论文部分内容阅读
目的甲状腺髓样癌的术前诊断直接影响到手术与治疗方式。我们通过改进细针吸取细胞学(FNAC)检查中的标本采集技术并采用新细胞块(CB)制作方法,以协助提高甲状腺髓样癌的FNAC术前确诊率。方法首先,采用持笔式细针穿刺技术(外径0.8 mm注射针),通过增加初次穿刺时的提插次数或通过二次穿刺获取足够的标本。其次,从已染色的FNAC涂片上刮取标本。最后将所获得的标本均采用新的蛋白乙醇凝固-甲醛固定法制作CB及切片,并进行IHC及刚果红染色,综合分析常规FNAC涂片、CB切片的形态学和IHC、刚果红染色结果,完成病理诊断。结果对8例甲状腺FNAC(5例怀疑甲状腺髓样癌,3例肿瘤类型不能确定)进行了CB制作,其中2例通过增加穿刺时的提插次数获得足够标本,3例通过二次穿刺获取标本,3例通过刮取已染色涂片的细胞获取标本。通过CB切片进行TTF-1、calcitonin、thyroglobulin、chromogranin A、synaptophysin、Ki-67、CD56和CEA免疫组化染色和刚果红染色,8例患者均确诊为甲状腺髓样癌。结论改进细针穿刺取样技术并采用新的FNAC-CB制作技术成功进行免疫组化染色,能有效提高甲状腺髓样癌的诊断准确率,故推荐在FNAC诊断甲状腺髓样癌中采用该方法。
Objective The preoperative diagnosis of medullary thyroid carcinoma directly affects the operation and treatment. We helped improve the preoperative FNAC diagnosis of medullary thyroid carcinoma by improving the specimen collection technique in fine needle aspiration cytology (FNAC) and using new cell block (CB) production methods. Methods First of all, using pen-held fine needle aspiration technique (OD 0.8 mm injection needle), sufficient specimens were obtained either by increasing the number of extractions at the time of primary puncture or by secondary puncture. Second, samples were taken from stained FNAC smears. Finally, the obtained specimens were made CB and sections with a new protein-ethanol coagulation-formaldehyde fixation method and IHC and Congo red staining. The morphology, IHC, congo red staining results of conventional FNAC smears, CB sections were analyzed comprehensively. Complete pathological diagnosis. Results 8 cases of thyroid FNAC (5 cases of medullary thyroid carcinoma suspected and 3 cases of tumor type can not be determined) were made of CB, of which 2 cases by increasing the number of punctured needle to obtain enough specimens, 3 specimens obtained by the second puncture , Three cases by scraping stained smear cells to obtain specimens. Immunohistochemistry and congo red staining of TTF-1, calcitonin, thyroglobulin, chromogranin A, synaptophysin, Ki-67, CD56 and CEA were performed on CB sections, and all 8 patients were diagnosed as medullary thyroid carcinoma. Conclusion The improved fine needle aspiration technique and the successful FNAC-CB technique for immunohistochemical staining can effectively improve the diagnostic accuracy of medullary thyroid carcinoma. Therefore, this method is recommended for the diagnosis of medullary thyroid carcinoma with FNAC.