桥本病合并甲状腺癌——附4例报告

本文报告４例桥本病合并甲状腺癌，对桥本病表现，甲状腺癌类型及两者的过渡情况进行了形态学观察，结果发现；４例桥本病均可见滤泡上皮有增生，４例均合并有多灶性乳头状癌，癌组织与增生的异形上皮之间有移行现象，其中１例还合并有滤泡癌。本文结合文献资料从发病率，合并发生机理及临床病理特点对桥本合并甲状腺癌进行了分析。认为乳头状癌与桥本病关系密切。     

桥本病合并甲状腺癌31例临床病理分析

目的探讨桥本病合并甲状腺癌的临床病理特征。方法回顾性分析手术治疗的327例甲状腺结节合并桥本病患者,其中31例桥本病合并甲状腺癌。从临床资料、病理特征,分析桥本病合并甲状腺癌的诊断及治疗的方法。结果 28例90.3%(28/31)合并甲状腺乳头状癌、3例9.7%(3/31)为滤泡性癌。并做免疫组织化学进行鉴别诊断。结论对于甲状腺结节合并桥本病患者应考虑手术治疗,并做术中冷冻快速切片,有利于术中确诊及正确选择手术方式。术后患者应给予甲状腺素治疗。     

甲状腺癌鉴别诊断的几点体会

甲状腺癌分乳头状癌、滤泡型癌、髓样癌和未分化癌 4型 ,前两型不易鉴别 ,现结合工作实践着重谈几点体会。1　甲状腺乳头的鉴别乳头是甲状腺疾病中常见的形态之一 ,鉴别其性质是病理诊断中必须解决的问题。根据乳头的分布和形态特点分为 :①弥漫性乳头状增生 :多见于弥漫性毒性甲状腺肿 ,受TST的刺激 ,滤泡上皮增生肥大 ,形成明显的乳头状突起 ;上皮高柱状 ,核位于基底 ,染色正常或浓染 ,胞质透明 ;低倍镜下仍保持腺体小叶结构 ,病变弥漫均匀。②局灶性乳头状增生 :甲状腺结节性病变伴有局灶性乳头状增生 ,非肿瘤性结节中的乳头 ,多为宽乳…     

10例甲状腺隐性癌的临床病理分析

为了提高甲状腺癌尤其是甲状腺隐性癌的病理诊断准确性，避免和减少误诊和漏诊，通过对26例甲状腺癌的临床病理分析，结果发现26例甲状腺癌中隐性癌10例；结节性甲状腺肿并发隐性癌3例，甲亢并隐性癌2例，滤泡性腺瘤并隐性癌1例，颈淋巴结转移1例；其中结节性甲状腺肿并发的为滤泡性癌，其余的则是乳头状癌。表明甲状腺癌中有相当一部分为隐性癌，且多合并甲状腺良性病变。     

CD105在不同类型甲状腺癌组织中的表达及与淋巴结转移相关性的研究

目的研究甲状腺癌组织中CD105的表达意义及与淋巴结转移的相关性。方法SP法检测105例存档蜡块标本中CD105的表达。结果正常甲状腺组织、良性甲状腺肿瘤组织标本30例，无CD105的表达。甲状腺乳头状癌标本40例中26例阳性，滤泡状癌20例中17例阳性，未分化癌标本15例中14例阳性，上述两两比较其差异均有显著性；甲状腺乳头状癌中有淋巴结转移的标本24例中22例阳性，无淋巴结转移的标本16例中4例阳性，二者比较其差异均有显著性。结论CD105在正常甲状腺组织、良性甲状腺组织的血管内皮细胞膜上无表达，在甲状腺乳头状癌、滤泡状癌和未分化癌中依次升高。CD105可以作为预测甲状腺癌转移的参考指标。     

甲状腺癌的治疗进展

甲状腺癌在内分泌肿瘤和头颈肿瘤中均占第一位。长期以来的统计表明，甲状腺癌的发病率约2／10万，临床上罕见，不被人们重视。近年来统计表明有逐年增高的趋势，已成为常见的恶性肿瘤之一。甲状腺癌可分为分化型甲状腺癌和未分化型甲状腺癌。原发于甲状腺的大细胞癌、小细胞癌、鳞状细胞癌、巨细胞癌、腺样囊性癌、粘液腺癌以及分化不良的乳头状腺癌及滤泡型腺癌等恶性程度较高的癌均归入未分化癌。乳头状腺癌和滤泡状腺癌被称为分化型甲状腺癌。     

