多发性甲状腺乳头状癌伴桥本甲状腺炎中肿瘤克隆起源的分析  

Clonal origin analysis of the tumor cells in multifocal papillary thyroid carcinoma with Hashimoto′s thyroiditis

作　　者：王炜[1] 丁金旺[2] 徐如君 罗定存 项晶晶 赵盼 周虹 Wang Wei;Ding Jinwang;Xu Rujun;Luo Dingcun;Xiang Jingjing;Zhao Pan;Zhou Hong(Department of Pathology,Affiliated Hangzhou First People′s Hospital,Zhejiang University School of Medicine,Hangzhou 310006,China)

机构地区：[1]浙江大学医学院附属杭州市第一人民医院病理科,杭州310006 [2]浙江大学医学院附属杭州市第一人民医院肿瘤外科,杭州310006

出　　处：《中华普通外科杂志》2019年第2期143-146,共4页Chinese Journal of General Surgery

基　　金：杭州市卫生科技计划项目(2015A05).

摘　　要：目的分析多发性甲状腺乳头状癌伴桥本甲状腺炎中,同一病例不同肿瘤灶的BRAF、RAS基因突变的表达。方法使用一代测序和扩增阻碍突变系统(ARMS)检测37例多发性甲状腺乳头状癌伴桥本甲状腺炎中BRAFV600E突变和N-/H-/K-RAS基因密码子12、13、61突变的表达以及在患者多病灶之间表达的差异。结果37例患者的80份肿瘤样本中共检出BRAFV600E突变51例,检出RAS基因突变3例。37例病例中有20例(54.1%)的多发病灶为不同的克隆起源,与文献结果(37/60)比较,差异无统计学意义(P>0.05)。结论半数以上多发性甲状腺乳头状癌伴桥本甲状腺炎病例中,肿瘤细胞来自不同的克隆起源,桥本甲状腺炎更可能是伴随甲状腺乳头状癌的肿瘤免疫反应的一部分。Objective To investigate the relationship between Hashimoto thyroiditis (HT) and thyroid papillary carcinoma (PTC) by analyzing the expression of BRAF V600E mutation and (N-,H-,K-)RAS codons 12,13 and 61 mutants in cases of multifocal PTC with HT. Methods 80 tumor samples in 37 multifocal PTC with HT cases,were analyzed for the genotypic changes of BRAF V600E,as well as the (N-,H-,K-)RAS codons 12,13 and 61 mutants by DNA sequencing assay and amplification refractory mutation system (ARMS). Results BRAF V600E mutation was detected in 51 samples and RAS gene mutations was found in 3 samples (N-RAS codon 61 mutant in 2 samples and H-RAS codon 61 mutant in 1 sample).Different clonal origin was present in 20 cases of multifocal PTC with HT (54.1%,20/37).There was no statistical significance (P>0.05) in the incidence of the difference in the origin of tumor cells,compared with the results (61.7%,37/60) of multifocal PTC without HT in the related literature. Conclusion In more than half of multifocal PTC with HT cases,the tumor cells originate from different clones.Our results do not support the opinion that HT predisposes patients to develop PTC,because HT does not have a significant effect on expression of BRAF and RAS gene mutation in PTC,accordingly HT is more likely to be a part of the host tumor immune response system.

关 键 词：甲状腺肿瘤 桥本甲状腺炎 BRAF RAS 基因突变 

分 类 号：R736.1[医药卫生—肿瘤]