甲状腺乳头状癌嗜酸细胞变异型伴桥本甲状腺炎临床病理观察

Oncocytic variant of papillary thyroid carcinoma associated with Hashimoto's thyroiditis

目的探讨甲状腺乳头状癌嗜酸细胞变异型伴桥本甲状腺炎的病理形态学特征。方法对1例甲状腺乳头状癌嗜酸细胞变异型伴桥本甲状腺炎进行病理形态学及免疫组化分析,复习该病变的相关文献并讨论其诊断及鉴别诊断要点。结果组织学形态主要表现为乳头状癌间质中有大量淋巴细胞、浆细胞浸润,癌细胞嗜酸性变。免疫组化示肿瘤组织CK19、HBME-1、CK、TG、TTF-1和EMA呈弥漫或大部分(+),calcitonin、p53和Ki-67均(-)。结论甲状腺乳头状癌嗜酸细胞变异型伴桥本甲状腺炎具有比较独特的组织学形态,在临床病理诊断中很容易误诊为桥本甲状腺炎伴滤泡上皮嗜酸变等形态结构相近的良、恶性病变。形态学上乳头状癌癌细胞特征性核改变及免疫组化CK19和HBME-1(+)有助于其诊断和鉴别诊断。

Objective To review and discuss the pathological features of oncocytic variant of papillary thyroid carcinoma associated with Hashimoto ＂s thyroiditis. Methods One case of oncocytic variant of papillary thyroid carcinoma associated with Hashimoto＇s thyroiditis was investigated with pathological morphology and immunohistochemistry methods. Relevant literatures were reviewed. Discussion was focused on the diagnosis and differential diagnosis of MFPTC. Results The histological characteristics of oncocytic variant of papillary thyroid carcinoma associated with Hashimoto＇s thyroiditis included papillary carcinoma of interstitial infiltration of large number of lymphocytes and plasma cells, eosinophilic cell change. Immunohistochemical staining of CK19, HBME1, CK, TG, TTF-1 and EMA showed simultaneous expression with diffusely or mostly positive pattern. Calcitonin, P53 and Ki67 were negative. Conclusion Oncocytic variant of papillary thyroid carcinoma associated with Hashimoto＇s thyroiditis has a relatively unique histological feature. In the clinical setting, this tumor can easily be misdiagnosed as Hashimoto＇s thyroiditis associated with follicular eosinophilic change and other similar morphology of benign and malignant lesions. Morphological features of papillary carcinoma of the nuclear changes in cells and immunohistochemical CK19, HBME-1 staining, etc. contribute to its diagnosis and differential diagnosis.