Harach H R, Bergholm U
Department of Pathology, University Hospital, University of Uppsala, Sweden.
J Clin Pathol. 1993 Feb;46(2):113-7. doi: 10.1136/jcp.46.2.113.
To show that medullary carcinomas of the thyroid are morphologically indistinguishable from gut carcinoids: the value of histochemistry in their identification and differential diagnosis from metastatic carcinoid tumours to the thyroid and some follicular cell neoplasms.
15 thyroid medullary carcinomas with features of gut carcinoids were histochemically studied for the presence of argyrophil and argentaffin granules, and calcitonin, thyroglobulin, and serotonin immunoreaction.
Histological features of midgut (classic) carcinoids were observed in two tumours, foregut carcinoids in 12, and hindgut carcinoids in one. All tumours showed, to a greater or lesser extent, a calcitonin immunoreaction and argyrophilia. These markers were present only in a small area showing a classic pattern of thyroid medullary carcinoma in the hindgut carcinoid-like neoplasm. Argentaffin granules and serotonin immunostaining occurred in occasional cells from four foregut carcinoid-like tumours. Thyroglobulin was not expressed in all cases and amyloid stroma was expressed in three.
In some cases a diagnosis of metastatic carcinoid tumour to the thyroid can be considered only after ruling out clinically and histochemically medullary carcinoma of the thyroid. Immunolocalisation techniques are also essential for the differentiation between medullary carcinoma and thyroid follicular cell neoplasms that resemble carcinoid tumours. It is proposed that this tumour variant to be incorporated into current classifications as another histological subtype of C cell carcinoma.
证明甲状腺髓样癌在形态学上与肠道类癌无法区分：组织化学在其识别以及与甲状腺转移性类癌肿瘤和一些滤泡细胞肿瘤鉴别诊断中的价值。
对15例具有肠道类癌特征的甲状腺髓样癌进行组织化学研究，检测嗜银和亲银颗粒、降钙素、甲状腺球蛋白及5-羟色胺免疫反应的存在情况。
在2例肿瘤中观察到中肠（经典型）类癌的组织学特征，12例为前肠类癌，1例为后肠类癌。所有肿瘤均或多或少显示降钙素免疫反应和嗜银性。这些标志物仅在1例后肠类癌样肿瘤中一小片呈现经典甲状腺髓样癌模式的区域中存在。4例前肠类癌样肿瘤的散在细胞中出现亲银颗粒和5-羟色胺免疫染色。甲状腺球蛋白并非在所有病例中均表达，3例有淀粉样间质表达。
在某些情况下，只有在临床和组织化学上排除甲状腺髓样癌后，才能考虑诊断为甲状腺转移性类癌肿瘤。免疫定位技术对于髓样癌与类似类癌肿瘤的甲状腺滤泡细胞肿瘤之间的鉴别也至关重要。建议将这种肿瘤变体作为C细胞癌的另一种组织学亚型纳入当前分类中。
