Grant C S, Hay I D, Ryan J J, Bergstralh E J, Rainwater L M, Goellner J R
Department of Surgery, Mayo Clinic and Medical Center, Rochester, Minnesota 55905.
World J Surg. 1990 May-Jun;14(3):283-9; discussion 289-90. doi: 10.1007/BF01658504.
Distinguishing cellular follicular adenomas (FA) from minimally invasive follicular carcinomas (FC) continues to plague even experienced thyroid pathologists. DNA ploidy analysis has been promoted as a means of making this differentiation; however, the finding of DNA aneuploidy in FA has caused concern that they may demonstrate potential for malignant behavior or should even be reclassified as low-grade noninvasive cancers. In histologically-proven FC, nuclear DNA content has been claimed to have predictive power equivalent to that of all other prognostic factors combined. The aims of the present study, therefore, were to define the DNA ploidy characteristics of FA and FC, to assess the diagnostic potential of cell-cycle parameters, and, in FC, to investigate the prognostic role of such measurements. We measured DNA content of 124 tumors (60 FA, 64 FC). DNA pattern was normal (diploid) in 75% of FA and 45% of FC, tetraploid/polyploid (T/P) in 13% of FA and 25% of FC, and aneuploid in 12% of FA and 30% of FC. FC was histologically verified in 39% of DNA normal, 67% of T/P, and 73% of aneuploid tumors. DNA index, S-phase, G2M, and S-phase plus G2M were analyzed and were not helpful in differentiating between FA and FC. No patient with FA developed tumor recurrence. In FC (excluding the Hürthle cell variant), no significant differences were found among the 3 DNA ploidy groups with respect to either cancer death or tumor recurrence; however, combining the Hürthle cell variant of follicular carcinomas with pure follicular carcinomas, the presence of distant metastases, DNA aneuploidy, and patient age were the only independently significant prognostic variables.(ABSTRACT TRUNCATED AT 250 WORDS)
即使是经验丰富的甲状腺病理学家，区分细胞性滤泡性腺瘤（FA）和微侵袭性滤泡癌（FC）也仍然是个难题。DNA倍体分析被推崇为进行这种区分的一种方法；然而，在FA中发现DNA非整倍体引发了人们的担忧，即它们可能表现出恶性行为的潜力，甚至应该被重新归类为低级别非侵袭性癌症。在组织学确诊的FC中，核DNA含量被认为具有与所有其他预后因素相加相当的预测能力。因此，本研究的目的是确定FA和FC的DNA倍体特征，评估细胞周期参数的诊断潜力，并在FC中研究这些测量的预后作用。我们测量了124个肿瘤（60个FA，64个FC）的DNA含量。75%的FA和45%的FC的DNA模式为正常（二倍体），13%的FA和25%的FC为四倍体/多倍体（T/P），12%的FA和30%的FC为非整倍体。39%的DNA正常、67%的T/P和73%的非整倍体肿瘤经组织学证实为FC。分析了DNA指数、S期、G2M期以及S期加G2M期，它们对区分FA和FC并无帮助。没有FA患者出现肿瘤复发。在FC（不包括许特莱细胞变体）中，3个DNA倍体组在癌症死亡或肿瘤复发方面均未发现显著差异；然而，将滤泡癌的许特莱细胞变体与纯滤泡癌合并来看，远处转移的存在、DNA非整倍体和患者年龄是仅有的独立显著预后变量。（摘要截选至250词）
