患者为42岁女性,超声显示甲状腺双侧叶密度不均匀,右侧叶可见结节状低密度灶,直径约8mm;左侧叶未见明显结节灶。甲状腺右侧叶后方、双侧颈部多发小淋巴结。术后常规组织病理如下: ![图片](http://image109.360doc.com/DownloadImg/2024/05/2422/284036300_1_20240524103848972.png)
根据形态学特点,为具有乳头状核(RAS样核)特征的非浸润型甲状腺滤泡性肿瘤,符合NIFTP的组织形态学诊断标准,如下: 原单位免疫CD56失表达,支持了肿瘤细胞具有RAS样核特征: ![图片](http://image109.360doc.com/DownloadImg/2024/05/2422/284036300_2_20240524103849612.jpeg)
但BRAF免疫阳性表达,提示须关注2022年第五版WHO中NIFTP诊断的次要标准,肿瘤最终诊断为滤泡亚型甲状腺乳头状癌。 ![图片](http://image109.360doc.com/DownloadImg/2024/05/2422/284036300_3_20240524103849847.png)
![图片](http://image109.360doc.com/DownloadImg/2024/05/2422/284036300_4_20240524103850534.jpeg)
![图片](http://image109.360doc.com/DownloadImg/2024/05/2422/284036300_5_20240524103850847.png)
第四版WHO甲状腺肿瘤分类中,新增具有乳头样核特点的非浸润性甲状 腺滤泡性肿瘤 (NIFTP),并与UMP、透明变梁状肿瘤(HTT)统称为交界性肿瘤。第五版WHO分类中,以低风险肿瘤取代交界性肿瘤,更新其诊断标准及分子特征,强调诊断甲状腺低风险肿瘤须除外BRAF样等高危分子异常。 参考文献: 1. Michelle
D. Williams, Zhiyan Liu, Esther Diana Rossi, Shipr.a Agarwal, Aleš Ryška, Abir
Al Ghuzlan, Simion L. Chiosea, Nicole Cipriani, Suna Erkilic, Michael
Fridman,Jen-Fan Hang, Agnes Harahap, Chan Kwon Jung, Kennichi Kakudo, Moosa
Khalil, Elham Khanafshar, Priyanthi Kumarasinghe, Truong Phan-Xuan Nguyen,
Idris Tolgay Ocal, Manju L. Prasad, Marc Pusztaszeri, Peter Sadow, Raja
Seethala, Giovanni Tallini, Huy Gia Vuong, Gülçin Yegen, Virginia A. Livolsi,
and Yuri E. Nikiforov. Six years of NIFTP: Rate of acceptance and variation of
diagnostic approaches across different continents. The Journal of Clinical
Endocrinology & Metabolism. 2024, May 21. 2. Liu
Z., Andrey Bychkov, Chan Kwon Jung, Mitsuyoshi Hirokawa, Shaofeng Sui, SoonWon
Hong, Chiung-Ru Lai, Deepali Jain, Sule Canberk, Kennichi Kakudo. Interobserver
and intraobserver variation in the morphological evaluation of noninvasive
follicular thyroid neoplasm with papillary like nuclear features in Asian
practice. Pathol Intl, 2019. Apr;69(4):202-210 3. 刘志艳, 觉道健一。第五版 WHO 甲状腺肿瘤分类中低风险肿瘤的解读。中华医学杂志,
2022, 102(48): 3806-3810 苏鹏,张晓芳,刘红刚,纪小龙,王铁生,张仁亚,敖启林,许跃,白玉萍,刘志艳。具有乳头样核特征非浸润性甲状腺滤泡性肿瘤细胞核特征判读一致性研究。中华内分泌代谢杂志,2020, 36(7),582-602 5. 刘志艳。具有乳头样核特征的非浸润性甲状腺滤泡性肿瘤及其诊断标准。中华病理学杂志,2017,46(3),205-208
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