微小乳头状甲状腺癌行颈淋巴结清扫术的必要性探讨

目的探讨微小乳头状甲状腺癌手术行颈部淋巴结清扫术的必要性。方法分析1999年5月～2009年10月收治的微小乳头状甲状腺癌手术患者的临床病理资料。分为单发灶组(42例)和多发灶组(27例),均行中央组(Ⅵ区)、同侧或双侧颈深组(Ⅲ+Ⅳ区)淋巴结清扫术。结果Ⅵ区淋巴结转移发生率单发灶组与多灶组分别为2例(4.8%)与7例(25.9%),Ⅲ+Ⅳ区淋巴结转移发生率单发灶组与多发灶组分别为0例(0)与3例(11.1%)。两组Ⅵ,Ⅲ+Ⅳ区淋巴结转移率差异具有统计学意义(P<0.05)。术后4例发生一过性低钙血症,3例短暂性喉返神经麻痹,1例淋巴瘘,1例多灶组术后7个月复发,1例单灶组术后42个月复发。无1例死亡病例。结论多发灶性的微小癌应积极施行淋巴结清扫;单发灶性微小癌可在定期随诊观察下暂不行预防性的颈淋巴结清扫术,既不会影响患者的生存率又能提高生存质量。     

Partial remission of metastatic papillary thyroid carcinoma with sunitinib. Report of a case and review of the literature

The ratio of aldosterone-to-renin activity is currently recommended as a screening test for primary aldosteronism (PA). There are many factors interfering the interpretation of aldosterone-renin ratio (ARR) and could hamper in-time diagnosis of PA. Here, we first report a patient with underlying Page phenomenon and an accidentally disclosed adrenal incidentaloma. High renin secretion from Page phenomenon had masked higher ARR into normal ARR obscuring the diagnosis of PA. However, adrenal venous sampling (AVS) confirmed the autonomous aldosterone secretion with left adrenal vein plasma aldosterone concentration (PAC) 124.1 ng/dl and a lateralization ratio 3.3. AVS may discriminate masked PA due to high renin secretion from Page kidney. It is suggested that clinicians should cautiously interpret aldosterone-renin ratio and consider diagnostic AVS if hyperaldosteronism is highly suspected especially in the background of other secondary hypertension.     

The relationship between chronic lymphocytic thyroiditis and central neck lymph node metastasis in papillary thyroid carcinoma

正Objective To explore the effect of Hashimoto’s thyroiditis(HT)on central lymph nodal metastasis(CLNM)in papillary thyroid carcinoma(PTC)patients.Methods A retrospective study of 179 patients who underwent thyroidectomy with nodal excision and with nodal excision     

Correlation between B-RAFV600E mutation and clinico-pathologic parameters in papillary thyroid carcinoma: data from a multicentric Italian study and review of the literature

Recently, a somatic point mutation of the B-RAF gene (V600E) has been identified as the most common genetic event in papillary thyroid carcinoma (PTC), with a prevalence variable among different series. Since discordant data on the clinico-pathologic features of B-RAF mutated PTC are present in the literature, the aim of the present co-operative study was to establish the prevalence of this genetic alteration and to perform a genotype-phenotype correlation in a large cohort of patients with PTC. To this purpose, a series of 260 sporadic PTCs with different histological variants were included in the study. The mutational analysis of the B-RAF gene was performed either by RT-PCR followed by single-stranded conformational polymorphism or by PCR and direct sequencing. Statistical analyses were obtained by means of chi2/Fisher's exact test and t-test. Overall, a heterozygous T > A transversion at nucleotide 1799 (V600E) was found in 99 out of 260 PTCs (38%). According to the histological type of the tumor, the B-RAF (V600E) mutation was present in 48.3% of cases of classic PTCs (85 out of 176), in 17.6% (nine out of 51) of follicular variants of PTCs, in 21.7% (five out of 23) in other PTC variants and in none of the ten poorly differentiated tumors. B-RAF (V600E) was significantly associated with the classic variant of PTC (P = 0.0001) and with an older age at diagnosis (P = 0.01). No statistically significant correlation was found among the presence of B-RAF (V600E) and gender, tumor node metastasis (TNM), multicentricity of the tumor, stage at diagnosis and outcome. In conclusion, the present study reports the prevalence of B-RAF (V600E) (38%) in the largest series of sporadic PTCs, including 260 cases from three different Italian referring centers. This prevalence is similar to that calculated by pooling together all data previously reported, 39.6% (759 out of 1914 cases), thus indicating that the prevalence of this genetic event lies around 38-40%. Furthermore, B-RAF (V600E) was confirmed to be associated with the papillary growth pattern, but not with poorer differentiated PTC variants. A significant association of B-RAF mutation was also found with an older age at diagnosis, the mutation being very rare in childhood and adolescent PTCs. Finally, no correlation was found with a poorer prognosis and a worse outcome after a median follow-up of 72 months.     

