Cribriform-morular variant of papillary carcinoma: a distinctive variant representing the sporadic counterpart of familial adenomatous polyposis-associated thyroid carcinoma?
Cribriform-morular variant of papillary carcinoma: a distinctive variant representing the sporadic counterpart of familial adenomatous polyposis-associated thyroid carcinoma?
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乳头状癌的筛状-桑叶变异：一种独特的变异，代表家族性腺瘤性息肉病相关甲状腺癌的散发对应物？
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发表时间：
1999
期刊：
影响因子：
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通讯作者：
J. Chan
中科院分区：
文献类型：
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作者：
J. Cameselle;J. Chan
我们在此描述了四例不寻常的散发性甲状腺肿瘤，其具有独特的滤泡细胞肿瘤的形态学特征，先前提出作为家族性腺瘤性息肉病的可行指标。我们还回顾了文献中报道的其他五个类似案例。这9名患者均为年轻女性，年龄在16岁至30岁之间。肿瘤的大体尺寸为 1.5 至 5.6 厘米；它们是实性且孤立的，除了一例显示两个肿瘤结节，每个肺叶一个。组织学上，病变被包封，表现出筛状、滤泡状、乳头状、小梁状和实体生长模式的复杂混合，以及桑葚状（鳞状）区域。筛状结构很明显，是在没有纤维血管基质介入的情况下由细胞的网状条和拱形成的。毛囊区域通常没有胶体，乳头排列有柱状细胞。存在小梁排列的焦点区域，让人想起透明变性小梁腺瘤。肿瘤细胞呈立方形或高，具有频繁的核假复层和丰富的嗜酸性至嗜氧性细胞质。细胞核通常深染，但不同程度地存在核沟、苍白或透明的细胞核以及核内细胞质包涵体。肿瘤中散布着由生物素积累引起的具有特殊核清除的桑葚。除1例外，其余病例均有血管和/或被膜侵犯，2例发现淋巴结转移。免疫组织化学染色显示甲状腺球蛋白、上皮膜抗原、细胞角蛋白（包括 34betaE12）、波形蛋白、雌激素和孕激素受体、bcl-2 和 Rb 蛋白的反应性。对 7 例病例的随访显示，所有患者在诊断后 1 至 13 年内均存活，没有任何疾病证据。因此，这种变异的行为似乎与传统乳头状癌相似，由于其独特的组织学特征，我们建议将这种肿瘤命名为乳头状癌的筛状-桑花状变异。
We describe herein four cases of an unusual sporadic thyroid tumor that shares the morphologic features of a distinctive follicular cell neoplasm previously proposed as a feasible indicator of familial adenomatous polyposis. We also review five other similar cases reported in the literature. All of the nine patients were young women, aged 16 to 30 years. Grossly, the neoplasms measured 1.5 to 5.6 cm; they were solid and solitary, except one case, which showed two tumor nodules, one in each lobe. Histologically, the lesions were encapsulated, and they exhibited an intricate blending of cribriform, follicular, papillary, trabecular, and solid patterns of growth, with morular (squamoid) areas. Cribriform structures were prominent, being formed by anastomosing bars and arches of cells in the absence of intervening fibrovascular stroma. Follicular areas were usually devoid of colloid, and the papillae were lined by columnar cells. There were focal areas of trabecular arrangement reminiscent of hyalinizing trabecular adenoma. The tumor cells were cuboidal or tall, with frequent nuclear pseudostratification and abundant eosinophilic-to-oxyphilic cytoplasm. The nuclei were usually hyperchromatic, but nuclear grooves, pale or clear nuclei, and intranuclear cytoplasmic inclusions were variably present. Morules with peculiar nuclear clearing caused by biotin accumulation were scattered in the tumors. Vascular and/or capsular invasion were noted in all of the cases except one, and lymph node metastasis was found in two cases. Immunohistochemical stains showed reactivity for thyroglobulin, epithelial membrane antigen, cytokeratins (including 34betaE12), vimentin, estrogen and progesterone receptors, bcl-2, and Rb proteins. Follow-up in seven cases showed that all of the patients were alive with no evidence of disease at 1 to 13 years after diagnosis. Thus, the behavior of this variant seems to be similar to that of conventional papillary carcinoma Because of the distinctive histologic features, we propose naming this tumor the cribriform-morular variant of papillary carcinoma.