5例甲状腺内胸腺癌临床病理分析
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摘要
目的·探讨甲状腺内胸腺癌的临床病理特征。方法·回顾性分析5例甲状腺内胸腺癌患者的临床病例资料。对手术切除的肿瘤组织行组织学观察及免疫组织化学染色,采用EB病毒(EBV)编码小RNA(EBV-encoded RNA,EBER)原位杂交方法检测EBV感染情况,采用突变扩增阻滞系统方法检测BRAF基因V600E突变。结果·5例患者中,男性3例,女性2例,年龄51～69岁,平均年龄60.8岁。肿瘤均位于甲状腺内,最大直径2.0～3.5 cm。肿瘤在蛋白水平表达广谱型细胞角蛋白(CK)、细胞角蛋白19(CK19)、抑癌基因P40蛋白(P40)、白细胞分化抗原5(CD5)、白细胞分化抗原117(CD117)、B细胞淋巴瘤因子2(Bcl-2)、细胞增殖核抗原(Ki-67),其他相关肿瘤鉴别诊断标志物高分子量细胞角蛋白(34βE12)、甲状腺过氧化物酶(TPO)、甲状腺球蛋白(TG)、甲状腺转录因子1(TTF1)、突触素(SYN)、EBV、鼠类肉瘤滤过性毒菌致癌同源体B1蛋白(BRAF)均呈阴性。EBER原位杂交结果为阴性,且无BRAF基因V600E突变。结论·甲状腺内胸腺癌是一种惰性肿瘤,非常少见;肿瘤细胞表达CD5、CD117,具有重要的鉴别诊断意义。
Objective · To investigate the clinicopathological features of intrathyroid thymic carcinoma.Methods · Clinical data of 5 patients with intrathyroid thymic carcinoma were retrospectively reviewed.Histological examination and immunohistochemical staining were performed on the surgically resected tumors.The infection of EB virus(EBV) was detected by in situ hybridization of EBV-encoded RNAs(EBER).BRAF V600 E mutation was examined by amplification refractory mutation system.Results · There were 3 males and 2 females with age between 51 and 69 years(average of 60.8 years).All 5 cases were intrathyroid tumors.The tumors were 2.0-3.5 cm in diameter.All 5 cases showed positive staining for CK,CK19,P40,CD5,CD117,Bcl-2,and Ki-67 at protein level,and negative staining for other related differential diagnosis markers including 34βE12,TPO,TG,TTF1,SYN,EBV,and BRAF.In situ hybridization of EBER showed negative results and no BRAF V600 E mutation was found.Conclusion · Intrathyroid thymic carcinoma is a low-grade malignant tumor.Expressions of CD5 and CD117 in tumor cells play a very important role in the differential diagnosis.
Objective · To investigate the clinicopathological features of intrathyroid thymic carcinoma.Methods · Clinical data of 5 patients with intrathyroid thymic carcinoma were retrospectively reviewed.Histological examination and immunohistochemical staining were performed on the surgically resected tumors.The infection of EB virus(EBV) was detected by in situ hybridization of EBV-encoded RNAs(EBER).BRAF V600 E mutation was examined by amplification refractory mutation system.Results · There were 3 males and 2 females with age between 51 and 69 years(average of 60.8 years).All 5 cases were intrathyroid tumors.The tumors were 2.0-3.5 cm in diameter.All 5 cases showed positive staining for CK,CK19,P40,CD5,CD117,Bcl-2,and Ki-67 at protein level,and negative staining for other related differential diagnosis markers including 34βE12,TPO,TG,TTF1,SYN,EBV,and BRAF.In situ hybridization of EBER showed negative results and no BRAF V600 E mutation was found.Conclusion · Intrathyroid thymic carcinoma is a low-grade malignant tumor.Expressions of CD5 and CD117 in tumor cells play a very important role in the differential diagnosis.
引文
[1]DeLellis RA,Lloyd RV,Heitz PU,et al.World Health Organization classification of tumours:pathology and genetics of tumours of endocrine organs[M].Lyon:IARC Press,2004:96-97.
[2]Lloyd RV,Osamura RY,Kl鰌pel G,et al.WHO classification of tumours of endocrine organs[M].4th ed.Lyon:IARC Press,2017:125-126.
[3]方三高.WHO(2017)内分泌器官肿瘤分类[J].诊断病理学杂志,2018,25(3):239-241.
