鼻咽部甲状腺样低级别乳头状腺癌临床病理观察

Clinicopathologic features of thyroid-like low-grade nasopharyngeal papillary adenocarcinoma

目的探讨鼻咽部甲状腺样低级别乳头状腺癌(LGNPPA)的临床病理特点。方法对1例鼻咽部低级别甲状腺样乳头状腺癌进行组织形态学和免疫组化分析,并复习相关文献。结果患者男性,22岁。因鼻堵反复发作1年多。鼻内镜显示鼻咽部球形赘生物,灰红色,最大径1.5 cm,表面见点状伪膜附着。镜检:肿瘤表面被覆单层或假复层柱状上皮,其下由乳头状和管状腺体组成,乳头可见纤维血管轴心,部分区域呈梭形。腺体不规则,呈囊性、管状、梭形。瘤细胞圆形、卵圆形,形态一致,相对温和,排列拥挤,胞质轻度嗜酸,核重叠,细胞核染色均匀,部分细胞核空泡状,类似甲状腺乳头状癌。免疫组化:TTF-1、CK7、CK5/6、CK19、EMA和vimentin(+),p63小灶(+),Ki-67阳性指数为3%,而S-100、SMA、Tg、CK20和PAS均(-)。结论鼻咽部甲状腺样低级别乳头状腺癌是一种较为罕见的肿瘤,好发于青少年,组织学特点较典型,手术切除无复发或转移。

Objective To explore the clinicopathologic features of thyroid-like low-grade nasopharyngeal papillary adenocarcinoma. Methods The clinicopathologic features,imaging and immunohistoehemistry were analyzed in a case of thyroid-like low-grade nasopharyngeal adenocarcinoma with review of the literature. Results The patient was a 22-year-old man complaining of nasal obstruction. Laryngoscopic study identified a spherical mass located on the nasopharyngeal region. Histologically,the papillae were complex and tightly packed with hyalinized fibrovascular cores and lined by columnar and pseudostratified cells with intervening spindle-shaped cells. Both cell types had round to oval vesicular nuclei and mildly eosinophilic cytoplasm. The tumour cells were strongly and diffusely positive for TTF-1,CK7,CK5/6,CK19,EMA and vimentin,but negative for CK20,S-100,SMA,PAS and Tg. Conclusion Thyroid-like lowgrade nasopharyngeal papillary adenocarcinoma is an extremely rare neoplasm in the nasopharynx which typically occurs in adolescents. These tumours are amenable to surgical resection and have an excellent prognosis.