甲状旁腺病变细针穿刺标本的临床病理分析  

Clinicopathological Analysis of Parathyroid Lesions in Fine-needle Aspiration Cytology

作　　者：李海凤 纪燕英 周璐 陈健宁[1] LI Hai-feng;JI Yan-ying;ZHOU Lu;CHEN Jian-ning(Department of Pathology,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院病理科,广东广州510630

出　　处：《中山大学学报（医学科学版）》2022年第6期1035-1040,共6页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广州市科技计划项目(202102010156);中山大学附属第三医院国家自然科学基金培育项目(2020GZRPYMS01)。

摘　　要：【目的】探讨甲状旁腺病变细针穿刺标本的临床病理特点。【方法】回顾性分析我院病理科2019年1月至2022年7月期间收集的12例甲状旁腺病变细针穿刺病例,总结甲状旁腺病变细针穿刺病例的临床特征、细胞学形态及免疫组化表达特点。【结果】男性6例,女性6例,中位年龄47岁(39.25~63.25)岁。超声影像学特征多表现为实性结节,少数表现为囊实性结节,边界尚清,内部回声欠均匀。液基细胞学显示甲状旁腺病变的细胞数量可从少量到丰富不等。细胞体积偏小而圆(类似于淋巴细胞),大小较一致;细胞胞浆可多可少,胞界不清;细胞核呈细颗粒或“胡椒盐”样。细胞排列方式多样,包括小簇状、小滤泡型、小梁型、小片状或大片状,大的细胞团一般边界较模糊。12个病例的细胞蜡块中免疫组化均显示甲状旁腺激素(PTH)阳性、甲状腺球蛋白(TG)阴性。【结论】甲状旁腺病变细针穿刺标本临床少见,诊断相对困难。当涂片中细胞呈小簇、小梁状排列,细胞小而圆,核呈细颗粒状或粉尘状时,病理医生应当考虑甲状旁腺病变可能;细胞蜡块免疫组化PTH阳性、TG阴性有助明确诊断。【Objective】To investigate the clinicopathological characteristics of parathyroid lesions in fine-needle aspi-ration cytology.【Methods】The clinical and pathological features of 12 cases of parathyroid lesions in fine-needle aspira-tion cytology in our hospital were retrospectively analyzed.【Results】There are 6 males and 6 females,with the median age of 47 years(39.25~63.25 years).Ultrasound results demonstrated that the majority of cases were solid nodules with clear boundary and uneven internal echoes.Liquid-based cytology showed that the cellularity ranged from minimal to abundant.The majority of cases showed small and round cells with finely or coarsely granular(salt and pepper)chromatin.The cyto-plasm of parathyroid cells was moderate to scant,and had indistinct cytoplasmic border.The architectural patterns includ-ed small cluster,small follicular,trabecular,small flake or large flake,the boundary of large cell groups was generally fuzzy.All twelve samples were positive for parathyroid hormone(PTH)and negative for thyroglobulin(TG)on cell blocks.【Conclusions】Parathyroid lesions in fine-needle aspiration cytology are rare and pose a diagnostic challenge.When cells arranged in small clusters or trabecular on liquid-based smears,and the cells were small and round with finely or coarsely granular(salt and pepper)chromatin,pathologists should be aware of the possibility of parathyroid lesions.PTH positivity and TG negativity on cell blocks is helpful in confirming the diagnosis in this instance.

关 键 词：甲状旁腺病变 诊断陷阱与挑战 细针穿刺活检 细胞学 

分 类 号：R365[医药卫生—病理学]