KTCC QUIZ (September    2018)   
甲状腺穿刺吸引細胞診 (thyroid FNA)
1.腺腫様結節 2.好酸性細胞腫瘍 3.乳頭癌 4.低分化癌 5.髄様癌
Which diagnosis is appropriate to choose?
1. Nodular goiter 2. Oxyphilic tumor 3. Papillary  carcinoma 4. Poorly differentiated carcinoma 5. Medullary carcinoma
解説(explanatory notes )
答えは「2. 好酸性細胞腫瘍」でした。腫瘍細胞は孤立散在性に出現しています。ライト緑好性の厚い顆粒状細胞質をもち、細胞境界は明瞭で、二核細胞が目立ちます。クロマチンパターンは顆粒状で、明瞭な核小体がみられます。この症例は、細胞質内小腺腔が散見されます。組織診では、広汎浸潤型好酸性細胞型濾胞癌でした。髄様癌の場合は、細胞境界が不明瞭で、ごま塩状クロマチンが特徴的です。低分化癌の場合は、立体的な大型集塊として出現する場合が多いです。
The answer is "2. Oxyphilic cell tumor." The tumor cells appear isolated. They have thick and granular cytoplasm, obvious cell border, binucleated cells, granular chromatin pattern, and enlarged nucleoli. In this case, tumor cells have intracytoplasmic inclusions. The histological diagnosis was oxyphilic cell variant of widely invasive follicular carcinoma. In the cases of medullary carcinoma, the tumor cells have obscure cell border and salt & pepper chromatin pattern. In the cases of poorly differentiated carcinoma, the tumor cells often appear as 3D-large clusters.
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