甲状腺乳头状癌与乳头状增生的免疫组化鉴别诊断

Differential diagnosis of papillary thyroid carcinoma from papillary thyroid hyperplasia by immunohistochemistry

目的:探讨CK19、HBME-1、galectin-3和CD10在甲状腺乳头状癌与乳头状增生的鉴别诊断意义。方法:应用免疫组化EnVision法对85例甲状腺病变进行免疫组化标记。其中典型乳头状癌(CPC)32例,滤泡性变型乳头状癌(FVPC)11例,乳头状微癌(PM)7例,结节性甲状腺肿伴乳头状增生(NGWPH)20例和滤泡性腺瘤伴乳头状增生(FAWPH)15例。结果:CK19在CPC、FVPC、PM、NGWPH和FAWPH的表达阳性率分别为96.9%、100%、100%、30.0%和26.7%,HBME-1为96.9%、90.9%、85.7%、10.0%和13.3%,galectin-3为93.8%、81.8%、85.7%、10.0%和13.3%,CK19、HBME-1和galectin-3在甲状腺良、恶性乳头状病变中的表达相比差异有显著性(P<0.01)。CD10在良、恶性病变和正常组织中均阴性表达。结论:联合标记CK19、HBME-1和galectin-3抗体对鉴别甲状腺乳头状癌与乳头状增生具有较高的实用价值,但不具有绝对价值。

Objective To study the significance of CK19, HBME-1, galectin-3 and CD10 in the differential diagnosis of papillary thyroid carcinoma from papillary thyroid hyperplasia. Methods A total of 85 cases, including 32 with classical papillary carcinoma（CPC）, 11 with follicular variant papillary carcinoma（FVPC）,7 with papillary microcalinoma （PM）, 20 with nodular goiter with papillary hyperplasia（NGWPH） and 15 with follicular adenoma with papillary hyperplasia （FAWPH）, were examined using a panel of antibodies by EnVision immunocytochemical labeling. Results The positive expression rates of CK19, in CPC, FVPC, PM, NGWPH and FAWPH were 96.9%, 100%, 100%,30% and 26.7%, HBME-1 96.9%, 90.9%, 85.7%, 10% and 13.3%, and galectin-3 93.8%, 81.8%, 85.7%, 10% and 13.3%, respectively. There was significant different between papillary thyroid carcinoma and papillary thyroid hyperplasia in CK19, HBME-1 and galectin-3 expression （P〈0.01）. CD10 expression was negative in normal, benign and malignant lesions. Conclusions The combination of CK19 with HBME-1 and galectin-3 may be used to differentiate papillary thyroid carcinoma from papillary thyroid hyperplasia though it is not always definite.