Collagen Profiles and Architectural Analyses of the Stromal-Capsular Components of Thyroid Neoplasms Correlating with Their Invasive Capabilities and Differential Diagnosis

本研究的主要内容包括以下两个方面：一是对滤泡性肿瘤诊断方法的重新评价，提出了一种新的组织结构检查技术;另一个阐明了甲状腺肿瘤间质和包膜的胶原分布。14个包膜滤泡肿瘤被广泛解剖，没有切向切片，以代表整个包膜的周长，连续组织切片。对这些切片的全面评估将14例分为5个良性腺瘤，7个只有囊内血管浸润的包膜癌，2个具有局灶性囊浸润的微创癌，在这9个早期滤泡癌中，发现血管浸润至少在7个中发生多中心，并显示出地理上均匀的分布。在所有9个肿瘤的周围，发现血管浸润远多于包膜浸润 ...更多信息 早期癌症广泛解剖的多个切片有助于揭示微小但令人信服的血管浸润发现。此外，纤维包膜最大厚度为3.8 mm，包膜与实质之间的界面不规则，也是这些早期癌的特征。因此，在与38例类似的局部毛囊的先前情况下进行比较。随机组织切片中的肿瘤诊断为良性腺瘤（21例）和包膜癌或微侵袭癌（17例），广泛的包膜周围评估不仅可以有效区分具有轻微侵袭能力的滤泡性肿瘤和良性腺瘤，而且可以应用严格的标准充分评估侵袭性病灶。尽管上述所有腺瘤与早期癌的临床预后相似，但由于随访时间有限，本文介绍的广泛检查方法对于识别包裹性滤泡性肿瘤中的恶性肿瘤实际上是有用的和必要的。13例滤泡性肿瘤的免疫表型（5例腺瘤和8例微创癌）和27例乳头状癌的特征是聚焦于纤维囊或囊，比如基质中含有抗弹性蛋白和几种胶原蛋白肽的抗体。常规组织学染色和超微结构证实了这一发现。基底层样物质和弹性蛋白的丰富的层状分布被发现在滤泡性肿瘤的包膜特征，最明显的腺瘤，并出现局灶性或区域浸润性癌。在乳头状癌的包膜样间质中，完全缺乏这样的发现;相反，类似于一些滤泡状癌的纤维包膜中缺乏弹性蛋白的区域，I型和III型胶原的弥漫性沉积占上风。包膜是滤泡性肿瘤的独有特征，被认为是由于除了可能的宿主对扩张性生长的反应外，而对I型和III型胶原蛋白有反应的纤维组织的增加，显示出囊状-在乳头状癌和某些早期滤泡状癌中，类似的结构或在淋巴结内被认为是与浸润性生长有关的间质反应。少

The main stream of this research constitutes following two summaries : one focusing on the reassessment of diagnostic approaches on follicular neoplasms and proposing a new technique for a histoarchitectual examination ; and another clarifying the collagen profiles of stroma and capsule associated in thyroidal tumors.Fourteen encapsulated follicular neoplasms were extensively dissected without tangential sectioning to represent tHe circumference of the entire capsule on sequential histologic sections. A thorough evaluation of these sections divided the 14 cases into five benign adenomas, seven encapsulated carcinomas with only intracapsular angioinvasion, and two minimally invasive carcinomas with focal capsular invasion.Among these nine early-stage follicular carcinomas it was found that angioinvasion occurred multicentrically in at least seven and showed a geographically even distribution. Angioinvasion was found far more often than capsular invasion on the circumference of all nine … More early-stage carcinomas. Multiple sections produced by this extensive dissection aided the disclosure of minute but convincing findings of angioinvasion. Also, a fibrous capsule ds thick as 3.8 mm at maximum as well as an irregular interface between the capsule and parenchyna were often found to be characteristic in these early-stage carcinomas. Thus, upon comparison with 38 previous cases of similarly localized follicular. neoplasms in wlilch randomly sampled histologic sections yielded diagnoses of benign adenoma (21 cases) and encapsulated or minimally invasive carcinoma (17 cases), extensive circumferential evaluation of the capsule is considered to allow not only effective distinction of follicular neoplasm with slight invasive capability from benign adenoma but also adequate assessment of invasive foci with application of strictcriteria. Despite the similarity of clirilcal prognosis between all the above adenomas and early-stage carcinomous, given the limited followup period, an extensive examination method introduced herein is practically useful and necessary for identification of malignancy in encapsulated follicular neoplasms.Furthermore, the immunophenotypes of 13 follicular neoplasms (five adenoma and eight minimally invasive carcinoma) and 27 papillary carcinomas have been characterized focusing their fibrous capsule or capsule-like stroma with antibodies against elastin and several types of collagen peptide. The findings were reinforced with conventional histologic stains and ultrastructure. An abundant lamellar distribution of basal lamina-like substances and elastin was found characteristic in the capsule of follicular neoplasms, most pronounced in adenoma, and appearing focally or in zones in invasive carcinoma. In the capsule-like stroma of papillary carcinoma, such findings were totally lacking ; instead, similar to the zones lacking elastin in the fibrous capsule of some follicular carcinomas, diffuse deposits of type I and III collagen prevailed. The capsule, an exclusive feature of follicular neoplasms, is considered to result from accumulation of compressed paraneoplastic interstitial constituents in addition to a possible host reaction against the expansile growth, whereas the increase of fibrous tissues reactive for types I and III collagen showing either a capsule-like architecture or within the interstitium is considered to be a stromal reaction related to the invasive growth in papillary carcinoma and some earlv follicular carcinomas. Less