甲状腺转移癌(附9例报告)

目的：探讨甲状腺转移癌的发病特点、诊断及治疗。方法：分析甲状腺转移癌9例，中住年龄51岁．原发食管癌3例，肺癌3例，肾透明细胞癌、恶性黑色素瘤、喉癌各1例。针吸穿刺确诊5例，手术切除及确诊4例．其中1例肾透明细胞癌行部分切除及术后放疗，单纯放疗2例，化疗3例。由原发癌至转移间隔1个月～4年。中位时间8个月。患者均以颈前肿物就诊，1例伴声音嘶哑。结果：B超检查为甲状腺内多发弥漫性低回声团块．部分患者表现为结节性甲状腺肿。1例肾透明细胞癌患者存活7．5年，其余均在10个月内死于广泛转移。结论：甲状腺转移癌罕见．但有恶性肿瘤既往史伴有甲状腺肿块的患者应考虑转移癌的可能，诊断依靠B超、针吸活检、免疫组化染色。甲状腺转移预后不良，但肾透明细胞癌甲状腺转移积极治疗仍有望长期生存。     

Umbilical metastasis from gynecologic malignancies

Umbilical metastasis from gynecologic malignancies is very rare. We report 15 patients with primary gynecologic malignant tumours associated with umbilical metastases treated in this hospital from 1958 to Jan. 1991, including 10 epithelial ovarian cancer, 1 malignant teratoma of the ovary, 2 endometrial carcinoma and 2 squamous cell carcinoma of the cervix. Excepting 1 patient initially diagnosed as stage 1 endometrial carcinoma, all patients had advanced tumours. Umbilical lesions were discovered at the time of initial diagnosis of the primary tumour in 6 cases. The main clinical finding is an umbilical nodule or an ulcerated nodule in a diameter less than 2 cm. Usually the prognosis was poor. The average survival from initial diagnosis of umbilical metastasis to death was 14 months in 12 patients. There were 4 cases with longer survival, including 1 patient with endometrial carcinoma who survived for 40 months, and 3 patients with ovarian carcinoma who survived for 54, 52, 31 months, respectively. Two cases are surviving with tumour. It indicates that aggressive therapy may prolong survival time, especially in patient with ovarian cancer.     

Metastasis to the thyroid gland: Characterization and survival of an institutional series spanning 28 years

IntroductionSecondary neoplasms in the thyroid are rare. The study aim was to provide an overview of non-thyroid tumours that metastasize to the thyroid through our institutional experience.Materials and methodsThis study entailed a review of the pathology database searching for patients with metastasis to the thyroid at the Karolinska University Hospital between 1992 and 2019 and review of their medical files.ResultsOut of 1939 surgical procedures with a histopathological diagnosis of a thyroid malignancy, 31 cases (1.6%, 65% females) with a diagnosis of metastatic epithelial neoplasms to the thyroid gland were identified. The median age at discovery of the thyroid metastasis was 68 years (range 48–85). The most common primary tumours were clear cell renal cell carcinoma (ccRCC) (36%), followed by non-small cell lung cancer (19%), oesophageal cancer (16%), head and neck malignancies (16%), malignant melanoma (10%) and unknown primary tumour (3%). The median time from the diagnosis of the primary tumour to diagnosis of the thyroid metastasis was 20 months (0–232) and was longest for patients with ccRCC (median 107 months). At 12 months after the non-thyroid metastasis diagnosis 48% had died. The longest survival was observed in ccRCC and the shortest in lung cancer. Surgical management of the metastasis was associated with improved survival (25 vs 3.8 months, p = 0.001).ConclusionsNon-thyroid metastases to the thyroid were rare but should be suspected in patients with previous history of non-thyroid malignancy and a thyroid nodule. Prognosis was poor, but surgical management was beneficial in selected patients.     

Primary squamous cell carcinoma of the thyroid: immunohistochemical profile and literature review

BACKGROUND: Squamous cell carcinoma accounts for 1% of primary thyroid malignancies and is characterized by a rapidly unfavorable outcome. CASE PRESENTATION: A 64-year-old woman presented with a painless mass in the left neck, coexisting with thyroid goiter. Total thyroidectomy with lymphadenectomy was performed and a primary thyroid squamous cell cancer was confirmed histologically after excluding any other possible primary malignancies. The tumor's immunohistochemical profile was explored using a large panel of antibodies. The tumor featured a positive immunoreaction to cytokeratins 7-19 and to squamous cell carcinoma antigen. Low-molecular-weight cytokeratins 5-6 and epithelial membrane antigen were also expressed. The neoplasm's proliferative index (Mib1) was 60%. No immunostaining was detected for cytokeratins 10-20, thyroglobulin, TTF-1, CD5, galectin-3 or p53. CONCLUSIONS: This case of primary thyroid squamous cell carcinoma immunohistochemically profiled using a large panel of immunoreactions may offer useful information on the histological differentiation of thyroid squamous cell carcinoma from other (uncommon) thyroid carcinomas and the distinction between primary and secondary thyroid cancers.     

