甲状腺滤泡癌癌巢结构与超声造影表现初步观察

Preliminary observation on nest structure and contrast-enhanced ultrasonography in follicular thyroid carcinoma

目的观察甲状腺滤泡癌中是否存在血管包绕的肿瘤细胞巢(VETC)结构,分析其特点。方法选取甲状腺滤泡癌患者10例、乳头状癌患者21例,收集患者年龄、肿瘤大小等资料,通过免疫组化染色检测CD31、血管生成素-2(Ang-2)和CXCR4蛋白表达;通过公共数据库资料分析蛋白表达与患者预后关系;通过超声造影影像学分析VETC结构对超声造影表现的影响;采用t检验进行2组间数据的统计学比较。结果甲状腺滤泡癌组织中均存在VETC结构,乳头状癌中均不存在VETC结构;甲状腺滤泡癌的VETC结构可整体发生淋巴结、血管转移。Ang-2蛋白在甲状腺滤泡癌中呈高表达。甲状腺滤泡癌超声造影表现为“全肿瘤均匀式快速充盈”的灌注方式,乳头状癌则为“非均匀式充盈”的方式;与甲状腺乳头状癌[(2.82±0.23)s]比较,滤泡癌[(2.02±0.07)s]患者其始增至达峰时间在单位距离内时间更短,t=5.708,P=0.005。结论甲状腺滤泡癌具有VETC结构,且其超声造影具有“全肿瘤均匀式快速充盈”的特点,Ang-2蛋白是甲状腺滤泡癌的潜在治疗靶点。

Objective To observe whether there is a vascular-enclosed tumor cell nest(VETC)structure in follicular thyroid carcinoma,and analyze its characteristics.Methods Totally 10 patients with follicular thyroid carcinoma and 21 patients with papillary carcinoma were selected.The age,tumor size and other data of the patients were collected.The angiopoietin-2(Ang-2),CD31 and CXCR4 protein expression detected by immunohistochemical staining.The relationship between protein expression and patient survival was analyzed by public database data.The influence of VETC structure on contrast-enhanced ultrasound performance was analyzed by contrast-enhanced ultrasound imaging.Statistical comparison of data between 2 groups was performed by t test.Results There were VETC structures in all thyroid follicular carcinoma tissues,but no VETC structures in papillary carcinomas.The VETC structures of thyroid follicular carcinomas could metastasize to lymph nodes and blood vessels as a whole.Ang-2 protein was highly expressed in thyroid follicular carcinoma.The contrast-enhanced ultrasonography of follicular thyroid carcinoma showed a perfusion pattern of"uniform and rapid filling of the whole tumor",while papillary carcinoma showed a"non-uniform filling"pattern.Compared with papillary thyroid carcinoma,follicular carcinoma patients had a shorter time per unit distance[(2.82±0.23)s vs(2.02±0.07)s,t=5.708,P=0.005].Conclusion Follicular thyroid carcinoma has a VETC structure,and its contrast-enhanced ultrasound has the characteristics of"uniform and rapid filling of the whole tumor".Ang-2 protein is a potential therapeutic target for follicular thyroid carcinoma.