Carcangiu M L, Bianchi S
Department of Pathology, Yale University Medical School, New Haven, CT 06510-8070.
Am J Surg Pathol. 1989 Dec;13(12):1041-9. doi: 10.1097/00000478-198912000-00006.
We report 15 cases of a distinctive variant of thyroid papillary carcinoma designated as "diffuse sclerosing papillary carcinoma" (DSPC). This lesion is characterized by the following morphologic findings: (a) diffuse involvement of one or both lobes, (b) numerous micropapillary formations located within cleftlike spaces consistent with lymph vessels, (c) extensive squamous metaplasia, (d) large number of psammoma bodies, (e) marked lymphocytic infiltration, (f) prominent fibrosis. Of all these features, we believe the widespread intrathyroid lymphatic permeation to be the most important, in the sense of conditioning the other morphologic findings and the behavior of the tumor. When compared with conventional papillary carcinoma, the DSPC variant exhibits the following characteristics: (a) similar predilection for women, (b) younger age at the time of presentation, (c) greater incidence of cervical lymph node involvement, (d) greater incidence of lung metastases, (e) smaller probability of disease-free survival on follow-up. The practical importance of the recognition of this variant of papillary carcinoma lies in its ability to clinically simulate thyroiditis and the more aggressive therapeutic approach that might be needed to eradicate it.
我们报告了15例一种独特的甲状腺乳头状癌变体，称为“弥漫性硬化性乳头状癌”（DSPC）。该病变具有以下形态学特征：（a）一个或两个叶弥漫受累；（b）在与淋巴管一致的裂隙样间隙内有大量微乳头形成；（c）广泛的鳞状化生；（d）大量砂粒体；（e）显著的淋巴细胞浸润；（f）明显的纤维化。在所有这些特征中，我们认为甲状腺内广泛的淋巴渗透是最重要的，因为它决定了其他形态学特征和肿瘤的行为。与传统乳头状癌相比，DSPC变体具有以下特征：（a）对女性的偏好相似；（b）就诊时年龄较小；（c）颈部淋巴结受累的发生率更高；（d）肺转移的发生率更高；（e）随访时无病生存的概率更小。认识到这种乳头状癌变体的实际重要性在于其在临床上可能模拟甲状腺炎，以及根除它可能需要更积极的治疗方法。
