Apel R L, Asa S L, LiVolsi V A
Department of Pathology, Mount Sinai Hospital, University of Toronto, Ontario, Canada.
Am J Surg Pathol. 1995 Jul;19(7):810-4.
We report 13 cases of a peculiar thyroid tumor of follicular epithelial differentiation with distinctly papillary architecture, oxyphilic cytology, and lymphocytic infiltrates in papillary stalks. The majority of these tumors arose in glands with chronic lymphocytic thyroiditis. The combination of oxyphilic cells and lymphocytic stroma gives these tumors a startling resemblance to papillary cystadenoma lymphomatosum, or "Warthin's tumor" of the salivary gland. Twelve tumors occurred in women (age range: 26-66 years, mean 44 years). Two tumors were in the isthmus, six in the right lobe, and four in the left lobe. The only man, 34 years old, had multiple bilateral tumor nodules. The lesions ranged from 0.3 cm to 3.5 cm in maximum dimension. The largest lesion, in a 58-year-old woman, infiltrated skeletal muscle. Three other patients had lymph node metastases, while the nine remaining tumors were confined to the thyroid. Follow-up in these cases suggests that although the histological appearance of these neoplasms is unusual, they behave as typical papillary carcinomas. The striking lymphocytic infiltration and oxyphilic metaplasia in these tumors as well as the association with chronic lymphocytic thyroiditis suggest that as yet undefined immunological mechanisms may play a role in the pathogenesis of this disorder.
我们报告了13例具有独特滤泡上皮分化的甲状腺肿瘤，其具有明显的乳头结构、嗜酸性细胞学特征以及乳头柄内的淋巴细胞浸润。这些肿瘤大多数发生于伴有慢性淋巴细胞性甲状腺炎的腺体。嗜酸性细胞和淋巴细胞性间质的组合使这些肿瘤与乳头状囊腺瘤淋巴瘤（即唾液腺的“沃辛瘤”）惊人地相似。12例肿瘤发生于女性（年龄范围：26 - 66岁，平均44岁）。2例肿瘤位于峡部，6例位于右叶，4例位于左叶。唯一的男性患者34岁，有多个双侧肿瘤结节。病变最大径范围为0.3 cm至3.5 cm。最大的病变发生于一名58岁女性，浸润至骨骼肌。另外3例患者有淋巴结转移，其余9例肿瘤局限于甲状腺。这些病例的随访表明，尽管这些肿瘤的组织学表现不寻常，但它们的行为如同典型的乳头状癌。这些肿瘤中显著的淋巴细胞浸润和嗜酸性化生以及与慢性淋巴细胞性甲状腺炎的关联提示，尚未明确的免疫机制可能在该疾病的发病机制中起作用。
