甲状腺乳头状癌86例病理学观察
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摘要
目的探讨甲状腺乳头状癌的病理形态学特点、诊断依据和鉴别诊断要点。方法选择1992年7月~2013年5月21年间诊断的86例甲状腺乳头状癌患者的病理资料进行回顾性分析。结果乳头状癌占同期甲状腺癌的90.5%,男女比为1∶5.61,发病高峰年龄为30~40岁,肉眼检查肿瘤为灰白色疤痕样病灶或边界不清的肉红色结节或囊状腔隙内有颗粒状、乳头状突出物。镜下见74.4%的病例有乳头状结构,核呈毛玻璃样,可见核沟、核内假包涵体和核重叠现象,53.5%的病例见脉管内瘤栓,75.6%的病例有间质纤维增生,41.9%可见砂砾体。结论乳头状癌是甲状腺癌最常见的组织学类型,女性多于男性,病理诊断的主要依据:(1)特征性的核;(2)浸润性生长;(3)间质纤维增生,砂砾体形成。典型病变不一定出现在每一个病例中,不能把某一个形态特点当做一成不变的真理,需多要素综合分析判断,特别是要注意与良性乳头鉴别。免疫组织化学检测有助于作出正确诊断。
Objective To investigate the pathologic morphology features and diagnosis basis of thyroid papillary cancer and differentiate diagnosis essentials. Methods Retrospectively analysis was conducted on pathological data of 86 patients who were diagnosed thyroid papillary carcinoma from July 1992 to May 21 th 2013 for 21 years. Results Papillary carcinoma accounted for 90.5% among thyroid cancer in the same period, and male to female ratio was 1:5.61, and the peak age of onset was 30-40 years old. Visual examination showed that tumors were off-white scar-like lesions or illdefined fresh red nodules or granular and papillary projections in cystic cavity. By microscopy, we could see that there were 74.4% of patients with papillary structures whose nuclears were like ground glass, and we could see nuclear grooves, false inclusion bodies in the nucleus and the nucleus overlap. We could see that there were 53.5% of cases with tumor thrombus within the vessel, 75.6% of patients with interstitial fibrous hyperplasia and 41.9% of patients with psammoma body. Conclusion Papillary cancer is the most common histological type of thyroid cancer, and it occurs in women more than men. Pathological diagnosis is mainly based on(1) characteristic nuclear,(2) invasive growth,(3) interstitial fibrous hyperplasia and psammoma body formation. Typical lesions are not necessarily present in every case.We should not put certain morphological feature as immutable truth, and we should comprehensively analyze and determine papillary carcinoma based on multiple factors, especially, and we should pay attention to the identification between benign papilla and papillary carcinoma. Immunohistochemistry helps to make the correct diagnosis.
Objective To investigate the pathologic morphology features and diagnosis basis of thyroid papillary cancer and differentiate diagnosis essentials. Methods Retrospectively analysis was conducted on pathological data of 86 patients who were diagnosed thyroid papillary carcinoma from July 1992 to May 21 th 2013 for 21 years. Results Papillary carcinoma accounted for 90.5% among thyroid cancer in the same period, and male to female ratio was 1:5.61, and the peak age of onset was 30-40 years old. Visual examination showed that tumors were off-white scar-like lesions or illdefined fresh red nodules or granular and papillary projections in cystic cavity. By microscopy, we could see that there were 74.4% of patients with papillary structures whose nuclears were like ground glass, and we could see nuclear grooves, false inclusion bodies in the nucleus and the nucleus overlap. We could see that there were 53.5% of cases with tumor thrombus within the vessel, 75.6% of patients with interstitial fibrous hyperplasia and 41.9% of patients with psammoma body. Conclusion Papillary cancer is the most common histological type of thyroid cancer, and it occurs in women more than men. Pathological diagnosis is mainly based on(1) characteristic nuclear,(2) invasive growth,(3) interstitial fibrous hyperplasia and psammoma body formation. Typical lesions are not necessarily present in every case.We should not put certain morphological feature as immutable truth, and we should comprehensively analyze and determine papillary carcinoma based on multiple factors, especially, and we should pay attention to the identification between benign papilla and papillary carcinoma. Immunohistochemistry helps to make the correct diagnosis.
引文
[1]刘彤华.诊断病理学[M].第3版.北京:人民卫生出版社,2012:412.
[2]徐晓丽,周学科,陆洪芬,等.巨滤泡型甲状腺乳头状癌临床病理观察[J].诊断病理学杂志,2008,15(6):455.
[3]邓敏,叶顾萍,马建中,等.甲状腺乳头状癌中CK19、galectin-3和TPO的表达及意义[J].临床与实验病理学杂志,2011,27(8):843-846.
[4]Christopher DM主编,回允中主译.肿瘤组织病理学诊断[M].第3版.北京:北京大学医学出版社,2009:1057.
[5]Furlan JC,Bedard YC,Rosen IB.Role of fine-needte aspiration biopsy and frozen section in the manangement of papillary throid carcinoma subtypes[J].World J Surg,2004,28(9):880-885.
[6]成殷,崔全才.甲状腺高细胞亚型的临床病理学研究进展[J].诊断病理学杂志,2015,22(3):181-183.
