組織學、炎癥和非腫瘤性病變（Histology, inflammation and non neoplastic lesions）The thyroid has two basic cell types: the follicular epithelium (TTF-1 and thyroglobulin positive) and the C cells (TTF-1, neuroendocrine-marker, and calcitonin positive; thyroglobulin negative). Normal follicular epithelium is low cuboidal. The stroma or interstitium is scant but highly vascular.甲狀腺有兩種基本細胞類型：（1）濾泡上皮，表達TTF-1和甲狀腺球蛋白（TG）；（2）C細胞，表達TTF-1、神經內分泌標記物和降鈣素，不表達TG。正常濾泡上皮為低立方上皮。間質稀少，血管豐富。Inflammatory diseases of the thyroid are rarely seen in surgical pathology, with a few exceptions detailed in this chapter. Conceptually, they can be classified by type of response:甲狀腺炎癥性疾病在外科病理學中很少見，本章詳細介紹了一些例外情況。從概念上講，它們可以按炎癥反應的類型進行分類：
Acute inflammation and necrosis: acute thyroiditis
急性炎癥和壞死：急性甲狀腺炎
Foreign body giant cells and lymphocytes, diffuse: subacute thyroiditis (de Quervain’s syndrome)
異物巨細胞和淋巴細胞，彌漫性：亞急性甲狀腺炎（de Quervain綜合征）
Histiocytes, lymphocytes, and rare giant cells, focal: palpation thyroiditis (a reaction to physical trauma, not a primary inflammatory disease)
組織細胞、淋巴細胞和罕見巨細胞，局灶性：觸診性甲狀腺炎（對物理創(chuàng)傷的反應，而非原發(fā)性炎癥性疾?。?/span>
Lymphocytic infiltrate with germinal centers: lymphocytic thyroiditis or Hashimoto’s thyroiditis
淋巴細胞浸潤伴生發(fā)中心：淋巴細胞性甲狀腺炎或橋本甲狀腺炎
Dense fibrosis and chronic inflammation: sclerosing Hashimoto’s versus fibrosing thyroiditis (Riedel’s, a very rare entity)
致密纖維化和慢性炎癥：硬化性橋本病與纖維化性甲狀腺炎（Riedel病，一種非常罕見的疾病
Lymphocytic thyroiditis is a descriptive term implying a generalized lymphocytic infiltrate. The term Hashimoto’s thyroiditis refers to an autoimmune process attacking the thyroid, and it is characterized by the following:淋巴細胞性甲狀腺炎是一個描述性術語，意味著廣泛的淋巴細胞浸潤。術語橋本甲狀腺炎是指攻擊甲狀腺的自身免疫疾病，其特征如下：Figure 23.1. Hashimoto’s thyroiditis. The thyroid follicles are displaced by germinal centers (arrow).圖23.1 橋本甲狀腺炎。甲狀腺濾泡被生發(fā)中心取代（箭）。Small, atrophic follicles with Hürthle cell change (oncocytic change)
小的、萎縮的濾泡，伴Hürthle（許特萊）細胞改變（嗜酸細胞改變）
Scattered nuclear atypia may be seen in this setting, including large hyperchromatic Hürthle cell nuclei, as well as areas of nuclear clearing and pleomorphism that can simulate papillary carcinoma. Therefore, be cautious about diagnosing papillary carcinoma in the setting of lymphocytic thyroiditis. However, these patients can also get papillary carcinoma!在這種情況下，可以看到散在的核異型性，包括大的深染的Hürthle細胞核，以及可能貌似乳頭狀癌的核透明和核多形性區(qū)域。因此，在淋巴細胞性甲狀腺炎背景下診斷乳頭狀癌應慎重。然而，這些患者也可能真有乳頭狀癌！Graves’ disease (diffuse toxic hyperplasia) is a hyperplastic, hyperthyroid condition in which autoantibodies stimulate the thyroid-stimulating hormone receptor to produce excess thyroid hormone. In treated form, more commonly seen in pathology, the follicles are large and distended, with prominent papillary infoldings (Figure 23.2). The papillary architecture can become florid, but the nuclear features are not those of papillary carcinoma (discussed later). Scalloping of the colloid is prominent. In untreated Graves’ disease, on the other hand, the thyroid is highly cellular with minimal colloid.Graves病（彌漫性毒性增生）是一種增生性甲狀腺功能亢進癥，自身抗體刺激促甲狀腺激素受體產生過量甲狀腺激素。病理科較常見治療后改變，濾泡大而膨脹，有明顯的乳頭狀突起（圖23.2）。乳頭狀結構可能旺熾，但沒有乳頭狀癌的核特征（稍后討論）。膠體有明顯的扇貝形結構。另一方面，未治療的Graves病，甲狀腺高度富于細胞，膠質極少。