儿童甲状腺乳头状癌临床分析及肺转移风险因素讨论

目的 探讨分析儿童甲状腺乳头状癌临床特征及肺转移风险因素以指导临床工作.方法 收集2005-2016年郑州大学第一附属医院甲状腺外科收治的14岁以下首次行手术治疗并经过术后常规病理证实为甲状腺乳头状癌患者资料40例,将有关头颈部恶性肿瘤或淋巴瘤病史、继发性甲状腺癌、甲状腺功能亢进合并甲状腺乳头状癌,病例资料不完整的病例排除.40例患儿年龄3 ～ 14岁,其中男12例,女28例.最大肿瘤直径7.5 cm,最小肿瘤直径0.3 cm.肿瘤病灶单发22例,多发18例.肿瘤合并颈部淋巴结转移33例,无颈部淋巴结转移7例.肿瘤合并肺转移10例,无肺转移30例.采用x2检验和Logistic回归分析儿童甲状腺乳头状癌患者年龄、性别、肿瘤直径、病灶数、手术方式、颈部淋巴结转移等临床特征及肺转移相关风险因素.结果 儿童甲状腺乳头状癌肺转移的阳性率为25.0％(10/40),统计分析发现:肿瘤合并肺转移患儿阳性率在多发病灶数(x2=8.620,P=0.003)、肿瘤直径≥2 cm(x2=5.763,P=0.016)中较高且差异有统计学意义,经Logistic回归分析示:多病灶数是儿童甲状腺乳头状癌肺转移的危险因素(OR:13.058,P=0.028).结论 较高的肺转移率为儿童甲状腺乳头状癌的临床特征,对于多病灶的甲状腺乳头状癌患儿,肺转移风险明显增高.     

甲状腺乳头状癌肾上腺转移1例报告并文献复习

背景与目的：甲状腺乳头状癌约是化型甲状腺癌最常见的病理类型,预后良好,但一旦发生远处转移,预后便会明显变差。常见的远处转移部位主要是肺和骨,转移至神经,肝脏,胰腺,肾上腺等器官的病例则少见。本文通过报告1例甲状腺乳头状癌合并肾上腺转移患者的诊治,并结合相关文献分析讨论,以期加强对甲状腺乳头状癌患者少见部位转移的认识,避免漏诊和误诊。 方法：回顾性分析1例合并左侧肾上腺转移的甲状腺乳头状癌患者的临床资料,并复习相关文献。 结果：本病例54岁男性患者,2018年因甲状腺细针穿刺细胞学检查证实的双侧甲状腺乳头状癌行双侧甲状腺全部切除术+颈淋巴结清扫术,1年后年度体检CT证实左侧肾上腺肿块,行左侧肾上腺肿块切除术,术后病理证实为转移性甲状腺乳头状癌合并肾上腺腺瘤。 结论：甲状腺乳头状癌远处转移尤其肾上腺转移少见,但是由于远处转移对患者预后明显不利,因此对于甲状腺乳头状癌患者进行终生随访监测是有必要的,监测手段包括CT、MRI等,也包括甲状腺癌特殊监测手段如甲状腺球蛋白、I131全身显像、I131 SPECT/CT等,一旦发现肿瘤样病变时,应仔细鉴别其良恶性以指导进一步治疗。     

