【摘要】 目的 探讨鼻咽低级别甲状腺样乳头状腺癌（thyroid-like low grade nasopharyngeal papillary adenocarcinoma, TL-LGNPPA）的临床病理特征、免疫组化特点、病理诊断要点及鉴别诊断。方法 回顾性选取2019年8—9月常州市第三人民医院病理科诊断的2例TL-LGNPPA，进行HE切片观察、免疫组化染色，基因检测，并整理资料分析。结果 本研究报道2例女性患者（年龄分别为39岁和29岁），均发生于鼻中隔后端肿物，且甲状腺均无异常。HE镜下表现：肿瘤均生长在黏膜下，含有纤维血管轴心的乳头状结构，肿瘤细胞小到中等大，呈单层立方或假复层柱状上皮。肿瘤细胞排列比较拥挤，有的重叠，部分细胞核折叠形成核沟。肿瘤细胞形态呈卵圆形或者圆形，总体形态与甲状腺乳头状癌相似。病理性核分裂及肿瘤性的坏死罕见。免疫标记示：癌细胞表达CK、Vim、CK7、CK19、CK8/18、TTF-1、GAL-3，而TG阴性，原位杂交EBER均阴性，BRAKF V600E基因未突变，Ki67指数分别为2%、3%。本研究2例患者分别随访9个月及8个月，均未复发和转移。结论 TL-LGNPPA特征性表达TTF-1，且TG阴性，排除甲状腺乳头状癌转移后确诊。完整切除预后良好。更多还原

【Abstract】 Objective To investigate the clinicopathological features, immunohistochemical characteristics, key points of pathological diagnosis and differential diagnosis of thyroid-like low-grade nasopharyngeal papillary adenocarcinoma(TL-LGNPPA). Methods Two cases of TL-LGNPPA diagnosed in the Department of Pathology of Changzhou Third People’s Hospital in August and September 2019 were retrospectively selected. HE section observation,immunohistochemical staining,genetic testing,and data collation and analysis were performed. Results In this study, two female patients( aged 39 and 29 years, respectively) were reported, both had tumors at the posterior end of the nasal septum, and there was no abnormality in the thyroid gland. HE microscopic findings: tumors grow under the mucosa,containing a papillary structure of the fibrovascular axis, tumor cells are small to medium-large, and appear as a single-layered cubic or pseudostratified columnar epithelium. The arrangement of tumor cells is relatively crowded,some overlap, and some nuclei fold to form nuclear sulcus. The tumour cells are oval or round in shape and have a general morphology similar to that of papillary thyroid carcinoma. Pathologic nuclear fissure and neoplastic necrosis are rare. Immunomarkers showed that cancer cells expressed CK, Vim, CK7, CK19, CK8/18, TTF-1 and GAL-3, while TG was negative, in situ hybridization EBER was negative, BRAKF V600E gene was not mutated, and Ki67 index was 2% and 3%, respectively. Two patients in this study were followed up for 9 months and 8 months respectively, and no recurrence and metastasis were found. Conclusion TL-LGNPPA characterizes TTF-1 and is TG negative, which is confirmed after ruling out papillary thyroid carcinoma metastasis. The prognosis for complete resection is good.更多还原