Figure 23.2. Graves’ disease with papillary hyperplasia. These papillary formations are due to hyperplasia of the follicular epithelium. The follicular cells are round, fairly evenly spaced, and have dark uniform chromatin (arrow), similar to normal follicles.圖23.2 Graves病伴乳頭狀增生。這些乳頭狀結構是由于濾泡上皮增生所致。濾泡細胞呈圓形，分布相當均勻，染色質深染而均勻（箭），類似于正常濾泡。Goiter is a nonspecific term for enlargement (hyperplasia) of the thyroid but is often used to refer to the nodular enlargement of the thyroid due to iodine deficiency (endemic goiter) or enzyme defects (sporadic goiter). Multinodular hyperplasia may be sampled by fine-needle aspiration (FNA) if a single nodule becomes dominant and suspicious, or the whole gland may be removed for cosmetic or physiologic reasons. The nodules usually fall on the colloid nodule-to-follicular adenoma spectrum (see later).甲狀腺腫是甲狀腺腫大（增生）的非特異性術語，但通常是指由于碘缺乏（地方性甲狀腺腫）或酶缺陷（散發(fā)性甲狀腺腫）引起的甲狀腺結節(jié)性腫大。如果單個結節(jié)占優(yōu)勢且可疑，可通過細針穿刺（FNA）對多結節(jié)增生進行取樣，或者出于美容或生理原因，可切除整個甲狀腺。結節(jié)通常位于膠質結節(jié)至濾泡性腺瘤的形態(tài)學譜系（見下文）。The world of thyroid neoplasms can be broken down into several large categories. The first two categories arise from follicular epithelium, and they are divided in this chapter into two groups based on cytologic and nuclear features. The first category is made up of folliculartype cells that resemble normal thyroid follicular epithelium. This category includes Hürthle cells, which can be found in nonneoplastic thyroid. The second major category is the papillary carcinoma group, of which there are many variants; they have in common a set of diagnostic nuclear features. The third category of neoplasms arises from the neuroendocrine or C cell component of the thyroid; medullary carcinoma is the main entity in this group. Table 23.1 summarizes the architectural and cytologic features of thyroid neoplasms.甲狀腺腫瘤可以分為幾個大類。（譯注：本章分為三大類：濾泡型病變、乳頭狀癌和神經內分泌病變）。前兩大類起源于濾泡上皮，根據細胞學和核特征分為兩組。第一大類由濾泡型細胞組成，類似于正常甲狀腺濾泡上皮。這一大類包括Hürthle細胞，可以在非腫瘤性甲狀腺中發(fā)現。第二大類是乳頭狀癌組，其中有許多變異型；它們有共同的診斷性核特征。第三大類起源于甲狀腺的神經內分泌或C細胞成分；髓樣癌是本組的主要實體。表23.1總結了甲狀腺腫瘤的結構和細胞學特征。 Table 23.1. Summary of architectural and cytologic features of thyroid neoplasms.濾泡型病變（Follicular-Type Lesions）Follicular-type cells are notable for their uniformity. The nuclei tend to be round and monotonous, although they may be enlarged compared with normal thyroid. The overall impression is that of a regular array of cells, without crowded, overlapping, or irregular nuclei (Figure 23.3). The cells should respect each others’ personal space, so to speak. The chromatin should be even and smooth, not cleared out, coarse, or chunky.濾泡型細胞呈現明顯的均質性。核往往呈單調的圓形，盡管核可能比正常甲狀腺增大?？傮w印象是細胞排列規(guī)則，不擁擠，不重疊，沒有不規(guī)則核（圖23.3）?？梢哉f，細胞懂得尊重彼此的個人空間。染色質應均勻、光滑，不是透明的、粗糙的或粗塊狀。Figure 23.3. Follicular cells. Normal follicular epithelium has round uniform nuclei that tend not to overlap or crowd each other (arrow). This field is a combination of large and small follicles full of colloid and could represent normal thyroid, nodular hyperplasia, or a follicular neoplasm.圖23.3 濾泡細胞。正常濾泡上皮具有圓形均勻的細胞核，一般不重疊、不擁擠（箭）。圖示充滿膠質的大濾泡和小濾泡的組合，可能代表正常甲狀腺、結節(jié)性增生或濾泡性腫瘤。