王滿(mǎn)香-2017 年甲狀腺病理國(guó)際高峰論壇

Thyroidcasepresentation1609398DepartmentofPathology,HubeiCancerHospitalWangManxiang,

DengYunte

2017.3.25-26Nanjing49-yfemale,sufferedintermittentpaininherrightlegforamonth,andpresentedwithneckmassfor3days.Nopasthistoryofmajordisease.Ultrasoundexamination

showeddiffuseenlargementofbilateralthyroidglandswithmultiplenodules

andcalcification;bilateralneckandsupraclavicularlymphnodeswerefound.Clinicaldiagnosis:thyroidcarcinoma.Surgicaloperation:totalthyroidectomyandbilateralnecklymphnodesdissection.GrossexaminationTheleftandrightthyroidlobes:5*4*2cmand4.5*4*2cm,respectively,whichappearedtanandpartiallywhiteincolor；Dozensofcentralandlaterallymphnodes:1.2cmto3.5*2*1.5cminsize；MicroscopicViewABApseudopapillaryBYourdiagnonsis?IHCCK7CK19TTF-1TGPAX-8NapsinAIHC:Positive：CK7、CK19、TTF-1、NapsinA；Negative：TG、PAX-8、CD56、Syn、CgA、BRAF(V600E)；Focalpositive：CK5/6、P63、Vimentin、HBME-1；KI-67(LI:50%)Molecularexamination：EGFR-wt;ALK-negDiagnonsisThyroidmetastasisfromlungadenocarcinoma;lymphnodes(41/41)showingthepresenceoftumor.Importantmorphologichints:thediffuseinfiltratinggrowthpatternoftumorcellsbetweennormalthyroidglands;notransformationbetweenthetwocomponents.manytumorcellsshowninthelymphaticvessels；micropapillaryclusterswithoutground-glassnucleiandnuclearinclu-sions.Immunophenotype：Positive：CK7、CK19、TTF-1、NapsinA；Negative：TG、PAX-8ClinicalandImagingfindings.

Differentialdiagnonsis

VSprimaryanaplasticcarcinomaTumornestsinvadeintonormalthyroidglandsdiffusely,butnotreplace/destroythenormalstructureofglands;Alotofcanceremboluscanbefoundinthetissue;Therearenodifferentiatedcomponentssuchaspapillarycarcinomaorfollicularcarcinomaalthoughwithwidelysampling;IHCShowsTTF-1、NapsinA(+)andPAX-8、TG(-)；CTrevealedpulmonarymasses.So,primarythyriodanaplasticcarcinomacanbeexcluded.Butsometimes,itisreallydifficulttodistinguishmetastasesfromprimarymalignancies.Then,pray!ThevascularinvasionofthyroidanaplasticcarcinomaAnewlycase

H17017965-ymaleTendaysafterthyroidectomy。PET-CTdetectionofbilateralneck,supraclavicular,

mediastinal,righthilarandretroperitoneal

lymphnodesmetastases;nootherabnormalities.OriginalIHCPostive:CK7、CEA；Negtive:TG、TTF-1、CT、CK5/6、P63、CK20、SynOriginalDiagnosis:Thyroidpoorlydifferentiatedcarcinoma？Contactwiththeclinicianandpatient’swife;Dogastroscopyexamination;Addseveralimmunohistochemistrymarkers.BiopsyofgastroesophagealjunctionIHCCDH17VillinCK7Pax-8TTF-1TGPostive:Villin、CDH17、CK7、P53、CEA；Ki-67(Li:50%)Negtive:CK5/6、P63、PAX-8、TTF-1、TG、Her-2AdditionalIHCforthyroidlesionsPostive:Villin、CDH17、CEA；Negtive:PAX-8、TG、TTF-1、NapsinAVillinCDH17CK7Pax-8TTF-1TGGastroesophagealadenocarcinoma.Thyroidpoorlydifferentiatedcarcinoma,whichmetastasizesfromgastriccarcinoma,accordingtotheclinicalandimmunohistochemicalfindings.FinalDiagnosis[1]ChungAY,etal.Metastasestothethyroid:areviewoftheliterature

fromthelastdecade.Thyroid.2012;22:258–68.

[2]M.K.Nakhjavani,etal.Metastasistothethyroidgland:areportof43

cases.Cancer,1997;79:574–578.

Metastasistothyroidglandisuncommon,withreportedincidencesrangingfrom1.4to3%ofallpatientswhohadthyroidectomybecauseofmalignanttumor[1].Butinautopsystudieswhodiedofwidespreadmetastaticdisease,theincidenceisupto24%[2].Themostcommonmalignanciesmetastasizetothethyroidarerenalcell,colorectal,lungandbreastcarcinomas[1].Literaturereview(what)Althoughthethyroidglandhasarichvascularsupply,fewmetastatictumorsoccurbecauseoffastarterialflow,highoxygensaturationandiodinecontentofthethyroidglandsthatmayinhibitthegrowthofmalignantcells.Metastasisoftenoccurredinthyroidglandswithabnormalities,suchasneoplasmorbenignconditionswhichmayhavedecreasedbloodsupply,decreasedoxygenandiodinecontentandthusismorevulnerabletometastaticmalignancy.(why)ChungAY,etal.Metastasestothethyroid:areviewoftheliterature

fromthelastdecade.Thyroid.2012;22:258–68.

Misdiagnosisiscommonbecauseitisdifficulttodistinguishuncommonmetastasesfromprimarymalignancies,especiallyinapatientwithnopasthistoryofanymalignancy.(how)Ca