摘要
目的:探讨甲状腺微小乳头状癌(PMC)术中冰冻病理诊断的主要依据,分析延迟诊断及假阴性诊断陷阱。方法:回顾性观察72例甲状腺PMC的冰冻切片与石蜡切片,观察术中快速印片的形态特征,免疫组化法检测CK19、HBME-1及Galectin-3在PMC石蜡切片的表达。结果:PMC术中冰冻确诊45例:88.9%(40/45)见间质硬化,91.1%(41/45)见周围组织浸润,均见核异型及核内包涵体。PMC延迟诊断(6例)及假阴性(5例)中81.8%(9/11)以滤泡亚型及包裹亚型为主,36.4%(4/11)未见间质硬化。PMC冰冻取材阴性的(16例)肿瘤直径均≤0.3cm。PMC术中快速印片能清晰显示核异型、核沟及核内包涵体。PMC石蜡切片免疫组化染色证实98.1%(52/53)出现CK19、HBME-1、Galectin-3三者联合弥漫中强阳性表达。结论:滤泡型及包裹型PMC是冰冻切片的主要诊断陷阱。参差不齐的浸润性边界、间质硬化、无渐进性过渡的异型、核内包涵体是冰冻切片诊断PMC的主要依据。术中快速印片是冰冻诊断的重要辅助方法。
Objective：To characterize the morphological features of thyroid papillary microcarcinoma（PMC）on intraoperative frozen sections and avoid the pitfall in delayed diagnosis and false-negative diagnosis of PMC.Methods：A retrospective review was made on 72 PMC cases based on the pathological characteristics of frozen sections,paraffin sections and the intraoperative cytology imprinting features.Immunohistochemical stains for CK19,HBME-1 and Galectin-3 were performed on 53 cases of PMC.Results：In the frozen section definite positive group（45 cases）,interstitial sclerosis and invasion were detected in 88.9% and 91.1% cases respectively,and all cases contained typical nuclear features of micropapillary carcinoma such as nuclear atypia and intranuclear inclusions.While in frozen section delayed（6 cases）and frozen section false-negative（5 cases）patients,there was no interstitial sclerosis in 36.4%（4/11）cases.In addition,follicular-pattern and encapsulated-pattern PMC constituted 81.8%（9/11）cases.In the frozen section negative（16 cases）patients,none of the diameter of PMC was more than 0.3cm.Intraoperative cytology imprinting can help to observe the cytology feuture of PMC such as nuclear atypia,nuclear grooves and nuclear pseudoinclusions more distinctively.The immunohistochemical staining of CK19,HBME-1 and Galectin-3 revealed that 98.1%（52/53）of PMC showed diffuse,moderate to strong positive co-expressions of the three molecules.Conclusion：The main diagnosis pitfall on intraoperative frozen sections of PMC lies in follicular-pattern and encapsulated-pattern PMC.The appearance of irregular invasion margin,interstitial sclerosis,sharp separation of the nuclear atypia,and nuclear pseudoinclusions are very helpful to make accurate intraoperative frozen diagnosis.Intraoperative cytology imprinting combined with frozen section can raise the diagnostic accuracy of PMC.
出处
《中日友好医院学报》
2011年第6期326-330,F0004,共6页
Journal of China-Japan Friendship Hospital
关键词
甲状腺肿瘤
微小乳头状癌
术中冰冻
thyroid neoplasia
papillary microcarcinoma
frozen section
