Chan J K, Tsui M S, Tse C H
Histopathology. 1987 Feb;11(2):191-201. doi: 10.1111/j.1365-2559.1987.tb02622.x.
Three cases of an unusual diffuse sclerosing variant of papillary carcinoma of the thyroid occurring in young adults are reported. The tumour is characterized by diffuse involvement of one or both lobes of the thyroid, marked squamous metaplasia, numerous psammoma bodies, extensive interstitial fibrosis and heavy lymphocytic infiltration with formation of germinal centres. Lymphatic and vascular permeation was found in all three cases. An interesting finding was the presence of irregularly disposed thin bundles of smooth muscle within the fibrous stroma, presumably a result of splaying of the smooth muscle of vessel walls by the sclerotic process. The papillary areas of the tumour stained for thyroglobulin and cytokeratin, while the squamous areas stained strongly for cytokeratin but not for thyroglobulin. The tumours were negative for calcitonin and carcinoembryonic antigen, but showed weak staining for S-100 protein. Numerous S-100 positive Langerhans/interdigitating reticulum cells were scattered within the tumour islands and the lymphoid infiltrate, suggesting an immunological reaction mediated by these antigen-presenting cells.
本文报告了3例发生于年轻成年人的甲状腺乳头状癌罕见弥漫性硬化变异型病例。肿瘤的特征为甲状腺一叶或两叶弥漫受累、显著的鳞状化生、大量砂粒体、广泛的间质纤维化以及伴有生发中心形成的重度淋巴细胞浸润。所有3例均发现有淋巴管和血管浸润。一个有趣的发现是在纤维性间质内存在不规则排列的薄束状平滑肌，推测是硬化过程使血管壁平滑肌伸展所致。肿瘤的乳头区甲状腺球蛋白和细胞角蛋白染色阳性，而鳞状区细胞角蛋白染色强阳性，但甲状腺球蛋白染色阴性。肿瘤降钙素和癌胚抗原阴性，但S-100蛋白呈弱阳性染色。大量S-100阳性的朗格汉斯细胞/交错突网状细胞散在于肿瘤岛和淋巴浸润内，提示由这些抗原呈递细胞介导的免疫反应。
