甲状腺微小乳头状癌热消融技术研究进展及现状分析

甲状腺微小乳头状癌（papillary thyroid microcarcinoma,PTMC）广义上指最大直径＜10 mm的乳头状癌。随着检查技术及水平的提高,甲状腺癌的检出率逐渐增加,并且PTMC在甲状腺乳头状癌（papillary thyroid carcinoma,PTC）中的构成比越来越高。目前针对PTMC,尤其是低危PTMC的治疗决策争论不断,但是精准化、微创化、个体化的治疗方式是目前的发展趋势。     

Influencing factors for recurrence of hepatocellular carcinoma treated with radiofrequency ablation

Radiofrequency ablation (RFA), a new local therapy, has recently been developed for hepatocellular carcinoma (HCC). In this study, we have checked for the factors influencing the recurrence of HCC following RFA. We gave special emphasis to complete coagulation. The study population was comprised of 47 patients (80 tumors) with HCC with tumor size of <3 cm in maximal diameter. The patients were observed for a period of 2-3 years (average 865 days). The local recurrence rate was 19% at the end of 1 year, and 21% by the end of 2 years. The patients with local recurrence received significantly fewer RFA sessions (P<0.05) compared to patients with no recurrence. The frequencies of complete coagulation were significantly less (P<0.05) in patients with local recurrence than patients without local recurrence. The distant recurrence rate was 38% at 1 year, and 60% at 2 years. Patients with distant recurrence had significantly increased number of tumors (2.0+/-1.4) (P<0.05) compared to patients without distant recurrence (1.2+/-0.4). In conclusion, obtaining complete coagulation is an important factor to prevent local recurrence and the number of tumors predicted the distant recurrence in patients with HCC undergoing RFA.     

Long-term follow-up for patients with papillary thyroid carcinoma treated as benign nodules

BACKGROUND: The recent prevalence of ultrasonography and fine-needle aspiration biopsy (FNAB) has facilitated the detection and diagnosis of papillary thyroid carcinoma. However, there are still cases that are preoperatively misdiagnosed and treated as benign nodules because ultrasonographic and FNAB findings do not provide sufficient evidence for a malignant diagnosis. In this study, we investigated the clinical outcomes of patients with papillary carcinoma that had not been recognized preoperatively. PATIENTS AND METHODS: We investigated the prognoses of 56 patients with papillary carcinoma who underwent thyroidectomy without node dissection under a diagnosis of benign nodules. RESULTS: None of the patients underwent further surgery such as completion total thyroidectomy and node dissection after the pathological diagnosis of papillary carcinoma was established. However, to date, only 3 patients (5.3%) showed recurrence 116, 133 and 148 months after the initial surgery, respectively. Two patients showed recurrence in the remnant thyroid and one showed recurrence in the bone. None of the patients have died of thyroid carcinoma. CONCLUSION: Papillary carcinomas misdiagnosed as benign nodules on ultrasonography and FNAB are indolent and very slow-growing. Immediate further surgery is not needed for such cases, even if they were resected as benign nodules at the initial surgery.     

超声引导下微波消融和射频消融与手术切除治疗甲状腺微小乳头状癌的疗效观察

目的探讨超声引导下微波消融和射频消融与手术切除治疗甲状腺微小乳头状癌的疗效。方法选取2014年5月至2018年2月间南京明基医院收治的227例甲状腺微小乳头状癌患者进行回顾性分析,其中,使用超声引导下微波消融治疗的79例患者纳入A组,使用超声引导下射频消融治疗的75例患者纳入B组,使用手术切除治疗的73例患者纳入C组。观察A、B组患者治疗前后肿瘤直径,比较三组患者甲状腺激素水平、术前术后应激反应和并发症发生情况。结果与治疗前相较,A、B两组患者经过治疗后肿瘤直径均缩小,差异均有统计学意义(均P <0. 05),但组间比较,差异无统计学意义(P <0. 05)。治疗后,A、B两组患者促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)和游离甲状腺素(FT4)比较,差异无统计学意义(P> 0. 05)。C组TSH指标均高于A、B两组,FT3和FT4指标均低于A、B两组,差异均有统计学意义(均P <0. 05)。术后1d和3d,A、B两组患者肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)比较,差异无统计学意义(P> 0. 05)。C组患者TNF-α和IL-6指标均高于同期A、B两组,差异均有统计学意义(均P <0. 05)。三组患者术后并发症比较,C组患者发生率均高于A、B两组,差异均有统计学意义(均P <0. 05)。结论超声引导下微波消融与射频消融治疗甲状腺微小乳头状癌效果较好,患者肿瘤体积缩小率高,术后甲状腺激素水平稳定,应激反应恢复快,并发症少。     

