Vascular invasion, lymph node metastasis and extraglandular extension of well-differentiated carcinoma of the thyroid

Forty-five surgically removed thyroid glands with well-differentiated carcinoma were histologically analyzed to clarify the relationships among vascular invasion, lymph node metastasis and extraglandular extension. Using Victoria blue-HE stain, vascular invasion can be detected as the evident finding of circular elastic fibers surrounding the cancer cluster. In our series, 60% of the subjects were positive for vascular invasion. Patients with vascular invasion tend to show lymph node metastasis and/or extraglandular extension. This correlation was statistically significant. Therefore, in a patient with lymph node metastasis and/or extraglandular extension, there is a greater possibility of vascular invasion being present as well.     

Enhancement of lymph node metastasis and distant metastasis of thyroid carcinoma

BACKGROUND: The mechanisms of local and distant metastases are imperfectly understood. The goal of the current study was to add to the body of knowledge regarding local and distant metastases of thyroid malignancies. METHODS: The authors performed multivariate analysis of 573 patients who underwent surgery between November 1994 and May 2002 for follicular (FTC; n = 100), papillary (PTC; n = 236), or medullary thyroid carcinoma (MTC; n = 237) at a university hospital. RESULTS: In multivariate analysis, extrathyroidal extension consistently evolved as the key risk factor for both lymph node metastasis and distant metastasis. This correlation was most pronounced in MTC and least pronounced in FTC. The risk of lymph node metastasis also increased with reoperative status in patients with MTC and with primary tumor diameter in patients with MTC (tumor diameter > 10 mm) and patients with PTC (tumor diameter > 20 mm). In the PTC group, lymph node metastasis was more common among patients younger than age 45. In the MTC group, extrathyroidal growth and distant metastasis were associated exclusively with lymph node metastasis. Lymph node metastasis was the only secondary risk factor for distant metastasis. In the analysis of risk factors for distant metastasis in the FTC and PTC groups, no interaction was found between extrathyroidal growth and lymph node metastasis. This finding suggests that extrathyroidal growth and lymph node metastasis of FTC and PTC, and presumably also MTC, represent separate mechanisms and routes of distant metastasis. CONCLUSIONS: Screening for both local residual disease and distant metastases should be intensified in the high-risk population of patients whose primary tumors exhibit large diameters, extrathyroidal growth, or lymph node metastasis.     

Predictive value of the Delphian lymph node in cervical lymph node metastasis of papillary thyroid carcinoma

IntroductionDelphian lymph node metastasis (DLNM) has proven to be a risk factor for a poor prognosis in head and neck malignancies. This study aimed to reveal the clinical features and evaluate the predictive value of the Delphian lymph node (DLN) in papillary thyroid carcinoma (PTC) to guide the extent of surgery.MethodsTianjin Medical University Cancer Institute and Hospital pathology database was reviewed from 2017 to 2020, and 516 PTC patients with DLN detection were enrolled. Retrospective analysis was performed, while multivariate analysis was performed to identify the risk factors for DLNM.ResultsAmong the 516 PTC patients with DLN detection, the DLN metastasis rate was 25.39% (131/516). Tumor size >1 cm, location in the upper 1/3, central lymph node metastasis (CLNM), lateral lymph node metastasis (LLNM) and lymphovascular invasion were independent risk factors for DLNM. Patients with DLNM had a higher incidence of ipsilateral CLNM, contralateral CLNM (CCLNM) and LLNM, and larger numbers and size of metastatic CLNs than those without DLNM. The incidence of CLNM among cN0 patients with DLNM was higher than that among those without DLNM. The incidence of CCLNM among unilateral cN + patients with DLNM was similarly higher than that among patients without DLNM.ConclusionsDLNM indicates a high likelihood and large number of cervical lymph nodes metastases in PTC patients. Surgeons are strongly recommended to detect DLN status during operation by means of frozen pathology, so as to evaluate the possibility of cervical nodal metastasis and decide the appropriate extent of surgery.     

