甲状腺乳头状癌形态学变型与预后的关系  

Relationship of morphologic variants of papillary thyroid carcinoma and the prognosis

作　　者：朱晓丽[1] 周晓燕[1] 孙团起[2] 陆洪芬[1] 朱雄增[1] 

机构地区：[1]复旦大学附属肿瘤医院病理科,上海200032 [2]复旦大学附属肿瘤医院头颈外科,复旦大学上海医学院肿瘤学系,上海200032

出　　处：《临床与实验病理学杂志》2010年第5期560-565,共6页Chinese Journal of Clinical and Experimental Pathology

基　　金：国家教育部高等学校博士点学科专项基金(新教师基金)(200802461109);上海市卫生局局级课题(2007077)

摘　　要：目的研究和分析甲状腺乳头状癌(papillary thyroid carcinoma,PTC)变型的形态学及临床病理特征,并探讨与预后的关系。方法收集155例PTC,对石蜡包埋组织切片HE染色后进行形态学观察分型,并探讨与临床病理特征的关系。结果 (1)根据WHO甲状腺肿瘤分类标准,155例PTC可归到8个变型中,典型PTC(47.7%,74/155)最常见。在典型PTC中年龄≥45岁的病例占77%(57/74),明显高于滤泡型PTC(28.6%,2/7)和嗜酸细胞型PTC(33.3%,3/9,P<0.05)。乳头状微癌的淋巴结转移率(27.5%,11/40)明显低于其他变型(P<0.005)。弥漫硬化型PTC的局灶浸润率(4/8,50%)明显高于典型PTC(10/74,13.5%);实体型PTC(2/7,28.6%)的远处转移率明显高于典型PTC(2/74,2.7%);(2)45例(29%)PTC伴淋巴细胞性甲状腺炎(lymphocytic thyroiditis,LT),局部浸润发生率在伴有LT的PTC(4.4%,2/45)中明显低于不伴LT的PTC(16.4%,18/110,P<0.05)。(3)对42例PTC随访8～12年,5年生存率为100%(42/42),10年生存率为96.6%(28/29)。结论 (1)典型PTC最常见,与之相比,滤泡型PTC、嗜酸细胞型PTC预后可能较好,而弥漫硬化型、高细胞型和实体型PTC预后较差。(2)伴淋巴细胞性甲状腺炎的PTC局灶浸润率低,提示预后较好;(3)随访资料表明,PTC的总体生存率高,预后好。Purpose To study the morphologic and clinicopathologic features of papillary thyroid carcinoma （PTC） variants and explore the relationship between PTC variants and prognosis.Methods 155 cases of papillary thyroid carcinoma have been collected.Morphologic features were observed and the clinicopathologic features and follow-up data had been analyzed.Results （1） According to WHO classification of thyroid tumor,155 cases of PTC were classified into eight PTC variants,typical PTC（74/155,47.7%） was the most common variants.77 percent （57/74） of typical PTC were older than 45 and higher than follicular variant and oxyphilic variant（28.6%,33.3%,P0.05）.Lymph node metastasis ratio in micro-PTC （27.5%,11/40） was lower than other variants（P0.05）.Lymph node metastasis in tall cell variant was 100%（9/9）.Focal invasion in diffuse sclerosing variant（4/8,50%）was more common than typical PTC（10/74,13.5%）.The distant matastasis ratio（2/7,28.6%） of solid variant was higher than typical PTC（2/74,2.7%）.（2） 45 cases of PTC companied with lymphocytic thyroiditis.The extrathyroid stromal invasion in PTC with lymphocytic thyroiditis（4.4%,2/45）was lower than those cases without lymphocytic thyroiditis（16.4%,18/110,P0.05）.（3）134 cases of PTC had been followed up for 8～12 years and 31.3%（42/134） had been replied.Five-year survival rate was 100%（13/13）and Ten-year survival rate was 96.6%（28/29） respectively.Conclusions （1） The classical PTC were the most common variants;Compared with typical PTC,the prognosis of follicular variant and oxyphilic cell variant may be better,but diffuse sclerosis variant ,tall cell variant and solid variant may be worse.（2） The lower ratio of extrathyroid invasion in PTC with lmphocytic thyroditis implied a good prognosis.（3）The following-up data showed that the prognosis of PTC was good with high overall survival rate and low mortality rate.

关 键 词：甲状腺乳头状癌 变型 临床病理学特征 预后 

分 类 号：R736.1[医药卫生—肿瘤]