甲状腺微小癌合并转移的诊治

目的　探讨合并转移的甲状腺微小癌的诊断和治疗。方法　回顾性分析收治的 18例合并转移的甲状腺微小癌患者的临床资料。结果　 18例均采取手术治疗 ,术中及住院期间无死亡。 5例 ( 2 7.8% )术后转移 ,明显高于同期 10 0例无转移的甲状腺微小癌 ( 2 .0 % ,P <0 .0 0 1)。病理切片结果提示本组的癌灶均已穿透包膜 ,存在包膜外血管浸润。其中 7例因广泛转移于术后 5年内死亡。结论　应高度重视本病的危害性。甲状腺B超检查结合转移灶穿刺活检可提高本病诊断率。手术为首选的治疗方法。术后可辅以甲状腺素 ,1 31 I同位素等治疗。     

结节性甲状腺肿合并多灶性甲状腺微小乳头状癌23例临床分析

目的分析结节性甲状腺肿合并甲状腺微小癌的临床特征、诊断和行甲状腺全切术+Ⅵ区淋巴结清扫术的必要性。方法回顾性分析23例结节性甲状腺肿合并多灶性甲状腺微小癌病人的诊疗过程和随访结果。结果 23例病人术前均做B超检查,其中诊断为甲状腺微小癌2例(9.1%),可疑为甲状腺微小癌16例(72.7%),上述均为单一病灶;其中可疑癌灶术前行细针穿刺细胞活检8例(36.4%),细胞学检查诊断为甲状腺乳头状癌6例(27.3%);23例病人术中冰冻病理均诊断为甲状腺微小乳头状癌并结节性甲状腺肿,其中仅3例为双侧、多灶性微小癌(13.04%);术后石蜡切片证实23例均为结节性甲状腺肿并多灶性甲状腺微小乳头状癌,多灶性为单侧3例(13.04%)。手术方法均为甲状腺全切术+患侧Ⅵ区淋巴结清扫,合并淋巴结转移15例(65.2%);术后均行促甲状腺激素抑制治疗,其中4例淋巴结转移病人行131I核素治疗。所有病人随访3~64个月,无局部复发或转移。结论术前B超检查、细针穿刺细胞学活检、术中冰冻病理检查有利于提高甲状腺微小癌的诊断率,但这些术前常规诊断方式及术中病理检查会明显低估和漏诊结节性甲状腺肿病人肿多灶性甲状腺微小乳头状癌。多灶性甲状腺微小乳头状癌的诊断有赖于术后石蜡切片病理检查。对合并结节性甲状腺肿的甲状腺微小癌病人应行甲状腺全切术加患侧Ⅵ区淋巴结清扫。     

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目的 分析甲状腺微小癌的临床特征和预后，并探讨其手术切除范围。方法 回顾分析1970年1月至1997年12月手术治疗的92例甲状腺微小癌的临床资料。结果 男女之比为1：6．08，55例（59．78％）是在甲状腺良性病变术中或术后发现，82例（89．13％）为单发癌结节。平均随访8．5的，4例死于局部复发和远处转移。结论 甲状腺微小癌女性发病率高，且以单发癌结节为主，多数因甲状腺良性病变在术中或术后发现，甲状腺微小癌预后较好。     

甲状腺全切除术治疗甲状腺微小癌128例临床分析

目的：分析甲状腺微小癌的临床、病理特点,探讨甲状腺全切除术在治疗甲状腺微小癌中的意义。 方法：回顾性分析2009年10月—2012年12月经手术和病理证实的128例甲状腺微小癌患者的临床资料。患者均行甲状腺全切除术,部分行辅助131I治疗。 结果：128例患者中,单发微小癌87例（67.97%）,多发微小癌41例（32.03%）;单发微小癌肿瘤直径均在0.3 cm以上,术前经超声检查可发现病灶;多发微小癌术前超声可明确所有病灶者25例（60.98%）,另16例（39.02%）多发微小癌中除较大的病灶（>0.3 cm）在术前超声检查中明确外,其余病灶均是在术中冷冻切片中发现或术后石蜡切片中发现;多发病灶局限于单侧甲状腺腺体者 22例（53.66%）,分散于双侧腺体者19例（43.34%）。术后随访率100%,1例出现颈部淋巴结转移。 结论：掌握甲状腺微小癌的临床、病理特点,仔细检查,可避免漏诊;甲状腺全切除术对治疗甲状腺微小癌有重要意义。     

