生长抑素受体显像在内分泌临床的应用

许多内分泌肿瘤和组织都有高密度生长抑素受体 (SSR)表达 ,目前生长抑素受体显像 (SRS)已广泛应用于临床。研究证实SRS对功能性或无功能性胰腺内分泌肿瘤、类癌及副神经节瘤等具有明显显像价值 ;对垂体腺瘤、嗜铬细胞瘤及甲状腺疾病也可能具有一定显像价值。此外SRS还可以作为类癌和垂体瘤对生长抑素治疗反应的预测指标。研究证实放射性标记的SSR靶向放射治疗是神经内分泌肿瘤有效的姑息治疗方法。随着对SRS和SSR靶向放射治疗的认识不断加深 ,将为内分泌肿瘤的诊治开拓广阔前景     

生长抑素受体显像在内分泌临床的应用

许多内分泌肿瘤和组织都有高密度生长抑素受体（SSR）表达，目前生长抑素受体显像（SRS）已广泛应用于临床。研究证实SRS对功能性或无功能性胰腺内分泌肿瘤、类癌及副神经节瘤等具有明显显像价值；对垂体腺瘤、嗜铬细胞瘤及甲状腺疾病也可能具有一定显像价值。此外SRS还可以作为类癌和垂体瘤对生长抑素治疗反应的预测指标。研究证实放射性标记的SSR靶向放射治疗是神经内分泌肿瘤有效的姑息治疗方法。随着对SRS和SSR靶向放射治疗的认识不断加深，将为内分泌肿瘤的诊治开拓广阔前景。     

核素骨显像诊断老年性肺癌骨转移的临床价值

目的 评价核素骨显像在诊断老年性肺癌骨转移中的临床价值。方法 用ＳＰＥＣＴ核素全身骨显像探测及分析骨转移灶。结果 核素骨显像检出骨转移灶为１００．０％,明显高于Ｘ－ＣＴ（３０．０％）及Ｘ线平片（２５．０％）,且发现肺磷癌和肺腺癌发生骨转移率最高。结论 核素骨显像对老年性肺癌骨转移诊断有重要价值。     

甲状腺髓样癌合并乳头状癌1例

<正>甲状腺癌是内分泌系统中常见恶性肿瘤,约占全身恶性肿瘤的0.2%-1%,是近年来发病速率增长最快的恶性肿瘤。甲状腺乳头状癌占70%-80%,甲状腺髓样癌占5%-10%,其中,甲状腺髓样癌合并乳头状癌发生的概率极低,国内外报道大多为个例报道,其发生发展机制尚不明确,现就本院发生的一例甲状腺髓样癌合并乳头状癌病例报道如下。1临床资料患者,女,44岁,以检查"发现甲状腺肿物3年余"     

99mTc-HYNIC-TOC生长抑素受体显像诊断胰腺神经内分泌肿瘤的临床应用

传统的影像学检查方法(如CT、MRI)在胰腺神经内分泌肿瘤定位和分期中的价值有限.神经内分泌肿瘤表达生长抑素受体,因此应用放射性核素标记的生长抑素类似物能进行肿瘤显像.目的:评价99mTc-HYNIC-TOC生长抑素受体显像诊断和定位胰腺神经内分泌肿瘤的临床价值.方法:37例临床确诊或怀疑胰腺神经内分泌肿瘤患者行99mTc-HYNIC-TOC生长抑素受体显像,其中胰岛素瘤18例,胃泌素瘤4例,胰高血糖素瘤4例,未分类的胰腺神经内分泌肿瘤ll例.静脉注射99mTc-HYNIC-TOC 350～400 MBq后1、4 h行全身显像,部分阳性区域行局部显像或单光子发射计算体层摄影(SPECT)/CT.结果:37例患者中99mTc-HYNIC-TOC显像阳性27例,其中胰岛素瘤9例,胃泌素瘤4例,胰高血糖素瘤3例,未分类的胰腺神经内分泌肿瘤11例.99mTc-HYNIC-TOC显像诊断胰腺神经内分泌肿瘤的检出率为73.0%.99mTc-HYNIC-TOC显像改变了6例患者的肿瘤分期,并证实了7例患者的治疗效果.结论:99mTc-HYNIC-TOC显像可有效帮助诊断,定位胰腺神经内分泌肿瘤,指导分期,并辅助临床评价各种治疗方法的疗效.     

