甲状腺髓样癌

目的 评价手术治疗甲状腺髓样癌的疗效和术后监测血清降钙素的意义。方法 回顾性分析１９９２年１月～１９９８年１２月的１４例甲状腺髓样癌的诊治资料。结果 全组均经病理证实为甲状腺髓样癌,６４．３％并颈淋巴结转移。据ＡＪＣＣ临床分期,Ⅰ期１例,Ⅱ期７例,Ⅲ期５例,Ⅳ期１例。术后监测血清降钙素的９例中４例持续增高,经Ｂ超扫描证实有残留甲状腺癌病灶和淋巴结肿大而再次手术治疗。再次术后３例血清降钙素恢复正常,     

甲状腺髓样癌

目的探讨甲状腺髓样癌的诊断要点及临床治疗原则。方法对我院１９７６～１９９６年收治的８８例甲状腺髓样癌的临床资料进行回顾性分析。结果患者均以颈部肿块就诊,可伴发腹泻。病理证实淋巴结转移率７３２４％。散发型甲状腺髓样癌８６例,家族型甲状腺髓样癌２例。误诊率２３８６％（２１／８８）。治疗方法均以手术切除原发灶或合并颈淋巴结清除为主。术后随访局部广泛切除术的５,１０,１５年存活率分别为４５４５％,２５００％,１００％;合并行颈部淋巴清扫术的５,１０,１５年存活率分别为７２４１％,６３１６％,６６６７％。结论甲状腺髓样癌术前确诊困难,但有下列情况应考虑本病：不论甲状腺是否触及肿块,但有淋巴结肿大并伴有顽固性非炎性腹泻者;有家族史者;血清降钙素明显高于或低于正常者。作者主张不论是否触及肿大淋巴结,对甲状腺髓样癌均应行原发灶根治性切除加同侧颈部淋巴清扫术。     

甲状腺髓样癌合并甲亢误诊2例

1病例报告例1女,30岁。因“颈部增粗伴食欲亢进,心悸、多汗、手颤5年”入院,否认家族性甲状腺肿瘤病史。查:甲状腺II度肿大,于左叶甲状腺上极似可触及一肿物,边界不清,甲状腺上极可闻及血管杂音T37.72nmol/L,T44260nmol/L,TSH<0.01IU/ml,TAG3982μg/L,TMG>600IU/ml。甲状腺B超:     

甲状腺髓样癌1例报道并文献复习

<正>90%以上的甲状腺癌为分化型甲状腺癌。甲状腺髓样癌发病率较低,但危险性较高,手术是目前首选且唯一被证明可以治愈的方法,王宇等^[1]中国专家共识推荐在全甲状腺切除术的基础上行双侧预防性中央区清扫术。但如何清扫颈部淋巴结意见不同^[2-3]。本文报道1例甲状腺髓样癌病例,并回顾国内外近年来的相关研究,总结如下。     

甲状腺髓样癌15例

甲状腺髓样癌（medullary thyroid carcinoma,MTC）是甲状腺恶性肿瘤中较少见的病理类型,起源于甲状腺滤泡旁细胞（C细胞）,或是RET原癌基因种系突变所致,多散发,具有独特的临床特征。MTC占全部甲状腺恶性病的5%～8%[1],     

甲状腺髓样癌术后的病情监测

目的 研究判断甲状腺髓样癌（ＭＴＣ）患者手术是否成功以及残二定位的方法。方法 对１４例ＭＴＣ术后的患者进行了钙负荷－降钙素激发试验,并检测血癌胚怕（ＣＥＡ）、胃泌素（ＧＳＴ）、肠血管活性肽（ＶＩＰ）,同时对降钙素增高的患者进行生长抑素受体核素显像。结果 １４例２钙负荷－降钙素激发试验后降钙素峰值均升高,其中７例２降钙素基因值异常升高（６９．７－１６６９．１ｎｇ／Ｌ）,峰值更高;对其７例进一步进行Ｓ     

甲状腺髓样癌26例临床分析

目的探讨甲状腺髓样癌临床特点、诊断、手术原则和术后处理。方法回顾性分析26例甲状腺髓样癌的临床资料,其中散发性24例,家族性2例。均行手术治疗,7例术后行60Co放疗。结果26例中随访22例(84.6%),平均随访(62.7±26.1)月;失访4例。死亡5例,死于肺转移3例,死因不明2例。术后随访5年者17例,5年生存率为70.6%(12/17),术后复发4例。结论甲状腺髓样癌术前诊断困难,大部分病人仅以甲状腺肿块就诊,手术应以患侧甲状腺叶加峡部切除为主,对术前B超示双侧甲状腺肿块病人可行甲状腺全切术或近全切除术,有淋巴结转移者加行同侧颈淋巴结清扫术。     

