甲状腺胸腺样分化癌细胞学诊断价值

Cytological diagnosis of carcinoma showing thymus-like differentiation of the thyroid gland

目的探讨甲状腺胸腺样分化癌(CASTLE)的细胞学特点及鉴别诊断。方法将1例CASTLE患者术中新鲜标本制作细胞印片、冰冻切片,术后固定标本制作石蜡切片及免疫组化染色,所有切片均进行光镜下分析,对照诊断。结果 CASTLE细胞印片检查显示:肿瘤细胞呈小片状及簇状分布,背景中见良性的小淋巴细胞散在分布。肿瘤细胞核质比大,胞质少,嗜双色性,细胞界限不清,部分细胞大小不一,异型明显;核呈圆形及卵圆形,空泡状,可见明显的小核仁,偶见大核仁及核分裂。结论细胞学检查对诊断甲状腺CASTLE有帮助,但其细胞学特征与恶性淋巴瘤、颈部淋巴结转移性淋巴上皮瘤样癌相似,在诊断时需加以鉴别。

Objective To investigate the cytological features and differential diagnosis of carcinoma showing thymus-like differentiation（CASTLE） of the thyroid gland.Methods The fresh specimen of a case of CASTLE of the thyroid gland underwent cytological and histological examination such as smears,frozen sections,paraffin hematoxylin-eosin staining and immunostaining sections,which were analyzed by light microscopy for contrast diagnosis.Results Examination of the smears showed that small sheets and clusters of poorly-differentiated malignant cells intermixed with benign-looking small lymphocytes.The tumor cells had an increased nuclear-cytoplasmic ratio,focally prominent atypia,a little amphophilic cytoplasm,indistinct cell borders,roundish-to-ovoid vesicular nuclei,small but prominent nucleoli,occasional macronuclei,and very sparse mitotic figures.Conclusions Cytological examination is of help in diagnosing CASTLE of the thyroid gland,while its cytological features closely resemble those in malignant lymphoma and metastatic lymphoepitheliod carcinoma in cervical lymph nodes and differentiations are required in the diagnosis of CASTLE.