Ishimaru Y, Fukuda S, Kurano R, Miura K, Tajiri J, Maeda K
Department of Surgical Pathology, Kumamoto University School of Medicine, Japan.
Am J Surg Pathol. 1988 Mar;12(3):240-6. doi: 10.1097/00000478-198803000-00009.
We report a case of follicular thyroid carcinoma with clear cell change displaying unusual ultrastructural features. Light microscopy revealed a metastatic neoplasm in the 12th thoracic vertebra that was composed of nests consisting mainly of clear cells. The tumor was interpreted as a metastasis of a clear cell type of thyroid carcinoma, based on positive immunohistochemical staining for thyroglobulin. However, unlike the metastatic bone lesions, the primary tumor in the thyroid consisted mainly of neoplastic follicular cells with lightly eosinophilic cytoplasm. A distinct follicular formation was noted throughout the tumor. In a portion of the tumor, a solid or stratified disposition of the cells was also observed. The primary tumor contained only a few clear cells similar to those seen in the metastatic bone lesions. In addition, we noted a transition between the follicular cells and the clear cells. Thus, this neoplasm was diagnosed as a follicular thyroid carcinoma with clear cell change, but not a specific type of thyroid neoplasm. Electron-microscopic examination revealed that the cells corresponding to clear cells under light microscopy had abundant cytoplasm characterized by varying degrees of dilation of rough endoplasmic reticulum (RER), which might reflect increased synthesis, storage of secretory products, or both.
我们报告一例具有透明细胞改变的滤泡状甲状腺癌，其显示出不寻常的超微结构特征。光镜检查显示第12胸椎有一个转移性肿瘤，由主要由透明细胞组成的巢状结构构成。基于甲状腺球蛋白免疫组化染色阳性，该肿瘤被解释为透明细胞型甲状腺癌的转移灶。然而，与转移性骨病变不同，甲状腺的原发性肿瘤主要由具有轻度嗜酸性细胞质的肿瘤滤泡细胞组成。整个肿瘤中均可见明显的滤泡形成。在肿瘤的一部分中，还观察到细胞呈实性或分层排列。原发性肿瘤仅含有少数与转移性骨病变中所见相似的透明细胞。此外，我们注意到滤泡细胞与透明细胞之间存在过渡。因此，该肿瘤被诊断为具有透明细胞改变的滤泡状甲状腺癌，而非特定类型的甲状腺肿瘤。电子显微镜检查显示，光镜下对应于透明细胞的细胞具有丰富的细胞质，其特征为粗面内质网（RER）不同程度的扩张，这可能反映了分泌产物合成、储存的增加或两者兼有。
