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目的:探讨原发性甲状腺鳞状细胞癌的临床病理特点、病理诊断及鉴别诊断。方法:复习5例原发性甲状腺鳞状细胞癌的临床病理资料,采用HE染色、免疫组化技术和电镜技术进行观察分析。结果:5例中3例为女性。发病中位年龄55岁,术后平均生存3~7个月。临床主要表现为颈部肿块、声嘶、呼吸困难和吞咽困难;光镜下病变多呈高分化鳞状细胞癌,广泛浸润至周围组织;广谱细胞角蛋白(CKpan)、细胞角蛋白19(CK19)5例均弥漫强阳性,细胞增殖标记抗体(Ki-67)的阳性表达率为30%~50%。甲状腺转录因-子1(TTF1)、甲状腺球蛋白(TG)和外套层细胞淋巴瘤标记(CD5)均不表达;超微结构示瘤细胞有异形性,胞质内可见张力原纤维丝,细胞间有发育良好的桥粒。结论:原发性甲状腺鳞状细胞癌是罕见的高度恶性肿瘤,侵袭性强,诊断时应排除继发性鳞状细胞癌以及其他类型甲状腺病变伴鳞化。
Objective: To investigate the clinicopathological features, pathological diagnosis and differential diagnosis of primary thyroid squamous cell carcinoma. Methods: The clinical and pathological data of 5 cases of primary thyroid squamous cell carcinoma were reviewed and observed by HE staining, immunohistochemistry and electron microscopy. Results: Three of the five patients were female. The median age was 55 years and the mean survival time was 3 to 7 months. The main clinical manifestations of the neck mass, hoarseness, dyspnea and difficulty swallowing; light microscopic lesions were highly differentiated squamous cell carcinoma, extensive infiltration into the surrounding tissue; broad-spectrum cytokeratin (CKpan), cytokeratin 19 ( CK19) 5 cases were diffusely strong positive, the positive rate of Ki-67 expression was 30% to 50%. Thyroid transcription factor-1 (TTF1), thyroglobulin (TG) and mantle cell lymphoma marker (CD5) were not expressed. The ultrastructure showed that the tumor cells were irregular and the fibroblasts were seen in the cytoplasm. Between well-developed desmosomes. CONCLUSIONS: Primary thyroid squamous cell carcinoma is a rare and highly malignant tumor with strong invasiveness. Secondary squamous cell carcinomas and other thyroid lesions should be excluded in the diagnosis.