甲状腺破骨细胞样巨细胞性未分化癌2例并文献复习

目的：报道2例少见的甲状腺破骨细胞样巨细胞性未分化癌并进行文献复习。方法：对此瘤的临床病理特征做详细的形态学观察和免疫组织化学检查并进行分析。结果：甲状腺破骨细胞样巨细胞性肿瘤主要由两种细胞组成，一种为多核巨细胞，分两型：一型为破骨细胞样多核巨细胞，核数目多；一型为较小的具明显异型性的瘤巨细胞，核数目较少。另一种为单核细胞，也分两型：一型为组织细胞样单核细胞，一型为梭形、多角形的单核细胞。免疫组织化学研究显示，破骨细胞样多核巨细胞、组织细胞样单核细胞CD68（＋＋），所有细胞vimentin（＋＋），cytokeratin、EMA、NSE、Syn、CgA和calcitonin为（－）；少量梭形单核细胞、异型多核细胞的thyroglobulin显局灶阳性。结论：该肿瘤属甲状腺未分化癌的另一种亚型。破骨细胞样多核巨细胞是组织细胞样单核细胞融合的结果，来源于单核巨噬系统，属反应性改变。

Anaplastic thyroid carcinoma with osteoclast- like giant cells: a report of 2 cases and review of the lit-erature

Objective To report 2 cases of anaplastic thyroid carcinoma with osteoclast-like giant cells and review of the literature. Methods The clinicopathologic features and immunohistochemical findings of this neoplasm were analyzed. Results This neoplasm was composed of two kinds of the cells: one was multinuclear cells and the another, mononuclear cells. The multinuclear cells were divided into two types of cells: one was a osteoclast-like giant cell (OCL-GC); the another was a pleomorphic multinuclear cell. The mononuclear cells were also divided into two types of cells: one was histiocytoid mononuclear cells and another was spindle and polygon cells. Immunohistochemically, the majority of OCL-GC and histiocytoid mononuclear cells showed positive for CD68, and all cell types showed positive for vimentin, but negative for cytokeratin, epithelial membrane antigen, neuron-specificenolase, synaptophysin, chromogranin and calcitonon. Thyroglobulin showed weak reactive in minority of spindle and pleomorphic multinuclear cells. Conclusions This tumor is belong to a new subtype of anaplastic carcinoma of the thyroid. OCL-GC is derived from histiocytoid mononuclear cells via cellular fusion,which is reactive components to the neoplasm.