选择性中央区淋巴结清扫治疗cNO甲状腺乳头状癌的临床价值

目的探讨选择性中央区淋巴结清扫术在临床颈淋巴结阴性（cN0）的甲状腺乳头状癌患者中的治疗价值。方法回顾性分析中国医科大学附属第一医院2007年1月至2011年12月期间收治的326例cN0甲状腺乳头状癌患者的临床资料,并对影响中央区淋巴结转移的相关因素进行分析。结果本组326例cN0甲状腺乳头状癌患者的中央区淋巴结转移率为35．89％（117／326）。年龄在〈45岁、肿瘤直径〉1cm及原发灶浸润包膜的cN0甲状腺乳头状癌患者的淋巴结转移率明显高于年龄≥45岁、肿瘤直径≤1cm及原发灶未浸润包膜的oN0甲状腺乳头状癌患者（年龄：46．56％比28．72％,P=0．001;肿瘤直径：44．44％比26．45％,P=0．001;包膜浸润：50．00％比33．09％,P=0．020）。进一步的多因素分析显示,年龄〈45岁和肿瘤直径〉1cm是cN0甲状腺乳头状癌中央区淋巴结转移的独立危险因素（P〈0。05）。术后6例出现暂时性喉返神经损伤,18例并发暂时性甲状旁腺功能低下,4例出现暂时性喉上神经损伤,1例并发急性喉头水肿,无永久性喉神经损伤、甲状旁腺功能低下等并发症发生。术后266例（81．60％）获得随访,随访7～67个月（平均31．2个月）,有3例发生侧颈区淋巴结转移。结论cN0甲状腺乳头状癌行选择性中央区淋巴结清扫术是必要的、安全的处理方式,建议对cN0甲状腺乳头状癌常规行患侧中央区淋巴结清扫术,特别是年龄〈45岁和肿瘤直径〉1cm的cN0甲状腺乳头状癌患者。     

细针穿刺洗脱液测定甲状腺球蛋白鉴别转移淋巴结性质

目的:临床研究通过细针穿刺洗脱液测定甲状腺球蛋白水平鉴别甲状腺乳头状癌颈部淋巴结性质的可行性。方法:20例甲状腺乳头状癌伴明显颈部淋巴结转移的病人,术中对切除甲状腺和颈部淋巴结行直视下细针穿刺,对穿刺洗脱液行甲状腺球蛋白(Tg)的测定,并与病理检查结果比对。结果:甲状腺内乳头状癌病灶的穿刺洗脱液Tg值中位数为84.4(19.0～446.1)ng/mL,甲状腺良性组织的穿刺洗脱液Tg值中位数为133.4(16.0～558.3)ng/mL,两者比较无统计学差异。直径>1 cm的转移性淋巴结穿刺洗脱液Tg值中位数为78.0(14.9～1000.0)ng/mL,显著高于直径>1 cm的反应性增生淋巴结穿刺洗脱液Tg值[0.1(0.1～1.3)ng/mL]。直径1 cm的穿刺洗脱液Tg值明显高于直径     

甲状腺微小乳头状癌中央区淋巴结转移的危险因素分析

探讨甲状腺微小乳头状癌(PTMC)颈部中央区淋巴结转移的危险因素。回顾分析手术治疗的56例甲状腺微小乳头状癌患者的临床病理资料,分析中央区淋巴结转移的危险因素。结果显示,患者中央区淋巴结转移率为57.1%(32/56),单因素和多因素分析发现,性别、年龄、肿瘤直径、多灶性、包膜侵犯是淋巴结转移的危险因素(P0.05),肿瘤位置、是否合并桥本甲状腺炎与中央区淋巴结转移无关(P0.05)。结果表明,对于有高危因素的甲状腺微小乳头状癌患者应行预防性中央区淋巴结清扫。     

甲状腺乳头状癌中央组淋巴结清扫术173例临床分析

目的探讨甲状腺乳头状癌（PTC）患者行中央组淋巴结清扫术（CLND）的指征。 方法回顾性分析2013年1月至2015年2月上海市第一人民医院南院乳腺甲状腺血管外科173例行CLND的PTC患者的临床病理资料。 结果本组PTC患者中央组淋巴结转移（CLNMs）发生率为46.8%（81/173）,无一例发生CLND相关并发症。年龄、颈侧区淋巴结肿大及肿瘤大小与CLNMs有关。其中肿瘤直径≥0.25 cm的CLNMs发生率为48.5%（81/167）,而<0.25 cm的6例无一例发生CLNMs,且肿瘤直径0.25~0.49 cm的PTC患者中CLNMs占32.4%（12/37）。 结论CLND是安全的,对于PTC患者应行预防性CLND。未行CLND术后病理发现的PTC,若肿瘤直径≥0.25 cm的应二次手术行CLND。     

