本文总结了中山医学院病理解剖教研室甲状腺髓样癌21例,占同期所有甲状腺癌的4.7％。女性14例,男性7例。发病年龄16～65岁,平均36岁。随访6例,其中术后生存4年以上者5例。说明本瘤为中度恶性,与预后极差的未分化癌不同。但组织学上易误诊为未分化癌。用免疫组织化学方法证明有降钙素或用电镜检查证明有神经分泌颗粒则诊断最为可靠。本组21例中3例无淀粉样物,其中1例电镜证实有神经分泌颗粒,因此无淀粉样物不能排除本瘤。瘤细胞以多边形细胞为主者多见,梭形细胞为主者次之。后者核分裂较多而间质淀粉样物较少。根据瘤细胞的形态和排列可分为:巢状型11例,束状型6倒,带状型、腺管状型、类癌样型、弥漫型各1例。1例间变成小细胞致密型未分化癌,1例合并小乳头状癌。肿瘤浸润包膜10例,浸润淋巴管及血管各11例,这与癌组织常累及局部淋巴结是一致的。 This article summarized 21 cases of medullary thyroid carcinoma in the pathological anatomy department of Zhongshan Medical College, which accounted for 4.7% of all thyroid cancers in the same period. There were 14 females and 7 males. The age of onset is 16 to 65 years old, with an average age of 36 years. Follow-up was performed in 6 patients, including 5 patients who survived more than 4 years after surgery. The tumor is described as moderately malignant and is different from undifferentiated cancer with poor prognosis. However, histology is often misdiagnosed as undifferentiated cancer. Using immunohistochemical methods to prove calcitonin or electron microscopy to prove that there are neurosecretory particles is the most reliable diagnosis. Of the 21 patients in this group, 3 were non-amyloids, and 1 was confirmed by electron microscopy as a neurosecretory granule. Therefore, no amyloid can exclude this tumor. The most common tumor cells were polygonal cells, followed by spindle cells. The latter has more nuclear fission and less interstitial amyloid. According to the morphology and arrangement of tumor cells, they can be divided into 11 cases: nested type, 6-beam type, 1 case with banded type, glandular tubular type, carcinoid type, and diffuse type. One patient developed small cell-type, undifferentiated carcinoma, and one patient had small papillary carcinoma. Tumor infiltrating capsules in 10 cases, infiltrating the lymphatic vessels and blood vessels in 11 cases, which is consistent with cancer tissue often involving regional lymph nodes.