本周病例（08.8.4－8.10）
1、你考虑什么诊断？
甲状腺柱状细胞型**状癌
原帖由 flyinjj 于 2008-8-10 15:12 发表
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。
2、需要做什么鉴别诊断？
甲状腺高细胞型**状癌、嗜酸细胞型**状癌、结甲**状增生、转移性腺癌
下面这段话，应该是对于高细胞型和柱状细胞型一个很全面的解释了
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.
3、本病预后如何？
本亚型多见于老年人，男性多见，是一种高度恶性的甲状腺癌，远处转移率高，与高细胞型癌预后相似，预后较差。
－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－
本期题目是对之前154期的补充，将高细胞型和柱状细胞型放在一起比较，可能更有收获。结合回答先后和完整性，mgna1980、flyinjj加一分；zhang1976329累积半分；lfl001200546、czwxzxd、蓝欣欣、wskik120、jdk1986、yhj1972鲜花鼓励！
希望大家一如既往的支持病理每周一题，
[ 本帖最后由 pathology 于 2008-8-17 16:43 编辑 ] | 
发表于 2007-12-29 22:58
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发表于 2008-8-5 13:40
pathology
