论文部分内容阅读
目的探讨细针穿刺诊断甲状腺朗格汉斯细胞组织细胞增生症(LCH)的细胞病理学特点及鉴别诊断要点。方法对4例甲状腺LCH的细针穿刺进行常规涂片并观察细胞学特点、沉渣包埋及免疫组化标记,对其中3例行BRAF V600E突变检测。结果 4例均为男性,发病年龄8~40岁,均为系统性LCH累及甲状腺,其中1例合并甲状腺乳头状癌。涂片见大量单个散在或松散聚集的组织细胞,细胞核略增大,核膜不规则,可见明显纵行核沟,核仁不明显,核分裂象少见。背景中嗜酸性粒细胞数量不等。免疫组化示肿瘤细胞S-100、CD1a和CD68(+),TTF-1和AE1/AE3(-)。基因突变检测BRAF V600E突变(-)。结论甲状腺LCH少见,临床表现不典型,细胞学形态易混淆,术前诊断难度高。诊断与鉴别诊断的关键在于对该疾病的认识及免疫组化的应用。
Objective To investigate the cytopathological features and differential diagnosis of Langerhans cell histiocytosis (LCH) by fine-needle aspiration. Methods Fine needle aspiration of thyroid LCH was performed in 4 cases. Cytology, sediment embedding and immunohistochemical staining were performed. BRAF V600E mutation was detected in 3 cases. Results All 4 patients were male, with a mean age of onset of 8 to 40 years. All of them were systemic LCH-associated thyroid glands, and 1 of them had thyroid papillary carcinoma. See a large number of smears scattered in a single loose or loosely organized tissue cells, the nucleus slightly increased nuclear membrane irregular, visible longitudinal krypton ditch, nucleoli are not obvious, mitotic figures rare. Eosinophils in the background vary in number. Immunohistochemistry showed tumor cells S-100, CD1a and CD68 (+), TTF-1 and AE1 / AE3 (-). Gene mutation was detected by BRAF V600E mutation (-). Conclusions LCH is rare in thyroid, the clinical manifestations are not typical, the morphology of cytology is easy to be confused, and the diagnosis of LCH is difficult. The key to diagnosis and differential diagnosis lies in the understanding of the disease and the application of immunohistochemistry.