第4版WHO分化型甲状腺癌病理分类及其进展

摘要/Abstract

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R736.1

唐娟, 刘志艳. 第4版WHO分化型甲状腺癌病理分类及其进展[J]. 外科理论与实践, 2021, 26(06): 504-509.

TANG Juan, LIU Zhiyan. Differentiated thyroid carcinoma: 4th edition WHO pathological classification and future[J]. Journal of Surgery Concepts & Practice, 2021, 26(06): 504-509.

图/表5

表1

2017版WHO的PTC亚型及诊断标准

	分型	特征性肿瘤细胞比例	主要形态学特征
高侵袭性	高细胞型	≥30%	拉长的滤泡或具有双轨征的乳头;肿瘤细胞高度为宽度的2~3倍;嗜酸性胞质;肿瘤细胞边界清晰
	柱状细胞型	≥30%	肿瘤细胞多为假复层柱状;TTF-1表达各异，可表达CDX2;预后与肿瘤是否有包膜、是否浸润性生长有关
	鞋钉型	≥30%	复杂多级乳头和微乳头结构;肿瘤细胞嗜酸性胞质，细胞核位于顶端
	实体/梁状型	100%或接近100%	多见于年轻人或具有放射暴露史者;与肺转移有关;成人死亡率略增高
惰性	滤泡亚型	100%	无真性乳头、滤泡结构，具有PTC细胞核特点
	弥漫硬化型	无要求	广泛砂砾体、弥漫纤维化、淋巴管内癌栓;广泛鳞状上皮化生;淋巴细胞性甲状腺炎
	微小乳头状癌	直径（单个肿瘤或多个肿瘤总和）≤1 cm	具有PTC细胞核特征
	梭形细胞型	5%~95%的梭形细胞	免疫表型表达CK和TTF-1，无坏死和核分裂像;无含铁血黄素沉着
	包裹型	无要求	有完整包膜，无论是否浸润
	结节性筋膜炎样型		结节性筋膜炎样/纤维瘤病样间质
	Warthin样型		乳头被覆嗜酸性大肿瘤细胞，间质富于淋巴细胞;淋巴细胞性甲状腺炎背景;部分肿瘤中央囊性变
	嗜酸细胞型		十分罕见，嗜酸性胞质，需与高细胞型鉴别
	透明细胞型		透明胞质，可见部分嗜酸性细胞
	筛状桑葚型		乳头、滤泡或实性结构，通常腔内缺乏胶质;肿瘤细胞多为柱状，核沟与核内包涵体数量不等;可见典型桑葚体;肿瘤细胞表达TTF-1，甲状腺球蛋白不表达或仅局灶表达;β-catenin异常表达于肿瘤细胞核

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参考文献43

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第4版WHO分化型甲状腺癌病理分类及其进展

Differentiated thyroid carcinoma: 4th edition WHO pathological classification and future

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