目的：探讨甲状腺滤泡型乳头状癌（FVPTC）的超声表现。方法绍兴市第七人民医院自2002年3月至2012年12月经手术和病理证实的FVPTC患者30例，分析其超声表现，观察并记录结节的大小、形态、边界、声晕、纵横比、内部回声、微小钙化及颈部淋巴结受累情况，同时结合病理结果进行对照研究。结果30例FVPTC的超声表现可分为3种类型：（1）Ⅰ型6例（20%，6/30），具备乳头状甲状腺癌的典型超声表现，结节形态不规则，边界不清，内部呈极低回声，可见微小钙化；（2）Ⅱ型14例（47%，14/30），结节形态不规则，边缘可见成角或分叶，境界较清晰，内部呈等回声或低回声，较少见微小钙化；（3）Ⅲ型10例（33%，10/30），声像图表现形似腺瘤，结节边界清晰且边缘光整，内部呈均匀中等回声。30例FVPTC患者的镜下结构特征也可相应分为3类：（1）Ⅰ型6例，病灶无明显包膜，形态不规则，呈浸润性生长；（2）Ⅱ型14例，病灶有包膜，形态不规则，病灶对包膜侵犯明显，局部突破包膜，周边可见卫星病灶；（3）Ⅲ型10例，病灶有较为完整的包膜，形态规则，病灶对包膜无明显侵犯或累及程度和范围很小。包膜内型（Ⅱ、Ⅲ型）和非包膜内型（Ⅰ型）FVPTC患者形态、边界、有无声晕、纵横比、内部回声、有无微小钙化比较，差异均有统计学意义（Fisher确切概率法，P均＜0.05）；而包膜内型和非包膜内型FVPTC患者有无淋巴结累及的差异无统计学意义（Fisher确切概率法，P＞0.05）。结论 FVPTC的超声表现兼具滤泡性肿瘤和普通乳头状甲状腺癌的特点，其超声表现与不同的病理亚型有关。%Objective To investigate the ultrasonic features and pathological basis of follicular variant of papillary thyroid carcinoma (FVPTC). Methods Ultrasonic presentation of 30 patients with FVPTC conifrmed by surgery and pathology from the Seventh People′s Hospital of Shaoxing during March 2002 and December 2012 were analyzed retrospectively and compared with pathological results. Results Ultrasonic presentation of 30 FVPTC cases could be classiifed into three types:(1) Six cases (20%, 6/30) of typeⅠ, with typical sonographic features of papillary thyroid carcinoma:nodules with irregular shape, unclear boundary, and very low echo inside, microcalciifcation could be seen. (2) Fourteen cases (47%,14/30) of typeⅡ, presented as clearer iso-echoic or hypo-echoic nodules, with irregular shape, angled and lobular edge, rare microcalciifcation. (3) Ten cases (33%, 10/30) of typeⅢ, presented as adenoma-like features, nodule with clear boundary and regular edge, uniform medium echo inside. The microscopic structure characteristics could be divided into three categories:6 cases of typeⅠ, lesions were featured with no obvious capsule, irregular shape and inifltrative growth;14 cases of type Ⅱ, lesions with irregular shape, which invading the capsule with partial protrusion and peripheral small satellite lesions;10 cases of typeⅢ, lesions with more complete envelope, more regular shape with no signiifcant or lower level and smaller extent invasion of the capsule. Differences in morphology, boundary, aspect ratio, internal echo, presentation of microcalciifcations between the encapsulated type (typeⅡ,Ⅲ) and non-encapsulated type (typeⅠ) FVPTC were statistically signiifcant (Fisher′s exact test, all P<0.05). While the difference in lymph nodes involvement between them was not statistically signiifcant (Fisher′s exact test, both P>0.05). Conclusion Ultrasonic presentation of FVPTC show characteristics of both follicular tumor and papillary carcinoma, and the ultrasonic presentations are closely related to the pathological subtypes.
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