive and all of them were ab solutely CD15negative.The intensity of immunostaining for HBME-1varied with the degree of papillary and nuclear changes.7cases of Grave's disease with papillary hyperplasia showed no re activity for HBME-1or CD15.Conclusions:Papillary lesions associated with nodular goitre and papillary thyroid carcinoma share similar morphology and HBME-1expression,a strong case can be made that these two conditions comprise a disease spectrum.Nodular goitre with papillary structure is not a single entity but comprises a spectrum of disorders which have heterogeneity in morphologyand immuoreactivity.Reticular scar in nodular goiter means malignancy.Recognition of these two pathological entities is important for diagnosis of thyroid disease.