Colloid nodule, adenomatoid nodule, and follicular adenoma all describe a spectrum of hyperplastic to neoplastic lesions composed of a nodular cluster of follicular epithelium. This area is somewhat confusing as the same lesion may get different names depending on whether it is seen by FNA or on resection. A colloid nodule is a hyperplastic nodule of large distended follicles in which the ratio of colloid to cells is high (a key finding on FNA). A follicular adenoma is defined as a solitary encapsulated nodule with compression of the surrounding thyroid and is usually composed of small microfollicles with scant colloid (a low colloid to cell ratio; Figure 23.4). This lesion, seen on FNA, is called a follicular neoplasm, as follicular adenoma and carcinoma can not be distinguished by FNA alone. Finally, there is the adenomatoid nodule, a hyperplastic lesion that has some features of the adenoma.膠質結節(jié)、腺瘤樣結節(jié)和濾泡性腺瘤都是描述一組由濾泡上皮形成的結節(jié)狀簇集所形成的增生性至腫瘤性病變的形態(tài)學譜系。這些內容有點混亂，因為同一個病灶可能會根據FNA或切除標本的不同而有不同的名稱。膠質結節(jié)是一種增生性結節(jié)，由大的擴張濾泡組成，其中膠質與細胞的比例很高（FNA的一個關鍵發(fā)現）。濾泡性腺瘤是一種孤立的有包膜的結節(jié)，周圍甲狀腺受擠壓，通常由小的微濾泡組成，膠質稀少（膠質與細胞比例低，圖23.4）。FNA看到的這種病變稱為濾泡性腫瘤，因為FNA無法區(qū)分濾泡性腺瘤和癌。最后是腺瘤樣結節(jié)，一種增生性病變，具有腺瘤的部分特征。Figure 23.4. Follicular adenoma. This field shows a microfollicular pattern in a follicular adenoma. The capsule is not seen here. The neoplasm is composed of tightly packed small follicles (arrow) with round nuclei that, like normal follicular epithelium (see Figure 23.3), tend not to overlap or crowd. There are scattered enlarged nuclei, some with pale chromatin that should not be mistaken for true nuclear clearing.圖23.4。濾泡性腺瘤。圖示濾泡性腺瘤中的微濾泡模式。這里看不到包膜。腫瘤由緊密排列的小濾泡（箭）組成，核圓形，就像正常濾泡（見圖23.3），一般不重疊、不擁擠。有散在的增大的核，部分核具有淡染的染色質，不要誤認為真正的核透明。Before calling a lesion a follicular adenoma, however, you must submit and examine the entire capsule. Follicular carcinoma may appear histologically similar to adenoma but for the diagnostic capsular or vascular invasion. This is why you cannot make the distinction by FNA alone. You should also exclude the follicular variant of papillary carcinoma (discussed later).然而，必需取材并觀察整個包膜，才能將病變稱為濾泡性腺瘤。濾泡性癌的組織學形態(tài)可能類似腺瘤，但有診斷性包膜或血管浸潤。這就是FNA不能區(qū)分的原因。還應排除濾泡型乳頭狀癌（稍后討論）。Hürthle cell adenoma is very similar to a follicular adenoma in concept except the cells are large pink oncocytes with round nuclei (Hürthle cell change; Figure 23.5). Nucleoli may be prominent, and the nuclei may appear very enlarged or irregular in shape, unlike in follicular adenoma. As with follicular neoplasms, evaluating the capsule is key to calling it benign or malignant.Hürthle細胞腺瘤在概念上與濾泡性腺瘤非常相似，但細胞為粉紅色嗜酸性大細胞，核圓形（Hürthle細胞改變；圖23.5）。與濾泡性腺瘤不同，核仁可能顯著，核可能很大或形狀不規(guī)則。與濾泡性腫瘤一樣，評估包膜是將其稱為良性或惡性腫瘤的關鍵。Figure 23.5. Hürthle cell adenoma. Like follicular adenomas, there is a thick fibrous capsule surrounding the neoplasm (arrow). In a Hürthle cell adenoma, the cells have abundant pink cytoplasm, and, although the nuclei are still overall round and nonoverlapping, there is increased nuclear atypia in the form of some prominent nucleoli and irregular nuclear shapes.圖23.5。Hürthle細胞腺瘤。正如濾泡性腺瘤，該腫瘤周圍有一層厚厚的纖維包膜（箭）。在Hürthle細胞腺瘤中，細胞有豐富的粉紅色細胞質，但總體上核仍然是圓形且不重疊，核非典型性有所增加，表現為有一些明顯的核仁和不規(guī)則的核形狀。