7例甲状腺具有乳头状癌核特征的非浸润性滤泡性肿瘤临床病理分析

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features(NIFTP):a clinicopathological analysis of seven cases

目的探讨甲状腺具有乳头状癌核特征的非浸润性滤泡性肿瘤(NIFTP)的临床病理特征、诊治及预后。方法应用光镜、免疫组化染色及聚合酶链式反应(PCR)技术对7例NIFTP进行观察,并复习相关文献。结果7例NIFTP中女性3例、男性4例,平均年龄48.9(35~64)岁。均为超声检查发现,TI-RADS 3-4A类。光镜下,细胞以滤泡状生长方式为主,细胞核呈毛玻璃样改变,可见核沟,其中2例同时伴有乳头状癌(PTC)。免疫表型:肿瘤细胞CK19、TG、TPO、Galectin-3等均有不同程度阳性。PCR结果显示1例K-RAS突变;1例(伴发乳头状癌)显示NRAS突变(PTC与NIFTP均突变)。患者均行甲状腺腺叶切除术,术后随访8~57个月,未见肿瘤复发或转移。结论NIFTP临床多无症状,特征性组织学形态、免疫组化及基因检测有助于诊断与鉴别诊断,随访资料显示预后较好。

Objective To ulteriorly elucidate the clinicopathological features,therapy and prognosis of the NIFTP.Methods Seven cases of NIFTP were studied by histology,immunohistochemistry and PCR,and review of relevant literatures.Results A total of 7 patients were examined(4 males and 3 females)with an average age of 48.9 years(35 to 64 y).Thyroid nodules were found incidentally by B-type ultrasound examination,and classified as TI-RADS 3-4A.Histologically,there were encapsulated or well-circumscribed follicular lesions.Some of the tumor cells showed nuclear characteristics of papillary thyroid carcinoma,two of them had concurrent PTC.Tumor cells were variably positive for CK19、TG、TPO、Galectin-3.Two mutation was found in K-RAS and NRAS.All the patients underwent thyroidectomy.Recurrence or metastasis was not found after 3-52 months follow-up.Conclusion Most NIFTP patients present with the unintentional nodules.Morphologic,immunohistochemical features and genetic test are helpful for differential diagnosis.Follow-up data suggest that NIFTP has favorable prognosis.