Katoh R, Kawaoi A, Muramatsu A, Hemmi A, Suzuki K
Department of Pathology, Yamanashi Medical University, Tamaho-cho, Japan.
Am J Surg Pathol. 1993 Jul;17(7):698-705. doi: 10.1097/00000478-199307000-00007.
To elucidate the nature and significance of calcium oxalate crystals in the pathologic thyroid, we used polarized light microscopy to review 357 thyroid lesions. Under polarized light, calcium oxalate crystals had brilliant birefringence, and they were invariably identified within the colloid of follicles. The highest prevalence of crystals (87.9%) was in nodular goiters; they were also found in 60.0% of follicular adenomas and 33.3% of follicular carcinomas. The prevalence of crystals in papillary carcinomas was very low (5.4%). Therefore, the overall prevalence was 69.4% in benign nodules and 7.6% in malignant nodules. A heavy deposit of crystals was seen only in benign nodules except for one case of follicular carcinoma. Graves' disease, focal thyroiditis, and subacute thyroiditis showed low prevalence: 25.0, 46.9, and 40.0%, respectively. In cases of toxic nodules, the crystals were sparsely identified within nodules, but abundantly observed in surrounding inactive tissues. Immunohistochemistry for thyroid hormones confirmed that the crystals tended to appear in inactive follicles. On tissue x-ray film, the crystals appeared as microcalcifications. As a result of these findings, we suggest that examinations of crystals are likely to be useful in the differential diagnosis of thyroid diseases and in possible estimations of the functional state of lesions.
为阐明病理性甲状腺中草酸钙结晶的性质和意义，我们使用偏光显微镜检查了357个甲状腺病变。在偏光下，草酸钙结晶具有明亮的双折射，且总是在滤泡胶体中被识别出来。结晶的最高发生率（87.9%）见于结节性甲状腺肿；在60.0%的滤泡性腺瘤和33.3%的滤泡性癌中也发现了结晶。乳头状癌中结晶的发生率非常低（5.4%）。因此，良性结节中的总体发生率为69.4%，恶性结节中的为7.6%。除1例滤泡性癌外，仅在良性结节中可见大量结晶沉积。格雷夫斯病、局灶性甲状腺炎和亚急性甲状腺炎的发生率较低，分别为25.0%、46.9%和40.0%。在毒性结节病例中，结节内结晶稀疏，但在周围无活性组织中大量观察到。甲状腺激素免疫组化证实，结晶倾向于出现在无活性的滤泡中。在组织X光片上，结晶表现为微钙化。基于这些发现，我们认为对结晶的检查可能有助于甲状腺疾病的鉴别诊断以及对病变功能状态的可能评估。