双侧甲状腺癌的外科治疗

目的总结双侧甲状腺癌的外科治疗方法及疗效。方法回顾性分析32例双侧甲状腺癌的临床资料。4例为双侧甲状腺微小癌,其中3例行双甲状腺次全切除术,1例行甲状腺全切除术;7例合并一侧微小癌,其中1例行甲状腺全切除外,6例行一侧近全切除 对侧全切除术;余21例中行一侧全切 对侧近全甲状腺切除术3例,全甲状腺切除术18例。行一侧颈清扫术14例,同期双侧颈总清扫术11例,其中1例因与颈总动脉粘连而有癌灶残留,术后予核素碘治疗。结果32例中除1例失访外,其余随访6月~9年,3例局部复发,其中2例死亡,另1例再次手术痊愈;1例出现远处转移死亡,1例死于其他疾病。结论双侧甲状腺癌甲状腺切除的范围应视癌灶大小和数量以及侵犯程度而定;如伴颈部淋巴结肿大,应同期行颈清扫术。     

桥本病合并甲状腺癌的诊疗体会(附16例报告)

目的总结桥本病(Hashimoto'sdisease,HD)合并甲状腺癌(thyroidcarcinoma,TC)的临床特点和诊治经验。方法回顾性分析1993年7月～2005年7月16例HD合并TC患者的临床资料。16例均于彩超下行细针穿刺,9例1次、3例2次针吸查见癌细胞;4例针吸阴性者,B超示包膜不完整而高度怀疑HD合并TC,行术中冰冻诊断确诊。16例均行患侧甲状腺腺叶及峡部全切、对侧甲状腺次全切除,其中3例加行同侧改良式颈淋巴结清扫。结果术后病理诊断HD合并乳头状癌13例、滤泡状癌3例。全组患者均有不同程度的甲状腺功能减退,常规行甲状腺替代和(/或)抑制治疗。术后并发轻度声音嘶哑1例,予营养神经药物和颈部理疗3月后好转。1例术后4年死于甲状腺癌转移,余15例健在。结论HD患者甲状腺触诊或怀疑有结节者可常规行超声检查或99mTc甲状腺扫描,超声引导下行细针穿刺细胞学检查对提高HD合并TC的诊断有较高参考价值;手术是最有效的治疗方法,一般采用患侧甲状腺及峡部全切加对侧甲状腺次全切除术,颈淋巴结肿大时可加行改良颈淋巴结清扫术;术后常规应用甲状腺素治疗可预防甲状腺功能低下。     

甲状腺髓样癌的外科治疗

虽然甲状腺癌是人体内分泌系统中最常见的恶性肿瘤，但甲状腺髓样癌并不多见，约占甲状腺癌的3％～10％。我科2005年共收治甲状腺癌患者542例，甲状腺髓样癌仅18例，占3．3％。甲状腺髓样癌是来自于甲状腺滤泡旁细胞（亦称C细胞）的一种恶性肿瘤。甲状腺滤泡旁细胞为神经内分泌细胞，亦属APUD（amine precursor uptake and dccarboxylation）系的细胞，即胺前身摄取和脱羟细胞，该细胞的主要特征为分泌降钙素及多种物质包括癌胚抗原（CEA），并产生淀粉样物。     

巨大甲状腺肿瘤的外科治疗(83例效果分析)

目的总结H大甲状腺肿瘤外科治疗的疗效。方法回顾性分析83例巨大甲状腺肿瘤行外科治疗患者的临床资料,良性56例,恶性27例,肿瘤直径平均13（10～17）cm,行单纯手术切除82例,手术加辅助治疗1例。结果本组无手术死亡病例。83例均获随访,平均时间6年（6个月～10年）,56例良性肿瘤,无一例复发。27例恶性肿瘤中,1例术后15个月死亡,1例术后6年内死亡,3例8年内死于肿瘤复发或转移,其余均健在;5年生存率达96．3％（26／27）,10年生存率达81．3％（22／27）。结论外科手术切除治疗巨大甲状腺肿瘤是安全、有效的。     

Single Center Experience in Primary Surgery for Medullary Thyroid Carcinoma

Medullary thyroid carcinoma (MTC) is a rare disease, and most studies are either based on small numbers or multicenter studies with their inherent difficulties. Since 1995, a total of 440 patients with MTC underwent surgery in our clinic. A primary operation was performed in 188 patients (43% of 440). In 60 patients, the primary operation was performed because of a germline RET mutation (prophylactic surgery). Most (84%, 158/188) of the patients had pathologic calcitonin levels. Notably, MTC was found in almost 10% (3/30) of patients with normal calcitonin levels. However, all patients with lymph node metastases (LNMs) had elevated calcitonin levels. Total thyroidectomy (TTx) was performed in all patients. Lymph node dissection (LND) was performed at various extensions: one-compartment LND in 35% (66/188), three-compartment LND in 31% (58/188), and four-compartment LND in 29% (22/188). In general, lymph node dissection increased the likelihood of complications. LNM and distant metastases (DM) correlated with the extent of the primary tumor (pT category). The presence of LNM ranged from 17% (pT1 tumor) to 100% (pT4 tumor), whereas the presence of DM ranged from 0% (pT1 tumor) to 81% (pT4 tumor). Biochemical cure (normal calcitonin levels) was obtained in 72% (137/188) of patients. All 60 patients undergoing prophylactic surgery (tumor stage pT0/pT1) were biochemically cured. In contrast, only 60% (77/128) of the remaining patients were cured. The data suggest that primary surgery should be scheduled as soon as possible to treat patients at a node-negative stage. In the case of normal basal and elevated stimulated calcitonin levels, TTx and cervicocentral LND is recommended. If the basal calcitonin level is elevated, LND should include the cervicolateral compartment.This article was presented at the International Association of Endocrine Surgeons meeting, Uppsala, Sweden, June 14–17, 2004.     

