甲状腺显示胸腺样分化的癌9例免疫组化与超微病理研究  

Carcinoma showing thymus-like differentiation of the thyroid:a clinicopathologic,immunohistochemical and ultrastructural study of 9 cases

作　　者：王艳芬[1,2] 刘标[1] 时姗姗[1] 余波[1] 周晓军[1] 

机构地区：[1]南京大学医学院附属金陵医院/南京军区南京总医院病理科,南京210002 [2]扬州市第一人民医院病理科

出　　处：《诊断病理学杂志》2016年第1期10-14,共5页Chinese Journal of Diagnostic Pathology

基　　金：国家自然科学基金(编号:81171391)

摘　　要：目的探讨甲状腺显示胸腺样分化的癌（CASTLE）临床病理、免疫表型、超微结构特征及生物学行为。方法回顾性分析9例CASTLE的临床病理资料，行免疫组化标记和电镜观察，并采用原位杂交法检测EBER表达情况。结果CASTLE多发生于甲状腺下极，以膨胀性生长为主。肿瘤排列方式和细胞特点与发生于胸腺的鳞状细胞癌或淋巴上皮瘤样癌相似。免疫组化示9例肿瘤细胞CD5、CDll7、p63、HMWK、GLUT-1、Pax8、E—cadherin、bcl-2和p53均（＋），5例CAⅨ（＋），6例CEA（＋），3例神经内分泌标记（＋）。超微结构显示肿瘤细胞含较多的线粒体及张力原纤维，细胞间桥粒丰富，其中1例胞质内见神经内分泌颗粒。随访4—65个月（平均31月），9例均健在，其中2例分别于首次术后18．5个月和22个月发生局部复发。结论CASTLE是一种低度恶性的甲状腺癌，其组织学和免疫组化与胸腺癌相似。GLUT-1可作为CASTLE新的免疫标记物，与CD5、CD117联合检测有助于该肿瘤的确诊与鉴别。Objective To investigate the clinicopathologic, immunophenotypic, uhrastructural features and biological behavior of thyroid carcinoma showing thymus-like differentiation （CASTLE）. Methods The clinicopathologic data of 9 patients with CASTLE were retrospectively reviewed. Immunohistochemical and uhrastructural findings were analyzed extensively, and the expression of EBER was also assessed by in situ hybridization. Results CASTLE mostly occurred at the lower pole of thyroid lobe and primarily showed expansive growth. The tumor cells were positive for CD5, CD117, p63, HMWK, GLUT-1, Pax8, E-cadherin, bcl-2 and p53 in all cases, and for CA-IX, CEA, p16 and neuroendocrine markers in some cases. Uhrastmctural examination indicated that the tumor cells contained large quantities of tonofilament with abundant intercellular desmosomes, including intracytoplasmic neuroendocrine granules in one case. All patients were alive during clinical follow-up for 4 to 65 months, although 2 patients had local neoplasm recurrence postoperatively in 18.5 and 22 months, respectively. Conclusions CASTLE is a low-grade malignant thyroid tumor with morphological, immunophenotypic and uhrastructural features similar to thymic carcinoma. GLUT-1 can be used as a novel biomarker for CASTLE, and combined detection of GLUT-1 with CD5 and CD117 aids in the diagnosis of this tumor.

关 键 词：甲状腺肿瘤 显示胸腺样分化的癌 免疫表型 葡萄糖转运蛋白-1 超微病理 

分 类 号：R736.1[医药卫生—肿瘤]