桥本甲状腺炎不典型增生甲状腺上皮细胞的组织病理学研究

Histopathological study of atypical hyperplastic thyroid epithelial cells in Hashimoto＇s thyroiditis

目的探讨桥本甲状腺炎（HT）中不典型增生甲状腺上皮细胞（thyroid epithelial cells，TEC）的组织病理学改变及其与甲状腺乳头状癌（PTC）的关系。方法从存档病例中选取30例HT不典型增生TEC病例和50例PTC，以甲状腺瘤旁滤泡和HT中的相对正常滤泡为对照组（各40例），进行常规形态学观察和细胞角蛋白19（CK19）、增殖细胞核抗原（PCNA）以及B细胞淋巴瘤因子2（Bcl-2）免疫组化标记（Max—Vision法），结果用χ^2检验进行分析。结果HT中不典型增生TEC有一定异型性，细胞排列拥挤，核增大，出现毛玻璃样改变。HT中不典型增生TEC和PTC上皮均明显表达CK19、PCNA和Bcl-2，与对照组相比差异有统计学意义（P〈0．05），但前两组内差异无统计学意义（P〉0．05）。结论HT中不典型增生TEC呈现某些PTC的形态学、免疫学表型特征，表达PTC特异的CK19，可能是HT癌变过程的中间环节，应引起高度重视。

Objective To explore histopathological features of the atypical hyperplastic thyroid epithelial cells （TEC） in Hashimoto＇s thyroiditis （HT）, and to investigate its association with papillary thyroid carcinoma （PTC）. Methods Thirty cases of HT with atypical hyperplastic TEC and 50 cases of PTC were selected from archives, the comparatively normal follicles around thyroid adenoma and in HT served as control group. The morphological changes in HT were observed and the expressions of CK19, PCNA, Bcl-2 were detected by Max- Vision immunohistochemistry techniques. The results were analyzed by Chi-square test. Results The atypical hyperplastic TEC in HT showed some PTC-like features such as crowded cells, nucleus enlargement and ground glass appearance in the nucleus. As compared to the control, CK19, PCNA and Bcl-2 were positively expressed in both atypical hyperplastic TEC in HT and PTC cells （ P 〈 0.05 ）. Conclusion The atypical hyperplastic TEC in HT showed some morphological and immunological features of PTC, with the PTC specific marker CK19 expression, suggesting that the atypical hyperplastic TEC in HT may link HT with PTC, leading to malignant transformation, which should be closely watched.