甲状腺乳头状癌与乳头状增生的病理研究

  目的 探讨Galectin3，CK19及Ki-67在甲状腺乳头状癌与乳头状增生中的表达，寻找有助于两者鉴别诊断的标志物。方法 运用免疫组化方法检测100例甲状腺乳头状癌、100例良性乳头状增生中Galectin3，CK19及Ki-67的表达。结果 Galectin3，CK19及Ki-67在甲状腺乳头状癌阳性表达率分别为100 %，97 %及93 %，而在乳头状增生中表达率分别为13 %，30 %及1 %，3种蛋白在乳头状癌与良性乳头状增生间差异有统计学意义（P＜0.05）。在乳头状癌中2种或3种蛋白同时阳性表达为94.3 %，而乳头状增生为0。结论 Galectin3，CK19及Ki-67是鉴别诊断甲状腺乳头状癌与乳头状增生的有用标志物，尤其联合使用更有价值。     

单纯乳头状甲状腺癌与合并桥本甲状腺炎的乳头状甲状腺癌的临床特点及分析

目的 分析单纯乳头状甲状腺癌(PTC)与PTC合并桥本甲状腺炎(HT)患者的临床特点.方法 将149例PTC患者,按是否合并HT分为PTC组(n=120)与HT-PTC组(n=29).对比两组患者的性别、年龄、术前促甲状腺激素(TSH)水平、甲状腺微小乳头状癌(PTMC)发生率、术后左旋甲状腺激素剂量以及术后TSH抑制...     

甲状腺乳头状癌的变异型

甲状腺乳头状癌(PTC)组织学变异型众多,大部分变异型与典型乳头状癌有相似的临床行为,但有少数变异型预后较差,如高细胞变异型、柱状细胞变异型、实体/梁状变异型等;且有一些变异型在诊断上有争议,如滤泡变异型易误诊为滤泡腺瘤、透明细胞变异型可能与肾细胞癌混淆、诊断高细胞变异型所需的高细胞的比例和细胞高度有分歧意见等.     

Chronic myeloid leukemia in a man with papillary carcinoma of the thyroid treated with radioactive iodine

Leukemia as a second malignancy after treatment of thyroid cancer is rare. Most cases reported in the literature have occurred after cumulative doses higher than 800 mCi and it is most commonly acute leukemias. We report a case of chronic myeloid leukemia (CML) occurring in a 40-year-old man 14 years after treatment of papillary thyroid carcinoma. Our patient had the longest interval between the diagnosis of CML and administration of 131I.     

Laparoscopic radiofrequency ablation for hepatocellular carcinoma

We examined the case of laparoscopic radiofrequency ablation (L-RFA) to hepatocellular carcinoma (HCC), and then the method of this treatment was considered in terms of selection and adjustment. Between January 2008 and May 2010, L-RFC was performed on 18 cases (27 tumors). A total operation time was 203 minutes (± 85.5). The median survival time was 562 days (± 197 day). The amount of blood was 21.0 g (± 68.4), and 3 postoperative complications (pleural effusion) were observed. The average length of hospital stay after the operation was 8 days. There was no vestigial remnant in all cases after the operation. The prognosis of death due to a liver failure was one case on the 516th day after the operation. All other 17 cases were survived. If the tumors were identified by the naked eye and ultrasonography, and considering the position in relation to the main vas, the ablation would be possible for the troublesome part in case of the percutaneous approach. Therefore, we thought the application of RFA to HCC would be more expandable.     

