Ostrowski M L, Merino M J
Department of Pathology, Methodist Hospital, Houston, TX 77030, USA.
Am J Surg Pathol. 1996 Aug;20(8):964-74. doi: 10.1097/00000478-199608000-00005.
A review of 92 consecutive cases of papillary thyroid carcinoma diagnosed at The Methodist Hospital revealed 11 tall cell variant (TCV) cases in nine women and two men. There was a greater average age and larger tumor diameter of TCV cases compared with papillary thyroid carcinoma of the usual type (UPTC), but these differences were not statistically significant. Extrathyroidal extension of tumor was noted in nine of 11 TCV cases and was intraoperatively evident in five cases. The presence of extrathyroidal extension represented a statistically significant difference between TCV and UPTC (p = 0.0001) in a multivariate stepwise logistic regression analysis, with controls for variables of age, sex, tumor size, and lymph node metastases. In 11 TCV patients, tumor recurrence was present in two cases, and there was one tumor-associated death with 1 to 4 years of follow-up. Immunohistochemical stains for thyroglobulin, vimentin, keratins, and Leu-7 were positive in all TCV cases and in 16 of 16 UPTC. Immunoreactivity with antibodies to Leu M1 antigen, a myelomonocytic marker included in cluster designation group (CD 15), which is present in many adenocarcinomas, was present diffusely in all TCV, in contrast to UPTC (with sparse immunostaining in only one of 16 cases). Immunoreactivity with antibodies to ZC-23, an anti-carcinoembryonic antigen (CEA) monoclonal antibody with cross-reactivity to nonspecific cross-reacting antigen and biliary glycoprotein antigen, was present in all TCV but was not present in UPTC. COL-1, a CEA-specific monoclonal antibody, was nonimmunoreactive with all TCV and UPTC cases. Epithelial membrane antigen (EMA) was present in all TCV but was also present focally in eight of 16 UPTC, sometimes in a membranous pattern in epithelium surrounding cystic or hemorrhagic spaces. Strong immunoreactivity with antibodies to Leu M1 and EMA in papillary carcinomas of the thyroid has been associated with advanced stages of disease and tumor-associated mortality. The pattern of immunoreactivity in TCV is dissimilar to that in UPTC and is supportive evidence that TCV is a neoplasm that is distinct from papillary thyroid carcinoma of the usual type.
对卫理公会医院确诊的92例连续性甲状腺乳头状癌病例进行回顾，发现其中有11例高细胞变异型（TCV）病例，包括9名女性和2名男性。与普通型甲状腺乳头状癌（UPTC）相比，TCV病例的平均年龄更大，肿瘤直径也更大，但这些差异无统计学意义。11例TCV病例中有9例出现肿瘤甲状腺外浸润，其中5例在术中可见。在多因素逐步逻辑回归分析中，对年龄、性别、肿瘤大小和淋巴结转移等变量进行控制后，甲状腺外浸润的存在表明TCV与UPTC之间存在统计学显著差异（p = 0.0001）。在11例TCV患者中，2例出现肿瘤复发，随访1至4年有1例与肿瘤相关的死亡。所有TCV病例以及16例UPTC中的16例，甲状腺球蛋白、波形蛋白、角蛋白和Leu - 7的免疫组化染色均为阳性。与Leu M1抗原抗体的免疫反应性，Leu M1抗原是许多腺癌中存在的集落指定组（CD 15）中的一种骨髓单核细胞标志物，在所有TCV中均呈弥漫性存在，而UPTC则不同（16例中仅1例有稀疏免疫染色）。与ZC - 23抗体的免疫反应性，ZC - 23是一种抗癌胚抗原（CEA）单克隆抗体，与非特异性交叉反应抗原和胆汁糖蛋白抗原有交叉反应，在所有TCV中均存在，但在UPTC中不存在。COL - 1，一种CEA特异性单克隆抗体，对所有TCV和UPTC病例均无免疫反应性。上皮膜抗原（EMA）在所有TCV中均存在，但在16例UPTC中的8例中也有局灶性存在，有时在囊性或出血性空间周围的上皮中呈膜状模式。甲状腺乳头状癌中与Leu M1和EMA抗体的强免疫反应性与疾病晚期和肿瘤相关死亡率有关。TCV中的免疫反应模式与UPTC不同，支持了TCV是一种与普通型甲状腺乳头状癌不同的肿瘤的证据。
