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【摘要】 目的：观察甲状腺微小乳头状癌的临床病理并检测其免疫表型，探讨相关疾病的鉴别诊断。方法：光学显微镜下观察223例甲状腺微小乳头状癌的组织形态；对74例甲状腺微小乳头状癌、32例甲状腺增生性病变行免疫组织化学方法标记细胞角蛋白19（CK19）、间皮细胞（MC）、细胞黏附凝集素3（Galectin-3）、CD56，复习相关文献。结果：在223例甲状腺微小乳头状癌中以滤泡状排列为主者占38.6%（86/223），核的特征不典型者占13.9%（31/223）。在74例甲状腺微小乳头状癌中CK19、MC、Galectin-3、CD56阳性表达率分别为100.0％、98.6%、98.6%、4.1%；在32例增生性病变中4者阳性表达率分别为37.5％、12.5%、18.8%、68.8%。结论：部分甲状腺微小乳头状癌细胞以滤泡状排列为主，核的特征不够典型，诊断较为困难。根据滤泡细胞增生活跃，细胞核具有乳头状癌的基本特点，病变与周围滤泡截然不同，且肿瘤性滤泡穿插于硬化间质或正常滤泡之间，可与增生性病变鉴别。CK19、Galectin-3、MC弥漫性中强阳性表达，CD56阴性表达对其诊断有重要价值，联合应用可以提高诊断的准确性和特异性。
【关键词】 甲状腺肿瘤·癌，乳头状·微小癌·细胞角蛋白19·半乳凝素-3·上皮·分化抗原簇56·免疫组织化学
Immunohistochemical and morphological characteristics of the papillary thyroid microcarcinoma REN Yu-bo, ZHOU Geng-yin, ZHANG Xue-dong, LI Yu-hong, JIA Ai-hua, DONG Xin-qian 1Department of Pathology, People’s Hospital of Liaocheng （Liaocheng 252000, China）2Department of Pathology, Qilu Hospital of Shandong University （Jinan 250012, China）
【ABSTRACT】 Objctive: To investigate the immunohistochemical and morphological characteristics of the papillary thyroid microcarcinoma(PTM), and differential diagnosis of the related disease. Methods: The morphological characteristics of 223 patients with PTM were observed under light microscope. Seventy-four cases of PTM and 32 cases of proliferative lesion of thyroid were observed under light microscope with stains of hematoxylin and eosin and immunohistochemical staining. The antibody included CK19, MC, Galectin-3 and CD56. Results: Eighty-six cases were follicular-patterned and 31 cases nuclear features were untypical in 223 cases of PTM. The positive expression rates of CK19、MC、Galectin-3、CD56 were 100.0%, 98.6%, 98.6% and 4.1% in 74 cases of PTM, and were 37.5％, 12.5%, 18.8%, 68.8% in proliferative lesion of thyroid, respectively. Conclusion: Some cases of PTM show a follicular-patterned and the nuclear features. It is untypical compared with classical papillary thyroid carcinoma. It can be differentiated from proliferative lesion with absence of envelope, obviously various and unusually proliferated follicular cells, sclerotic stroma, neoplastic follicles among the collagen and normal follicles. The wide and intensive expression of CK19, Galectin-3, and the negative expression of CD56 are extremely useful in the diagnosis of PTM, four-marker panel with CK19, Galectin-3, MC and CD56 can improve the specificity and accuracy of the differential diagnosis of PTM.