中央区淋巴结清扫在cN0期甲状腺乳头状癌中的应用

目的 观察不同临床特点cN0期甲状腺乳头状癌患者的中央区淋巴结转移情况,探讨预防性中央区淋巴结清扫术的应用指征及手术范围。方法 回顾性分析2015年3月至2016年12月期间我院收治的93例甲状腺乳头状癌患者的病历及病理资料。分析患者性别、年龄、肿瘤大小、是否为多灶癌、肿瘤是否累及被膜等因素与中央区淋巴结转移率的关系。所有病例均行甲状腺全切除或近全切除术+患侧中央区淋巴结清扫术,并将患侧中央区标本送冰冻及石蜡病理检查,后再行对侧中央区淋巴结清扫术。观察中央区淋巴结转移情况及患侧中央区淋巴结冰冻与石蜡病理检查符合情况。结果 本组病例男性18例,女性75例;平均年龄41±13.9岁。T165例,T218例,T310例,T40例;单侧多灶癌8例;肿瘤突破甲状腺包膜9例。本组中央区淋巴结转移率为46.2%（43/93）,18.2%（17/93）为双侧中央区淋巴结转移。性别、肿瘤位置、年龄、肿瘤直径、T分期等因素与CLN转移差异无统计学意义。患侧中央区淋巴结冰冻病理检查的敏感性、特异性、准确性分别为86.0%、100%、93.5%。结论 对cN0期甲状腺乳头状癌应常规行患侧中央区淋巴结清扫术;术中冰冻检查能准确预测患侧中央区淋巴结转移状态;术中应常规行冰冻切片检查,如患侧中央区淋巴结转移时,建议行双侧中央区淋巴结清扫术。     

甲状腺乳头状癌前上纵隔淋巴结转移与临床病理因素相关性分析

目的：为探讨临床病理学因素与前上纵隔淋巴结转移的相关性,从而进一步探讨甲状腺癌颈淋巴结清扫手术中同期前上纵隔淋巴结清扫的临床意义。 方法：纳入54例甲状腺乳头状癌患者,在做颈淋巴结清扫的过程中,同时行前上纵隔淋巴结清扫取样进行临床研究,比较其与性别、年龄、肿瘤的大小、多灶性、有无甲状腺外侵犯、有无淋巴血管侵犯,第6区淋巴结转移情况等临床病理因素的相关性。 结果：甲状腺乳头状癌患者的甲状腺肿瘤直径>4 cm、肿瘤有血管淋巴侵犯、6区淋巴结转移>3个,与前上纵隔淋巴结转移有关（P<0.05）,而与性别、年龄、多灶性、有无甲状腺外侵犯无关（P>0.05）。 结论：临床病理学因素与前上纵隔淋巴结转移具有关,甲状腺癌颈淋巴结清扫手术中同期前上纵隔淋巴结清扫对治疗甲状腺乳头状癌具有一定的临床意义。     

青少年甲状腺乳头状癌双颈淋巴结转移临床分析

目的探讨青少年甲状腺乳头状癌双颈转移患者的临床特点、治疗方法及预后。方法回顾性分析1970年1月1日至1985年12月31日收治的24例青少年甲状腺乳头状癌双颈淋巴结转移患者的临床资料。结果该组青少年患者占该科同期收治同年龄段甲状腺乳头状癌患者的34．8％（24／69）,随访时间均在20年以上,10年和20年生存率分别为100％和90．9％。局部肿瘤复发率20．8％（5／24）,肺转移率12．5％（3／24）。结论青少年甲状腺乳头状癌双颈淋巴结转移患者尽管有较高的复发率,但在根治性手术治疗的基础上,预后很好。     