胰腺转移性肿瘤的诊断和治疗

目的探讨胰腺转移性肿瘤的临床病理特点、诊治和预后。方法回顾性分析18例胰腺转移性肿瘤的临床病理资料,其中原发肿瘤为肺癌8例,胃癌2例,恶性纤维组织细胞瘤1例,甲状腺癌1例,黑色素瘤1例,卵巢癌1例,。肾癌1例,食管癌1例,直肠癌1例,肝癌1例。胰腺转移性肿瘤无特异性临床症状。14例行CT或B超引导下细针穿刺活检,经细胞学检查证实;4例由术后组织病理学证实。在18例胰腺继发肿瘤中,单发14例,多发4例。结果CT平扫表现为胰腺低密度肿物,除。肾癌胰腺转移灶表现为高血供,明显增强外,其余均表现为乏血管肿瘤,增强不明显。18例患者均行放化疗综合治疗,治疗后生存期8～38个月,平均生存期19个月。结论胰腺转移性肿瘤在临床上较为少见,无特异的临床症状和影像学表现。根据不同的原发肿瘤,选择合适的综合治疗模式,对于胰腺继发肿瘤的治疗和预后有重要的意义。     

Management of intracranial metastases of differentiated carcinoma of thyroid

Summary Brain metastases in differentiated carinoma of the thyroid is a rare occurrence. We treated five documented cases of carcinoma of thyroid with brain metastases out of 400 cases of thyroid cancer treated between 1972 to 1993. 4 were females out of which one was pregnant during the appearance of brain metastases. All cases were treated with thyroidectomy, and radioiodine as primary therapy. Brain metastases developed 6 months to 11 years following treatment of the primary and were treated with radiotherapy and suppressive levothyroxine. We observed the beneficial effect of suppressive thyroxine and the poor prognosis associated with pregnancy and withdrawl of thyroid replacement therapy. 3 of the 5 patients are alive 12–23 months after treatment for brain metastases, while 2 patients died at 4 months and 7 years post brain metastases due to pulmonary and hepatic failure, respectively.     

UMBILICAL METASTASIS FROM GYNECOLOGIC MALIGNANCIES──A CLINICAL STUDY OF 15 CASES

ＵＭＢＩＬＩＣＡＬＭＥＴＡＳＴＡＳＩＳＦＲＯＭＧＹＮＥＣＯＬＯＧＩＣＭＡＬＩＧＮＡＮＣＩＥＳ──ＡＣＬＩＮＩＣＡＬＳＴＵＤＹＯＦ１５ＣＡＳＥＳＹａｏＺｈｉｎｕｉ；Ｌｉｕｌｉｙｉｎｇ；ＬｉＪｉｎｇｘｉａｎ姚志慧，刘丽影，李竞贤（ＣａｎｃｅｒＨｏｓｐｉｔ...     

Endobronchial metastases secondary to solid tumors: report of eight cases and review of the literature

Endobronchial metastases (EBM) secondaries to extrapulmonary solid malignant tumors are rare. Breast, colon and renal adenocarcinomas are the most frequent tumors associated with EBM. Since 1990 we have treated eight patients with EBM secondary to renal adenocarcinoma (three cases), colon adenocarcinoma (two cases), gastric adenocarcinoma (one case), bladder carcinoma (one case) and basal cell carcinoma (one case). Endobronchial lesions were detected by bronchoscopy and their metastatic nature was confirmed histopathologically in all eight cases. We also conducted a review of EBM reporting studies published in English language. The median interval from the diagnosis of the primary tumour was 41 months. Symptoms and radiological findings were indistinguishable from those of primary lung cancer. Five patients were treated with external radiotherapy with symptomatic improvement while two patients had chemotherapy and one patient underwent surgical resection of the metastasis. Systemic treatment was used in six cases with no significant effect on EBM. Median survival after EBM diagnosis was 9 months with one patient surviving 3.5 years and two patients still alive at 1 year. In conclusion, EBM usually represent a late manifestation requiring differential diagnosis from a primary lung cancer. Local treatment may result in symptomatic improvement but prognosis is generally poor averaging 1-2 years in most series.     