The defining feature of a follicular carcinoma (or Hürthle cell carcinoma) is the presence of capsular or vascular invasion, so examination of the capsule is critical. Atypia and necrosis, while seen in follicular carcinoma, are not sufficient to make the diagnosis.* Capsular invasion is a controversial area, and experts disagree on the exact criteria that define it; however, a mushrooming growth of tumor through the capsule is accepted by most. Vascular invasion must be found within the capsule itself or outside the capsule. The tumor deposit should be visibly attached to the vessel wall (Figure 23.6).濾泡性癌（或Hürthle細胞癌）的決定性特征是存在包膜或血管浸潤，因此檢查包膜是至關重要的。非典型性和壞死雖然可見于濾泡性癌，但不足以診斷為濾泡性癌。*包膜侵犯是有爭議的領域，專家們對確切的定義標準不一致；然而，大多數人都接受腫瘤呈蘑菇狀生長并穿透包膜。血管侵犯必須是發(fā)生在包膜內或包膜外。要看到腫瘤沉積物附著在血管壁上（圖23.6）。*Random pearl: In this, the thyroid is like most other neuroendocrine organs, including parathyroid, adrenal, and pituitary. The diagnosis of malignancy is not based on atypia, which can be seen in hyperplastic conditions, but on capsular/vascular invasion or metastases.*隨機紅包：這方面，甲狀腺與大多數其他神經內分泌器官（包括甲狀旁腺、腎上腺和垂體）一樣，惡性腫瘤的診斷不是基于異型性（可見于增生性疾?。?，而是基于包膜/血管浸潤或轉移。Figure 23.6. Follicular carcinoma. The neoplasm here resembles a follicular adenoma at low power, with a dense microfollicular pattern and a thick capsule. However, there is vascular invasion in the capsule, diagnostic of follicular carcinoma. A tumor plug (asterisk) is seen in the lumen of a large vessel (arrow). The surface of the tumor plug becomes endothelialized (arrowhead).圖23.6。濾泡性癌。該腫瘤在低倍鏡下類似于濾泡性腺瘤，具有致密的微濾泡模式和厚包膜。然而，包膜內有血管浸潤，這濾泡性癌的診斷性特征。在大血管的管腔（箭）中可以看到瘤栓（星號）。瘤栓的表面有一層內皮（箭頭）。Follicular carcinoma comes in two strengths: minimally invasive (where you have to struggle to find the diagnostic vascular invasion) and widely invasive (where you have to dissect it off the adherent neck structures). It is not associated with radiation or thyroiditis, unlike papillary carcinoma. It spreads via the blood to lung and bone.濾泡性癌根據浸潤程度分兩種：微小浸潤性（你必須努力找到診斷性血管侵犯）和廣泛浸潤性（你必須將其從粘附的頸部結構上分離）。與乳頭狀癌不同，它與輻射或甲狀腺炎無關。它通過血液播散到肺和骨。Insular carcinoma is rarely diagnosed and can be thought of as a poorly differentiated carcinoma. The cells grow in sheets and cords (insular pattern; Figure 23.7) and on high power resemble the round and uniform cells of follicular carcinoma. Pleomorphism is not a typical feature here, but mitoses, necrosis, vascular invasion, and infiltrative growth are common.島狀癌很少診斷，可視為一種低分化癌。細胞呈片狀和條索狀生長（島狀模式；圖23.7），高倍鏡下類似于濾泡性癌的圓形均勻細胞。多形性不是其典型特征，但是常見核分裂、壞死、血管浸潤和浸潤性生長。Figure 23.7. Insular carcinoma. Instead of microfollicles, the tumor has acquired a pattern of ribbons, cords, and slit-like spaces.圖23.7 島狀癌。腫瘤形成緞帶狀、條索狀和狹縫狀的空隙，而不是微濾泡。乳頭狀癌（Papillary Carcinoma）Papillary carcinoma (there is no papillary adenoma), despite the name, may come with or without the papillae. The diagnosis actually rests on the nuclear features, which are consistent across variant types. The nuclear features are as follows:乳頭狀癌（沒有乳頭狀腺瘤），盡管名為“乳頭”，實際上可以沒有乳頭。診斷實際上取決于核特征，這些特征在不同變異型中是一致的。其核特征如下：Chromatin is cleared out (resembling orphan Annie eyes). This imparts a characteristic low-power look to the lesion; the cells stand out as crisp and pale, almost glittery or glassy (Figure 23.8). It is an artifact of formalin.