甲状腺乳头状癌跳跃性颈侧区淋巴结转移的影响因素分析

目的:探讨甲状腺乳头状癌跳跃性颈侧区淋巴转移情况(颈侧区淋巴结转移而中央区淋巴结无转移)及其影响因素。方法:回顾2014年1月—2015年12月期间福建省立医院177例术后病理证实颈侧区淋巴转移的甲状腺乳头状癌患者资料(均为首次手术),分析患者临床病理特征与跳跃性颈侧区淋巴转移的关系以及跳跃性颈侧区淋巴转移的影响因素。结果:177例颈侧区淋巴转移的患者中发现29例(16.4%)跳跃性颈侧区淋巴转移。单因素分析结果显示,甲状腺乳头状癌跳跃性颈侧区淋巴转移与原发灶≤1 cm、肿瘤位置累及上极明显有关(χ~2=8.645,P=0.003;χ~2=4.267,P=0.039),与年龄、性别、病灶数、病灶分布、肿瘤侵犯、肿瘤分期、是否合并桥本病无关(均P0.05);跳跃性颈侧区淋巴转移患者中央区及颈侧区的淋巴结检出个数及转移个数均较非跳跃性颈侧区淋巴转移患者少(均P0.05)。Logistic回归分析结果显示,原发灶≤1 cm(OR=3.499,95%CI=1.509~8.110,P=0.004)与肿瘤累及上极(OR=0.397,95%CI=0.171~0.924,P=0.032)均为甲状腺乳头状癌跳跃性颈侧区淋巴转移独立的影响因素。结论:肿瘤直径≤1 cm、累及上极是甲状腺乳头状癌跳跃性颈侧区淋巴转移的独立影响因素。     

肺癌跳跃式纵隔淋巴结转移的临床病理探讨

目的　探索肺癌跳跃式纵隔淋巴结转移的病理特点 ,为合理施行淋巴结清除术提供可靠的理论依据。方法　 1992年 10月至 1998年 6月 ,为 398例肺癌病人施行了根治性肺切除、规范淋巴结清除术 ,对其中 4 7例 ( 2 9 4 % )跳跃式纵隔转移淋巴结病例进行病理学研究。结果　各型或各叶肺癌中 ,跳跃式转移淋巴结分布最密集的部位依次是第 7、4、3、5组淋巴结 ,分别占 2 9 8%、2 4 5 %、14 9%与10 6 % ;就鳞癌与腺癌而言 ,肿瘤长径在 1cm以内者均无跳跃式淋巴结转移 ,跳跃式淋巴结转移率随长径增加而增加 ;低分化腺癌淋巴结转移率明显高于高分化者 (P <0 0 1) ;发生跳跃式淋巴结转移的肿瘤平均长径鳞癌与腺癌分别为 15 3mm与 9 1mm。结论　对肺癌淋巴结的廓清 ,切勿仅凭手触摸或靠肉眼观察淋巴结大小而盲目判定其是否转移或清除。除T1 中肿瘤长径 <1cm的鳞癌外 ,淋巴结的规范清除应重视其跳跃性 ,原则上必须包括同侧胸腔的肺门及上、下纵隔各组淋巴结 ,尤其要重视跳跃式淋巴结转移分布较密集区域 ,即右侧的第 3、4、7组与左侧的第 4、5、7组淋巴结     

Beclin 1 is Highly Expressed in Papillary Thyroid Carcinoma and Correlates with Lymph Node Metastasis

Background : Autophagy is believed to be important in tumorigenesis and tumor progression. The human beclin-1 gene, a key regulator of autophagy formation, located on chromosome 17q21, has been identified as the mammalian orthologue of Atg6 (autophagy-related gene) and may be a haploinsufficient tumor suppressor gene. Loss of expression or point mutation could serve as a mechanism of loss of beclin-1 tumor suppressor function in cancers. However, our recent study revealed that point mutation of the beclin-1 gene is a rare event in papillary thyroid carcinoma (PTC).

Methods : We investigated the expression of beclin-1 in human PTC. Tissue samples from 86 cases of papillary thyroid carcinoma were used for the present study. 57 cases of papillary thyroid carcinoma were with lymph node metastasis. The expression of beclin-1 in tumor, normal tissue adjacent to tumor, distant normal tissue, metastatic lymph node and normal lymph node was examined with immunohistochemistry. The beclin-1 expression between tumor and normal tissue, metastatic and normal lymph node was also analyzed.

Results : The expression of beclin-1 was detected in 88.4% (76/86) of the tumors and 98.2% (56/57) of metastatic lymph nodes. In contrast, normal tissues adjacent to tumor, distant normal tissues and normal lymph nodes showed no or very weak expression of beclin-1. Beclin-1 was significantly correlated with tumorigenesis and lymph node metastasis in human PTC.

