剪切波弹性成像在乳腺良恶性病变中的应用进展

乳腺癌发病率逐年上升,且趋于年轻化。鉴别乳腺良恶性病变是预防、诊断及治疗乳腺癌的重点。剪切波弹性成像是一项新的超声定量技术,已在乳腺、甲状腺、腮腺、睾丸等组织病变呈现出重要临床应用价值。本文就剪切波弹性成像对鉴别诊断乳腺良恶性病变的应用进展进行综述。     

Parotid Gland Metastasis of Breast Cancer: Case Report and Review of the Literature

BACKGROUND: Parotid gland metastasis in breast cancer is extremely rare, and only 14 cases have been reported between 1982 and 2010. CASE REPORT: A 67-year-old female patient was diagnosed with invasive lobular carcinoma of the left breast. Although clinical staging was T1N3M1 (stage IV), the tumor experienced a complete response to chemotherapy. We therefore performed a mastectomy followed by radiotherapy, and continued administration of trastuzumab. However, 11 months later, the patient complained of a swelling in the left parotid gland. Histology following a partial parotidectomy revealed a parotid gland metastasis from the breast. CONCLUSION: Treatment with capecitabine in addition to trastuzumab, which is one of the strategies applied in HER2-positive breast cancer, was effective in our patient. Analysis of the 14 cases of parotid gland metastasis from the breast reported between 1982 and 2010 revealed that the metastasis may occur not by direct lymphatic but by hematogenous spread.     

Estradiol receptor-binding protein in head and neck neoplastic and normal tissue

Estradiol (E2) receptor-binding protein was measured in 42 neoplasms and normal tissues from the head and neck region. Tissues with high E2 receptor protein content included normal skin and normal mucosa of the nose and the floor of the mouth and of the parotid and submandibular salivary glands. Two of four papillary carcinomas of the thyroid, three of five pleomorphic adenomas of the parotid, four of six squamous cell carcinomas of the oral cavity, one of angiofibroma of the nose, and an eye (sclera) melanoma also had a high content of E2-binding protein. The demonstration of estrogen receptors in these neoplasms may indicate that these tumors also, as many breast lesions, may be hormone-dependent. If this is correct, an appropriate hormonal treatment may influence their biological evolution.     

Metastatic disease to the parotid gland

OBJECTIVES: The purpose of this study was to review the clinico-pathologic findings and outcome of patients with metastasis to the parotid lymph nodes and gland. METHODS: Retrospective study. Thirty-four out of 520 patients with a parotid mass treated at our institution met the criteria for this study. Age, gender, clinical findings, histopathology, treatment. and outcome were analyzed. RESULTS: Twenty-three patients had metastases to parotid lymph nodes from a squamous cell carcinoma of the skin, seven from a cutaneous malignant melanoma after a mean interval of 15 months, two from a ductal breast carcinoma, one with a metastatic disease from a rhabdomyosarcoma of the lower limb, and one from a Merkel cell carcinoma. The 5-year cause-specific and absolute survival for squamous cell carcinoma was 64% and 48% respectively and 71% and 57% for malignant melanomas. CONCLUSIONS: Metastatic disease to the parotid gland is mostly caused by squamous cell carcinoma. Despite combined treatment modalities long-term survival remains poor.     

Hydatid cysts of the breast and parotid gland

We report 2 interesting cases of hydatid cysts in unusual sites: in the breast and the deep lobe of the parotid gland.     

乳腺-甲状腺多原发癌的临床分析

目的探讨乳腺-甲状腺多原发癌的临床特点。方法收集2010-05—2016-05间在郑州大学第二附属医院诊断为乳腺-甲状腺多原发癌患者24例,对其临床资料进行回顾性分析。结果 (1)24例乳腺-甲状腺多原发癌均为女性。(2)同时癌9例,异时癌15例。乳腺癌首发12例,甲状腺癌首发3例。(3)两原发癌发生间隔时间在3a内的18例,占75%。(4)乳腺多原发癌与乳腺单癌发病诊断年龄无统计学差异,甲状腺多原发癌发病诊断年龄与甲状腺单癌发病诊断年龄比较,差异无统计学意义(P0.05)。(5)多原发癌中乳腺首发癌浸润性癌占80.95%;再发癌以导管内癌为主,占66.66%。多原发癌中甲状腺癌均为乳头状癌,其首发癌与再发癌中乳头状微小癌分别为83.33%、91.66%。(6)乳腺多原发癌ER阳性率为62.5%,乳腺单发癌ER阳性率52.63%,差异无统计学意义(P0.05)。(7)24例多原发癌中,乳腺癌与甲状腺癌,均获得根治性手术机会,预后良好。结论乳腺-甲状腺多原发癌的第二原发癌好发于3a内,其再发癌肿瘤分化好,临床分期较早。早发现、早诊断,治疗效果好。     

