Vickery A L, Carcangiu M L, Johannessen J V, Sobrinho-Simoes M
Semin Diagn Pathol. 1985 May;2(2):90-100.
In addition to a description of the basic criteria for the diagnosis of papillary carcinoma, a review of discussions by all workshop participants on the illustrative cases is presented. Areas of consensus included the following: classification of mixed papillary and follicular carcinomas as papillary, regardless of follicular dominance; recognition of three morphological variants--follicular, encapsulated, and diffuse sclerosing; nonspecificity of individual histological criteria, with the necessity to utilize a combination of characteristic features as guidelines for establishing a diagnosis; citing of nuclear features as probably the most important diagnostic criteria, ie, increased N/C ratio, irregularity in outline, and paleness of staining (ground glass appearance); grading of tumors on the basis of either cytological or architectural characteristics remains of unproven prognostic value. (Gross extent of tumor at the first operation remains the most valuable single prognostic criterion.); defining small carcinomas by size rather than using the imprecise term "occult" with its variable definitions including some clinically evident tumors; classifying as undifferentiated those carcinomas presenting a mixed papillary and anaplastic appearance at the time of the first operation, and retaining the papillary designation for papillary cancers which later undergo dedifferentiation; and recognition that thyroglobulin is a constant and keratin an inconstant tumor cell marker, with the latter not specific for distinguishing papillary carcinomas from follicular carcinomas or from hyperplastic adenomas.
除了描述乳头状癌的基本诊断标准外，还介绍了所有研讨会参与者对示例病例的讨论情况。达成共识的领域包括：将混合性乳头状和滤泡状癌归类为乳头状癌，无论滤泡成分是否占主导；认识到三种形态学变异——滤泡状、包膜型和弥漫性硬化型；个别组织学标准的非特异性，需要综合特征作为诊断依据；指出核特征可能是最重要的诊断标准，即核质比增加、轮廓不规则和染色变淡（毛玻璃样外观）；根据细胞学或结构特征对肿瘤进行分级，其预后价值尚未得到证实。（首次手术时肿瘤的大体范围仍然是最有价值的单一预后标准。）；通过大小而非使用定义不精确的“隐匿性”一词来定义小癌，“隐匿性”一词的定义包括一些临床明显的肿瘤；将首次手术时呈现混合性乳头状和间变性外观的癌归类为未分化癌，而将后来发生去分化的乳头状癌保留乳头状癌的名称；认识到甲状腺球蛋白是一种恒定的肿瘤细胞标志物，而角蛋白是一种不恒定的标志物，后者对区分乳头状癌与滤泡状癌或增生性腺瘤不具有特异性。