Postoperative recurrence of papillary thyroid carcinoma with lymph node metastasis

Background and Objectives

: The purpose of this study was to retrospectively analyze the features of patients with papillary thyroid carcinoma (PTC) presenting with neck lymph node (LN) metastasis.

Methods

: The study enrolled 909 patients with PTC who had undergone total thyroidectomy. After a median follow‐up of 14.6 years, 73 (8.0%) patients died of thyroid cancer. A total of 536 patients had the tumor confined to the thyroid (intra‐thyroid), 111 had lymph node (LN) metastasis, 225 showed soft tissue invasion, and 37 had distant metastasis.

Results

: Compared with the intra‐thyroid group, the group with LN metastases showed larger tumor size, higher postoperative thyroglobulin levels, advanced TNM stage, higher recurrence rates (5.2% vs. 31.5%), and higher disease‐specific mortality (1.3% vs. 12.6%). Of the 111 patients with PTC and LN metastases, 35 (31.5%) were diagnosed with recurrence during a mean follow‐up period of 16.9 ± 0.6 years. Among the 35 patients with recurrent PTC, 14 (40.0%) died of thyroid cancer. The mortality group was characterized by older, mostly male patients who presented with larger initial tumor size compared with survivors.

Conclusions

: In patients with PTC, the rates of recurrence and cancer mortality were higher in the group with LN metastasis than that in the intra‐thyroid tumor group. J. Surg. Oncol. 2015 111:149–154. © 2015 The Authors. Journal of Surgical Oncology Published by Wiley Periodicals, Inc.     

甲状腺乳头状癌颈部淋巴结转移特点及清扫策略

背景与目的：目前,在甲状腺癌颈淋巴结清扫方面存有较大分歧。该研究总结甲状腺乳头状癌淋巴结转移的特点,为择区淋巴结清扫提供理论依据。方法：回顾性分析2006年7月—2014年8月收治的462例甲状腺乳头状癌患者病历资料,分析其淋巴结转移规律及其影响因素,评判cN0标准的准确性。结果：全组患者均行患侧中央区(Ⅵ区)淋巴结清扫,320例行侧颈区淋巴结清扫术(Ⅱ～Ⅴ区)或择区淋巴结清扫(Ⅱ～Ⅳ区中的部分或全部),90例行对侧中央区淋巴结活检。73.2%(338/462)符合cN0标准,病理证实其中有184例淋巴结转移,cN0标准误诊率达60.9%。颈部淋巴结总转移率为65.4%(302/462),侧颈区淋巴结转移率为42.6%(197/462),“跳跃转移”率为13.1%(42/320),对侧中央区淋巴结转移率为50%(45/90)。男性、肿瘤累及腺叶上1/3、肿瘤T3或T4、多中心病灶是淋巴结转移的危险因素。肿瘤累及腺叶上1/3是喉前淋巴结转移及“跳跃转移”的危险因素。喉前淋巴结转移及中央区淋巴结2个以上转移者侧颈区淋巴结转移率显著增加(分别为85.7%和83.3%, P＜0.05)。结论：现行cN0标准不能作为确定淋巴结清扫范围的依据;甲状腺乳头状癌易发生淋巴结转移,其中Ⅵ区淋巴结转移率最高,依次为Ⅲ区、Ⅱ区、Ⅳ区、Ⅴ区;初次手术应常规清扫患侧中央区淋巴结,建议将Ⅵ区淋巴结送冰冻病理;当喉前淋巴结有转移或Ⅵ区2个以上淋巴结转移时,或肿瘤累及腺叶上1/3者,有必要行侧颈区(或择区)淋巴结清扫;对侧中央区淋巴结转移率较高,需予以重视;中央区淋巴结再分亚区具有重要意义,应深入研究。     

甲状腺乳头状癌颈侧区淋巴结转移的影响因素

甲状腺乳头状癌是甲状腺癌中最常见的病理类型,具有恶性程度低、进展缓慢、病程长、预后好等生物学特点,但易发生颈侧区淋巴结转移.甲状腺乳头状癌颈侧区淋巴结转移与年龄、性别、肿瘤大小、肿瘤部位、被膜受累/腺外侵犯、多灶性、中央区转移淋巴结数量等因素相关.了解甲状腺乳头状癌颈侧区淋巴结转移的影响因素对甲状腺乳头状癌颈淋巴结清扫范围的确定及其适应证具有重要的临床意义.     

