Mizukami Y, Michigishi T, Nonomura A, Hashimoto T, Noguchi M, Ohmura K, Matsubara F
Pathology Section, Kanazawa University Hospital, Japan.
Acta Pathol Jpn. 1992 Jun;42(6):419-26. doi: 10.1111/j.1440-1827.1992.tb03247.x.
The effect of 131I therapy was examined in 13 thyroid glands affected by Graves' disease 3 to 29 years after irradiation for hyperthyroidism. All of the patients had clinically palpable thyroid nodules. Two patients were in a latent hypothyroid, 6 in a euthyroid and 5 in a hyperthyroid state. The microscopic changes in the thyroids showed a pattern of multiple adenomatous nodules with cystic changes, marked oxyphilic cell changes with nuclear atypism and various degrees of chronic thyroiditis. Immunohistochemical staining for TG and T4 was negative to mildly positive in these oxyphilic cells and entirely negative for EGF and CEA. The DNA ploidy pattern was diploid pattern in 6 cases. One papillary-type microcarcinoma occurred, but there was no evidence of a relationship between the tumor and the irradiation. The pathologic findings in Graves' thyroid gland after 131I therapy are not specific, but pathologists should differentiate this lesion from adenomatous goiter, which occurs with no apparent cause, or from thyroid carcinoma because of the marked nuclear atypism of this lesion.
对13例因甲亢接受放疗3至29年后受Graves病影响的甲状腺进行了131I治疗效果的检查。所有患者临床上均可触及甲状腺结节。2例处于亚临床甲减状态，6例甲状腺功能正常，5例处于甲亢状态。甲状腺的微观变化表现为多个腺瘤样结节伴囊性变、显著的嗜酸性细胞改变伴核异型性以及不同程度的慢性甲状腺炎。这些嗜酸性细胞中TG和T4的免疫组化染色呈阴性至弱阳性，而EGF和CEA则完全阴性。6例的DNA倍体模式为二倍体模式。发生了1例乳头状微癌，但没有证据表明肿瘤与放疗之间存在关联。131I治疗后Graves甲状腺的病理表现不具有特异性，但病理学家应将此病变与无明显病因的腺瘤样甲状腺肿或甲状腺癌相鉴别，因为该病变存在显著的核异型性。
