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- 甲状腺乳头状癌的诊断
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| 肉眼检查： | |||||
ORIGINAL ARTICLE
Diagnostic utility of CD56 immunohistochemistry in papillary carcinoma
of the thyroid
Dina El Demellawya,, Ahmed Lotfy Nasrb, Slim Babaya, Salem Alowamic
Diagnosis of papillary thyroid carcinoma (PTC), in many but not all cases, is an easily achievable diagnosis with
almost minimal interobservable variability between pathologists. However, some cases of PTC, particularly the
follicular variant, are quite challenging and show wide interobservable variability even among expert thyroid
pathologists. Since proper diagnosis of PTC is crucial as it affects patients’ clinical management and prognosis,
indications of PTC must be clearly apparent to be an objective rather than a subjective diagnosis. Unfortunately, to
date, immunohistochemistry and molecular studies have failed to fully solve this problem. In this study, we assessed
the protein expression and loss using antibodies against CD56 in normal follicular thyroid epithelium, follicular
thyroid lesions, and follicular thyroid neoplasms in an attempt to evaluate its diagnostic value. A total of 185 cases
were studied with tissues from 75 carcinomas (72 papillary, 2 follicular, 1 Hu¨rthle cell) and 35 adenomas (32 follicular
and 3 Hu¨rthle cell) evaluated by immunohistochemistry for the expression of this marker. Non-neoplastic thyroids
included 65 cases: nodular hyperplasia (n ¼ 25), thyrotoxic hyperplasia (Grave’s disease) (n ¼ 5), lymphocytic
thyroiditis (n ¼ 19), and Hashimoto’s thyroiditis (n ¼ 6). Ten cases of normal thyroids from radical laryngectomies for
laryngeal squamous cell carcinomas were also studied.
The marker pattern and intensity of staining were scored. Positive expression of the markers in 10% or more of
follicular epithelium within the tumor or lesional cells was considered positive. An expression ofo10% was considered
to be negative. Diffuse CD56 expression was consistently present in normal, lesional, and neoplastic follicular
epithelium, except for PTC, including the follicular variant. We concluded that CD56 is of value to distinguish PTC
from other thyroid follicular pathology/histology with a sensitivity of 100% and a specificity of 100%. We suggest that
CD56 is extremely useful in the diagnosis of PTC, including the follicular variant, and to distinguish it from other
follicular cell-derived thyroid tumors/lesions. Application of CD56 by a group of expert pathologists on a larger series
of follicular thyroid neoplasms of uncertain malignant potentials may potentially provide an objective diagnostic tool.
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Papillary carcinoma of the thyroid (PTC) is the commonest thyroid cancer. In the recent decades an obvious
increase in the incidence of PTC has occurred. The pathological diagnosis of PTC is usually an easy diagnosis in
the majority of cases. However since the introduction of follicular variant of PTC and the wide threshold range
in interpretation of the clearly set pathological criteria for diagnosis of PTC, between pathologists including
experts, the diagnosis in some cases became quite difficult. Unfortunately some cases are unjustifiably over-called
as follicular variant of PTC as a result of the wide inter observable variability between pathologists, including
thyroid pathologists.
Ancillary studies such as immmunohistochemistry may be helpful, but till now there is no 100% consistent
marker(s), that distinct between PTC and other follicular thyroid lesions and tumors.
We assessed expression of antibodies against CD56, CK19, P63 and E-Cadherin in PTC and other follicular
thyroid lesions and neoplasms. A total of 175 cases were studied. The neoplastic cases included 75 carcinomas
(72 papillary, 2 follicular, 1 Hurthle cell) and 35 adenomas (32 follicular and 3 Hurthle cell). The non-neoplastic
thyroids included 65 cases, (25 nodular hyperplasia, 5 thyrotoxic hyperplasia (Grave's disease), 19 lymphocytic
thyroiditis and 6 Hashimoto's thyroiditis). All cases were evaluated by immunohistochemistry for the expression
of the above mentioned markers. The markers' patterns and intensities of staining were scored. Positive
expression of the markers equal or >10% of the follicular epithelium within the tumor or lesional cells was
considered positive. An expression of <10% was considered to be negative.
Our results showed CD56 positive in all the lesions and tumors except for PTC in all cases (100%). CD56 was
negative in all PTC cases (100%). CK 19 showed positive expression in PTC accounting for 85% of cases and in
26% of non PTC lesions/tumors. P63 showed selective focal positivity in PTC cases, in contrast to other non PTC
lesions/tumors. P63 expression was in 70% of cases of PTC and was consistently absent in all the non PTC cases.
E-Cadherin showed consistent non discriminatory expression in all cases included in the study.
We concluded that a panel consisted of CD56, CK19 and P63 is of value in distinction of PTC from other thyroid
follicular lesion. P63 is a specific but less sensitive marker for PTC than CK19. CD56 is more specific and sensitive
marker than CK19, however it is a negative rather than a positive marker for PTC. E-Cadherin is of no value in
the diagnosis of thyroid follicular lesions/tumors. We recommend application of a panel composed of CK19, P63
and CD56 by a group of expert thyroid pathologists on a large series of follicular malignant thyroid neoplasms of
uncertain malignant.
