甲状腺乳头状癌中鳞状细胞成分的鉴别诊断及预后意义  

Defferential diagnosis and prognostic significance of squamous cell components in papillary thyroid carcinoma

作　　者：任文浩 黄小征[1] 周立新[1] 白艳花[1] REN Wenhao;HUANG Xiaozheng;ZHOU Lixin;BAI Yanhua(Key Laboratory of Carcinogenesis and Translational Research Ministry of Education/Beijing,Department of Pathology,Peking University Cancer Hospital&Institute,Beijing 100142,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所病理科/恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《临床与实验病理学杂志》2023年第12期1482-1486,1491,共6页Chinese Journal of Clinical and Experimental Pathology

基　　金：北京市海淀区卫生健康发展科研培育计划项目(HP2023-31-503003)。

摘　　要：目的探索甲状腺乳头状癌(papillary thyroid carcinoma,PTC)中鳞状细胞成分的病理诊断标准及预后意义。方法收集23例含有鳞状细胞成分的PTC,复阅病理切片,应用免疫组化EnVision法检测p40、CK5/6、Ki-67、BRAF V600E、p53、PD-L1(22C3)、PAX8、CD10等与诊断、预后或治疗相关的标志物表达水平,综合评估鳞状细胞成分的组织学特点及免疫表型,将鳞状细胞成分进行组织学分类,统计其与临床病理特征的关系及对预后的影响。结果鳞状细胞成分可划分为鳞状分化(19例)和未分化癌(4例)两大类。未分化癌中,鳞状细胞成分均弥漫成片分布,细胞中-重度异型,Ki-67增殖指数≥30%;p53高表达仅存在于未分化癌中。与鳞状分化组相比,未分化癌组具有鳞状细胞成分最大径更大、高BRAF V600E阳性率、高PD-L1综合阳性评分和极差的疾病无进展生存及总生存。鳞状分化对预后的影响不明显,仅有1例二次手术病例出现再次复发。结论鳞状细胞成分的异型性、分布特点、最大径、Ki-67及p53可有效鉴别鳞状分化及未分化癌。BRAF V600E和PD-L1阳性提示对未分化癌进行靶向治疗和免疫治疗的可行性。Purpose To investigate the diagnostic criteria and prognostic significance of squamous cell components in papillary thyroid carcinoma(PTC).Methods Twenty-three cases of PTC containing squamous cell components were collected,and pathological sections were reviewed.p40,CK5/6,Ki-67,BRAF V600E,p53,PD-L1(22C3),PAX8,and CD10,markers related to diagnosis,prognosis,and treatment,were detected by immunohistochemistry.Histological characteristics and immunophenotype of squamous cell components were comprehensively evaluated.The squamous cell components were classified histologically.The relationship between squamous cell classification and clinicopathological parameters,and their prognostic impact were analyzed.Results The squamous cell components were divided into squamous differentiation(19 cases)and anaplastic carcinoma(4 cases).In the latter,the squamous cell components were diffusely distributed in sheets;the cell atypia was moderate to severe;and the Ki-67 index was at least 30%.High expression of p53 was found only in anaplastic carcinoma.Compared with squamous differentiation,anaplastic carcinoma had a larger diameter,higher BRAF V600E positive rate,high PD-L1 combined positive score,and extremely worse progression-free survival and overall survival.Squamous differentiation had inconspicuous impact on survival,and only one case relapsed after secondary surgery.Conclusion The cell atypia,distribution,maximum diameter,Ki-67 and p53 expression of squamous cell components are helpful in differentiating squamous components from anaplastic carcinoma.Positive BRAF V600E and PD-L1 expression suggest the feasibility of targeted therapy and immunotherapy for anaplastic carcinoma.

关 键 词：甲状腺乳头状癌 鳞状分化 未分化癌 BRAF V600E PD-L1 

分 类 号：R736.1[医药卫生—肿瘤]