Multiple primary breast and thyroid cancer.

The occurrence of breast and thyroid multiple primary cancers was evaluated using data from the Connecticut Tumor Registry. The study population consisted of 1618 women with primary thyroid cancer and 39,194 women with primary breast cancer diagnosed between 1935 and 1978. Thirty-four thyroid cancer patients subsequently developed breast cancer and 24 breast cancer patients later had thyroid cancer. A significantly elevated risk of thyroid cancer following breast cancer (SIR = 1.68) and breast cancer following thyroid cancer (SIR = 1.89) was demonstrated. The finding was even more notable when compared with the risks obtained for other sites. The elevated risk was particularly evident in women under 40 years of age at time of diagnosis of the first cancer. Analysis by histologic type revealed that the highest risk of second primary breast cancer was found among patients with follicular or mixed papillary-follicular thyroid cancer. Women under age 40 with follicular carcinoma had a 10-fold risk of developing breast cancer (4 observed, 0.4 expected). An enhanced risk of second primary tumours was evident for the entire period after treatment of the first primary, although it was highest within one year after diagnosis of the first primary. This may be due to the close medical surveillance of cancer patients which would increase early diagnosis of second tumours. Our findings suggest that breast and thyroid cancer may share common aetiologic features.     

甲状腺癌近期内再手术探讨

目的探讨甲状腺癌近期内再手术的原因、手术指征、手术时机及手术方式.方法回顾性分析1994年1月～2003年6月间33例甲状腺癌患者3个月内再手术的临床资料.结果再手术中发现甲状腺癌残留14例,其中伴颈部淋巴结转移4例,对侧甲状腺腺瘤残留2例.22例获得随访,随访时间6个月～9年,中位随访时间4年,本组未出现肿瘤复发.结论甲状腺癌首次手术时漏诊、误诊及首次手术切除范围不足是导致近期内再手术的主要原因.对明确有再手术指征者,手术应尽早进行.再手术时应选择适当的手术方式,以提高患者的长期生存率,减少并发症的发生.     

Endobronchial metastatic disease: Analysis of 32 cases

Endobronchial metastasis (EM) from nonpulmonary tumors is uncommon. A 9-year retrospective study at the University Hospital Vall d'Hebron (Barcelona, Spain) identified 32 patients with EM. All but four cases were diagnosed by fiberoptic bronchoscopy with bronchial biopsy. Primary tumors included the following types: breast cancer (20), colorectal cancer (3), melanoma (2), gastric cancer (1), neuroblastoma of the olfactory nerve (1), abdominal leiomyosarcoma (1), hypernephroma (1), endometrial carcinoma (1), papillary thyroid cancer (1), and hepatocarcinoma (1). Median age at diagnosis of EM was 58.7 years and median interval from the diagnosis of the primary tumor to the diagnosis of EM was 50.4 months. Seventeen patients (53%) had evidence of other metastatic sites at endobronchial relapse. The more common clinical manifestations included cough (37.5%), haemoptysis (28%), dyspnea (18.7%), and recurrent pulmonary infections (6.2%). Eight patients (25%) had no symptoms. There appears to be a predilection for metastatic involvement of the right and left upper lobe bronchus. Treatment was instituted in 20 patients, and their median survival was 11 months, in comparison with the 3 months found in 12 patients who received only palliative therapy because of advanced disseminated disease. Breast cancer is the most common tumor causing EM. The prognosis of patients with EM depends on the type of the primary tumor and the presence of other metastatic sites. Treatment must be individualized. © 1996 Wiley-Liss, Inc.     

全甲状腺切除术治疗甲状腺癌的临床分析

目的探讨甲状腺癌行全甲状腺切除术的诊疗经验。方法回顾性分析83例甲状腺癌行全甲状腺切除术的临床资料及病理特点并进行1—5年随访观察。结果83例中67例为首次手术,16例为二次手术;48例术后行^131I内照射治疗;83例均术后服用甲状腺激素。随访75例中有2例死于转移癌。结论术前评估对制定甲状腺癌的治疗方案有重要意义,全甲状腺切除术辅以术后甲状腺激素抑制治疗,并适当予以放射性碘治疗,是兼顾患者预后和生活质量治疗甲状腺癌的合理选择。     