超声检查在甲状腺微小乳头状癌诊断中的应用进展

甲状腺微小乳头状癌是临床上预后较好的甲状腺癌,早期诊断和治疗是提高甲状腺微小乳头状癌患者生存率的关键。随着高频超声技术的广泛应用和空间分辨率的提高,目前超声检查已成为甲状腺疾病筛查首选的影像学方法,尤其是对甲状腺微小乳头状癌的早期发现具有重要的临床价值。本文就超声诊断技术在甲状腺微小乳头状癌诊断中的应用进展进行了阐述。     

扫描为热结节的甲状腺癌术后发生Graves突眼一例

患者女,29岁,患者于1986年12月发现右颈前有一樱桃大小结节,无感觉、生长缓慢。1987年10月测T_3、T_4及甲状腺~(131)Ⅰ摄取率均正常。扫描为右叶热结节。同年11月于某职工医院作结节摘除术,术后病理:甲状腺乳头状癌。12月入我院作第二次手术。术前甲状腺~(131)Ⅰ扫描:结节摘除处放射线稀疏,结节周围恢复吸~(131)Ⅰ功能。行甲状腺右叶全切,左     

c-Met在甲状腺乳头状癌患者肿瘤组织中的表达及其临床意义

目的探讨c-Met在甲状腺乳头状癌患者肿瘤组织中的表达及其临床意义。方法选取2010年6月-2016年6月住院治疗的甲状腺乳头状癌、甲状腺肿、甲状腺腺瘤女性患者各50例,分析全部患者临床、病理及随访资料,将甲状腺乳头状癌患者作为观察组,甲状腺腺瘤及结节性甲状腺肿患者作为对照A组与对照B组,分别观察并记录c-Met在甲状腺乳头状癌患者肿瘤组织中的表达情况,c-Met在结节性甲状腺肿、甲状腺腺瘤患者病理组织中的表达情况。结果在对各组进行年龄、基因突变、基因扩增、自分泌/旁分泌信号和c-Met活化、蛋白的超表达分析发现,观察组在基因突变、自分泌/旁分泌信号和c-Met活化、蛋白的超表达中表达水平明显高于对照组,(P0.05);在基因扩增方面,观察组与对照组有明显差异,在基因扩增方面观察组表达水平偏低(P0.05)。结论 c-Met在甲状腺乳头状癌患者肿瘤组织中的表达出现变异,cMet在甲状腺乳头状癌的治疗方面具有临床意义。     

成人及青少年弥漫硬化型甲状腺乳头状癌的临床病理特征分析

目的 分析成人及青少年弥漫硬化型甲状腺乳头状癌的临床病理特征。方法 回顾性分析2013年5月至2015年12月在天津医科大学肿瘤医院头颈外科收治的4 739例甲状腺乳头状癌患者的临床资料,其中36例为弥漫硬化型甲状腺乳头状癌。并对成人弥漫硬化型甲状腺乳头状癌及青少年弥漫硬化型甲状腺乳头状癌进行数据分析。结果 青少年弥漫硬化型甲状腺乳头状癌患者双侧发生率、弥散型率、侵出腺叶率、中央区淋巴结转移率及侧颈淋巴结转移率均高于成人患者,但差异无统计学意义(P>0.05)。两者仅颈部淋巴结复发率差异有统计学意义(P<0.05)。结论 大部分弥漫硬化型甲状腺乳头状癌患者为年轻患者,青少年弥漫硬化型甲状腺乳头状癌更易双侧发生,侵出腺叶及淋巴结转移率更高且相对于成人患者更易复发。     

生长抑素受体与肿瘤临床

表达生长抑素受体的人类肿瘤中，起源于神经内分泌组织或细胞者居多，但也见胃癌、大肠癌、胰腺癌、胰腺癌、淋巴瘤和前列腺癌等。应用核素标记配基进行肿瘤生长抑素受体显像及受体亚型研究，不仅可以了解这些肿瘤的生物学特征，而且有助于肿瘤特别是转移灶的定位诊断，进而指导临床内、外科治疗。     

A case of malignant thymoma mimicking thyroid carcinoma: a pitfall in fine-needle aspiration

A case of malignant thymoma presenting as an anterior neck mass is reported. The tumor extended from the thyroid gland to the superior mediastinum. It did not accumulate Tc-99m pertechnetate, but continued to accumulate Tl-201 at the late phase. A fine-needle aspiration cytology from the tumor showed tight clusters of epithelial cells with crowded ovoid nuclei. The tumor was initially diagnosed as thyroid carcinoma, clinically and cytologically. A thymoma with a dominant epithelial component has to be considered in the differential diagnosis of a suspected papillary carcinoma of the thyroid.     

