中国实用外科杂志2025，Vol.45Issue(9)：996-1000,5.DOI:10.19538/j.cjps.issn1005-2208.2025.09.06
甲状腺乳头状癌少见亚型临床病理特征
Clinicopathological features of rare subtypes of papillary thyroid carcinoma
摘要
Abstract
Papillary thyroid carcinoma(PTC)is the most common thyroid malignancy,and a subset of subtypes exhibits moderate to high aggressiveness;accurate recognition is pivotal for prognostic assessment and individualized management.The fifth edition of the World Health Organization(WHO)classification emphasizes an integrated histologic-molecular diagnostic paradigm and,for the first time,explicitly designates high-risk histologic subtypes,including the tall cell subtype,hobnail subtype,and columnar cell subtype.Although the diffuse sclerosing subtype and the solid/trabecular subtype are categorized as intermediate risk,they likewise carry a considerable risk of metastasis.Distinct molecular profiles characterize these subtypes:the diffuse sclerosing subtype frequently harbors RET fusions;the tall cell subtype commonly shows BRAF V600E and TERT promoter mutations;and the hobnail subtype is closely associated with TP53 mutations.High-grade PTC,defined by tumor necrosis and a high mitotic rate,demonstrates biological behavior approaching that of poorly differentiated thyroid carcinoma.Standardized pathologic diagnosis requires adequate sampling in combination with immunohistochemistry and molecular testing to minimize misdiagnosis or underdiagnosis.Molecular subtyping further informs risk stratification and selection of targeted therapies.Overall,the diagnosis of rare PTC subtypes is transitioning from morphology alone to integrated molecular pathology,thereby laying the foundation for precision medicine and individualized treatment.关键词
甲状腺乳头状癌/WHO分类/少见亚型/诊断要点/分子特征Key words
papillary thyroid carcinoma/WHO classification/rare subtypes/diagnostic points/molecular characteristics分类
医药卫生引用本文复制引用
陈春燕,刘志艳..甲状腺乳头状癌少见亚型临床病理特征[J].中国实用外科杂志,2025,45(9):996-1000,5.基金项目
National Nature Science Foundation of China General Program(No.82472629) （No.82472629）
Major Program for Prevention and Control of the Four Major Chronic Diseases,Ministry of Science and Technology of the People's Republic of China(No.2024ZD0525600) （No.2024ZD0525600）
Nature Science Fund of Science and Technology Commission of Shanghai Municipality(No.23ZR 1448200) 国家自然科学基金面上项目(No.82472629) （No.23ZR 1448200）
中华人民共和国科学技术部四大慢病重大专项项目(No.2024ZD0525600) （No.2024ZD0525600）
上海市自然科学基金项目(No.23ZR 1448200) （No.23ZR 1448200）
