甲状腺髓样癌临床病理分析

Clinicopathologic analysis of medullary thyroid carcinoma

目的:探讨甲状腺髓样癌(MTC)的临床病理特点、免疫表型及电镜诊断特点。方法:回顾性分析10例甲状腺髓样癌的临床资料,采用免疫组化、组织化学方法研究其病理形态特点,结合文献分析甲状腺髓样癌的电镜诊断特点。结果:散发型甲状腺髓样癌8例,家族型甲状腺髓样癌2例,6例淋巴结转移;9例肿瘤间质刚果红染色(+);免疫组化:癌组织中降钙素(+)10例、铬粒素A(+)10例、突触素(+)7例,1例见甲状腺球蛋白阳性细胞,CD44V6在髓样癌中的阳性表达率为60%;电镜下见癌细胞胞质内有大小不一的神经内分泌颗粒。结论:MTC具有多分化肿瘤的特点,可产生多种神经内分泌物质;其诊断依赖于组织病理学、免疫组化和组织化学,电镜在MTC的诊断中有重要价值;降钙素(CT)是其特异性标记物;CD44V6的高表达与MTC的颈部淋巴结转移密切相关。

Objective：To investigate the clinical and pathological characteristics and immunophenotype of medullary thyroid carcinoma（MTC） and its uhrastmcmral characteristic. Methods： The clinical intormation of 10 cases MTC were retrospectively reviewed. Histochemistry and immunohistochemistry were performed to study the pathological characteristics, diagnosis of electron micro- scope was discussed. Results：Sporadic type of MTC was found in 8 cases, and familial type in 2 case. 6 cases were observed with Lymph node metastasis ;There was amyloid In the stroma of 9 cases. The immunohistochemical results showed calcitonin（CT） and CgA were positive in all cases; 7 cases were positive for Syn, TG was present in 1 case, The positive rate of CD44V6 expression in MTC was 60%. The main ultrastuctural characteristic of the tumor was small and large secretory granules in the cytoplasm. Conclusions： MTC has the characteristics of multiple differentiation tumor, which can produce numerous hormones. Its diagnosis depends on its his- topathology, histochemistry and immunohistochemistry. Electron microscope is of great value in the diagnosia of MTC. Calcitonin is a specific molecular marker for the diagnosis of MTC. The overexpression of CD44V6 in MTC is closely relate to the lymph node metastasis.