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目的探讨甲状腺显示胸腺样分化癌(CASTLE)的临床病理特征、免疫表型和鉴别诊断。方法对2例甲状腺CASTLE进行临床资料分析、随访、病理形态学观察、免疫组化及原位杂交检测,并结合文献进行讨论。结果2例CASTLE均为女性,分别为27岁和40岁,肿块位于甲状腺下极。巨检:肿瘤灰白色,实性。镜检:肿瘤细胞呈多边形或鳞状上皮样,具有空泡状核,核仁清楚,排列成片块状、巢状或条索状,常见丰富的小淋巴细胞浸润以及纤维组织间质。例1肿瘤侵犯至甲状腺外软组织。肿瘤细胞CD5、HCK和CD117(+),部分CEA(+),TTF-1、TG、CT和CD21(-);间质淋巴细胞TdT(-)。原位杂交EBV(-)。分别于术后4个月、9个月对2例进行随访,未见复发或转移。结论CASTLE是发生于甲状腺或颈部软组织的一种少见肿瘤,多数病例预后良好。需要与转移性鼻咽癌或淋巴上皮样癌、甲状腺鳞状细胞癌和间变性癌、异位胸腺瘤、滤泡树突状细胞肿瘤等相鉴别,免疫组化检测CD5、CD117、EMA和CD21有助于鉴别诊断。
Objective To investigate the clinicopathological characteristics, immunophenotypes and differential diagnosis of thythyoid thyroid carcinoma (CASTLE). Methods Two cases of thyroid CASTLE were analyzed by clinical data, followed up, pathomorphological observation, immunohistochemistry and in situ hybridization, and discussed with the literature. Results 2 CASTLE were female, respectively, 27 years and 40 years old, mass in the thyroid gland. Giant check: tumor gray, solid. Microscopic examination: the tumor cells were polygonal or squamous epithelium, with vacuolar nuclei, clear nucleoli, arranged in lumps, nests or cords, common small lymphocytic infiltration and interstitial fibrosis. Example 1 Tumor invasion to extra-thyroid soft tissue. Tumor cell CD5, HCK and CD117 (+), partial CEA (+), TTF-1, TG, CT and CD21 (-); interstitial lymphocytes TdT (-). In situ hybridization EBV (-). Two patients were followed up for 4 months and 9 months respectively. No recurrence or metastasis was found. Conclusions CASTLE is a rare tumor occurring in thyroid or neck soft tissue. The prognosis is good in most cases. Need to distinguish with metastatic nasopharyngeal carcinoma or lymphoid epithelial carcinoma, thyroid squamous cell carcinoma and anaplastic carcinoma, ectopic thymoma, follicular dendritic cell tumor phase identification, immunohistochemical detection of CD5, CD117, EMA and CD21 Help to differentiate the diagnosis