强子显示向滤泡上皮分化证据、并以显著核特征性为特

1甲状 状 — —Sternberg'sDiagnosticSurgical2Withincreasingexperience,itbecameevidentthatthecellsofpapillarycarcinomahavecharacteristicnuclearfeatures.Thesehaveacquiredsomuchrelevancethatcurrentlythediagnosisofpapillarycarcinomaismoredependentupontheirpresencethanonthepapillaryarchitecture,whichmaybeminororaltogetherabsentRosaiandAckerman'sSurgical34Papillarycarcinomaisawell-differentiatedmalignanttumorofthyroidfollicularcellsthatshowsasetofcharacteristicnuclearfeatures.Althoughapapillarygrowthpatternisfrequentlyseen,itisnotrequiredforthe4DiagnosticPathologyandMolecularGeneticsofthe关键在于核的特征性甲状 状癌的特结细砂砾其5结 Papillarythyroidlesionsincludepapillarycarcinoma,papillaryhyperplasia(oftenassociatedwithhyperfunction),andpapillarychangeinanadenomaoradenomatousfollicularnodule.-Sternberg'sDiagnosticSurgical6788EndocrPract.9核特征增拥核轮廓不规则、核膜核内假包核毛玻璃核 不分先后核轮廓不规则、核膜增核内假包涵大小标内容标位置标Pathology12010 核砂砾Human

核特征出现的频率和特异大部分PTC中，出现几乎所有的核特征部分PTC出现几条才足以诊断？无定论。4不分先后？核增大、轮廓不规则、滤泡上皮+核特征经 状癌的诊断很少遇特征性不明显 状病变，诊断重复性部分罕见亚型，认识Thetypicalnuclearfeaturesmaybe(multi)focalbutifonlyminorchangesareseeninanon-invasivefolliculararch,tumor,somecallit“folliculartumorofuncertainmalignantpotential”.—DiagnosticCriteriaHandbookin您的意AmJClinPathol，08Endocr 您的意见ArchPatholLab您的意见Pathol，09

诊断特的

在PTC中的比5- 状癌伴筋膜炎样间质HEADNECKSURG， Papillary “papillarymicrotumor”2004-WHO：不大于1cm+（因其他原因手术后）PapillaryIntJSurg>20 临床检查、颈部超声或术前评估未见明显转Papillary 外、28%有淋转移、0.7%有远处转移，5%复发，DiagnosticPathologyandMolecularGeneticsofthe 疑该如何定义偶该如何严格的定义该如何看待mPTC免疫组化及分子生物学方面有无指导意义临床该如何准确的处理 非肿瘤区有无桥本甲状腺炎、Graves结构：生长模式、细胞高柱状、实性 JKoreanMedSci5014 Human 或非包裹性mPTC中显著高于包裹性mPTC。Todate,theWHOclassificationforpapillarythyroidcancerdoesnotdifferentiatebetweenencapsulated,partiallyandnotencapsulatedentities.WethereforesuggestthattheWHOclassificationshouldbeextendedtoacompulsoryoftheencapsulationstatusin HormMetabHuman Mod 上：有纤维化；下：无纤维

纤维化的包膜不算 组织形态问MultifocalityisnotuniquetoclassicalmPTCandoccursmoreofteninmFVPTC.TheriskoflymphnodemetastasesisgreaterformPTCthan JournalofSurgicalResearch，214Human Human 其他指术前见 及远处转移（ClinicalNuclearTSH（无显著意义WorldJ：儿童（放疗史）、45 （Thyroid，2014体重指数：有意义！尤其对于45岁以下患者来说是否偶见：有意义术前甲状腺功能（EndocrRes，2014）：与术后是否发生甲减术后是否行I131Endocrin2014JClinEndocrinolMeta2013AmJ

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Mod 调、157 JournalofCancerResearchandTherapeutics评分系sex(female=0,multifocality(absent=0,lymphnodemetastasis(absent=0,EurJEndocrinl2012总mPTC总体来 性边界、腺内播散或多灶性、腺 、 转移对于具 的病例，应适当扩大手术范至少单侧腺叶切除思在大部分研究都无WHO对mPTC的观点密切联系临床！不误导 可以通过注释的方Nonewriskfactors,butone,cancomple explainthesurgeof[smallpapillarycancer]lesions:theexponentialincreaseinthe