[4]方三高,魏建国,周晓军.WHO(2017)内分泌器官肿瘤分类解读(甲状腺)[J].临床与实验病理学杂志,2018,34(2):119-123.
[5]Miyauchi A,Kuma K,Matsuzuka F,et al.Intrathyroidal epithelial thymoma:an entity distinct from squamous cell carcinoma of the thyroid[J].World J Surg,1985,9(1):128-135.
[6]Kakudo K,Mori I,Tamaoki N,et al.Carcinoma of possible thymic origin presenting as a thyroid mass:a new subgroup of squamous cell carcinoma of the thyroid[J].J Surg Oncol,1988,38(3):187-192.
[7]Chan JK,Rosai J.Tumors of the neck showing thymic or related branchial pouch differentiation:a unifying concept[J].Hum Pathol,1991,22(4):349-367.
[8]Kakudo K,Bai Y,Ozaki T,et al.Intrathyroid epithelial thymoma(ITET)and carcinoma showing thymus-like differentiation(CASTLE):CD5-positive neoplasms mimicking squamous cell carcinoma of the thyroid[J].Histol Histopathol,2013,28(5):543-556.
[9]Choi KY,Kwon MJ,Ahn HK,et al.Extrathyroid carcinoma showing thymuslike differentiation(CASTLE):a new case report and review of the therapeutic role of neck dissection and radiotherapy[J].World J Surg Oncol,2014,12:247.
[10]崔秀杰,张春燕,苏鹏,等.头颈部显示胸腺样分化的癌临床病理学分析[J].中华病理学杂志,2017,46(3):155-159.
[11]王蕴珺,孙团起,向俊,等.胸腺样分化甲状腺癌16例临床诊治分析[J].中国实用外科杂志,2017,37(1):84-87.
[12]王艳芬,刘标,时姗姗,等.甲状腺显示胸腺样分化的癌9例免疫组化与超微病理研究[J].诊断病理学杂志,2016,23(1):10-14.
[13]Dorfman DM,Shahsafaei A,Miyauchi A.Intrathyroidal epithelial thymoma(ITET)/carcinoma showing thymus-like differentiation(CASTLE)exhibits CD5immunoreactivity:new evidence for thymic differentiation[J].Histopathology,1998,32(2):104-109.
[14]Ito Y,Miyauchi A,Nakamura Y,et al.Clinicopathologic significance of intrathyroidal epithelial thymoma/carcinoma showing thymus-like differentiation:a collaborative study with member institutes of the Japanese Society of Thyroid Surgery[J].Am J Clin Pathol,2007,127(2):230-236.
[15]Nakagawa K,Matsuno Y,Kunitoh H,et al.Immunohistochemical KIT(CD117)expression in thymic epithelial tumors[J].Chest,2005,128(1):140-144.
[16]Kojika M,Ishii G,Yoshida J,et al.Immunohistochemical differential diagnosis between thymic carcinoma and type B3 thymoma:diagnostic utility of hypoxic marker,GLUT-l,in thymic epithelial neoplasms[J].Mod Pathol,2009,22(10):1341-1350.
[17]刘勤江,魏温涛,田尤新,等.甲状腺胸腺样分化癌5例分析[J].中国普外基础与临床杂志,2017,24(7):830-836.
[18]Liu Z,Teng XY,Sun DX,et al.Clinical analysis of thyroid carcinoma showing thymus-like differentiation:report of 8 cases[J].Int Surg,2013,98(2):95-100.
[19]Sun T,Wang Z,Wang J,et al.Outcome of radical resection and postoperative radiotherapy for thyroid carcinoma showing thymus-like differentiation[J].World J Surg,2011,35(8):1840-1846.
[20]Ge W,Yao YZ,Chen G,et al.Clinical analysis of 82 cases of carcinoma showing thymus-like differentiation of the thyroid[J].Oncol Lett,2016,11(2):1321-1326.
[21]Hanamura T,Ito K,Uehara T,et al.Chemosensitivity in carcinoma showing thymus-like differentiation:a case report and review of the literature[J].Thyroid,2015,25(8):969-972.
[22]张建伟,王军,满国栋,等.甲状腺显示胸腺样分化癌影像及临床特点分析[J].中国医学文摘(耳鼻咽喉科学),2017,23(5):229-232.
[2]Lloyd RV,Osamura RY,Kl鰌pel G,et al.WHO classification of tumours of endocrine organs[M].4th ed.Lyon:IARC Press,2017:125-126.
