VEGF-C和CD44V6与甲状腺乳头状癌颈淋巴结转移的关系

 [摘要]:目的 探讨VEGF-C和CD44V6与甲状腺乳头状癌颈淋巴结转移的相关性。 [方法]采用免疫化学SP法检测80例甲状腺乳头状癌患者肿瘤组织的VEGF-C和CD44V6蛋白表达进行检测,其中伴有颈淋巴结转移(N+)的甲状腺乳头状癌患者38例,不伴颈淋巴结转移(N-)的甲状腺乳头状癌患者42例。结果 颈淋巴结转移组甲状腺乳头状癌原发灶标本VEGF-C和CD44V6的表达阳性率分别为:86.84%和81.58%,不伴颈淋巴结转移组甲状腺乳头状癌原发灶标本VEGF-C和CD44V6的表达阳性率分别为：61.9%和52.38% ,两组之间差异有统计学意义(P<0.05)。VEGF-C和CD44V6的表达呈正相关(r=0.525,P<0.01);结论VEGF-C和CD44V6在甲状腺癌淋巴转移中起着重要作用, VEGF-C和CD44V6可作为甲状腺乳头状癌病理生物学行为的观测指标。     

Optimizing treatment for children and adolescents with papillary thyroid carcinoma in post-Chernobyl exposed region: The roles of lymph node dissections in the central and lateral neck compartments

There is lack of data to predict lymph node metastases in pediatric thyroid cancer. The aims are to study (1) the factors affecting the lymph node metastases in children and adolescence with papillary thyroid carcinoma in region exposed to radiation and (2) to evaluate the predictive significance of these factors for lateral compartment lymphadenectomy. Five hundred and nine patients with papillary thyroid carcinoma underwent total thyroidectomy and lymph nodes resection (central and lateral compartments of the neck) surgery during the period of 1991–2010 in Belarus were recruited. The factors related to lymph node metastases were studied in these patients. In the patients with papillary thyroid carcinoma, increase number of cancer-positive lymph nodes in the central neck compartment were associated with a risk to develop lateral nodal disease as well as bilateral nodal disease. Futhermore, positive lateral compartment nodal metastases are associated with age and gender of the patients, tumour size, minimal extra-thyroidal extension, solid architectonic, extensive desmoplasia in carcinoma, presence of psammoma bodies, extensive involvement of the thyroid and metastatic ratio index revealed after examination of the central cervical chain lymph nodes. The presence of nodal disease, degree of lymph node involvement and the distribution of lymph node metastases significantly increase the recurrence rates of patients with papillary thyroid carcinoma. To conclude, the lymph nodes metastases in young patients with papillary thyroid carcinoma in post-Chernobyl exposed region are common and the pattern could be predicted by many clinical and pathological factors.     

Solitary Metastasis from Papillary Thyroid Carcinoma in Cirrhotic Liver with Hepatocellular Carcinoma

We report a surgical case of hepatocellular carcinoma and solitaryliver metastasis from papillary thyroid carcinoma in differentlobes of the liver. The former, located in the right anteriorsuperior segment, and the latter, in the left caudate lobe,were resected simultaneously. The hepatocellular carcinoma wasa micro(thin)-trabecular, pseudoglandular type of Edmondson'sgrade. II. The liver metastasis was a papillary carcinoma offollicular variant from the thyroid. This is the first reportof hepatocellular carcinoma accompanying a solitary liver metastasisfrom papillary thyroid carcinoma without metastasis in otherorgans.     

甲状腺乳头状癌中CD44v6BRAF和Rasp21的表达

目的探讨甲状腺乳头状癌中CD44v6、BRAF和Rasp21的表达,及其与淋巴结转移的关系。方法应用免疫组化sP法,对38例有颈淋巴结转移的甲状腺乳头状癌（PTC＋LNM）患者、22例甲状腺乳头状癌但无颈部淋巴结转移患者和50例甲状腺腺瘤（TA）患者组织中的CD44v6、BRAF和Rasp21进行检测。结果有淋巴结转移组（PTC＋LNM）的CD44v6、BRAF和Rasp21阳性率显著高于无淋巴结转移组（PTC）和甲状腺腺瘤（TA）组（P〈0．05）。结论CD44v6、BRAF和Rasp21的阳性表达与甲状腺乳头状癌的颈淋巴结转移密切相关,可作为甲状腺乳头状癌较好的转移及预后评估指标。     