Mucoepidermoid carcinoma of the thyroid: a case report and literature review

The mucoepidermoid carcinoma is a neoplasia that usually occurs at salivary glands, breast, pancreas and gastrointestinal tract. The primary occurrence on thyroid gland is rare and only 33 cases were previously published. Although the majority of cases of mucoepidermoid carcinoma of the thyroid (MECT) show a benign evolution, this paper describes a patient with an aggressive tumor. A literature review over clinical, histopathological, immunohistochemical features and histogenetic origin was discussed.     

Clinical and histological characteristics of papillary thyroid microcarcinoma: results of a retrospective study in 243 patients

CONTEXT: The recognition of thyroid microcarcinoma has increased due to the widespread use of ultrasound-guided fine-needle aspiration biopsies. OBJECTIVE: The objective of this study was to describe histological and clinical characteristics of papillary thyroid microcarcinoma (PTMC) less than or equal to 1 cm. DESIGN: This study was a retrospective cohort. SETTING: This study was conducted at a university hospital endocrine clinic. PATIENTS: Over a 9-yr period, 243 consecutive patients with PTMC were studied. RESULTS: PTMC was an incidental finding at surgery in 21.4% of the PTMC cases. There were no differences in the clinical characteristics between those with incidental PTMC and those with suspected thyroid carcinoma. None of the patients with a cancer less than 8 mm had distant metastases, whereas distant metastases were observed in patients with cancers >/= 8 mm (P 相似文献   

甲状腺乳头状癌患者ret基因重排突变

目的　研究ret基因重排突变与甲状腺乳头状癌(PTC)发生、发展的关系。方法　检测27例PTC,另有其他组织类型甲状腺癌10例、良性甲状腺病变33例及病变旁正常甲状腺组织30例(对照)甲状腺组织标本。首先以多重PCR筛查重排突变基因(ret/PTC)的存在,再以鉴定PCR(ID PCR)确定ret重排突变类型(ret/PTC1, 2, 3),最后通过自动测序证实。结果　(1)有15例标本显示ret/PTC阳性,其中11例为ret/PTC1; 3例为ret/PTC3; 1例为ret/PTC2。ID PCR产物通过直接基因测序得到证实。( 2 )所有15例ret/PTC阳性的组织标本均为PTC,发生率为55. 6% (15 /27)。(3)ret/PTC阳性及阴性的两组PTC患者在性别、年龄、肿瘤大小及颈部淋巴结累及率方面差异无统计学意义。但甲状腺外软组织侵犯率在ret/PTC阳性的患者低于阴性患者(33. 3% vs66. 7%,P<0. 05)。唯一1例有远处肺转移的患者为ret/PTC阴性。结论　ret重排突变特异性发生于PTC中,可能与PTC的发病密切相关。     

Choroidal and skin metastases from papillary thyroid cancer: case and a review of the literature

