弥漫硬化型甲状腺乳头状癌临床病理特征分析

Clinicopathological features of diffuse sclerosing variant of papillary thyroid carcinoma

目的探讨弥漫硬化型甲状腺乳头状癌DSVPTC的临床病理特征、鉴别诊断及预后。方法回顾性分析4例DVPTC的临床病理特征、免疫表型,并对患者进行随访同时复习相关文献。结果其中3例为青年女性患者,癌细胞均具有经典性甲状腺乳头状癌典型的核特征,镜下肿瘤细胞均处于慢性淋巴细胞性甲状腺炎的背景中,可见大量的淋巴细胞浸润、大量的砂砾体形成、广泛的间质纤维化,伴有鳞状上皮化生,癌细胞团多呈实性、多灶生长,4例患者均出现了淋巴结转移。免疫组化:TG、CK19、TTF-1均呈(+),CD56(-),p53弱(+),CyclinD1(+),Ki-67增殖指数均≤1。结论 DSVPTC是一种罕见的甲状腺乳头状癌亚型,具有高侵袭性,淋巴节转移率和复发率较高,预后较经典型甲状腺乳头状癌差。

Objective To investigate the clincopathologic features, differential diagnosis and prognosis of diffuse sclerosing variant of papillary thyroid carcinoma. Methods The clinicopathological features and immunophenotype of four cases of diffuse sclerosing variant of papillary thyroid carcinoma were retrospectively analyzed. The patients were followed up and the relevant literature was reviewed. Results Three of them were young female patients and the tumor cells had the characteristics of classic papillary thyroid carcinoma nucleus. Microscopically, the tumor cells were in the background of chronic lymphocytic thyroiditis. A large number of lymphocytes infiltrated, a lot of psammoma bodies were formed and extensive interstitial fibrosis was noted with squamous metaplasia. Most of tumor cells were solid and multifocal. All four patients had lymph node metastasis. Immunohistochemically, TG, CK19, TTF-1 and cyclin D1 were positive. CD56 was negative, P53 was weakly positive and Ki-67 proliferation index was less than or equal to 1%. Conclusion Diffuse sclerosing variant of papillary thyroid carcinoma is a rare variant of papillary thyroid carcinoma with high invasiveness, high lymph node metastasis rate, and high recurrence rate. The prognosis is worse than that of classic papillary thyroid carcinoma.