Cribriform-morular variant of papillary thyroid carcinoma: Clue to early detection of familial adenomatous polyposis-associated colon cancer
Cribriform-morular variant of papillary thyroid carcinoma: Clue to early detection of familial adenomatous polyposis-associated colon cancer
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DOI：
10.1007/s00268-004-7475-4
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发表时间：
2004-09-01
影响因子：
2.6
通讯作者：
Kakudo, K
中科院分区：
文献类型：
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作者：
Tomoda, C;Miyauchi, A;Kakudo, K
甲状腺乳头状癌(PTC)的筛状-桑拿型(CMV)是一种罕见的PTC组织学亚型，表现为筛状和梭形细胞区的组合生长模式。这种独特的组织学特征的甲状腺癌最初是在家族性腺瘤性息肉病(FAP)患者中发现的，尽管后来在没有息肉病的患者中也发现了这种情况。由于其罕见，其临床特征尚不清楚。我们回顾了1991年6月至2003年3月间在我们病理报告的4194例PTC患者中发现的7例CMV-PTC患者。CMV在所有PTC中的患病率为0.16%。我们邀请这些患者来我们医院，这样我们就可以获得详细的家族史，并建议进行结肠镜检查和胚系APC基因分析。两名没有主观症状的患者患有结肠癌和结肠癌息肉。两例患者均发现APC基因的胚系突变。据透露，一名拒绝邀请的患者的父亲接受了结肠息肉手术。其余4例患者均未发现息肉病或APC基因突变。常见的临床特征包括年龄较小(平均25岁)，以女性为主，肿瘤局限，无淋巴结转移，甲状腺癌术后无复发。3例结肠息肉病患者中有2例为双侧多发性甲状腺肿瘤，其余4例(无息肉病)为单发肿瘤。PTC患者巨细胞病毒的组织病理学改变应引起对FAP的怀疑，特别是如果有多个肿瘤的话。这一发现可以导致结肠癌的早期发现。
The cribriform-morular variant (CMV) of papillary thyroid carcinoma (PTC) is a rare histologic subtype of PTC that shows a combination of growth patterns including cribriform and spindle cell areas. The thyroid cancer with this unique histology was originally reported in patients with familial adenomatous polyposis (FAP), although it was later found in patients without polyposis as well. Because of its rarity, its clinical features are not clear. We reviewed seven patients with CMV-PTC who were found among 4194 patients with PTC in our pathology riles between June 1991 and March 2003. The prevalence of CMV was 0.16% among all PTCs. We invited these patients to our hospital so we could obtain a detailed family history and recommend colonoscopic examination and germline APC gene analysis. Two patients without subjective symptoms had polyposis of the colon and colon cancers. Germline APC gene mutations were found in both patients. The father of a patient who refused the invitation was revealed to have undergone surgery for colon polyposis. In the remaining four patients, neither polyposis nor APC gene mutation was found. Common clinical features included a young age (mean 25 years), predominance of females, circumscribed tumors, negative node metastasis, and no recurrence of the thyroid cancer after surgery. Two of the three patients with colon polyposis had bilateral multiple thyroid tumors, whereas the remaining four (without polyposis) had a solitary tumor. The histopathology of CMV in patients with PTC should arouse a suspicion of FAP, especially if there are multiple tumors. This finding can lead to early detection of colon cancer.