A retrospective study of papillary thyroid carcinoma: Hashimoto's thyroiditis as a protective biomarker for lymph node metastasis

PurposeThere is approximately 10%–50% of papillary thyroid carcinoma (PTC) patients with Hashimoto's thyroiditis (HT). In this research, we sought to better understand the role of HT in PTC progression as well as lymph node metastasis.MethodsIt is a retrospective and cross-sectional study, and 4131 PTC patients who underwent thyroidectomy were finally enrolled. Chi-square test, univariate and multivariate logistic regression analyses were employed to evaluate both the risk factors and the critical roles of HT during PTC metastasis.ResultIn this cohort, 1555 patients (37.6%) were diagnosed with HT. According to multivariate analysis, male sex, high levels of TG and TPOAb, tumor extrathyroidal extension, maximum diameter >1 cm, and multifocality were independent risk factors for both central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM). In addition, age <55 years and smoking were risk factors for CLNM, while CLNM was one of the risk factors for LLNM. Furthermore, HT was suggested a valuable protective factor for both CLNM and LLNM. In patients with HT, the total number of central lymph nodes was higher, while the positive rate was lower. Compared with those without HT, age and sex did not predict CLNM and LLNM in patients with HT.ConclusionHT is considered a protective factor for both CLNM and LLNM in PTC. For patients with HT, surgeons should pay more attention to the preservation of parathyroid gland and the protection of recurrent laryngeal nerve due to less lymph node metastasis. Otherwise, radical operation is highly recommended.     

A case of anaplastic transformation of thyroid carcinoma in the cervical lymph node metastasis

A case of a well-differentiated thyroid carcinoma with an area of anaplastic transformation in the cervical lymph node metastasis is reported. The combination of postoperative radiotherapy with chemotherapy, followed by total thyroidectomy and left radical neck dissection was undertaken for the cervical lymph node metastasis with anaplastic progression, and the patient is living, well and tumor-free more than two years after surgery. This case suggests that neck dissection is necessary for well-differentiated thyroid carcinoma with lymph nodes metastasis to prevent the development of anaplastic transformation in the future.     

甲状腺髓样癌颈部淋巴结转移的预测模型

目的:构建甲状腺髓样癌(medullary thyroid carcinoma,MTC)颈部淋巴结转移情况的临床预测模型,个体化预测术前淋巴结转移概率.方法:回顾性筛选美国国立癌症研究所"监测、流行病学和结果"数据库(Surveillance,Epidemiology,and End Results,SEER)中的20...     

Impact of Lin28 on lymph node metastasis in papillary thyroid carcinoma

Lin28 is involved in the progression of several types of tumors. Data collected from clinical trials have suggested that Lin28 expression is correlated with poor prognosis in thyroid carcinoma. The present study was conducted to investigate the association between Lin28 expression and the clinicopathological parameters of papillary thyroid carcinoma (PTC). Accordingly, the clinical data and diagnostic results from 237 patients with PTC were collected. Immunohistochemical staining was performed to evaluate the Lin28 expression levels in thyroid tissue samples. Associations between the expression levels and clinicopathological parameters were evaluated. Lin28 was expressed in 96/237 (40.5%) of PTC specimens. Compared with patients with no Lin28 expression, patients with expression had higher rates of lymph node metastasis (P<0.001) and larger tumors (P=0.011). Multivariate analysis revealed that Lin28 was associated with lymph node metastasis. Next, bioinformatics analysis was performed based using the Gene Expression Omnibus database and The Cancer Genome Atlas database. Lin28 expression was associated with aggressive tumor characteristics, such as lymph node metastasis and larger tumors. In conclusion, the present study revealed that Lin28 expression served as a risk factor for lymph node metastasis. Accordingly, Lin28 expression may be used as a prognostic marker to predict lymph node metastasis in patients with PTC. In addition, Lin28 may serve as a therapeutic target in the management of this tumor type, which may help improve patient outcomes.     