Papillary carcinoma of the thyroid. A clinicopathologic study of 241 cases treated at the University of Florence, Italy

A clinicopathologic study of 241 cases of papillary thyroid carcinoma treated at the University of Florence Medical School, Florence, Italy is presented. The features of greatest prognostic value were patient's age at presentation, small tumor size, total encapsulation, extrathyroid extension, multicentricity, and presence of distant metastases. The prognosis of the disease was not influenced by the pattern of tumor growth, presence of solid areas, initial presence or subsequent development of cervical lymph node metastases, type of initial thyroid operation, performance of neck dissection, or prophylactic administration of radioactive iodine. It is concluded that conservative thyroid surgery in the form of lobectomy, without neck dissection or prophylactic administration of iodine 131 (131I), constitutes adequate therapy for most cases of papillary thyroid carcinoma. More extensive therapy should be considered for older patients and for those in whom the tumor exhibits extrathyroid extension or easily detectable multicentricity.     

甲状腺癌淋巴管生成与转移的研究进展

淋巴道转移是甲状腺乳头状癌最常见的转移途径,是决定甲状腺乳头状癌分期、选择治疗方案和影响预后的重要因素。淋巴管生成在淋巴道转移过程中起着决定作用,而肿瘤淋巴管生成的分子机制尚未完全明确。研究较多且可以肯定的是VEGF家族在肿瘤淋巴管生成中起重要作用,最近研究发现类肝素酶（heparanase,HPSE）可以诱导VEGF—C的产生进而促发淋巴管生成,进一步深化了淋巴管生成的研究。一些特异性强的淋巴管内皮标记物相继发现,如：VEGFR-3、LYVE-1、Pwxl、D2—40等,也为研究淋巴管在肿瘤生物学中的作用提供了必要前提条件。研究甲状腺癌淋巴管生成和转移的分子发生机制,阐明淋巴管生成在甲状腺癌淋巴转移中的作用,将为甲状腺癌的分子靶向治疗和判断预后提供新的理论依据。     

Occult papillary carcinoma of the thyroid with distant metastases

It is well established that small clinically undetected thyroid carcinomas can produce extensive lymphatic metastases. However, occult papillary carcinoma of the thyroid presenting as a large blood-borne metastasis and occult papillary carcinoma of the thyroid leading to death are both uncommon. The authors report two unusual cases of clinically occult carcinoma of the thyroid. The first case is a 2.4 mm microscopic carcinoma presenting as a large solitary pulmonary metastasis, and is one of the smallest reported primary papillary thyroid carcinomas presenting as a distant hematogenous metastasis. The second case represents a lethal carcinoma with extensive metastases not diagnosed until autopsy. These two cases effectively illustrate that the absence of a clinically detectable thyroid abnormality does not exclude the possibility of extensive hematogenous and lymphatic metastases from a minute or undetected carcinoma of the thyroid.     

Clinical presentations and outcomes of surgical treatment of follicular variant of the papillary thyroid carcinomas

BACKGROUND: The follicular variant of papillary thyroid carcinoma (FVPTC) presents with biological and morphological features similar to papillary thyroid carcinoma. Pre-operative diagnosis of FVPTC and its clinical course is important in identifying appropriate surgical procedures. METHODS: This study enrolled 85 patients, 68 females (mean age 41.4+/-13.7 years) and 17 males (mean age 50.1+/-12.3 years) with papillary thyroid carcinomas diagnosed as FVPTC. From the patient database at Chang Gung Medical Center (CGMC), 170 pure papillary thyroid carcinoma cases and 85 with minimally invasive follicular thyroid carcinomas of gender- and age-matched patients were randomly selected as control groups. All patients were categorized into high- and low-risk groups according to AMES criteria. RESULTS: Of the three groups, 7.1% (follicular), 11.8% (FVPTC) and 34.1% (pure papillary thyroid carcinoma) of patients presented with lymph node or soft tissue invasion (P=0.0001). Additionally, 29.4, 11.8 and 2.4% of patients with follicular carcinoma, FVPTC and pure papillary thyroid carcinoma, respectively, presented with distant metastases at the time of diagnosis. Of the 85 FVPTC cases, 75 underwent pre-operative fine needle aspiration cytology (FNAC) examination at CGMC. Only 11 cases were diagnosed pre-operatively with papillary thyroid carcinomas. Kaplan-Meier survival curves for these three groups demonstrated that follicular thyroid carcinoma had a prognosis worse than both papillary thyroid carcinomas. CONCLUSIONS: Most FVPTC cases were diagnosed as follicular neoplasm via pre-operative FNAC. In this study, FVPTC patients had a high ratio of distant metastases, few lymph node metastases and soft tissue invasion. Aggressive treatment was indicated for the high-risk FVPTC patients.     