Surgical Experience in Children With Differentiated Thyroid Carcinoma

Background: The optimal surgical treatment in children with well-differentiated thyroid carcinoma remains an important point of discussion. In this study, we evaluated our surgical experience and reviewed the literature accordingly to identify the most adequate treatment.Methods: We retrospectively analyzed 21 children, all under the age of 18 years at the time of diagnosis, with differentiated thyroid carcinoma (17 papillary, 3 follicular, and 1 Hürthle cell carcinoma). Total thyroidectomy was performed, followed by radioiodine therapy, as a part of the initial treatment in all patients. The results were compared with data from the literature.Results: Eleven children (52%) who presented with cervical lymph node metastases were treated by a modified radical neck dissection. Pulmonary metastases were seen at diagnosis in three patients. Six patients developed temporary complications. During follow-up, with a median of 11 years (range, 2–26 years), two patients (10%) developed recurrences, and no patient died during this observation period. A literature search confirmed our experience of excellent results without an increase of complications in the more aggressively treated patients.Conclusions: In children with differentiated thyroid cancer, treatment should consist of total thyroidectomy, followed by a modified radical neck dissection (when indicated) and iodine-131 ablation treatment. This aggressive approach seems to be justified because of the high incidence of nodal involvement and the low complication and recurrence rate after surgery.     

Medullary Thyroid Carcinoma: Long-Term Outcomes of Surgical Treatment

Background

Medullary thyroid carcinoma (MTC) accounts for 5 to 10% of all thyroid cancers but is responsible for a disproportionate number of deaths.

Methods

We performed a retrospective review to describe clinical outcomes in patients with medullary thyroid carcinoma, screening a subset of patients for somatic mutations in the RET and p18 genes and performing genotype-phenotype correlation in a tertiary-care referral hospital from 1967 to 2009.

Results

We studied a total of 94 patients identified from a prospectively maintained thyroid cancer database. Data gathered included patient demographics, serum calcitonin, clinical outcomes, histopathology, genetic analysis, and status at final follow-up. A subset cohort (n = 50) was screened for somatic mutations in the RET gene and the three exons of the p18 gene. The subset cohort was composed of hereditary medullary thyroid carcinoma (HMTC) (n = 19, index patients = 10, screen detected = 9) and sporadic medullary thyroid carcinoma (SMTC) (n = 31). There were no mutations in the p18 gene in the subset cohort.

Conclusions

A total of 67 SMTC and 27 (28.7%) HMTC cases identified. SMTC were older at initial presentation (52 vs. 34, P = 0.003), had higher preoperative serum calcitonin levels (7968 vs. 1346 ng/L, P = 0.008), and had lymph node recurrence (P = 0.001) compared to HMTC. The tumors were smaller in HMTC (P = 0.038). Overall 10-year survival in SMTC versus HMTC was 69 versus 93% (P = 0.12). On multivariate analysis, vascular invasion (hazard ratio 6.4, P = 0.019) was an adverse predictor for disease-free survival. HMTC in the era of RET analysis presents with a smaller primary tumor, lower preoperative serum calcitonin levels, and lower rates of lymph node metastasis. Mutations in the p18 gene were not a major factor in medullary thyroid carcinoma tumorigenesis.     

Latent Subclinical Medullary Thyroid Carcinoma: Diagnosis and Treatment

n = 11), palpable metastatic lymph node ( n = 6), distant metastases ( n = 4). In nine cases the diagnosis was made by both fine-needle aspiration cytology and serum CT measurement. In the four other cases the initial cytology was incorrect, but the diagnosis was revised on the basis of elevated basal CT values. In 11 patients (group 2) presenting with nodular thyroid disease, SMTC was not clinically detectable. SMTC was preoperatively suspected by elevated CT levels: basal CT > 10 pg/ml and pentagastrin-stimulated CT peak > 100 pg/ml. One patient in group 1 with distant metastases was not operated on. All of the other 12 patients underwent total thyroidectomy and extensive lymph node dissection. The mean size of the tumors was 27 mm. Lymph node involvement was found in nine patients. After surgery, CT levels returned to normal in five patients but remained elevated in five others; the two remaining patients died of distant metastases. All 11 patients in group 2 underwent total thyroidectomy and central neck dissection. None of the 11 patients had nodal extension. All 11 patients are biochemically cured. It was concluded that routine measurement of basal serum CT in those with nodular thyroid disease allows early, preoperative diagnosis of subclinical SMTC and improves the results of surgery.