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lantian0508 离线
姓 名: | ××× | 性别: | 女 | 年龄: | 27 |
标本名称: | 左侧甲状腺包块。 | ||||
简要病史: | |||||
肉眼检查: | 灰红色肿块1个,2cmx2cmx1.5cm,切面灰红色,有包膜。 |
镜下见:甲状腺滤泡呈腺瘤样增生,局部滤泡穿破包膜向周围生长,细胞异型不明显,未见血管侵犯。免疫组化:CK19+,MC+,galectin-3+,TPO+,bcl-2+,CD31和CD34未见血管侵犯依据。直径2cm的包块做成5个蜡块全部包埋,做连续切片,仅在两张切片看到三点灶状浸润包膜区域,深切片浸润灶消失,未见明确的血管浸润,细胞异性型不明显。请发表你的意见,谢谢。
lantian0508 离线
以下是引用lantian0508在2010-5-8 20:15:00的发言:
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尽管下文比较笼统区分甲状腺良恶性滤泡上皮肿瘤,但在实践中,乳头状癌标记CK19和HBME-1多为弥漫性强阳性。
Cytojournal. 2009 Sep 18;6:18.
Saleh HA, Feng J, Tabassum F, Al-Zohaili O, Husain M, Giorgadze T.
Department of Pathology, Wayne State University, Sinai-Grace Hospital, Detroit, MI, USA. hsaleh@dmc.org
BACKGROUND: Fine needle aspiration biopsy (FNAB) is a common and excellent procedure for the evaluation of thyroid lesions that require surgical resection. At times, the FNAB diagnosis can be difficult, particularly of follicular-patterned lesions. Previous studies have shown that some immunohistochemical (IHC) markers may be helpful in establishing more accurate diagnosis. In this study, our goal was to evaluate four of the recently investigated markers in differentiating benign from malignant thyroid nodules on FNABs. MATERIALS AND METHODS: We performed IHC staining of galectin-3, Ret oncoprotein (Ret), HBME-1, and cytokeratin 19 (CK19), on cell block sections of thyroid FNAB cases that had corresponding surgical resections. They included 44 benign lesions (37 hyperplastic or cellular nodules, HN; and 7 follicular adenomas, FA) and 27 malignant tumors (6 follicular carcinoma, FC; 19 classic papillary carcinoma, PTC; and 2 follicular variant of papillary carcinoma, FVPC). The stains were done according to the standard avidin-biotin-peroxidase method. RESULTS: Statistical analysis showed that immunoexpression was significantly higher in the malignant group for all four markers. The sensitivity for positive expression for all benign lesions versus malignant tumors was as follows: 10/44 (22.7%) versus 25/27 (92.6%) for galectin-3; 14/44 (31.8%) versus 23/27 (85%) for Ret; 12/44 (27.3%) versus 24/27 (88.8%) for HBME-1; and 13/44 (29.5%) versus 23/27 (85%) for CK19. The sensitivity and specificity was highest for galectin-3 (92.6% and 77.3%, respectively) followed by HMBE-1 (88.9% and 72.7%, respectively). When combining the markers' expressions, the panel of galectin-3 + HBME-1 showed the highest sensitivity and specificity (90.7% and 75%, respectively), but this was, however, lower than galectin-3 alone (92.3% and 77.3%, respectively). CONCLUSION: We conclude that galectin-3 is the best single marker in differentiating benign from malignant thyroid lesions with the highest sensitivity and specificity. The galectin-3 + HBME-1 was the best combination for distinguishing benign from malignant lesions. Because they were the best two independent and combined markers, we recommend the use of the galectin-3 + HBME-1 panel to enhance the diagnostic accuracy of follicular-patterned thyroid lesions on FNABs.
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