染色質透明（像孤兒安妮的眼睛）。使得病變在低倍鏡下呈現特征性外觀；細胞鮮明而淡染，似乎閃閃發(fā)光或毛玻璃樣（圖23.8）。這是福爾馬林固定造成的假象。
（譯注：插圖，Little Orphan Annie，小孤兒安妮，卡通人物，空洞無神的雙眼）Figure 23.8. Papillary carcinoma, low power. The nuclear features of papillary carcinoma are eyecatching even at low power, as the clear nuclei give a translucent or glassy appearance to the tumor nodule (arrow). This is an example of an incidental microcarcinoma, arising in Hashimoto’s thyroiditis (note germinal centers, arrowhead).圖23.8 乳頭狀癌，低倍。乳頭狀癌的核特征即使在低倍鏡下也引人注目，因為核透明，使腫瘤結節(jié)呈現半透明或毛玻璃樣（箭）。這是一例偶然發(fā)生的微小癌，發(fā)生于橋本甲狀腺炎背景中（注意生發(fā)中心，箭頭）。Nuclei are overlapping, crowded, and pleomorphic. They often appear boxy and angular at higher power, and you get the impression that too many nuclei have been stuffed into a single row (Figure 23.9); some are squeezed up and out of the row.
核重疊，擁擠，多形性。高倍，核通常呈方形和成角，給人的印象是太多核被擠成一排（圖23.9）；有些核被擠到外面。
Figure 23.9. Papillary nuclei. (A) In this example, although the nuclear clearing is not striking, the presence of oval nuclei crowded into a row (arrow) suggests papillary carcinoma, as does the presence of nuclear grooves (arrowhead). Compare these nuclei to those of follicular epithelium see (Figure 23.3). (B) In this lesion the nuclear clearing is much more evident. However, the nuclei are still oval in shape and crammed together such that they mold to each other, popping up and out of their crowded rows (arrow).圖23.9 乳頭狀癌核特征。（A）本例，盡管核透明不那么顯著，但卵圓形核擠成一排（箭）提示乳頭狀癌，核溝（箭頭）也提示乳頭狀癌。將這些核與濾泡上皮核進行比較（見圖23.3）。（B）這例核透明更加明顯。然而，核仍然是橢圓形，擠在一起，使它們相互鑲嵌，有些核被擠到外面（箭頭）。Note that prominent nucleoli are not a feature of papillary carcinoma. Psammoma bodies are fairly specific for papillary carcinoma but are generally seen only in the context of papillary architecture. True psammoma bodies are dark purple, ringed like a tree, and usually found in the interstitium, not in follicles (Figure 23.10). There are several variants of papillary carcinoma.注意，顯著核仁不是乳頭狀癌的特征。砂粒體對乳頭狀癌相當特異，但通常僅見于乳頭狀結構。真正的砂粒體呈深紫色，環(huán)狀，如樹的年輪，通常位于間質中，而不是濾泡中（圖23.10）。乳頭狀癌有幾種變異型，如下：Figure 23.10. Psammoma body. This dense purple laminated calcification (arrow) is virtually diagnostic of papillary thyroid carcinoma in the thyroid or in a neck lymph node. Telltale scratches in the tissue section (arrowheads) often show where a psammoma body was dragged across the block during sectioning.圖23.10 砂粒體。這種致密的紫色層狀鈣化（箭）幾乎是甲狀腺或頸部淋巴結中甲狀腺乳頭狀癌的診斷性特征。組織切片（箭頭）上的明顯劃痕通常提示在切片過程中砂粒體被拖過的位置（譯注：也可能是砂粒體鈣化損傷了刀片，切片時形成了刀痕）。Papillary microcarcinoma: Although histologically identical to papillary carcinoma, papil-lary microcarcinomas are less than 1 cm (by definition), usually incidentally discovered, and, if solitary, are considered clinically benign.