转移性肾上腺癌的临床治疗（附15例报告）

目的:分析我院收治的15例肾上腺转移性恶性肿瘤的临床资料，结合文献复习，总结临床诊治体会。方法:回顾性分析我院2011年1月至2019年5月收治的15例肾上腺转移性恶性肿瘤患者的临床资料。男12例，女3例；平均年龄为63岁(53～73岁)。肾上腺转移瘤的最大径中位值为4.4 cm（2.0~9.8 cm），左侧11例，右侧3例，双侧1例。原发恶性肿瘤来源:肺7例，肝3例，肾2例，子宫1例，胰腺1例，腹膜后肿物1例。本研究中15例肾上腺转移恶性肿瘤为原发肿瘤确诊后诊断，距离原发肿瘤诊断的中位时间为15.6个月(5~28个月)。15例患者均行手术切除治疗。结果:术后病理细胞类型:腺癌4例，肝细胞癌3例，透明细胞癌2例，弥漫性大B细胞瘤2例，神经内分泌癌1例，癌肉瘤1例，肺小细胞癌1例，肺大细胞癌1例。术后定期随访患者，15例患者生存4~78个月。患者最终死于肿瘤广泛转移。结论:我院肾上腺转移性恶性肿瘤的原发肿瘤以肺癌最为常见，多数转移瘤在定期复查中无意发现。我院肾上腺转移瘤以左侧多见。肾上腺转移瘤治疗方式有手术治疗、介入治疗、经皮肿瘤消融、免疫治疗、放疗和化疗等。     

Primary papillary thyroid carcinoma previously treated incompletely with radiofrequency ablation

Radiofrequency ablation (RFA) recently has been applied to benign thyroid nodules, mainly for the cosmetic reasons, and limited cases of local recurrences or focal distant metastases of well-differentiated thyroid cancer, in the high-risk reoperative condition or for the palliative purpose. But no report has been made on the RFA for primary thyroid cancer to date. We report on a patient with primary papillary carcinoma of thyroid gland who had undergone RFA before the cytological diagnosis of malignancy, later referred and treated with robotic surgery successfully. We can learn the following lessons from our case; (1) the RFA for operable primary thyroid malignancy should be avoided, because of the possibility of remnant viable cancer and undetectable nodal metastasis, and (2) robotic or endoscopic thyroid surgery may be a feasible operative method for benign or malignant thyroid nodules previously treated with RFA.     

18F-FDG PET/CT显像偶发甲状腺癌的葡萄糖代谢与临床病理学的相关性研究

背景与目的：18F-FDG PET/CT的广泛应用导致偶发甲状腺癌的比例明显增加,偶发甲状腺癌灶的糖代谢与甲状腺癌病理学的相关性尚不清楚。研究因非甲状腺疾病行18F-FDG PET/CT显像、偶发甲状腺癌的患者,分析甲状腺癌灶的糖代谢与肿瘤的分化程度、淋巴结转移的相关性。方法：回顾性分析18F-FDG PET/CT显像偶发甲状腺瘤患者195例,53例患者手术病理诊断为甲状腺癌。分别测量甲状腺癌灶的最大标准摄取值(SUVmax)、病变大小、病变个数,同时测量患者正常甲状腺组织的SUVmax。通过病理分析病理学分型、淋巴结转移,患者分为G1组(分化型甲状腺癌)、G2组(非分化型甲状腺癌)、G3组(甲状腺癌无淋巴结转移)和G4组(甲状腺癌有淋巴结转移)。分析G1组与G2组、G3组与G4组间甲状腺癌灶的糖代谢的差异。结果：53例患者中,PET显像发现甲状腺癌灶53个。病理学发现甲状腺癌灶62个,乳头状甲状腺癌37例,滤泡状甲状腺癌4例,髓样癌9例,低分化癌3例。正常甲状腺组织的SUVmax为1.51±0.30,G1组(41例)SUVmax为4.25±1.70,G2组(12例)SUVmax为6.34±2.45,G1组和G2组的SUVmax均显著高于正常甲状腺组织(t=11.0,t=7.10,P<0.01),但G1组与G2组的SUVmax差异无统计学意义(t=3.61,P>0.05)。G3组(29例)的SUVmax为4.77±2.15,G4组(24例)的SUVmax为4.67±2.02,差异无统计学意义(t=0.33,P=0.56)。结论：18F-FDG PET/CT显像偶发癌分化型甲状腺癌、非分化型甲状腺癌均具有高糖代谢改变;不同分化程度、淋巴结转移能力的甲状腺癌灶的糖代谢水平差异无统计学意义。     

