Wang Jian, Guli Qie-Re, Ming Xiao-Cui, Zhou Hai-Tao, Cui Yong-Jie, Jiang Yue-Feng, Zhang Di, Liu Yang
Department of Pathology, The First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, China.
Institute of Pathology and Pathophysiology, China Medical University, Shenyang, China.
Onco Targets Ther. 2018 Mar 16;11:1521-1528. doi: 10.2147/OTT.S158975. eCollection 2018.
This study reports a case of primary mucinous carcinoma of the thyroid gland with signet-ring-cell differentiation, and reviews the literature to evaluate its real incidence and the prognosis of these patients.
A 74-year-old Chinese woman, presenting with a mass in the right lobe of thyroid gland, came to the hospital. Computed tomography revealed a mass in the right lobe of the thyroid gland, accompanied with right neck lymphadenectasis and airway deviation caused by tumor compression. Thyroid imaging suggested a thyroid malignant tumor and suspicious lymph node metastasis. Histologically, the tumor was characterized by the tumor cells arranged in small nests or trabeculae with an abundant extracellular mucoid matrix. The tumor cells formed diffuse invasion among thyroid follicles. In the peripheral regions, prominent signet-ring-cells formed a sheet-like structure and extended into the extrathyroidal fat tissue. The tumor cells were diffusely positive for thyroid transcription factor-1 (TTF-1) and PAX8, while they were focally positive for pan-cytokeratin (AE1/AE3) and weakly expressed thyroglobulin.
Based on the histological features and immunohistochemical profile, a diagnosis of primary mucinous carcinoma of the thyroid gland with signet-ring-cell differentiation was rendered.
Using a panel of immunohistochemical markers may be helpful for differential diagnosis and for determining whether the tumor is primary or not.
本研究报告一例具有印戒细胞分化的甲状腺原发性黏液癌病例，并复习文献以评估其实际发病率及这些患者的预后。
一名74岁中国女性因甲状腺右叶肿物前来我院就诊。计算机断层扫描显示甲状腺右叶有一肿物，伴有右颈部淋巴结肿大及肿瘤压迫导致的气道偏移。甲状腺影像学检查提示甲状腺恶性肿瘤及可疑淋巴结转移。组织学上，肿瘤的特征为肿瘤细胞呈小巢状或小梁状排列，伴有丰富的细胞外黏液样基质。肿瘤细胞在甲状腺滤泡间形成弥漫性浸润。在周边区域，显著的印戒细胞形成片状结构并延伸至甲状腺外脂肪组织。肿瘤细胞甲状腺转录因子-1（TTF-1）和PAX8弥漫性阳性，而广谱细胞角蛋白（AE1/AE3）局灶性阳性，甲状腺球蛋白表达较弱。
根据组织学特征和免疫组化结果，诊断为具有印戒细胞分化的甲状腺原发性黏液癌。
使用一组免疫组化标志物可能有助于鉴别诊断以及确定肿瘤是否为原发性。