甲状腺乳头状微小癌术后复发的相关因素分析

目的：研究影响甲状腺乳头状微小癌（PTMC）术后复发的相关临床病理学因素。方法：回顾性分析124例PTMC患者的临床资料,采用单因素及多因素分析,探讨PTMC相关临床病理因素与术后复发的相关性。结果：平均随访57（18~120）个月,复发率为10.5%（13/124）,单因素分析显示肿瘤直径≥5 mm（P=0.013）、颈部淋巴结转移（P=0.001）、多发癌灶（P=0.007）及甲状腺包膜侵犯（P=0.000）与PTMC复发显著相关;多因素分析显示颈部淋巴结转移（P=0.001）、多发癌灶（P=0.007）及甲状腺膜包膜侵犯（P=0.000）与PTMC复发显著相关。结论：PTMC总体预后良好,但仍有较高的复发率,且复发与某些临床病理学因素显著相关,在决定手术方式时应充分考虑这些因素。     

甲状腺微小癌诊断与外科治疗规范化

甲状腺微小癌定义为结节直径≤1cm的甲状腺癌。颈部超声的普遍应用增加了微小癌的检出率。常规的术前诊断方法包括临床体格检查,甲状腺超声检查和细针穿刺病理活检,恶性超声特征为细小钙化,边缘不规则。规范化的诊断内容应该包括哪一侧甲状腺叶,癌灶个数,最大直径,是否浸润包膜外,是否淋巴结转移,是否远处转移。甲状腺微小癌的外科治疗存在争议,规范化的外科治疗包括针对偶然发现的微小癌和非偶然发现的微小癌两方面,甲状腺近全切除或全切除是甲状腺癌的常规术式,但对于甲状腺微小癌甲状腺腺叶切除或次全切除是否需进一步手术或者是否需行颈部淋巴结清扫则由个体临床和病理特点决定。     

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。     

多灶性甲状腺乳头状癌的生物学特性及治疗分析

目的 探讨多灶性甲状腺乳头状癌的临床特性及治疗.方法 回顾性分析1995-1997年间在天津市肿瘤医院手术治疗并经病理证实的86例多灶性甲状腺乳头状癌的临床资料,研究其临床生物学特征.结果 多灶性甲状腺乳头状癌者共86例,占同期甲状腺乳头状癌的23.4%.病灶位于单侧12例,位于双侧74例;颈部淋巴结转移51例(59.3%);病灶中含微小癌者46例(53.5%);合并桥本甲状腺炎者23例(26.7%);周围组织侵犯19例(22.1%);发生远处转移者1例(1.2%);10年生存率95.3%.美国癌症联合会(AJCC)分期与预后相关(x2=63.395,P=0.000).结论 多灶性甲状腺乳头状癌多发生于双侧甲状腺,病灶中含微小癌者及合并桥本甲状腺炎者较多,AJCC分期是多灶性甲状腺乳头状癌的重要预后因素.     

甲状腺微小癌(附57例临床分析)

分析甲状腺微小癌的临床特征和预后,并探讨其手术切除范围。方法回顾性分析１９８５年１月至１９９５年１２月手术治疗５７例甲状腺微小癌的临床资料。结果５７例甲状腺微小癌的男女比为１：６．１。有３４列（５９．７％）是在甲状腺良性病变手术时或手术后发现的５０例（８７．７％）为单发癌结节。术中发现３８例（６６．７％）癌结节质地较硬。仅有１例病人术后２年出现对侧叶复发,无手术死亡。结论甲状腺微小癌女性女病率较高     

甲状腺乳头状微小癌36例临床分析

目的总结甲状腺乳头状微小癌的诊治体会。方法回顾性分析1996年1月至2005年12月经手术和病理诊实的36例甲状腺乳头状微小癌的临床资料。结果36例甲状腺乳头状微小癌,术前诊断9例（25％）,术中冰冻切片诊断22例（61．1％）,所有病例经石腊切片确诊,与良性结节并存20例。随访5个月至8年,无手术并发症,无手术死亡,复发1例。结论重视术前彩超及术中冰冻切片可减少本病的漏诊,甲状腺微小癌的外科治疗应根据病例的具体情况而定。     

