低分化甲状腺癌治疗策略探讨

目的:对低分化甲状腺癌（poorly differentiated thyroid carcinoma,PDTC）的治疗策略进行探讨。方法:回顾性分析电子科技大学医学院附属肿瘤医院头颈外科中心2010年3月至2019年11月收治的31例PDTC患者,比较不同治疗方式对PDTC生存时间的影响,所有患者均接受手术治疗,术后...     

甲状腺低分化癌合并乳头状癌个案报道并文献复习

本文回顾了2019年3月20日解放军总医院第一医学中心普通外科收治的1例典型单侧甲状腺低分化癌合并乳头状癌的治疗全过程,结合多学科综合治疗模式,提高对该类疾病的认识,为个体化方案制定提供参考。     

Hyperfunctioning follicular carcinoma of the thyroid. A case report

A 76-year-old female patient with a large neck lump of 15-year duration, was accompanied by palpitation and tremor. The lump was 9 x 5cm in size and the lower half of it was not palpable because the lower pole was located in the mediastinum. Physical examination revealed two enlarged lymph nodes in the right supraclavicular area. Chest X-ray film showed a coin lesion in the right lung that seemed to be a metastasis. The patient was apparently thyrotoxic with elevated serum concentrations of 15.7 micrograms/dl thyroxin and 359 ng/dl triiodothyronine. A neck scintigraphy using 123Iodine showed a thyroid hot nodule in accordance with this lesion. A total thyroidectomy with a modified neck dissection was carried out. This was followed by 131Iodine therapy. Specimen of the primary lesion weighed 147 g. Pathology of this tumor was follicular carcinoma of the thyroid. The patient was doing well 14 months after surgery. In the literature, three cases of similar hyperfunctioning thyroid carcinoma have been reported, all of which had a large primary lesion. The histological features proved to be of follicular or papillofollicular type. The treatment in these cases was administration of an antithyroid drug followed by surgical removal.     

Poorly differentiated thyroid carcinoma with sternal invasion. A case report and review of the literature

INTRODUCTION

Surgical resection of poorly differentiated thyroid carcinoma with direct invasion of the sternum has not been previously reported. Only 4 cases of concomitant thyroidectomy and sternal resection and reconstruction for sternal metastases have been published.

PRESENTATION OF CASE

A 66-year-old female with a poorly differentiated thyroid carcinoma and direct sternal invasion underwent total thyroidectomy and resection of the manubrium and both clavicular heads, and chest wall reconstruction with polypropylene mesh and bilateral myocutaneous pectoralis major muscle flaps. Postoperatively, the patient received radioactive iodine ablation. She developed a local recurrence, requiring additional ablation with radioactive iodine and external beam radiation therapy. Although there was no clinical or radiographic evidence of recurrent disease 5-years postoperatively, a possible local recurrence was discovered 4 months later.

DISCUSSION

In previous case reports the sternal metastases were not in continuity with the thyroid tumor. In our patient, however, there was evidence of direct extension between the thyroid tumor and the sternal mass that were connected together with cords of tumor.

CONCLUSION

In our patient with poorly differentiated thyroid carcinoma invading the sternum, total thyroidectomy and resection of the manubrium with sternal reconstruction, combined with adjuvant radioactive iodine ablation and external beam radiation therapy was associated with prolonged survival after 5 years despite a small local recurrence.     

An evidence-based review of poorly differentiated thyroid cancer

Background

Poorly differentiated thyroid cancer (PDTC) presents the endocrinologist and surgeon with challenges of recognition and treatment given the lack of consensus on histopathologic definition and limited literature on surgical and nonsurgical treatment.

Methods

We offer an operational pathologic definition for PDTC, which should help guide future work in this area. Poorly differentiated thyroid cancer should include insular and trabecular variants but should not include solid type lesions (included by other workers) or more differentiated tumors that may have poor prognosis such as tall cell, columnar, diffuse sclerosing, and oncocytic lesions. Systematic evidence-based literature reviews focusing on two questions were carried out: (1) is PDTC associated with an intermediate prognosis relative to anaplastic and WDTC? and (2) What are the postoperative treatment options for poorly differentiated thyroid cancer?