Voice and vocal self-assessment after thyroidectomy

BACKGROUND: Voice alterations after thyroidectomy can be found even with preserved function of laryngeal nerves. The purpose of this study was to evaluate voice before and after thyroid surgery and the role of orotracheal intubation on voice changes. METHODS: We conducted a prospective nonrandomized study of patients who underwent thyroid surgery and compared the results with a control group of patients who underwent breast surgery. Subjects underwent a videolaryngoscopic exam, a subjective and an objective voice analysis and a Voice Handicap Index (VHI) questionnaire before and after surgery. RESULTS: A total of 100 patients who underwent thyroidectomy and 30 who underwent breast surgery were studied. Both groups were similar in demographic, clinical, and surgical variables. Postoperative videolaryngoscopy showed larynx alterations in 28% of the thyroidectomized patients, without significant alterations in the control group. There were subjective voice changes in 29.7% of the patients without vocal fold immobility after thyroid surgery and no statistically significant changes after breast surgery. Acoustic analysis showed significant increased values in the voice turbulence index (VTI) parameter in both groups, although higher in the thyroid one. In the VHI assessment, voice complaints were more frequently registered in the thyroid group rather than in the control group. CONCLUSIONS: Voice alterations are frequent after thyroidectomy even with preserved vocal fold mobility. Such alterations were more frequently detected in that group than in patients who underwent breast surgery. Orotracheal intubation is just one of the multiple factors involved.     

经乳晕入路行腔镜甲状腺切除术的应用价值

目的:探讨行腔镜乳晕入路手术治疗甲状腺疾病的价值。方法:2008年11月至2009年12月为15例患者行经双侧乳晕三孔法腔镜甲状腺手术,通过分离胸前皮下和颈阔肌深面,注入CO2(压力6～8mmHg),建立操作空间。用超声刀切割、分离甲状腺组织和血管;术中保护喉返神经、喉上神经及甲状旁腺。结果:15例手术均获成功,其中甲状腺囊肿切除术1例,甲状腺腺瘤切除术5例,单侧甲状腺部分切除术3例,双侧甲状腺部分切除术3例,甲状腺次全切除术3例。手术时间(110.0±31.3)min,术中出血(70±20.5)ml,术后1例颈部皮肤灼伤,1例胸部少量皮下积液,无中转开放手术。结论:经乳晕径路行腔镜甲状腺手术具有极佳的美容效果,值得临床推广应用。     

Video-assisted thoracic surgery for the resection of pulmonary metastases

We report the use of video-assisted thoracic surgery (VATS) as a treatment or pulmonary metastases. Between July 1994 and March 2002, 75 patients were treated for metastatic lung tumor by VATS. These patients included 45 males and 30 females with an average age of 60.6 years. Their primary diseases were Colon cancer (38), renal cell carcinoma (12), breast cancer (6), seminoma (3), thyroid carcinoma (3), parotid cancer (2), pharyngeal cancer (2) and the others (9). Tumor size ranged from 6 to 62 mm in diameter. A preoperative high resolution spiral computed tomography (CT) scan was used to locate the nodule in all patients. Ten recurrence cases were performed re-resection by VATS approach with an average period was 22 month. We conclude that VATS is a good candidate for the resection of lung metastases in the selected cases.     

Breast cancer in thyroid diseases

The authors have analyzed 48 cases of breast cancer detected among more than 16,000 patients with thyroid pathology including thyroid carcinoma. It was established that breast cancer associated with thyroid pathology (thyroid cancer included) had specific features of the clinical course. Relative risk of breast carcinoma in thyroid cancer patients was not higher than the incidence in female population. Possible etiologic and pathogenic factors of the relationship between thyroid pathology and breast tumors are discussed. It is supposed that hypersecretion of prolactin and gonadotropins might play some role in such association. Radiotherapy and chemotherapy for breast carcinoma also can be predisposing factors to the development of subsequent thyroid pathology.     

