225例甲状腺非典型腺瘤病理组织学及免疫组化研究

Thyroid atypical adenoma--morpholo gical and immunohistochemical study of 225 cases

目的 观察甲状腺非典型腺瘤的病理学特点、分型及免疫学表型。方法 HE染色光镜观察组织学特点并分型 ,免疫组化 (S P法 )检测bcl 2、p5 3、PCNA表型。结果 2 2 5例巨检分为 :孤立型 168例 ,占 75 % ,多结节型 5 2例 ,占 2 3 % ,隐匿型 5例 ,占 2 % ;光镜下组织学分为 :腺泡状型 180例 ,占 80 % ,弥漫型 3 4例 ,占 15 % ,小梁状型 11例 ,占 5 % ;细胞形态学以不规则型为主 ,占 5 5 % ( 12 4 / 2 2 5 ) ,梭形细胞型占 3 0 % ( 67/ 2 2 5 ) ,透明细胞型占 10 % ( 2 3 / 2 2 5 ) ,畸异细胞型占 5 % ( 11/ 2 2 5 )。免疫组化bcl 2、p5 3、PCNA在腺泡状、弥漫型、小梁状型中的阳性表达率分别为 82 .8%、2 4 .5 %、75 .3 % ;81.4 %、2 3 .5 %、76.5 % ;83 .5 %、2 5 .1%、76.0 %。三组间无显著差异 (P >0 .0 5 ) ;与滤泡状腺瘤比较有显著差异 (P <0 .0 1) ;与滤泡状癌比较无显著差异 (P >0 .0 5 )。结论 甲状腺非典型腺瘤组织学和细胞学均分为三型 ,生物学行为系原位癌。

Objective To stud y the characteristics of pathologic morp hology,classification and immunophentype of thyroid atypical adenome.Metho ds Using HE staining authors studi ed histologic features with light micros cope and classified,and detected phentype of bcl 2,p53 and PCNA by immunohistochem is try (S P method).Results Gen erally form include:isolating type,168(7 5%);multiple nodes type,52(23%);hiding t ype,5(2%).Histologically,alveolar type,1 80(80%);diffuse type,34(15%);and small b ecular type,11(5%)were found.Cytomorphol ogically,unregular type,55%(124/225);spi ndle cell type,30%(67/225);clear cell ty pe,10%(23/225);deformed cell type,5%(11/ 225)were observed.Immunohistochemically, t he positive rates for bcl 2,p53 and PCNA ,alveolar type were 82.8%,24.5%,75.3%;di ffuese type 81.4%, 23.5% ,76.5%;and smal l becular type 83.5%, 25.1% ,76.0% respe ctively.There were distinct difference compared with follicular adenoma(P< 0.01 ).There were not distinct difference compared with fo llicular carcinoma and among the three groups(P>0.05).Conclusions There are three patterns in bot h cytology and histology of thyroid atyp ical adenoma,belonging to carcinoma in situ in b iologic behaviour.