新医学2025，Vol.56Issue(7)：670-677,8.DOI:10.12464/j.issn.0253-9802.2024-0419
伴有嗜酸细胞形态特征甲状腺结节细针穿刺细胞学标本的鉴别诊断
Differential diagnostic clues of fine needle aspiration cytology in thyroid nodules characterized with oncocytic cell features
摘要
Abstract
Objective To explore the differential diagnostic clues of fine needle aspiration cytology in thyroid nodules accompanied with oncocytic features.Methods Fine needle aspiration samples of thyroid nodules were collected from Department of Pathology,the Third Affiliated Hospital of Sun Yat-sen University between November 2019 and December 2024,including oncocytic thyroid neoplasm,Hashimoto's thyroiditis,medullary thyroid carcinoma and oncocytic variant of papillary thyroid carcinoma.Morphological characteristics of fine needle aspiration were analyzed and differential diagnostic clues for this group of diseases were summarized.Results A total of 56 samples were collected from 55 patients including 22 cases of oncocytic thyroid neoplasm(21 cases of oncocytic thyroid adenoma and 1 case of oncocytic thyroid carcinoma by postoperative pathology),17 cases of Hashimoto's thyroiditis,11 cases of medullary thyroid carcinoma(from 10 patients)and 6 cases of oncocytic variant of papillary thyroid carcinoma,respectively.In oncocytic thyroid neoplasm,oncocytic cells tended to gather in clusters or distribute in large flat sheets or trabeculae,and almost no normal thyroid follicular cells or reactive lymphoid tissues were observed.In certain samples,the phenomenon of capillary penetrating among cells was noted and tumor cells were distributed in crowding in same cases of cell blocks.Hashimoto's thyroiditis is composed of varying numbers of oncocytic cells,massive reactive hyperplastic lymphoid tissues and fragments of germinal center.Benign thyroid follicular cells were found in few samples.In medullary thyroid carcinoma,the tumor cells appeared as single or small clustered with loss of cell cohesion,diverse cell morphology and dust-or salt-and-pepper like nucleus,and small nucleolus and nuclear inclusions were also observed.The tumor cells in the cell blocks were scattered or distributed in nests.The quantity of tumor cells in oncocytic variants of papillary thyroid carcinoma was high,arranged in scattered,flat sheets or small clusters.The cytoplasm was abundant and eosinophilic with extremely irregular nuclear membrane and an elevated nuclear cytoplasmic ratio.Conclusions Fine needle aspiration cytology contributes to distinguishing thyroid nodules with oncocytic features.Large sheet or trabecular distribution of oncocytic cells prompts oncocytic thyroid neoplasm.The phenomenon of capillary penetrating among oncocytic cells offers diagnostic value for oncocytic thyroid neoplasm.When a significant amount of reactive hyperplastic lymphoid tissues is observed,clinical serological and imaging features should be integrated to evaluate the possibility of coexist Hashimoto's thyroiditis.Loss of tumor cell cohesion and nuclei with"dust-like"or"salt-and-pepper"chromatin are more indicative of medullary thyroid carcinoma.The nuclear atypia in oncocytic cells is a critical feature for differentiating papillary thyroid carcinoma.关键词
甲状腺结节/细针穿刺细胞学/嗜酸细胞/诊断线索Key words
Thyroid nodule/Fine needle aspiration cytology/Oncocytic cells/Differential diagnostic clue引用本文复制引用
李海凤,谭东林,林维真,纪燕英,郑瑾玥,邵春奎,陈健宁..伴有嗜酸细胞形态特征甲状腺结节细针穿刺细胞学标本的鉴别诊断[J].新医学,2025,56(7):670-677,8.基金项目
广东省基础与应用基础研究基金项目(2024A1515012426) （2024A1515012426）
广州市科技计划项目(202102010156) （202102010156）