Outpatient parotidectomy.

Encouraged by the success of outpatient thyroid surgery, we have performed outpatient parotidectomy in more than 56 selected patients during the past 5 years. As a result of the success of the procedure and the enthusiastic patient response, the proportion of parotid operations performed on an inpatient basis has declined in the latter part of the series. The indication for surgery in virtually all cases was a mass in the parotid gland. The surgical technique used for inpatient or outpatient parotidectomy was the same. If a diagnosis of carcinoma was made based on frozen section examination, definitive surgery was performed, and the patient was admitted to the hospital. Postoperative interviews were conducted with all patients who had outpatient parotid surgery. There was almost uniform patient satisfaction with the performance of the procedure on an outpatient basis. Outpatient parotid surgery permits more efficient use of hospital facilities and more effective use of the surgeon's time. Outpatient parotid surgery was found to be a safe, cost-effective procedure, convenient for both the patient and the surgeon in selected patients.     

Scope of minor operations in the dispensary

The following procedures are reviewed briefly with reference to their employment in the office or dispensary, with limitations and safeguards: hemorrhoids, rectal fistula and fissure, pruritus ani, varicose veins, vein ligation, varicose ulcer, circumcision, soft warts, Melanoma, sebaceous cysts, neurogenic tumors, lipoma, parotid tumor, ganglion, breast tumor, ranula, pilonidal cyst, cervical sinus, removal of scars and keloids, cervical polyp, urethral caruncle, Bartholin abscess, cauterization of the cervix, curettage, lumbar puncture and local anesthesia for the reduction of fractures.Ambulant treatment of pruritus ani, rectal fistulae (except superficial short tracts), certain superficial tumors, parotid tumors (except if recent), breast tumors, and curettage for abortion or suspected malignancy we feel is contraindicated. All others have been satisfactorily treated in the dispensary.Several techniques for these various office procedures are outlined.     

Surgical management of large tumors of the neck: Report of two unusual cases

Two cases of unusually large tumors of the neck are presented. The first tumor was a hyperfunctioning adenomatous goiter, which weighed 1,075 Gm. The second was an adenocarcinoma of the parotid gland of the mixed tumor type, which weighed 2,100 Gm.In the surgical management of large cervical tumors adequate exposure is essential. In removal of large goiters the trachea should be located in order to facilitate tracheotomy if that becomes necessary. If part of the goiter is intrathoracic, the superior pole of the thyroid and the superior thyroid vessels should be isolated, doubly ligated and divided before one attempts to elevate the intrathoracic portion. The dead space left by removal of the goiter should be drained with a strip of finely woven gauze.Mixed tumors of the parotid gland are almost invariably malignant histologically but rarely metastasize. In the removal of large parotid tumors avoidance of injury to the internal carotid artery is of prime importance. It is safer to ligate the common carotid artery than the internal carotid. The facial nerve should be preserved if possible. Postoperative radium therapy is advisable.     

Neuromonitoring in Thyroid Surgery: The View of the Laryngologist

BACKGROUND: In thyroid surgery, identifying the recurrent laryngeal and the superior laryngeal nerve under direct vision reduces the incidence of nerve injury. METHODS: Neuromonitoring, consisting of the continuous depiction of electromyography (EMG) signals and discontinuous nerve stimulation and interpretation during the surgical procedure, is an established part of standard ENT procedures, e.g. surgery of the parotid gland with monitoring of the facial nerve. This technique has been introduced into surgical procedures for the thyroid gland in many surgical centres. RESULTS: Also in thyroid surgery, neuromonitoring can be a useful tool for identifying and monitoring the laryngeal nerves. Reported limitations of neuromonitoring in thyroidectomy are often caused by inadequate use of the equipment and lack of knowledge about neurophysiology in EMG monitoring. Recent studies have raised questions and pointed out pitfalls concerning technical procedure, sensitivity, postoperative outcome, and documentation; these issues are addressed by the laryngologist with many years of experience in recurrent nerve palsy, its clinical diagnosis, and its conservative and surgical treatment. CONCLUSIONS: By understanding and using neuromonitoring techniques, the surgeon is able to minimize the risk of recurrent and superior laryngeal nerve injury.     

