Pathologic features of Hashimoto's-associated papillary thyroid carcinomas
Pathologic features of Hashimoto's-associated papillary thyroid carcinomas
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DOI：
10.1053/hupa.2001.21138
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发表时间：
2001-01-01
期刊：
影响因子：
3.3
通讯作者：
Palazzo, JP
中科院分区：
文献类型：
--
作者：
Di Pasquale, M;Rothstein, JL;Palazzo, JP
一些研究者发现桥本氏（自身免疫性）甲状腺炎（HT）患者甲状腺乳头状癌（PC）的发病率增加，这提出了这两种疾病之间可能不仅仅是偶然关联的可能性。在本研究中，我们分析了桥本氏相关甲状腺癌的病理，看看这些肿瘤是否表现出任何独特的特征。实性细胞结节作为肿瘤前病变在HT患者中的可能意义被研究，回顾16年来所有HT病例，发现30例PC和3例滤泡癌（FC），在PC中有7例（23%）滤泡变异体。20例（67%）PC表现为不同程度的瘤内纤维化，从厚的纤维间隔分隔肿瘤结节到纤维化几乎完全覆盖肿瘤，仅可见显微镜下残留的肿瘤巢。在大多数病例中，肿瘤内的结缔组织增生反应为纤维瘤样病变，有致密的透明化胶原和平淡的梭形细胞。所有肿瘤，无论纤维化程度如何，均表现为PC的核特征。肿瘤纤维化程度与肿瘤外甲状腺无相关性。肿瘤有明显纤维化，肿瘤外无纤维化。4例PC（13%）表现为囊性间隙，壁厚透明，局灶性乳头状增生，衬有扁平和立方上皮，使人联想到血管性肿瘤，有4个不典型的实性显微结节，细胞融合；其中2例伴PC，另外2例伴弥漫性HT，不伴PC。这些结节由细胞核清晰的细胞组成，偶有沟槽，无核假包涵体。通过免疫组化，3个结节中2个显示细胞角蛋白19的细胞质反应性，2个结节中RET/PTC（转染期间重排，乳头状甲状腺癌）抗体阳性。总之，ht相关的PC可能经常表现出明显的间质结缔组织增生和假血管模式，如果PC的细胞学特征由于肿瘤被纤维化明显闭塞而无法识别，这两种情况都会给诊断带来困难。不典型结节可能是HT患者PC的前兆病变。W.B. Saunders Company版权所有(C) 2001。
Some investigators have found an increased incidence of papillary carcinoma (PC) of the thyroid in patients with Hashimoto's (autoimmune) thyroiditis (HT), which raises the possibility that there may be more than an incidental association between these 2 diseases, In this study, we analyzed the pathology of Hashimoto's-associated thyroid carcinomas to see if these tumors showed any distinctive features. The possible significance of solid cellular nodules as preneoplastic lesions in patients: with HT was investigated, A review of all the cases of HT during a 16-year period yielded 30 PC and 3 follicular carcinomas (FC), Within the PC there were 7 (23%) follicular variants. Twenty (67%) of the PC showed various degree of intratumoral fibrosis, ranging from thick fibrous septa separating tumor nodules to almost complete obliteration of the tumor by the fibrosis, with only microscopic residual tumor nests. In most of the cases, the desmoplastic response within the tumors was of the fibromatosis-like type with dense hyalinized collagen and bland-appearing spindle cells. All the tumors, independently of the degree of fibrosis, showed the nuclear features of PC. No correlation was found between the degree of fibrosis in the tumors and the thyroid gland outside the tumors. There were tumors with marked fibrosis without fibrosis outside the tumors. Four cases of PC (13%) showed a growth pattern characterized by cystic spaces with thick hyalinized walls and focal papillary hyperplasia lined by flat and cuboidal epithelium, reminiscent of a vascular neoplasm, There were 4 atypical solid microscopic nodules with confluent cellularity; 2 of them associated with a PC and the other 2 with diffuse HT without PC, These nodules ere composed of cells with clear nuclei and occasional grooves without nuclear pseudoinclusions. By immunohistochemistry, 2 of 3 nodules showed cytoplasmic reactivity for cytokeratin 19, and 2 of 3 nodules were positive for the RET/PTC (rearrangcd during transfection, papillary thyroid carcinoma) antibody. In summary, HT-associated PC may frequently display prominent stromal desmoplasia and a pseudovascular pattern, both of which can present diagnostic difficulties if the cytologic features of PC are not recognized because of the marked obliteration of the tumor by the fibrosis. Atypical nodules may represent a precursor lesion of PC in patients with HT. Copyright (C) 2001 by W.B. Saunders Company.