35例甲状腺髓样癌的临床病理特征

Clinical pathological features of 35 cases of medullary thyroid carcinoma

目的:甲状腺髓样癌(medullary thyroid carcinoma,MTC)发病率低,细针抽吸术(fine-needle aspiration,FNA)对其的诊断准确性不高。本研究探讨经超声引导下FNA诊断为MTC的细胞学病理特征、鉴别诊断、治疗、预后和分子特征。方法:从细胞病例库中筛选出MTC 35例,每例FNA样本行传统涂片和液基制片,分别行苏木精-伊红(hematoxylin-eosin,HE)染色和巴氏染色。由2位高年资细胞病理学专科医师重新评估其细胞病理学特征,并结合相关文献进行回顾性分析、总结。结果:光镜下MTC细胞表现多样,排列方式以黏附性差的单个细胞散在分布为主,或以黏附性好、合胞体样细胞团为主;细胞形态呈多角形、浆细胞样和圆形,常常以2种或3种形态混杂出现,双核及巨核细胞多见,多核细胞少见;细胞核染色质呈细颗粒状、胡椒盐样,还可见一些少见特征,如偶见核内假包涵体及小核仁。免疫细胞化学染色结果示:降钙素(calcitonin,CT)、突触素(synaptophysin,Syn)、嗜铬素A(chromogranin A,CgA)、白细胞分化抗原56(cluster of differentiation 56,CD56)、癌胚抗原(carcino-embryonic antigen,CEA)、甲状腺转录因子1(thyroid transcription factor 1,TTF-1)均阳性,甲状腺球蛋白(thyroglobulin,TG)阴性。结论:本文回顾性分析并总结了MTC的临床特征、细胞病理特点、鉴别诊断、治疗、预后及分子特征,有助于细胞病理医师作出更客观准确的判读,并帮助临床选择最佳的手术方案。

Objective:Medullary thyroid carcinoma(MTC)is rare and diagnostic accuracy of fine-needle aspiration(FNA)is not high.This study investigates the cytopathological features,diagnosis,treatment,prognosis,and molecular characteristics of MTC diagnosed through ultrasound-guided FNA.Methods:FNA samples from 35 MTC cases were selected from cytology databases.Each sample underwent traditional smears and liquid-based preparations with hematoxylin-eosin(HE)and Papanicolaou staining.Two experienced cytopathologists retrospectively evaluated the cytological features and summarized the findings in combination with relevant literature.Results:MTC cytological presentations varied,with cells mostly dispersed singly or loosely cohesive.The cells appeared polygonal,plasmacytoid,or round,often showing two or three mixed morphologies.Binucleated and giant cells were common,while multinucleated cells were rare.The chromatin was finely granular,resembling“salt-andpepper.”Uncommon features,such as intranuclear pseudoinclusions and small nucleoli,were also observed.Immunocytochemistry showed positive staining for calcitonin(CT),synaptophysin(Syn),chromogranin A(CgA),cluster of differentiation(CD56),carcinoembryonic antigen(CEA),and thyroid transcription factor 1(TTF-1),while thyroglobulin(TG)was negative.Conclusion:MTC is relatively rare in FNA.This study’s retrospective analysis of its clinical characteristics,cytopathological features,differential diagnosis,treatment,prognosis,and molecular features will aid cytopathologists in making more accurate diagnoses and assist clinicians in selecting optimal surgical strategies.