甲状腺嗜酸性细胞肿瘤诊治体会(附10例报告)

目的：探讨甲状腺嗜酸性细胞肿瘤（Ｈｕｒｔｈｌｅ ｃｅｌｌ ｔｕｍｏｒ）的诊断治疗方案。方法：对我院１９８６～２０００年收治的１０个病例进行回顾性分析。采用的甲状腺嗜酸性细胞肿瘤病理诊断标准为：每高倍镜视野中必须含有７５％以上的嗜酸性细胞,根据有无核异形、血管和／或包膜浸润及甲状腺外组织浸润及其程度,将其分为良性、不确定型和恶性。结果：１０例甲状腺嗜酸性细胞肿瘤中仅一例为不确定型,其余均为良性嗜酸性细胞肿瘤。２例行峡部切除术,２例行患侧腺叶次全切除术;３例行患侧腺叶全切除术,３例行患侧腺叶全切除加对侧腺叶次全切除术。术后未出现严重并发症,中位随访时间为８０．１个月,无一例复发。结论：１０例甲状腺嗜酸性细胞肿瘤病人病理诊断结果与临床随访结果相符合。良性肿瘤应根据肿瘤部位行峡部切除术或患侧腺叶全切除术,对不确定型需结合年龄和肿瘤大小决定手术范围,恶性肿瘤应行甲状腺全切除术。     

甲状腺嗜酸细胞肿瘤的诊断与外科治疗

我院自1994至2004年共收治甲状腺嗜酸细胞肿瘤(Hurthle cell thyroid tumor,HCT)11例,现总结报告如下。临床资料1.一般资料:11例患者中,男性3例,女性8例;年龄29~67岁,中位年龄48岁;病史最短1月,最长9年,所有患者均无头颈部手术及放射线接触史。2.临床表现:11例患者均因颈部包块     

嗜酸性细胞癌的诊断和治疗

嗜酸性细胞癌(HCC)是甲状腺滤泡状癌中的一种类型。它可以表现为分化肿瘤或更具有侵袭性的肿瘤。预后主要与患者的年龄、肿瘤的大小、肿瘤的侵犯程度和结节的原发和远处转移有关。     

嗜酸性细胞癌的诊断和治疗

嗜酸性细胞癌(HCC)是甲状腺滤泡状癌中的一种类型。它可以表现为分化肿瘤或更具有侵袭性的肿瘤。预后主要与患者的年龄、肿瘤的大小、肿瘤的侵犯程度和结节的原发和远处转移有关。     

甲状腺嗜酸性细胞肿瘤l3例报告

甲状腺嗜酸性细胞肿瘤比较罕见，因其术前误诊率高，术中与术后病理检查结果常出现偏差，且恶性度较高，预后不良，给临床治疗带来困难。本文总结了我院10年共13例病例，现报告如下。     

甲状腺嗜酸细胞肿瘤15例诊治分析

目的进一步探讨甲状腺嗜酸细胞肿瘤的临床诊断和治疗。方法分析2001-2007年上海交通大学医学院附属瑞金医院外科诊治15例甲状腺嗜酸细胞肿瘤的临床资料、手术方式和苏木精伊红染色（HE）切片结果。结果14 例经病理证实为嗜酸细胞腺瘤,1例为一侧嗜酸细胞腺瘤合并对侧嗜酸细胞腺癌。术中冰冻切片仅有6例明确诊断,其余均依赖术后石蜡切片确诊。行患侧全切或近全切除3例 ,患侧次全切除12例。随访1～7年,中位随访时间38个月,无复发及死亡。结论甲状腺嗜酸细胞肿瘤有潜在恶性可能,手术是治疗嗜酸细胞肿瘤的有效手段。     

胃嗜酸性肉芽肿的诊断与治疗

目的 提高胃嗜酸性肉芽肿的诊治水平及疗效。方法 回顾性分析1988年8月-1998年10月我院收治经手术病理证实的胃嗜酸性肉芽肿病人20例，并进行随访。结果 ５例行部分胃切除，８例行大部胃切除，３例行次全胃切除。４例行根治性胃切除术，手术无并发症及死亡。随访经Ｘ线钡餐或纤维胃镜复查１８例（９０％），其中７～９年１０例，４～６年６例，１－３年２例，均无复发，且未见癌变。结论 仔细询问病史，Ｘ线钡餐、纤维胃镜及外周血嗜酸性粒细胞计数是明确胃嗜酸性肉芽肿的重要依据。其中纤维胃镜必须在边缘作挖掘式活检深达胃粘膜下组织病理检查。可提高术前诊断率。手术切除是最有效的治疗方法。     

骨嗜酸性肉芽肿的诊断和治疗

骨嗜酸性肉芽肿的诊断和治疗徐宏光李秀坤靳松陈方满＊⒇嗜酸性肉芽肿为组织细胞增生症Ｘ中的一种，好发于儿童及青年，男多于女，５０％以上发生于颅骨、肋骨和股骨，可单发或多发，单发者多见，本文报告１９８５年以来收治的临床资料完整且经病理证实的１９例，并对其诊...     

