伴鳞样成分的甲状腺间变性癌临床病理分析

Clinicopathologic Analysis of Anaplastic Thyroid Carcinoma with Squamoid Cell Component

目的:探讨伴鳞样成分的甲状腺间变性癌(anaplastic thyroid carcinoma with squamoid eell component,ATC-SCC)的诊断、鉴别诊断及临床病理特征方法:回顾性分析85例少见甲状腺肿瘤的临床病理资料,通过HE切片进行形态学观察,对5例ATC-SCC,6例甲状腺鳞状细胞癌(squamous cell carcinoma,SCC),8例甲状腺呈胸腺样分化癌(carcinoma showing thymus-like elements,CASTLE)和2例甲状腺降钙素阴性的神经内分泌肿瘤(calcitonin-negative neuroendocrine tumor of the thyroid gland,CNNETT)进行9项免疫组织化学染色,包括Cytokeratin(CK)、Vimentin(VM)、Chromogranin A(CgA)、Synaptophysin(SYN)、CD117、CD5、Calcitonin(CT)、Thyroglobulin(TG)和Thyroid transcription factor-l(TTF-1),并对结果进行分析结果:5例ATC-SCC中,男性2例,女性3例;年龄41～79岁,平均年龄53.2岁;肿物位于左腺叶3例,右腺叶2例。临床表现为无痛性颈部肿物。肿物通常体积较大,质地硬实,与周围组织粘连。镜下可见肿瘤组织由梭形细胞、多形性巨细胞、破骨样细胞和鳞状上皮样细胞以不同比例混合而成,并可见胞浆红染的横纹肌样细胞及大片坏死免疫组织化学染色显示5例ATC-SCC的肿瘤细胞CK和VM均阳性。鳞状上皮样细胞为主要成分时需要与SCC、CASTLE和CNNETT进行鉴别。结论:ATC-SCC多见于老年人,女性较多见,生长迅速,常扩展至甲状腺外累犯颈部软组织,预后非常差。

Objective： To investigate the clinicopathologic features, diagnosis, and differential diagnosis ofanaplastic thyroid carcinoma with squamoid cell component （ ATC-SCC ）. Methods： The data of 85 cases with rare thyroid neoplasms were retrospectively analyzed. Morphological observation of the sections from all cases was conducted after H＆E staining. Five cases ofATC-SCC, 6 cases of thyroid squamous cell carcinoma （ TSCC ）, 8 cases of with thyroid carcinoma showing thymus-like differentiation （ CASTLE ）, and two cases of calcitonin-negative neuroendocrine tumor of the thyroid gland （ CNNETT ） were selected. Immunohistochemistry （ SP method ） was performed using 9 markers, namely, cytokeratin （ CK ）, vimentin （ VM ）, chromogranin A, synaptophysin, CD 117, CD5, calcitonin, thyroglobulin, and thyroid transcription factor-1. The results of the immunohistochemical staining were analyzed. Results： Three of the 5 patients with ATC-SCC were female. The average age of the patients was 53.2 years （ ranging from 41 to 79 years ）. Three lesions were located in the right lobe, whereas 2 were in the left lobe. The clinical manifestations showed a painless neck mass. Tumor size was usually large, and the texture was hard. The tumor was adherent with peripheral soft tissues. Histologically, the tumors consisted of an admixture of spindle, pleomorphic giant, osteoclast-like, and squamoid cells. On occasion, the tumor cells showed eosin- ophilic cytoplasm with a rhabdoid-like appearance. Hemorrhage and necrosis were common in all tumors. Immunohistochemistry showed that the cells in all 5 ATC-SCC cases were positive for CK and VM. Differential diagnosis was also conducted in the TSCC, CASTLE, and CNNETT cases when the squamoid cells were presented as the main components in the tumor. Conclusion： ATC-SCC mainly occurs in aged people, usually in females. Characterized by fast growth in most of patients, the tumor usually infiltrates the surrounding tissues, such as the extrathyroidal soft tissue of the neck. The prognosis of ATC-SCC is very pool and multi-modality therapy, including surgery and chemoradiotherapy, may offer hope for long-term survival.