付欣 1刘家艳 1杨巧 2胡沛臻 1王映梅 1王哲 1范林妮1
作者信息
- 1. 空军军医大学第一附属医院病理科,西安 710032
- 2. 西安大兴医院病理科,西安 710016
- 折叠
摘要
Abstract
Objective:Metastatic lung adenocarcinoma to the thyroid can resemble primary thyroid neoplasms in both morphology and immunophenotype,leading to potential misdiagnosis.This study aims to analyze and summarize the clinical characteristics,cytopathological features,immunophenotype,and molecular genetic alterations of cases diagnosed as metastatic lung adenocarcinoma via fine needle aspiration(FNA)of the thyroid,to enhance understanding and avoid diagnostic pitfalls.
Methods:Six cases diagnosed as metastatic lung adenocarcinoma of the thyroid by FNA from the Department of Pathology of the First Affiliated Hospital of Air Force Medical University and Xi'an Daxing Hospital were retrospectively reviewed.Clinical data,cytopathological features,immunophenotypic profiles,and molecular findings were summarized and compared with corresponding primary lung tumor tissues.Relevant literature was reviewed for comprehensive analysis.
Results:Among the 6 patients diagnosed with metastatic lung adenocarcinoma to the thyroid,there were 4 females and 2 males,aged between 42 to 71 years(median age:57 years).Three had a known history of lung cancer,while the remaining 3 presented with thyroid lesions as their initial symptom,2 of whom were later confirmed to have lung adenocarcinoma through lung biopsy.Ultrasound findings included 3 patients with solitary hypoechoic nodules,2 with diffuse thyroid involvement,and 1 with multiple mixed echo nodules.Cytological examination of thyroid FNA revealed highly cellular smears,with tumor cells arranged in three-dimensional clusters or sheets;3 patients exhibited intracytoplasmic mucin.The tumor cells showed marked atypia,including enlarged nuclei,prominent nucleoli,coarse chromatin,and in 1 patient,visible mitotic figures.Immunohistochemistry showed diffuse positive for cytokeratin 7(CK7)and thyroid transcription factor-1(TTF-1),and partial to diffuse positivity for Napsin A;all patients were negative for thyroglobulin(TG)and paired box gene 8(PAX-8).Among the 5 patients who underwent molecular testing,3 were found to have EML4-ALK fusions and 3 had EGFR mutations.
Conclusion:The immunophenotypic overlap between primary thyroid carcinoma and metastatic lung adenocarcinoma necessitates careful differential diagnosis.Diagnosis of thyroid metastasis from lung adenocarcinoma via FNA requires integration of clinical history,cytomorphology,immunohistochemistry,and molecular testing.Features supporting metastatic lung adenocarcinoma include three-dimensional cell clusters,coarse chromatin,prominent nucleoli,high mitotic activity,necrosis,and intracytoplasmic mucin.关键词
甲状腺/转移性肺腺癌/细针穿刺术/细胞病理学/免疫表型/分子遗传改变Key words
thyroid/metastatic lung adenocarcinoma/fine needle aspiration/cytopathology/immunophenotype/molecular genetic alterations
