甲状腺乳头状增生活跃与微小乳头状癌的诊断与鉴别诊断  

Histopathological and differential diagnosis of thyroid papillary hyperplasia and micropapillary carcinoma

作　　者：佟杰[1] 罗杰[1] 笪冀平[1] 王跃[1] 张红雷[1] 张敏[1] 

机构地区：[1]卫生部中日友好医院病理科,北京100029

出　　处：《诊断病理学杂志》2011年第3期173-177,共5页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨甲状腺乳头状增生活跃与微小乳头状癌(PMC)的诊断与鉴别诊断。方法收集PMC 100例,结节性甲状腺肿伴乳头状增生活跃53例。对比两者病理形态特征、流行病学及外科治疗方式,并检测CK19、HBME-1、galectin-3、CD56和p63的表达。结果 100%(53/53)的乳头状增生活跃出现具有纤维血管轴心的真性乳头,73.6%(39/53)伴2级及以上分支。无1例出现典型毛玻璃核、核明显异型重叠、包涵体等微小乳头状癌的细胞核特征,亦无间质硬化及浸润特征。甲状腺PMC中98.6%(73/74)CK19﹑HBME-1和galectin-3出现弥漫强阳性,而乳头状增生活跃组中无1例出现。结论乳头状增生活跃可出现2级分支的真性乳头,但不出现典型毛玻璃核、核异型、核内包涵体等微小乳头状癌的典型细胞学特征,把不具有细胞学特征的真性乳头诊为乳头状癌一定要慎重。CK19﹑HBME-1﹑galectin-3三者弥漫强阳性是鉴别乳头状增生活跃及微小乳头状癌的非常有意义的指标。Purpose To investigate the histopathological and differential diagnosis of thyroid papillary hyperplasia and micropapillary carcinoma.Methods The comparisons between 100 micropapillary carcinomas and 53 nodular goiters with foci of papillary hyperplasia were made based on their epidemiological and pathological characteristics,surgical management and the expression of CK19,HBME-1,galectin-3,CD56 and p63.Results Histopathologically,all the papillary thyroid hyperplasia tissues（53/53） contained the papillary structures supported by fibrovascular cores（true papillae）.True papillae comprised of more than 2 branches were observed in 73.6%（39/53） of the hyperplastic disease.Typical pathological features of thyroid micropapillary carcinoma such as ground-glass nuclei,nuclear atypia and overlapping,intranuclear cytoplasmic inclusions,stromal sclerosis and invasion were not found in the papillary hyperplasia.The immunohistochemical staining of CK19,HBME-1 and galectin-3 revealed that 98.6%（73/74） of the micropapillary carcinoma showed diffuse,moderate to strong positive expression of the three molecules,in contrast to papillary hyperplasia in which the above expression pattern was absent.Conclusions The presence of true papillae with more than 2 branches is identified in thyroid papillary hyperplasia.However,these papillae do not have the typical nuclear features of micropapillary carcinoma such as ground-glass nuclei,nuclear atypia and intranuclear inclusions.Extreme cautions should be taken in diagnosing micropapillary carcinoma from true papillae that lack the above nuclear features.The diffuse,moderate to strong positive co-expression pattern of CK19,HBME-1 and galectin-3 is useful for differential diagnosis between thyroid micropapillary carcinoma and papillary hyperplasia.

关 键 词：甲状腺 微小乳头状癌 乳头状增生 CK19 HBME-1 galectin-3 CD56 p63 

分 类 号：R736.1[医药卫生—肿瘤]