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目的探讨伴有结节性筋膜炎样间质的甲状腺乳头状癌的临床病理特征、诊断与鉴别诊断要点。方法对1例伴有结节性筋膜炎样间质的甲状腺乳头状癌进行临床病理观察和免疫组化染色,并复习文献。结果患者女性,19岁。肿块位于甲状腺右叶,边界清楚,切面灰白色。组织学见肿瘤主要由上皮及间质两种成分组成,上皮成分具有典型的甲状腺乳头状癌特征,约占40%;间质主要由长梭形细胞组成,排列呈束状或编织状,细胞胞质丰富,细胞核染色质细腻,可见清楚小核仁,少量细胞有轻度非典型性,偶见核分裂象,间质成分约占60%。免疫组化示上皮细胞CK19、TG和TTF1(+),梭形细胞SMA和vimentin(+)。结论伴有结节性筋膜炎样间质的甲状腺乳头状癌是甲状腺乳头状癌的一个亚型,其梭形间质细胞具有肌纤维母细胞特征,该亚型的预后与经典型甲状腺乳头状癌相似。鉴别诊断包括经典型甲状腺乳头状癌、慢性纤维性甲状腺炎、纤维型桥本甲状腺炎、甲状腺未分化癌等。
Objective To investigate the clinicopathological features, diagnosis and differential diagnosis of papillary thyroid carcinoma with nodular fasciitis-like interstitium. Methods One case of papillary thyroid carcinoma with nodular fasciitis-like interstitium was observed by clinicopathological and immunohistochemical staining. The literature was reviewed. Results Female patient, 19 years old. The tumor is located in the right lobe of the thyroid gland, the border is clear, the cut surface is gray and white. Histology, see the tumor mainly by the epithelial and interstitial components of two components, the epithelial component has a typical papillary thyroid cancer characteristics, accounting for about 40%; interstitial mainly spindle cells, arranged in a bundle or braided, cells Cytoplasm rich, fine chromatin in the nucleus, showing clear small nucleolus, a small amount of cells with mild atypia, occasional mitosis, interstitial composition of about 60%. Immunohistochemistry showed epithelial cells CK19, TG and TTF1 (+), spindle cells SMA and vimentin (+). Conclusions Papillary thyroid carcinoma with nodular fasciitis-like interstitium is a subtype of thyroid papillary carcinoma. Fibrous spindle cells have the characteristics of myofibroblasts. The prognosis of this subtype is similar to that of classic thyroid papillary Cancer is similar. Differential diagnosis includes classic thyroid papillary carcinoma, chronic fibrous thyroiditis, fibrosing Hashimoto’s thyroiditis, undifferentiated thyroid cancer and so on.