甲状腺混合性癌4例临床病理分析

Mixed thyroid carcinoma: a clinicopathological analysis of 4 cases

目的探讨甲状腺混合性癌的临床病理学特征、组织发生、免疫组化及诊断与鉴别诊断。方法回顾性分析新近诊治的4例甲状腺混合性癌的临床病理资料,运用全自动免疫组化仪进行TG、TTF-1、calcitonin、Syn、CGA、galectin-3、mesothelia、CK19、TPO、CD56、B-raf和Ki-67免疫标记染色,进行随访并复习相关文献。结果 4例患者均为女性。其中2例为髓样癌与乳头状癌混合,1例为甲状腺髓样癌与微小浸润型滤泡癌混合,另1例为甲状腺乳头状癌与微小浸润型滤泡癌混合。免疫组化:4例中髓样癌区域calcitonin、Syn和CGA均(+);滤泡癌区域TG和TTF-1(+),calcitonin、Syn和CGA(-);乳头状癌区域galectin-3、mesothelia、CK19和B-raf均(+),而TPO、CD56、calcitonin、Syn和CGA均(-)。结论两种不同类型的甲状腺癌混合发生在临床是十分少见的,其来源存在多种学说,免疫组化标记可辅助其诊断。

Objective To investigate the clinical and pathological characteristics, immunophenotype, diagnosis,treatment and prognosis in 4 caese of mixed thyroid carcinoma. Methods Clinical and pathological data were retrospectively analyzed in 4 cases of mixed thyroid carcinoma. The expression of TG,TTF-1,calcitonin,Syn,CGA,galectin-3,mesothelia,CK19,TPO,CD56,B-raf and Ki-67 were detected by a full automatic immunostainer. And the related literatures were reviewed. Results The 4 patients were female. There were 2 cases of mixed medullary carcinoma with papillary carcinoma,1 case of mixed medullary carcinoma and minimally invasive follicular carcinoma,and another 1 case of mixed of papillary thyroid carcinoma and minimally invasive follicular carcinoma. Immunophenotyping showed that calcitonin,SYN and CGA were expressed in medullary carcinoma region; TG and TTF-1 were expressed in follicular carcinoma region,where calcitonin,Syn and CGA were not expressed; galectin-3,mesothelia,CK19 and B-raf were expressed in papillary carcinoma region where TPO,CD56,calcitonin,Syn and CGA were not expressed. Conclusion Two different types of thyroid cancer mixed happens very rare,which has a variety of theories. Immunohistochemical markers can assist in the diagnosis.