甲状腺原发的具有胸腺特征的癌

Carcinoma showing thymus like elements of thyroid

目的：探讨甲状腺具有胸腺特征的癌的临床病理特征。方法：光镜观察及免疫组化染色。结果：６ 例均为男性，最大６７岁，最小３８ 岁（ 平均４５ 岁） 。症状主要为颈部包块、声嘶或呼吸困难。６ 例中３ 例位于甲状腺右叶，３ 例位于甲状腺左叶。肿瘤境界清楚，切面灰白色，部分呈结节状。光镜下肿瘤细胞呈结节状或条索状排列。瘤细胞巢或条索周围可见成熟的淋巴细胞浸润。局部可见鳞化或“哈氏”小体样结构。６ 例中３ 例术后无复发，迄今存活期分别为６ 年、８ 年及１４ 年。２ 例分别于术后２ 年及２ 年半复发，但经二次手术后均得以很好控制，迄今存活已９ 年及１１ 年。另１ 例术后半年复发，术后２ 年因肺转移死亡。结论：甲状腺具有胸腺特征癌不同于甲状腺其他类型的癌，其预后很好。

Purpose To demonstrate the clinical and pathological features of thyroid carcinoma showing thymus like elements of thyroid (CASTLE). Methods Microscopical observation and immunohistochemical study. Results All six patients were male and the main symptoms and signs included cervical mass、 hoarseness and dyspnea. Among the six patients, three had masses in the left lobe, and three the right lobe. All the masses were well demarcated and appeared grey white on cut surface. Some of them showed nodular appearance partially. Microscopically, the tumor cells arranged in nodules and cords and there were a lot of mature lymphocytes surrounding the nodules and cords. Most of the tumors showed squamous differentiation, and occasionally, Hassles corpsule could be found. Three of the six patients had no recurrence after operation and the disease free period were 6 years, 8 years and 14 years respectively. Two cases had recurrence 2 years and 2 5 years after operation, but both were well controlled after the second operation. The disease free period of these two cases have been 9 years and 11 years by now. The last case recurred half year after operation and died of lung metastases 2 years later. Conclusion The CASTLE of thyroid are different from other thyroid carcinomas and has a better prognosis.