Mandibular metastasis from papillary thyroid carcinoma--a case report

Mandibular metastases from papillary carcinoma of the thyroid are very uncommon. Whereas follicular carcinoma metastasizes hematogenously, papillary carcinoma usually remains intrathyroidal and tends to metastasize only to regional nodes. A case of metastatic papillary carcinoma to the mandible is presented here. The metastasis arose five years after a right thyroid lobectomy and isthmectomy for lesions diagnosed as papillary carcinoma. Though relatively rare, thyroid tumors metastatic to the mandible should be included in the differential diagnosis of tumors in the oral region because early detection and treatment of these metastatic lesions may result in long-term survival.     

CXCR5/CXCL13及ERK1在甲状腺乳头状癌中的表达及意义

目的:观察甲状腺乳头状癌及其转移灶中CXCR5/CXCL13及ERK1的表达,探讨其在肿瘤发生发展中的可能作用。方法:选取2014年1月到2016年5月在本院进行手术的110例甲状腺乳头状癌患者及同期手术的结节性甲状腺肿患者,采用免疫组化法检测CXCR5/CXCL13及ERK1在甲状腺乳头状癌及其转移灶中的表达量。结果:CXCL13、CXCR5及ERK1在甲状腺乳头状癌及其转移淋巴结中的表达均高于正常腺体组织及结节性甲状腺肿患者（P<0.05）。CXCL13、CXCR5及ERK1蛋白在甲状腺乳头状癌中的表达与年龄和性别无关,与淋巴结转移呈正相关（P<0.05）。CXCR5/CXCL13蛋白的表达与ERK1呈正相关。结论:趋化因子CXCL13及其受体CXCR5在甲状腺乳头状癌发生发展及其淋巴结转移中发挥了重要作用,为临床甲状腺乳头状癌的诊断及靶向治疗提供一定的理论依据。     

Superior vena cava syndrome caused by supraclavicular lymph node metastasis of renal cell carcinoma

A 65-year-old woman presented with gross hematuria in February 1997. Left renal tumor was revealed and radical nephrectomy was performed. Pathological examination revealed papillary renal cell carcinoma, pT3aN1M1 (ipsilateral adrenal gland). Interferon-α was administered for 1 year. Two years after the nephrectomy, metastasis to the left supraclavicular lymph node appeared. Seven years after the nephrectomy, the metastatic tumor invaded the brachiocephalic vein and extended to the superior vena cava (SVC), compatible with SVC syndrome. Although interferon-α and external-beam radiotherapy was performed, she died in February 2005. Autopsy revealed a left supraclavicular lymph node metastasis invading the thyroid gland, mediastinum, and brachiocephalic vein. The tumor thrombus descended via the SVC into the right atrium. The right lung artery was obstructed by tumor thrombus. There were no visceral metastases and no local recurrence.     

甲状腺癌组织c-erbB-2/neu蛋白表达及其临床意义

目的：探讨甲状腺癌中c-erbB-2蛋白（p185）的表达与临床预后因素的相关性及意义。方法：运用免疫组化SP法检测45例甲状腺癌石蜡标本中,p185的表达并与临床预后因素进行相关分析。结果：45例患者中p185蛋白的阳性表达率为71．1％（32／45）。其中乳头状癌的p185为71．0％（22／31）;滤泡癌及髓样癌的p185阳性表达分别为2／4和2／4;未分化癌的p185阳性表达分别为5／6。p185表达与甲状腺癌的组织学类型之间存在明显相关性;与性别及年龄无相关;在有淋巴结转移及有复发、远处转移或死亡的患者中,p185的表达呈明显增强趋势,与无复发组相比较差异有统计学意义,P〈0．05。结论：在甲状腺癌中,p185存在着不同程度的表达,在一定程度上反映了甲状腺癌的组织学分化程度、淋巴结转移和复发倾向;p185的强阳性表达暗示着淋巴结转移概率的增加,将对甲状腺癌的手术方式选择有指导意义;p185的阳性表达可作为判断甲状腺癌预后的临床病理指标。     

