甲状舌管癌诊断与治疗(附3例病例分析)

甲状舌管癌是一种罕见的恶性肿瘤，术前不易诊断，诊断主要依靠病理切片分析。复习北京大学口腔医学院1986年1月至2006年8月间收治的甲状舌管癌3例，结合文献探讨其临床、病理特点及合理的治疗方案。甲状舌管癌占所有甲状舌管病变的2．9％，其临床表现缺少特异性，与良性病变类似。本文3例中2例甲状舌管癌术前诊断为甲状舌管囊肿，另1例诊断为皮样囊肿；术后病理诊断均为甲状舌管癌。原发性甲状舌管癌诊断应符合以下标准：病变位于甲状舌管囊肿或甲状舌管中；甲状腺经临床或病理检查未发现肿瘤。甲状腺来源的乳头状癌是其最常见的病理类型，其病理学表现有以下特征：真乳头的形成；毛玻璃状细胞核、核内假包涵体、核沟及核微丝等特征性细胞核改变；砂粒体样结构是甲状腺乳头状癌的特征性结构；甲状腺免疫球蛋白染色阳性。甲状舌管癌发展缓慢，预后较好。采用Sistrunk术式切除病变是主要的治疗方法，术后需要密切随访。伴有甲状腺肿物或颈部淋巴结肿大的病例应当进行甲状腺切除或颈淋巴清扫术。而甲状腺功能抑制治疗及放射性碘治疗的作用尚不确定。

Diagnosis and treatment of thyroglossal duct carcinoma:Report of 3 cases

Thyroglossal duct carcinoma is a rare malignant tumor which is usually diagnosed postoperatively. Clinical and pathological features of 3 cases of thyroglossal duct carcinoma were investigated and the optimal treatment protocol was proposed. The clinical presentation of thyroglossal duct carcinoma is very similar to that of its benign counterpart. Two cases were diagnosed as thyroglossal duct cyst prior to the operation, the remaining one as dermoid cyst. All three cases were diagnosed as papillary carcinoma of thyroid origin after microscopic examination. The characteristic histological hallmarks including: formation of papillary structure; nuclear morphological variations such as ground glass nuclei, pseudo-inclusions, intranuclear grooves and filaments; concentrically calcified structures termed psammoma bodies which is regarded as a strong indication of papillary carcinoma;positivity in immunohistological staining for thyroglobin. Sistrunk procedure of excision is the choice for treatment. A close follow-up is needed. In the presence of thyroid gland masses or cervical lymphadenopathy, thyroidectomy or neck dissection should be recommended.