伴有纤维瘤病/筋膜炎样间质的甲状腺乳头状癌临床病理观察
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摘要
目的探讨伴有纤维瘤病/筋膜炎样间质的甲状腺乳头状癌(PTC-FFLS)的临床病理学特征、免疫组化特点以及鉴别诊断。方法对1例PTC-FFLS的组织形态学和免疫组化染色结果进行分析,同时复习文献。结果组织学上,肿瘤由上皮和其间丰富的间质成分组成。上皮性成分表现为经典型的甲状腺乳头状癌形态,间质成分为长梭形细胞组成,呈束状排列,细胞核纤细,核分裂象罕见。免疫组化:上皮性成分TTF1、CK19、HBME-1和galectin-3(+),β-catenin膜(+),梭形细胞vimentin、SMA和β-catenin核和浆(+),TTF1和TG(-)。结论伴有纤维瘤病/筋膜炎样间质的甲状腺乳头状癌是一种非常少见的甲状腺乳头状癌亚型,需与甲状腺内梭形细胞病变进行鉴别。
Objective To study the clinicopathologic features, immunophenotype and differential diagnosis of papillary thyroid carcinoma with fibromatosis/fasciitis-like stroma(PTC-FFLS). Methods A case of PTC-FFLS was studied with histopathologic analysis and immunohistochemistry. Relevant literatures were also reviewed. Results Histopathologically, the tumor consisted of epithelial and abundant mesenchymal components. Epithelial component was characteristic of classic thyroid papillary carcinoma, and mesenchymal component was spindle cells which arranged in fascicular pattern. The nuclei of spindle cells were slender and the mitosis was rare. Immunohistochemically, the epithelial components were positive for TTF1, CK19, HBME-1, Galectin-3, and membranous β-catenin. The spindle cells were positive for vimentin, SMA, and aberrant β-catenin(nuclear and cytoplasm), but negative for TTF1 and TG. Conclusion Papillary thyroid carcinoma with fibromatosis/fasciitis-like stroma is a very rare subtype of papillary carcinoma of the thyroid and should be distinguished from spindle lesions of the thyroid.
Objective To study the clinicopathologic features, immunophenotype and differential diagnosis of papillary thyroid carcinoma with fibromatosis/fasciitis-like stroma(PTC-FFLS). Methods A case of PTC-FFLS was studied with histopathologic analysis and immunohistochemistry. Relevant literatures were also reviewed. Results Histopathologically, the tumor consisted of epithelial and abundant mesenchymal components. Epithelial component was characteristic of classic thyroid papillary carcinoma, and mesenchymal component was spindle cells which arranged in fascicular pattern. The nuclei of spindle cells were slender and the mitosis was rare. Immunohistochemically, the epithelial components were positive for TTF1, CK19, HBME-1, Galectin-3, and membranous β-catenin. The spindle cells were positive for vimentin, SMA, and aberrant β-catenin(nuclear and cytoplasm), but negative for TTF1 and TG. Conclusion Papillary thyroid carcinoma with fibromatosis/fasciitis-like stroma is a very rare subtype of papillary carcinoma of the thyroid and should be distinguished from spindle lesions of the thyroid.
引文
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[8] Wu Z, Chu X, Fan S, et al. Papillary thyroid carcinoma with fibromatosis-like stroma: a case report and review of the literature[J]. Oncol Lett,2013,5(1):215-217.
[9] Naganuma H, Iwama N, Nakamura T, et al. Papillary carcinoma of the thyroid gland forming a myofibroblastic nodular tumor: report of two cases and review of the literature [J]. Pathol Int, 2002,52(1):54-58.
[10] Sim?es-Pereira J, Cabrera RA, Leite V. A case of thyroid fibromatosis: a rare lesion of this gland [J]. Endocrinol Diabetes Metab Case Rep, 2016,3:27855230.
[11] Us-Krasovec M, Golouh R. Papillary thyroid carcinoma with exuberant nodular fasciitis-like stroma in a fine needle aspirate. A case report [J]. Acta Cytol, 1999,43(6):1101-1104.
