甲状腺胸腺样分化癌5例分析  

Analysis of 5 cases with carcinoma showing thymus-like differentiation of the thyroid

作　　者：刘勤江[1] 魏温涛[1] 田尤新[1] 杨荣[2] 

机构地区：[1]甘肃省肿瘤医院头颈外科,兰州730050 [2]甘肃省肿瘤医院病理科,兰州730050

出　　处：《中国普外基础与临床杂志》2017年第7期830-836,共7页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨甲状腺胸腺样分化癌(carcinoma showing thymus-like differentiation,CASTLE)的组织学来源、诊断、鉴别诊断及治疗。方法对5例甲状腺CASTLE实施手术根治性切除及术后放射治疗,对手术切除的肿瘤组织进行免疫组化S-P法染色,检测肿瘤细胞CD5、CD117、细胞角蛋白-5/6(CK5/6)、P63蛋白、甲状腺转录因子-1(TTF-1)、癌胚抗原(CEA)、降钙素(CT)、抗原Ki-67、嗜铬粒蛋白A(Cg A)、甲状腺球蛋白(Tg)、氧化物酶增殖物激活受体γ(PPARγ)、钠碘转运体(NIS)以及促甲状腺激素受体(TSHR)的表达,并采用DNA测序法检测鼠类肉瘤滤过性毒菌致癌同源体B1(BRAF)基因和端粒酶逆转录酶(TERT)启动子突变情况。同时与同期收治的甲状腺低分化癌8例及甲状腺未分化癌6例患者的资料进行综合对比分析。结果甲状腺CASTLE肿瘤细胞的CD5、CD117、CK5/6以及P63均呈阳性表达,TTF-1、CT、Cg A、Tg、PPAR-γ、NIS以及TSHR均呈阴性表达;甲状腺低分化癌及未分化癌中CD5和CD117均呈阴性表达,CK5/6、P63、TTF-1、Cg A、Tg、NIS及TSHR显示部分病例呈阳性表达。甲状腺CASTLE中未发现BRAFV600E基因及TERT启动子突变,甲状腺低分化癌和未分化癌中均未发现BRAFV600E突变。甲状腺低分化癌存在TERT启动子突变4例(4/8),其中C228T位点突变3例,C250T位点突变1例;甲状腺未分化癌存在TERT突变2例(2/6),其中C228T位点突变1例,C250T位点突变1例。全部5例甲状腺CASTLE患者术后随访3~47个月(平均25.6个月)无复发及转移。结论甲状腺CASTLE的组织学来源可能与甲状腺无关。联合检测CD5、CD117、P63、TTF-1、Tg、NIS及TSHR,对甲状腺CASTLE的诊断及鉴别诊断具有重要的临床价值,检测BRAFV600E及TERT启动子突变,对甲状腺CASTLE诊断与鉴别诊断的意义尚需进一步研究。Objective To investigate the histological origin, diagnosis, differential diagnosis and treatment of thyroid carcinoma showing thymus-like differentiation （CASTLE）. Methods Five patients with thyroid CASTLE were adopted by surgical resection and postoperative radiotherapy, and the CD5, CD117, CK5/6, P63, thyroid transcription factor-1 （TTF-1）, carcino-embryonic antigen （CEA）, calcitonin （CT）, Ki-67, chromogranin A （CgA）, thyrobolulin （Tg）, peroxisome proliferator activated receptorγ （PPAR-γ）, sodium iodide symporter （NIS）, and thyroid stimulating hormone receptor （TSHR） were detected in tumor tissues by immunohistochemistry S-P method and v-raf murine sarcoma viral oncogene homolog B1 （BRAF）V600E gene and telomerase reverse transcriptase （TERT） promoter mutations were detected by DNA sequencing. Eight cases of poorly differentiated thyroid carcinoma and 6 cases of anaplastic thyroid carcinoma were adopted by comprehensive comparative analysis. Results Thyroid CASTLE tumor cells showed the positive expression of CD5, CD117, CK5/6 and P63, and the negative expression of TTF-1, CT, CgA, Tg, PPAR-γ, NIS and TSHR. There were partly positive expression for CK5/6, P63, TTF-1, CgA, Tg, NIS and TSHR, and negative expression for CD5 and CD117 in the poorly differentiated thyroid carcinoma and anaplastic thyroid carcinoma. The BRAFV600E gene and TERT promoter mutations were not detected in thyroid CASTLE, and the BRAFV600E gene mutations were also not detected in the poorly differentiated thyroid carcinoma and anaplastic thyroid carcinoma. Four cases of poorly differentiated thyroid carcinoma showed the TERT promoter mutations （4/8） included 3 cases with C228T and 1 case with C250T. Two cases of anaplastic thyroid carcinoma showed the TERT promoter mutations （2/6） included 1 case with C228T and 1 case with C250T. There was no recurrence and metastasis after 3-47 months （an average of 25.6 months） of followed-up in thyroid CASTLE patients. Conclusions The histologica

关 键 词：胸腺样分化癌 甲状腺 免疫组化 DNA 测序 

分 类 号：R736.1[医药卫生—肿瘤]