A case of extraadrenal pheochromocytoma associated with adrenal cortical nodular hyperplasia and papillary thyroid carcinoma.

A 64-year-old woman was admitted in November, 1996 for fluctuating blood pressure. There was multinodular goiter in her neck. High urine VMA and serum aldosterone were noted. Computed tomography showed an oval lesion in the left adrenal gland. Left adrenalectomy was performed and the pathology was proved to be adrenal cortical nodular hyperplasia. Fluctuating blood pressure and high urine VMA persisted after the operation. CT scan of the abdomen revealed a soft tissue mass in lower abdomen. The patient was admitted again in September, 1997. Laboratory examinations showed normal serum aldosterone, normal plasma renin activity and high urine VMA. Aspiration cytology of the thyroid gland disclosed papillary thyroid carcinoma. [131I]-metaiodobenzylguanidine image revealed a high uptake lesion in the right L-3 paravertebral area. Tumor excision and thyroidectomy were performed. The pathology was reported as extraadrenal pheochromocytoma and papillary thyroid carcinoma. Papillary thyroid carcinoma is rarely associated with pheochromocytoma. To our knowledge, this paper is the first report of a patient with extraadrenal pheochromocytoma associated with papillary thyroid carcinoma and adrenal cortical nodular hyperplasia.     

Papillary thyroid carcinoma without metastases manifesting as an autonomously functioning thyroid nodule

A 59-year-old woman with papillary thyroid carcinoma inside of an autonomously functioning thyroid nodule is described in this report. The patient was referred to our clinic because of rapid weight loss and swelling on the left side of the neck. Ultrasonography of the thyroid demonstrated a nonhomogeneous nodule in the lower part of an enlarged left lobe. Both 99mTc and 123I thyroid scintigraphic imaging showed a hot area corresponding to the nodule with lower uptake in the remaining thyroid tissue. Histopathological examination of the nodule revealed papillary adenocarcinoma, and the immunohistochemistry proved weak but positive staining for triiodothyronine and thyroxine. Based on these findings, the nodule was diagnosed as a functioning papillary adenocarcinoma. Although thyroid carcinoma manifesting as a hot nodule on the radionuclide isotope scan is an extremely rare occurrence, the current case is clinically important because it suggests that the diagnosis of a hot nodule cannot always rule out thyroid carcinoma in the nodule, and that even a hot nodule requires careful management so that the malignancy is not overlooked.     

Medullary thyroid cancer, papillary thyroid microcarcinoma and Graves' disease: an unusual clinical coexistence

We describe the unusual case of a Caucasian woman who had a diagnosis of medullary thyroid cancer and papillary microcarcinoma 5 years after a diagnosis of Graves' disease. The patient came to our observation for recurrence of hyperthyroidism. An ultrasound scan revealed diffuse thyroid enlargement with a nodule, recently increased in size. The serum CT and carcinoembrional antigen were elevated, and the fine-needle aspiration cytology with immunocytochemical analysis for CT was suggestive for medullary thyroid carcinoma. The nodular lesion showed intense 111In-pentetreotide uptake, whereas total body scintigraphy with the same tracer and with Thallium-201, 99mTc (V) dimercaptosuccinic acid was negative for lymph node and distant metastasis. The histological examination of thyroidectomy specimens confirmed the diagnosis of medullary thyroid cancer, showing a lymphocytic intratumoral infiltration. The histological analysis of the controlateral lobe showed an occult papillary microcarcinoma. Medullary thyroid carcinoma and papillary microcarcinoma showed intense staining with policlonal anti-RET antibodies, although genetic analysis was negative for RET mutations most frequently involved in familial and sporadic medullary thyroid carcinomas. Possible implications about the coexistence of the 3 thyroid diseases are discussed.     

Cribriform-morular variant of papillary thyroid carcinoma: characteristic histologic feature of adenomatous polyposis. A case report

We report the case of a 24-year-old woman with familial adenomatous polyposis and diagnosed with cribriform-morular variant of papillary thyroid carcinoma. Neck ultrasound and computed tomography identified multiple nodules in the thyroid gland and neck lymph nodes. The cytological analysis was compatible with the diagnosis of papillary cancer of the thyroid. Total thyroidectomy with lymph node dissection was performed. The histological analysis established the diagnosis of cribriform-morular variant of papillary thyroid carcinoma. Despite preoperative findings suggesting an aggressive form of thyroid cancer with lymph node involvement, the final diagnosis was a variant of papillary thyroid carcinoma often associated with familial adenomatous polyposis and known to have a good prognosis.     

