Wong Kristine S, Barletta Justine A
Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Surg Pathol Clin. 2023 Mar;16(1):27-44. doi: 10.1016/j.path.2022.09.005. Epub 2022 Dec 12.
Thyroid pathology is notoriously fraught with high interobserver variability, and follicular-patterned tumors are among some of the most challenging to assess accurately and reproducibly. Given that encapsulated or well-circumscribed follicular-patterned tumors often have similar molecular profiles, that is, frequent RAS or RAS-like alterations, the diagnosis usually relies on histopathologic examination alone. Unfortunately, many of the features that are used for diagnosis and prognosis of these tumors have long been controversial and frequently debated topics, both due to their subjectivity and their evolving (or not yet resolved) definitions. In more recent years, the introduction of noninvasive follicular thyroid neoplasm with papillary-like nuclear features has added further complexity to this discussion. In particular, the criteria and significance of nuclear features of papillary thyroid carcinoma, architectural patterns, and invasive growth still pose significant diagnostic challenges and confusion. This review explores some of the challenges in evaluating encapsulated follicular-patterned tumors, focusing on those histologic elements.
甲状腺病理学以观察者间差异大而闻名，滤泡型肿瘤是最难准确且可重复评估的肿瘤之一。鉴于包膜完整或边界清晰的滤泡型肿瘤通常具有相似的分子特征，即频繁的RAS或RAS样改变，诊断通常仅依赖于组织病理学检查。不幸的是，用于这些肿瘤诊断和预后的许多特征长期以来一直是有争议且经常被讨论的话题，这既是由于其主观性，也是由于其不断演变（或尚未解决）的定义。近年来，具有乳头样核特征的非侵袭性滤泡性甲状腺肿瘤的出现使这一讨论更加复杂。特别是，甲状腺乳头状癌的核特征、结构模式和侵袭性生长的标准及意义仍然带来重大的诊断挑战和困惑。本综述探讨了评估包膜完整的滤泡型肿瘤时的一些挑战，重点关注那些组织学特征。
