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目的探讨甲状腺玻璃样变小梁状肿瘤(HTT)临床病理特点、诊断与鉴别诊断。方法结合文献对本院病理科会诊的2例HTT临床资料、组织形态、免疫组化及BRAFV600E突变检测结果进行分析。结果 2例均为女性,年龄分别为46岁和51岁。肿瘤均位于左侧腺叶,具有完整纤维包膜。组织学形态示肿瘤具有特征性小梁状生长方式和小梁内玻璃样变物质。肿瘤的细胞学特点类似于甲状腺乳头状癌,瘤细胞呈多角形、卵圆形或高柱状,具有嗜酸或透明的胞质。细胞核呈卵圆形,具有不明显的核仁,可见核内包涵体和核沟,核分裂象罕见。瘤细胞常可见胞质内黄色小体和砂砾体。免疫组化染色瘤细胞甲状腺球蛋白和甲状腺转录因子1和CD56均(+),降钙素、细胞角蛋白19、间皮细胞(HBME-1)、突触素和嗜铬粒素A均(-)。其中1例半乳糖凝集素-3(-)。Ki-67(克隆号MIB-1)2例均显示细胞膜着色,而另一个克隆SP6(+)且增殖指数<1%。2例BRAF V600E蛋白均(-)。遗传学证实均无BRAFV600E突变。2例患者术后分别随访12和24个月,均无局部复发或转移。结论 HTT是一种罕见的甲状腺肿瘤。临床表现无特异性,易误诊。HTT具有低度恶性潜能。组织病理学特点结合MIB-1免疫组化标记可确诊该肿瘤。
Objective To investigate the clinical and pathological features, diagnosis and differential diagnosis of thyroid-like hyaline trabecular tumors (HTT). Methods The clinical data, histological features, immunohistochemistry and BRAFV600E mutation detection results of two cases of pathological consultation in our hospital were analyzed with the literature. Results Both cases were female and were 46 years old and 51 years old respectively. Tumors are located in the left lobe, with a complete fiber capsule. Histopathological features of tumors with trabecular-like growth pattern and trabecular within the glass-like material. The cytology of the tumor is similar to that of papillary thyroid carcinoma. The tumor cells are polygonal, oval or tall columnar with eosinophilic or transparent cytoplasm. The nucleus was oval, with insignificant nucleoli, visible inclusions and nuclear ditch, mitotic figures rare. Tumor cells often visible cytoplasmic yellow bodies and gravel. Immunohistochemical staining Thyroglobulin and thyroid transcription factor 1 and CD56 (+), calcitonin, cytokeratin 19, mesothelial cells (HBME-1), synaptophysin and chromogranin A -). One case of galectin-3 (-). Both Ki-67 (clone number MIB-1) showed cell membrane staining while the other clone SP6 (+) had a proliferation index of <1%. Two cases of BRAF V600E protein (-). No genetically confirmed BRAFV600E mutation. Two patients were followed up for 12 and 24 months, respectively. No local recurrence or metastasis was found. Conclusion HTT is a rare thyroid tumor. No specific clinical manifestations, easy to misdiagnosis. HTT has a low malignant potential. Histopathological features combined with MIB-1 immunohistochemical markers can confirm the tumor.