甲状腺髓样癌的临床病理分析

目的探讨甲状腺髓样癌的形态特征、免疫表型及鉴别诊断。方法对5例经病理诊断为甲状腺髓样癌患者的临床资料、大体及光镜下形态特点及免疫组化结果进行回顾性分析和研究。结果患者以颈部肿物就诊,大体表现为边界清楚的孤立结节,2例有假包膜,癌组织主要由多角形细胞及梭形细胞构成,异型性不一,有多种组织学结构,以巢状和束状为主,少数形成滤泡。3例间质未见淀粉样物,免疫组化降钙素阳性,嗜铬素A、神经元特异性烯醇化酶及突触素阳性程度不一。甲状腺球蛋白1例阳性。结论甲状腺髓样癌形态多样,尤其需要与腺瘤、低分化滤泡癌、未分化癌等鉴别。主要依据形态特点,结合免疫组化等综合判断。

Objective To investigate the pathologicalmorphological and immunohistochemical features and differential diagnosis of medullary thyroid carcinoma （MTC）. Methods 5 cases of MTC were confirmed by pathology. The tumors were retrospectively analyzed with clinical data, gross and light microscopy observation and immunohistochemistry. Results The cervial mass was the initial syndrom in the patients.Most tumors were solitary nodule with clear boderline,two of them with disguised capsule. The tumors were composed of spindle and polygonal cells,arranged in various patterns,such as nest-like,fascicular, follicular. There was not amyloid in the stroma of three cases of tumors. The immunohistochemical results showed calcitonin （CT） was positive in all cases,but chromogranin A （CgA）, neuron-specific enolase （NSE）, synaptophysin （Syn） was positive variously. Thyrogtobulin （TG） was present in one tumor. Conclusion MTC has multiple morphologic features. It was ofen misdiagnosed with adenoma, poor different follicular carcinoma, anaplastic carcinoma. Its diagnosis depends on its histopathology and immunohistochemistry character.