甲状腺8例微小乳头状癌的病理分析

目的探讨甲状腺微小乳头状癌临床病理特征。方法对经手术切除的甲状腺疾病标本进行病理检查,复习资料,筛选出甲状腺微小乳头状癌病例8例,应用显微镜观察其形态以及特点。结果女5例,男3例,年龄40岁左右。形态特征：癌灶呈结节状或纤维瘢痕状,灰白色,界限不清,质硬,大小约为0．2～1．0cm,瘤细胞呈乳头状结构,毛玻璃状核、核内包涵体、核沟,纤维性间质反应或砂粒体。结论甲状腺乳头状微小癌为乳头状癌变型的特殊表现形式,常与其它良性疾病伴发,需在外检时细致、系统地多取材,仔细阅片,以免造成漏诊,引起医疗纠纷。     

65例甲状腺微小癌的临床病理特点

目的分析甲状腺微小癌的临床病理特征和预后,探讨诊断要点及手术切除范围。方法回顾分析65例甲状腺微小癌的临床病理资料。结果甲状腺微小癌的发病率占同期甲状腺癌的17．2％,本组47(72．3％)例是在甲状腺良性痛变中发现的,18(27．7％)例是在颈淋巴结转移后,进一步复查甲状腺才发现的。组织类型以乳头状腺癌为主,女性多发,男女比为1：7．1。结论甲状腺微小癌以单发癌结节为主,带瘤生存期最长,多数在甲状腺良性病变手术时或术后偶然发现,属低度恶性肿瘤,如第一次手术范围适当预后良好。     

常规超声联合超声造影诊断甲状腺微小乳头状癌的价值分析

目的 探讨常规超声联合超声造影诊断对甲状腺微小乳头状癌的诊断价值.方法 选取86例疑似甲状腺微小乳头状癌患者作为研究对象,均进行常规超声联合超声造影诊断及病理诊断,比较常规超声联合超声造影诊断和病理诊断的检出情况,以病理诊断为金标准,分析常规超声联合超声造影的诊断结果,并分析其影像学表现.结果 86例疑似甲状腺微小乳头...     

Surgical treatment of differentiated microcarcinomas of the thyroid

Thyroid microcarcinomas (TMC) are histologically malignant diseases, despite their limited dimensions and non-aggressive behaviour; frequent multifocality of the disease and local recurrence is really possible after conservative resection. Modern therapeutic approaches to thyroid microcarcinoma include both radical surgical treatment, influenced by the frequent locoregional diffusion of TMC, consisting of a total thyroidectomy with an eventual central and/or functional unilateral lymphadenectomy, depending on the clinical evidence of lymh node metastases and conservative treatment based on more limited resections which take into account the slow clinical progression of this type of tumour. The aim of our work is to examine the therapeutic guidelines for surgical treatment of TMC which, in our experience, are closely dependent on clinical presentation type. From 1991 to 2000, more than 400 patients with thyroid disease were referred to the Department of Surgical Science and Applied Medical Technologies "F. Durante". Threehundred-seventythree patients received surgical treatment: in 311 patients a benign disease was diagnosed, while in 62 neoplasia was present. In total we observed 30 TMC, consisting of 28 papillary and 2 follicular microcarcinomas. On the basis of clinical presentation we divided patients in three groups: A--patients with a clinically suspicious neoplastic lesion before surgical treatment; B--patients in whom histological diagnosis of cancer was "incidental" after an operation performed for benign disease; C--patients in whom a neck lymph node metastases were clinically found before diagnosis of an "occult" papillary carcinoma in the thyroid gland. 27 total thyroidectomies and 3 conservative resections, that required successive total exeresis, were performed. In 5 cases a central neck lymph node dissection was carried out and in 5 + 1 cases functional modified lateral neck dissections was deemed necessary. Our data suggest that an evaluation of tumor's malignancy cannot be carried out on the basis of its dimensions alone. Indeed, biological aggressivity, whether local or at a distance, is a prerogative of both large and small tumours. Therefore a microcarcinoma must be considered a full-blown form of thyroid cancer and as such must be treated. Total thyroidectomy may be followed by identification of possible local metastases. "Whole body" scintigraphy allows to identify and treat with radioiodine therapy, possible recurrent lesions. Therefore in conclusion, total resection is not only a useful, but also a necessary treatment for the correct diagnostic and therapeutic follow-up of these patients.     

