Glomski Krzysztof, Nosé Vania, Faquin William C, Sadow Peter M
Pathology Service, WRN219, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
Department of Pathology, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
Endocr Pathol. 2017 Jun;28(2):177-185. doi: 10.1007/s12022-017-9483-6.
The diagnosis of follicular-patterned carcinomas, including follicular thyroid carcinoma, oncocytic (Hürthle cell) carcinoma, and the encapsulated follicular variant of papillary thyroid carcinoma, requires evidence of capsular and/or vascular invasion. With minimally invasive carcinomas classified often within less than a millimeter of tissue segregating them from adenomas and non-invasive follicular thyroid neoplasms with papillary-like nuclear features, opinions vary internationally over how much of the capsule to submit in order to deem it well enough represented, considering that even if grossly entirely submitted in microcassettes, without leveling through each tissue block, the capsule is truly never entirely examined microscopically. Here, we retrospectively examine submission practices and outcomes at a single, high-volume institution over a 25-year period. Our results indicate that the vast majority of lesions with poor outcomes are those with wide invasion, and tumors lacking gross evidence of capsular perturbation rarely lead to recurrence or metastasis, an unsurprising result that should prompt re-evaluation of our grossing methods and approach to follicular-patterned tumors in a time of cost restraint, molecular diagnostics, and low biological potential of encapsulated, circumscribed neoplasia of the thyroid.
滤泡型癌的诊断，包括滤泡状甲状腺癌、嗜酸性细胞（许特莱细胞）癌以及甲状腺乳头状癌的包膜性滤泡变异型，需要有包膜和/或血管侵犯的证据。对于微侵袭性癌，其与腺瘤以及具有乳头状核特征的非侵袭性滤泡性甲状腺肿瘤的组织分隔通常小于1毫米，国际上对于送检多少包膜才能认为其有足够代表性存在不同观点，因为即使将大体标本全部放入微型标本盒中，若不逐块组织进行平整，包膜实际上从未在显微镜下得到完全检查。在此，我们回顾性研究了一家高病例量机构在25年期间的送检操作及结果。我们的结果表明，绝大多数预后不良的病变是那些具有广泛侵犯的病变，而缺乏包膜受扰大体证据的肿瘤很少导致复发或转移，这一结果并不意外，在当前成本受限、分子诊断以及甲状腺包膜完整、边界清晰的肿瘤生物学潜能较低的时代，这应促使我们重新评估对滤泡型肿瘤的取材方法和处理方式。
