5例缺乏包膜的甲状腺高分化滤泡癌的临床病理分析

目的探讨形态上类似结节性甲状腺肿的甲状腺高分化滤泡癌的临床病理特征及其与结节性甲状腺肿的鉴别方法。方法对5例原误诊为结节性甲状腺肿,后出现骨、脑等远处转移的甲状腺高分化癌进行临床病理分析,并应用免疫组织化学EnVsion方法检测CD44v6、nm23、Ki-67、Galectin-3、HBME-1和CK19的表达,以结节性甲状腺肿为对照。结果 5例甲状腺高分化滤泡癌在病理形态上类似结节性甲状腺肿,以巨滤泡结节状生长方式为主,少区细胞核有不确定的乳头状核的改变,无明显包膜或血管浸润;临床上无明显有诊断意义的病史。上述免疫组化指标在癌中均有不同程度表达,而在结节性甲状腺肿中几乎不表达,具有鉴别意义。结论形态上类似结节性甲状腺肿的甲状腺高分化滤泡癌容易误诊,而应用免疫组织化学染色能够较好地区分甲状腺高分化滤泡癌与结节性甲状腺肿。

Clinical pathological analysis of five cases well-differentiated thyroid follicular carcinoma which lacked capsules

Objective To investigate the clinical and pathological features and identified methods with nodular goiter of well-differentiated thyroid follicular carcinoma which similar to nodular goiter. Methods Clinical pathological analysis of well-differentiated thyroid follicular carcinoma in five cases originally misdiagnosed as nodular goiter, which developed distant metastasis in bone and brain afterwards. Detecting the expression of CD44v6, nm23, Ki-67, Galectin-3, HBME-1, CK19 by immunohistochemistry EnVsion , and taking nodular goiter as reference. Results The five cases of well-differenti ated thyroid follicular carcinoma similar to nodular goiter in pathological morphology, based mainly on giant follicular nodular growth pattern, and a few areas of nuclei have uncertainty papillary nuclear changes, with no capsule or vascular invasion; Clinically, there is no obvious medical history of diagnostic significance. Immunohistochemical indexes mentioned above are expressed in high differentiation in different degree, but there is no expression in nodular goiter, exist with signif icant differences. Conclusion Well-differentiated thyroid follicular carcinoma which similar to nodular goiter was easily misdiagnosed, while immunocytochemistry staining would better distinguish between well-differentiated thyroid follicular carcinoma and nodular goiter,