滤泡型甲状腺乳头状癌的临床诊断及分子生物学研究进展
摘 要 滤泡型甲状腺乳头状癌（follicular variant of papillary thyroid carcinoma， FVPTC）是甲状腺乳头状癌（papillary thyroid carcinoma， PTC）中常见的亚型。FVPTC又可分为包膜型FVPTC和非包膜型FVPTC，不同分型的FVPTC的临床表现及分子生物学特性各不相同，如包膜型FVPTC的临床表现类似于滤泡型甲状腺瘤或滤泡型甲状腺癌，而非包膜型FVPTC类似于经典型甲状腺乳头状癌。由于FVPTC特殊的病理特点，术前超声、细针吸引细胞学检查及术中冰冻切片检查均难确诊，目前对其诊断及分型主要依靠术后病理切片的HE染色，结合基因检测将有助于诊断。然而，学术界对FVPTC的临床表现、分子生物学特性以及治疗方案的观点尚不统一。因此，对FVPTC有待深入研究，并制定科学合理的精准化治疗方案。
关键词 滤泡型甲状腺乳头状癌；诊断；病理；分子生物学特性
中图分类号：R736.1 文献标志码：A 文章编号：1006-1533（2017）04-0004-06
The clinical diagnosis of follicular variant of papillary thyroid carcinoma and its research progress of molecular biology
YUAN Haoran， SHI Yongzhao（Department of Thyroid-Breast Surgery of Shanghai Fifth People’s Hospital affiliated to Fudan University， Shanghai 200240， China）
ABSTRACT The follicular variant of papillary thyroid carcinoma（FVPTC）is the common subtype of papillary thyroid carcinoma（PTC）. The FVPTC can be further divided into encapsulated and nonencapsulated FVPTC. Different subtypes of FVPTC have different clinical manifestations and molecular biological characteristics， such as the clinical manifestation of encapsulated FVPTC is similar to that of follicular thyroid adenoma or follicular thyroid carcinoma while nonencapsulated FVPTC is similar to that of classic papillary thyroid carcinoma. It is difficult to confirm the diagnosis of FVPTC by preoperative ultrasonography and fine needle attract cytology（FNAC）as well as intraoperative frozen section examination due to the special pathological characteristics of FVPTC. At present， the diagnosis and classification of FVPTC mainly rely on the postoperative pathological staining with HE， and combined with genetic testing can assist the diagnosis. However， the ideas of clinical manifestations， molecular biological characteristics and the treatment of FVPTC are unified in academic circles. The further research is needed for FVPTC， and the plan of scientific and reasonable accurate treatments should be made.
KEY WORDS follicular variant of papillary thyroid carcinoma； diagnosis； clinicopathology； molecular biology
近年來，随着发病率的不断上升[1-2]，甲状腺癌已成为发病率最高的内分泌肿瘤，同时也成为头颈部最常见的恶性肿瘤[3]。甲状腺癌中最常见的是甲状腺乳头状癌（papillary thyroid carcinoma，PTC），占70%～80%[4-5]，其主要类型是经典型甲状腺乳头状癌（classical papillary thyroid carcinoma，CPTC）。此外，依据2004年世界卫生组织甲状腺和甲状腺旁腺肿瘤分类，PTC还包括15个亚型[6]，按肿瘤侵袭性可分为高危和低危两大组。滤泡型甲状腺乳头状癌（follicular variant of papillary thyroid carcinoma，FVPTC）是PTC中除CPTC外最为常见的亚型，占PTC的9%～22.5%[7-9]，亦有占41%的报道[10]。FVPTC属于低危组，并具有多个亚型。