Sagan C, Fiche M, Cuilliere P, Leborgne J, Charbonnel B, Le Bodic M F
Service d'Anatomie Pathologique B, Hôpital G. & R. Laënnec, Nantes.
Ann Pathol. 1993;13(4):256-9.
The authors report the case of a 12-year-old girl presenting with a diffuse sclerosing papillary carcinoma of the thyroid. The diagnosis was made on a total thyroidectomy specimen three months after thyroid enlargement was detected. This child had previously been treated medically for thyroiditis because of an enlarged thyroid gland with serum antithyroid autoantibodies. A few cases have been described in the literature. Six morphologic findings define this variant of papillary carcinoma: a diffuse growth pattern involving one or both lobes of the thyroid, prominent fibrosis, heavy lymphocytic infiltration with germinal centers, large numbers of psammoma bodies, squamous metaplasia and papillae within cleft-like tissue spaces. Some authors stated that this variant has a poorer prognosis than the usual papillary carcinoma of the thyroid. However, in some series a few patients survive without local recurrence or distant metastasis at a mean follow-up period of more than 10 years. Immunohistochemical studies have shown high accumulation of S-100 protein positive dendritic cells. Such an infiltration has been correlated with a better prognosis.
作者报告了一例12岁女孩患弥漫性硬化性甲状腺乳头状癌的病例。在发现甲状腺肿大三个月后，通过甲状腺全切除标本做出诊断。该患儿此前因甲状腺肿大及血清抗甲状腺自身抗体曾接受过甲状腺炎的药物治疗。文献中已描述了少数病例。六个形态学特征定义了这种乳头状癌变体：累及甲状腺一叶或两叶的弥漫性生长模式、显著纤维化、伴有生发中心的大量淋巴细胞浸润、大量砂粒体、鳞状化生以及裂隙样组织间隙内的乳头。一些作者指出，这种变体的预后比甲状腺常见乳头状癌更差。然而，在一些系列研究中，部分患者在平均随访超过10年的时间里存活且无局部复发或远处转移。免疫组织化学研究显示S-100蛋白阳性树突状细胞高度聚集。这种浸润与较好的预后相关。
