摘要
目的探讨甲状腺结节细针穿刺细胞学标本中伴有嗜酸细胞形态特征者的鉴别诊断要点。方法收集中山大学附属第三医院病理科2019年11月至2024年12月的甲状腺结节细针穿刺标本,包括甲状腺嗜酸细胞肿瘤、桥本甲状腺炎、甲状腺髓样癌及嗜酸细胞亚型甲状腺乳头状癌,分析这组疾病的细针穿刺细胞形态学特征及总结鉴别诊断要点。结果共纳入55例患者的56份标本,其中甲状腺嗜酸细胞肿瘤22例(术后病理学诊断21例为嗜酸细胞腺瘤、1例为嗜酸细胞癌),桥本甲状腺炎17例,甲状腺髓样癌10例(11份标本),嗜酸细胞亚型甲状腺乳头状癌6例。甲状腺嗜酸细胞肿瘤嗜酸细胞局部形成多簇状聚集或呈大片状或小梁状分布的趋势,几乎看不到相对正常的甲状腺滤泡上皮及反应性增生的淋巴组织,部分标本出现毛细血管在细胞间穿越现象,部分病例的细胞蜡块中肿瘤细胞呈现镶嵌似的相互推挤式排列。桥本甲状腺炎伴有数量不等的嗜酸细胞,较多反应性增生的淋巴组织及生发中心片段,少数标本有良性的甲状腺滤泡上皮。甲状腺髓样癌的肿瘤细胞呈松散或失黏附的单个散在或小簇状,细胞形态多样,细胞核呈粉尘状/胡椒盐样,亦可见小核仁及核内包涵体,细胞蜡块中的肿瘤细胞散在或呈巢团状分布。嗜酸细胞亚型的甲状腺乳头状癌细胞量偏丰富,细胞呈单个散在、平铺片状或小簇状,细胞胞浆丰富、嗜酸,核膜不规则,核浆比失调。结论细针穿刺细胞学检查有助于鉴别伴有嗜酸细胞形态特征的甲状腺结节。嗜酸细胞呈大片或小梁状排列提示为嗜酸细胞肿瘤,毛细血管在嗜酸细胞间出现穿越现象对嗜酸细胞肿瘤更具诊断价值。当出现较多反应性增生的淋巴组织时,需结合临床血清学及影像学,判断是否为桥本甲状腺炎。肿瘤细胞失黏附及粉尘状/胡椒盐样核提示为甲状腺髓样癌。嗜酸细胞的细胞核非典型性是甲状腺乳头状癌鉴别要点。
Objective To explore the differential diagnostic clues of fine needle aspiration cytology in thyroid nodules accompanied with oncocytic features.Methods Fine needle aspiration samples of thyroid nodules were collected from Department of Pathology,the Third Affiliated Hospital of Sun Yat-sen University between November 2019 and December 2024,including oncocytic thyroid neoplasm,Hashimoto’s thyroiditis,medullary thyroid carcinoma and oncocytic variant of papillary thyroid carcinoma.Morphological characteristics of fine needle aspiration were analyzed and differential diagnostic clues for this group of diseases were summarized.Results A total of 56 samples were collected from 55 patients including 22 cases of oncocytic thyroid neoplasm(21 cases of oncocytic thyroid adenoma and 1 case of oncocytic thyroid carcinoma by postoperative pathology),17 cases of Hashimoto’s thyroiditis,11 cases of medullary thyroid carcinoma(from 10 patients)and 6 cases of oncocytic variant of papillary thyroid carcinoma,respectively.In oncocytic thyroid neoplasm,oncocytic cells tended to gather in clusters or distribute in large flat sheets or trabeculae,and almost no normal thyroid follicular cells or reactive lymphoid tissues were observed.In certain samples,the phenomenon of capillary penetrating among cells was noted and tumor cells were distributed in crowding in same cases of cell blocks.Hashimoto’s thyroiditis is composed of varying numbers of oncocytic cells,massive reactive hyperplastic lymphoid tissues and fragments of germinal center.Benign thyroid follicular cells were found in few samples.In medullary thyroid carcinoma,the tumor cells appeared as single or small clustered with loss of cell cohesion,diverse cell morphology and dust-or salt-and-pepper like nucleus,and small nucleolus and nuclear inclusions were also observed.The tumor cells in the cell blocks were scattered or distributed in nests.The quantity of tumor cells in oncocytic variants of papillary thyroid carcinoma was high,arranged in scattered,flat sheets or small clusters.The cytoplasm was abundant and eosinophilic with extremely irregular nuclear membrane and an elevated nuclear cytoplasmic ratio.Conclusions Fine needle aspiration cytology contributes to distinguishing thyroid nodules with oncocytic features.Large sheet or trabecular distribution of oncocytic cells prompts oncocytic thyroid neoplasm.The phenomenon of capillary penetrating among oncocytic cells offers diagnostic value for oncocytic thyroid neoplasm.When a significant amount of reactive hyperplastic lymphoid tissues is observed,clinical serological and imaging features should be integrated to evaluate the possibility of coexist Hashimoto’s thyroiditis.Loss of tumor cell cohesion and nuclei with“dust-like”or“salt-and-pepper”chromatin are more indicative of medullary thyroid carcinoma.The nuclear atypia in oncocytic cells is a critical feature for differentiating papillary thyroid carcinoma.
作者
李海凤
谭东林
林维真
纪燕英
郑瑾玥
邵春奎
陈健宁
LI Haifeng;TAN Donglin;LIN Weizhen;JI Yanying;ZHENG Jinyue;SHAO Chunkui;CHEN Jianning(Department of Pathology,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)
出处
《新医学》
2025年第7期670-677,共8页
Journal of New Medicine
基金
广东省基础与应用基础研究基金项目(2024A1515012426)
广州市科技计划项目(202102010156)。
关键词
甲状腺结节
细针穿刺细胞学
嗜酸细胞
诊断线索
Thyroid nodule
Fine needle aspiration cytology
Oncocytic cells
Differential diagnostic clue