Conclusions

We have found level IV evidence that PDTC is intermediate between WDTC and anaplastic cancers in terms of prognosis. It represents a disease where appropriate administration of aggressive treatment not typically necessary for routine WDTC and not effective for anaplastic disease may uniquely result in substantial benefit. Limited level IV data show conflicting results regarding ¹³¹I treatment benefit. Given lack of morbidity and potential for benefit, we recommend that ¹³¹I therapy be considered in all patients postoperatively. Recommendation regarding external beam radiotherapy (XRT) is based primarily on extrapolation from studies in forms of poor-prognosis WDTC where substantial data exist regarding treatment benefit. We recommend that external beam treatment be considered in all patients with PDTC with T3 tumors without distant metastasis, all patients with T4 tumors, and all patients with regional lymph node involvement.

     

Prostasomes are secreted from poorly differentiated cells of prostate cancer metastases

BACKGROUND: Prostasomes are small (40-500 nm), granule-like bodies, found in normal epithelial cells of the prostate and secreted into the prostate duct system. Also poorly differentiated prostate cancer cells are producing prostasomes, since we could isolate and purify prostasomes from vertebral metastases with biochemical methods. To find out whether these prostasomes are secreted into extracellular sites of the metastases, we used electron microscopy. METHODS: Small biopsies from vertebral metastases of prostate cancer, taken directly from the operating field at surgery, were immediately fixated, embedded in plastic and processed for electron microscopy. RESULTS: We found that prostasomes could be identified extracellularly in the interstitial tissues as well as in the cytoplasm of the metastatic cells. CONCLUSION: We conclude that prostasomes produced by the cells of vertebral metastases of prostate cancer are distributed both intracellularly and extracellularly in the interstitial spaces of the tissue. Thus, prostasomes of metastases could perhaps be exploited as targets for immunodiagnosis and/or immunotherapy.     

Angiogenesis in poorly differentiated medullary carcinoma of the stomach

KDR and flt-1), and basic fibroblast growth factor (bFGF) and its receptors (bek and flg). Archival specimens of MTPDA (n = 22) and non-MTPDA (n = 47) were studied. The expression of VEGF and bFGF, the vessel count, and positivity of KDR on endothelium were all significantly higher in MTPDA than in non-MTPDA. The vessel count correlated with the VEGF expression in MTPDA. The vessel count and VEGF expression increased with the increasing stage of disease in MTPDA but not in non-MTPDA. The expression of bFGF and its receptors did not correlate with the vessel count and stage of disease in either type. These findings thus suggest that the biological behavior of medullary type poorly differentiated adenocarcinoma of the stomach is angiogenesis-dependent. The correlation of the VEGF expression and its endothelial receptors with the vessel count and the stage of disease thus suggests that VEGF is a factor responsible for the induction of angiogenesis in this type. (Received for publication on Jan. 21, 1997; accepted on July 8, 1997)     

分化型甲状腺癌的治疗

目的　为探讨分化型甲状腺癌的治疗方法。方法　对 173例分化型甲状腺癌患者的临床资料特别是治疗方法进行分析总结。结果　 173例患者均行手术切除 ,按照临床分期选择不同术式。术后辅以内分泌治疗。手术后出现神经损伤及其他手术并发症 3 0例 ,无手术死亡。随访期 5a以上者 91例 ,无死亡病例 ,但发生颈淋巴结转移 4例 ,胸骨转移 2例 ,肺转移 1例。结论　分化型甲状腺癌采用手术切除加内分泌治疗疗效颇佳。     

Cystic poorly differentiated nephroblastoma: A case report and review of literature