探讨桥本病与甲状腺乳头状癌的关系

目的观察桥本病合并甲状腺乳头状癌的超声表现,探讨桥本病与甲状腺乳头状癌是否存在关系。方法对1582例甲状腺疾病患者进行术前常规超声检查,回顾性分析其中桥本病合并甲状腺乳头状癌患者的超声声像图,并与病理结果对照。结果桥本病合并甲状腺乳头状癌患者35例,超声正确诊断19例(19/35,54.29%)。本组甲状腺乳头状癌的发生率在桥本病患者中(35/80,43.75%)高于非桥本病患者(235/1502,15.65%),在出现结节的桥本病患者中(32/59,54.24%)高于无结节桥本病患者(3/20,15.00%),差异均有统计学意义(P均<0.05)。结论桥本病、尤其是合并结节的桥本病较甲状腺其他良性病变更易并发甲状腺乳头状癌。超声是诊断桥本病合并甲状腺乳头状癌的重要手段。     

CK19、HBME-1、Galectin-3、TPO及CD56联合检测在甲状腺乳头状癌诊断中的意义

甲状腺肿瘤是最常见的内分泌器官肿瘤,其中以甲状腺乳头状癌（papillary thyroid carcinomas,PTC）最为常见,早期手术预后较好,因此及早做出诊断有重要意义。病理检查是PTC确诊的主要手段,但由于近年提出的甲状腺微小乳头状癌及滤泡型乳头状癌等特殊类型的存在,使PTC诊断变得困难,尤其是与结节性甲状腺肿伴滤泡上皮乳头状增生和乔本甲状腺炎等甲状腺滤泡上皮良性增生病变难以鉴别。目前免疫组化仍是诊断PTC的主要方法。本文旨在探讨免疫组化联合检测CK19、HBME-1、Galectin-3、TPO、CD56在PTC诊断中的意义。     

结节性甲状腺肿伴微小乳头状癌^99Tc^m-甲氧基异丁基异腈显像分析

结节性甲状腺肿的病因主要是在单纯性弥漫性甲状腺肿基础上反复进展,导致滤泡上皮由弥漫性转变为局灶性增生,部分区域则出现退行性变;由于长期的增生性病变和退行性病变反复交替,腺体内出现不同发展阶段的结节。部分结节性甲状腺肿由于上皮细胞的过度增生,可以形成胚胎性腺瘤或乳头状腺癌,也可形成甲状腺癌［1］。单纯结节性甲状腺肿的临床诊断较为容易,伴发有微小乳头状癌的临床诊断则比较困难。本文采用^99Tc^m‐甲氧基异丁基异腈（^99Tc^m‐MIBI）核素显像,对1例结节性甲状腺肿伴微小乳头状癌患者进行显像,现报道如下。     

桥本甲状腺炎癌变与甲状腺乳头状癌相关性分析

Lindsay等在1952年首先报告了桥本甲状腺炎（HT）癌变的情况，302例HT中甲状腺癌的发病率为12％，随后Dailey等报告278例HT中甲状腺癌的发病率为17％，HT癌变以乳头状癌为主，滤泡状癌偶见。本文通过免疫组化检测CK19、Ret/P1℃、PCNA等肿瘤标记物，探讨甲状腺乳头状癌与HT癌变相关的诊断和鉴别诊断指标，有助于HT癌变和甲状腺乳头状癌的早期诊断。     

甲状腺乳头状病变形态学探讨

目的:探讨结节性甲状腺肿伴乳头状增生与甲状腺乳头状癌的组织形态学特点、两者间的关系及鉴别诊断。方法:对469例结节性甲状腺肿及39例甲状腺乳头状癌进行临床病理分析。结果:469例中34例(7.25%)伴单纯性乳头状增生,17例(3.62%)伴非典型乳头状增生,7例(1.49%)伴癌变。39例乳头状癌中12例(30.77%)伴结节性甲状腺肿,2例(5.13%)伴桥本甲状腺炎。结论:结节性甲状腺肿是甲状腺癌的癌前疾病,对伴有非典型性增生的乳头状病变应加强随访。     

桥本甲状腺炎合并甲状腺癌的临床病理研究

目的:探讨桥本甲状腺炎(HT)与甲状腺乳头状癌(PTC)的关系。方法:单纯HT73例,HT合并PTC23例,分析两者的临床表现、病理组织学表现,并作酪氨酸激酶受体(RET)免疫组化染色。结果:HT临床表现多样化,部分表现为结节状,合并的甲状腺癌均为乳头状癌,且微小癌占多数。50%HT病变对于RET染色存在局灶性阳性反应。结论:HT病变组织中不同程度地存在与PTC相同的肿瘤基因,HT合并的PTC可能与HT有关。     

Dermatitis herpetiformis is associated with atrophic but not with goitrous variant of Hashimoto's thyroiditis

