甲状腺转移性肺腺癌的临床和细胞病理学特征  

Clinical and cytopathological characteristics of metastatic lung adenocarcinoma to the thyroid

作　　者：付欣 刘家艳 杨巧 胡沛臻 王映梅 王哲 范林妮 FU Xin;LIU Jiayan;YANG Qiao;HU Peizhen;WANG Yingmei;WANG Zhe;FAN Linni(Department of Pathology,First Affiliated Hospital of Air Force Medical University,Xi’an 710032;Department of Pathology,Xi’an Daxing Hospital,Xi’an 710016,China)

机构地区：[1]空军军医大学第一附属医院病理科,西安710032 [2]西安大兴医院病理科,西安710016

出　　处：《临床与病理杂志》2024年第12期1720-1727,共8页Journal of Clinical and Pathological Research

摘　　要：目的:甲状腺转移性肺腺癌与甲状腺原发肿瘤形态和免疫表型均有重叠,容易误诊。本研究探讨并总结经甲状腺细针穿刺术(fine needle aspiration,FNA)诊断为转移性肺腺癌的临床特点、病理形态特征、免疫表型及分子遗传学改变,以提高对该类病变的认识并避免诊断陷阱。方法:收集空军军医大学第一附属医院和西安大兴医院病理科经甲状腺FNA诊断为转移性肺腺癌的患者6例,总结其临床特点,观察其细胞病理学特征、免疫表型及分子遗传改变,并与肺原发灶肿瘤组织对照,结合相关文献进行复习、总结。结果:6例转移性肺腺癌患者中4例女性,2例男性,年龄42~71(中位数57)岁。3例有肺癌病史,另外3例无明确病史,以甲状腺为首发症状,其中2例后续经肺活检证实为肺腺癌。超声检查显示3例为孤立性低回声结节,2例为弥漫性病变,1例为多发性低-混合回声结节。甲状腺FNA细胞学特征:穿刺涂片中细胞量丰富,呈三维立体的细胞团或片状排列,3例细胞质内可见黏液。细胞异型性显著,核增大、核仁明显,染色质粗糙,1例可见核分裂象。免疫表型:肿瘤细胞细胞角蛋白7(cytokeratin 7,CK7)、甲状腺转录因子-1(thyroid transcription factor-1,TTF-1)弥漫阳性,天冬氨酸蛋白酶A(Napsin A)弥漫或部分阳性,但不表达甲状腺滤泡上皮标志甲状腺球蛋白(thyroglobulin,TG)、配对盒基因8(paired box gene 8,PAX-8)。分子遗传改变:5例行基因检测,其中3例检测到EML4-ALK融合,3例EGFR突变。结论:甲状腺癌与甲状腺转移性肺腺癌免疫表型交叉重叠,需要进行鉴别诊断。FNA诊断甲状腺转移性肺腺癌需结合临床病史、细胞形态、免疫表型及分子检测结果综合分析,三维立体细胞团、粗糙的染色质、显著的核仁、高核分裂象、坏死及细胞质内黏液更支持转移性肺腺癌的诊断。Objective:Metastatic lung adenocarcinoma to the thyroid can resemble primary thyroid neoplasms in both morphology and immunophenotype,leading to potential misdiagnosis.This study aims to analyze and summarize the clinical characteristics,cytopathological features,immunophenotype,and molecular genetic alterations of cases diagnosed as metastatic lung adenocarcinoma via fine needle aspiration(FNA)of the thyroid,to enhance understanding and avoid diagnostic pitfalls.Methods:Six cases diagnosed as metastatic lung adenocarcinoma of the thyroid by FNA from the Department of Pathology of the First Affiliated Hospital of Air Force Medical University and Xi’an Daxing Hospital were retrospectively reviewed.Clinical data,cytopathological features,immunophenotypic profiles,and molecular findings were summarized and compared with corresponding primary lung tumor tissues.Relevant literature was reviewed for comprehensive analysis.Results:Among the 6 patients diagnosed with metastatic lung adenocarcinoma to the thyroid,there were 4 females and 2 males,aged between 42 to 71 years(median age:57 years).Three had a known history of lung cancer,while the remaining 3 presented with thyroid lesions as their initial symptom,2 of whom were later confirmed to have lung adenocarcinoma through lung biopsy.Ultrasound findings included 3 patients with solitary hypoechoic nodules,2 with diffuse thyroid involvement,and 1 with multiple mixed echo nodules.Cytological examination of thyroid FNA revealed highly cellular smears,with tumor cells arranged in three-dimensional clusters or sheets;3 patients exhibited intracytoplasmic mucin.The tumor cells showed marked atypia,including enlarged nuclei,prominent nucleoli,coarse chromatin,and in 1 patient,visible mitotic figures.Immunohistochemistry showed diffuse positive for cytokeratin 7(CK7)and thyroid transcription factor-1(TTF-1),and partial to diffuse positivity for Napsin A;all patients were negative for thyroglobulin(TG)and paired box gene 8(PAX-8).Among the 5 patients who underwent molecular

关 键 词：甲状腺 转移性肺腺癌 细针穿刺术 细胞病理学 免疫表型 分子遗传改变 

分 类 号：R73[医药卫生—肿瘤]