BackgroundCystic poorly differentiated nephroblastoma (CPDN) is a rare variant of nephroblastoma which follows a benign clinical course.Case diagnosis/treatmentIn this report, we document a case of CPDN in a 2 year old boy who presented with recurrent gross painless hematuria and progressive abdominal distension. Abdominal ultrasound showed a multicystic lesion and CT scan features of Stage III Wilms tumour. Nephrectomy was done after two cycles of chemotherapy according to the SIOP Nephroblastoma therapeutic protocols. Histology showed blastemal cells in the wall of only one of the cysts, with no solid expansile nodules. The patient had to have five more cycles of chemotherapy and also radiotherapy for residual tumour.ConclusionsSurgery is curative in Stage I CPDN and adjuvant therapy is not required. Adequate sampling is critical to ensure accurate diagnosis and appropriate management. We suggest that a minimum of 2–3 tissue sections should be taken per centimetre of tumour diameter. Related entities including cystic nephroma, cystic Wilms tumour and completely necrotic nephroblastoma are discussed in the differential diagnosis.     

Hyperamylasemia due to poorly differentiated adenosquamous carcinoma of the ovary

In a patient with poorly differentiated ovarian carcinoma, the symptomatology was mistaken for acute pancreatitis. A review of the pertinent literature argues in favor of the early use of amylase isoenzymes in patients whose history, objective signs, and routine diagnostic studies fail to disclose pancreatic disease.     

膀胱低分化上皮癌致类白血病反应1例报告

患者,男,54岁,因反复无痛性肉眼血尿1年余人院.无尿频,尿急,尿痛,无腰痛,无发热恶心及呕吐.外院未行相关检查.人院时查体:偏瘦,一般情况可,心肺未闻及异常,腹软无压痛及反跳痛,全身未触及肿大淋巴结.     

小肠低分化神经内分泌癌的诊断与治疗

小肠神经内分泌癌是一类起源于弥散性神经内分泌系统的低分化高度恶性肿瘤,弥漫性表达神经内分泌分化的一般性标志物.该病表现为类癌综合征,但大多数患者起病隐匿且缺乏特异性临床表现,术前诊断较困难.2012年6月18日江苏省苏北人民医院收治1例因接受胶囊内镜检查导致胶囊滞留引起肠梗阻的患者.患者经手术治疗解除肠梗阻症状,术中发现远端小肠恶性病变,术后病理检查结果证实为回肠低分化神经内分泌癌伴转移.     

A case of follicular carcinoma of the thyroid gland, with uptaking metastases, treated with surgery and isotope therapy]

A short review of the relevant literature is followed by the presentation of a case of follicular cancer of the thyroid with uptaking spinal metastases. Five months after almost total thyroidectomy for right macrofollicular goitre and left follicular cancer, a 131-I scintiscan showed uptake in the right lobe of the thyroid and IX and X dorsal vertabrae. Resection of the remainder of the thyroid was followed by the administration of 100 and then 150 mC of 131-I. The result at 10 months was satisfactory, though not final; no uptake at the Xth vertebra, reduced uptake at the IXth, disappearance of subjective and objective symptoms of spinal pain.     

Diagnosis and treatment of differentiated thyroid carcinoma

Thyroid cancer is the most common endocrine malignancy. More than 90% of primary thyroid cancers are differentiated papillary or follicular types. The prognosis for patients with differentiated thyroid carcinomas is favorable. Female gender and younger age (<50 years) are good prognostic factors. The diagnosis of papillary thyroid cancer is not difficult with ultrasonography and fine-needle aspiration cytology under ultrasonography, whereas that of follicular cancer is difficult, especially of minimally invasive follicular carcinoma. The diagnosis of most follicular cancer is made by pathologic diagnosis postoperatively. The primary treatment of differentiated thyroid carcinoma is thyroid surgery with lymph node dissection. The extent of resection of the thyroid gland depends on size the of the thyroid cancer and area of invasion. If a patient has distant metastasis, total thyroideectomy and radioactive iodine ablation therapy, followed by L-thyroxine therapy, should be offered. The extent of initial surgery, indications for radioiodine ablation therapy, and the degree of thyroid-stimulating hormone (TSH) suppression are all issues that are still being debated. The aim of TSH-suppressive therapy is to restore euthyroidism and to decrease serum TSH levels to reduce the growth and progression of thyroid cancer.