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。

Diagnosis and differential diagnosis of medullary thyroid carcinoma

Objective To investigate the morphologic features and immunophenotype of medullary thyroid carcinoma(MTC) and its differential diagnosis.Methods 25 cases of MTC were studied with routine staining and immunohistochemical staining using antibodies against calcitonin(CT),thyroglobin(Tg),chromograin A(CgA),synaptophysin(Syn),S-100 protein,NSE,CEA,CD44V6 and HMB-45. Results The tumors were composed of spindle and polygonal cells,arranged in various patterns,such as nest-like,fascicular,glandular(tubular and follicular),diffuse and carcinoid-like types,et al.The immunohistochemical results showed CT and CgA positive in 25 cases;21 cases were positive for CEA and NSE,and 18 cases,positive for Syn;23 cases were negative for Tg and HMB-45;CD44V6 expression were observed in 40% of MTC,and 30% FTC,and 80% MTC with lymphnode metastasis,respectively. Conclusions Calcitonin is a specific marker for the diagnosis of MTC;If calcitonin is negative,the positive expression of CEA and neuroendocirine hormone may facilitate the diagnosis and differential diagnosis of MTC.