丰富的胶体能否排除甲状腺细针穿刺中的嗜酸性（许特莱细胞）癌？127例嗜酸性（许特莱细胞）病变的细胞组织学相关性。

Can abundant colloid exclude oncocytic (Hürthle cell) carcinoma in thyroid fine needle aspiration? Cytohistological correlation of 127 oncocytic (Hürthle cell) lesions.

作者信息

Yang G C H, Schreiner A M, Sun W

机构信息

Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, New York, NY, USA.

出版信息

Cytopathology. 2013 Jun;24(3):185-93. doi: 10.1111/j.1365-2303.2012.00988.x. Epub 2012 Jun 6.

DOI:10.1111/j.1365-2303.2012.00988.x

PMID:22672530

Abstract

OBJECTIVE

The objective of the present study was to find out whether the presence or absence of certain cytological features can exclude oncocytic (Hürthle cell) carcinoma in thyroid fine needle aspiration (FNA) to minimize unnecessary surgery.

METHODS

Over a 17-year period, 127 hypercellular, oncocyte-exclusive, lymphocyte-absent aspirates obtained via ultrasound-guided FNA with on-site assessment had histology slides for review. The presence or absence of six cytological features (microfollicular arrangement, discohesive single cells, small cell dysplasia, large cell dysplasia, transgressing blood vessels and colloid) and one histological feature (macrofollicular component) were determined for each case independently by two cytopathologists.

RESULTS

Histology showed 12 (9.4%) cases of Hashimoto thyroiditis, 23 (18.1%) oncocytic adenomatoid nodules in nodular goitre, 66 (52.0%) oncocytic adenomas and 26 (20.5%) oncocytic carcinomas (13 minimally invasive without angioinvasion, six minimally invasive with angioinvasion, seven widely invasive). Histologically, a macrofollicular component was present in seven of 26 (26.9%) oncocytic carcinomas, including one case with abundant thin colloid. A microfollicular arrangement, discohesive single cells, small cell dysplasia, large cell dysplasia and transgressing vessels were present in oncocytic carcinoma, oncocytic adenoma and oncocytic adenomatoid nodules in nodular goitre.

CONCLUSIONS

A macrofollicular component is frequently present in oncocytic carcinoma, oncocytic adenoma and oncocytic adenomatoid nodules in nodular goitre. None of the cytological features studied, including abundant colloid, can exclude oncocytic carcinoma. Oncocytic carcinoma can only be excluded by thorough histological examination of thyroidectomy specimens. A molecular marker is needed to triage oncocytic lesions in thyroid FNA.

摘要

目的

本研究的目的是确定某些细胞学特征的有无能否在甲状腺细针穿刺活检（FNA）中排除嗜酸细胞性（许特尔细胞）癌，以尽量减少不必要的手术。

方法

在17年的时间里，对127份通过超声引导下FNA获得的、细胞丰富、仅含嗜酸细胞且无淋巴细胞的抽吸物进行了现场评估，并对其组织学切片进行了复查。两名细胞病理学家分别独立确定每个病例是否存在六种细胞学特征（微滤泡排列、分散的单个细胞、小细胞异型性、大细胞异型性、侵犯血管和胶体）和一种组织学特征（大滤泡成分）。

结果

组织学检查显示，有12例（9.4%）桥本甲状腺炎，23例（18.1%）结节性甲状腺肿中的嗜酸细胞性腺瘤样结节，66例（52.0%）嗜酸细胞性腺瘤和26例（20.5%）嗜酸细胞性癌（13例微侵袭性且无血管侵犯，6例微侵袭性且有血管侵犯，7例广泛侵袭性）。组织学上，26例（26.9%）嗜酸细胞性癌中有7例存在大滤泡成分，其中1例含有丰富的稀薄胶体。微滤泡排列、分散的单个细胞、小细胞异型性、大细胞异型性和侵犯血管在嗜酸细胞性癌、嗜酸细胞性腺瘤和结节性甲状腺肿中的嗜酸细胞性腺瘤样结节中均有出现。