喉鳞状细胞癌伴甲状腺乳头状癌1例

患者,男,55岁。因发现颈部肿物2年,声音嘶哑2个月,呼吸困难1个月于2009年10月22日入院。吸烟、饮酒史20年。否认放射物质接触史及甲状腺癌家族史。入院体检:颈前偏右可触及一大小约3cm×3cm×2cm的肿物,无压痛,质韧,表面光滑,可移动。甲状腺右叶可触及一肿物,大小     

同侧甲状腺髓样癌合并乳头状癌1例

1病例报告患者,女,36岁,因发现颈部肿块1个月余入院。患者近1年有咽异物感,无咽痛、声嘶,无吞咽及呼吸困难,无胸闷、心悸、怕热、烦躁及肢体水肿,无低热及进行性消瘦史,进食叮,二便正常,体重无减轻。查体：颈软,气管居中,甲状腺左侧叶可扪及一直径约1cm肿块,     

喉B细胞淋巴瘤1例

1临床资料患者,女,60岁,因声音嘶哑8个月余于2008年2月11日入院。半年前曾于当地医院行＂右声带肿块＂切除术,术后未行病理检查,术后声嘶一度好转。半年前再次出现声嘶,无喉痛及发热,声嘶逐渐加重,无饮食呛咳。入院后电子喉镜检查：右侧声带上方与会厌喉面之间的黏膜隆起明显,表面黏膜光滑,双侧声带光滑,活动可（图1）。     

甲状腺乳头状微小癌癌基因和肿瘤标志物研究进展

近年来的流行病学研究提示甲状腺乳头状微小癌(PMC)发病率逐渐增高,甲状腺乳头状微小癌的发生发展与多种因素有关,如年龄、性别、种族差异、环境因素、家族史、癌基因等,现对与甲状腺乳头状微小癌有关的癌基因和肿瘤标志物的研究进展进行综述。     

单侧甲状腺微小乳头状癌合并对侧甲状腺小结节患者的临床分析

目的 总结单侧甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)合并对侧甲状腺小结节(最大径＜1 cm)患者的临床特点及处理方法.方法 回顾性分析253例单侧PTMC对侧腺叶合并有术前B超诊断为良性小结节患者的临床资料.253例患者均行甲状腺一侧腺叶切除、对侧近全切除或全切除术.对患者相关临床特征采用x2检验进行单因素分析,采用Logistic回归进行多因素分析.结果 53例(20.9％)患者对侧小结节术后病理诊断为PTMC,其余200例(79.1％)为良性结节.单因素分析发现,对侧结节PTMC发生与合并桥本甲状腺炎和一侧多发癌灶有关(x2=24.834,x2=5.182,P值均＜0.05),与年龄、性别、病灶大小、被膜侵犯、淋巴转移、结节数量及甲状腺球蛋白水平无关.多因素分析显示只有一侧多发癌灶是对侧结节PTMC发生的独立危险因素(OR=5.352,P＜0.05).结论 甲状腺多发小结节患者若一侧为多灶性的PTMC,对侧小结节发生B超难以分辨的PTMC的概率较高,宜采取甲状腺全切除术的治疗策略.     

甲状腺微小乳头状癌行中央区淋巴结清扫的必要性探究

目的：分析甲状腺微小乳头状癌发生中央区淋巴结转移的危险因素,探讨中央区淋巴结清扫的必要性。方法：回顾2004—01—2012—05期间手术治疗的85例甲状腺微小乳头状癌患者的临床资料,通过单因素及多因素分析,明确中央区淋巴结转移的危险因素,为选择性地进行中央区淋巴结清扫术提供依据。结果：85例患者均接受了中央区淋巴结清扫术,其中同侧中央区清扫者66例,双侧中央区清扫者19例。3例同期行颈部淋巴结清扫术。33例（38．8％）发生中央区淋巴结转移,3例（3．53％）发生颈侧区淋巴结转移。单因素分析显示：不同性别、年龄组中央区淋巴结转移差异无统计学意义（P〉0．05）;肿瘤直径大于5mm、甲状腺外侵犯、多中心病灶、双侧病灶及术中探及中央区可疑阳性巴结者,发生中央区淋巴结转移的比例明显增高（P〈0．05）。多因素分析显示：肿瘤直径大于5mm（OR=3．862,P〈0．05）、甲状腺外侵犯（OR=3．885,P〈0．05）是发生中央区淋巴结转移的独立危险因素。结论：甲状腺微小乳头状癌患者肿瘤直径大5mm和（或）甲状腺外侵犯时,发生中央区淋巴结转移的危险性增加,有必要行中央区淋巴结清扫术。     

