桥本氏甲状腺炎并发甲状腺癌的临床病理学研究

A pathological study of carcinogenesis in Hashimoto's thyroiditis complicated with thyroid carcinoma

目的 探讨桥本氏甲状腺炎并发甲状腺癌的临床病理学特征和癌发生的病理学基础。方法 采用ＨＥ染色和免疫组化法观察１６例桥本氏甲状腺炎合并甲状腺癌和１２例单纯甲状腺癌的病理学形态和基因蛋白的表达。结果 桥本氏甲状腺炎合并甲状腺癌主要为乳头状癌。镜下可见淋巴组织增生病变区甲状腺滤泡上皮细胞不典型增生，中度表达ｐ５３、Ｋｉ－６７、ｂｃｌ－２和ｃ－ｅｒｂＢ－２，与癌组织的表达无显著差异（Ｐ＞０． ０５），而极显著高于非甲状腺炎的癌旁组织（Ｐ＜０．０ｌ）。结论 桥本氏甲状腺炎合并甲状腺癌可能是在多基因协同作用下，残存的滤泡上皮细胞发生不典型增生而癌变。

Objective To study the pathological feature and pathological basis of carcinogenesis in Hashimoto's thyroiditis (HT) complicated with thyroid carcinoma. Methods By using HE and immunohistochemical staining, pathologogical morphology and the expression of gene protein were observed in the paraffin-embedded from 16 cases of HT complicated with thyroid carcinoma and 12 cases of thyroid carcinoma. Results Papillary carcinoma was the main pathological type of HT complicated with thyroid carci- noma. Under the microscopy, atrophy and hyperplasia of the thyroid epithelial cell (TEC) surrounding proliferative lymphomatic tis- sue were observed. The TEC with displasia was similar characteristically to the cells of papillary carcinoma. These TEC could express immunohistochemically p53, ki-67, bcl-2 and c-erbB-2, similar to the cancer cells at middle-high stage (P>0. 05), but the expres- sion level markedly higher than that of the gland tissue without HT ( P <0.01). Conclusion The carcinogenesis of HT complicated with thyroid carcinoma might contributed to the residual TEC from hyperplasia to dysplasia under the co-operation of multigenes.