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目的探讨甲状旁腺非典型腺瘤(APA)的病理特征。方法回顾性分析北京积水潭医院病理科诊断的37例APA的病理切片及临床资料。结果 37例APA,男性15例,女性22例。发病年龄23~78岁,平均年龄48.3岁。肿瘤最大径0.8~5 cm,8例(22.9%)可见完整包膜,余标本包膜不完整或与周围组织粘连。镜下,29例(78.4%)见宽大的不规则胶原纤维带,并移行或延伸到肿瘤包膜;32例(86.5%)见肿瘤包膜非穿透性浸润;18例(48.6%)肿瘤细胞呈不同程度的异型性;7例(18.9%)偶见病理性核分裂,全部<5个/50HPF的标准;3例(8.1%)见小灶性坏死。随访,4例复发,复发率10.8%,复发后全部诊断为恶性:2例包膜侵犯,1例血管侵犯,1例肺转移。结论 APA组织学接近于癌,但绝大部分预后良好,类似于普通腺瘤。病理医师应严格掌握APA的诊断标准并进行严密随访,避免个别恶性肿瘤被误诊。
Objective To investigate the pathological features of parathyroid atypical adenoma (APA). Methods The pathological sections and clinical data of 37 APA patients diagnosed in Beijing Jishuitan Hospital were retrospectively analyzed. Results 37 cases of APA, 15 males and 22 females. The age of onset is 23 to 78 years, with an average age of 48.3 years. The largest tumor diameter 0.8 ~ 5 cm, 8 cases (22.9%) shows a complete capsule, the remainder of the capsule is incomplete or adhesions with the surrounding tissue. In the microscopic examination, 29 cases (78.4%) showed extensive irregular collagen fibers and migrated or extended to the tumor capsule. 32 cases (86.5%) had non-penetrating tumor capsule, and 18 cases (48.6% Cells showed varying degrees of atypia; 7 cases (18.9%) occasionally pathological mitosis, all <5 / 50HPF standards; 3 cases (8.1%) see focal necrosis. Follow-up, 4 cases of recurrence, the recurrence rate was 10.8%, all diagnosed as malignant after relapse: 2 cases of encroachment, 1 case of vascular invasion, 1 case of lung metastasis. Conclusion APA histology is close to cancer, but most of the prognosis is good, similar to ordinary adenoma. Pathologists should strictly grasp the diagnostic criteria of APA and follow-up closely to avoid the misdiagnosis of individual malignant tumors.