Conclusions : High expression of beclin-1 in PTC and metastatic lymph node suggest that neo-expression of beclin-1 may play a role in tumorigenesis and lymph node metastasis in human PTC.     

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??Risk factors of central lymph node metastasis of papillary thyroid carcinoma?? A single-center retrospective analysis of 3273 cases LIU Wen, CHENG Ruo-chuan, SU Yan-jun, et al. Department of Thyroid Surgery, the First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
Corresponding author??CHENG Ruo-chuan, E-mail:cruochuan@foxmail.com
Abstract Objective To investigate the clinicopathological features of papillary thyroid carcinoma ??PTC??and the risk factors of central lymph node metastasis ??CLNM??. Methods The clinicopathological features in PTC patients with complete case data admitted from January 2007 to June 2016 in the First Affiliated Hospital of Kunming Medical University were analyzed retrospectively. The risk factors of CLNM were analyzed by χ2 test and multivariate logistic regression model.Results The CLNM rate of PTC was 40.6% ??1331/3273??. On average?? 7.0 ??4.0??12.0??central lymph nodes were dissected?? and 3.70??±3.84??lymph nodes were proved to be metastatic. Univariate analysis showed that gender?? age?? tumor diameter?? extrathyroid extension?? multifocality?? concurrent nodular goiter?? initial symptoms and observation or not were related to CLNM??P??0.05??. Tumors located in the lower part of the thyroid ??41.6%??was the risk factor for CLNM ??P??0.001??, while multifocality was unrelated ??P=0.68??. The metastasis rate of bilateral multiple regions??51.3%???? unilateral multiple regions ??47.2%???? single region ??36.7%????P=0.003??. Multivariate logistic regression analysis showed that gender?? age?? tumor diameter?? extrathyroidal extension and observation were independent risk factors of CLNM. Conclusion Clinical and pathological features have certain predictive value for CLNM?? and can provide a reference for the treatment program of PTC patients.     

Retropharyngeal node metastasis from papillary thyroid carcinoma

BACKGROUND: Papillary thyroid carcinomas commonly metastasize to paratracheal and jugular lymph nodes. Metastasis to the retropharyngeal node is rare for this tumor. METHODS: Five patients underwent surgical treatment for metastasis of thyroid papillary carcinoma to the retropharyngeal lymph nodes that presented as a parapharyngeal or retropharyngeal mass. All patients had a history of total or subtotal thyroidectomy as their initial treatment. Among them, 3 patients had undergone ipsilateral modified radical neck dissection at their initial treatment. The other 2 patients had a history of bilateral or ipsilateral modified neck dissection for their subsequent cervical lymph node metastases. RESULTS: Metastatic retropharyngeal nodes were successfully resected via transcervical approach in all patients. Although aspiration and difficulty in swallowing were observed in 2 patients after surgical treatment for metastatic retropharyngeal nodes, these complications spontaneously resolved within a few months. CONCLUSIONS: This study suggests that neck dissection and/or metastatic cervical lymph nodes might alter the direction of lymphatic drainage to the retrograde fashion, resulting in the unusual metastasis to the retropharyngeal lymph nodes. Although the cases described here are rare, metastasis to the retropharyngeal node should be considered at the follow-up for thyroid papillary carcinoma. Because these metastases will be missed by routine ultrasonography of the neck, periodic CT scan or MRI is recommended for follow-up, especially for patients with a history of neck dissection.     

家族性甲状腺乳头状癌

目的：探索家族性甲状腺乳头状癌的临床特征,诊断标准和处理原则。方法：在随机的145例甲状腺乳头状癌患进行前瞻性的调查共发现家族性甲状腺乳头状癌有7个家族17例患者,其中14例患者为本院手术,3例外院手术,17例患者病例均经本院病理科证实,占同期的甲状腺乳头状癌的9．65％（14／145）,结果：本组年龄30－74岁,平均年龄45岁,原发灶大小0．8－2．8cm,平均1．7cm,单侧9例,双侧8例（47．5％）;3个家族同时有3例患病（42．8％）;有4个家族的成员患有甲状良性肿瘤和非肿瘤性甲状腺疾病,17例患者中伴有结节性甲状腺肿的10例,全甲状腺切除8例,腺叶加峡部切除9例,行甲状腺癌联合根治术的6例,14例有不同区域的淋巴结转移,占82．3％,（14／17）。结论：家族性甲状腺乳头状癌占甲状腺乳头状癌10％左右,双侧病变近50％,淋巴结转移率高,处理基本同于散发性甲状腺乳头状癌,但是,患病家族成员应长期随访。     

