摘要：转移性甲状腺滤泡癌f(ollicular thyroid carcinoma, FTC)很少见。本研究的目的是比较以远处转移(distant metastatic,DM)和以甲状腺原发结节(primary thyroid nodule, PT) 为首发表现的转移性FTC患者间的临床、组织学和分子差异。从患者的病历和手术后病理报告中获取相关的临床和病理信息。重新阅读能调取出的病理切片。对可获取组织的原发性和1或转移性病灶进行分子检测。共有36例转移性FTC患者入组:15例DM和21例PT。DM患者的年龄明显大于PT患者(P=0.0001)。骨是DM患者最常见的初始转移部位(P= 0.03),而肺是PT患者最常见的初始转移部位(P= 0.03)。DM患者甲状腺原发癌灶的独特组织学特征是广泛的肿瘤内纤维化(50%)，偶尔甚至导致肿瘤的恶性组织学特征不明显(2 例)。嗜酸细胞在PT患者中更为常见(P=0.03)。在85%的转移性FTC病例中发现了致病性突变，最常见的是RAS (55%)和TERT启动子(45%) 的突变；其中，RAS和TERT的共突变率为30%。还发现了PTEN、NF1、RET和BRCA2基因的致病性突变。DM和PT患者发生致病性突变的频率和类型无差异。在转移癌灶中存在但在原发癌灶中不存在的致病性突变罕见(1例)。总之，与以PT为首发表现的FTC患者相比，以DM为首发表现的FTC患者更倾向于发生在年龄较大的患者中、更易转移至骨且更易出现可能代表着肿瘤消退的广泛纤维化。
关键词：转移，甲状腺滤泡癌，消退，纤维化，RAS，TERT启动子
(Am J Surg Pathol 2019;43:514-522)
美国外科病理学杂志中文版2019年第四期正文NO.2
（李佳丽 翻译 唐峰 审校）
美国外科病理学杂志中文版2019年第四期正文NO.2
（李佳丽 翻译 唐峰 审校）
The American Journal of Surgical Pathology 中文版版权说明：
©2019 Wolters Kluwer Health.
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【本文经《美国外科病理学杂志》授权发布，其他媒体转载或引用须经《美国外科病理学杂志》同意 ，否则追究法律责任；所有文章仅供公益交流，不代表本站立场。欢迎提供素材、资料等，投稿邮箱： tougao@91360.com，一经采纳将给予稿费】
©2019 Wolters Kluwer Health.
This material is from Wolters Kluwer Health, and authorize to 91360 Medical Group（Shen Zhen）Co.,Ltd. (91360 Pathologist group) and Shanghai EBM Info Tech Co., Ltd. (CME Window) freely distribute such material to medical professionals. No part of this material may be reproduced in any form, stored in a retrieval system or transmitted in any form, by any means.
Opinions expressed in this material are not necessarily those of Wolters Kluwer or associates. No responsibility is assumed by Wolters Kluwer or associates, for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made.
【本文经《美国外科病理学杂志》授权发布，其他媒体转载或引用须经《美国外科病理学杂志》同意 ，否则追究法律责任；所有文章仅供公益交流，不代表本站立场。欢迎提供素材、资料等，投稿邮箱： tougao@91360.com，一经采纳将给予稿费】
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