甲状腺乳头状癌颈淋巴结转移规律与手术方式的选择

目的:从甲状腺乳头状癌颈部淋巴结转移规律探讨其最佳手术方式.方法:回顾性分析我院近三年367例甲状腺乳头状癌(papillary thyriod carcinoma,PTC)根治术患者的临床及病理资料.结果:颈淋巴结总转移率为77.11%(283/367),中央区(VI区)转移率为 70.30%(258/367),颈侧区(Ⅱ、Ⅲ、Ⅳ、Ⅴ区)转移率为 62.67%(230/367),颈侧区中的Ⅱ区转移率最高60.49%(222/367).发病年龄、原发灶个数、肿瘤是否累及被膜、癌灶直径、肿瘤边界是否清晰、癌灶位置、超声血流信号分级、癌症是否合并桥本氏甲状腺炎或结节性甲状腺肿对颈部淋巴结转移的影响差异均有统计学意义(P<0.05);性别因素及癌灶是否钙化对颈部淋巴结转移的影响差异无统计学意义(P>0.10),经logistic回归分析发现,肿瘤是否累及被膜对颈部淋巴结转移的影响因素最大.结论:VI区是甲状腺乳头状癌最常见的转移部位,术中应常规清除,其次依次为Ⅱ、Ⅲ、Ⅳ、Ⅴ区.对于患者原发肿瘤若累及包膜、或多发病灶、或癌灶直径>1 cm及患者发病年龄<45岁等应同时做颈侧区清扫.     

甲状腺乳头状癌VEGF、MMP-9及COX-2蛋白表达与淋巴道转移和血管生成的相关性

 目的 通过检测血管内皮细胞生长因子(VEGF)、基质金属蛋白酶-9(MMP -9)、环氧化酶-2(COX-2)在 甲状腺乳头状癌（PTC）细胞中的表达情况,探讨它们与PTC颈淋巴结转移的关系。 方法 采用免疫组织化学SP法检测74例PTC(有淋巴结转移者39例,无淋巴结转移者35例)中VEGF、 MMP-9、COX-2的表达,并对CD34表达阳性血管进行MVD计数。 结果 VEGF、MMP-9、COX-2的表达与MVD值在淋巴结转移组与无转移组之间的差异均具有统计学意义 (P<0.05),与PTC淋巴结转移呈正相关;VEGF、MMP-9、COX-2的表达与MVD值正相关 (P<0.05) ,VGEF、MMP-9阳性表达率与肿瘤大小密切相关（P<0.05）。 结论 甲状腺乳头状癌VEGF、MMP-9、COX-2蛋白表达与其淋巴道转移和MVD有关,检测这几种蛋白表 达将有助于判断甲状腺乳头状癌的转移潜能、血管生成能力及预后。     

甲状腺乳头状癌颈部的处理

目的 探讨甲状腺乳头状癌颈部处理的最佳方案。方法 总结１９６５年１月～１９８７年１月４２４例甲状腺乳头状癌的临床资料,根治原发灶的同时,对颈部淋巴结阳性（Ｎ＋）患者进行颈清扫术,对颈部淋巴结阴性（Ｎ０）患者进行观察,待出现颈淋巴结转移后再行治疗性颈清扫术。所有患者均随访１０年以上。结果 ２５８例颈部Ｎ＋患者的５,１０年生存率分别为８４．３％和８０．４％,而１６６例Ｎ０患者的５,１０年生存率分别为９     