甲状腺微小癌的诊治

目的 探讨甲状腺微小癌诊断和外科治疗的经验。方法 对诊断明确的31例甲状腺微小癌进行回顾性分析。结果 31例均于术中冰冻和术后病理检查确诊。乳头状腺癌26例，滤泡性腺癌5例。伴颈淋巴结转移2例。20例合并甲状腺良性疾病。31例中4例术后无瘤生存时间≥10年，13例术后无瘤生存时间≥5年。结论 甲状腺微小癌术前不易诊断，对甲状腺良性疾病手术时应仔细，对可凝结节行冰冻切片，术后常规连续病理切片以提高发现率。首次手术应行患侧腺叶切除术，有淋巴结转移再行改良颈淋巴结清扫术仍可取得较好疗效。     

Appropriate treatment for asymptomatic papillary microcarcinoma of the thyroid

Since the 1990 s, asymptomatic papillary microcarcinoma (PMC), papillary carcinoma measuring or= 30 years of age and most of these patients had lesions measuring 相似文献   

EZH2和P16基因在甲状腺乳头状癌中表达的临床意义

目的研究EZH2和P16蛋白在甲状腺癌组织中的表达及意义。方法应用免疫组化SP法对甲状腺乳头癌50例和甲状腺瘤20例进行EZH2和P16检测。结果 EZH2在甲状腺癌的阳性表达率高于甲状腺瘤组织（48.0%与20.0%,P〈0.05）,P16在甲状腺癌组织中的表达率低于甲状腺瘤组织（42.0%与75.0%,P〈0.05）,EZH2和P16的表达与转移、复发有关（P〈0.05）,与性别、年龄、肿瘤大小、临床分期无关（P〉0.05）。结论 EZH2和P16可能参与了甲状腺癌的发生和发展,对甲状腺癌的进展监测、预后评估有一定临床应用价值。     

家族性甲状腺乳头状微小癌8例分析

目的总结家族性甲状腺乳头状微小癌（PTMC）的临床特征和诊治方法。方法分析经手术和病理学检查证实的8例家族性甲状腺乳头状微小癌临床资料。结果8例患者随访时间9～13个月,平均10．8个月。无复发及死亡,未发现远处转移。因甲状腺良性病变手术而发现微小癌2例,另6例术前怀疑为甲状腺癌,经病理证实为微小癌。颈部淋巴结转移2例均发生于颈深上组淋巴结。腺叶多发结节2例均发生颈部淋巴结转移,单发结节6例未发生颈部淋巴结转移。2例先期手术后,亲属中11人行常规甲状腺彩色超声检查,6例发现甲状腺结节,经手术和病理证实均为甲状腺乳头状微小癌。结论PTMC多数在良性结节术中或术后病理检查发现,家族性发病罕见。术前触诊、彩色超声检查、术中探查及冰冻组织切片对提高甲状腺乳头状微小癌的诊断非常重要。对甲状腺肿瘤高发区患者亲属进行筛查有助于早期发现肿瘤。患侧腺叶切除术作为常规术式可以避免二次手术。     

甲状腺微小乳头状癌的高频超声特征与临床病理学特点的关系

目的 分析甲状腺微小乳头状癌的高频超声特征和病理学特点.方法 回顾性分析经手术病理检查确诊的89例甲状腺微小乳头状癌患者的超声诊断特征,并将超声结果与病理诊断结果进行比对.结果 高频超声检查提示为甲状腺微小乳头状癌超声诊断符合率为94.4％.主要集中在40～59岁,其中Ⅰ型血流8例,Ⅱ型血流16例,Ⅲ型血流65例,L/T（纵横比）≥1有83例.结论 甲状腺微小乳头癌不同的病理特征决定了不同的超声图像,多普勒高频彩超鉴别和诊断甲状腺微小乳头癌具有准确率高、操作方便、费用低等优点,值得在临床推广应用.     

