Takada Nami, Hirokawa Mitsuyoshi, Ito Masahiro, Ito Aki, Suzuki Ayana, Higuchi Miyoko, Kuma Seiji, Hayashi Toshitetsu, Kishikawa Masao, Horikawa Shuichi, Miyauchi Akira
Department of Clinical Laboratory, Kuma Hospital, Kobe, Japan.
Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Japan.
Endocr J. 2017 Oct 28;64(10):1017-1023. doi: 10.1507/endocrj.EJ17-0242. Epub 2017 Aug 10.
Papillary thyroid carcinoma (PTC) with desmoid-type fibromatosis (DTF) is characterized by genetic alterations of the fibroblasts. PTC-DTF is extremely rare, and the reports on such cases have been sporadic. Immunohistochemical staining using the antibody for beta-catenin is useful in diagnosing the variant. This report aims to describe the clinical, pathological, and immunohistochemical findings in 14 cases of PTC-DTF and to clarify the diagnostic significance of the variant. The patients included 9 women and 5 men, with a mean age of 49.3 years. PTCs with focal DTF components and with extensive DTF components included 7 cases each. No significant differences were noted in terms of age, gender, and serum thyroglobulin levels between extensive and focal DTF cases. On aspiration cytology, 12 cases were reported as suspicious for malignancy or malignant, and schwannoma or fibroma was suggested in 1 case each. The DTF components were histologically classified into 4 types, namely, central (4 cases), peripheral (1 case), mixed (7 cases), and diffuse type (2 cases). The stromal components were consistent with those of DTF. Immunohistochemically, fibroblasts in the DTF components showed nuclear and cytoplasmic expression for beta-catenin in 12 cases. The features are observed even in cases in which stromal components focally exist. Neither carcinoma cells nor the fibroblasts with Ki-67 labeling index >5% were found in all cases. We agree that PTC with nodular fasciitis-like stroma should be renamed to PTC-DTF.
伴有韧带样型纤维瘤病（DTF）的甲状腺乳头状癌（PTC）的特征是成纤维细胞的基因改变。PTC-DTF极为罕见，关于此类病例的报道也较为零散。使用β-连环蛋白抗体进行免疫组织化学染色有助于诊断该变体。本报告旨在描述14例PTC-DTF的临床、病理和免疫组织化学结果，并阐明该变体的诊断意义。患者包括9名女性和5名男性，平均年龄为49.3岁。伴有局灶性DTF成分和广泛DTF成分的PTC各有7例。广泛DTF病例和局灶性DTF病例在年龄、性别和血清甲状腺球蛋白水平方面未发现显著差异。细针穿刺细胞学检查中，12例报告为可疑恶性或恶性，各有1例提示为神经鞘瘤或纤维瘤。DTF成分在组织学上分为4种类型，即中央型（4例）、外周型（1例）、混合型（7例）和弥漫型（2例）。间质成分与DTF一致。免疫组织化学检查显示，12例DTF成分中的成纤维细胞β-连环蛋白呈核及胞质表达。即使在间质成分局灶存在的病例中也观察到了这些特征。所有病例均未发现癌细胞及Ki-67标记指数>5%的成纤维细胞。我们同意，伴有结节性筋膜炎样间质的PTC应重新命名为PTC-DTF。