Long-term outcome of breast cancer patients treated with radiofrequency ablation

Background

Radiofrequency ablation (RFA) is considered to be the most promising non-surgical ablation technique for the treatment of small breast cancer. However, few data are available regarding long-term follow-up of patients treated with this modality.

Methods

Since 2005, we have performed RFA and sentinel lymph node (SLN) biopsy in 19 cases. Axillary lymph node dissection (ALND) was performed in patients with positive SLNs. From 24 to 202 days after RFA, the ablated tumour tissue was excised by mammotome biopsy and examined histologically or immunohistochemically with H&E staining, nicotinamide adenine dinucleotide (NADH)-diaphorase staining, and single-stranded (ss) DNA staining. All cases were followed-up after breast radiation and systemic therapies.

Results

Although complete response was histologically confirmed in only 8 cases, NADH-diaphorase and ssDNA staining did not demonstrate any viable tumour cells in the ablated lesions. At a mean follow-up of 60 months (follow-up range, 37–82 months), there were no cases of in-breast recurrence, although one patient died due to hepatic metastases. Cosmesis of the conserved breast was excellent or good in all of the cases, but a hard lump was persistent after RFA in half of the cases.

Conclusions

The long-term outcome of patients treated with RFA is encouraging with regard to cosmesis and local control. Because a persisted lump may cause patient discomfort, anxiety and fear, however, further studies are needed to establish the optimal technique. Moreover, a prospective study will be required to determine the equivalency in local recurrence rates between the RFA therapy and conventional breast-conserving treatment.     

Possible branchiogenic carcinoma coinciding with metastatic papillary thyroid carcinoma.

We report the discovery of a cystic lesion of flat lining epithelium with areas of squamous carcinoma, associated with metastatic cervical nodes of a papillary thyroid cancer, and discuss the diagnostic possibilities.     

Combining transarterial chemoembolization with radiofrequency ablation for hepatocellular carcinoma

The aim of this study was to compare the effectiveness of combination of radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) with that of RFA alone in patients with hepatocellular carcinoma (HCC). All possible trials comparing RFA plus TACE with RFA alone for HCC were included into this meta-analysis. We estimated the summary odds ratio (OR) with its 95 % confidence interval (95 % CI) to assess the effects. Nineteen eligible studies matched the selection criteria, including 1,728 patients. Meta-analysis showed that the combination of TACE and RFA (OR_1 year?=?2.14, 95 % CI?=?1.57–2.91, P?<?0.001; OR_3 years?=?1.98, 95 % CI?=?1.28–3.07, P?=?0.001; OR_5 years?=?2.70, 95 % CI?=?1.42–5.14, P?=?0.003) were associated with higher survival rates. No evidence of publication bias was observed. High-quality evidence suggests that TACE plus RFA improve the survival rates compared with RFA alone for patients with HCC.     

甲状腺球蛋白抗体对甲状腺乳头状癌131I清甲疗效的影响

背景与目的：甲状腺球蛋白抗体(thyroglobulin antibody,TgAb)在甲状腺乳头状癌(papillary thyroid carcinoma,PTC)中较为常见。该研究旨在探讨PTC患者术后TgAb对¹³¹I清甲疗效的影响。方法：纳入329例非远处转移性PTC患者,根据¹³¹I清甲前TgAb水平分为G1组(大于115 U/mL,n=84)和G2组(<115 U/mL,n=245),G2组再以40 U/mL为界分为S1(大于40 U/mL,n=31)和S2(小于40 U/mL,n=214)两个亚组,中位随访时间24个月,比较两组患者清甲疗效并分析其影响因素,观察¹³¹I清甲剂量对患者疗效的影响。结果：G1组女性居多,年龄更小(P=0.000,P=0.004),其余临床病理基线资料差异均无统计学意义(P均>0.05)。G1组清甲成功率为35.7%,G2组为72.7%,差异有统计学意义(P=0.000);S1和S2两个亚组清甲成功率分别为54.8%和75.2%,差异有统计学意义(P=0.017);G1组高、低剂量¹³¹I清甲后成功率分别为34.1%、37.2%,与G2组的71.9%、73.2%差异均有统计学意义(P均=0.000);G1组与G2组内分别采用低剂量¹³¹I与高剂量¹³¹I清甲的成功率差异均无统计学意义(P均>0.05)。多因素分析显示,清甲疗效仅与清甲前TgAb值有关(P=0.018)。结论：TgAb可以影响PTC患者的¹³¹I清甲疗效,TgAb越高者清甲疗效越差。增加¹³¹I治疗剂量未能进一步提高患者的清甲成功率。     