滤泡型甲状腺乳头状癌的临床诊断及分子生物学研究进展

滤泡型甲状腺乳头状癌（follicular variant of papillary thyroid carcinoma, FVPTC)是甲状腺乳头状癌(papillary thyroid carcinoma, PTC)中常见的亚型。FVPTC又可分为包膜型FVPTC和非包膜型FVPTC，不同分型的FVPTC的临床表现及分子生物学特性各不相同，如包膜型FVPTC的临床表现类似于滤泡型甲状腺瘤或滤泡型甲状腺癌，而非包膜型FVPTC类似于经典型甲状腺乳头状癌。由于FVPTC特殊的病理特点，术前超声、细针吸引细胞学检查及术中冰冻切片检查均难确诊，目前对其诊断及分型主要依靠术后病理切片的HE染色，结合基因检测将有助于诊断。然而，学术界对FVPTC的临床表现、分子生物学特性以及治疗方案的观点尚不统一。因此，对FVPTC有待深入研究，并制定科学合理的精准化治疗方案。     

甲状腺微小乳头状癌淋巴结转移规律及手术方式的临床研究

目的 探讨甲状腺微小乳头状癌淋巴结转移规律及合理的手术方式.方法 回顾性分析我院130例甲状腺微小乳头状癌患者的临床及病理资料.结果 130例均经病理证实,单侧108例,双侧22例,中央组淋巴结转移37例(28.5%),颈侧区淋巴结转移17例(13.1%).结论 甲状腺微小乳头状癌具有多灶性特点,故初次手术应该行甲状腺全切或次全切除、中央组淋巴结清扫,并根据术前超声、其他影像学资料及术中探查情况行颈侧区淋巴结清扫.

Abstract：

Objective To evaluate the regularity of papillary thyroid microcarcinoma lymph node metastasis and rational surgical methods. Methods The clinical and pathological data of 130 cases of thyroid papillary microcarcinoma were retrospectively reviewed. Results Totally 130 cases were all confirmed by pathology, including 108 cases of unilateral lesions, 22 cases of bilateral lesions. 37 cases (28.5%) had central lymph node metastasis, 17 cases ( 13.1 ) % occurred lateral of neck lymphatic metastasis. Conclusions Papillary thyroid microcarcinoma is often multifocal, so the initial surgery should be thyroidectomy or subtotal resection and central lymph node dissection should be done, Wheather to perform the lateral neck lymph node dissection or not should be based on preoperative ultrasound and other imaging data and inrtaoperativcly exploration.     

Metastatic thyroid carcinoma

Although metastases to the thyroid gland are common in autopsy studies, clinically significant metastases are rare. A 58-year-old Turkish patient, presenting with thyroid metastasis 2 years after undergoing left nephrectomy for renal cell carcinoma, is reported in this case report. Thyroid metastasis can be the initial presentation of renal cell carcinoma, or it may occur a long time after nephrectomy, which can lead to misdiagnosis of primary thyroid neoplasm. Radiographic features are not useful in making discrimination between the two, however a fine needle aspiration biopsy can be useful. The role of surgical therapy is controversial.     

New molecular targeted therapies in thyroid cancer

Carcinoma of the thyroid gland is the most common malignancy of the endocrine system. Differentiated tumors are often curable with surgical resection and radioactive iodine. A small percentage of such patients, however, do not undergo remission and need new therapeutic approaches. Both anaplastic and medullary thyroid carcinomas exhibit aggressive behavior and are usually resistant to current therapeutic modalities. Thyroid carcinoma represents a fascinating model and a particularly promising paradigm for targeted therapy because some of the key oncogenic events are activating mutations of genes coding for tyrosine kinases, and these occur early in cancer development. A prototype is the RET proto-oncogene, a receptor tyrosine kinase, which is a key regulator of development and a 'hotspot' for oncogenic mutations. Mutations in the RET proto-oncogene have been identified as causative for papillary carcinoma and familial medullary thyroid carcinoma, making it an attractive target for selective inhibition in these subtypes. ZD 6474 has shown promising activity in preclinical models against RET kinase, and its contemporary inhibition of vascular endothelial growth factor and epidermal growth factor pathways renders it a very attractive drug for clinical trials in thyroid cancer. Activating point mutation of B-RAF can occur early in the development of papillary carcinoma. Moreover, papillary carcinomas with these mutations have more aggressive properties and are diagnosed more often at an advanced stage. Clinical evaluation of B-RAF-targeting drugs is undergoing and trials in thyroid cancer are planned. Agents that restore radioiodine uptake, such as histone deacetylase inhibitors and retinoids, represent another exciting field in new drug development in thyroid cancer.     

