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目的探讨甲状腺间叶性软骨肉瘤(MC)的临床病理学特征、免疫表型、诊断以及鉴别诊断。方法分析1例甲状腺MC的临床特征、组织学形态、免疫表型及特殊染色结果,并复习相关文献。结果患者男性,33岁。以颈部无痛性肿块半年就诊。肿瘤位于甲状腺被膜内,似有完整包膜;切面灰白、灰黄色相间,有光泽,中央可见点、片状钙化、骨化,质硬。镜下肿瘤由未分化小细胞及分化较好岛状软骨细胞交织而成,小细胞区细胞丰富,由圆形、短梭形细胞组成,可见核分裂象;富于血管,可见血管外皮瘤样结构;软骨细胞多分化较好,细胞核有异型,可见钙化、骨化。免疫组化:小细胞CD99(+)、部分Leu-7和vimentin(+),而S-100、TG、AE1/AE3、FⅧRag、LCA、NSE、Syn、CgA、GFAP、NF和CD117均(-);软骨细胞S-100、NSE、GFAP和FⅧRag(+)。术后无复发和转移。结论甲状腺MC极其罕见,具有典型的病理组织学特征,需与伴有软骨化生的甲状腺未分化癌、非典型腺瘤及有软骨成分的癌肉瘤鉴别。预后可能有别于其他部位MC,尚需进一步随访。
Objective To investigate the clinicopathological features, immunophenotype, diagnosis and differential diagnosis of mesenchymal thyroid carcinoma (MC). Methods One case of thyroid MC was analyzed for clinical features, histological features, immunophenotypes and special staining results, and reviewed the relevant literature. Results The patient was male, 33 years old. To painless neck half a year visit. The tumor is located in the thyroid capsule, seems to have a complete envelope; section gray, gray and white, shiny, central visible, flake calcification, ossification, hard. Microscopic tumor by undifferentiated small cells and well-differentiated island-like interwoven island cells, small cell-rich cells by the round, short spindle cells, mitotic figures can be seen; rich in blood vessels, visible vascular endothelial tumor-like structure ; Chondrocyte well differentiated, abnormal nuclei, visible calcification, ossification. Immunohistochemistry: Small cell CD99 (+), partial Leu-7 and vimentin (+) while S-100, TG, AE1 / AE3, FⅧRag, LCA, NSE, Syn, CgA, GFAP, ); Chondrocytes S-100, NSE, GFAP and FⅧRag (+). No recurrence and metastasis after surgery. Conclusion Thyroid gland is extremely rare and has typical histopathological features. It needs to be distinguished from undifferentiated thyroid carcinoma, atypical adenomas and cartilage components. The prognosis may be different from other parts of MC, still need further follow-up.