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- 甲状腺肿物一例，兼谈甲状腺乳头状癌的诊断标准
Histomorphologic Features of Papillary Carcinoma
Architectural Features
1. Growth patterns:
- papillary, follicular, solid, trabecular, organoid; multiple growth patterns can occur;
2. Elongated or twisted follicles with little colloid;
3. Psammoma bodies;
4. Intratumoral irregular fibrosis;
5. Inspissated colloid (darker appearing colloid as compared to the surrounding thyroid).
6. Papillary protrusions into follicles;
7. Squamous metaplasia
Cytomorphologic Features
1. Nuclear enlargement;
2. Nuclear irregularities in size and shape;
3. Dispersed to optically clear appearing ("Orphan Annie") nuclear chromatin;
4. Margination of the chromatin along the nuclear membrane;
5. Loss of nuclear basal polarity with haphazardly arrayed nuclei within the cell;
6. Crowding and overlapping nuclei;
7. Eosinophilic nuclear (pseudo)inclusions;
8. Nuclear grooves;
9. When present, nucleoli tend to localize along the nuclear membrane;
10. Nondescript cytoplasmic changes.
Thyroid Papillary Carcinoma: Diagnostic Major and Minor Criteria
Most Important Criteria (in order of importance) [brackets contain percentage of cases showing these features]
1. Cytoplasmic invaginations (pseudoinclusions) into nucleus [25%]
2. Abundant nuclear grooves [100%]
3. Ground glass nuclei [98%]
4. Psammoma bodies [16%]
5. Enlarged overlapping nuclei [99%]
6. Irregularly shaped nuclei [100%]
Less Important Criteria
Dark staining colloid [86%]
Irregular contours of follicles [64%]
Scalloping of colloid [59%]
Elongated follicles [80%]
Multinucleated macrophages in lumen of follicles [14%]
My diagnosis:Thyroid papillary carcinoma, follicular variant
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lfl001200546 离线
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We use nuclear features to diagnose papillary carcinoma: nuclear enlargement, overlapping, pseudoincluaions, Orphan Anne's eye, nuclear grooves. Supporting evidences include thick colloid, psamomma body and others. Papillary architecture is good when it is there but not essential for diagnosis becaue follicular variant does not have papillary architecture.