BACKGROUND: Dermatitis herpetiformis (DH) is a gluten-sensitive skin disease that is associated with a variety of autoimmune disorders. Several investigations demonstrated an association between DH and autoimmune thyroid disease. However, it has not been shown if DH is associated with atrophic or goitrous variant of Hashimoto's thyroiditis. MATERIALS AND METHODS: We investigated a cohort of 41 DH patients (18 male, 23 female) and a control group (11 male, 19 female; sex and age matched healthy volunteers) to find out which variant of Hashimoto's thyroiditis is associated with DH. All patients had thyroid hormones and antibodies measured. In addition to that, thyroid sonography as well as detailed history-taking of previous thyroid disease were performed. RESULTS: In the control group no individual with elevated levels of thyroid antibodies nor abnormal thyroid hormones nor thyroid atrophy was found. Median thyroid volume in the control group was 11 mL (range 4.8-24.7 mL). However, in nine DH patients (22%) elevated levels of antithyroid microsomal (TM) antibodies were seen (P < 0.01). Three of them had abnormal thyroid hormones (7%). In the group of DH patients a significantly smaller thyroid volume was found (median 8 mL, range 1. 6-25.2 mL; P < 0001). Thyroid atrophy (volume < 4.4 mL) was found in 10 DH patients (24%) of whom 9 were females. All patients with elevated levels of TM antibodies or abnormal thyroid hormones and all patients with a history of previous hypothyroidism had a thyroid volume < 7 mL. Goitrous variant of Hashimoto's thyroiditis was not seen in any of the DH patients. CONCLUSIONS: Our findings demonstrate that DH is associated with atrophic but not with goitrous variant of Hashimoto's thyroiditis.     

彩色多普勒超声在甲状腺疾病中的初步应用

本文报道了61例甲状腺疾病的彩超应用。其中甲状腺结节41例(癌、腺瘤及增生结节)、甲状腺炎及弥漫性毒性甲状腺肿(Graves’病)各10例。结果Graves’病腺体内血流信号相当丰富,多处可见高速动脉血流,桥本氏病腺体内血流信号轻度增加或不增加;在局限性炎性病灶内,原有血管走行无改变,与甲状腺癌内部新生血管。有明显差异;良恶性结节血流信息虽重迭较多。但本组外周动脉血流检出率,癌明显小于腺瘤(P<0.01)。有待进一步研究。     

Differential diagnosis of Hashimoto's thyroiditis from thyroidal neoplastic diseases]

Thyroid lymphoma is a relatively rare disease, but has attracted the attention of many investigators because of its putative relationship with Hashimoto's thyroiditis. The definite diagnosis of thyroid lymphoma, especially the histologic distinction from small cell carcinoma or Hashimoto's thyroiditis, has been problematical and even regarded as impossible during the past decades. Recent progress in immunological methods including molecular biology has resolved many of the diagnostic problems in this field, thereby providing a scientific basis for approaching these diseases. In this review, we have discussed the important role of Hashimoto's thyroiditis in the etiology of thyroid lymphoma; the B-cell nature of proliferating cells in thyroid lymphoma; the histologic differential diagnosis.     

甲状腺癌超声诊断为TI-RADS2-3类原因分析

[目的]分析甲状腺癌超声诊断为超声甲状腺影像报告和数据系统(TI-RADS) 2～3类的原因,提高对不典型甲状腺癌的认识,减少不必要的误诊.[方法]回顾性分析30例甲状腺癌超声诊断为TI-RADS 2～3类的临床资料及超声图像特征.[结果]30例术前超声诊断为TI-RADS 2～3类的甲状腺肿块术后病理分别为微小乳头状癌17例,乳头状癌3例,滤泡状癌6例,髓样癌4例,其中11例合并桥本甲状腺炎.[结论]甲状腺癌误诊为TI-RADS 2～3类的原因多为肿决位于复杂的甲状腺背景或微小癌合并有多发良性结节或单发表现不典型甲状腺髓样癌.可疑甲状腺结节需行细针穿刺.     

