Schürmann G, Mattfeldt T, Feichter G, Koretz K, Möller P, Buhr H
Department of Surgery, University of Heidelberg, Federal Republic of Germany.
Hum Pathol. 1991 Feb;22(2):179-84. doi: 10.1016/0046-8177(91)90040-v.
A retrospective analysis of surgically resected thyroid cold solitary nodules was performed by stereology, DNA flow cytometry, and immunohistochemistry in 15 follicular adenomas and 15 well-differentiated follicular carcinomas to determine if a differential diagnosis of both follicular neoplasms can be done exclusively from cytologic criteria. Between 150 and 200 tumor cell nuclei (TCN) were studied per case for their TCN profile area, perimeter, and density, as well as for stereologic estimates, including the new parameter, volume-weighted mean particle volume (Vv). Flow-cytometric analyses included measurement of the DNA index and the percentage of cells in S phase and G2M phase. The same tumors were examined for the expression of thyroglobulin and the intermediate filaments vimentin and keratin. Follicular adenomas and follicular carcinomas did not show any significant differences in stereologic estimates related to TCN size. Both groups included similar proportions of diploid and aneuploid neoplasms. Aneuploid follicular neoplasms showed a significantly greater area, perimeter, and volume of TCN as compared with diploid tumors, regardless of their histologic diagnosis. Follicular adenomas and follicular carcinomas expressed a similar staining pattern for the tested immunoreagents, with a few cases coexpressing vimentin and keratin. From our results, a differential diagnosis of follicular neoplasms cannot be performed on the basis of cytologic aspirates exclusively. Infiltration of capsula or vessels remains the only safe indicator of malignancy in the absence of metastases. The lack of cytologic differences suggests that some follicular adenomas are preinvasive carcinomas, not yet showing infiltrative growth at the time of resection.
通过体视学、DNA流式细胞术和免疫组织化学对15例滤泡性腺瘤和15例高分化滤泡癌的手术切除甲状腺冷实性结节进行回顾性分析，以确定这两种滤泡性肿瘤是否仅能根据细胞学标准进行鉴别诊断。每例研究150至200个肿瘤细胞核（TCN）的TCN轮廓面积、周长和密度，以及体视学估计值，包括新参数体积加权平均颗粒体积（Vv）。流式细胞术分析包括测量DNA指数以及S期和G2M期细胞的百分比。对相同的肿瘤进行甲状腺球蛋白以及中间丝波形蛋白和角蛋白表达的检测。滤泡性腺瘤和滤泡癌在与TCN大小相关的体视学估计方面未显示任何显著差异。两组中二倍体和非整倍体肿瘤的比例相似。无论组织学诊断如何，非整倍体滤泡性肿瘤与二倍体肿瘤相比，其TCN的面积、周长和体积均显著更大。滤泡性腺瘤和滤泡癌对所检测的免疫试剂表现出相似的染色模式，少数病例同时表达波形蛋白和角蛋白。根据我们的结果，不能仅基于细针穿刺抽吸物对滤泡性肿瘤进行鉴别诊断。在无转移的情况下，包膜或血管浸润仍然是恶性肿瘤的唯一可靠指标。缺乏细胞学差异表明，一些滤泡性腺瘤是浸润前癌，在切除时尚未表现出浸润性生长。