乳頭狀微小癌（微小乳頭狀癌）：組織學等同于乳頭狀癌，直徑小于1cm（根據定義），通常是偶然發(fā)現，如果是孤立的，則認為臨床良性。
Follicular: The follicular variant is a lesion with follicular architecture (no papillae) and papillary nuclei (Figure 23.11). It behaves like a papillary carcinoma and is now signed out as one. Differentiating between a follicular adenoma and a follicular variant of papillary carcinoma is no trivial task, as the nuclear changes can be patchy. Beware fixation artifact (which can produce nuclear clearing but not the other features) and lymphocytic thyroiditis (which produces reactive changes that can simulate papillary nuclei).
濾泡型：具有濾泡結構（無乳頭）和乳頭狀癌核特征（圖23.11）。它的生物學行為類似于乳頭狀癌，現在已認可它是一種癌。區(qū)分濾泡性腺瘤和濾泡性乳頭狀癌并不容易，因為細胞核改變可能是斑片狀的。小心固定假象（可產生核透明，但不能產生其他特征）和淋巴細胞性甲狀腺炎（可產生可假冒乳頭狀癌核特征的反應性改變）。
Figure 23.11. Follicular variant of papillary carcinoma. The architecture is that of a follicular adenoma, but the nuclei, oval in shape and crowded together (arrows), are those of papillary carcinoma.
圖23.11 濾泡型乳頭狀癌。其結構正如濾泡性腺瘤，但核呈橢圓形且擁擠（箭），為乳頭狀癌核特征。Diffuse sclerosing variant: Although rare, the diffuse sclerosing variant is important to recognize because of its worse prognosis. You can think of this variant as being widely infiltrative in its behavior, as opposed to discrete and mass-forming, and therefore more aggressive. The features include a desmoplastic or sclerotic stroma, squamous metaplasia, psammoma bodies, a dense lymphocytic infiltrate, and vascular invasion.
彌漫硬化型：盡管罕見，但由于預后較差，識別這種亞型很重要。你可以認為這種亞型呈現廣泛浸潤，而不是形成孤立性腫塊，因此侵襲性更強。其特征包括促結締組織增生性間質或硬化性間質、鱗狀化生、砂粒體、密集的淋巴細胞浸潤和血管浸潤。
Others: Other variants include tall cell, columnar cell, trabecular, cribriform, and cystic variants.
其他：其他亞型包括高細胞型、柱狀細胞型、小梁型、篩狀型和囊性變異型。
Anaplastic carcinoma is often a papillary carcinoma that has dedifferentiated (Figure 23.12). The tumor cells may appear as sheets of pleomorphic cells (truly undifferentiated), as nonkeratinizing squamous cell carcinoma (squamoid differentiation), or sarcomatoid. A background of papillary carcinoma is not uncommon, but anaplastic carcinoma may arise from other types of carcinoma as well.間變性癌通常是去分化的乳頭狀癌（圖23.12）。腫瘤細胞可能表現為成片的多形性細胞（真正的未分化）、非角化性鱗狀細胞癌（鱗狀分化）或肉瘤樣細胞。乳頭狀癌的背景并不少見，但間變性癌也可能起源于其他類型的癌。Figure 23.12. Anaplastic carcinoma. Nests and sheets of poorly differentiated carcinoma, some areas with a squamoid appearance (arrow).