双侧甲状腺乳头状癌合并甲状旁腺腺瘤1例

1病例资料患者,男,63岁,体检发现甲状腺占位入院。甲状腺超声示甲状腺双叶多个低回声团,边界模糊,边缘不规整,呈毛刺状,甲状腺右叶后方见低回声,大小约3.1cm×2.4cm,边界清,形态不规整,与甲状腺界限欠清,双颈部Ⅱ~Ⅴ区淋巴结肿大,诊断甲状腺双叶实性占位,甲状腺右叶后方异常回声,双侧淋巴结转移。入院后第3天全身麻醉下行双颈部淋巴结探查加双甲状腺切除术。术中探查左Ⅲ区,右Ⅳ区淋巴结一枚,送检快速冷冻。探查双     

甲状腺微小乳头状癌规范化诊疗的进展与争议

国内外针对发病率持续增加的甲状腺微小乳头状癌(PTMC)制定了多个指南与专家共识,内容涵盖PTMC的诊断、治疗等多方面.然而由于PTMC相对惰性的肿瘤生物学特性和良好的预后,其疾病管理策略的选择相对多样,围绕该疾病的规范化诊疗,特别是治疗的争议也与日俱增.本文就PTMC规范化诊疗的进展和争议作一述评.     

甲状腺乳头状癌钙化的临床意义

目的:探讨钙化在甲状腺乳头状癌中表达的意义.方法:回顾性分析甲状腺乳头状癌患者88例,探讨甲状腺乳头状癌内钙化灶与患者年龄、TSH水平、癌灶大小和肿瘤TNM分期有无相关性.结果:钙化与患者年龄、TNM分期和TSH水平没有明显相关性,而与肿瘤大小呈正相关,肿瘤直径越大,发生钙化的可能性越高(P<0.05).统计发现TSH水平与肿瘤大小也没有明显相关性.结论:钙化尤其是微钙化对提示甲状腺乳头状癌有一定的指导意义,而钙化的发生与肿瘤大小成正比,肿瘤越大,发生钙化的可能性越高.     

Variants of papillary thyroid carcinoma: association with histopathological prognostic factors

Papillary carcinoma is the most common thyroid malignancy. Many variants of this tumor have been described, with different morphological and molecular characteristics. Although most cases have excellent prognosis, the relationship between tumor architecture and its biological behavior remains controversial.ObjectiveTo present the experience of a single center on the prevalence of thyroid papillary carcinoma variants and their relationship with other histopathological prognostic factors.MethodRetrospective study of all the cases submitted to thyroidectomy for papillary carcinoma in the same institution over 11 years.ResultsWe included 517 patients, 81.9% of them were women. The average age was 47.2 years. The variants recognized to have higher aggressiveness potential corresponded to 5.6% of the sample. We found an association of tumor subtypes with greater lesion diameter, T staging, lymphovascular and gland capsule invasion.ConclusionA small percentage of papillary carcinoma cases is represented by variants recognized by their greater potential for aggression. There are associations between these variants and several other histopathological factors already recognized for their prognostic value, which may, by themselves, influence the outcome of these cases.     

甲状腺乳头状癌Ⅵ区淋巴结清扫非劣性研究

目的：了解未行含Ⅵ区的择区性淋巴结清扫术的分化良好的甲状腺乳头状癌患者的复发情况;探讨分化良好的甲状腺乳头状癌是否要常规行含Ⅵ区的择区性颈淋巴结清扫术。方法：不同时期处理的甲状腺乳头状癌患者267例,按时间分成2组：A组为近期行含Ⅵ区的择区性淋巴结清扫的甲状腺乳头状癌151例;B组为早期未行Ⅵ区择区性淋巴结清扫的甲状腺乳头状癌116例。原发灶处理2组均一致：肿瘤发生侧行甲状腺全切除,甲状腺峡部全切,健侧甲状腺次全切除;若肿瘤两侧同时发生,则行双侧甲状腺全切术。统计第1组中Ⅵ区淋巴结转移发生率;随访第2组患者,观察头颈部淋巴结复发情况以及生存情况。结果：A组151例患者中59例仅行Ⅵ区淋巴结清扫,其中发生转移者22例,其余92例同时行Ⅱ、Ⅲ、Ⅳ、Ⅵ区颈淋巴结清扫,其中各区都没有转移者31例,Ⅵ区和其他区均转移者33例（35．8％）,只有Ⅵ区颈淋巴结转移者17例（18．4％）,除Ⅵ区外其他区域淋巴结有转移者11例（11．9％）。即甲状腺乳头状癌病例中Ⅵ区淋巴结转移率为47．7％（72／151）。B组116例甲状腺乳头状癌伴有颈淋巴结转移者47例,占40．5％;5年生存率为99．3％;复发率为6．0％（7／116）。A组颈淋巴结转移率（54．9％）高于B组（40．5％）。结论：分化良好的甲状腺乳头状癌患者较多的转移到气管前和喉返神经周围淋巴结,Ⅵ区淋巴清扫可成为常规。     

