新的国际组织学分类中不确定恶性潜能的囊状甲状腺肿瘤

A. Abrosimov, Абросимов Александр Юрьевич
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引用次数: 3

摘要

国际癌症研究机构(IARC)于2017年发布的新版《世卫组织内分泌器官肿瘤分类》第四版与2004年第三版一样,对甲状腺肿瘤进行了大量关注。专家修订了具有乳头状核特征的包膜性非侵入性滤泡性甲状腺肿瘤的恶性标准。以前的版本分类这些肿瘤为恶性滤泡变异型甲状腺乳头状癌(PTC)。新版本将其行为状态视为边缘或不确定恶性潜能的肿瘤。由于未知的恶性细胞学标记,术前细胞学涂片无法估计滤泡性甲状腺肿瘤的恶性程度,10%的肿瘤术后由于包膜/血管浸润和/或可疑的ptc样核特征的组织学特征不明确而无法估计。本文介绍了具有乳头状核特征的非侵袭性甲状腺滤泡性肿瘤的诊断标准,以及恶性潜能不确定的滤泡性和高分化肿瘤两种分类标准。作为恶性肿瘤的基本特征,侵袭性生长的诊断意义值得特别关注。结合修订后的国际分类标准,我们讨论了充分的组织学检查的重要性和新的边界分类对囊状甲状腺肿瘤手术治疗的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Encapsulated follicular thyroid tumors of uncertain malignant potential in the new international histological classification
The new fourth edition of the WHO classification of tumors of endocrine organs published by the International agency for research of cancer (IARC) in 2017 as the previous third edition of 2004 pays substantial attention to the thyroid gland tumors. Experts revised criteria of malignancy in category of encapsulated non-invasive follicular thyroid neopasm with papillary-like nuclear features. The previous edition classified these tumors as malignant follicular variant of papillary thyroid carcinoma (PTC). The new edition considers their behavior status as borderline or tumors of uncertain malignant potential. An estimation of malignancy of follicular thyroid tumors is impossible in preoperative cytological smears due to unknown cytological markers of malignancy and in 10% tumors after surgery due to equivocal histological features of capsular/vascular invasion and/or doubtful PTC-like nuclear features. Criteria of non-invasive follicular thyroid neoplasm with papillary-like nuclear features as well as criteria of two classification categories of follicular and well differentiated tumors of uncertain malignant potential (UMP) are presented in this paper. A special attention is paid to diagnostic significance of invasive growth as a basic feature of malignancy. In connection with the revised criteria of international classification we discuss an importance of adequate histological examination and influence of new borderline categories on surgical treatment of encapsulated follicular thyroid tumors in the paper.
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