【病理每周一题】No.157（08.8.4－8.10，答案已公布） - 爱爱医医学论坛

原帖由 flyinjj 于 2008-8-10 15:12 发表

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细胞排列成假复层，胞浆丰富嗜酸性。胞核椭圆形，染色质稍粗，不成毛玻璃样，没有核沟。部分区域能看见明显的核下空泡。

Macroscopically, the tumors are large. They may or may not have a capsule. Extrathyroidal invasion is common. On scanning-magnification, columnar cell carcinoma is characterized by predominantly papillary growth pattern with stratified tumor cells somewhat lined in long paralleled ribbons. Other patterns, such as microfollicular, cribiform, organoid, and solid as well as poorly differentiated areas may be focally evident in some cases. The papillare are lined by tall columnar cells without typical nuclear features seen in those conventional papillary carcinomas. Instead, the nuclei are elongated, euchromatic or hyperchromatic. Nuclear stratification is a typical feature. Mitotic figures are often numerous. Cytoplasm is often scant, and when present, it is usually clear or granular with subneclear vacuolization. In fact, the general cytologic features of the columnar cell carcinoma resemble those seen in early secretory endometrium or endometrioid carcinoma. Areas with usual nuclear features of papillary as well as psammoma body can be focally present. They also possess immunorectivity for thyroidglobulin. It is often helpful to exclude the possibility of a metastatic endometrioid carcinoma or colorectal carcinoma by demonstrating immunoreactivity for thyroidglobulin in these tumors.

The histologic appearance of columnar cell carcinoma is quite distinct and a correct diagnosis should be rendered if most of distinctive features are observed. The lesion should not be confused with the tall cell variant of papillary carcinoma. It is present more often in women. The tall cells are defined as cells with the height two times that of the width. The tumor cells have prominent and plentiful eosinophilic and finely granular cytoplasm due to accumulation of mitochondria; the cytoplasmic membrane is sharply delineated. Occasional subnuclear vacuolization may be present. The nuclei in tall cell variant are enlarged, with nuclear pseudoinclusion and groove; they are situated in the center or basilar portion of the cell without nuclear stratification. Despite these differences between the two tumors, tumors with mixed features of columnar cell and tall cell have been reported.

Akslen LA, Varhaug JE. Thyroid carcinoma with mixed tall-cell and columnar-cell features.Am J Clin Pathol. 1990;94:442-5.

原帖由 flyinjj 于 2008-8-10 15:12 发表

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zcf_314 发表于 2008-7-12 16:07