Biological significance of occult micrometastases in histologically negative axillary lymph nodes in breast cancer patients using the recent American Joint Committee on Cancer breast cancer staging system

The biological significance of occult metastases in axillary lymph nodes of breast cancer patients is controversial. The purpose of the study was to determine the prognostic significance of occult micrometastases using the current American Joint Committee on Cancer (AJCC) staging system in a cohort of women with node-negative breast cancer, of whom 5% received adjuvant systemic therapy and who all had long-term follow-up. We studied a cohort of 214 consecutive histologically node-negative breast cancer patients with a median follow-up of 8 years. Blocks of the axillary lymph nodes were assessed for occult micrometastases by examination of an additional hematoxylin-eosin-stained slide and by immunohistochemical staining using an antibody to low molecular weight keratin. Occult metastases were classified according to the sixth edition of the AJCC cancer staging manual. We examined the prognostic effects of occult micrometastases and other clinicopathologic features on recurrence outside the breast with disease-free interval (DFI) and survival from breast cancer with disease-specific survival (DSS). Cytokeratin-positive tumor cells were identified in the lymph nodes in 29 of 214 cases (14%). Two cases had isolated tumor cells and no cluster larger than 0.2 mm [pN0(i+)], whereas 27 of 214 (13%) had micrometastases (larger than 0.2 mm and 相似文献   

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。     

Locally invasive,well-differentiated thyroid cancer: 22 Years' experience at Memorial Sloan-Kettering Cancer Center

Our experience with 32 cases of locally invasive well-differentiated thyroid carcinoma suggests the following: (1) Thyroidectomy may be limited to the area of gross tumor involvement with little risk of recurrence in the normal opposite lobe. (2) Elective neck dissection should be considered in patients with locally invasive tumors since the incidence of nodal metastases is high. As observed in this study, occult metastases were present in five of six patients dissected electively, and nodal metastases developed later in four of eight patients observed. (3) Surgical procedures for the primary tumor should remove all gross disease. This is possible with conservative operations in most patients; the only deaths from uncontrolled local disease occurred in two patients in whom gross disease was left at the first procedure. Most deaths were caused by distant metastases, and the 5, 10 and 15 year survival rates were 86, 64 and 64 percent, respectively.     

Surgical treatment of metastases from thyroid cancer in the axial skeleton. A retrospective study of 18 cases

Between 1990 and 1997, 18 patients with a mean age of 55.5 years (11 females, 7 males) underwent surgical treatment for a metastasis from thyroid cancer involving the axial skeleton. At the time of surgery all patients had a poor prognosis: 7 metastases revealed the thyroid cancer, all 18 patients had a neurological or mechanical complication, 9 had multiple metastases, all were over 40 years of age. After arteriography with embolization, the surgical procedure consisted of curettage of the tumor and reconstruction, followed by treatment with iodine 131. The survival rate 3 years after surgery was 50%. At the last review, the functional outcome was good and 17 patients had total neurological recovery. Four complications occurred: 1 operative hemorrhage, 3 postoperative infections. Four patients had local recurrence of the metastasis with a one-year survival rate of 20%. When the thyroid cancer was revealed by the axial metastasis, the 3-year-survival rate was 42%. In cases with huge metastases, the 3-year-survival rate was 71%. It appears from these data that surgical treatment of metastases from thyroid cancer in the axial skeleton still achieves a good functional outcome even in cases where neurological or mechanical complications had occurred before surgery.     

Papillary Microcarcinoma: Is There Any Difference between Clinically Overt and Occult Tumors?