cN0甲状腺乳头状癌淋巴结转移的危险因素分析

背景与目的：术后病理证实的淋巴结转移在临床淋巴结转移阴性(clinical lymph node negative, cN0)的甲状腺乳头状癌中并不罕见,该研究旨在探讨cN0甲状腺乳头状癌淋巴结转移的危险因素,特别是大量淋巴结转移(>5个)、单侧单发癌灶对侧中央区转移的危险因素。方法：收集北京协和医院2008年—2014年由同一手术团队实施手术的cN0甲状腺乳头状癌患者350例(男性85例,女性265例;其中单侧单发癌灶212例)。分析患者的临床病理学特征,通过单因素、多因素分析寻找淋巴结转移的危险因素。结果：350例患者中共出现淋巴结转移138例(39.4%),大量淋巴结转移20例(5.7%),在单侧单发癌灶且行双侧腺体切除联合双侧中央区淋巴结清扫的169例患者中,24例出现对侧中央区淋巴结转移(14.2%)。淋巴结转移的危险因素的单因素分析中,肿物大小小于等于1 cm和大于1 cm(33.6%vs 58.5%,P<0.01)、超声肿物有钙化和无钙化者(31.7%vs 43.7%, P=0.03)淋巴结转移差异有统计学意义;多因素分析中,非微小癌是淋巴结转移的独立危险因素(OR=2.792, P<0.001)。出现大量淋巴结转移危险因素的单因素分析中,女性和男性(3.8%vs 11.8%,P=0.012)、年龄小于40岁和大于等于40岁(10.7%vs 3.4%,P=0.006)、肿物大小小于等于1 cm和大于1 cm(3.4%vs 13.4%,P=0.002)、超声肿物低回声和非低回声(13.9%vs 4.8%,P=0.026)者在有无大量淋巴结转移上差异有统计学意义;多因素分析中,男性(OR=5.152,P=0.002)、非微小癌(OR=5.712,P=0.001)、年龄小于40岁(OR=3.959,P=0.006)是大量淋巴结转移的独立危险因素。男性(OR=3.105,P=0.022)、非微小癌(OR=3.863,P=0.008)是单侧单发癌灶对侧中央区淋巴结转移的独立危险因素,其对侧中央区淋巴结转移率分别为26.5%、26.1%。结论：cN0甲状腺乳头状癌出现淋巴结转移的比例较高;对于其中非微小甲状腺乳头状癌应常规行中央区淋巴结清扫,对于男性、年龄小于40岁的微小甲状腺乳头状癌也应考虑采取积极的手术方式。     

甲状腺自身抗体水平与分化型甲状腺癌中央区淋巴结转移的相关性

目的:探讨甲状腺自身抗体［甲状腺球蛋白抗体（TGAb）、甲状腺过氧化物酶抗体（TPOAb）和促甲状腺激素受体抗体（TRAb）］增高是否会影响分化型甲状腺癌（DTC）的中央区（VI区）淋巴结转移率。方法:回顾性分析200例单中心收治的行甲状腺全切术+中央区淋巴结清扫术且病理证实为DTC患者的临床及病理资料,比较不同的自身抗体组合状态患者的临床病理特征的差异以及分析不同自身抗体组合状态是否是影响DTC患者中央区淋巴结阳性的独立危险因素。结果:共纳入200例DTC患者,年龄≤45岁80例,>45岁120例;男性67例,女性133例;TGAb阳性、TPOAb阳性、TRAb阴性者24例;TGAb阳性、TPOAb阳性、TRAb阳性者29例;TGAb阳性、TPOAb阴性、TRAb阴性者27例;TGAb阳性、TPOAb阴性、TRAb阳性者23例;TGAb阴性、TPOAb阳性、TRAb阴性者14例;TGAb阴性、TPOAb阳性、TRAb阳性者17例;TGAb阴性、TPOAb阴性、TRAb阴性者48例;TGAb阴性、TPOAb阴性、TRAb阳性者18例。发现自身抗体阳性状态更倾向于双侧肿瘤（P＜0.05）以及中央区淋巴结阳性（P＜0.001）DTC患者,但未发现这8种不同组合在年龄、性别、肿瘤大小、是否侵犯神经、血管、是否多灶性及术前TSH水平方面比较差异有统计学意义（P＞0.05）。本研究中央区淋巴结阳性者112例,阴性者88例,多因素分析结果发现肿瘤多灶性、双侧性、自身抗体均阳性组合状态（TGAb阳性、TPOAb阳性、TRAb阳性）以及术前TSH降低是影响中央区淋巴结转移的独立危险因素（P均＜0.05）,未发现自身抗体其他组合状态及其他因素与中央区淋巴结转移有关（P＞0.05）。结论:DTC患者甲状腺自身抗体（TGAb、TPOAb、TRAb）均增高是影响中央区淋巴结阳性的高危因素,增加中央区淋巴结转移率,建议行预防性中央区淋巴结清扫。     