46例甲状腺Hurthle细胞肿瘤的诊断与治疗

目的总结甲状腺Hurthle细胞肿瘤（HCNs）的诊断与治疗经验。方法回顾性分析1972年—2003年手术治疗甲状腺HCNs的临床资料。结果37例临床表现为甲状腺单发结节或肿块,9例表现为甲状腺多发结节。4例HCNs有颈淋巴结转移。初诊虽经BUS、CT、ECT及FNAC检查,仅10例诊断HCNs。术前细针穿刺活检及术中快速冷冻病理切片确诊HCNs 28例,良性者行同侧甲状腺全切除,恶性者加作对侧甲状腺切除术。术后石蜡病理切片确诊18例,首次手术时漏诊HCNS而行二次手术者切除原则同首次手术。46例手术后均治愈。经2～10年随访,无复发转移。结论应充分认识甲状腺HCNs,术中若疑似HCNs,应行快速冷冻病理切片检查,如能正确选择合适的手术方法,预后佳良。     

甲状腺Hurthle细胞肿瘤

复习相关文献，对甲状腺Hurthle细胞肿瘤作综述性报道如下：（1）Hurthle细胞肿瘤与滤泡状肿瘤在分子水平存在很大差异；（2）临床与细胞形态学标准不能准确区发Hurthle细胞肿瘤良恶性及预测肿瘤复发；（3）Hurthle细胞腺瘤应采取腺叶加峡部切除要，腺癌宜行全甲状腺切除，存在转移淋巴结时附加颈淋巴结清除要，对所有病人应进行长期随记；（4）Hurthle细胞肿瘤应列为一种独立的病理类型；（5）区发腺瘤与腺癌的标准需进一步明确以指导临床治疗；（6）目前Hurthle细胞肿瘤病人宜采取个体化原则治疗。     

Hurthle cell neoplasms of the thyroid gland revisited.

Hurthle cell tumours (benign and malignant) have been regarded as lesions with uncertain biological behaviour. However recent clinico-pathological studies have shown that they should be categorized as benign or malignant on the basis of capsular and/or vascular invasion, like other differentiated thyroid neoplasms. The fact that the tumours are composed of Hurthle cells is irrelevant. Currently, histological parameters do not seem to predict biological behaviour of Hurthle cell carcinomas.     

甲状腺Hurthle细胞肿瘤19例诊治分析

目的 探讨甲状腺Hurthle细胞肿瘤的诊断和治疗.方法 回顾性分析我院1994年至2008年收治的19例甲状腺Hurthle细胞肿瘤,并进行随访.结果 本组均行手术治疗.术后病理检查甲状腺Hurthle细胞腺瘤16例,Hurthle细胞腺癌3例,伴颈部淋巴结转移2例;切除标本中合并甲状腺滤泡型腺瘤2例、桥本甲状腺炎3例.16例患者获得随访,随访时间3个月至13年,中位随访时间5年,未发现肿瘤复发或转移.结论 选择适宜的手术方式,甲状腺Hurthle细胞肿瘤患者可获较好的预后.     

Hurthle cell neoplasm of the thyroid gland

Background: A clinicopathological analysis and long‐term follow up of 32 patients with Hurthle cell neoplasm (HCN) was undertaken to contrast the clinical and histological features between benign versus malignant HCN of thyroid and to examine the effect of treatment on the outcome. Methods: This is a retrospective study of 32 patients with HCN who were identified out of an archival clinical/pathological/imaging database of 3752 thyroid cancer patients seen between 1976 and June 2006. All patients underwent thyroid surgery. Data for the non‐surgical treatment along with follow up were also analysed. Results: Seventeen patients were classified as malignant HCN (MHCN) and 15 as benign HCN (BHCN). Among the MHCN, there were 11 women and 6 men, whereas among BHCN there were 14 women and 1 man. Three patients designated MHCN presented with metastases, one with pulmonary metastases and two others with skeletal metastases who developed lung metastases 9–19 months later. The mean tumour size was 4.43 ± 0.66 cm for MHCN, and 2.57 ± 0.32 cm for BHCN (P = 0.03). Multicentric tumour foci were evident in five cases (29%) of MHCN but none among the BHCN (P = 0.03). At neck exploration cervical lymph node dissection was carried out in nine MHCN patients with findings of tumour metastases in 33%. Postoperatively, three MHCN patients had no thyroid remnant on ultrasound and computed tomography of neck and undetectable serum thyroglobulin; these were considered to be in remission. Fourteen other MHCN patients with postoperative thyroid remnant and/or distant metastases received ¹³¹I treatment. Eight of these patients had negative whole‐body scans after ¹³¹I treatment and undetectable thyroglobulin. Accordingly, 11 MHCN patients (64.7%) showed evidence of remission and 6 patients did not respond to ¹³¹I treatment. After a mean follow up of 35 months, all BHCN patients are alive with no evidence of disease. Of the MHCN, 11 (64.7%) were in remission and 35% had evidence of persistence/recurrence. One patient who had recurrence is dead. A lack of effectiveness of ¹³¹I therapy in two patients with distant metastases is an important finding. Conclusion: Features of MHCN consisted of a large tumour size, unequivocal capsular and vascular invasion, multicentric tumour foci, metastatic lymph node deposits in one‐third of patients and presence of distant metastasis in a few. Findings of dominant Hurthle cell cytology in a fine‐needle aspiration biopsy from a thyroid nodule should prompt surgical resection of the lesion to assess malignancy.     