圖23.12。間變性癌。巢狀和片狀低分化癌，某些區(qū)域呈鱗狀外觀（箭）。The most important lessons of the papillary variants are these: not all papillary lesions are papillary carcinoma (Graves’ disease, for example), and not all papillary carcinomas have papillary architecture (follicular variant, for example). Also, not all cleared out nuclei are papillary carcinoma. Beware fixation artifact (as discussed earlier), and have a very high threshold of suspicion for papillary carcinoma in the setting of lymphocytic (Hashimoto’s) thyroiditis. A true carcinoma arising in Hashimoto’s thyroiditis should stand out sharply from its neighbors, as in an uninflamed thyroid (see Figure 23.8). Varying degrees of nuclear clearing that come and go across the section are likely to be insignificant.乳頭狀病變最重要的教訓是：并非所有的乳頭狀病變都是乳頭狀癌（例如Graves?。膊⒎撬械娜轭^狀癌都有乳頭狀結構（例如濾泡型乳頭狀癌）。此外，并非所有透明核都是乳頭狀癌。小心固定假象（如前所述），在淋巴細胞性（橋本）甲狀腺炎的背景下，不要輕易診斷乳頭狀癌。橋本甲狀腺炎中，真正的癌應該與相鄰組織截然不同，正如無炎癥的甲狀腺中的癌（見圖23.8）。不同程度的核透明在切片中來來往往，可能沒有意義。Papillary carcinomas are associated with radiation and (possibly) thyroiditis as risk factors; unlike follicular carcinoma, they spread to lymph nodes. The prognosis is usually excellent. Age is the most important prognostic factor (younger is better).乳頭狀癌可能與放射和（可能）甲狀腺炎相關，是危險因素；與濾泡性癌不同，它們擴散到淋巴結。預后通常很好。年齡是最重要的預后因素（年齡越小預后越好）。神經內分泌病變（Neuroendocrine Lesions）Medullary carcinoma has features common to other neuroendocrine tumors; the growth may be nested or trabecular, and the cells range from epithelioid to spindled, with uniform finely speckled nuclei (Figure 23.13). At low power, or with poor histology, the sheet-like growth may simulate an anaplastic carcinoma. However, nuclear features or immunohistochemistry should easily tell the difference (calcitonin positivity and thyroglobulin negativity should do it). Medullary carcinomas produce prominent amyloid, which is Congo-red positive.髓樣癌具有其他神經內分泌腫瘤的共同特征；生長方式可以是巢狀或小梁狀，細胞形態(tài)范圍從上皮樣到梭形，具有均勻細膩的點彩狀細胞核（圖23.13）。在低倍鏡下，或組織學分化較差時，片狀生長可能貌似間變性癌。然而，核特征或免疫組織化學應該很容易區(qū)分（降鈣素陽性和TG陰性）。髓樣癌產生顯著的淀粉樣蛋白，剛果紅呈陽性。Figure 23.13. Medullary carcinoma. Although the pattern of infiltrative nests of cells may resemble anaplastic carcinoma, the nuclei are much more bland, with pale, finely speckled, neuroendocrine-type chromatin.圖23.13。髓樣癌。盡管浸潤性細胞巢的生長方式可能類似于間變性癌，但核形態(tài)更溫和，呈淡染的細膩點彩狀神經內分泌型染色質。頸部囊性非腫瘤性病變（Cystic Nonneoplastic Lesions of the Neck）While not thyroid lesions, cystic nonneoplastic lesions of the neck are included here as they are commonly seen in surgical pathology and are sometimes mistaken clinically for a thyroid nodule. Such lesions include the following:雖然不是甲狀腺病變，但這里也包括頸部囊性非腫瘤性病變，因為它們在外科病理學中常見，有時臨床誤認為甲狀腺結節(jié)。這些病變包括：Thyroglossal duct cyst: a midline structure (as are the thyroid and the tongue) consisting of a cyst lined by ciliated epithelium and thyroid follicles
甲狀舌管囊腫：由纖毛上皮和甲狀腺濾泡被覆的囊腫組成的中線結構（如甲狀腺和舌）
Branchial cleft cyst: an anterolateral structure (as are the branchial clefts) that looks somewhat tonsillar: squamous, columnar, or ciliated epithelium with a dense underlying lymphocytic infiltrate (not bronchial [i.e., lung] or brachial [i.e., arm])
鰓裂囊腫：一種前外側結構（如鰓裂），看起來有點像扁桃體：鱗狀、柱狀或纖毛上皮，下方有密集的淋巴細胞浸潤（注意英文拼寫，不是支氣管[即肺]或臂[即胳膊]）
The Practice of Surgical Pathology：A Beginner’s Guide to the Diagnostic ProcessDiana Weedman Molavi, MD, PhDSinai Hospital, Baltimore, MarylandISBN: 978-0-387-74485-8 e-ISBN: 978-0-387-74486-5Library of Congress Control Number: 2007932936? 2008 Springer Science+Business Media, LLC僅供學習交流，不得用于其他任何途徑。如有侵權，請聯系刪除。
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