学习中，总结的非常经典！

 Dr.Chan写于2009年的甲状腺乳头状癌诊断标准：
TABLE 44-10
Key Points and Caveats in Diagnosis of Papillary Carcinoma

Diagnostic Criteria for Papillary Carcinoma

Based on a constellation of features, no single one of which is
pathognomonic. For a noninvasive tumor, the diagnostic label papillary
carcinoma should be applied only when the typical cytologic features are well developed.
Basic Criteria
1.  Cytologic features: ovoid nuclei that are crowded, without polarization,
clear or pale, and grooved, with or without pseudoinclusions
2. demonstration of vascular or capsular invasion not required
Strong Supporting Feature, if Present
1.  Psammoma bodies
Other Supporting Histologic Features
1.  Papillae (including abortive papillae)
2.  Follicles that are elongated or irregularly shaped
3. dark-staining colloid
4. multinucleated histiocytes in lumens of follicles or papillae
Deceptively “Benign” Patterns Warranting Serious Consideration of
the Possibility of Papillary Carcinoma
1.  “Colloid nodule” with delicate papillary budding in some follicles, or
psammoma bodies, or many clear nuclei (papillary carcinoma,
macrofollicular variant)
2.  Picture resembling Hashimoto’s thyroiditis or lymphocytic thyroiditis, 
but with many “knife marks” on the histologic section because of the
presence of psammoma bodies (diffuse sclerosing variant of papillary
carcinoma)
3.  “Follicular adenoma” with many elongated follicles and dark-staining
colloid or abortive papillae (papillary carcinoma, encapsulated follicular
variant)
4.     “Degenerate    cyst”    but    with    occasional    small    papillary    tufts    projecting    into   
the lumen or some follicles in the fibrous wall lined by cells with high
nuclear-to-cytoplasmic ratio (cystic variant of papillary carcinoma)
5.  Spindle cell proliferation resembling nodular fasciitis or fibromatosis
(papillary carcinoma variant with exuberant nodular fasciitis–like stroma)

 谢谢，学习了

 Translation of 63 Floor, thanks to Dr. zhanghx (sorry that my Chinese input doesnot work now)

乳头状癌诊断：关键特点和注意事项
乳头状癌的诊断标准
应根据多个特征综合判断并作出诊断，任何单个特征都不足以诊断。对于非浸润性肿瘤，唯有充分形成典型的细胞学特征，才能诊断为乳头状癌。
一、基本标准：
1.细胞学特征：卵圆形核，拥挤，无极性，透明或淡染（毛玻璃样），核沟，有或无假包含体。
2.不需要证实血管或包膜侵犯
二、如果出现，则强力支持乳头状癌：
1.砂粒体
三、其他支持诊断的组织学特征：
1.乳头（包括流产型乳头）
2.滤泡拉长，或形状不规则
3.胶质深染
4.滤泡腔内或乳头内出现多核组织细胞
四、强力提示乳头状癌可能性的欺骗性“良性”表现：
1.“胶质结节”伴部分滤泡内出现纤细的乳头状上皮芽，或砂粒体，或许多透明核（乳头状癌，微滤泡亚型）
2.图象类似Hashimoto甲状腺炎或淋巴细胞性甲状腺炎，但由于存在砂粒体，切片上有很多“刀痕”（乳头状癌，弥漫性硬化性亚型）
3.“滤泡性腺瘤”伴很多拉长滤泡和深染胶质或流产乳头（乳头状癌，包膜型滤泡亚型）
4.“退变的囊肿”但有少量乳头状突起伸向腔内，或纤维囊壁上的部分滤泡被覆着高核/质比的细胞（乳头状癌，囊性亚型）
5.梭形细胞增生，类似结节性筋膜炎或纤维瘤病（伴丰富的结节性筋膜炎样间质的乳头状癌亚型）

 大大的受益了！

前几天刚好还遇到一个甲状腺的标本，在癌与不癌中纠结了数天，现在看了各位老师的贴，真的是受益匪浅，太谢谢老师们了！

 

学习了，谢谢老师。

谢谢各位老师了

 

学习了，谢谢！