伴有结节性筋膜炎样间质的甲状腺乳头状癌临床病理观察  

Papillary thyroid carcinoma with exuberant nodular fasciitis-like stroma

作　　者：刘定荣[1] 阎晓初[2] 傅春玲[1] 卫惠杰[1] 吴彤[1] 刘凤[1] 李伟[1] 

机构地区：[1]重庆市涪陵中心医院病理科,重庆408000 [2]第三军医大学附属西南医院病理科,重庆400038

出　　处：《诊断病理学杂志》2015年第8期479-481,484,共4页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨伴有结节性筋膜炎样间质的甲状腺乳头状癌的临床病理特征、诊断与鉴别诊断要点。方法对1例伴有结节性筋膜炎样间质的甲状腺乳头状癌进行临床病理观察和免疫组化染色,并复习文献。结果患者女性,19岁。肿块位于甲状腺右叶,边界清楚,切面灰白色。组织学见肿瘤主要由上皮及间质两种成分组成,上皮成分具有典型的甲状腺乳头状癌特征,约占40%;间质主要由长梭形细胞组成,排列呈束状或编织状,细胞胞质丰富,细胞核染色质细腻,可见清楚小核仁,少量细胞有轻度非典型性,偶见核分裂象,间质成分约占60%。免疫组化示上皮细胞CK19、TG和TTF1(+),梭形细胞SMA和vimentin(+)。结论伴有结节性筋膜炎样间质的甲状腺乳头状癌是甲状腺乳头状癌的一个亚型,其梭形间质细胞具有肌纤维母细胞特征,该亚型的预后与经典型甲状腺乳头状癌相似。鉴别诊断包括经典型甲状腺乳头状癌、慢性纤维性甲状腺炎、纤维型桥本甲状腺炎、甲状腺未分化癌等。Objective To study the clinicopathologic features,diagnosis and differential diagnosis of papillary thyroid carcinoma（ PTC） with exuberant nodular fasciitis-like stroma. Methods The clinical and histopathologic features were analyzed in a case of PTC with exuberant nodular fasciitis-like stroma. Immunohistochemical stain was carried out on paraffin-embedded tisues,and relevant literatures were reviewed. Results A nodule from right lobe of thyroid of a 19-year-old girl was analyzed. Grossly,the mass was well-demarcated,the cut surface of it was grayish-white in color.Microscopically,it was composed of spindle stromal cell component and neoplastic epithelioid cell component. The spindle cells arranged in fascicular or interlaced pattern and accounted for 60% or more of the tumor. They had oval to elongated nucleus with fine chromatin and small distinct nucleolus. The histologic features of the neoplastic epithelioid cells were typical for thyroid papillary carcinoma. Immunohistochemically,the spindle cells were positive for vimentin and smooth muscle actin. The epithelioid cells were positive for cytokeratin-19,thyroid transcription factor-1 and thyroglobulin.Conclusion PTC with exuberant nodular fasciitis-like stroma is a morphological variation of the PTC. The features of the proliferative stromal cells were identical to myofibroblasts. The differential diagnosis includes typical PTC,chronic fibrous thyroiditis fibrous variant of Hashimoto＇s thyroiditis,undifferentiated carcinoma,and soft tissue tumors.

关 键 词：乳头状癌 甲状腺 间质 变异 

分 类 号：R736.1[医药卫生—肿瘤]