原发性甲状腺B细胞淋巴瘤的临床分析

目的:探讨原发性甲状腺B细胞淋巴瘤的临床表现、诊断及治疗。方法:回顾性分析8例原发性甲状腺B细胞淋巴瘤患者的临床资料,采用多种手段综合诊断及多种方法综合治疗。结果:随访2～7年,失访3例,死亡1例,存活4例,2年生存率为85.1%,5年生存率为76.3%。结论:多种手段综合诊断及多种方法综合治疗原发性甲状腺B细胞淋巴瘤,可提高诊断率,减少误诊,提高疗效。     

Lymph node status of lateral neck compartment in patients with N1b papillary thyroid carcinoma

Conclusion Loco-regional recurrence-free survival was significantly decreased in the papillary thyroid cancer patients with >?6 metastatic lymph nodes and a lymph node ratio >?0.22. Also, the risk of lung metastasis was significantly increased in cases with bilateral neck node metastases.

Objective This study focused on the metastatic lymph node status of the lateral neck compartment to understand its prognostic significance for loco-regional recurrence and distant metastasis.

Methods Between January 2004 and December 2009, 1040 patients were diagnosed with papillary thyroid cancer and underwent treatment.

Results In a multivariate analysis, sex, the number of metastatic lymph nodes, and the lymph node ratio was significantly associated with loco-regional recurrence. The sensitivity/specificity of >?6 metastatic lymph nodes for predicting recurrence was 64.0%/69.7%. The 5-year loco-regional recurrence-free survival of patients with 0–6 metastatic lymph nodes and >?6 metastatic lymph nodes were 93.4% and 79.2%, respectively. The 5-year loco-regional recurrence-free survival of patients with a lymph node ratio ≤?0.22 and a lymph node ratio >?0.22 were 97.1% and 78.8%, respectively. In the multivariate analysis, only bilateral neck node metastases were significantly associated with lung metastasis.     

Lymphovascular invasion is associated with lateral cervical lymph node metastasis in papillary thyroid carcinoma

OBJECTIVES: The objective of this retrospective study to evaluate whether lymphovascular invasion (LVI) is associated with lateral cervical lymph node metastasis and tumor recurrence in papillary thyroid carcinoma (PTC). METHODS: We evaluated the medical records of patients with PTC who had undergone total thyroidectomy and subsequent I remnant ablation at Asan Medical Center, Seoul, Korea, from January 1997 thorough December 2000. RESULTS: A total of 662 patients (585 women and 77 men; mean age, 44.8 years) with PTC were enrolled in the study. Of these patients, 33 were found to have LVI. We found a significant association between LVI and lateral cervical lymph node metastasis at the time of initial surgery (P = .001). Multivariate analyses adjusting for clinicopathologic parameters known to predict recurrence such as age, gender, tumor size, extrathyroid extension, and multifocality also showed a significant association between LVI and lateral cervical lymph node metastasis. For the 633 patients without distant metastasis at the time of initial surgery, LVI was also significantly associated with tumor recurrence during the follow-up period (median, 68 months; range, 3-108 months): 29% versus 13.6% for patients with and without LVI, respectively (P = .048 by log-rank test). However, this association was lost on multivariate analyses adjusting for conventional clinicopathologic predictors of recurrence. CONCLUSIONS: In patients with PTC, LVI is associated with lateral cervical lymph node metastasis and clinical recurrence.     

甲状腺乳头状癌颈部淋巴结转移规律及影响因素分析

目的：探讨甲状腺乳头状癌颈部淋巴结转移规律及其相关影响因素,为甲状腺乳头状癌颈部淋巴结清扫术提供一定的临床依据。方法：回顾性分析314例甲状腺乳头状癌患者的临床资料。314例患者中,行甲状腺腺叶峡部切除、中央区淋巴结清扫术79例,甲状腺全切、中央区淋巴结清扫术173例,甲状腺全切、中央区淋巴结清扫术、侧颈部改良根治性颈部淋巴结清扫术62例。手术中清扫出淋巴结1～55个,其中阳性淋巴结0～14个。结果：314例患者中经病理证实共有168例（53．50％）患者有淋巴结转移,其中中央区淋巴结转移159例（50．64％）,中央区＋侧颈转移淋巴结55例（17．52％）,单纯侧颈淋巴结转移9例（2．87％）。患者年龄、肿瘤直径、甲状腺被膜受侵犯、临床分期是甲状腺乳头状癌颈部淋巴结转移的影响因素（P〈0．05）。结论：甲状腺乳头状癌患者最常发生中央区淋巴结转移,应常规进行中央区淋巴结清扫术。