彩超诊断甲状腺癌颈部淋巴结转移的临床价值

为了术前超声扫描检查甲状腺癌患者的颈部,有无颈部淋巴结转移,为临床拟定手术方式提供有价值的信息。收集中国协和医科大学肿瘤医院198例甲状腺癌伴颈部淋巴结肿大的患者,详细扫描颈部各区域,按颈部分区精确记录淋巴结的部位及超声影像特点。结果经手术病理确诊198例患者中有177倒为淋巴结转移,3例为颈部淋巴结核,1例为恶性淋巴瘤,17例为淋巴结炎性病变。177例颈部淋巴结转移的患者中,140例诊断正确,准确率为79％。其他21例患者有8例诊断正确,准确率为38％。初步研究结果提示,超声诊断甲状腺癌颈部淋巴结转移的准确率较高,对临床拟定手术方式具有重要的指导意义,可作为术前常规的检查项目。     

Patterns of regional lymph node metastasis of nasopharyngeal carcinoma: A meta-analysis of clinical evidence

Background

Abnormal NF-??B2 activation has been implicated in the pathogenesis of multiple myeloma, a cancer of plasma cells. However, a causal role for aberrant NF-??B2 signaling in the development of plasma cell tumors has not been established. Also unclear is the molecular mechanism that drives the tumorigenic process. We investigated these questions by using a transgenic mouse model with lymphocyte-targeted expression of p80HT, a lymphoma-associated NF-??B2 mutant, and human multiple myeloma cell lines.

Methods

We conducted a detailed histopathological characterization of lymphomas developed in p80HT transgenic mice and microarray gene expression profiling of p80HT B cells with the goal of identifying genes that drive plasma cell tumor development. We further verified the significance of our findings in human multiple myeloma cell lines.

Results

Approximately 40% of p80HT mice showed elevated levels of monoclonal immunoglobulin (M-protein) in the serum and developed plasma cell tumors. Some of these mice displayed key features of human multiple myeloma with accumulation of plasma cells in the bone marrow, osteolytic bone lesions and/or diffuse osteoporosis. Gene expression profiling of B cells from M-protein-positive p80HT mice revealed aberrant expression of genes known to be important in the pathogenesis of multiple myeloma, including cyclin D1, cyclin D2, Blimp1, survivin, IL-10 and IL-15. In vitro assays demonstrated a critical role of Stat3, a key downstream component of IL-10 signaling, in the survival of human multiple myeloma cells.

Conclusions

These findings provide a mouse model for human multiple myeloma with aberrant NF-??B2 activation and suggest a molecular mechanism for NF-??B2 signaling in the pathogenesis of plasma cell tumors by coordinated regulation of plasma cell generation, proliferation and survival.     

