甲状腺乳头状微小癌快速冰冻切片的病理特征分析

The pathological characteristics of thyroid papillary microcarcinoma in quick freezing sections

目的:探讨甲状腺乳头状微小癌快速冰冻切片的病理镜下特征,为提高甲状腺乳头状微小癌快速冰冻切片准确率。方法:回顾镜下观察153例快速冰冻切片诊断并石蜡常规确诊为甲状腺乳头状微小癌的病理形态特征,观察指标包括:组织结构,细胞核形态以及其它组织形态三方面要素。结果:快速冰冻切片显微镜镜下观察:肿瘤性纤维化149例,肿瘤浸润性生长143例,乳头状结构102例,核增大变椭圆152例,核内假包含体/核沟143例,核排列拥挤重叠120例,核膜不规则113例,淋巴细胞浸润67例,砂砾体57例,伴有多核巨细胞38例,出现核仁10例,伴有鳞状上皮化生5例,镜下特征占比分别为:97.4%,93.5%,66.7%,99.3%,93.5%,78.4%,73.9%,43.8%,37.3%,24.5%,6.5%,3.3%。结论:具有乳头状结构、核的特征性改变和浸润性生长是甲状腺乳头状微小癌术中快速冰冻切片的主要病理特征,其中核的特征性改变和具有浸润性生长是其在术中快速冰冻切片中的诊断要点。

Objective:To study the pathological characteristics of thyroid papillary microcarcinoma under microscope in order to improve the diagnosis rate of thyroid papillary microcarcinoma using the quick freezing section method.Methods:Reviewing the pathological characteristics under microscope of 153 cases that were diagnosed as thyroid papillary microcarcinoma using both routine paraffin and quick freezing section methods.The structure of tissue,morphology of nuclear and tissue are observed.Results:Quick freezing sections were observed under the microscope lens:149 cases of tumor fibrosis,143 cases of invasive tumors,102 cases of papillary structure,152 cases of size-increased ovary nucleus,143 cases of pseudo inclusion bodies/nuclear grooves,120 cases of crowded and overlap arrangement of nucleus,113 cases of irregular nuclear membrane,67 cases of lymphocyte infiltration,57 cases of sand bodies,38 cases with giant cells,10 cases with nucleolus,5 cases with squamous metaplasia,the microscopic features of proportion respectively:97.4%,93.5%,66.7%,99.3%,93.5%,78.4%,73.9%,43.8%,37.3%,24.5%,6.5%,3.3%.Conclusions:The presence of papillary structure,characteristic changes of nucleus and invasive growth are the main pathological characteristics of thyroid papillary microcarcinoma in quick freezing sections.Among characteristics mentioned above,characteristic changes of nucleus and invasive growth are essential to the diagnosis of quick freezing section in the operation.