Breast cancer metastasis into thyroid papillary carcinoma: A case report

Both metastatic tumors and breast cancer metastases in the thyroid gland are rare. Tumor metastasis into a primary thyroid cancer is rarer. We present a case with breast cancer metastasis into a metachronous thyroid papillary carcinoma which is the only case in literature.     

甲状腺疾病和乳腺癌相关性研究的进展

内分泌功能的变化和相关疾病的发生有着密切的关系.甲状腺与乳腺同属激素依赖性器官,甲状腺疾病与乳腺癌之间存在着一些共同的致病危险因素,乳腺癌患者多并发甲状腺形态学、病理学及功能改变.尽管甲状腺疾病与乳腺癌之间相关性的研究已有一定深入,但其结果却不甚一致,相关机制仍不十分明确.     

Multiple primary thyroid and breast cancer in Israel, 1960-1976

The occurrence of breast and thyroid multiple primary neoplasms has been evaluated using data from the Israel Cancer Registry. During the 16 years 1960-1976, 3,072 cases of thyroid cancer were registered in Israel. The occurrence of a second primary tumour was reported in 92 of these patients. In this latter group were 25 female patients (27%) with breast cancer, developing synchronously in 7 cases and metachronously in the remaining 18. The average age at the time of appearance of breast cancer was 50 years. Most of the patients (84%) were of European origin. The most common histological types were ductal and intraductal carcinoma and scirrhous adenocarcinoma. The possible aetiological factors common to breast and thyroid cancer are discussed. Efforts aimed at improving the survival of patients with thyroid cancer must incorporate strategies for the early detection and treatment of secondary breast cancer.     

Association of Thyroid, Breast and Renal Cell Cancer: A Population-based Study of the Prevalence of Second Malignancies

Background

Analysis of the National Cancer Institute’s Surveillance, Epidemiology, and End Results data has shown that the incidence of thyroid cancer is higher in patients with a preexisting malignancy and that the incidence of other malignancies is higher in patients with thyroid cancer. The purpose of this study was to evaluate the prevalence of a second malignancy in patients treated for thyroid, breast or renal cell cancer and determine what associations, if any, exist between these cancers.

Methods

This study utilized the novel data system, Explorys, as its population base. Patient cohorts were constructed using ICD-9 codes, and prevalence rates were obtained for each cancer. Rates of second malignancy were obtained and compared to the baseline prevalence for a particular malignancy.

Results

Female thyroid cancer patients had a 0.67- and twofold increase in prevalence of a subsequent breast and renal cell cancer. Female breast and renal cell cancer patients had a twofold and 1.5-fold increase in the prevalence of thyroid cancer, respectively. Male patients with thyroid cancer had a 29- and 4.5-fold increase in prevalence of subsequent breast and renal cell cancer. Male patients with breast and renal cell cancer had an increased prevalence of subsequent thyroid cancer, 19- and threefold, respectively.

Conclusions

Our study demonstrated a bidirectional association between thyroid, breast and renal cancer in both male and female patients. This may have important implications for patient follow-up and screening after treatment of a primary cancer.     

Mediastinal metastasis of the thyroid papillary carcinoma mimicking thymoma

Mediastinal tumors are a common condition encountered by general thoracic surgeons, and the most frequent of such tumors is thymoma. However, metastatic mediastinal tumors are rare. Here we report a case of papillary carcinoma of the thyroid to the mediastinum that mimicked thymoma. The patient, a 60-year-old woman who had been treated for thyroid cancer 6 years previously, visited our hospital because of an abnormal shadow in the anterior mediastinum. Radiological findings and laboratory data did not suggest any recurrence of the thyroid cancer, but computed tomography examination revealed a thymoma-like mass. (18)F-Fluoro-2-deoxy-D: -glucose positron emission tomography revealed two lesions: an anterior mediastinal mass and a right breast nodule. We resected both tumors. Histological examination revealed that the mediastinal mass was a metastasis from the thyroid papillary carcinoma, whereas the nodule was an early breast cancer. At the 9-month follow-up examination the patient was well without evidence of recurrence of either cancer.