Analysis of Hurthle cell neoplasms of the thyroid by interphase fluorescence in situ hybridization.

Recent studies have indicated that numerical chromosomal abnormalities including changes in p53 and cyclin D1 may be involved in Hurthle cell tumorigenesis. We analyzed a series of Hurthle cell neoplasms of the thyroid to evaluate the diagnostic and prognostic utility of numerical anomalies by DNA fluorescent probes for cyclin D1 and p53 gene loci and chromosomes 5, 7, 11, 12, 17, and 22. Interphase fluorescence in situ hybridization (FISH) analysis was performed on paraffin-embedded tissue sections from 10 Hurthle cell adenomas, 19 Hurthle cell carcinomas, and 7 normal thyroid tissues used as controls. Directly labeled fluorescent DNA probes for the centromere region of chromosomes 7, 11, 12, and 17 and locus-specific probes for chromosomes 5 and 22, cyclin D1, and p53 were utilized for dual-probe hybridizations. Sixty percent (6 of 10) Hurthle cell adenomas and 63% (12 of 19) Hurthle cell carcinomas showed chromosome gains. Twenty percent (2 of 10) Hurthle cell adenomas and 26% (5 of 19) Hurthle cell carcinomas showed chromosome losses. Normal thyroid tissues used as controls showed no chromosomal abnormalities. Among Hurthle cell tumors with chromosomal abnormalities, adenomas averaged 2.7 gains and 0.3 losses per case, and carcinomas averaged 3.3 gains and 0.6 losses per case. The two adenomas with chromosome losses each showed loss of one chromosome, whereas the five carcinomas with losses averaged 1.8 losses per case. Chromosome 22 was the most common loss identified, occurring in three of the 11 patients who died of disease. These results indicate that chromosomal imbalances as gains are common in both benign and malignant Hurthle cell neoplasms, but Hurthle cell carcinomas tend to have more chromosome losses than adenomas. Among Hurthle cell carcinomas in this study, chromosome losses were identified only from patients who died of disease. The loss of chromosome 22 may have prognostic value in Hurthle cell carcinoma of the thyroid.     

Molecular analysis of Hurthle cell neoplasms by gene profiling

BACKGROUND: Though Hurthle cell tumors are considered a variant of follicular lesions, recent data have suggested that Hurthle cell carcinomas may be more closely related to papillary thyroid carcinomas (PTCs). These studies were conducted to determine if molecular profiling can enhance our understanding of Hurthle cell neoplasms. METHODS: Thirteen Hurthle cell tumors (9 adenomas, 4 carcinomas) were analyzed with the Affymetrix HU-95 gene chips. Molecular profiles obtained were compared to 14 follicular adenomas (FAs), 7 follicular carcinomas (FCs), 10 PTCs, 11 follicular variant PTCs, and 9 hyperplastic nodules. Hierarchical cluster analysis defined potential groupings and differences among samples. RESULTS: Hurthle cell carcinomas grouped with FCs 100% of the time. Surprisingly, Hurthle cell adenomas clustered with FCs when compared to FAs and FCs in 8/9 (88%) cases. All 13 Hurthle cell lesions migrated as a distinct group separate from PTCs and FVPTCs. Finally, all Hurthle cell lesions clustered with FCs, rather than PTCs, when compared to both groups. CONCLUSIONS: Molecular profiles of Hurthle cell adenomas and carcinomas are more similar to FCs than benign lesions or PTCs. Although Hurthle cell adenomas generally behave in a benign fashion, the molecular signature of these lesions suggests a more malignant phenotype.