Wenig B M, Thompson L D, Adair C F, Shmookler B, Heffess C S
Department of Endocrine and Otorhinolaryngic-Head & Neck Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA.
Cancer. 1998 Feb 15;82(4):740-53.
Thyroid papillary carcinoma of columnar cell type is considered an uncommon histologic subtype of papillary carcinoma characterized by its morphologic features and purportedly aggressive biologic course.
Sixteen cases of thyroid papillary carcinoma of columnar cell type were identified from the Endocrine Tumor Registry at the Armed Forces Institute of Pathology and the Washington Hospital Center. Clinical records and follow-up were available in all cases. Paraffin blocks were available for histochemical and immunohistochemical studies in 15 of the 16 cases.
Of the 16 cases reported, 13 patients were female and 3 were male. The ages ranged from 16-76 years (average, 47 years; median, 40 years). An asymptomatic neck mass was the most common clinical presenting symptom. Macroscopically, the tumors varied from circumscribed or encapsulated to infiltrative, ranging in size from 1.5-6.5 cm. Histologically, the tumors had diverse growth patterns, including papillary, solid, microfollicular, and cribriform. A common pattern was the presence of markedly elongated follicles arranged in parallel cords. Colloid-filled follicles could be found, at least focally, in all cases. The characteristic histologic appearance included the presence of elongated cells showing nuclear stratification. Other features included the presence of vacuolated-appearing cells, spindle-shaped cells, and squamoid nests. Limited areas in the tumors showed morphologic features typical of thyroid papillary carcinoma. In 14 of the cases, the tumor was encapsulated, showed limited invasive growth, or was a microscopic tumor. In two of the cases, there was extrathyroidal invasion. Immunohistochemical studies showed consistent reactivity with cytokeratin and vimentin; varied reactivity with thyroglobulin, epithelial membrane antigen, carcinoembryonic antigen, and LeuM1; and no reactivity with calcitonin or chromogranin. Treatment was by surgical resection; supplemental radioactive iodine therapy was administered in eight patients. Follow-up was available for all patients, 13 of whom (81%) were alive and free of disease or had died of unrelated causes over periods ranging from 2-11 years (average, 5.8 years). All 13 of these patients had tumor confined completely to the thyroid gland. One patient died 4 months after diagnosis secondary to sepsis. Two patients (17%) had aggressive biologic courses. In both patients there was extrathyroidal invasion. One of these patients died of metastatic disease to the lungs 3 years after diagnosis; the other was alive with bilateral pulmonary metastases 9 years after the diagnosis.
The findings of the current study indicate that thyroid papillary carcinoma of columnar cell type is a distinct morphologic type but not a distinct clinical type of thyroid papillary carcinoma. The biologic behavior of this tumor is predicated on clinical stage, with the presence or absence of extrathyroidal invasion being the single most important parameter. Treatment of patients with these tumors should be based on the clinical stage and not on the morphologic appearance.
柱状细胞型甲状腺乳头状癌被认为是乳头状癌中一种不常见的组织学亚型，其特征在于形态学特征以及据称具有侵袭性的生物学进程。
从武装部队病理研究所和华盛顿医院中心的内分泌肿瘤登记处识别出16例柱状细胞型甲状腺乳头状癌病例。所有病例均有临床记录和随访资料。16例中的15例有石蜡块可用于组织化学和免疫组织化学研究。
在报告的16例病例中，13例为女性，3例为男性。年龄范围为16 - 76岁（平均47岁；中位数40岁）。无症状颈部肿块是最常见的临床症状。宏观上，肿瘤从边界清楚或有包膜到浸润性不等，大小为1.5 - 6.5厘米。组织学上，肿瘤有多种生长模式，包括乳头状、实性、微滤泡状和筛状。一种常见模式是存在明显拉长的滤泡，排列成平行索状。在所有病例中至少局灶性地可发现充满胶质的滤泡。特征性组织学表现包括存在显示核分层的拉长细胞。其他特征包括出现空泡状细胞、梭形细胞和鳞状巢。肿瘤的有限区域显示出甲状腺乳头状癌的典型形态学特征。14例病例中，肿瘤有包膜，显示有限的浸润性生长，或为微小肿瘤。2例病例有甲状腺外侵犯。免疫组织化学研究显示与细胞角蛋白和波形蛋白有一致反应性；与甲状腺球蛋白、上皮膜抗原、癌胚抗原和LeuM1反应性各异；与降钙素或嗜铬粒蛋白无反应性。治疗采用手术切除；8例患者接受了补充放射性碘治疗。所有患者均有随访资料，其中13例（81%）存活且无疾病或死于无关原因，随访时间为2 - 11年（平均5.8年）。这13例患者的肿瘤均完全局限于甲状腺。1例患者诊断后4个月因败血症死亡。2例患者（17%）有侵袭性生物学进程。这2例患者均有甲状腺外侵犯。其中1例患者诊断后3年死于肺转移；另1例患者诊断后9年存活，有双侧肺转移。
本研究结果表明，柱状细胞型甲状腺乳头状癌是一种独特的形态学类型，但不是甲状腺乳头状癌的独特临床类型。该肿瘤的生物学行为取决于临床分期，有无甲状腺外侵犯是最重要的单一参数。这些肿瘤患者的治疗应基于临床分期而非形态学表现。