[3]方三高.WHO(2017)内分泌器官肿瘤分类[J].诊断病理学杂志,2018,25(3):239-241.
[4]方三高,魏建国,周晓军.WHO(2017)内分泌器官肿瘤分类解读(甲状腺)[J].临床与实验病理学杂志,2018,34(2):119-123.
[5]Miyauchi A,Kuma K,Matsuzuka F,et al.Intrathyroidal epithelial thymoma:an entity distinct from squamous cell carcinoma of the thyroid[J].World J Surg,1985,9(1):128-135.
[6]Kakudo K,Mori I,Tamaoki N,et al.Carcinoma of possible thymic origin presenting as a thyroid mass:a new subgroup of squamous cell carcinoma of the thyroid[J].J Surg Oncol,1988,38(3):187-192.
[7]Chan JK,Rosai J.Tumors of the neck showing thymic or related branchial pouch differentiation:a unifying concept[J].Hum Pathol,1991,22(4):349-367.
[8]Kakudo K,Bai Y,Ozaki T,et al.Intrathyroid epithelial thymoma(ITET)and carcinoma showing thymus-like differentiation(CASTLE):CD5-positive neoplasms mimicking squamous cell carcinoma of the thyroid[J].Histol Histopathol,2013,28(5):543-556.
[9]Choi KY,Kwon MJ,Ahn HK,et al.Extrathyroid carcinoma showing thymuslike differentiation(CASTLE):a new case report and review of the therapeutic role of neck dissection and radiotherapy[J].World J Surg Oncol,2014,12:247.
[10]崔秀杰,张春燕,苏鹏,等.头颈部显示胸腺样分化的癌临床病理学分析[J].中华病理学杂志,2017,46(3):155-159.
[11]王蕴珺,孙团起,向俊,等.胸腺样分化甲状腺癌16例临床诊治分析[J].中国实用外科杂志,2017,37(1):84-87.
[12]王艳芬,刘标,时姗姗,等.甲状腺显示胸腺样分化的癌9例免疫组化与超微病理研究[J].诊断病理学杂志,2016,23(1):10-14.
[13]Dorfman DM,Shahsafaei A,Miyauchi A.Intrathyroidal epithelial thymoma(ITET)/carcinoma showing thymus-like differentiation(CASTLE)exhibits CD5immunoreactivity:new evidence for thymic differentiation[J].Histopathology,1998,32(2):104-109.
[14]Ito Y,Miyauchi A,Nakamura Y,et al.Clinicopathologic significance of intrathyroidal epithelial thymoma/carcinoma showing thymus-like differentiation:a collaborative study with member institutes of the Japanese Society of Thyroid Surgery[J].Am J Clin Pathol,2007,127(2):230-236.
[15]Nakagawa K,Matsuno Y,Kunitoh H,et al.Immunohistochemical KIT(CD117)expression in thymic epithelial tumors[J].Chest,2005,128(1):140-144.
[16]Kojika M,Ishii G,Yoshida J,et al.Immunohistochemical differential diagnosis between thymic carcinoma and type B3 thymoma:diagnostic utility of hypoxic marker,GLUT-l,in thymic epithelial neoplasms[J].Mod Pathol,2009,22(10):1341-1350.
[17]刘勤江,魏温涛,田尤新,等.甲状腺胸腺样分化癌5例分析[J].中国普外基础与临床杂志,2017,24(7):830-836.
[18]Liu Z,Teng XY,Sun DX,et al.Clinical analysis of thyroid carcinoma showing thymus-like differentiation:report of 8 cases[J].Int Surg,2013,98(2):95-100.
[19]Sun T,Wang Z,Wang J,et al.Outcome of radical resection and postoperative radiotherapy for thyroid carcinoma showing thymus-like differentiation[J].World J Surg,2011,35(8):1840-1846.
[20]Ge W,Yao YZ,Chen G,et al.Clinical analysis of 82 cases of carcinoma showing thymus-like differentiation of the thyroid[J].Oncol Lett,2016,11(2):1321-1326.
[21]Hanamura T,Ito K,Uehara T,et al.Chemosensitivity in carcinoma showing thymus-like differentiation:a case report and review of the literature[J].Thyroid,2015,25(8):969-972.
[22]张建伟,王军,满国栋,等.甲状腺显示胸腺样分化癌影像及临床特点分析[J].中国医学文摘(耳鼻咽喉科学),2017,23(5):229-232.