KTCC QUIZ (May    2018)   
甲状腺穿刺吸引細胞診 (thyroid FNA)
1.腺腫様結節 2.硝子化索状腫瘍 3.乳頭癌 4.髄様癌 5.肉腫
Which diagnosis is appropriate to choose?
1. Nodular goiter  2. Hyalinizing trabecular tumor 3. Papillary carcinoma 4. Medullary carcinoma 5. Sarcoma
解説(explanatory notes )
答えは「4. 髄様癌」でした。多数の紡錘形細胞が孤立散在性に出現しています。出現細胞に結合性がないことと、特徴的なごま塩状クロマチンが診断のポイントです。核内細胞質封入体は乳頭癌や硝子化索状腫瘍だけでなく、髄様癌でも出現します。硝子化索状腫瘍の場合は、核内細胞質封入体が多数みられるのが特徴です。肉腫の場合は、核の大小不同が著しく、高度な核異型を示します。診断に迷うときには、カルシトニン免疫染色が有用です。
The answer is "4. Medullary carcinoma." Cytological smear is highly cellular, with isolated spindle cells. Diagnostic points are less cohesiveness and "salt and pepper" chromatin of the cells. Intranuclear cytoplasmic inclusions (ICIs) can be seen in not only papillary carcinoma and hyalinizing trabecular tumor, but also medullary carcinoma. In hyalinizing trabecular tumor cases, numerous ICIs are characteristic. Sarcoma cells show severe anisonucleosis and nuclear irregularity. Calcitonin immunostaining is useful for definite diagnosis of medullary carcinoma.


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