摘要
目的探讨NTRK重排甲状腺乳头状癌(NTRK-rearranged papillary thyroid carcinomas,NRPTC)临床病理、免疫表型及分子遗传学特征。方法收集176例甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的临床资料,采用免疫组化Optiview法检测pan-TRK的表达,应用荧光定量PCR检测pan-TRK阳性者的NTRK基因重排情况,获得7例NRPTC,回顾性分析7例NRPTC的临床病理学、免疫表型及分子遗传学特征。结果7例NRPTC中,男女比为3∶4,平均34.29岁。肿瘤最大径0.8~3.5 cm。7例NRPTC均呈多结节样生长,由滤泡、实性、伴或不伴乳头混杂生长,其中5例以滤泡为主,1例乳头为主,1例实性为主。7例中6例可见肾小球样结构,2例乳头水肿和(或)胶原变性;7例胞质均淡染,2例可见乳头核极性反转。4例可见脉管内癌栓,5例侵犯甲状腺外组织。肿瘤背景甲状腺大部分呈淋巴细胞性甲状腺炎改变,其余为结节性甲状腺肿或无明显异常。7例NTRK重排阳性者pan-TRK免疫组化均为2+或3+,且BRAF V600E均未突变。荧光定量PCR示:6例为NTRK3重排,1例为NTRK1重排。7例NRPTC随访7~33个月,有4例颈部淋巴结转移,2例肺转移。结论NRPTC临床表现具有侵袭性,淋巴结转移率高,部分病例可发生远处转移。镜下大多呈浸润性、多结节状生长,以滤泡结构为主,胞质常淡染。常伴甲状腺内外淋巴管、血管播散。pan-TRK免疫组化结合BRAF V600E突变检测可以作为NRPTC的初筛方法。
Purpose To analyze the clinical,pathological,immunohistochemical and molecular features of NTRK-rearranged papillary thyroid carcinomas(NRPTC).Methods The clinical data of 176 cases of papillary thyroid carcinoma(PTC)were collected.The expression of pan-TRK was detected by immunohistochemistry(Optiview method),and the NTRK gene rearrangement of pan-TRK positive was detected by fluorescent quantitative PCR.7 cases of NRPTC were obtained,and their clinical,pathological,immunophenotypic and molecular characteristics were analyzed retrospectively.Results Among the 7 NRPTCs,the ratio of male to female was 3∶4,with an average age of 34.29 years.The maximum diameter of the tumor was 0.8 to 3.5 cm.Under the microscope,7 cases of NRPTC showed multinodular growth,mixed growth of follicles,solid,with or without papilla,of which 5 cases were follicles predominantly,1 case was papillary predominantly,and 1 case was solid predominantly.Among the 7 NRPTCs,glomerular-like structures were seen in 6 cases,papilledema and/or collagen degeneration in 2 cases.Cytoplasm was slightly stained in 7 cases,and papillary nucleus polarity reversal was seen in 2 cases.Intravascular tumor thrombus was seen in 4 cases,and tumor invaded the extrathyroidal tissue in 5 cases.Most of the thyroid glands in the tumor background showed lymphocytic thyroiditis,and the rest were nodular goiter or had no obvious abnormality.Seven patients with NTRK rearrangement were positive for pan-TRK immunohistochemistry 2+or 3+,and BRAF V600E was not mutated.Fluorescence quantitative PCR showed that 6 cases were NTRK3 rearrangement and 1 case was NTRK1 rearrangement.Following-up for 7-33 months showed that 4 cases had cervical lymph node metastasis and 2 had lung metastasis of the 7 NRPTC.Conclusion The clinical manifestations of NRPTC are aggressive,with a high rate of lymph node metastasis,and distant metastasis occurs in some cases.Microscopically,most of them show infiltrative,multinodular growth,mainly follicular structure,and the cytoplasm is often slightly stained.It is often accompanied by intra-and extra-thyroidal lymphatic vascular spread.Pan-TRK immunohistochemical staining combined with BRAF V600E mutation status can be used as a primary screening method for NRPTC.
作者
张丽
任彩虹
陈余朋
张声
郑珂
ZHANG Li;REN Cai-hong;CHEN Yu-peng;ZHANG Sheng;ZHENG Ke(Department of Pathology,the First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China)
出处
《临床与实验病理学杂志》
CAS
CSCD
北大核心
2022年第9期1078-1083,共6页
Chinese Journal of Clinical and Experimental Pathology
关键词
甲状腺乳头状癌
NTRK重排
免疫组织化学
临床病理特征
papillary thyroid carcinoma
NTRK-rearranged papillary thyroid carcinomas
immunohistochemistry
clinicopathologic feature