[7]袁修学,袁静萍.柱状细胞亚型甲状腺乳头状癌临床病理观察[J].诊断病理学杂志,2015,22(12):674-676.
[8]侯刚,李道胜,李宁,等.甲状腺微小乳头状癌快速冷冻切片诊断及免疫组化分析[J].诊断病理学杂志,2007,14(2):130.
[9]周锐,王圣应.甲状腺乳头状癌的变异型[J].国际肿瘤学杂志,2011,38(3):203-206.
[10]张兴海,马成权.甲状腺乳头状癌术式的选择(附54例分析)[J].安徽医学,2010,31(6):598-600.
[11]周炜洵,肖雨,刘彤华,等.细胞角蛋白在甲状腺乳头状癌中的表达[J].中华病理学杂志,2003,32(6):530-533.
[12]陈晓东,周本成,赖日权,等.细胞角蛋白表达在甲状腺乳头状癌诊断中的应用[J].诊断病理学杂志,2003,10(1):25-26.
[13]张静,邱钜世,陈金培,等.CK19、CK20在甲状腺乳头状癌诊断中的应用价值[J].临床与实验病理学杂志,2002,18(2):181-182.
[14]陈杰.病理诊断免疫组化手册[M].北京:中国协和医科大学出版社,2014:90.
[15]怀建国,蒋艳,杨小苗,等.免疫组化联合检测在甲状腺乳头状病变诊断中的意义[J].诊断病理学杂志,2015,22(7):433-435.
[16]黄悦,黄文斌,赵建华,等.CD56在甲状腺乳头状癌诊断中的价值[J].诊断病理学杂志,2010,17(1):14-16.
[17]莫祥兰,黄振录,周祥祯,等.TPO在甲状腺乳头状癌与乳头状增生鉴别诊断中的作用[J].诊断病理学杂志,2006,13(2):117-119.
[18]白杨,孙璐,郭爱桃,等.CK19、galectin-3和syndecan-1在甲状腺乳头状病变鉴别诊断中的意义[J].诊断病理学杂志,2013,20(12):771-774.
[19]陈永峰,陈妍,薛荣,等.甲状腺微小癌临床病理观察[J].诊断病理学杂志,2014,21(10):637-639.
[2]徐晓丽,周学科,陆洪芬,等.巨滤泡型甲状腺乳头状癌临床病理观察[J].诊断病理学杂志,2008,15(6):455.
[3]邓敏,叶顾萍,马建中,等.甲状腺乳头状癌中CK19、galectin-3和TPO的表达及意义[J].临床与实验病理学杂志,2011,27(8):843-846.
[4]Christopher DM主编,回允中主译.肿瘤组织病理学诊断[M].第3版.北京:北京大学医学出版社,2009:1057.
[5]Furlan JC,Bedard YC,Rosen IB.Role of fine-needte aspiration biopsy and frozen section in the manangement of papillary throid carcinoma subtypes[J].World J Surg,2004,28(9):880-885.
[6]成殷,崔全才.甲状腺高细胞亚型的临床病理学研究进展[J].诊断病理学杂志,2015,22(3):181-183.
[7]袁修学,袁静萍.柱状细胞亚型甲状腺乳头状癌临床病理观察[J].诊断病理学杂志,2015,22(12):674-676.
[8]侯刚,李道胜,李宁,等.甲状腺微小乳头状癌快速冷冻切片诊断及免疫组化分析[J].诊断病理学杂志,2007,14(2):130.
[9]周锐,王圣应.甲状腺乳头状癌的变异型[J].国际肿瘤学杂志,2011,38(3):203-206.
[10]张兴海,马成权.甲状腺乳头状癌术式的选择(附54例分析)[J].安徽医学,2010,31(6):598-600.
[11]周炜洵,肖雨,刘彤华,等.细胞角蛋白在甲状腺乳头状癌中的表达[J].中华病理学杂志,2003,32(6):530-533.
[12]陈晓东,周本成,赖日权,等.细胞角蛋白表达在甲状腺乳头状癌诊断中的应用[J].诊断病理学杂志,2003,10(1):25-26.
[13]张静,邱钜世,陈金培,等.CK19、CK20在甲状腺乳头状癌诊断中的应用价值[J].临床与实验病理学杂志,2002,18(2):181-182.
[14]陈杰.病理诊断免疫组化手册[M].北京:中国协和医科大学出版社,2014:90.
[15]怀建国,蒋艳,杨小苗,等.免疫组化联合检测在甲状腺乳头状病变诊断中的意义[J].诊断病理学杂志,2015,22(7):433-435.
[16]黄悦,黄文斌,赵建华,等.CD56在甲状腺乳头状癌诊断中的价值[J].诊断病理学杂志,2010,17(1):14-16.
[17]莫祥兰,黄振录,周祥祯,等.TPO在甲状腺乳头状癌与乳头状增生鉴别诊断中的作用[J].诊断病理学杂志,2006,13(2):117-119.
[18]白杨,孙璐,郭爱桃,等.CK19、galectin-3和syndecan-1在甲状腺乳头状病变鉴别诊断中的意义[J].诊断病理学杂志,2013,20(12):771-774.
[19]陈永峰,陈妍,薛荣,等.甲状腺微小癌临床病理观察[J].诊断病理学杂志,2014,21(10):637-639.