摘要
目的探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)癌旁非典型性滤泡的形态学特征、分布状况及临床病理意义。方法采用EliVision法观察50例PTC癌旁Galectin-3阳性标记的非典型性滤泡的分布特征与组织形态。同时采用半定量评价不典型滤泡的分布密度,分析其与癌旁淋巴细胞浸润、肿瘤多中心性生长、腺外浸润及淋巴结转移间的关系。结果 50例PTC的癌旁组织中94%(47/50)检测到Galectin-3阳性标记的非典型性滤泡。滤泡常失去圆润轮廓,呈滤泡拉长或边缘成角现象。滤泡腔内胶质缺失,偶见胶质深红染,部分滤泡腔内见多核巨细胞。滤泡上皮胞质增多、淡染,胞核体积略增大,染色质细腻,核仁易见(1～2个)。核重叠常见,而核沟与核分裂象少见,未见核内假包涵体。非典型性滤泡呈多灶性、非连续分布,其分布密度为4.63灶/10 HPF,少数病例非典型性滤泡与癌组织间有组织学移行。非典型性滤泡的分布密度与癌旁淋巴细胞浸润(P=0.000)及PTC多中心性生长(P=0.002)明显相关。当其分布密度达7.5灶/10 HPF时,对PTC多中心性生长的诊断特异性达91%。结论 (1)多数PTC癌旁组织中存在Galectin-3阳性标记的非典型性滤泡,呈不完全性PTC样的形态学特征。(2)伴免疫性甲状腺炎的癌旁组织中非典型性滤泡分布密度明显升高,支持甲状腺炎对PTC发生的潜在诱导作用。(3)多灶性分布的非典型性滤泡可能是多中心性PTC组织发生的基础,评价癌旁非典型滤泡的分布密度,有助于提示临床PTC多中心性生长的风险。(4)非典型性滤泡的分布密度较好地阐释了免疫性甲状腺炎与PTC多中心性生长间的相关性。
Purpose To observe the distribution and histological features of atypical follicles in peritumoral tissue of PTC and evaluate their clinicopathologic significance. Methods Immunostaining of galectin-3, a widely recognized marker of PTC, was performed for the recognition of atypical follicles in peritumoral tissue from 50 cases of conventional PTC. Semi-quantitative evaluation of the density of atypical follicles was conducted. The associations between the density of atypical follicles and lymphocyte infihration in peritumoral tissue, tumoral muhicentricity, extrathyroidal invasion, and lymph node metastasis were analyzed, respectively. Results Among 50 cases of PTC, 94% （47/50） showed Galectin-3-positive atypical follicles in the peritumoral tissue. The atypical follicles were general- ly smaller than the normal thyroid follicles, some lost the round contours and showed stretched shapes with sharp edges. Nuclear en- largement, optically clear nuclei and nuclear overlapping could be observed in the atypical follicular epithelium, but no nuclear pseud- oinclusions were found. The distribution of atypical follicles demonstrated muhifocal and non-consecutive characteristics, with an aver- age density of 4.63 foci/10 low-power fields. The density of atypical follicles in the cases with lymphocyte infiltration in peritumoral tis- sues was significantly higher than that of cases without lymphocyte infiltration （P = 0. 000）. Furthermore, the density of atypical folli- cles in the samples showing multicentricity of PTC was also higher than that of the solitary PTC samples （P = 0. 002）. Conclusions （ 1 ） Most cases of PTC contain galectin-3-positive atypical follicles in the peritumoral tissues, which morphologically display incomplete PTC-like nuclear alterations and changes in the shape of follicle. （2） The increased density of atypical follicles associated with the in- flammatory background further supports the role of inflammation on the pathogenesis of PTC. （3） The muhifocal and non-consecutively distributed atypical follicles might be the underlying histological origin of muhicentric PTC. （4） Furthermore, the density of atypical follicles provides reasonable explanations, from the morphological viewpoint, for the well-established association between multicentric PTC and thyroiditis since it is upregulated in both circumstances.
出处
《临床与实验病理学杂志》
CAS
CSCD
北大核心
2013年第2期180-185,共6页
Chinese Journal of Clinical and Experimental Pathology
