甲状腺透明变梁状肿瘤诊断及相关分子标志物研究进展  

Research progress in diagnosis and related molecular markers of hyalinizing trabecular tumor

作　　者：卢今奇 徐蓉[1] 戴译萱 王进 LU Jinqi;XU Rong;DAI Yixuan;WANG Jin(The Affiliated Zhangjiagang Hospital of Soochow University,Zhangjiagang 215600,China)

机构地区：[1]苏州大学附属张家港医院病理科,江苏张家港215600 [2]苏州大学附属张家港医院骨科,江苏张家港215600

出　　处：《社区医学杂志》2023年第17期920-924,共5页Journal Of Community Medicine

基　　金：苏州市“科教兴卫”青年科技项目(KJXW2021060);苏州大学附属张家港医院院级青年项目(YJQN2020003,YJQN2020004);张家港市科技局项目(ZKYL2211,ZKYL2210)。

摘　　要：甲状腺透明变梁状肿瘤(HTT)是一种滤泡源性肿瘤,瘤细胞呈特征性的小梁状排列伴间质透明样变性。HTT术前诊断较为困难,由于形态学的相似性,HTT在细针抽吸(FNA)细胞学和冷冻切片(FS)中易与甲状腺乳头状癌(PTC)、甲状腺髓样癌(MTC)等混淆,从而导致不必要的手术治疗。本综述从HTT细胞学、组织学诊断、超声显像、免疫组化及分子概况等方面总结HTT的最新研究进展。以“甲状腺透明变”“透明变梁状肿瘤”“小梁状肿瘤”为关键词,检索2018-01-01-2023-05-15中国知网及PubMed相关文献。纳入标准:HTT组织学特征;FNA细胞学特征;透明变梁状肿瘤的分子特征。排除标准:其他甲状腺低风险肿瘤,如具有乳头样核特点的非浸润性甲状腺滤泡性肿瘤、恶性潜能未定的肿瘤、伴随HTT乳头状癌的相关研究。最终纳入分析文献49篇。结果表明,HTT好发于中年女性,临床上大部分患者没有明显症状,超声表现为孤立性、境界清楚的椭圆形或圆形实性低回声结节。HTT独特细胞学特征是常见的三维细胞簇和细胞簇边缘的层状柱状肿瘤细胞,但HTT的细胞学诊断具有挑战性,易与PTC和MTC等混淆。显微镜下,HTT主要特征是瘤细胞呈小梁状或巢团状排列伴明显的小梁内透明样变性。HTT是甲状腺滤泡源性的肿瘤,瘤细胞TG、TTF-1、CD56免疫组织化学均阳性,CK19、Calcitonin通常阴性,Ki-67(MIB-1)检测HTT表现出特异性的膜阳性。特殊染色显示,PAS染色阳性,刚果红染色阴性。分子检测发现,几乎在所有的HTT病例中均存在PAX8-GLIS3基因重排。对于术前诊断为HTT病例,需行甲状腺腺叶切除术,术后密切随访。提示,HTT是一种滤泡上皮起源的罕见肿瘤,是预后良好的低风险肿瘤。免疫组织化学Ki-67(MIB-1)独特表达模式以及新型PAX8-GLIS1、PAX8-GLIS3基因融合的分子检测有助于HTT术前诊断,从而避免过度治疗。对诊断为HTT的病例应�Hyalinizing trabecular tumor(HTT)is a follicular tumor with characteristic trabecular arrangement of tumor cells accompanied by interstitial hyaline degeneration.The preoperative diagnosis of HTT is relatively difficult.Due to morphological similarities,HTT is easily confused with papillary thyroid carcinoma(PTC)and medullary thyroid carcino-ma(MTC)in fine needle aspiration(FNA)cytology and frozen section(FS),leading to unnecessary surgical treatment.This study summarizes the latest research progress in HTT from the perspectives of cytology,histological diagnosis,ul-trasound imaging,immunohistochemistry,and molecular overview.With the key terms of"hyaline transformation of the thyroid gland","hyaline transformation of trabecular tumors"and"hyaline transformation of trabecular tumors",Chi-na National Knowledge Infrastructure and PubMed were searched from January 01,2018to May 05,2023.Inclusion cri-teria were as follows:HTT histological characteristics;FNA cytological characteristics;the molecular characteristics of transparent trabecular tumors.Exclusion criteria were as follows:relevant studies on other low-risk thyroid tumors,such as non-invasive follicular thyroid tumors with papillary nucleus characteristics,tumors with uncertain malignant potential,and papillary carcinoma accompanied by HTT.Finally,49articles were included for analysis.The results indicated that HTT was more common in middle-aged women,and most patients have no obvious symptoms clinically.Ultrasound manifestations included solitary,well-defined oval or circular solid hypoechoic nodules.The unique cytological features of HTT were the common three-dimensional cell clusters and layered columnar tumor cells at the edges of the cell clusters.However,the cytological diagnosis of HTT was challenging and easily confused with PTC and MTC.Under the micro-scope,the main feature of HTT was that the tumor cells were arranged in a trabecular or nesty pattern with obvious hya-line degeneration within the trabecular area.HTT was a thyroid follicular derived

关 键 词：甲状腺透明变梁状肿瘤 甲状腺乳头状癌 诊断 MIB-1 综述文献 

分 类 号：R736.1[医药卫生—肿瘤]