Appropriate treatment for asymptomatic papillary microcarcinoma of the thyroid

Since the 1990s, asymptomatic papillary microcarcinoma (PMC), papillary carcinoma measuring ≤ 1.0 cm, has frequently been detected using ultrasonographic screening and diagnosed by ultrasonography-guided fineneedle aspiration biopsy. Thyroid carcinoma was detected in 3.5% of otherwise healthy women aged ≥ 30 years of age and most of these patients had lesions measuring ≤ 1.5 cm in diameter, which is not discrepant with previous autopsy findings that latent PMC showed a high incidence. A recent observation trial showed that only 6.7% of low-risk PMC definitely became enlarged during 5 years of follow up, indicating that observation is an attractive alternative to surgery for PMC. However, PMC with clinically apparent metastasis detected on imaging is likely to show a recurrence to the lymph node and careful neck dissection as well as total thyroidectomy may be required. If surgical treatment is performed for low-risk PMC, prophylactic modified radical neck dissection is not necessary and lobectomy (with isthmectomy) and central node dissection is adequate if the tumor is located only in one lobe.     

Ki-67、XIAP在甲状腺乳头状癌中的表达及相互关系

目的探讨细胞核增殖抗原Ki-67与X连锁凋亡抑制蛋白（XIAP）在甲状腺乳头状癌中的表达及相互关系。方法应用免疫组织化学法（S-P法）检测35例甲状腺乳头状癌,28例甲状腺腺瘤组织中ki-67和XIAP的表达情况。结果 Ki-67、XIAP在甲状腺乳头状癌中的阳性率分别为65.71%和4.29%,与甲状腺腺瘤比较差异有统计学意义（P〈0.05）,但两者之间无相关关系（rs=0.0865,P〉.05）。Ki-67在甲状腺乳头状癌组织中的表达与性别、年龄、肿瘤大小、结节数量无关（P〉0.05）。XIAP的表达女性高于男性（P〈0.05）。结论 Ki-67,XIAP在甲状腺乳头状癌中的表达增高,但两者间无相关关系。     

多灶性甲状腺微小乳头状癌临床病理特征分析及中央区淋巴结清扫的意义

目的 探讨多灶性甲状腺微小乳头状癌临床病理特征及中央区淋巴结清扫的意义.方法 分析浙江大学附属第一医院胃肠甲状腺乳腺外科2011年1月～2012年6月收治的40例行甲状腺全切或近全切除及预防性中央区淋巴结清扫的多灶性甲状腺微小乳头状癌的临床病理学资料及手术相关并发症.结果 40例患者中女性27例,平均年龄46.2岁,原发肿瘤平均直径7 mm,25例（62.5%）为双侧微小癌,11例（27.5%）原发肿瘤侵出甲状腺包膜,21例（52.5%）存在中央区淋巴结转移;术后3例（7.5%）出现低钙血症表现,2例（5.0%）出现声音嘶哑,术后3～6个月均恢复正常.结论 多灶性甲状腺微小乳头状癌的侵袭性较高,因其有较高的中央区淋巴结转移率,建议行中央区淋巴结清扫.     

