摘要
目的:探讨散发性甲状腺髓样癌(MTC)临床特点、术中及术后病理特征、治疗及预后。方法:收集9例MTC患者临床资料,重新阅读冷冻切片及石蜡切片,完善免疫组化及特殊染色,分析临床病理特征并结合文献复习。结果:患者年龄45~70岁,中位年龄57岁,女性7例。8例接受冷冻切片病理检查,3例术中诊断为MTC,5例诊断甲状腺癌(乳头状癌或组织学分型不明确)。术后病理示肿瘤最长径0.3~6.9 cm,镜下见淀粉样沉积物将肿瘤组织分隔成实性巢团状或条带状,细胞呈多边形、圆形、高柱状、短梭形,胞浆颗粒感,核分裂象低。肿瘤组织内血管丰富,钙化常见。免疫组化:肿瘤细胞降钙素、CEA、Syn、CgA几乎均阳性。其中有1例为MTC(最大径1.3 cm)和甲状腺乳头状癌(最大径0.6 cm)合并发生。结论:散发性MTC术中冷冻切片较难明确诊断,石蜡切片需要警惕并发甲状腺乳头状癌,当肿瘤内无明显淀粉样蛋白沉积时,掌握组织学其他特点,辅以免疫组化染色利于确诊。
Objective:To discuss the clinical characteristics of sporadic medullary thyroid carcinoma(MTC),the pathological characteristics of frozen and paraffin sections,as well as the treatment and prognosis.Methods:Collect clinical data of 9 patients,observe frozen and paraffin sections,supplement immunohistochemistry and special staining,analyze clinicopathological characteristics and review literature.Result:The patients were 45-70 years old,with a median age of 57 years old,and 7/9 of them were female.Eight cases received frozen biopsy during the operation,3 cases were diagnosed as MTC,and 5 cases were diagnosed with thyroid cancer(papillary carcinoma or histological classification to be determined).The longest diameter of these tumors were 0.3-6.9 cm.The tumor tissue was separated into solid nests or strands by amyloid deposits,and the cells were polygonal,round,tall columnar,and short spindle-shaped.Granular cytoplasm and low mitotic figures.Most cases have calcification,and the tumor tissue is rich in blood vessels.The immunohistochemistry of tumor cells was almost positive for Calcitonin,CEA,Syn,and CgA.In one case,MTC(maximum diameter 1.3 cm)and Papillary thyroid carcinoma(PTC)(maximum diameter 0.6 cm)occurred simultaneously.Conclusion:Frozen biopsy of MTC during operation is difficult to diagnose accurately.Paraffin section diagnosis needs to be alert to concurrent PTC.When there is no obvious amyloid deposits in the tumor,a clear diagnosis requires the understanding of other histological characteristics and immunohistochemical staining.
作者
王瑾
昂琳
黄金
郑丽
赵敏
WANG Jin;ANG Lin;HUANG Jin;ZHENG Li;ZHAO Min(Department of Pathology,the Second People's Hospital of Hefei,Hefei 230011,China)
出处
《中国现代普通外科进展》
CAS
2021年第6期455-459,共5页
Chinese Journal of Current Advances in General Surgery
基金
国家自然科学基金(82002821)
安徽省教育厅高校自然科学研究重点项目(KJ2019A0947)。
关键词
甲状腺肿瘤
髓样癌
降钙素
免疫组化
病理特征
Thyroid tumors
Medullary carcinoma
Calcitonin
immunohistochemistry
Pathological characteristics
