[Clinicopathologic and molecular features of cribriform morular variant of papillary thyroid carcinoma].

Objective: To investigate the clinicopathologic and molecular features of the rare cribriform morular variant of papillary thyroid carcinoma (CMV-PTC). Methods: The clinicopathologic data of 10 patients with CMV-PTC were retrospectively reviewed. Immunohistochemical (IHC) staining was done using LSAB method. DNA sequencing for APC were applied using Sanger method. BRAF V600E mutation was examined using ARMS method. The cytological, morphological, IHC and molecular features were analyzed. Results: All patients were female at an average age of 27 years old. The tumors were mostly located in the right lobe of thyroid. Fine needle aspiration cytology was performed in three patients; two were diagnosed as suspicious for PTC and one as PTC. Nine tumors presented as solitary nodule and two as multiple nodules in both lobes. Infiltration was demonstrated in three cases. The average size was 2.6 cm. The neoplastic cells were arranged in papillary, cribriform, solid and glandular patterns, with rare or without colloid inside the lumen. The number of morula varied, ranging from zero to many. The neoplastic cells were variably enlarged, showing round, oval or spindle shape. Nuclear irregularity was identified as irregular membrane, nuclear grooves or pseudoinclusion, but no typical ground glass feature. Peculiar nuclear clearing could be observed in the morular cells. IHC staining showed the neoplastic cells were negative for thyroglobulin and p63, but positive for TTF1, cytokeratin 19 and estrogen receptor. Diffuse staining with cytokeratin was seen in the neoplastic cells and the morula. Specific cytoplasmic and nuclear staining of ß-catenin was seen in the neoplastic cells but not the morula. Ki-67 proliferation index was 1%-30%. No recurrence or metastasis was observed. One patient was demonstrated to harbor both somatic and germline mutations of the APC gene, who was found to have adenomatous polyposis and her mother died of colonic carcinoma. No BRAF V600E mutation was detected. Conclusions: CMV-PTC is rare and shows atypical cytological and clinicopathological features, and it is easily misdiagnosed.TG, TTF1, ER and ß-catenin are specific IHC markers for CMV-PTC. The morula is negative for cytokeratin 19, in contrast to squamous metaplasia. Although CMV-PTC has indolent clinical behavior, a definite diagnosis is necessary to rule out the possibility of APC gene mutation and related extra-thyroidal neoplasm, such as FAP and Gardner syndrome.

[Study of apoptosis and expression of apoptotic related genes P53 bcl-2 C-myc in oral lichen planus].

OBJECTIVE: To investigate the difference of apoptosis and expression of apoptotic related genes p53 bcl-2 C-myc in the development of oral lichen planus(OLP). METHODS: Apoptotic cells were detected by TUNEL and immunohistochemical method was used to study P53 bcl-2 C-myc expression in 45 samples with OLP(23 cases of erosive OLP group and 22 cases of non erosive OLP group). RESULTS: Apoptosis occurred in 100% of the cases and apoptotic index(AI) was 24.3%+/-12.0% (1.9%-50.5%). AI of erosive OLP group was 19.0%+/-10.4% (1.9%-50.5%), and AI of non erosive OLP was 29.4%+/-11.2% (10.4%-49.3%). The obvious differences existed between erosive group and non erosive group (P<0.05). The expression of p53 bcl-2 C-myc positive rates were 31.1% 35.5% 33.3% respectively. The p53 bcl-2 C-myc positive rates in erosive OLP group were 39.1% 52.2% 43.2%and that with non-erosive OLP group were 22.7% 18.2% 22.7% respectively. There was only statistically significance between erosive group and non-erosive group (P<0.05) in expression of bcl-2. CONCLUSION: Apoptosis and apoptotic related genes p53 bcl-2 C-myc participate in clinical development of OLP. The changes of AI are related to the chronic inflammation of lesion with OLP. We should attach importance to over expression of bcl-2 in erosive OLP.