Autoimmune thyroid disease: immunological, pathological, and clinical aspects

Autoimmune thyroiditis, most notably Hashimoto's thyroiditis, appears to be increasing in prevalence and is now more easily detected by sensitive laboratory tests and more invasive procedures such as fine needle aspiration. During the last decade, marked progress has been made in the understanding of these diseases. There is a greater awareness of the interaction between the humoral and cell-mediated arms of the immune system in autoimmune thyroiditis. Recent studies implicate a subpopulation of suppressor T lymphocytes which have an antigen-specific defect, resulting in their suboptimal interaction with the helper T lymphocytes and subsequent autoimmune manifestations. There is some evidence that thyroid epithelial cells which inappropriately express HLA-DR may enhance presentation of thyroid antigens to the immune system, possibly significant in the initiation or enhancement of the autoimmune response. The presence of various antithyroid autoantibodies allows the use of laboratory assays to confirm the clinical diagnosis and predict the results of treatment. There appears to be predisposing genetic factors in the development of autoimmune thyroiditis, with some geographical and racial differences. Environmental factors, most notably dietary intake of iodine, have also been implicated in the pathogenesis of Hashimoto's thyroiditis. Several animal models have been developed addressing such issues. Ongoing studies in the areas of postpartum thyroiditis and childhood thyroiditis are helpful in clarifying their relationship with Hashimoto's thyroiditis. Graves' disease and postpartum thyroiditis are being investigated as possible causes of postpartum depression. The association of Hashimoto's thyroiditis and carcinoma of the thyroid gland is still controversial, but its relationship with malignant lymphoma is now well accepted. Thus, although the pathogenesis of autoimmune thyroiditis remains elusive, there has been significant refinement of the clinical diagnosis, and immunological abnormalities of specific intrathyroidal lymphocytes have been identified. Hopefully, these new areas of knowledge will assist in the treatment of these diseases and in the prevention of the development of malignant lymphomas of the thyroid gland.     

甲状腺乳头状癌并发桥本氏甲状腺炎患者BRAF-V600E 基因表达及T 淋巴细胞亚群分析

目的 探讨甲状腺乳头状癌并发桥本氏甲状腺炎BRAF-V600E基因表达及T淋巴细胞亚群的变化。方法 选取2018年9月～2019年8月期间于重庆三峡中心医院就诊的单纯甲状腺乳头状癌患者(PTC 组)45例、单纯桥本氏甲状腺炎(HT组)患者55例、甲状腺乳头状癌并发桥本氏甲状腺炎患者(PTC-HT组)42例,以健康体检者(NC组)50例为对照。观察三组研究对象的BRAF -V600E基因表达及CD4⁺T,CD8⁺T,CD4⁺/CD8⁺的变化。结果 PTC 组患者BRAF- V600E突变率48.15%,HT组1.81%,PTC-HT组66.67%,NC组未见BRAF-V600E突变; 三个观察组CD8⁺T均比NC组显著升高,CD4⁺均比NC组显著降低,差异均有统计学意义(P<0.05),但PTC组患者CD4⁺显著低于HT组和PTC-HT组,PTC-HT组CD8⁺又显著低于HT组,差异均有统计学意义(均P<0.05)。三个观察组CD4⁺/CD8⁺均比NC组显著升高显著下降,差异均有统计学意义(P<0.05)。结论 与PTC组相比,BRAF- V600E在PTC-HT组患者表达率更高,PTC,PTC-HT和HT患者T淋巴细胞亚群均分化异常,机体存在免疫功能障碍,尤以PTC为甚。     

Cerebellar subacute syndrome due to corticosteroid-responsive encephalopathy associated with autoimmune thyroiditis (also called "Hashimoto's encephalopathy")

The corticosteroid-responsive encephalopathy associated with autoimmune thyroiditis (the so-called "Hashimoto's Encephalopathy") is a rare disorder with multiple symptomatology, breaking out with an acute or subacute onset and having a relapsing course, not correlated to thyroid hormone levels, with autoimmune pathogenesis, and usually associated with Hashimoto's thyroiditis. In this paper, we report on a case study regarding a 46 year-old woman showing a subacute course cerebellar syndrome, associated with Hashimoto's thyroiditis, diagnosed as "Hashimoto's encephalopathy". The possible pathogenesis and the major aspects of the differential diagnostic sector are discussed with particular reference to an ataxic syndrome caused by a progressive non-familial adult onset cerebellar degeneration (PNACD), associated with the thyroid disease itself.     

桥本氏甲状腺炎并发甲状腺机能亢进的超声表现

目的 探讨超声对桥本氏甲状腺炎（HT）并发甲亢的诊断价值。方法 本组26例HT甲亢患者均经穿刺病理证实，分为HT假性甲亢和HT合并甲亢两型。分析比较两型的声像图特征。结果 两型甲亢声像图表现有共同点：甲状腺峡部增厚，实质回声不均匀性减低，彩色血流丰富，甲状腺上动脉血流参数升高。但假性甲亢甲状腺双侧叶各径线均增大，峡部增厚更为明显，而合并甲亢以前后径增大为主。结论 两型HT甲亢声像图有相似之处，而甲状腺大小变化可作为鉴别两者的依据。