桥本甲状腺炎合并甲状腺恶性肿瘤30例临床病理分析

Clinicopathological Analysis of 30 Cases of Hashimoto′s Disease Complicated by Thyroid Carcinoma

目的探讨桥本甲状腺炎(Hashimoto thyroiditis,HT)合并甲状腺恶性肿瘤的临床病理特征。方法回顾性分析30例HT合并甲状腺恶性肿瘤的临床资料,另选取10例HT、10例甲状腺乳头状癌和5例甲状腺腺瘤做对照。应用免疫组化方法检测上述患者病变组织中p53蛋白及增殖细胞核抗原(proliferating cell nuclear antigen,PCNA)表达情况。结果 30例HT患者合并甲状腺乳头状癌26例,其中微小癌22例(73.3%);26例HT合并甲状腺滤泡癌1例;HT合并淋巴瘤3例,其中2例为边缘区B细胞黏膜相关淋巴瘤,1例弥漫大B细胞淋巴瘤。HT合并甲状腺乳头状癌患者、10例甲状腺乳头状癌患者及10例HT患者组织中PCNA增殖指数分别为(58.6±12.7)%、(56.5±11.2)%及(50.5±11.2)%,分别与5例甲状腺腺瘤组织PCNA增殖指数(2.2±1.8)%进行组间比较,差异均有统计学意义(P<0.001);其他组间比较,差异均无统计学意义(P>0.05)。p53蛋白在HT合并甲状腺乳头状癌、甲状腺乳头状癌及HT患者组织中阳性表达率分别为26.9%、30.0%和20.0%,组间比较差异无统计学意义(P>0.05);5例甲状腺腺瘤组织p53蛋白无阳性表达。随访除1例弥漫大B细胞淋巴瘤患者术后2年死亡,3例出现局部及颈部淋巴结复发外,其余患者均健在。结论 HT易合并甲状腺乳头状癌;HT患者存在甲状腺滤泡上皮细胞增生活跃,可能是甲状腺滤泡上皮细胞发生癌变的基础。HT合并甲状腺乳头状癌及甲状腺乳头状癌患者癌细胞p53阳性表达率相近,推测合并HT与否甲状腺乳头状癌患者可能有相同的预后。

Objective To explore the clinicopathological features of Hashimoto′s disease（HT） complicatedby thyroid carcinoma.Methods A retrospective analysis was performed on clinical data of 30 patients with HT complicated by thyroid carcinoma （group A）,10 with HT （group B）,10 with thyroid papillary carcinoma （group C） and 5 with thyroid adenoma （group D）.The expressions of p53 protein and proliferating cell nuclear antigen （PCNA） in lesional tissues were detected by immunohistochemistry.Results A total of 26 patients of group A were complicated by thyroid papillary carcinoma,including 22 by microcarcinoma （73.3%）,1 by thyroid follicular carcinoma,3 by lymphoma （including 2 B cell mucosa-related in marginal zone,1 diffuse large B cell lymphoma）.The proliferation indexes （2.2±1.8）% of groups A （HT with thyroid papillary carcinoma）,C and B were （58.6±12.7）%,（56.5±11.2）%,（50.5±11.2）%,respectively,significantly different from that of group D （P0.001）,but there was not difference between the other groups （P0.05）.The positive expressions of p53 protein of groups A （HT with thyroid papillary carcinoma）,C,B were 26.9%,30.0%,20.0%,respectively,the difference was significant （P0.05）.No p53 positive expression was noted in group D.All patients were still alive except 1 with diffuse large B cell lymphoma who died after 2 years and 3 presenting with recurrence of local and neck lymph nodes.Conclusion HT is apt to combination with thyroid papillary carcinoma;Active proliferation of thyroid follicular epithelial cells exists in HT patients,which may be the basis of cancerization of thyroid follicular epithelial cells.The p53 positive expression rate of HT with thyroid papillary carcinoma is almost similar to that of thyroid carcinoma,suggesting that both have the same prognosis.