Occult parathyroid carcinoma in a patient with papillary thyroid carcinoma and Hashimoto's thyroiditis

A 47-year-old female patient with a previous history of right thyroid lobectomy was admitted to the hospital because of a 3 cm nodule in the thyroid gland. Hormonal evaluation showed subclinical hypothyroidism with serum levels of thyroid stimulating hormone slightly elevated to 4.4 microg/dl (normal: 0.4-4 microg/dl). Thyroid ultrasound showed diffuse irregularity of the gland and the presence of a solitary nodule (30x18 mm in diameter) localized in the left lobe. A fine needle aspiration biopsy was performed. Cytological analysis revealed papillary thyroid carcinoma and Hashimoto's thyroiditis. Total thyroidectomy was performed. During the operation, two of the parathyroid glands were detected to be hyperplastic. Histopathological examination of the thyroid and parathyroid glands revealed Hashimoto's thyroiditis with papillary thyroid carcinoma and synchronous carcinoma of the parathyroid gland. To our knowledge, this association of occult parathyroid carcinoma in a patient with papillary thyroid carcinoma and Hashimoto's thyroiditis has not been reported in the literature. Given the high prevalence of autoimmune diseases in elderly women, a random occurrence of this triad represents the most likely explanation.     

Anaplastic thyroid cancer with transient thyrotoxicosis: case report and literature review.

A 55-year-old woman with anaplastic thyroid carcinoma presented with hyperthyroidism and neck swelling, hoarseness, and cervical lymphadenopathy. On physical examination, she was found to be clinically hyperthyroid with an enlarged, nontender multinodular goitre. Her serum thyroid hormone levels confirmed hyperthyroidism and technetium-99m pertechnetate scan failed to visualize the thyroid gland. Open biopsy showed an invasion of the thyroid gland by anaplastic thyroid carcinoma. The thyrotoxic phase lasted 60 days with predominantly increased thyroxine level and triiodothyronine/thyroxine (T3/T4) ratio decreased below 15. The thyrotoxic period was followed by subclinical hyperthyroidism and hypothyroidism which continued until she died of lung metastasis.     

Branchial cleft cyst as the initial impression of a metastatic thyroid papillary carcinoma: two case reports

Branchial cleft cysts are the most common lesions in lateral neck cysts, predominantly occurring in the fourth decade of life and without sexual propensity. Rare branchial cleft cysts are associated with malignant tumors metastatic from the oral cavity, nasal cavity, pharynx or thyroid gland. Occult thyroid papillary carcinomas often present as a solid mass in the lateral neck, with only a few cases revealing a branchial cleft cyst as the initial manifestation. Herein, we report two cases of metastatic thyroid papillary carcinoma that presented as lateral neck cysts, with preoperative diagnosis of branchial cleft cyst. Finally, after complete surgical resection and histopathologic examination, one case was diagnosed as cystic change of metastatic lymph node from thyroid papillary carcinoma, and the other was determined to be a branchial cleft cyst with concurrent lymph node metastasis from thyroid papillary carcinoma. When a branchial cleft cyst is diagnosed by clinical or histopathologic examination, a metastatic thyroid papillary carcinoma should be considered as part of the differential diagnosis.     

基层乡镇医院无病理诊断条件下单侧甲状腺结节术式选择

目的探讨基层医院无病理诊断条件下单侧甲状腺结节手术治疗可行的合理手术方式。方法 206例单侧甲状腺结节患者分为研究组104例,对照组102例。研究组采用患侧甲状腺腺叶+峡部切除,对照组采用患侧甲状腺部分切除、大部分切除或单纯甲状腺结节挖除。结果研究组术后病理诊断为甲状腺乳头状癌12例,无需二次手术治疗;对照组术后病理诊断为甲状腺乳头状癌10例,再行二次手术治疗,两组比较差异有统计学意义(P0.01)。研究组短暂喉返神经麻痹1例,对照组永久性喉返神经麻痹2例,两组均无术后呼吸困难及窒息、喉上神经损伤、甲状腺功能低下、甲状旁腺功能减退等。两组术后并发症比较差异无统计学意义(P0.05)。研究组随访甲状腺乳头状癌12例,患者均存活。结论患侧甲状腺腺叶+峡部切除是无病理诊断条件下基层医院治疗单侧甲状腺结节优选且具操作性的手术术式。