Clinical Significance of P53 Protein Expression in Papillary Thyroid Carcinoma

BACKGROUND: Although mutations in the p53 suppressor gene in thyroid carcinoma have usually been detected in anaplastic carcinoma, P53 protein expression has been detected immunohistochemically in papillary thyroid carcinoma (PTC). In the present study, we examined the immunohistochemical expression of P53 protein in PTC to investigate the relations between its expression and the clinicopathologic features. METHODS: The study was performed on 68 patients in whom thyroidectomy with lymph node dissection had been performed to treat PTC at Teikyo University Hospital. Expression of P53 protein was evaluated immunohistochemically in sections of paraffin-embedded tissue in 68 primary tumors and 196 lymph node metastases. RESULTS: Overexpression of P53 protein in the primary tumor was observed in 29 cases (43%). Statistical analysis revealed significant correlation between P53 protein expression in the primary tumor and large tumor size (unpaired t-test: p < 0.01), the presence of lymph node metastasis (unpaired t-test: p < 0.05), and the mean number of lymph node metastases (unpaired t-test: p < 0.05). Although 29 (43%) of the primary tumors overexpressed P53 protein, 143 (73%) of the metastatic lymph nodes overexpressed P53 protein irrespective of whether there was P53 overexpression by the primary tumor. CONCLUSIONS: The results of this study suggest that immunohistochemistry for P53 in the primary tumor could be useful in the clinical evaluation of patients with PTC. Moreover, P53 protein overexpression in lymph node metastasis may be useful as a treatment guide or target for lymph node recurrences.     

喉返神经入喉处淋巴结对于甲状腺乳头状癌中央区淋巴结清扫的重要性

目的 探讨喉返神经入喉处淋巴结转移在甲状腺乳头状癌手术诊治中的临床意义。方法 对2016年4月至11月接受手术治疗的598例甲状腺乳头状癌病人的临床资料进行临床研究。在中央区淋巴结清扫术中,探查喉返神经入喉处淋巴结,并采用纳米活性炭进行辅助示踪。将入喉处淋巴结与中央区其他淋巴结进行病理检查,并观察术后并发症发生情况。结果 喉返神经入喉处淋巴结检出率为 5.85%(35/598) ,肿瘤转移率为2.51%。该处淋巴结检出中,15例有转移,20例未转移。该处淋巴结转移与多种危险因素有关,包括肿瘤直径、位置和数量,肿瘤数量为其独立影响因素。该处淋巴结阳性病人中,石蜡病理检查证实伴有其他中央区淋巴结转移14例（93.3%）。7例（1.2%）发生术后近期并发症。结论 甲状腺乳头状癌可能发生喉返神经入喉处淋巴结转移。完整的中央区淋巴结清扫术应清扫喉返神经入喉处区域淋巴结。     

Thyroid follicular carcinoma metastasized to the lung, skull, and brain 12 years after initial treatment for thyroid gland--case report

A 65-year-old woman presented with multiple metastases from thyroid follicular carcinoma to the lung, skull, and brain. The skull and brain tumors had been successfully treated by surgery, thyroxine supplementation, and radiosurgery until she died of sudden intracerebral hemorrhage which had no connection with tumor treatment. The lung tumor was treated by conventional irradiation and radioactive ablation. Well-differentiated thyroid carcinoma is a slowly progressive tumor. Follicular carcinoma is thought to have the most optimistic prognosis even with metastases to the lymph nodes and lung. Radioactive ablation using iodine-131 is widely used to treat the primary and/or metastatic lesion. However, the prognosis for patients with brain metastases is poor. Intracranial metastasis of this tumor is rare, but has a mean posttreatment survival of around 12 months. Surgical excision of the metastatic intracranial lesion may be the only effective treatment.