每日一题_2022.12.27

A 47-year-old man with a history of hyperpara- thyroidism presents to his physician because of a mass in his anterior neck. Laboratory studies show an elevated serum calcitonin level. The patient reports that multiple family members have had “thyroid problems” in the past. Which of the following is the most likely histology of this patient’s neck mass?

一名有甲状腺功能亢进病史的47岁男性因为前颈部肿块到医生处就诊。实验室研究显示血清降钙素水平升高。患者报告多个家庭成员在过去有“甲状腺问题”。以下哪一项是该患者颈部肿块最可能的组织学？

(A)  Atrophic follicles with lymphocyte infiltrate and germinal centers具有淋巴细胞浸润和生发中心的萎缩滤泡

(B)  Nests of hormone-secreting tumor cells in an amyloid-filled stroma淀粉样基质中的激素分泌肿瘤细胞巢

(C)  Papillary pattern with ground-glass nuclei and psammoma bodies具有毛玻璃核和砂粒体的乳头状模式

(D)  Sheets of undifferentiated, pleomorphic cells未分化的多形性细胞片

(E)  Uniform follicles with sparse colloid and a large cell lining具有稀疏胶体和大细胞衬里的均匀滤泡

答案解析：

该患者最有可能患有多发性内分泌腺瘤 (MEN)2 型（以前称为 2A 型），这是一种以甲状旁腺肿瘤、甲状腺髓样癌和肾上腺髓质肿瘤为特征的遗传病。所有 MEN 综合征均遵循常染色体显性遗传模式，外显率不完全。MEN 2 被认为是由原癌基因 ret 的激活突变所致。MEN 1 型包括甲状旁腺增生、胰岛细胞瘤和垂体腺瘤，而 MEN 3 型（以前称为 2B 型）包括甲状腺髓样癌、粘膜神经瘤和嗜铬细胞瘤。甲状腺髓样癌是一种滤泡旁甲状腺细胞（“C细胞”）分泌降钙素的肿瘤。显微镜下，肿瘤由淀粉样基质中的肿瘤细胞巢组成。

正确答案：B