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갑상선 유두상 암종과 유두상 증식에 대한 S-100 단백 및 EMA 발현에 대한 연구
강대영,김경희,최정목,송규상,강동욱 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.2
The diagnosis of papillary carcinoma of the thyroid is readily achieved based on a defined aggregate of histopathologic features. A papillary architecture is an imporant but not pivotal component of the diagnosis. The classic nuclear features are the essential diagnostic element. However, both papillary architecture and nuclear features may be encountered in other conditions and produce problems in histopahologic interpretation. A papillary architecture may be found within a follicular or an oncocytic neoplasm of within the nodules of hyperplastic nodular goiter. Moreover, there may be scattered cells within several thyroid lesions that display some of the nuclear characteristics of papillary carcinoma. The distinction of these lesions from papillary carcinoma is important for differential diagnosis. Thus, the availability of supportive diagnosic evidence would be helpful. Immunoreactivity for S-100 and epithelial membrace antigen was investigated in 16 papillary thyroid carcinomas(PTC), including three examples of the follicular variant, 16 cases of papillary hyperplasis, 8 follicular adenomas, and 6 follicular carcinomas. The degree of reaction was rated on a four point scale: +++, most cells(>51%) have positive staining; ++, 11-50% of cells have positive staining; +, less than 10% of cells have positive staining; -, no positive staining is present. The results are summarized as follows: 1) All the papillary carcinomas showed intense nuclear and cytoplasmic expression of S-100 (+++; 7 cases, ++; 9 cases), and EMA was expressed(++; 7 cases, ++; 6 cases, +; 3 cases). 2) In the cases of papillary hperplasia, papillary foci were generally negative for S-100 and EMA(12/16 ; -). In some areas, they were focal, of weak intensity, and showed preferential apical cytoplasmic location of oncocytic change. 3) Four of eight follicular adenomas expressed S-100(++;2 cases, +; 2 cases), whereas four were completely negative. EMA was also expressed(++; 2 cases, +; 3 cases). 4) Follicular carcinoma showed variable expression of S100 and EMA Five of six follicular carcinomas expressed S-100(++; 2 cases, +; 3 cases), whereas one was negative. EMA was also expressed(++; 2 cases, +; 1 case). In conclusion, in the distinction of papilary carcinoma from papillary hyperplasia, we would recommend an initial histological appraisal, with immunohistochemical staining of S100 and EMA in difficult cases.
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