乔本甲状腺炎合并甲状腺乳头状癌27例临床病理特征

Clinicopathologic features of coexistent Hashimoto's thyroiditis with papillary thyroid carcinoma

目的总结乔本甲状腺炎(HT)合并甲状腺乳头状癌的临床病理特征。方法复习27例HT合并甲状腺癌患者的临床资料,并随访。除观察HE切片外,并选择部分病例做HBME-1、CK19、galectin-3、Ret-Oncoprotein和p53。探讨HT癌变的可能机制。结果105例HT中合并甲状腺乳头状癌27例,合并B细胞淋巴瘤2例。27例甲状腺乳头状癌发病率占HT的25.7%(27/105),其中乳头状微癌17例,普通型4例,滤泡型2例,实体型2例,弥漫硬化型1例,嗜酸细胞型1例。合并HT的甲状腺乳头状癌镜下形态学表现以及免疫组化HBME-1、CK19和galectin-3表达均与单纯甲状腺乳头状癌相似。2006年随访21例(77%)均健在,其余6例失访。结论HT合并甲状腺乳头状癌好发于中年女性,并且临床多无症状。肿瘤的发生与HT关系密切。由于HT患者中乳头状癌发病率较高(25.7%),而且又以微小癌占多数(63%),因此对中年女性的HT,应该仔细检查。

Objective To summarize the clinicopathologic features of coexistent Hashimoto＇s thyroiditis （HT） with papillary thyroid carcinoma （PTC）. Methods Clinical data of HT with coexistent thyroid carcinoma were reviewed with follow-up between 2002 and 2005 in this hospital. Clinical and gross findings were collected. All HE slides were reexamined and immunostains for HBME-1, CK19, galectin-3, and p53 were performed in selected cases. Staining results were evaluated and potential mechanism of malignant transformation in HT was discussed. Results In total 105 cases of HTs, twenty-seven cases had coexistent PTC and two had coexistent B cell lymphoma. The incidence of PTC among HT was 25.7% （27/105）. There were 25 females and 2 males with median age of 49.8 years old. Twenty-five out of 27 patients were clinically asymptomatic and a neck mass detected by chance. Normal TSH presented in 18 cases. Tumor diameter ≤1cm was counted for 17 cases （63%）. Histologic classification showed that 17 cases of papillary microcarcinomas （63%）, 4 classic variants （ 14.8% ）, 2 follicular variants （7.4%）, 2 solid variants （7.4%）, 1 diffuse sclerosing variant （3.7%）,and 1 oncocytic variant （3.7%）. Microscopic staining pattern （ HBME- 1, CK19, and galectin-3） of coexistent HT with PTC were similar to that of ordinary papillary thyroid carcinoma. Follow-up data showed that 21 out of 27 patients were alive with no evidence of recurrence or metastasis. Conclusion Coexistent HT with PTC occurs preferentially in the group of middle-aged women with no clinical discomfort. HT plays a significant role in thyroid carcinogenesis. Because of the high incidence （25.7 % ） of papillary carcinoma in Hashimoto＇ s population and high frequency （63%） of microcarcinoma among papillary carcinoma, it would be necessary to keep an eye on this particular type of thyroid carcinoma, and multiple sampling in suspected area of HT specimen is advised in the hope not to miss any small tumor in clinical practice.