目的 探讨巨滤泡型甲状腺乳头状癌（macrofollicular variant of papillary thyroid carcinoma,MFPTC）的临床病理特点。方法 回顾分析3例MFPTC病人临床资料、病理形态学及免疫组织化学检测结果。结果 MFPTC超声检查主要表现为不规则强回声,血流丰富。显微镜下可见巨大滤泡,腔内富含胶质。滤泡上皮细胞核被挤压呈立方至扁平状。免疫组织化学显示与其他类型PTC相同。MFPTC的肿瘤上皮细胞CK19、galectin-3、HBME-1呈弥漫或部分阳性。结论 MFPTC在临床病理诊断中容易漏诊。结合临床资料,独特的组织学形态以及免疫组织化学检查有助于明确诊断。
Objective To investigate the clinicopathologic features of macrofollicular variant of papillary thyroid carcinoma (MFPTC). Methods Three cases with MFPTC were analyzed retrospectively for the clinical data, pathological morphology and the results by immunohistochemical detection. Results The ultrasonic examination showed MFPTC mostly as irregular strong hyperechoic nodules with abundant blood flow. Under the microscope, huge follicles could be observed and there was rich of colloid in the cavity of follicles. The nucleus of the follicular epithelium was extruded into a cubic or flattened form. MFPTC could be diagnosed similar to the other PTC by immunohistochemistry. The diffusive or partial distribution of positive expression of CK19, galectin-3, and HBME-1 was shown in the epithelium of MFPEC. Conclusions MFPTC was inclined to be miss-diagnosed in the clinics and pathology. With clinical data and the histomorphologic feature combined with immunohistochemical examination, MFPTC could be confirmed pathologically.
[1] Emad R, Maha A, Kfoury HK, et al.Three cases of macrofollicular variant of papillary carcinoma[J]. Ann Sandi Med,2011,31(6):644-647.
[2] Albores-Saavedra J, Gould E, Vardaman C, et al.The macrofollicular variant of papillary thyroid carcinoma:a study of 17 cases[J]. Human Pathol,1991,2(12):1195-1205.
[3] Albores-Saavedra J, Housini I, Vuitch F, et al.Macrofollicular variant of papillary thyroid carcinoma with minor insular component[J]. Cancer,1997,80(6):1110-1116.
[4] Yeo MK, Bae JS, Oh WJ, et al.Macrofollicular variant of papillary thyroid carcinoma with extensive lymph node metastases[J]. Endocr Pathol,2014,25(3):265-272.
[5] Lugli A, Terracciano LM, Oberholzer M.Macrofollicuclar variant of papillary carcinoma of the thyroid: a histologic, cytologic, and immunohistochemical study of 3 cases and review of the literature[J]. Arch Pathol Lab Med,2004, 128(1):54-58.
[6] Cardenas MG, Kini S, Wisgerhof M.Two patients with highly aggressive macrofollicular variant of papillary thyroid carcinoma[J]. Thyroid,2009,19(4):413-416.
[7] Erol V, Makay O, Ertan Y, et al.Papillary thyroid cancer, macrofollicular variant: The follow-up and analysis of prognosis of 5 patients[J]. J Thyroid Res,2014,2014, 818134.
[8] Loree TR.Therpaentic implications of prognostic factors in differentiated carcinoma of the thyroid gland[J]. Semin Surg Oncol,1995,11(3):246-255.
[9] Policarpio-Nicolas ML, Sirohi D.Macrofollicular variant of papillary carcinoma, a potential diagnostic pitfall: A report of two cases including a review of literature[J]. Cytojournal,2013,10:16.
[10] Chung D, Ghossein RA, Lin O.Macrofollicular variant of papillary carcinoma: a potential thyroid FNA pitfall[J]. Diagn Cytopathol,2007,35(9):560-564.
[11] De Vito C, Bongiovanni M, Triponez F, et al.Macrofollicular variant of follicular thyroid carcinoma: a case report[J]. Endocr Pathol,2013,24(3):167-168.
[12] Lloyd RV, Erickson LA, Casey MB, et al.Observer variation in the diagnosis of follicular variant of papillary thyroid carcinoma[J]. Am J Surg Pathol,2004,28(10):1336-1340.
[13] Wiseman SM, Melck A, Masoudi H, et al.Molecular phenotyping of thyroid tumors identifies a marker panel for differentiated thyroid cancer diagnosis[J]. Ann Surg Oncol,2008,15(10):2811-2826.
[14] Dencic TM, Savin SB, Selemetjev SA, et al.Strong expression of HBME-1 associates with high-risk clinicopathological factors of papillary thyroid carcinoma[J]. Pathol Oncol Res,2015,21(3):735-742.
[15] Rossi ED, Raffaelli M, Mule A, et al.Simultaneous immunohistochemical expression of HBME-1 and galectin-3 differentiates papillary carcinomas from hyperfunctioning lesions of the thyroid[J]. Histopathology,2006,48(7):795-800.
[16] Atik E, Guray M, Gunesacar R, et al.Immunohistoche-mical analysis of thyroid follicular neoplasms and BRAF mutation correlation[J]. Indian J Cancer,2014,51(1):63-68.
