摘要
目的分析甲状腺乳头状微小癌（PMC）的临床病理学特征，观察CK19、HBME-1、Galectin-3、CD56及p63在PMC和良性甲状腺病变中的表达差异，及其在良恶性病变鉴别诊断中的意义。方法回顾性分析78例PMC患者的临床病理学资料，采用免疫组化方法检测CK19、HBME-1、Galectin-3、CD56和p63在51例PMC及48例甲状腺良性病变（18例乳头状增生活跃、17例结节性甲状腺肿、13例淋巴细胞性甲状腺炎）中的表达情况，术后随访6—269个月。结果78例PMC患者中，出现核异型重叠69例（88．5％），核沟67例（85．9％），核内包涵体50例（64．1％），乳头结构60例（76．9％）。51例PMC患者中，有50例（98．0％）同时出现CK19、HBME-1和Galectin-3中、强阳性表达（P〈0．0001），而良性病变（乳头状增生活跃、结节性甲状腺肿、淋巴细胞性甲状腺炎）患者未见同时出现CK19、HBME-1和Galectin-3中、强阳性表达。随访结果显示，有7例（9．0％）PMC患者腺叶内再发生，3例（3．8％）出现淋巴结转移，无远处转移及死亡患者。12例（15．4％）术中冰冻病理诊断未能取到PMC病灶者，其直径均≤3mm。结论不论乳头状结构的有无，同时出现核异型重叠、极性紊乱、毛玻璃核、核沟及核内包涵体是诊断PMC的关键，间质浸润、间质硬化及复杂分支的真性乳头结构是PMC诊断的主要依据。术中冰冻诊断对直径≤3mm的PMC有一定的局限性。CK19、HBME-1和Galectin-3均呈中、强阳性表达是PMC特征性表现，也是鉴别甲状腺良恶性病变的重要指标。
Objective To characterize the morphological features of thyroid papillary （PMC） and assess the significance of expression of CK19, HBME-1, Galeetin-3, CD56 and p63 in differential diagnosis of PMC from benign thyroid lesions. Methods Clinicopathologic features of 78 cases PMC were reviewed. Immunohistochemical analysis of CK19, HBME-1, Galectin-3, CD56, and p63 in 78 cases of PMC and 48 cases of benign thyroid lesions （ 18 cases of papillary hyperplasia, 17 cases of nodular goiter and 13 cases of lymphocytic thyroiditis） was conducted. The patients were followed up for from 6 to 269 months after surgical operation. Results 69 cases nuclear atypia and overlapping nuclei （88.5%）, 67 cases nuclear grooves （85.9%）, 50 cases nuclear pseudoinclusions （64.1% ） and 60 cases papillary architecture （76.9%） were detected in 78 cases of PMC. Moderate to strong co-expression of CK19, HBME-1 and galectin-3 was observed in 98.0% （50/51） in the PMC group but in none of the benign disease group. The expression of CD56 and p63 was negative in both groups. In the postoperative follow-up period of 6-269 months, 7 cases （9.0%） developed intrathyroid recurrence, 3 cases （3.8%） developed lymph node metastasis, no distant metastasis or death was observed. In 12 cases （ 15.4% ） the PMC lesion smaller than 3 mm in diameter was not found by frozen section diagnosis. Conclusions Overlapping nuclei, nuclear atypia, polar disorder, ground glass nuclei, nuclear grooves and nuclear pseudoinclusions are most important for the diagnosis of PMC with or without papillary architecture. The anppearance of definite interstitial invasion, interstitial sclerosis and true complex papillary architecture are more helpful to make right diagnosis. Intraoperative frozen section is of limited value for a reliable diagnosis of PMC in diameter ≤ 3 mm. Moderate to strong co-expression of CK19, HBME-1 and Galectin-3 is a very useful indicator for differential diagnosis of PMC from benign thyroid lesions.
出处
《中华肿瘤杂志》
CAS
CSCD
北大核心
2011年第8期599-604,共6页
Chinese Journal of Oncology
