甲状腺髓样癌原发及转移灶细针穿刺细胞学诊断

目的：提高甲状腺髓样癌（medullary thyroid carcinoma,MTC)细针穿刺（fine needle aspiration,FNA)细胞学诊断的准确性。方法：回顾分析14例组织学证实的MTC FNA标本及免疫细胞化学结果。总结10项细胞形态学特征；涂片背景、胶质、淀粉样物质，细胞数量，细胞排列结构，细胞异型性，细胞形状，有无双或多核细胞，核染色质以及有无核仁。结果：14例MTC主要细胞学特点为：（1）细胞呈浆细胞样和（或）梭形，前者更多见；（2）“盐和胡椒”样核染色质；（3）细胞轻至中度多形性，间有散在大细胞；（4）常见双核/多核细胞；（5）细胞呈散在或疏松团状排列；（6）核仁少见；（7）背景中基本无胶质，淀粉样物质并非多见，3例降钙素标记为阳性。结论：FNA可有效地术前诊断MTC，瘤细胞呈浆细胞样和（或）梭形，具神经内分泌肿瘤特点（包括“盐和胡椒”样核染色质，细胞散在分布倾向，细胞轻至中度多形性并间有少量大细胞及双核/多核细胞），核仁和胶质少见，可作为诊断依据。淀粉样物质非诊断必须，有选择地应用免疫细胞化学可提高FNA的诊断准确性。

Application of fine needle aspiration biopsies in the diagnosis of primary and metastatic medullary thyroid carcinoma

Purposes To improve the accuracy of cytologic diagnosis of medullary thyroid carcinomas (MTCs). Methods Fine needle biopsies (FNAs) of 14 cases of histologically confirmed MTCs and the immunocytochemical findings were studied retrospectively. Ten cytomorphologic characteristics, such as smear background, colloid, amyloid deposits, cellularity, cell arrangement, cell pleomorphism, cell shape, binucleation/multinucleation, chromatin pattern, and nucleoli were reviewed. Results The main cytomorphologic features of MTC are: (1) plasmacytoid and/or spindle shaped cells, (2) salt and pepper like chromatin, (3) mild to moderate pleomorphism with scattered large cells, (4) frequent binucleation/multinuleation, (5) dispersed cell pattern, (6) unremarkable nucleoli, (7) a background with little colloid and unfrequent amyloid deposit. Three cases presented with calcitonin positivity. Conclusions FNA can be used to detect MTC effectively before surgery. Diagnostic criteria consist of the presence of plasmacytoid and/or spindle shaped cells, the features of neuroendocrine neoplasm(including 'salt and pepper' like chromatin, dispersed cell pattern, mild to moderate pleomorphism with scattered large cells and frequent binucleation/multinuleation), unremarkable nucleoli, as well as little colloid. Amyloid deposit is not necessary for diagnosis. Immunocytochemical staining can be helpful in certain cases.