甲状腺乳头状腺癌与滤泡状腺癌的病理诊断(1)
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【摘要】 目的 对甲状腺乳头状腺癌与滤泡状腺癌的细胞学形态学进行分析。方法 采用细针吸取取材,巴氏染色,形态学观察和诊断,在863例甲状腺肿物针吸病例中,对经组织学证实的121例乳头状腺癌和滤泡状腺癌病例行病理检验对照研究。结果 85例乳头状腺癌中79例被细胞学所诊断,敏感度为92.94%;36例滤泡状腺癌中25例细胞学结果是正确的,敏感度为69.44%,形态学观察显示,乳头状腺癌涂片中的大量乳头状或球形结构的细胞团、核内包涵体、核沟、砂粒体和毛玻璃样核等是诊断依据。而分化好的滤泡状腺癌则无异型性。结论 细胞数量、乳头状结构、失粘现象、致密细胞团、滤泡共壁现象、核深浅不一及癌巨细胞等指标可能对滤泡状腺癌具有诊断意义,但需与滤泡型腺瘤及结节性甲状腺肿相鉴别。作者认为,通过对形态学的观察研究和经验的积累,可以提高滤泡状腺癌的细胞学诊断敏感性。
【关键词】甲状腺肿瘤;乳头状腺癌;滤泡状腺癌;病理诊断
【Abstract】 Objective To study the Seacitivity and cellular morphology of thyroid papillary carcinoma and follicular carcinoma that diagnosed by FNAC.Methods The cases of thyroid carcinoma that were diagnosed by FNA cytology and confirmed by surgical histology were retrospectively analysed.Results Of 85 cases of thyroid papillary careinoma,79 cases were diagnosed by FNA Cytology,the diagnosed sensitivity was 92.94%.36cases of follicular carcinoma,25cases were diagnosed by cytology,the sencitivity was 69.44%.The cytomorphologic features showed a lot of papillary structure with tissue fragments.Intranuclear inclusions,glassy muclei,psammoma bodies and wultinucleated giant cells were characteristic changes.The cellular atypia of well-differentiated follicular carcinoma was not evident.Conclusion The numbers of aspirated cells,papillary-like structure,dense cellular clusters and sheets of cells with rather remarkable variation in size and shape have diagnosing significiance.The increase of cytologist’s experience,it can raise the validity of diagnosis of thyroid carcinoma.
【Key words】
Thyroid neoplasm; Papillary carcinoma; Follicular carinoma; Diagnosis cytology
甲状腺恶性肿瘤中乳头状腺癌(Papillary adenocarcinoma,PAC)和滤泡状腺癌(Follicullar adenocarcinoma,FAC)居大多数。细针吸取细胞学(以下简称FNAC)对PAC的诊断已有许多作者进行了研究,在形态学特征方面以PAC的诊断依据充分,具有特异性改变,但对FAC的形态特点及诊断标准掌握不足,结果尚不能令人满意。为取得形态学证据,有必要就PAC和FAC的细胞形态学特征及鉴别诊断进行对比分析。
1 材料与方法
选择我院近27年来经FNAC诊断的甲状腺疾病病例863例,有组织学证实者818例,其中PAC 85例,FAC 36例。PAC中,男22例,女63例,男女之比为1:2.86;FAC中,男12例,女24例,男女之比为1:2。PAC中,年龄范围16~68岁,平均44.15岁;FAC中,年龄范围17~71岁,平均47.30岁。
PAC中有21例为乳头状囊腺癌,64例为实性癌或无较大的囊性变;FAC中,17例为分化好的FAC,19例为分化差的FAC。
触诊肿物的大小,并用直尺测量最大直径(除去皮肤及皮下组织的厚度尺寸):PAC中直径最小者0.7 cm,最大者4.5 cm,平均2.3 cm;FAC直径最小者1.0 cm,最大者5 cm,平均3.1 cm。
针吸手感及吸出物性状:富于细胞者为易进针的实性感,吸出物为血性颗粒状组织碎片,针吸过程其实为微粒组织的切片过程。囊性变者为囊性感,吸出物为多量陈旧性血性或淡咖啡色的混浊液体。针吸方法:常规7号针头针吸,进针方向应沿体轴平行穿刺。复查所有针吸涂片,观察镜下细胞形态特点,并与组织学结果对照统计分析 ......
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