甲状腺滤泡型乳头状癌临床病理学分析

Clinicopathological analysis of follicular variant of thyroid papillary carcionoma

目的探讨甲状腺滤泡型乳头状癌的临床病理学特征、诊断与鉴别诊断。方法分析17例甲状腺滤泡型乳头状癌的临床特征、病理学形态、免疫表型，并结合文献复习。结果滤泡型乳头状癌表现为甲状腺结节。17例中部分有完整包膜，部分无包膜或局部有包膜。镜下肿瘤细胞构成滤泡结构，滤泡不规则，不见乳头状结构。细胞核大，轮廓不规则，毛玻璃样核可见，核沟、核内包涵体可见。免疫组化可以表达CKl9、Galectin-3、HBME-1。结论滤泡型乳头状癌是甲状腺乳头状癌中一个亚型，主要构成滤泡结构，不见乳头形成。可被分为包裹亚型与浸润亚型。与甲状腺滤泡性腺瘤及滤泡癌鉴别有一定困难，正确认识其细胞核特征并结合免疫组化表现，可以作出正确诊断。

Objective To investigate the clinicopathological features, diagnosis and differential diagnosis of follicu- lar variant of papillary thyroid carcinoma （FVPTC）. Methods The clinical features, histopathological appearance and immunohistochemical findings were analyzed in 17 cases of FVPTC, with review of the relevant literature. Results Nod- ules were seen in 17 cases of FVPTC. Tumors were partially or completely encapsulated in some cases. The others had no capsular. The tumor was composed almost completely of follicles, without papillary growth pattern. Nuclear changes inclu- ding enlargement, nuclear overlapping, nuclear clearing, nuclear grooves and cytoplasmic pseudoinclusions were morpho- logical features in the diagnosis of FVPTC. By immunohistochemistry the tumor cells showed variable staining with CK19, galectin - 3, HBME - 1. Conclusion FVPTC is a common variant of papillary thyroid carcinoma. It is correctly diag- nosed by nuclear characteristics. It is classified into encapsulate FVPTC and infiltrative FVPTC. The main differential di- agnosis is follicular adenoma or follicular carcinoma. Immunohistochemieal staining can assist in separating FVPTC from other follicular tumor.