Yamashita T, Hosoda Y, Kameyama K, Aiba M, Ito K, Fujimoto Y
Ito Hospital, Tokyo, Japan.
Cancer. 1992 Dec 15;70(12):2923-8. doi: 10.1002/1097-0142(19921215)70:12<2923::aid-cncr2820701232>3.0.co;2-g.
Papillary carcinoma of the thyroid frequently occurs in young women. Four cases of papillary carcinoma were found in women in their 20s, and the disease was characterized by unusual morphologic and clinical features.
Four cases were analyzed clinically, grossly, microscopically, ultrastructurally, and immunohistochemically and compared with control cases of papillary carcinoma.
The tumors histologically showed various appearances with trabecular, solid cribriform, follicular, and papillary patterns. A striking finding was that stratified cancer cell nests with prominent nuclear clearings were scattered in the tumors. Ultrastructurally, the nuclear clearings were composed of fine thread-like fibrils, and they were bound unselectively to various antibodies against hormones and intermediate filaments. The four patients also had common clinicopathologic features as follows: they were all women in their 20s and their preoperative serum thyroglobulin levels were all normal despite the large size of their thyroid tumors. The tumors were grossly well encapsulated, and there was no lymph node metastasis, except in one patient who had only one positive node.
The peculiar nuclear features were distinct from intranuclear cytoplasmic inclusions or ground-glass nuclei, and these have not been reported previously to the authors' knowledge in conventional thyroid neoplasms. These tumors might represent another subtype of papillary thyroid carcinoma.
甲状腺乳头状癌常见于年轻女性。在20多岁的女性中发现了4例乳头状癌，该疾病具有不寻常的形态学和临床特征。
对4例病例进行临床、大体、显微镜、超微结构和免疫组化分析，并与乳头状癌对照病例进行比较。
肿瘤组织学表现多样，有小梁状、实性筛状、滤泡状和乳头状结构。一个显著发现是，肿瘤内散在分布着具有明显核空晕的分层癌细胞巢。超微结构上，核空晕由细的丝状纤维组成，它们无选择性地与各种抗激素和中间丝抗体结合。这4例患者还有如下共同的临床病理特征：均为20多岁的女性，尽管甲状腺肿瘤体积较大，但术前血清甲状腺球蛋白水平均正常。肿瘤大体上包膜完整，除1例有1个阳性淋巴结外，均无淋巴结转移。
这种特殊的核特征不同于核内胞质包涵体或毛玻璃样核，据作者所知，在传统甲状腺肿瘤中此前尚未有过相关报道。这些肿瘤可能代表甲状腺乳头状癌的另一种亚型。