13例伴印戒细胞分化的原发性乳腺癌临床分析

  目的  探讨伴印戒细胞分化的原发性乳腺癌的临床特点及预后。  方法  回顾性分析天津医科大学附属肿瘤医院1999年2月至2011年6月收治的13例伴印戒细胞分化的原发性乳腺癌患者的临床资料, 所有患者均为女性, 年龄38~84岁, 中位年龄53岁。首发症状多为乳腺肿物。治疗以乳腺癌改良根治术为主, 术后辅助放疗、化疗及内分泌治疗。  结果  本组13例术后经组织病理学检查均证实为伴印戒细胞分化的原发性乳腺癌, 其中临床分期Ⅰ期患者1例, Ⅱ期8例, Ⅲ期4例。术后平均随访53.8个月。3年生存率为46.2%(6/13), 5年生存率为30.8%(4/13), 10年生存率为7.7%(1/13)。  结论  与常见的乳腺浸润性导管癌相比, 伴印戒细胞分化的原发性乳腺癌发病率低, 侵袭性强, 确诊后应积极行手术、放化疗、内分泌等综合治疗。目前尚无可推荐的最佳特异治疗模式, 有关研究应继续进行。      

Pathogenese, Klassifikation und Histologie von Schilddrüsenkarzinomen

Thyroid cancer makes up approximately 1% of all human malignancies. Morphologically thyroid cancer can be subdivided into carcinomas with follicular cell differentiation, C cell differentiation and other rare carcinoma types. Recent molecular genetic discoveries provide insight into the mechanisms of the development and progression of thyroid carcinoma and furthermore offer perfect tools to support the morphological diagnosis. Exact histological classification of thyroid carcinomas is still the gold standard for the therapeutic management of thyroid carcinoma patients, if necessary based on immunohistochemical and/or molecular pathological findings.     

Renal cell carcinoma metastatic to the thyroid

Metastatic renal cell carcinoma to the thyroid is an uncommon occurrence that can cause clinical and pathologic problems in diagnosis. The authors report seven cases from the files of The University of Texas M.D. Anderson Cancer Center, Houston, Texas. Each presented clinically as a palpable thyroid nodule months or years after the primary renal cell carcinoma had been resected. Although renal cell carcinoma is more common in men, we found a female predominance of 6:1 in this series. These lesions appear as solitary "cold" nodules on iodine 131 scans and may be misdiagnosed as primary thyroid neoplasms, especially if the renal primary is still unrecognized. A correct diagnosis is important because surgical management can be curative. The diagnosis is facilitated by the use of fat stains, electron microscopic study, and immunoperoxidase stains.     

甲状腺机能亢进并甲状腺癌11例报告

本文报道11例甲亢合并甲状腺癌病例,占甲亢手术病人的3.4％。可发生于不同类型的甲亢病人,病理检查呈局灶性徽小癌6例占54.5％,多数病例要靠术后病理诊断。分析术前误诊原因:①临床上对本病缺乏应有认识。②大部分病例的癌肿尚属早期,常难发现。③对甲亢患者~(131)I扫描为冷结节,合并甲状腺癌的警惕性不够。治疗原则应同甲状腺癌,但对术后才明确诊断,肿瘤属于微小隐性癌,不一定要做二期手术,可术后口服甲状腺素随访观察。     

胰腺转移肿瘤25例诊治分析

目的:探讨胰腺转移肿瘤的诊断及治疗方法。方法:对1998年10月～2009年8 月空军总医院收治的25例胰腺转移肿瘤进行回顾性分析。结果:原发肿瘤为肺癌8 例、结肠癌5 例、胃癌4 例、胆囊癌3 例、食管癌2 例、肝癌1 例、胃恶性间质瘤1 例、恶性纤维细胞瘤1 例。胰腺转移肿瘤距原发肿瘤时间间隔平均24个月（0～192 个月）。 14例行B 超引导下细针穿刺活检组织病理学诊断;4 例术中冰冻切片诊断、7 例为临床诊断。行胰十二指肠切除+ 横结肠次全切除2 例,胰腺体尾+ 脾脏切除2 例,胆道内金属支架引流术1 例;放疗+ 化疗10例,局部放疗4 例,全身化疗2 例;4 例未治疗。24例随访,手术组中位生存27个月（10～76个月）,非手术治疗组中位生存11个月（2～20个月）,未治疗组中位生存1.5 个月（0.5～6 个月）。 结论:胰腺转移性肿瘤无特异的临床表现,手术切除可延长患者的生存时间。