The encapsulated papillary carcinoma of the thyroid. A morphologic subtype of the papillary thyroid carcinoma

Of a total of 182 papillary neoplasms, 25 lesions (average size, 3.1 cm) were classified on cytologic and histologic grounds as being encapsulated carcinomas. In eight of these tumors (32.2%) cervical lymph node metastasis and/or intraglandular lymphatic spread was observed. It was not possible to separate on histologic grounds those that did metastasize from those that did not. The excellent prognosis for the encapsulated variant of papillary thyroid carcinoma was confirmed by a long follow-up period in which no evidence of recurrences or further metastasis was registered as compared with the time of initial diagnosis, whatever the mode of therapy. On the basis of these findings, the encapsulated papillary carcinoma can be regarded as an early or slowly growing form of the papillary thyroid carcinoma.     

甲状腺乳头状癌声像图特征探讨

目的:评价甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的声像图特点。方法:回顾性分析34例经手术和病理证实的PTC彩色多普勒超声图像特点。结果:32例(94.1%)低回声,30例(88.2%)结节纵/横≥1,26例(76.5%)伴细微钙化,23例(67.6%)毛剌边缘,29例(85.3%)结节单发,20例(58.8%)边界不清晰,14例(41.2%)侧后方声影,6例(17.6%)检出血流信号,8例(23.5%)颈淋巴结肿大。出现上述异常声像图特征2项以上者占73.5%(25/34)。结论:低回声、微钙化、纵/横≥1、边界、毛剌是PTC具有特征性的超声表现。     

Inherited aspects of papillary thyroid carcinoma

The presence of papillary carcinoma of the thyroid in multiple generations of one kindred is a statistical impossibility as an occurrence of chance. However, traditional and molecular genetic analyses to date have failed to support the notion of a single gene mutation or identify one, in distinct contrast to medullary carcinoma of the thyroid. Findings to date, outside of distinct multicancer syndromes, suggest the interplay of inherited susceptibility and other factors, such as environmental exposures. It is possible that the main identifiable genetic risk factors at this time are the presence of multinodular goiter or Hashimoto's thyroiditis within the family.     

BRAF mutation in papillary thyroid carcinoma

The BRAF gene has been found to be activated by mutation in human cancers, predominantly in malignant melanoma. We tested 476 primary tumors, including 214 lung, 126 head and neck, 54 thyroid, 27 bladder, 38 cervical, and 17 prostate cancers, for the BRAF T1796A mutation by polymerase chain reaction (PCR)-restriction enzyme analysis of BRAF exon 15. In 24 (69%) of the 35 papillary thyroid carcinomas examined, we found a missense thymine (T)-->adenine (A) transversion at nucleotide 1796 in the BRAF gene (T1796A). The T1796A mutation was detected in four lung cancers and in six head and neck cancers but not in bladder, cervical, or prostate cancers. Our data suggest that activating BRAF mutations may be an important event in the development of papillary thyroid cancer.     

Familial occurrence of papillary thyroid carcinoma

The occurrence of familial medullary carcinoma in the thyroid is a well-known entity, but cases of familial papillary carcinoma have been rarely reported. A case of thyroid papillary carcinoma which occurred almost synchronously in a mother and her two daughters is presented. No significant difference between familial and nonfamilial papillary carcinoma was noted in clinical, histopathological and chemical findings. The pedigree of our case is considered to show autosomal dominant inheritance.