甲状腺髓样癌术前诊断及细胞病理学特征

Preoperative diagnosis and cytopathological features of medullary thyroid carcinoma

目的探讨血清学、超声、细针穿刺细胞学检查在甲状腺髓样癌术前诊断的应用价值,并探讨甲状腺髓样癌的细胞病理学形态特征。方法回顾分析34例甲状腺髓样癌临床病例资料及细胞病理学特征,并与同期的甲状腺乳头状癌及结节性甲状腺肿病例进行比较,总结甲状腺髓样癌的细胞病理学形态特征。结果甲状腺髓样癌组血清降钙素、癌胚抗原、降钙素原检测值升高例数均显著多于甲状腺乳头状癌组与结节性甲状腺肿组。对照术后病理诊断,超声诊断甲状腺髓样癌的准确率为75.00%,细针穿刺细胞学诊断甲状腺髓样癌的符合率为91.67%。甲状腺髓样癌细胞病理学主要形态特征有:胞质不规则形或梭形、核偏位的细胞、双核或多核巨细胞、散在突出的大细胞、染色质呈“胡椒盐样”、梭形细胞、淀粉样物。甲状腺乳头状癌细胞病理学特征:核增大,核卵圆形或不规则型,可见纵向核沟与核内假包涵体,常见小核仁,染色质毛玻璃样,常见浓厚胶质,偶见砂砾体。结节性甲状腺肿细胞病理学特征:可见成簇或小片蜂窝状的滤泡上皮细胞,核大小一致,分布均匀,常见多量巨噬细胞,背景可见较多红细胞及少量炎性细胞。结论血清降钙素、癌胚抗原、降钙素原检测与超声诊断对甲状腺髓样癌的术前诊断均有一定的参考价值,掌握甲状腺髓样癌细针穿刺细胞病理学特征,可与甲状腺乳头状癌及结节性甲状腺肿鉴别,有助于进一步提高其术前诊断准确率。

Objective To investigate the application value of serology,ultrasound and fine needle aspiration cytology in the preoperative diagnosis of medullary thyroid carcinoma,and to explore the cytopathological features of medullary thyroid carcinoma.Methods This study retrospetively analyzed the clinical data and cytopathological features of 34 cases of medullary thyroid carcinoma and compared them with those of papillary thyroid carcinoma and nodular goiter in the same period.The cytopathological features of medullary thyroid carcinoma were summarized.Results The medullary thyroid carcinoma group had significantly more cases with elevated levels of serum calcitonin,carcinoembryonic antigen and procalcitonin than the papillary thyroid carcinoma group and the nodular goiter group.Compared with postoperative pathological diagnosis,the accuracy rate of ultrasound in the diagnosis of medullary thyroid carcinoma was 75.00%,and the concordance rate of fine needle aspiration cytology in the diagnosis of medullary thyroid cancer was 91.67%.The cytopathological features of medullary thyroid carcinoma mainly included:irregular or spindle cytoplasm,cells with skewed nuclei,binucleated or multinucleated giant cells,scattered and protruding large cells,“pepper-salt-like”chromatin,spindle cells and amyloid.The cytopathological features of papillary thyroid carcinoma included:enlarged nuclei,oval or irregular nuclei,longitudinal nuclear grooves and intranuclear pseudoinclusions,common small nucleoli,ground glass-like chromatin,common dense glia and occasional psammoma bodies.The cytopathological features of nodular goiter included:clusters or small pieces of honeycomb follicular epithelial cells,same sized and evenly distributed nuclei,a large number of common macrophages,many red blood cells and a few inflammatory cells in the background.Conclusion Detection of serum calcitonin,carcinoembryonic antigen and procalcitonin detection as well as ultrasonic diagnosis are valuable for the preoperative diagnosis of medullary thyroid carcinoma.Fine needle aspiration cytology can help to distinguish medullary thyroid carcinoma from papillary thyroid carcinoma and nodular goiter,which is helpful to further improve the accuracy of preoperative diagnosis.