Introduction Papillary microcarcinoma (PMC) is a subtype of papillary thyroid carcinoma (PTC) associated with excellent prognosis. However, clinical and biologic behaviors of PMC may vary considerably between tumors that are clinically overt and those that are occult. Materials and Methods From 1964 to 2003, 185 of 628 patients with PTC were identified as having PMC, based on tumor size ≤1 cm. There were 110 overt and 75 occult PMCs detected based on clinical presentation. The clinicopathologic features, treatment, and long-term outcome of PMCs were evaluated and compared between the two groups. Results There were 37 men and 148 women with a median age of 45 years (range: 11–84 years). The median tumor size was 6.2 mm. Thirty-eight (21%) patients presented with cervical nodal metastases. Three (1.6%) had distant metastases and 5 (2.7%) underwent incomplete resection. Bilateral procedures were performed for 129 patients (70%) and 53 (29%) received postoperative I¹³¹treatment. During a mean follow-up of 8.2 years, 4 patients died of the disease and 13 developed recurrence. Clinically overt PMCs were significantly larger, were more likely to be multifocal, and more likely to lead to bilateral thyroidectomy. Extrathyroidal or lymphovascular invasion, nodal metastases, I¹³¹ablation, high-risk tumors, and postoperative recurrence occurred in overt PMC only. Patients with nodal metastases had a decreased survival and an increase in locoregional recurrence. Conclusions Despite a relatively good prognosis in PMC, a distinction should be made between clinically overt and occult PMCs in which clinically overt PMC should be managed according to tumor risk profile and clinical presentation. Free paper presentation at International Surgical Week 2005, Durban, South Africa 21–25 August, 2005     

云南省单中心279例甲状腺乳头状癌再手术原因分析

目的:探讨甲状腺乳头状癌(PTC)再手术患者复发原因及影响因素。方法:回顾性分析2007年1月—2016年6月间昆明医科大学第一附属医院甲状腺疾病诊治中心279例行再手术的PTC患者临床资料。结果:279例患者中,残余甲状腺复发156例(55.9%),淋巴结转移215例(77.1%),后者包括中央区135例(48.4%)和侧方151例(54.1%)。统计分析显示,女性、≥45岁是残余甲状腺复发的独立危险因素(均P0.05);未行中央区淋巴结清扫(CND)、初次手术行于县级医院是中央区淋巴结转移的独立危险因素(均P0.05);男性、初次术式为甲状腺全切或近全切(TT/NTT)、CND为侧方淋巴结转移的独立危险因素(均P0.05)。初次手术后中位复发时间专业甲状腺中心为33个月,主要为侧方(26.8%)和中央区淋巴结转移(42.9%);省级医院为24个月,主要为中央区区淋巴结转移(32.8%)和残余甲状腺复发(29.9%);地州级24个月、县级12个月,主要原因为残余甲状腺复发(36.7%,45.9%)。再次手术后,158例获随访10~123个月,死亡1例(0.4%)、永久性声音嘶哑7例(4.4%)、永久性低钙血症19例(12.0%)、131I治疗失分化9例(5.7%),复发22例(13.9%)。结论:非专科手术和不规范的术式导致PTC术后甲状腺和淋巴结转移率增高从而再手术的主要原因;选择单侧腺叶切除或TT/NTT+病灶同侧/双侧CND和/或加行侧方淋巴结清扫可有效降低复发率。再次手术患者永久性手术并发症和失分化发生率均较高,故应在初始治疗中采取规范化治疗方案,减少复发风险。     

Three cases of occult thyroid cancer with mediastinal lymph node metastasis manifesting as a mediastinal cyst

We experienced three cases (one 38-year-old male, 58-year-old and 67-year-old females) whose resected mediastinal cysts proved to be metastatic lymph nodes from occult thyroid cancer. Primary lesions in thyroid gland were detected by echography in all three cases though they were detected in one case out of two by CT, in one out of three by 201T1 scintigraphy, in two out of three by 123I scintigraphy. After these examinations on thyroid gland, operations (one lobectomy, one hemithyroidectomy, one total thyroidectomy) were performed. Primary lesions in thyroid gland were all papillary carcinomas, and ranged 4 x 3 mm to 12 x 10 mm in size. Multiple foci were found in two cases, many intrathyroidal metastases in one case, cervical lymph node metastases in two cases. In cases of mediastinal cyst, thyroid gland should be examined by echography paying attention to the mediastinal lymph node metastasis from occult thyroid cancer. When occult thyroid cancer with mediastinal lymph node metastasis is diagnosed, total thyroidectomy followed by 131I radiation therapy is recommended as the treatment for a primary lesion, because of multiple foci in thyroid gland and intrathyroidal metastases.     