上皮钙粘附蛋白在甲状腺乳头状癌中的表达与血清TSH浓度相关性的临床研究

目的研究甲状腺乳头状癌中上皮钙粘附蛋白（E-cadherin）的表达与血清TSH浓度的相关性,探讨E-cadherin在甲状腺乳头状癌中的作用及E-cadherin与血清TSH浓度在甲状腺乳头状癌中的相互作用。方法回顾性分析30例甲状腺乳头状癌患者血清TSH浓度,手术切除标本病理切片免疫组化染色后E-cadherin的表达情况。结果（1）E-cadherin在不同性别、年龄、肿瘤大小的甲状腺乳头状癌患者之间的阳性表达率差异无显著性（P〉0.05）;（2）E-cadherin阳性表达率与血清TSH浓度1组（rs=0.287,P〈0.05）、2组（rs=0.298,P〈0.05）、3组（rs=0.474,P〈0.05）均呈正相关,且E-cadherin的阳性表达率随着血清TSH浓度升高而增加。结论甲状腺乳头状癌组织中E-cadherin的表达阳性率与血清TSH浓度之间存在正相关,血清TSH可增进E-cadherin在甲状腺乳头状癌中的表达。探讨二者在甲状腺乳头状癌中的作用与相互关系,对甲状腺乳头状癌患者的治疗及预后判断有深远的意义。     

甲状腺微小乳头状癌的超声诊断及临床价值分析

目的探讨甲状腺微小乳头状癌的超声诊断意义及分析其临床价值。方法应用彩色多普勒高频超声,与病理诊断结果对照分析甲状腺肿瘤患者48例。结果直径≤1cm的甲状腺微小乳头状癌14例,其他类型如甲状腺腺瘤34例。经过高频彩色多普勒超声高分辨地显示出肿瘤的外部形态及其内部回声情况,两组结节的包膜、周围声晕、后方衰减及其内部微小钙化差异均有统计学意义（P〈0.05）。结论边缘粗糙毛刺状、形态不规则、结节内部存在微小钙化灶等3个重要特征,是甲状腺微小乳头状癌诊断的重要指标,彩色多普勒高频超声对鉴别甲状腺微小乳头癌与其他类型肿瘤具有很高的临床价值。     

甲状腺癌外科治疗及预后因素的研究

目的探讨甲状腺癌的临床病理特点、诊断和治疗,为进一步提高临床治疗效果提供新的资料和思路。方法回顾性分析1998年1月-2008年12月本医院外科手术治疗并病理确诊的344例甲状腺癌的临床资料,随访11个月～12年,所得数据使用SPSS13.0统计软件包进行分析,P〈0.05为差异具有统计学意义。结果本组资料统计结果显示344名患者中,男女发病比为1：2.8,存在明显差异。平均发病年龄为39.4岁,发病高峰年龄段在21～40岁之间。肿瘤组织分类中,以分化型甲状腺癌为主,占89.0%,其中乳头状癌占82.0%。甲状腺全切除组与甲状腺非全切除组相比,手术并发症较高,差异有显著性（P〈0.05）,而术后复发、颈淋巴结转移差异无显著性（P〉0.05）。甲状腺癌再次手术与初次手术相比,术后并发症、复发以及颈淋巴结转移均差异无显著性。结论手术切除是甲状腺癌的主要治疗方法,手术方式应根据病变性质、TNM分期及病人情况而采取个体化方案;影响甲状腺癌预后的因素有：性别、年龄、肿瘤大小、侵犯甲状腺外膜、临床病理分期。     

桥本甲状腺炎合并甲状腺癌

目的 探讨桥本甲状腺炎合并甲状腺癌的临床病理特点及两者的关系.方法 对48例桥本甲状腺炎和其中9例合并甲状腺癌的临床病理资料进行回顾性分析.结果 桥本甲状腺炎合并甲状腺癌的平均发病年龄45.2岁,女性多于男性.48例桥本甲状腺炎中9例合并甲状腺癌,且均为乳头状癌,占桥本甲状腺炎的18.8%,其中微小乳头状癌5例,经典型2例,滤泡型1例,嗜酸细胞型1例.癌旁甲状腺组织内多数可见滤泡上皮增生、乳头状增生、不典型增生至癌变的移行状态.其癌组织的镜下形态学表现与单纯甲状腺乳头状癌相似.结论 桥本甲状腺炎合并甲状腺癌发生率高,两者关系密切,好发于中年女性,多无临床症状.桥本甲状腺炎是一种具有恶性潜能的病变,应引起高度重视,并仔细检查.