[12] Yang YJ, LiVolsi VA, Khurana KK. Papillary thyroid carcinoma with nodular fasciitis-like stroma: pitfalls in fine-needle aspiration cytology [J]. Arch Pathol Lab Med, 1999,123(9):838-841.
[13] Terayama K, Toda S, Yonemitsu N, et al. Papillary carcinoma of the thyroid with exuberant nodular fasciitis-like stroma[J]. Virchows Arch, 1997,431(4):291-295.
[14] Mizukami Y, Kurumaya H, Kitagawa T, et al. Papillary carcinoma of the thyroid gland with fibromatosis-like stroma: a case report and review of the literature [J]. Mod Pathol, 1995,8(4):366-370.
[15] Mizukami Y, Nonomura A, Matsubara F, et al. Papillary carcinoma of the thyroid gland with fibromatosis-like stroma [J]. Histopathology, 1992, 20(4):355-357.
[2] Chan JK, Carcangiu ML, Rosai J. Papillary carcinoma of thyroid with exuberant nodular fasciitis-like stroma [J]. Am J Clin Pathol, 1991,95(3):309-314.
[3] Rebecchini C, Nobile A, Piana S, et al. Papillary thyroid carcinoma with nodular fasciitis-like stroma and β-catenin mutations should be renamed papillary thyroid carcinoma with desmoid-type fibromatosis [J]. Mod Pathol,2017, 30: 236-245.
[4] 刘定荣,阎晓初,傅春玲,等.伴有结节性筋膜炎样间质的甲状腺乳头状癌临床病理观察[J].诊断病理学杂志,2015,22(8):479-484.
[5] Takada N, Hirokawa M, Ito M, et al. Papillary thyroid carcinoma with desmoid-type bromatosis: a clinical, pathological, and immunohistochemical study of 14 cases [J]. Endocrine J, 2017,64(10):1017-1023.
[6] Basu S, Nair N, Shet T, et al. Papillary thyroid carcinoma with exuberant nodular fasciitis-like stroma: treatment outcome and prognosis [J]. J Laryngol Otol, 2006, 120(4):338-342.
[7] Ginter PS, Scognamiglio T. Papillary thyroid carcinoma with nodular-fasciitis-like stroma: a usual entity with distinctive morphology[J]. Int J Surg Pathol, 2015,23(4):305-307.
[8] Wu Z, Chu X, Fan S, et al. Papillary thyroid carcinoma with fibromatosis-like stroma: a case report and review of the literature[J]. Oncol Lett,2013,5(1):215-217.
[9] Naganuma H, Iwama N, Nakamura T, et al. Papillary carcinoma of the thyroid gland forming a myofibroblastic nodular tumor: report of two cases and review of the literature [J]. Pathol Int, 2002,52(1):54-58.
[10] Sim?es-Pereira J, Cabrera RA, Leite V. A case of thyroid fibromatosis: a rare lesion of this gland [J]. Endocrinol Diabetes Metab Case Rep, 2016,3:27855230.
[11] Us-Krasovec M, Golouh R. Papillary thyroid carcinoma with exuberant nodular fasciitis-like stroma in a fine needle aspirate. A case report [J]. Acta Cytol, 1999,43(6):1101-1104.
[12] Yang YJ, LiVolsi VA, Khurana KK. Papillary thyroid carcinoma with nodular fasciitis-like stroma: pitfalls in fine-needle aspiration cytology [J]. Arch Pathol Lab Med, 1999,123(9):838-841.
[13] Terayama K, Toda S, Yonemitsu N, et al. Papillary carcinoma of the thyroid with exuberant nodular fasciitis-like stroma[J]. Virchows Arch, 1997,431(4):291-295.
[14] Mizukami Y, Kurumaya H, Kitagawa T, et al. Papillary carcinoma of the thyroid gland with fibromatosis-like stroma: a case report and review of the literature [J]. Mod Pathol, 1995,8(4):366-370.
[15] Mizukami Y, Nonomura A, Matsubara F, et al. Papillary carcinoma of the thyroid gland with fibromatosis-like stroma [J]. Histopathology, 1992, 20(4):355-357.