散发性甲状腺髓样癌10例临床病理分析

Sporadic medullary thyroid carcinoma: a clinicopathological analysis of ten cases

目的探讨散发性甲状腺髓样癌(MTC)的临床病理特征。方法对10例MTC的临床资料进行回顾性分析,通过光镜观察及免疫组化染色进行临床病理分析,并复习相关文献。结果 10例患者中3男7女,发病年龄31~76岁(平均56. 3岁)。患者大多以体检发现颈部肿块就诊。肿瘤最大径0. 8~4 cm(平均直径2. 2 cm),其中1例合并乳头状微癌,10例肿瘤间质刚果红染色阳性。镜下肿瘤细胞呈实性、分叶、管状或岛状排列,肿瘤细胞体积变化较大,可以是圆形、多角形、浆细胞样或梭形,细胞核低~中度异型,核分裂活性相对较低。癌细胞巢周边有纤细的纤维血管间质、玻璃样变胶原组织及淀粉样物间质分隔。免疫组化:瘤细胞Ctn、CEA、CD56、CgA、TTF-1和Syn等不同程度(+),TG(-);Ki-67增殖指数5%~30%。MTC就诊时常已发生淋巴结转移,其恶性程度仅次于未分化癌,预后相对较差。结论 MTC较少见,临床表现无特异性,术前诊断有一定难度,诊断需要靠组织病理学、免疫组化和特殊染色,其中Ctn和刚果红染色在该肿瘤诊断中有重要意义。

Objective To investigate the clinicopathologic features of sporadic medullary thyroid carcinoma (MTC).Methods Ten cases of sporadic MTC were analyzed through light microscopy and immunohistochemical staining,with review of related literatures. Results The most common symptom was neck mass. Three males and seven females were included in this study. The age of the 10 patients ranged from 31 to 76 years,with a mean age of 56. 3 years. Tumors ranged in diameter from 0. 8 cm to 4. 0 cm,with an average diameter of 2. 2 cm. One of them was diognosed with micropapillary carcinoma,and all of the 10 cases were positive for Congo red staining. Histologically,tumor cells were arranged in solid,lobulated,tubular or island-like. Tumor cells were round,polygonal,plasma cell-like and so on. The nucleus was lowmedium in shape and the mitotic activity was relatively low. There were slender fibrovascular interstitial, vitreous collagenous tissue and amyloid separation in the tumor stroma. Immunohistochemistry showed that all 10 patients were diffuse expression of Calcitionin,CEA,TTF1,CD56,CgA,and Syn in tumour tissues,while TG was negative. The index of Ki-67 ranged from 5%-30%. Lymph node metastasis was very common. The malignancy of MTC was second only to undifferentiated carcinoma,and the prognosis was poorer than papillary thyroid carcinoma. Conclusion MTC is rare and it has no specific clinical features. It is very difficult for preoperative diagnosis. The diagnosis depends on histopathology,immunohistochemistry and special staining. Among them,Ctn and Congo red staining play an important role in the diagnosis of this tumor.