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性别 | 女 | 年龄 | 32岁 | 临床诊断 | 右侧甲状腺包块性质待查(甲状腺腺瘤 ?) |
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一般病史 | 发现右侧颈颈部无痛性包块20天。CT示:右侧甲状腺实质内见低密度占位表现;B超示:右侧甲状腺囊实混合性肿块声像(考虑甲状腺瘤,性质待查)。 | ||||
标本名称 | 右侧甲状腺包块 | ||||
大体所见 | 灰红色甲状腺组织一块,大小:4x3x2.5cm。切面见3x2x1cm囊腔,囊内容物灰白梁状。 |
诊断思路:囊肿内部的乳头状增生的滤泡上皮,特别是向着囊内生长的乳头状上皮,要特别注意和结节性甲状腺肿相鉴别;主要是诊断为包膜内乳头状癌和乳头状癌滤泡亚型的包膜内滤泡性乳头状癌时,
1、包膜内乳头状癌:可伴有淋巴结转移,具有乳头状癌核的特征;The papillary areas are largely limited to the area facing the cystic cavity. The follicular cells tend to be low columnar, with basally located normochromatic or hyperchromatic nuclei (instead of the centrally located, optically clear nuclei of papillary carcinoma)主要和结节性甲状腺肿中的良性乳头状结构鉴别(图1和图2所示)。
2、包膜内滤泡性乳头状癌:This tumor type, which has become the single most common source of consultation material in thyroid pathology and the subject ofconsiderable controversy, can be defined as a neoplasm surrounded by a capsule and having the cytoarchitectural features of papillary carcinoma, especially as far as the nuclei are concerned;(主要和良性滤泡结节鉴别,见图3);To make a diagnosis of this variant, the nuclear alterations should be widespread and well developed, and some supportive features (such as intratumoral sharply defined fibrohyaline bands, elongated and branching follicles, abortive follicles, and dense eosinophilic colloid) should be present;
3、以下三张图都不能诊断乳头状癌(结节性增生);本例的拍图质量太差,无法诊断,诊断的关键还是看核的特征(毛玻璃或透明、核内包涵体,砂粒体,间质纤维化,核沟,核分裂应该罕见或无,无核仁),且达到一定的数量,而不是局部的细胞学特征。
4、抛砖引玉,供参考!图片来源于阿克曼第十版。