甲状腺上皮样血管肉瘤临床病理观察  

Epithelioid angiosarcoma of thyroid:a case report and review of literature

作　　者：黄述斌[1] 李松梅[1] 杨荣芝[1] 王海平[1] 周爱娣[1] 

机构地区：[1]池州市人民医院病理科,安徽池州247000

出　　处：《诊断病理学杂志》2010年第5期361-364,共4页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨原发于甲状腺的上皮样血管肉瘤的临床病理特点及鉴别诊断要点。方法报道1例甲状腺上皮样血管肉瘤,并结合文献对其临床病理特点及鉴别诊断和预后进行讨论。结果患者为老年女性,以颈部包块伴声音嘶哑就诊。CT显示颈部巨大软组织肿块伴气管受压。组织学显示,瘤组织大部分排列成实性片状,瘤细胞核大,空泡状,含有明显的核仁,部分瘤细胞胞质空泡化,内含红细胞。除实性区域外,还可见内衬不典型内皮细胞的不规则互相吻合的血管腔。周围淋巴结内见肿瘤转移。免疫组化:瘤细胞Ckpan(AE1/AE3)、CK19、CD31、CD34和FⅧRAg(+),TG、TTF-1、calcitonin、S-100、EMA和HMB45(-)。结论原发于甲状腺的上皮样血管肉瘤是一种罕见的肿瘤,恶性程度较高,确诊主要依靠组织学和免疫组化检查,临床主要应与甲状腺未分化癌鉴别。Objective To explore the clinicopathologic characteristics and differential diagnosis of epithelioid angiosarcoma in thyroid. Methods A case of epithelioid angiosareoma of thyroid was reported, and the histological and immunohistochemical features were discussed according to related literrature. Results The case occurred in the aged woman and presented as a gradually enlarging thyroid mass companing with hoarse voice. CT images showed a large mass in the soft tissue of neck and compression of the trachea. Microscopically, the tumor consisted predominantly of solid sheets of large epithelioid cells with large vesicular nuclei and prominent nucleoli. Intracytoplasmie lumina containing red blood cells were identified. Formation of irregular and anastomotic vascular spaces lining atypical endothelial cells was also noted in some areas. In the peripheral lymph node metastasis were found. Immunohistoehemical analysis （using EnVision-plus method） showed that the tumor cells were diffusely positive for Ckpan（AE1/AE3）, CK19, CD31, CD34, FⅧ/Rag, and negative for TG, TTF-1, calcitonin, S-100, EMA and HMB45. Conclusion Primary thyroid epithelioid angiosarcoma is a rare entity with features of higher malignant tumor. Definite diagnosis should be made mainly on pathological examination in assistance with immunohistochemical analysis and the most frequent differential diagnosis is anaplastic carcinoma.

关 键 词：甲状腺肿瘤 上皮样血管肉瘤 免疫组化 鉴别诊断 

分 类 号：R736.1[医药卫生—肿瘤]