Followup of patients with papillary thyroid cancer: in search of the optimal algorithm

BACKGROUND: Cervical recurrence occurs in up to 30% of patients after surgical treatment for papillary thyroid cancer. This study sought to determine an appropriate algorithm for followup evaluation. STUDY DESIGN: Patients undergoing total thyroidectomy for papillary thyroid cancer were identified. Clinicopathologic data were recorded, as were the results of all followup evaluations including radioiodine scan, cervical ultrasonography, and serum thyroglobulin levels. The disease recurrence-free survival probability was estimated, and risk factors for recurrence were determined. RESULTS: Thyroidectomy with or without neck dissection was performed in 162 patients. We excluded 36 patients (followup less than 6 months in 26, extracervical disease at diagnosis in 4, unknown tumor size in 6) from the analysis. Of the remaining 126 patients, 109 (86.5%) had no evidence of disease, with serum thyroglobulin < 1 ng/mL at last followup; 4 (3.2%) had no evidence of disease (negative imaging), with serum thyroglobulin > 1 ng/mL, and 13 (10.3%) had recurrent disease. Cervical recurrence occurred in nine patients, all detected by routine ultrasonography. Pulmonary metastases occurred in four patients; three were diagnosed by chest CT and one by radioiodine scan. Thyroid stimulating hormone-suppressed thyroglobulin levels were available in 11 of the 13 patients and were elevated in 9. Patients with high T stage (extrathyroidal extension), or high N stage had an increased risk of recurrence. CONCLUSIONS: A followup strategy emphasizing routine cervical ultrasonography and unstimulated thyroglobulin is effective in identifying patients with recurrent papillary thyroid cancer, and may minimize the indiscriminate use of therapeutic radioiodine for radiographically occult disease. Surgery remains the optimal treatment of cervical recurrence, which is the dominant pattern of treatment failure.     

Prognostic significance of occult lymph node metastases in node-negative breast cancer

Background: Lymph node status, established by a single hematoxylin and eosin (H&E) section from each node, remains an important prognostic indicator in patients with breast cancer, but used alone it is insufficient to identify patients who will develop metastatic disease. This study was conducted to assess the significance of detecting occult metastases in 86 patients with breast cancer originally reported to be histologically node negative. None of the patients received adjuvant systemic therapy. Methods: Five additional levels from formalin-fixed, paraffin-embedded nodes were examined at 150-μm intervals with H&E staining and a cocktail of antikeratin antibodies (AE1/AE3) recognizing low molecular weight acidic keratins. Results: Nodes from 11 (12.8%) of 86 patients contained occult metastases. All metastases identified by cytokeratin antibody were also detected in H&E-stained sections. With median follow-up of 80 months, distant metastases occurred in five of 11 occult node-positive patients (45%) and 13 of 75 patients whose nodes were negative on review (17%). Median time to recurrence was 89 months for occult node-positive patients and not yet reached for node-negative patients (p=0.048). The disease-specific 5-year survival rate was 90% for occult node-positive patients and 95% for node-negative patients. Conclusions: The presence of occult metastases shortened the disease-free interval and suggested that more diligent axillary staging would more accurately identify patients who would benefit from systemic adjuvant treatment. Presented at the 49th Annual Cancer Symposium of The Society of Surgical Oncology, Atlanta, Georgia, March 21–24, 1996.     

Locoregional control in patients with palpable medullary thyroid cancer: results of standardized compartment-oriented surgery

BACKGROUND: Extent of neck dissection is controversial in patients with palpable medullary thyroid cancer (MTC). METHODS: We evaluated 64 MTC patients (19 hereditary, 45 sporadic) with palpable thyroid nodules (group 1, n = 35) or palpable lymph node metastases (group 2, n = 29). Standard surgery included total thyroidectomy, central compartment dissection, and additional neck dissection on indication. RESULTS: In group 1, 40% of the patients were cured. Thirty-one percent of all patients had central, 23% ipsilateral, 14% contralateral, and 14% mediastinal, metastases. Fifty-one percent developed locoregional recurrence. Locoregional recurrence (p = .043) and reoperations (p = .020) were noted more often after a less than standard initial procedure. In group 2, no patients were cured. All had central, 93% ipsilateral, 45% contralateral, and 52% mediastinal metastases. Thirty-eight percent developed locoregional recurrence. CONCLUSIONS: Locoregional recurrence frequently occurs in palpable MTC, and tumor control may be improved by standard central, bilateral, and upper mediastinal neck dissection.