Kaserer K, Scheuba C, Neuhold N, Weinhäusel A, Vierhapper H, Haas O A, Niederle B
Department of Clinical Pathology, University of Vienna, Medical School, Austria.
Am J Surg Pathol. 1998 Jun;22(6):722-8. doi: 10.1097/00000478-199806000-00009.
Routine screening of calcitonin serum levels in patients with nodular thyroid disorders has led to an increased rate of total thyroidectomies. We investigated prevalence and interrelationship of C-cell hyperplasia (CCH) and medullary thyroid carcinoma (MTC) in patients with thyroid and parathyroid disorders that showed increased calcitonin serum levels detected by routine screening. Within two years, 30 (mean age, 60 +/- 14 years) of 667 patients had a pentagastrin-stimulated calcitonin level of more than 100 pg/mL. All 30 underwent total thyroidectomy and were tested for germ-line mutations of the ret protooncogene. Entire surgical specimens were blocked, and C-cell disorders were assessed using conventional histology and immunohistochemistry. C-cell hyperplasia was defined by the presence of more than 50 C cells/l low-power field in both lobes and was classified as focal, diffuse, nodular, or neoplastic. Nineteen patients (female/male = 14/5) had MTC, and 11 males but no females had CCH only. Six of 16 patients with sporadic MTC had concomitant CCH. Three patients were index cases of new MTC families. We conclude that MTC with concomitant CCH is an unreliable marker for hereditary MTC risk and that CCH has a preneoplastic potential in the absence of germ-line mutations. In this series, CCH alone was not found in females.
对甲状腺结节性疾病患者进行降钙素血清水平的常规筛查，导致甲状腺全切术的比例增加。我们调查了甲状腺和甲状旁腺疾病患者中C细胞增生（CCH）和甲状腺髓样癌（MTC）的患病率及相互关系，这些患者经常规筛查发现降钙素血清水平升高。在两年内，667例患者中有30例（平均年龄60±14岁）的五肽胃泌素刺激降钙素水平超过100 pg/mL。所有30例患者均接受了甲状腺全切术，并检测了原癌基因ret的种系突变。将整个手术标本进行包埋，使用传统组织学和免疫组织化学评估C细胞疾病。C细胞增生的定义为双侧叶每低倍视野中C细胞超过50个，并分为局灶性、弥漫性、结节性或肿瘤性。19例患者（女/男=14/5）患有MTC，11例男性仅有CCH，无女性患者。16例散发性MTC患者中有6例伴有CCH。3例患者是新的MTC家族的索引病例。我们得出结论，伴有CCH的MTC不是遗传性MTC风险的可靠标志物，并且在没有种系突变的情况下CCH具有肿瘤前潜能。在本系列中，未在女性中发现单独的CCH。