A patient with widely metastatic papillary thyroid cancer who had been previously treated with (131)I and external beam radiation presented with purple nodular lesions on his face and scalp. On biopsy, the nodules were papillary carcinoma with cells that stained for thyroglobulin. Subsequently he developed decreased left eye visual acuity, and fundoscopy revealed lesions typical of choroidal metastases. Dermal and choroidal metastases of papillary thyroid carcinoma are both rare. However, the significance of these clinical manifestations may be overlooked and ignored unless the diagnosis is considered. New skin nodules or visual acuity decline in a patient with papillary thyroid cancer may represent manifestations of distant metastatic disease and should prompt thorough evaluation with dermatological examination and fundoscopy. Choroidal and skin metastases have almost always occurred in patients with advanced disease, but initial presentation with these lesions is possible, and in such instances a thorough search for additional sites of metastatic disease is recommended. Occasionally such metastases may respond to (131)I therapy or external beam radiation.     

Left maxillary sinus tumour‐induced hypophosphataemic osteomalacia and combined with thyroid papillary carcinoma: a case report and literature review

Tumour‐induced osteomalacia (TIO) is a rare disease characterised by hypophosphataemia and clinical symptoms of osteomalacia. Herein we report the case of a 29‐year‐old man who was admitted to hospital with progressive bone pain and was diagnosed with TIO caused by maxillary sinus tumours. In the preoperative evaluation, it was found that the patient had thyroid malignant tumours at the same time. Two operations were performed separately on the left maxillary sinus tumour and thyroid tumour after complete examination. After tumour resections, the symptoms of bone pain were relieved and the level of blood phosphorus was restored, long‐term replacement therapy was needed for thyroid. When a patient is diagnosed with TIO, it is necessary to screen for the presence of other malignant tumours and explore the treatment options in order to benefit patients preferably.     

Lingual thyroid carcinoma: a case report and review of the literature.

Ectopic thyroid tissue may reside anywhere along its embryologic path of descent. Most ectopias manifest as simple thyroglossal duct cysts in conjunction with a normally developed thyroid gland in its usual thyroid cervical bed. Lingual thyroid is a rare developmental abnormality characterized by the failure of the thyroid gland, or remnants, to descend from its embryologic site of origin at the foramen cecum to its usual pretracheal position. Carcinoma arising in a lingual thyroid is even more unusual with fewer than 30 cases reported in the literature. We report the second case of lingual papillary thyroid carcinoma and review the clinical features, natural history, diagnosis, and treatment of lingual thyroid carcinoma.     

Role of prophylactic ipsilateral central compartment lymph node dissection in papillary thyroid microcarcinoma

Central compartment lymph node (CCLN) management in patients without clinical or radiologic evidence of CCLN metastasis is debatable. The aim of the present study was to evaluate outcomes of surgery for papillary thyroid microcarcinoma (PTMC) with prophylactic ipsilateral CCLN dissection (PI-CCND) in a large cohort of patients treated at one single institution in a 5-year follow-up. Between January 2000 and December 2005, 2192 patients with papillary thyroid carcinoma underwent thyroid surgery. Inclusion criteria were patients with PTMC, absence of clinical or radiologic evidence of CCLN metastasis, and a follow-up for a period ≥60 months. Data from 842 patients were retrieved in the current retrospective cohort study. PI-CCND was routinely performed in addition to thyroid surgery in all cases. Ipsilateral CCLN metastasis was found in 218 patients (25.9%). Postoperative complications included 76 cases of transient hypoparathyroidism (9%), 11 cases of permanent hypoparathyroidism (2.6%), four cases of vocal cord palsy (0.5%), and one case of bleeding (0.1%). Univariate analysis and multivariate logistic regression analysis revealed that CCLN metastasis was statistically significantly correlated with tumor size and extracapsular invasion. Recurrence has been observed to date in 19 patients (2.26%). No CCLN site recurrence occured in patients who underwent PI-CCND. This study demonstrates the technical feasibility and safety of PI- CCND, which is a better way to determine lymph node status for a more accurate staging of disease and risk stratification. PI-CCND should be considered even if clinical or radiological exams are negative for CCLN metastasis.