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目的分析术中冰冻诊断甲状腺微小乳头状癌(PTMC)的临床病理特点,提高病理诊断水平,降低漏诊率。方法对许昌市中心医院2010至2014年术中冰冻病理诊断PTMC病例进行分析,结合常规石蜡切片、免疫组化证实并进行观察和文献复习。结果甲状腺微小乳头状癌23例,男7例,女16例,年龄17~75岁;其中18例合并良性甲状腺疾病,5例伴有中央区淋巴结转移,2例术后常规切片未见癌肿,2例术中漏诊,术后常规诊断为PTMC。组织学见乳头状癌浸润性生长行为,具有肿瘤细胞核异型、核沟、沙砾体及核内包涵体等甲状腺乳头状癌细胞特点。21例进行CK19、CD56、HBME-1、Galectin-3、ki67等标记。结论术中冰冻是诊断PTMC的有效方法,规范细致取材,可降低冰冻诊断PTMC的漏诊率。把握组织学特点和免疫组化标记特征,可提高冰冻诊断PTMC准确率。
Objective To analyze the clinicopathological features of frozen thyroid papillary carcinoma (PTMC) in operation, improve the pathological diagnosis and reduce the rate of misdiagnosis. Methods The surgical diagnosis of PTMC in Xuchang Central Hospital between 2010 and 2014 was analyzed. Paraffin sections were used for immunohistochemistry to confirm and review the literature. Results Thyroid micro papillary carcinoma in 23 cases, 7 males and 16 females, aged 17 to 75 years; of which 18 cases with benign thyroid disease, 5 cases with central lymph node metastasis, 2 cases of postoperative conventional sections no cancer , 2 missed diagnosis during operation, and postoperative routine diagnosis was PTMC. Histology of papillary carcinoma invasive growth, with tumor cell nuclear atypia, nuclear ditch, gravel and nuclear inclusions and other thyroid papillary carcinoma cells. 21 cases of CK19, CD56, HBME-1, Galectin-3, ki67 and other markers. Conclusion Intraoperative freezing is an effective method to diagnose PTMC. The detailed and careful specification can reduce the misdiagnosis rate of frozen diagnosis of PTMC. To grasp the histological features and immunohistochemical characteristics of markers to improve the accuracy of frozen diagnosis of PTMC.