王满香-甲状腺病理国际高峰论坛-读片会.pdf

Thyroidcasepresentation

1609398

DepartmentofPathology,HubeiCancerHospital

WangManxiang,DengYunte

2017.3.25-26Nanjing

•49-yfemale,sufferedintermittentpaininherrightlegfora

month,andpresentedwithneckmassfor3days.

•Nopasthistoryofmajordisease.

•Ultrasoundexaminationshoweddiffuseenlargementof

bilateralthyroidglandswithmultiplenodulesand

calcification;bilateralneckandsupraclavicularlymphnodes

werefound.

•Clinicaldiagnosis:thyroidcarcinoma.

•Surgicaloperation:totalthyroidectomyandbilateralneck

lymphnodesdissection.

Grossexamination

•Theleftandrightthyroidlobes:5*4*2cmand

4.5*4*2cm,respectively,whichappearedtanand

partiallywhiteincolor；

•Dozensofcentralandlaterallymphnodes:1.2cmto

3.5*2*1.5cminsize；

MicroscopicView

B

A

A

pseudopapillary

B

Yourdiagnonsis?

IHC

CK7CK19

TTF-1TG

PAX-8

NapsinA

•IHC:

–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%)

Diagnonsis

Thyroidmetastasisfromlungadenocarcinoma;

lymphnodes(41/41)showingthepresenceoftumor.

•Molecularexamination：EGFR-wt;ALK-neg

Importantmorphologichints:

thediffuseinfiltratinggrowthpatternoftumorcellsbetweennormal

thyroidglands;notransformationbetweenthetwocomponents.

manytumorcellsshowninthelymphaticvessels；

micropapillaryclusterswithoutground-glassnucl