WHO
5th edition關于甲狀腺乳頭狀微小癌的觀點
PTC
measuring ≤10 mm has been termed as PTC-microcarcinoma (also termed as occult
Sclerosing carcinoma, occult papillary carcinoma, incidental PTC).定義：≤10mm的甲狀腺乳頭狀癌被稱為甲狀腺乳頭狀微小癌(PTC-微小癌)（也稱為隱匿性硬化性癌、隱匿性乳頭狀癌、偶發(fā)性PTC）。Even
though not endorsed, this same terminology has been applied by some authors to
tumours measuring up to 15 mm.有一些作者將此術語可應用的上限定為最大15mm，盡管沒有得到公認。These
lesions are common and are often encountered during autopsy or in
thyroidectomies for benign thyroid disease, completion thyroidectomy and
thyroid removal during surgery for carcinoma of neighboring organ (laryngeal
carcinoma). The incidence of PTC-microcarcinoma has been reported as high as
36% in meticulously sectioned thyroid specimens.此類病變很常見，在因尸檢或良性甲狀腺疾病行甲狀腺部分切除術、甲狀腺全切除術和因鄰近器官腫瘤（如：喉癌）手術切除的甲狀腺標本中經?？梢杂龅?。據報道，如果對甲狀腺標本進行認真切開檢查，PTC-微小癌的發(fā)生率可高達36%。Due
to their small size these lesions can be missed on gross examination.由于它們的體積小，這些病變在大體檢查時可能會被遺漏。By
histology, a typical case of microcarcinoma will show an infiltrative scar like
pattern with neoplastic elements either at periphery or embedded within.組織學上，典型的微小癌病例顯示為浸潤性瘢痕樣模式，腫瘤細胞成分可以分布于病灶的外圍或嵌入其中央。Some
cases are completely encapsulated by a thick fibrous capsule, which maybe
focally calcified.有些病例被一層厚的纖維包膜完全包裹，可能伴有局部鈣化。Histologically,
the tumours may be totally follicular patterned or demonstrate papillary areas
as well; they can also occur as other histologic subtypes of PTC.組織學上，腫瘤可以完全呈濾泡狀或乳頭狀區(qū)域；它們也可以表現為PTC的其他組織學亞型。Overall,
the prognosis of PTC-microcarcinoma is excellent.However,
lymph node metastasis and distant metastasis have been reported, almost always
at presentation.然而，既有報告顯示PTC-微小癌可以發(fā)生淋巴結轉移和遠處轉移（幾乎總在就診時就已經出現）。Aggressive
clinical behaviour in PTC-microcarcinoma is associated with specific
PTC-subtype histology, vascular invasion, location within thyroid gland
(peripheral vs. central), molecular profile and family history of PTC.PTC-微小癌的侵襲性臨床行為與特定的PTC組織學亞型、血管侵犯、在甲狀腺內的位置（外周vs.中央）、分子譜特征和PTC家族史相關。In
2003 during a meeting held in Porto, Portugal, some authors have proposed
renaming papillary microcarcinoma as papillary microtumour if they lack
aggressive clinico-pathologic features.2003年在葡萄牙波爾圖舉行的一次會議上，一些作者提議：如果能證實不伴有侵襲性的臨床病理特征，可以將乳頭狀微小癌更名為乳頭狀微瘤。More recently, Aliyev et al
have defined papillary microtumour on the basis of the following exclusion
criteria: a) patient <19 years old; b) multiple tumour foci measuring in
aggregate >10 mm when all foci diameters are added; and (c) aggressive
histologic features (extrathyroidal extension, angioinvasion, tall, and/or
hobnail cells). This approach named the updated Porto proposal has been shown
in one study to identify those papillary microcarcinoma with extremely low
malignant potential.最近，Aliyev等人根據以下排除標準定義乳頭狀微瘤(papillary microtumour)：a) 患者 <19 歲) ; b) 所有病灶直徑累加，總計>10 mm；(c)侵襲性組織學特征（甲狀腺外侵犯、血管浸潤、高細胞和/或靴釘狀細胞）。一項研究顯示：更新的波爾圖建議可以識別具有極低惡性潛能的乳頭狀微小癌。It
is recommended that “papillary microcarcinoma” should not be considered as
distinct subtype, because as the name implies the size does not indicate a
specific histologic subtype. For this reason, the new classification requires
subtyping of papillary microcarcinomas (e.g., classic papillary
microcarcinoma).
最近更新的WHO第5版甲狀腺腫瘤分類建議：不應將“乳頭狀微小癌”視為獨立的亞型。因為顧名思義，大小并不表示它就是一種特定的組織學亞型?；谶@個理由，WHO要求對乳頭狀微小癌進行亞型分類（例如：經典型乳頭狀微小癌）。
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