Risk factors for right paraesophageal lymph node metastasis in papillary thyroid carcinoma: A meta-analysis

ObjectiveProphylactic dissection of the right paraesophageal lymph node (RPELN) in thyroid cancer is controversial. We performed a meta-analysis to provide evidence for RPELN dissection in thyroid cancer.MethodsWe searched the PubMed and Science Citation Index Expanded (SCIE) databases for relevant studies published up to January 31, 2019. The patients involved all had a pathological diagnosis of papillary thyroid cancer (PTC) and had undergone total thyroidectomy or right lobectomy with central compartment lymph node dissection. The RPELNs had been kept aside during the operation.ResultsFourteen cohort studies involving 11,090 patients with PTC were included in the meta-analysis. There was RPELN metastases (RPELNM) in 1038 patients (9.36%). The factors related to RPELNM were: age <45 years, male sex, right lobe tumor, tumor >1 cm, extrathyroidal extension, capsular invasion, right paratracheal lymph node metastasis (RPTLNM), central lymph node metastasis (CLNM), lateral lymph node metastasis (LLNM), and tumor multifocality. There was no association between RPELNM and Hashimoto's thyroiditis (HT) and inferior pole tumors or tumor in the middle of the gland. With superior pole tumors, there was even less RPELNM.ConclusionsThe clinical features related to RPELNM are age <45 years, male sex, tumor >1 cm, tumor diameter >2 cm, right lobe tumor, RPTLNM, extrathyroidal extension, capsular invasion, CLNM, CLNM ≥3, LLNM and multifocality, which should be considered when evaluating RPELN dissection.     

鼻咽癌咽后淋巴结转移研究现状

咽后淋巴结是鼻咽癌淋巴结转移通道中经历的第1级淋巴结，通过咽后淋巴结转移预测鼻咽癌区域淋巴结和远处转移状况，为鼻咽癌的准确分期和综合治疗提供了重要依据。     

鼻咽癌咽后淋巴结转移研究现状

咽后淋巴结是鼻咽癌淋巴结转移通道中经历的第1级淋巴结,通过咽后淋巴结转移预测鼻咽癌区域淋巴结和远处转移状况,为鼻咽癌的准确分期和综合治疗提供了重要依据。     

食管癌转移淋巴结放免显像定位的研究

目的：为放射免疫显像在诊断食管癌淋巴结转移中的应用,提供基础研究支持。方法：（１）免疫组化（ＬＳＡＢ法）测定不同组织冷冻切片和抗人食管鳞癌单抗Ｇ９的反应;（２）＾１２５Ｉ标记Ｇ９,形成标记化合物,在荷食管癌裸鼠腹腔注射＾１２５Ｉ－Ｇ９后的连续３天内,测定各主要组织、器官的放射性。结果：（１）ＩＳＡＢ显示,食管癌原发灶和转移淋巴结呈阳性反应,正常食管和无转移淋巴结阴性。（２）＾１２５Ｉ－Ｇ９在裸鼠体     

超声成像对乳头状甲状腺癌颈部淋巴结转移的诊断价值

目的 探讨超声成像对乳头状甲状腺癌(PTC)颈部淋巴结转移的诊断价值.方法 回顾性分析132例PTC患者的临床资料,通过建立Logistic回归模型分析超声成像对PTC颈部淋巴结转移的诊断价值,应用受试者工作特征(ROC)曲线分析超声成像相关指标诊断PTC患者发生颈部淋巴结转移的准确度.结果 以颈部淋巴结清扫术病理学检查结果作为金标准,132例PTC患者中,共有49例PTC患者发生颈部淋巴结转移,颈部淋巴结转移率为37.1%,淋巴结内囊性变、甲状腺包膜被累及程度、收缩期峰值血流速度(PSV)、阻力指数(RI)与PTC患者发生颈部淋巴转移的关系最为密切,ROC曲线下面积分别为0.813、0.926、0.895和0.902,预测PTC颈部淋巴结转移的准确度分别为90.75%、94.83%、92.46%和92.47%.结论 超声成像诊断PTC颈部淋巴结转移与病理诊断结果吻合度高,其中,淋巴结内囊性变、甲状腺包膜被累及程度、PSV和RI对预测PTC颈部淋巴转移具有较高的诊断价值.