Feng Gong, Laskin William B, Chou Pauline M, Lin Xiaoqi
Department of Pathology, Northwestern University, Chicago, Illinois.
Diagn Cytopathol. 2015 May;43(5):416-20. doi: 10.1002/dc.23254. Epub 2015 Jan 22.
Anaplastic thyroid carcinoma (ATC) is a rare, highly aggressive neoplasm, characterized by complete or partial composition by undifferentiated cells. We report a case of ATC with rhabdoid features in a 68-year-old male, who presented with a rapidly enlarging neck mass. Fine-needle aspiration (FNA) of the thyroid mass showed discohesive, pleomorphic round to polygonal rhabdoid cells with one to multiple eccentric, large, rounded nuclei with a prominent nucleolus, moderate to abundant, globoid cytoplasm which oftentimes harbor a pale para-nuclear inclusion. The cytoplasm of some cells contained variously sized, eosinophilic granules. Rare cells contained neutrophils in their cytoplasm. Mitoses including atypical mitotic figures and necrosis were readily seen. Histologic examination of needle core biopsy (NCB) revealed individual dispersed and sheets of pleomorphic neoplastic cells with similar cytomorphologic features as described above. The tumor extensively infiltrated a myxocollagenous stroma containing lymphocytes and neutrophils, and demonstrated foci of necrosis. Tumor cells were immunoreactive for keratins AE1/AE3, CAM5.2, and CK19; PAX-8, and p63, but negative for S-100, HMB-45, calcitonin, TTF-1, thyroglobulin, CD56, HBME-1, glypican-3, PAX-5, myogenin, CD31, and INI-1. The differential diagnosis of this malignant rhabdoid tumor is discussed.
间变性甲状腺癌（ATC）是一种罕见的、高度侵袭性的肿瘤，其特征是由未分化细胞完全或部分构成。我们报告一例68岁男性患有具有横纹肌样特征的ATC，该患者表现为颈部肿块迅速增大。甲状腺肿块的细针穿刺活检（FNA）显示细胞分散、多形性，呈圆形至多边形的横纹肌样细胞，有一个至多个偏心的、大的圆形核，核仁突出，胞质中等至丰富、呈球状，常含有淡染的核旁包涵体。部分细胞的胞质含有大小不一的嗜酸性颗粒。罕见细胞的胞质内含有中性粒细胞。可见有丝分裂，包括非典型有丝分裂象和坏死。针芯活检（NCB）的组织学检查显示单个分散及成片的多形性肿瘤细胞，其细胞形态学特征与上述描述相似。肿瘤广泛浸润含有淋巴细胞和中性粒细胞的黏液胶原性间质，并可见坏死灶。肿瘤细胞对角蛋白AE1/AE3、CAM5.2和CK19、PAX-8及p63呈免疫反应性，但对S-100、HMB-45、降钙素、TTF-1、甲状腺球蛋白、CD56、HBME-1、磷脂酰肌醇蛋白聚糖-3、PAX-5、肌细胞生成素、CD31及INI-1呈阴性。本文讨论了这种恶性横纹肌样肿瘤的鉴别诊断。