以骨折骨痛为首发症状的滤泡状甲状腺癌骨转移1例临床探讨并文献复习

目的:探讨滤泡状甲状腺癌骨转移的临床特征和治疗方法。方法:回顾性分析1例以左侧锁骨病理性骨折及骨痛为首发症状的滤泡状甲状腺癌患者的临床影像学资料、病理学资料,随访治疗效果,并复习相关文献。结果:患者左侧甲状腺肿物考虑为滤泡状甲状腺癌。C5、T10椎体、左侧锁骨考虑为转移癌。行左侧锁骨部分切除术,术后病理提示:滤泡状甲状腺癌骨转移。结论:对以病理性骨折和骨痛为主要症状的滤泡状甲状腺癌,影像学与组织活检相结合有利于降低误诊率,治疗方案取决于对患者局部病灶和全身状况的全面评估。     

Five simultaneous neoplasms

One case of five independent tumors is reported: Fibrosarcoma of the right thigh, bilateral carcinoma of breast, papillary carcinoma of thyroid, and basalioma below the left clavicula. A synopsis of literature containing the rare cases of more than three primary tumors is presented. The difficulties concerning localization, origin and registration of multiple primary malignancies and their differentiation to recurrencies and metastases are discussed.     

Papillary carcinoma of the thyroid with distant metastases to the cerebrum: a case report

Cerebral metastases from papillary carcinoma of the thyroid are a very uncommon condition, but such metastases behave more aggressively and show poor prognosis. These metastases almost always involve concomitant lung or bone metastases which may be the first metastatic sites. Here we report a 53-year-old man with diffuse goiter and cervical lymphadenopathy who developed symptoms of elevated intracranial pressure. Computed tomography demonstrated ring-enhanced lesions showing a severe mass effect in the right cerebrum and a nodule in the right thyroid gland accompanied by swollen lymph nodes. Biopsied specimens of the thyroid nodule demonstrated malignant cells of papillary carcinoma. Surgical excision of the metastatic brain lesions was followed by total thyroidectomy with regional lymphadenectomy. Histological examinations confirmed that the patient had cerebral metastases from papillary carcinoma of the thyroid without other distant metastasis. Neurological abnormality disappeared after surgery and treatment with radioactive iodine (131I) and oral thyroxine were initiated thereafter. This case suggests that the thyroid gland is potentially a primary source of metastatic brain carcinoma. Moreover, early detection of cerebral metastases is crucial because these metastatic lesions can be life threatening, in contrast to the relatively less severe clinical course of this malignancy unless it is associated with any distant metastasis.     

Phosphorylated c-Jun NH2-terminal kinase is overexpressed in human papillary thyroid carcinomas and associates with lymph node metastasis

To evaluate the associations of phosphorylated c-Jun NH2-terminal kinase (p-JNK) expression with clinicopathological features in patients with papillary thyroid carcinoma, p-JNK expression were immunohistochemically measured in 121 thyroid samples. p-JNK was overexpressed in papillary thyroid carcinomas with respect to matched nontumorous tissues (P = 0.000), which was supported by western blot analysis. Increased p-JNK expression was significantly associated with the presence of lymph node metastases (P = 0.001) and advanced TNM stages (P = 0.02). Furthermore, p-JNK expression was positively correlated with osteopontin (OPN) expression (r = 0.58, P < 0.001). Activation of p-JNK may play a role in the carcinogenesis and lymph node metastasis of papillary thyroid carcinoma, and may be a molecular target for therapeutic intervention.     

Skull metastasis revealing a papillary thyroid carcinoma

Although thyroid carcinoma is a relatively common form of malignancy,metastatic spread to the skull is rare.Here,we report a case of papillary thyroid carcinoma with frontal and parietal metastasis.A 61-year-old Chinese woman presented with a one year history of a growing mass on the center of the frontal and parietal bone,initially thought to be meningioma.Biopsy of the skull base mass after intracalvarium excision,indicated a tumor of thyroid origin.One month later the patient underwent a total thyroidectomy.Pathological examination confirmed a diagnosis of papillary thyroid carcinoma with frontal and parietal bone metastasis.Based on this experience,the key to successful management of the skull metastasis of thyroid carcinoma is prompt diagnosis and appropriate treatment.Skull metastasis should be considered at the outset of the clinical course of papillary thyroid cancer.To facilitate this,patients should be meticulously investigated by a multidisciplinary team to improve quality of life.