甲状腺髓样癌术中冰冻诊断及病理分析

摘要

目的：探讨甲状腺髓样癌（MTC）的临床病理特点及术中冰冻诊断特征，以提高对其诊断的准确性。方法收集甲状腺髓样癌患者11例，分析其临床资料、手术中冰冻与常规组织形态学比较及免疫表型，并结合文献进行讨论。结果11例患者中9例因颈部肿块就诊，其中1例体检发现，1例因 CEA 增高就诊。散发型 MTC 9例，家族性 MTC 2例。所有患者均行术中冰冻诊断。肿瘤组织主要由多角型细胞及梭形细胞组成，细胞异型性不一，组织学构型以巢状和束状为主，少数可形成滤泡结构及假乳头状结构，9例可见淀粉样物质，10例可见浸润周围正常甲状腺组织，1例伴有微小包膜浸润。免疫组化显示，CT 11例阳性， CgA、CEA 8例阳性，SYN 7例阳性，TG 均阴性。结论 MTC 具有多向分化和产生多种神经内分泌物质的特点，明确诊断主要依靠病理及免疫组化检查；冰冻诊断中，根据其浸润性生长、组织结构及仔细寻找淀粉样物质非常关键。%Objective To investigate the clinicopathological characteristics and the frozen section diagnosis of me-dullary thyroid carcinoma(MTC). Methods The 11 cases of MTC from Jan 2008 to Dec 2014 were retrospective ana-lyzed. The clinicopathological data,the frozen section diagnosis,the histopathological examination and immunohisto-chemistry were analyzed,and the related literature were reviewed. Results The syndrome in the 9 patients were cervi-cal mass,1 case showed serum CEA elevation. Sporadic type of MTC was found in the 9 cases,and familial type in the 2 case. The frozen section diagnosis had done in all the patients. The tumors were composed of polygonal or spindle cells with nest-like or fascicular structure. Occasionally,the tumor showed tubular,follicular or papillary structure. There was amyloid in the 9 cases of MTC. The 10 cases of MTC infiltrated the normal thyroid follicle,and 1 case had a micro-capsular infiltration. Immunohistochemical results showed CT positive in all case;8 cases were positive for CEA and CgA;7 cases were positive for SYN;TG was negative in all the cases. Conclusion MTC are multiple-differentia-ted tumor and it can produce numerous neuroendocrine hormones;the diagnosis of MTC depended on histopathological examination and immunohistochemistry. Infiltration of normal thyroid follicle,histological structure and finding of amy-loid is the most important in the frozen section diagnosis.