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目的探讨伴横纹肌样特征的甲状腺癌的临床病理特点。方法对1例伴横纹肌样特征的甲状腺未分化癌进行组织学、免疫表型检测和超微结构观察,并复习相关文献。结果患者女性,55岁。甲状腺右叶肿块迅速增大,并突破包膜,侵犯肌肉组织、上纵隔、气管及食管。镜下瘤细胞散在分布,黏附性差,呈类圆形,胞质丰富,胞质内见红染均质包涵体,核泡状、偏位,核仁突出,核分裂象可见。横纹肌样瘤细胞vimentin和CAM5.2(+),Ki-67指数80%。电镜示瘤细胞核类圆形,核仁明显,胞质内见不规则成簇分布的中间丝。患者术后6个月死亡。结论甲状腺未分化癌伴横纹肌样特征是罕见的高度恶性肿瘤,主要应与大细胞淋巴瘤、恶性黑色素瘤、生殖细胞瘤等相鉴别,特征性的组织形态及免疫组化标记有助于鉴别诊断。
Objective To investigate the clinicopathological features of thyroid carcinoma with rhabdomyosarcoma. Methods Histological, immunophenotypic and ultrastructural observations of one case of undifferentiated thyroid carcinoma with rhabdomyosarcoma were reviewed, and the related literatures were reviewed. Results Patients Female, 55 years old. Thyroid right lobe mass rapidly increased, and break through the capsule, violation of muscle tissue, the mediastinum, trachea and esophagus. Microscopic tumor cells scattered distribution, poor adhesion, was round, cytoplasm is rich in cytoplasm, see the red dye homogeneous inclusion bodies, bubble-shaped, deviation, prominent nucleoli, mitotic figures can be seen. Rhabdomyosarcoma cells vimentin and CAM5.2 (+), Ki-67 index of 80%. Electron microscopy showed that the nuclei of tumor cells were round, the nucleoli were obvious, and irregular filaments were found in cytoplasm. The patient died 6 months after surgery. Conclusion The undifferentiated thyroid carcinoma with rhabdomyosarcoma is a rare and highly malignant tumor, which should be differentiated from large cell lymphoma, malignant melanoma and germ cell tumor. The characteristic histomorphology and immunohistochemical markers are helpful for the differential diagnosis .