甲状腺乳头状癌组织学诊断要点的探讨

To Explore on Histologic Diagnostic Main Points of Papillary Carcinoma of Thyroid

目的 :探讨甲状腺乳头状癌组织学诊断要点 ,为提高病理确诊率提供依据。方法 :对 32例乳头状癌 ,包括典型乳头状癌 (CPC) 2 1例 ,滤泡型乳头状癌 (FVPC) 11例及 16例良性增生乳头病变的组织学诊断要点进行观察分析。结果 :1CPC多数在乳头主干周围见有游离的多边形乳头叶片的复杂乳头 ,致密的纤维支架 ,细胞核的毛玻璃样变 ,全部弥漫性 CK19阳性。19例有包膜内 ,10例包膜外浸润。并见到少数特殊的乳头形状。只有 6例有钙盐沉着 ,1例砂粒小体 ;2 FVPC有 8例为中、低分化 ,以癌巢为主 ,部分无胶质小滤泡 ,弥漫或多灶性毛玻璃核细胞 ,相应的 CK19阳性 ,5例包膜浸润 ,2例血管浸润。 3例高分化以滤泡为主 ,可见共壁 ,少量巢状浸润 ,而核毛玻璃样变显著 ,CK19弥漫或局灶性阳性。结论 :1CPC中乳头主干周游离多边形乳头叶片的复杂乳头 ,致密纤维支架 ,癌细胞的毛玻璃样核 ,CK19弥漫阳性以及包膜内、外的浸润是最主要的诊断要点 ;2 FVPC,中、低分化者以巢性浸润 ,无胶质小滤泡以及包膜、血管浸润 ,多灶性毛玻璃样变核 ,CK19阳性。高分化者 ,以滤泡为主 ,共壁、巢状浸润、癌细胞毛玻璃样核 ,相应 CK19弥漫阳性 ,是主要诊断要点。

Objective:To explore on histologic diagnostic main points of papillary carcinoma of thyroid for raising right rate of pathologic diagnosis provede basis. Methods:The observation and analysis of histo logic diagnostic main points to 32 papillary carcinomas, including 21 classical papillary carcinomas (CPC),11 Follicular variant papillary carcinomas (FVPC), and 16 benign hyperplastic papillary lesions. Results:①The CPC cases were showed the periphery of papillary main core with free multilateral papillary (call complex papillary ), dense fibrous core in most cases. Hairy glass-like mucleu cell, together, diffuse CK19 positive expression in all cases, Tumor infiltration into capsule in 19 cases and extra capsule infiltration in 10 cases, and 6 calcinosis, 1 with psammoma bodies;②The FVPC cases were showed the cancer cell nests infiltration and partly without colloid follicles, diffuse or focal hairy glass-like nucleu cell, together, CK19 positire in 8 moderate and low-differentiate cases, Capsule and vascular invasion in 5 and 2 cases, But the 3 well-differentiate cases were showed the major follicles and a few of share wall and cancer cell nests, diffuse or focal hairy glass-like nucleu cell, together, CK19 positive.Conclusion:①The CPC cases were showed complex papillae, dense fibrous core, hairy glass-like nucleu cell, CK19 positive and cancer cell infiltration intra or extracapsule as main points in histological diagnosis;②The FVPC cases were showed cancer cell nests infiltration and partly without colloid Follicles, capsule or vascular invasion, multifocal hairy glass-like nucleu cells and CK19 positive in moderate and low-differentiate cancer. But the well-differentiate cancers were showed the follicular cell diffuse or focal hairy glass-like nucleu with CK19 positive. That were suggest for diagnostic main points of FVPC.