不同病理类型并存的甲状腺恶性肿瘤8例临床病理特征分析  

Clinicopathological characteristics of 8 cases of thyroid malignancies with different pathological types

作　　者：张银华[1] 李新霞 董超[2] 张楠[2] ZHANG Yinhua;LI Xinxia;DONG Chao;ZHANG Nan(Department of Pathology,Affiliated Tumor Hospital,Xinjiang Medical University,Urumqi 830011,China;Department of the Thyroid and Breast Surgery,Affiliated Tumor Hospital,Xinjiang Medical University,Urumqi 830011,China)

机构地区：[1]新疆医科大学附属肿瘤医院病理科,乌鲁木齐830011 [2]新疆医科大学附属肿瘤医院乳腺头颈外科,乌鲁木齐830011

出　　处：《新疆医科大学学报》2022年第5期536-540,共5页Journal of Xinjiang Medical University

基　　金：新疆维吾尔自治区自然科学基金(2017D01C410)。

摘　　要：目的探讨不同病理类型并存的甲状腺恶性肿瘤的临床病理特点、免疫表型、诊断及鉴别诊断、治疗及预后。方法回顾性分析新疆医科大学附属肿瘤医院2010年1月—2019年12月收治及外院会诊的8例不同病理类型并存的甲状腺恶性肿瘤的临床病理特点。免疫组化检测(IHC):甲状腺球蛋白(Tg)、甲状腺转录因子-1(TTF-1)、降钙素(Calcitonin,CT)、细胞角蛋白19(CK19)、癌胚抗原(CEA)、嗜铬素A(CgA)、突触素(Syn)、神经细胞黏附分子(CD56)、人骨髓内皮细胞标记物(HBME-1)、半乳糖结合蛋白-3(Galectin-3)。结果(1)8例不同病理类型并存的甲状腺恶性肿瘤均为髓样癌(MTC)和乳头状癌(PTC)混合,4例为甲状腺混合性髓样-滤泡细胞癌(MMFCC),4例为甲状腺髓样癌合并乳头状癌(MTC-PTC)。(2)IHC:MTC区域均CEA、CT、CgA、Syn、CD56(+++),TTF-1(++),Tg、Galectin-3、CK19、HBME-1(-/+);PTC区域均Tg、TTF-1、CK19、HBME-1、Galectin-3(+++),CD56(-/+),CEA、CT、CgA、Syn(-)。结论不同病理类型并存的甲状腺恶性肿瘤少见,MTC和PTC混合的更少见。根据肿瘤混合分布情况可分为混合性髓样-滤泡细胞癌(Mixed myeloid follicular cell carcinoma,MMFCC)和甲状腺髓样癌合并乳头状癌(Medullary thyroid carcinoma with papillary thyroidcarcinoma,MTC-PTC),但组织形态及免疫表型均同独立的MTC和PTC。临床表现及影像学检查均无特异性的诊断价值,组织形态结合IHC有助于诊断,手术是主要治疗方式,预后类似于MTC。Objective To investigate the clinicopathological characteristics,immunophenotype,diagnosis,treatment and prognosis of thyroid malignant tumors with different pathological types.Methods Clinical and pathological data were retrospectively analyzed in 8 cases thyroid malignancies with different pathological types from January 2010 to December 2019 in the hospital,and immunohistochemical(IHC)detected the expression of Tg,TTF-1,Calcitonin(CT),CK19,CEA,CgA,Syn,CD56,HBME-1,Galectin-3.Results(1)The 8 cases thyroid malignant tumors with different pathological types were mixed myeloid carcinoma(MTC)and papillary carcinoma(PTC),4 cases were mixed medullary follicular cell carcinoma(MMFCC),and 4 cases were medullary carcinoma of thyroid combined with papillary carcinoma(MTC-PTC).(2)IHC:MTC region strongly expressed CEA,CT,CgA,Syn,CD56,moderate expressed TTF-1,and it negatively expressed Tg,Galectin-3,CK19,HBME-1;PTC region strongly expressed Tg,TTF-1,CK19,HBME-1,Galectin-3,weak expressed CD56,negative expressed CEA,CT,CgA,Syn.Conclusion Thyroid malignant tumors with different pathological types are rare,and those with MTC and PTC are even rare.According to the mixed distribution of tumors,the tumors can be divided into MMFCC and MTC-PTC,but the morphology and immunophenotype are the same as the independent MTC and PTC.There is no specific diagnostic value in clinical manifestations and imaging examination,and the clinicopathological characteristics and the immunohistochemical markers can assist with diagnosis.Surgery is main way for treatment,and theprognosis is similar to MTC.

关 键 词：髓样癌(MTC) 乳头状癌(PTC) 混合性髓样-滤泡细胞癌(MMFCC) 甲状腺髓样癌合并乳头状癌(MTC-PTC) 

分 类 号：R736.1[医药卫生—肿瘤]