Giorgadze Tamar A, Scognamiglio Theresa, Yang Grace C H
Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, New York, New York.
Cancer Cytopathol. 2015 Feb;123(2):71-81. doi: 10.1002/cncy.21504. Epub 2015 Jan 8.
The solid variant of papillary thyroid carcinoma (SVPTC) comprises approximately 3% of thyroid cancers, and there are conflicting reports about its behavior in the literature. The cytology of SVPTC is limited to 3 single case reports, a review article, and a monograph. We present the first cytologic study of SVPTC.
Fine-needle aspiration smears obtained with ultrasound guidance from 13 patients with histologically pure SVPTC were reviewed, and the cytologic features recorded. Ultrasound images were retrieved from radiology and were correlated with low-power histology images. Intratumor vascularity on Doppler imaging was correlated with cellularity in cytology samples.
Three cytomorphologic patterns of SVPTC were identified: cohesive, syncytial-type tissue fragments; microfollicles/trabeculae; and dyshesive single cells. All 3 SVPTCs in the first group were encapsulated without invasion. Two of 6 SVPTCs in the second group had a single lymph node metastasis; 4 were encapsulated, and 2 had pushing borders. Ultrasound images in the first and second SVPTC groups were similar, with the majority revealing a well defined, solid nodule with minimal intranodular vascularity. All 4 SVPTCs in the third group had infiltrative borders; and, with the exception of one 0.8-cm tumor, all had multiple lymph node metastases. Ultrasound in the third group revealed irregular borders. RET/PTC1 and RET/PTC3 mutations were found in 2 cases of the third group.
SVPTCs are heterogeneous tumors. The cohesive, syncytial tissue-fragment pattern can be recognized as SVPTC in smears and is associated with encapsulation and indolent behavior. The microfollicular/trabecular pattern is indistinguishable from that of the follicular variant of papillary thyroid carcinoma and has intermediate behavior. The dyshesive single-cell pattern correlates with infiltrative tumor growth and may not be unique to SVPTC.
甲状腺乳头状癌实性变体（SVPTC）约占甲状腺癌的3%，关于其生物学行为，文献报道存在争议。SVPTC的细胞学研究仅限于3篇单病例报告、1篇综述文章和1部专著。我们开展了首例SVPTC细胞学研究。
回顾性分析13例组织学诊断为纯SVPTC患者在超声引导下获取的细针穿刺涂片，并记录细胞学特征。从放射科调取超声图像，并与低倍组织学图像进行对比。将多普勒成像显示的肿瘤内部血管情况与细胞学样本中的细胞密度进行对比。
识别出SVPTC的3种细胞形态学模式：紧密型、合体细胞型组织碎片；微滤泡/小梁状；松散型单个细胞。第一组的所有3例SVPTC均有包膜，无浸润。第二组6例SVPTC中有2例出现单个淋巴结转移；4例有包膜，2例边界呈推挤状。第一组和第二组SVPTC的超声图像相似，多数表现为边界清晰的实性结节，结节内血管较少。第三组的所有4例SVPTC边界呈浸润性；除1例0.8 cm的肿瘤外，均有多发淋巴结转移。第三组超声显示边界不规则。第三组2例病例检测到RET/PTC1和RET/PTC3突变。
SVPTC是异质性肿瘤。紧密型、合体细胞型组织碎片模式在涂片中可识别为SVPTC，与包膜形成和惰性生物学行为相关。微滤泡/小梁状模式与甲状腺乳头状癌滤泡变体无法区分，生物学行为介于两者之间。松散型单个细胞模式与肿瘤浸润性生长相关，可能并非SVPTC所特有。
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