滤泡性乳头状癌．

１．膨胀性浸润．

２．拉长腺体．

３．特有的小滤泡．

４．滤泡腔内真乳头．

５．毛玻璃核．核重叠．核沟，包涵体．

６．鳝背样胶质

 上级医院会诊结果：结甲，局部增生活跃。

真不知道哪个是对的了。

 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

 甲状腺癌诊断的第一标准是"浸润"，这也是其它内分泌癌的共同特点。

此例浸润不明显。

 乳头状癌和滤泡癌诊断不一样

乳头状癌典型核的特征：毛玻璃核  核沟   核内包涵体   沙粒体。不需要包膜或血管浸润

滤泡癌必须寻找包膜 血管的浸润。

该例应考虑乳头状腺癌。