非常好，讲解详细，图文并茂，学习！谢谢zhongshihua老师！

另外补充陈国璋教授总结的诊断标准（曾有朋友疑惑：诊断癌是不是一定要有浸润？本病即是例证） 

甲状腺乳头状癌（PTC）的定义：
滤泡细胞分化的证据
典型者有乳头和滤泡结构
核的特征：毛玻璃样或苍白；核增大；形状不规则；深的核沟；假包涵体

包膜/血管侵犯不是必需的！

主要诊断标准：
1.核呈卵圆形，而不是圆形
2.核拥挤重叠（"上窜下跳"，无极性）
3.核染色质苍白或透明（直至毛玻璃样），或明显核沟
4.砂粒体（鉴别：胶质钙化）
次要诊断标准：
1.流产型乳头
2.大部分滤泡拉长或形状不规则
3.胶质深染
4.核内假包涵体
5.滤泡腔内多核组织细胞

诊断PTC的严格标准：
≥3个主要标准
或2个主要标准加≥4个次要标准

 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

 谢谢abin的完美补充！

 好东东，快来学习。

 学习，谢谢zhong老师和abin老师的讲解。

 谢谢老师们

 好东东，因该加精。标准应该牢记。

 谢谢

 

 

 谢谢，学习！

 经典

 

 

 great work! thanks for your good job.

 

Papilla should have fibrovascular core as shown on the first 2 pictures.

 

Nice photos. 

 学习了！